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Oki M.,Nagoya Medical Center | Saka H.,Nagoya Medical Center | Ando M.,Nagoya University | Asano F.,Gifu Prefectural General Medical Center | And 4 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2015

Rationale: The combination of an ultrathin bronchoscope, navigational technology, and endobronchial ultrasound (EBUS) seems to combine the best of mutual abilities for evaluating peripheral pulmonary lesions, but ultrathin bronchoscopes that allow the use of EBUS have not been developed so far. Objectives: To compare the diagnostic yield of transbronchial biopsy under EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a novel ultrathin bronchoscope with that using a thin bronchoscope with a guide sheath for peripheral pulmonary lesions. Methods: In four centers, patients with suspected peripheral pulmonary lesions less than or equal to 30 mm in the longest diameter were included and randomized to undergo transbronchial biopsy with EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a 3.0-mm ultrathin bronchoscope (UTB group) or a 4.0-mm thin bronchoscope with a guide sheath (TB-GS group). Measurements and Main Results: A total of 310 patients were enrolled and randomized, among whom 305 patients (150, UTB group; 155, TB-GS group) were analyzed. The ultrathin bronchoscope could reach more distal bronchi than the thin bronchoscope (median fifth- vs. fourth-generation bronchi; P < 0.001). Diagnostic histologic specimens were obtained in 74% (42% for benign and 81% for malignant lesions) of the UTB group and 59% (36% for benign and 70% for malignant lesions) of the TB-GS group (P = 0.044, Mantel-Haenszel test). Complications including pneumothorax, bleeding, chest pain, and pneumonia occurred in 3% and 5% in the respective groups. Conclusions: The diagnostic yield of the UTB method is higher than that of the TB-GS method. Clinical trial registered with www.umin.ac.jp/ctr/ (UMIN 000003177). Copyright © 2015 by the American Thoracic Society.


Asano F.,Gifu Prefectural General Medical Center | Shinagawa N.,Hokkaido University | Ishida T.,Fukushima Medical University | Shindoh J.,Ogaki Municipal Hospital | And 4 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2013

Rationale: In bronchoscopy, an ultrathin bronchoscope can be advanced to more peripheral bronchi. Because virtual bronchoscopic navigation (VBN) is a method to guide a bronchoscope under direct observation using VB images, VBN may be particularly useful when combined with ultrathin bronchoscopy. Objectives: This prospective multicenter study evaluated the value of VBN-assisted ultrathin bronchoscopy for diagnosing peripheral pulmonary lesions. Methods: We randomly assigned 350 patients with peripheral pulmonary lesions (diameter, <30 mm) to VBN-assisted or non-VBNassisted groups. An ultrathin bronchoscope (outer diameter, 2.8mm) was introducedtothetarget bronchus usingaVBNsystemin theVBNassisted group, whereas only computed tomography axial images were referred to in the non-VBN-assisted group. Specimen sampling sites were verified using X-ray fluoroscopy. Measurements and Main Results: Subjects for analysis included 334 patients. There was no significant difference in the diagnostic yield between the VBN-assisted group (67.1%) and the non-VBN-assisted group (59.9%; P = 0.173). The subgroup analysis showed that the diagnostic yield was significantly higher in the VBN-assisted group than in the non-VBN-assisted group for right upper lobe lesions (81.3% vs. 53.2%; P = 0.004); lesions invisible on posterior-anterior radiographs (63.2% vs. 40.5%; P = 0.043); and lesions in the peripheral third of the lung field (64.7% vs. 52.1%; P = 0.047). Conclusions: VBN-assisted ultrathin bronchoscopy does not improve the diagnostic yield for peripheral pulmonary lesions. However, the method improves the diagnostic yield for lesions in the subcategories (right upper lobe, invisible, peripheral third), warranting further study. Clinical trial registeredwithwww. umin.ac.jp/ctr/ (UMIN000001536). © 2013 by the American Thoracic Society.


Takanashi J.-i.,Kameda Medical Center | Imamura A.,Gifu Prefectural General Medical Center | Hayakawa F.,Okazaki City Hospital | Terada H.,Toho University
Journal of the Neurological Sciences | Year: 2010

Two patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) exhibiting lesions in the white matter and entire corpus callosum (type 2) are reported. The time course differed between the splenial lesion and other lesions in the white matter and corpus callosum other than the splenium; the latter disappeared earlier than the former. These findings strongly suggest that MERS type 2 resolves completely through MERS type 1 exhibiting an isolated splenial lesion, and MERS types 1 and 2 have the same pathophysiology. The possible prior white matter lesions in patients with MERS type 1 may explain the neurological symptoms or EEG abnormalities. © 2010 Elsevier B.V. All rights reserved.


