Fujioka, Japan
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To determine whether diffusion-weighted echo-planar MR images are sensitive to liver perfusion difference.Noncirrhotic livers of 71 patients (43 males, 28 females; age range, 22-87 years; mean, 61 years) without (n=51) and with (n=20) significant (>70%) portal vein stenosis (accompanying proximal hepatic arterial stenosis and/or biliary tract obstruction in 10) by tumors were examined with diffusion-weighted echo-planar sequences (modified for b factors of 1, 28, 66, 288 and 600 s/mm2). On the basis of multiple-perfusion-components theory, i.e., assuming logarithm of signal intensity for liver perfusion is linearly attenuated versus logarithm of a smaller b factor, we defined the slope of the line as the perfusion-related D′ value. The D′ values of these livers were calculated from images with b factors of 1, 28, and 66 s/mm2. The livers' apparent diffusion coefficient values for diffusion (ADCd values) were calculated from images with b factors of 288 and 600 s/mm2.The livers with significant portal vein stenosis had statistically lower mean D′ values than the livers without portal vein stenosis (P<001 on the Mann-Whitney U test). However, there was no significant difference in ADCd values between these liver types (P>05).The D′ value calculated from diffusion-weighted echo-planar sequences with plural smaller b factors may be sensitive to liver perfusion difference. © 2011 Elsevier Inc.

Moteki T.,Fujioka General Hospital | Ohya N.,Fujioka General Hospital | Horikoshi H.,Gunma Cancer Tomo Hospital
Journal of Computer Assisted Tomography | Year: 2011

OBJECTIVE: The objective of this study was to investigate whether the criterion "maximum depth of intraluminal appendiceal fluid greater than 2.6 mm" ("DEPTH >2.6 mm"), with the use of 64-detector row computed tomography, is useful to diagnose appendicitis. METHODS: We retrospectively evaluated 0.68-mm-thick images of 2894 intravenously enhanced abdominal-pelvic computed tomography using the following criteria: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent lymphadenopathy greater than 5 mm, (5) appendicolith, (6) periappendiceal inflammation, and (7) the new criterion, DEPTH >2.6 mm. Of the 2894 images, 1013 were classified into normal group (including 622 distended [diameter >6 mm] but normal appendices without adjacent lesions), modified group (235 distended normal appendices modified with adjacent lesions), proven-appendicitis group (82 operatively proven appendicitis cases), and clinical-appendicitis group (62 clinically certified appendicitis cases). RESULTS: The new criterion, DEPTH >2.6 mm, demonstrated both higher sensitivities and higher specificities in all groups (>90%), although this criterion showed lower specificities than some conventional criteria. In contrast, conventional criteria showed lower sensitivities or lower specificities (<60%) in one or more of these groups. CONCLUSIONS: DEPTH >2.6 mm is particularly useful for differentiating appendicitis from distended normal appendix. Copyright © 2011 by Lippincott Williams & Wilkins.

Moteki T.,Fujioka General Hospital | Ohya N.,Gunma Cancer Tomo Hospital | Horikoshi H.,Gunma Cancer Tomo Hospital
Journal of Computer Assisted Tomography | Year: 2010

OBJECTIVE: The objective of this study was to evaluate whether maximum depth of intraluminal appendiceal fluid (DEPTH) is useful in differentiating appendicitis without periappendiceal inflammation from enlarged normal appendices in children. METHODS: We retrospectively evaluated 826 intravenously enhanced abdominal-pelvic computed tomographic examinations in children (aged 0-18 years) using the following criteria for appendicitis: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent adenopathy, (5) appendicolith, and (6) DEPTH. Of 826, 192 were classified into the noncomplicated-normal appendix group (85 enlarged normal appendices [diameter >6 mm] without adjacent lesions), the complicated-normal appendix group (44 enlarged normal appendices with adjacent lesions), or the our-appendicitis group (63 operatively proved appendicitis without periappendiceal inflammation). RESULTS: The criterion "DEPTH greater than 2.6 mm" determined by receiver operating characteristic analysis between our-appendicitis and complicated-normal appendix groups demonstrated both higher sensitivity and higher specificity in all groups (>90%). In contrast, the other criteria showed lower sensitivities (<58%) in our-appendicitis group. CONCLUSIONS: The criterion "DEPTH greater than 2.6 mm" is particularly useful for differentiating appendicitis without periappendiceal inflammation from enlarged normal appendices in children. Copyright © 2010 by Lippincott Williams & Wilkins.

