Eiju General Hospital
Eiju General Hospital
Uchida T.,Eiju General Hospital
[Rinsho ketsueki] The Japanese journal of clinical hematology | Year: 2016
A 63-year-old man with Bence Jones-κ multiple myeloma (MM) presented with renal impairment. First, we administered a bortezomib-containing regimen which is considered to be the first choice among therapeutic approaches for MM patients with renal failure. However, his condition was refractory to bortezomib, and the renal dysfunction worsened (creatinine 12.55mg/dl) necessitating the initiation of hemodialysis. Subsequently, we administered an adjusted dose of lenalidomide and dexamethasone. Dialysis could be discontinued after 3 cycles of lenalidomide therapy. After 4 cycles, he achieved a stringent complete response (sCR) with the creatinine level at 1.85mg/dl. This case suggests lenalidomide to be an effective drug for patients with multiple myeloma and renal impairment refractory to treatment with bortezomib.
Yoshida H.,Eiju General Hospital |
Granger D.N.,Health science Center
Inflammatory Bowel Diseases | Year: 2011
Background: Inflammatory bowel diseases (IBDs) are associated with a hypercoagulable state and an increased risk of thromboembolism, with accelerated thrombus formation occurring both within the inflamed bowel and in distant tissues. While the IBD-associated prothrombogenic state has been linked to the inflammatory response, the mediators that link inflammation and thrombosis remain poorly defined. The objective of this study was to assess the role of tumor necrosis factor alpha (TNF-α) in the enhanced extraintestinal microvascular thrombosis that accompanies colonic inflammation. Methods: TNF-α concentration was measured in plasma, colon, and skeletal muscle of control mice and in mice with dextran sodium sulfate (DSS)-induced colitis. A light/dye injury method was used to induce microvascular thrombosis in cremaster microvessels. The effects of exogenous TNF-α on thrombus formation were determined in control mice. DSS-enhanced thrombus formation was evaluated in wildtype (WT) mice treated with an anti-TNF-α antibody (±an anti-IL-1β antibody) and in TNF-α receptor-deficient (TNFr -/-) mice. Results: DSS colitis enhanced thrombus formation in cremaster arterioles. A similar response was produced by TNF-α administration in control mice. TNF-α concentration was elevated in plasma, colon, and skeletal muscle. Immunoblockade of TNF-α or genetic deficiency of the TNF-α receptor blunted the thrombotic response of arterioles to DSS colitis. Additional protection was noted in mice receiving antibodies to both TNF-α and IL-1β. Conclusions: Our findings implicate TNF-α in the enhanced microvascular thrombosis that occurs in extraintestinal tissue during colonic inflammation, and suggests that the combined actions of TNF-α and IL-1β accounts for most of the colitis-enhanced thrombotic response. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.
Matsumura N.,Keio University |
Ogawa K.,Eiju General Hospital |
Kobayashi S.,Kobayashi Clinic |
Oki S.,Keio University |
And 3 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2014
Background: The morphologic features and clinical significance of version of the humeral head and glenoid remain unclear. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint. Methods: Images for analysis were computed tomography scans of 410 normal shoulders from healthy volunteers. Values of humeral head and glenoid version were measured. In glenoid version measurement, 3-dimensionally corrected slices were reconstructed to eliminate scapular inclination. Differences in humeral head version and glenoid version were assessed between dominant and nondominant shoulders and between men and women. Correlation analyses were also performed in the values of version between dominant and nondominant shoulders and between humeral head version and glenoid version. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26°±11°. Average glenoid retroversion was 1°±3°, ranging from -9° to 13°. Both humeral head retroversion and glenoid retroversion were significantly higher on the dominant side than on the nondominant side and significantly higher in men than in women. Humeral head version and glenoid version values were well correlated with those of the contralateral shoulder. No correlation was found between humeral head version and glenoid version. Conclusions: This study found differences in humeral head version and glenoid version by sex and shoulder dominance in a large sample. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
Hagihara M.,Eiju General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2011
An 85-year-old woman was admitted to our hospital with severe anemia after nail-plate fixation of the left femoral neck fracture. The patient was diagnosed with Coombs-negative autoimmune hemolytic anemia based on the measurement of red blood cell (RBC)-bound IgG molecules per cell. Pseudoaneurysm of the left profunda femoris artery was detected on magnetic resonance imaging and successfully removed by surgical repair of the artery. Anemia promptly improved, and the number of RBC-bound IgG normalized after the surgery. The destruction of RBCs was thought to have been responsible for temporary induction of anti-RBC autoimmune antibodies.
