Nagai M.,Sano Kousei General Hospital |
Ishikawa M.,Edogawa Hospital
World Neurosurgery | Year: 2017
Objective During a decompressive craniectomy performed for a severe cerebral infarction, sufficient coverage of the underlying bulging brain by converting the flat dura mater to a more domelike shape is essential. In this procedure, suturing to patch dural substitutes on the dural rifts occupies most of the operative time and is cumbersome. We present a new dural incision design that provides an appropriate volume of subdural space with minimal incisions. Methods The ideal incision design was geometrically analyzed and verified by simulations using a physics engine. Results Assuming a quadrilateral area on the dura mater surface termed S, expanding the entire area of S requires 2d (where d is the skull thickness) + a 30-mm extension of the shortest set of line segments connecting each vertex (LSCV) of S to cover the necessary volume of bulging brain. The shortest LSCV comprises 5 line segments connected with two 3-pronged intersections. The ideal incision design consists of a pair of curved line segments that maintain plane continuity along the LSCV, which automatically limits the maximum expansion. The ideal incision design of S consists of 5 uncinate line segments. Four of the line segments originate from each vertex of S and end by crossing over the LSCV, and one of the line segments crosses over 2 separate LSCV. A representative case is shown. Conclusions This technique minimizes the complexity of the operation and shortens the operation time. © 2017 Elsevier Inc.
Baez-Escudero J.L.,Methodist Hospital Research Institute |
Keida T.,Edogawa Hospital |
Dave A.S.,Methodist Hospital Research Institute |
Okishige K.,Red Cross |
Valderrabano M.,Methodist Hospital Research Institute
Journal of the American College of Cardiology | Year: 2014
Objectives This study sought to determine whether ethanol infusion in the vein of Marshall (VOM) can ablate intrinsic cardiac nerves (ICN). Background ICN cluster around the left atrial epicardium and are implicated in the genesis of atrial fibrillation (AF). Methods Patients undergoing catheter AF ablation underwent adjunctive ethanol injection in the VOM. A multipolar catheter was introduced in the VOM and used for high-frequency stimulation (HFS), either as HFS with P-wave synchronized (SynchHFS), 30 pulses, 100 Hz (n = 8) or as HFS with 3 to 10 s bursts (BurstHFS), 33 Hz (n = 72) at 25 mA for 1-ms duration. Atrioventricular (AV) nodal conduction slowing (asystole >2 s or R-R interval prolongation >50%) and AF inducibility were assessed before and after VOM ethanol infusion. Up to 4 1-ml infusions of 98% ethanol were delivered via an angioplasty balloon in the VOM. Results SynchHFS induced AF in 8 of 8 patients. In 4 of 8 AF initiated spontaneously without VOM capture. No parasympathetic responses were elicited by SynchHFS. BurstHFS was performed in 32 patients undergoing de novo AF ablation (Group 1) and 40 patients undergoing repeat ablation (Group 2). Parasympathetic responses were found in all 32 Group 1 patients and in 75% of Group 2 patients. After VOM ethanol infusion, parasympathetic responses were abolished in all patients (both groups). There were no acute complications related to VOM ethanol infusion. Conclusions The VOM contains ICN that connect with the AV node and can trigger AF. Retrograde ethanol infusion in the VOM reliably eliminates local ICN responses. The VOM is a vascular route for ICN-targeting therapies. © 2014 by the American College of Cardiology Foundation.