PubMed | Japan Atomic Energy Agency, Nozomi Orthopaedic Clinic Hiroshima, Fujioka General Hospital, Japan Society for the Promotion of Science and 3 more.
Type: | Journal: Archives of physical medicine and rehabilitation | Year: 2017

To examine the association between pedometer-based ambulatory physical activity (PA) and physical function in patients with knee osteoarthritis (OA).Cross-sectional observational study.Institutional practice.Participants in orthopaedic clinics (n = 207; age, 56-90 years; 71.5% female) diagnosed with radiographic knee OA (Kellgren/Lawrence [K/L] grade 1).Not applicable.Ambulatory PA was objectively measured as steps/day. Physical function was assessed using the Japanese Knee Osteoarthritis Measure (JKOM) functional subcategory, 10-meter walk, timed up and go (TUG), and five-repetition chair stand (5CS) tests.Patients walking <2500 steps/day had a low level of physical function with a slower gait speed, longer TUG time, and worse JKOM functional score compared with those who walk 2500-4999, 5000-7499, and 7500 steps/day adjusted for age, sex, body mass index [BMI], and K/L grade. Ordinal logistic regression analysis revealed that steps/day (continuous) was associated with better physical function adjusted for age, sex, BMI, and K/L grade. These relationships were still robust in sensitivity analyses that included patients with K/L grades 2 (n = 140).Although increased ambulatory PA had a positive relationship with better physical function, walking <2500 steps/day may be a simple indicator for a decrease in physical function in patients with knee OA among standard PA category. Our findings might be a basis for counseling patients with knee OA about their ambulatory PA and for developing better strategies for improving physical function in sedentary patients with knee OA.

Miyazawa Y.,Fujioka General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2014

A 40-year-old man was diagnosed with Langerhans cell histiocytosis (LCH) in October 2010. His LCH was refractory to conventional chemotherapy, and thus worsened to Langerhans cell sarcoma (LCS) in May 2011. Although we repeated combination chemotherapies, new infiltration of the liver and bone marrow, as well as primary lesions of the bone, lymph nodes, and skin, appeared. These intensive chemotherapies caused candida liver abscesses, invasive aspergillosis, disseminated varicella zoster virus infection and bacterial sepsis. We administered bendamustine for chemotherapy, which resulted in a partial response (PR) with no severe adverse events. Because of pancytopenia caused by secondary myelodysplastic syndrome, we stopped the bendamustine chemotherapy after two courses. PR was maintained for 4 months. We plan to perform allogeneic hematopoietic stem cell transplantation from a sibling donor after a conditioning regimen. Optimal therapy for adult LCH, which is a rare and treatment-resistant disease, has yet to be established. Bendamustine is a potential chemotherapeutic agent for standard treatment of LCS.

Mochiki E.,Gunma University | Ogata K.,Gunma University | Ogata K.,Gunma Prefecture Saiseikai Maebashi Hospital | Ohno T.,Gunma University | And 8 more authors.
British Journal of Cancer | Year: 2012

Background: A combination of S-1 and cisplatin has been shown to be effective with acceptable safety for the first-line treatment of far-advanced gastric cancer in Japan. This is the first randomised phase II trial to compare S-1paclitaxel with S-1cisplatin in this setting. Methods: Patients with unresectable and/or recurrent advanced gastric cancer were randomly assigned to receive one of the two regimens: S-1 (40 mg m -2 twice daily) on days 1-14 plus paclitaxel (60 mg m -2) on days 1, 8, and 15 of a 4-week cycle (S-1paclitaxel) or S-1 (40 mg m -2 twice daily) on days 1-21 plus cisplatin (60 mg m -2) on day 8 of a 5-week cycle (S-1cisplatin). The primary end point was the response rate (RR). Secondary end points included progression-free survival (PFS), overall survival (OS), and safety. Results: A total of 83 patients were eligible for safety and efficacy analyses. In the S-1paclitaxel and S-1cisplatin groups, RRs (52.3% vs 48.7%; P=0.74) and median PFS (9 vs 6 months; P=0.50) were similar. The median OS was similar in the S-1paclitaxel and S-1cisplatin groups (16 vs 17 months; P=0.84). The incidence of grade 3 or higher haematological toxicity was 19.0% with S-1paclitaxel and 19.5% with S-1cisplatin. The incidence of grade 3 or higher non-haematological toxicity was 14.2% with S-1paclitaxel and 17.1% with S-1cisplatin. Conclusion: S-1paclitaxel was suggested to be a feasible and effective non-platinum-based regimen for chemotherapy in patients with advanced gastric cancer. Our results should be confirmed in multicenter, phase III-controlled clinical trials. © 2012 Cancer Research UK All rights reserved.