Ogawa K.,Eiju General Hospital |
Matsumura N.,Eiju General Hospital |
Ikegami H.,Keio University
Journal of Trauma and Acute Care Surgery | Year: 2012
BACKGROUND: The majority of type I coracoid fractures set out in Ogawa's classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences. However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes. METHODS: Thirty-six patients, who had acute type I coracoid fractures surgically treated and were followed up for 1 year or longer, constituted the present study population. Reduction and stabilization were undertaken beginning with the most medial unstable injury of SSSC and proceeding to the lateral ones. The respective coracoid fractures were finally reduced and fixed. In the follow-up, patients were directly examined and evaluated using the ratios of the Constant score for the injured side to that for the normal side. RESULTS: There were a total of 80 ipsilateral injuries of SSSC, including the coracoid fractures, and double disruption accounted for 94% of the patients. Of these, 62 injuries were surgically treated. No complications associated with surgery were observed. Bone union was achieved in all fractures; no patients required an additional operation. The Constant score ratio at the follow-up was 93% ± 7.4% on average. CONCLUSION: Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union. Copyright © 2012 by Lippincott Williams & Wilkins.
Sugaya N.,Keiyu Hospital |
Shinjoh M.,Keio University |
Mitamura K.,Eiju General Hospital |
Takahashi T.,Keio University
Journal of Infection | Year: 2011
Objective: There were many cases of pandemic influenza A (H1N1) 2009 (H1N1/09) in Japan during the 2009-2010 epidemic. They accounted for 16% of the total population (20.7 million/128 million), and 59% of the patients were children 15 years of age and under (12.2 million/20.7million). However, there were only 38 paediatric deaths. We analyzed the clinical manifestations and treatment of children hospitalized because of H1N1/09 infection in order to clarify the association between treatment with neuraminidase inhibitors and the low mortality rate. Methods: A retrospective chart review was performed on a total of 1000 paediatric inpatients. Results: The causes of the hospitalizations were respiratory complications in 651 cases (65.1%), neurological complications in 255 cases (25.5%) and other complications in 94 cases. Neuraminidase inhibitors, primarily oseltamivir, had been used to treat 984 (98.4%) of the 1000 patients, and in 88.9% of the patients, treatment with neuraminidase inhibitors was initiated within 48 h after the onset of illness. Only 12 (1.2%) of the 1000 patients underwent mechanical ventilation, and one patient died of H1N1/09 infection. Conclusions: Although a high proportion of the patients in this study had severe respiratory complications, the case fatality rate was only 0.1%. The low mortality rate of children due to the H1N1/09 epidemic in Japan was probably attributable to the universal implementation of early treatment with neuraminidase inhibitors. © 2011 The British Infection Association.
Inoue M.,Eiju General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2012
A mass in the right upper lobe of the lung was observed in a chest X-ray examination of a 66-year-old woman. Pathological examination of the lung biopsy revealed a mucosa- associated lymphoid tissue (MALT) lymphoma within the lesion. A systemic survey demonstrated no other lesions, and the patient was diagnosed as having a solitary pulmonary MALT lymphoma (Stage IE). After 9 months of careful monitoring, progressive enlargement of the lung tumor and involvement of right hilar lymph nodes were observed using positron emission tomography-computed tomography. Therefore, surgical resection of the right upper lobe and right hilar lymph nodes was performed, and coexistence of MALT lymphoma with tuberculosis was identified by pathological investigations. The association of chronic inflammation with the development of MALT lymphomas has been widely accepted. In the present case, pulmonary tuberculosis may have played a role in the pathogenesis of pulmonary MALT lymphoma.