Kajimoto K.,Sensoji Hospital |
Sato N.,Nippon Medical School |
Keida T.,Edogawa Hospital |
Sakata Y.,Osaka University |
Takano T.,Nippon Medical School
Clinical Journal of the American Society of Nephrology | Year: 2015
Background and objectives The relationship among anemia, renal dysfunction, left ventricular ejection fraction, and outcomes of patients hospitalized for acute decompensated heart failure is unclear. The aim of this study was to evaluate the association between cardiorenal anemia syndrome and postdischarge outcomes in patients hospitalized for heart failure with a preserved or reduced ejection fraction. Design, setting, participants, & measurements Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry between April 1, 2007 and December 31, 2011, 4393 patients were evaluated to investigate the association among anemia, renal dysfunction, preserved or reduced ejection fraction, and the primary end point (mortality and readmission for heart failure since discharge). The patients were divided into four groups on the basis of eGFR and hemoglobin at discharge. The median follow-up period after dischargewas 432 (range=253–659) days. Results The primary end point was reached in 37.6% and 34.8% of the preserved and reduced ejection fraction groups, respectively. After adjustment for multiple comorbidities, there was no significant association of either renal dysfunction or anemia alone with the primary end point in patients with preserved ejection fraction, but the combination of renal dysfunction and anemia was associated with a significantly higher risk than that without either condition (hazard ratio, 1.54; 95% confidence interval, 1.12 to 2.12; P,0.01). In patients with reduced ejection fraction, adjusted analysis showed that a significantly higher risk of the primary end point was associated with renal dysfunction alone (hazard ratio, 1.65; 95% confidence interval, 1.21 to 2.25; P=0.002) and also, renal dysfunction plus anemia relative to the risk without either condition (hazard ratio, 2.19; 95%confidence interval, 1.62 to 2.96; P,0.001). Conclusions The findings show that renal dysfunction combined with anemia is associated with an increased risk of adverse post discharge outcomes in patients with preserved ejection fraction, whereas renal dysfunction is an independent predictor of the risk of adverse outcomes in patients with reduced ejection fraction, regardless of anemia. Copyright © 2014 by the American Society of Nephrology
Hama Y.,Edogawa Hospital |
Hama Y.,University of Tokyo |
Nakagawa K.,University of Tokyo
Breast Cancer | Year: 2013
Triple-negative breast cancer is extremely aggressive and more likely to metastasize than other subtypes of breast cancer. Better understanding of the distinct patterns of relapse and early detection will help identify patients who need aggressive treatment. Here we report a case of early stage triple-negative breast cancer with no lymph node metastasis at the time of breast-conserving surgery in a 46-year-old woman. She developed distant metastases immediately after completing adjuvant chemotherapy following surgery, which were detected by an [18F] 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) scan. Although routine use of FDG-PET is not recommended for early stage breast cancer, FDG-PET might be useful for the early detection of distant metastasis among patients with triple-negative breast cancer. © 2010 The Japanese Breast Cancer Society.
Miyata T.,Edogawa Hospital |
Yajima T.,Edogawa Hospital
Gastroenterological Endoscopy | Year: 2013
For 8 cases of malignant stenosis in the right colon, we used single-balloon enteroscopy to place colonic stents. For the transanal route, the balloon was passed through the stenosis, and the over-tube for the balloon enteroscopy was placed on the oral side of the stenosis. The balloon was then inflated. In case the endoscope or the over-tube couldn't pass through the stenosis, the balloon was inflated on the anal side of the stenosis. After the balloon was dilated, a guide wire was inserted beyond the stenosis. The endoscope was then removed leaving the guide wire and the over-tube. The stent was then inserted in the over-tube using the guide wire. The use of a colonic stent for malignant stenosis in the right colon is technically feasible and enables resolution of the malignant stenosis.
Osawa H.,Edogawa Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013
Nausea and vomiting are among the most problematic symptoms experienced by patients with cancer who are receiving chemotherapy. 5-hydroxytryptamine 3(5-HT3)-receptor antagonists, NK1 receptor antagonists(aprepitant)and dexamethasone are now the standard therapies for preventing chemotherapy-induced nausea and vomiting(CINV)that follow highly emetogenic chemotherapy, such as cisplatin and anthracycline. However, since it is not cleared which 5-HT3-recepter antagonist is a proper treatment for combined use with aprepitant and dexamethasone, we conducted a questionnaire survey, which used the numerical rating scale(NRS), for comparing palonosetron with granisetron in the same patient. Palonosetron showed a significant improvement of nausea for both acute(within 24 hours)and delayed phase(24-120 hours later), regardless of the type of chemotherapy(cisplatin or anthracycline-based regimen). Furthermore, palonosetron had a tolerable safety profile. Our study suggests that palonosetron-based antiemetic treatment will be a preferred choice for preventing CINV following highly emetogenic chemotherapy.