Fujita Y.,Gunma University | Ikeda M.,Gunma University | Yanagisawa T.,Fujioka General Hospital | Senoo Y.,Isesaki Fukushima Hospital | Okamoto O.,Gunma University
Neurology | Year: 2011

Objective: To present the relationship between TARDBP gene mutation and clinicopathologic findings of a Japanese pedigree affected by familial amyotrophic lateral sclerosis (FALS). Methods: The clinical, genetic, and neuropathologic characteristics of 4 members of a Japanese pedigree affected by FALS were examined. Results: All the patients showed motor neuron signs, and 2 of them also had parkinsonism. We identified A315E TARDBP mutation in one patient per clinical disease type and found loss of anterior horn cells, Bunina bodies, and phosphorylated TDP-43-positive neuronal and glial cytoplasmic inclusions in both the patients. However, the patient with only motor neuron signs had degeneration of the posterior column and spinocerebellar tracts as well as neuronal loss of the Clarke column, and the patient with both motor neuron signs and parkinsonism had severe nigral degeneration without Lewy pathology. Conclusion: The clinical and neuropathologic phenotypes of FALS may differ even with the same mutation of TARDBP, encoding TDP-43. Isolated TDP-43 pathology can produce ALS-plus syndrome © 2011 by AAN Enterprises, Inc.

PubMed | Gunma Prefectural Cardiovascular Center, Gunma University, Takasaki General Medical Center and Fujioka General Hospital
Type: Controlled Clinical Trial | Journal: European journal of nuclear medicine and molecular imaging | Year: 2016

Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients.In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m(2)] undergoing stress (99m)Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT.During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n=7; non-fatal myocardial infarction, n=3; hospitalization for heart failure, n=13; cerebrovascular accident, n=1; need for revascularization, n=38; and renal failure, i.e., hemodialysis initiation, n=7). ESV and SSS were associated with CDs (p<0.05), and eGFR and SDS were associated with MACCREs (p<0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p<0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p<0.05).Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD.

PubMed | Gunma University, Tsunoda Hospital, Saitama University and Fujioka General Hospital
Type: Journal Article | Journal: Case reports in gastroenterology | Year: 2016

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

Isho T.,National Hospital Organization Takasaki General Medical Center | Isho T.,Fujioka General Hospital | Usuda S.,Gunma University
Gait and Posture | Year: 2016

Trunk control plays an important role in movement control and postural balance during functional activities. The purpose of this study was to investigate the association of trunk control early after stroke with mobility performance and quantitative gait characteristics derived from trunk accelerations. Fifteen patients with hemiparesis following stroke (median age, 61 years [range, 56-78 years]; median time since stroke, 9 days [range, 7-15 days]) participated in this cross-sectional observational study. Subjects were evaluated using the Trunk Impairment Scale (TIS), the short-form of the Berg Balance Scale (SF-BBS), an isometric knee extension strength test, the Timed Up and Go test (TUG), and a timed walking test. The linear acceleration of the lower trunk was recorded along the 3 axes during walking and quantified using the autocorrelation coefficient and harmonic ratio to assess the variability and smoothness of upper-body movement. The TIS total score had a significant correlation with TUG time. The coordination subscale score of the TIS was significantly correlated with TUG time, walking speed, and accelerometry variables in univariate analysis. The TIS coordination subscale score was significantly related to accelerometry variables in the partial correlation analysis adjusted for SF-BBS score and knee extension strength on the paretic and nonparetic side. These results indicate that trunk motor impairment after stroke is closely associated with poor mobility performance and trunk instability in gait. These findings support intensive rehabilitation treatment targeting trunk control to regain better mobility and stable gait in patients early after stroke. © 2015 Elsevier B.V..

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