Yoshida H.,Eiju General Hospital |
Russell J.,Louisiana State University Health Sciences Center |
Senchenkova E.Y.,Louisiana State University Health Sciences Center |
Almeida Paula L.D.,Louisiana State University Health Sciences Center |
Granger D.N.,Louisiana State University Health Sciences Center
American Journal of Pathology | Year: 2010
Inflammatory bowel diseases (IBDs) are associated with an increased risk for thromboembolism, which is often manifested as deep vein thrombosis or pulmonary embolism, at extra-intestinal sites. Although some of the cytokines that contribute to IBD pathogenesis are also known to alter the coagulation pathway, it remains unclear whether these mediators also contribute to the extra-intestinal thrombosis often associated with IBD. The objective of this study is to evaluate the role of interleukin (IL)-1β in enhanced extra-intestinal thrombosis observed in mice with dextran sodium sulfate (DSS)-induced colitis. IL-1β concentrations were measured in plasma, colon, and skeletal muscle of wild-type (WT) control and colitic mice. Microvascular thrombosis was induced in cremaster muscle microvessels by using a light/dye injury model. The effects of exogenous IL-1β on thrombus formation were determined in control WT mice. DSS-induced thrombogenesis was evaluated in WT mice treated with an IL-1βantibody and in IL-1 receptor-deficient (IL-1r-/-) mice. DSS-induced colonic inflammation in WT mice was associated with enhanced thrombus formation in arterioles. IL-1β concentrations were elevated in inflamed colon and skeletal muscle. Exogenous IL-1β enhanced thrombosis in control mice in a dose-dependent manner. DSS colitic mice treated with the IL-1β antibody as well as IL-1r-/- mice exhibited significantly blunted thrombogenic responses. These findings implicate IL-1β as a mediator of enhanced microvascular thromboses that occur in extra-intestinal tissues during colonic inflammation. Copyright © American Society for Investigative Pathology.
Dembo T.,EIJU General Hospital |
Tanahashi N.,International University of Japan
Internal Medicine | Year: 2013
A 55-year-old man presented with vertigo, nystagmus, and gait ataxia followed by left hemiparesis (Opalski syndrome). T2-weighted magnetic resonance imaging revealed vascular compression of the left lateral side of the medulla oblongata by the left vertebral artery. On diffusion tensor imaging, the level of fractional anisotropy (FA) in the left corticospinal fibers caudal to the pyramidal decussation was lower than that observed in the right corticospinal fibers. Opalski syndrome caused by vascular compression is very rare. This is the first reported case of Opalski syndrome that was imaged on FA. © 2013 The Japanese Society of Internal Medicine.
Ogawa K.,Eiju General Hospital
The Journal of trauma | Year: 2010
BACKGROUND: Disorders or traumas requiring surgery other than suprascapular entrapment neuropathy that occur in the lateral supraspinatus fossa are decidedly uncommon. Because a wider operative field is necessary for treating these disorders, we have applied a trapezius-splitting approach with some modifications. METHODS: The procedure comprises a saber cut incision along with trapezius-splitting of 5 cm to 6 cm proximally from the position coinciding with the posterior margin of the acromioclavicular joint. At the lateral aspect of this division, a Gelpi retractor is set on the clavicle and the scapular spine to widen the narrow interspace between them. The underlying adipose tissue and supraspinatus muscle are forced aside en bloc posteriorly. Four patients were surgically treated using this approach and were postoperatively followed up for 22.2 months ± 7.8 months. RESULTS: A sufficient operative field for the major maneuver was secured in all four patients. None developed postoperative paralysis or atrophy of the trapezius, supraspinatus, or infraspinatus muscles. The three patients treated for nonunion or delayed union of coracoid fracture exhibited successful union, and the patient treated for osteochondroma of the clavicle had no recurrence. CONCLUSIONS: The main advantages of this procedure are minimal trauma to the musculature, a clearly visible field of the most lateral fossa, and the ability to approach the anterior or posterior shoulder region through the extended skin incision and deltoid-splitting approach if required. Results indicate that the procedure would be advantageous in the surgical treatment of disorders and traumas occurring in the lateral supraspinatus fossa.