Hama Y.,Edogawa Hospital
Academic Radiology | Year: 2014
Rationale and Objectives: Prostate calcification is a noninvasive landmark for daily positioning of image-guided radiation therapy. However, detectability of prostate calcification with megavoltage helical computed tomography (MVCT) has not been evaluated. The purpose of this study was to evaluate the detectability of prostate calcification and to investigate how to predict detectability of calcification with MVCT. Materials and Methods: Thirty patients with prostate cancer who were scheduled for helical tomotherapy were included in this study. The detectability of prostate calcification on MVCT was evaluated by comparing against kilovoltage multidetector-row CT (KVCT) as the standard of reference. Maximum signal intensity (SImax), area (A) of calcification, and the product of both (SImax·A) were compared between undetectable and detectable calcifications. Then, the threshold values of SImax, A, and SImax·A were decided to achieve 100% sensitivity on MVCT. Results: KVCT identified 49 calcifications in 28 of 30 patients. MVCT detected 19 (39%) of 49 calcifications in 15 (50%) of 30 patients. The minimum threshold values of SImax, A, and SImax·A to detect prostate calcifications were 953 HU, 20.98 mm2, and 7784 HU mm2, respectively. Using the threshold values of SImax, A, and SImax·A, 20% (10/49), 18% (9/49), and 35% (17/49) of calcifications were in the detection range, respectively. Conclusions: MVCT can depict about one-third of prostate calcifications detectable on KVCT. The product of maximum signal intensity and area of calcification is the most distinguishable index for predicting patients showing prostate calcifications on MVCT. © 2014 AUR.
Hama Y.,Edogawa Hospital
Clinical nuclear medicine | Year: 2014
89Sr is useful for the palliation of painful bone metastasis, but its antitumor activity as a monotherapy has not been shown by 18F-FDG PET. Here, we report a case of a 75-year-old woman with multiple bone metastases of breast cancer in which 18F-FDG PET demonstrated a significant reduction in uptake of 18F-FDG after administration of 89Sr.
Ito H.,Edogawa Hospital |
Abe M.,Edogawa Hospital |
Mifune M.,Edogawa Hospital |
Oshikiri K.,Edogawa Hospital |
And 3 more authors.
PLoS ONE | Year: 2011
Aims: To investigate the relationship between hyperuricemia (HUA) and the clinical backgrounds in Japanese patients with type 2 diabetes mellitus. Methods: After a cross-sectional study evaluating the association of HUA with the clinical characteristics in 1,213 patients with type 2 diabetes mellitus, the estimated glomerular filtration rate (eGFR) and the incidence of diabetic macroangiopathies was investigated in a prospective observational study in 1,073 patients during a 3.5 year period. HUA was defined by serum uric acid levels >327 μmol/L or as patients using allopurinol. Results: The frequency of HUA was significantly higher in the diabetic patients (32% in men and 15% in women) than in the normal controls (14% in men and 1% in women). In total, HUA was found in 299 (25%) of the patients during the cross-sectional study. Even after adjusting for sex, drinking status, treatment for diabetes mellitus, body mass index, hypertension, use of diuretics, hyperlipidemia, HbA1c and/or the eGFR, the HUA was independently associated with some diabetic complications. The eGFR was significantly reduced in HUA patients compared to those with normouricemia in the 12 months after observation was started. HUA was also an independent risk factor for coronary heart disease even after adjustment in the Cox proportional hazard model. Conclusions: HUA is a associated with diabetic micro- and macroangiopathies. HUA is a predictor of coronary heart disease and renal dysfunction in patients with type 2 diabetes mellitus. However, the influence of HUA is considered to be limited. © 2011 Ito et al.
Sakakibara N.,Edogawa Hospital
Japanese Journal of Plastic Surgery | Year: 2016
The devices approved by the government are not necessarily the best choices for use in patient care. This article reviews the new, upcoming devices for treating varicose veins that are already available on the global market. Up to now, the use of tumescent anesthesia as an adjunct to endovenous treatment has been essential. However, the use of non-thermal technologies is advantageous because of a lower morbidity risk for patients. Current methods of treatment are defined as: thermal tumescent procedures (TT technology) and non-thermal non-tumescent procedures (NTNT technology). The TT technologies include laser, radiofrequency, and steam thermal ablation, whereas the NTNT technologies include foam sclerotherapy, mechanicochemical ablation, glue, and intravascular devices. The TT technologies produce efficient and durable outcomes, and the NTNT technologies appear to be promising based on their initial safety and efficacy data. Once the NTNT technologies are proven to be non-inferior compared to the TT technologies in a randomized fashion, NTNT technologies may be ready to replace TT technologies.