Yamazaki H.,Kyoto Prefectural University of Medicine |
Yamazaki H.,CyberKnife Center |
Ogita M.,Fujimoto Hayasuzu Hospital |
Himei K.,Red Cross |
And 4 more authors.
Radiotherapy and Oncology | Year: 2015
Background and purpose Although reirradiation has attracted attention as a potential therapy for recurrent head and neck tumors with the advent of modern radiotherapy, severe rate toxicity such as carotid blowout syndrome (CBOS) limits its potential. The aim of this study was to identify the risk factors of CBOS after hypofractionated stereotactic radiotherapy (SBRT). Methods and patients We conducted a matched-pair design examination of pharyngeal cancer patients treated by CyberKnife reirradiation in four institutes. Twelve cases with CBOS were observed per 60 cases without CBOS cases. Prognostic factors for CBOS were analyzed and a risk classification model was constructed. Results The median prescribed radiation dose was 30 Gy in 5 fractions with CyberKnife SBRT after 60 Gy/30 fractions of previous radiotherapy. The median duration between reirradiation and CBOS onset was 5 months (range, 0-69 months). CBOS cases showed a median survival time of 5.5 months compared to 22.8 months for non-CBOS cases (1-year survival rate, 36% vs.72%; p = 0.003). Univariate analysis identified an angle of carotid invasion of >180°, the presence of ulceration, planning treatment volume, and irradiation to lymph node areas as statistically significant predisposing factors for CBOS. Only patients with carotid invasion of >180° developed CBOS (12/50, 24%), whereas no patient with tumor involvement less than a half semicircle around the carotid artery developed CBOS (0/22, 0%, p = 0.03). Multivariate Cox hazard model analysis revealed that the presence of ulceration and irradiation to lymph nodes were statistically significant predisposing factors. Thus, we constructed a CBOS risk classification system: CBOS index = (summation of risk factors; carotid invasion >180°, presence of ulceration, lymph node area irradiation). This system sufficiently separated the risk groups. Conclusion The presence of ulceration and lymph node irradiation are risk factors of CBOS. The CBOS index, including carotid invasion of >180°, is useful in classifying the risk factors and determining the indications for reirradiation. © 2015 Published by Elsevier Ireland Ltd.
Kamimura K.,Fujimoto Hayasuzu Hospital |
Nagamachi S.,Fujimoto Hayasuzu Hospital |
Wakamatsu H.,Fujimoto Hayasuzu Hospital |
Higashi R.,Fujimoto Hayasuzu Hospital |
And 6 more authors.
Annals of Nuclear Medicine | Year: 2010
Purpose Liver demonstrates a heterogeneous 18F fluoro- 2-deoxy-D-glucose (18F-FDG) uptake pattern and sometimes shows an abnormally increased uptake even when there is no malignant tissue. The aim of this study was to evaluate the relationships of liver 18F-FDG uptake as related to physical factors, fatty liver, blood glucose (BG), and other biochemical data. Methods 18F-FDG positron emission tomography (PET) imaging was performed in 101 consecutive subjects for cancer screening. Multiple stepwise regression analysis was used to define the best predictors of the liver standardized uptake value (SUV) among height, weight, waist circumference, body mass index (BMI), systolic and diastolic blood pressure, BG and other biochemical data, i.e., aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, total cholesterol, high-density lipoprotein cholesterol, triglycerides, total protein, total bilirubin, and alkaline phosphatase. Furthermore, we evaluated the association between liver 18F-FDG uptake and the metabolic syndrome. Results The independent factors for increased liver 18F-FDG uptake (mean SUV>= 2)wereBMI (P<0.0001), triglycerides (P = 0.0007), and high-density lipoprotein cholesterol (P = 0.0013). Other factors were not significantly associated with liver 18F-FDG uptake. In addition, the liver 18F-FDG uptake of metabolic syndrome subjects was significantly higher than that of a non-metabolic syndrome subjects. Conclusions BMI was the strongest determinant of liver 18F-FDG uptake, and the liver 18F-FDG uptake of metabolic syndrome subjects was significantly higher than that of non-metabolic syndrome subjects. This result suggests that a subject with a high liver 18F-FDG uptake should be screened for the metabolic syndrome. © The Japanese Society of Nuclear Medicine 2010.
Omae T.,Fujimoto Hayasuzu Hospital |
Kanmura Y.,Kagoshima University
Journal of Anesthesia | Year: 2012
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, b-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, bblockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF[48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients \75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients C75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients. © 2012.The Author(s).
Zakaria N.A.,Nara Institute of Science and Technology |
Zakaria N.A.,University of Technology Malaysia |
Kuwae Y.,Fujimoto Hayasuzu Hospital |
Tamura T.,Osaka Electro-Communication University |
And 2 more authors.
Computer Methods in Biomechanics and Biomedical Engineering | Year: 2015
We examined falling risk among elderly using a wearable inertial sensor, which combines accelerometer and gyrosensors devices, applied during the Timed Up and Go (TUG) test. Subjects were categorised into two groups as low fall risk and high fall risk with 13.5 s duration taken to complete the TUG test as the threshold between them. One sensor was attached at the subject's waist dorsally, while acceleration and gyrosensor signals in three directions were extracted during the test. The analysis was carried out in phases: sit-bend, bend-stand, walking, turning, stand-bend and bend-sit. Comparisons between the two groups showed that time parameters along with root mean square (RMS) value, amplitude and other parameters could reveal the activities in each phase. Classification using RMS value of angular velocity parameters for sit-stand phase, RMS value of acceleration for walking phase and amplitude of angular velocity signal for turning phase along with time parameters suggests that this is an improved method in evaluating fall risk, which promises benefits in terms of improvement of elderly quality of life. © 2013 Taylor & Francis.
Ishizuka T.,Kagoshima University |
Nakamura M.,Kagoshima University |
Ichiba M.,Kagoshima University |
Fujita S.,Fujimoto Hayasuzu Hospital |
And 3 more authors.
Dementia and Geriatric Cognitive Disorders | Year: 2012
Background: Mutations in the presenilin-1 gene (PSEN1) have been identified in autosomal dominant early-onset cases of Alzheimer's disease (AD). Aims: To investigate different clinical phenotypes of siblings possessing the same heterozygous P264L mutation in the PSEN1 gene. Methods: We evaluated clinical features, neuroimaging results, and neuropsychological examinations. The PSEN1 gene and other dementia-related gene mutations were screened. Results: We clinically diagnosed the proband as atypical AD with frontotemporal dementia features and diagnosed the elder brother of the proband as typical AD, based on neuropsychological symptoms and a brain imaging examination including amyloid imaging data. A heterozygous P264L mutation in the PSEN1 gene was identified in both siblings. Conclusion: This study is one of few reports of AD siblings possessing the same mutation but exhibiting different clinical phenotypes in a Japanese family possessing a P264L mutation in the PSEN1 gene. The current results suggest that unknown modifiers, including both genetic and epigenetic factors, may alter the pathological and clinical phenotypes of a genetically predetermined disease. Copyright © 2012 S. Karger AG, Basel.