Ishida T.,Fukushima Medical University | Asano F.,Gifu Prefectural General Medical Center | Yamazaki K.,Hokkaido University | Shinagawa N.,Hokkaido University | And 4 more authors.
Thorax | Year: 2011

Background: Bronchoscopy using endobronchial ultrasound (EBUS) can help to diagnose small peripheral pulmonary lesions. However, although biopsy sites can be confirmed, a bronchoscope cannot be guided in EBUS. Virtual bronchoscopic navigation (VBN) can guide a bronchoscope with virtual images, but its value has not been confirmed. Methods: This prospective multicentre study examines the value of VBN-assisted EBUS for diagnosing small peripheral pulmonary lesions. 199 patients with small peripheral pulmonary lesions (diameter ≤30 mm) were randomly assigned to VBN-assisted (VBNA) or non-VBN-assisted (NVBNA) groups. A bronchoscope was introduced into the target bronchus of the VBNA group using the VBN system. Sites of specimen sampling were verified using EBUS with a guide sheath under fluoroscopy. Results: The diagnostic yield was higher for the VBNA than for the NVBNA group (80.4% vs 67.0%; p=0.032). The duration of the examination and time elapsed until the start of sample collection were reduced in the VBNA compared with the NVBNA group (median (range), 24.0 (8.7-47.0) vs 26.2 (11.6-58.6) min, p=0.016) and 8.1 (2.8-39.2) vs 9.8 (2.3-42.3) min, p=0.045, respectively). The only adverse event was mild pneumothorax in a patient from the NVBNA group. Conclusions: The diagnostic yield for small peripheral pulmonary lesions is increased when VBN is combined with EBUS. Clinical trial number: UMIN000000569.


Komori S.,Gifu University | Komori S.,Gifu Prefectural General Medical Center | Ishida K.,Gifu University | Yamamoto T.,Gifu University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2014

Purpose: To conduct a ≥15-year follow-up assessment of the visual field (VF) in normal-tension glaucoma (NTG) patients receiving medical therapy and to identify risk factors for VF progression.Design: A retrospective clinical study.Methods: Medical records of 78 eyes of 78 NTG patients monitored for ≥15 years were reviewed. VF progression was defined by a mean deviation (MD) deteriorated twice by 3.00 dB from baseline (MD criterion) and an annual decrease in the MD slope exceeding −0.5 dB/year (MD slope criterion). Logistic regression analysis was employed to identify risk factors for VF progression.Results: The mean follow-up period was 18.3 years. The average intraocular pressure (IOP) before treatment was 15.1 ±1.9 mmHg and the average treated IOP was 13.5 ±1.5 mmHg with 2.0 medications. Forty-two eyes (53.8%) showed VF progression using the MD criterion and 15 eyes (19.2%) showed a negative MD slope less than −0.5 dB/year. Disc hemorrhage (DH) was observed in 30 eyes (38.5%). The mean VF progression rate was −0.38 ±0.30 dB/year in the DH group and −0.24 ±0.28 dB/year in the non-DH group (P = 0.012). Multiple logistic regression analysis identified DH [relative risk (RR) 4.28; P = 0.028] as a risk factor for VF progression using the MD criterion. DH (RR 8.77; P = 0.007) and IOP fluctuation during follow-up (RR 5.03; P = 0.048) were detected as risk factors using the MD slope criterion.Conclusions: DH and IOP fluctuation were associated with VF progression in NTG during long-term therapy. © 2014, Springer-Verlag Berlin Heidelberg.


Asano F.,Gifu Prefectural General Medical Center
Respiratory Investigation | Year: 2016

Bronchoscopy to examine peripheral pulmonary lesions is performed using a bronchoscope with an outer diameter of 5-6. mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of bronchoscope insertion, difficulty in guiding a bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems.Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites. In a meta-analysis, the diagnostic yield, that of lesions smaller than 2. cm, and complication rate were 73, 56.3, and 1.0%, respectively. Virtual bronchoscopic navigation is a method to guide a bronchoscope to peripheral lesions under direct vision using virtual bronchoscopic images of the bronchial route, and the diagnostic yield, that of 2-cm or smaller lesions, and complication rate were 73.8, 67.4, and 1.0%, respectively. Electromagnetic navigation utilizes electromagnetism; the diagnostic yield was 64.9-71%, and the pneumothorax complication rate was 4% for this modality. Ultrathin bronchoscopes can be advanced to the peripheral bronchus under direct vision in contrast to normal-size bronchoscopes, and the diagnostic yield and pneumothorax complication rates were reported to be 63 and 1.5%, respectively. The overall diagnostic yield of these new techniques on meta-analysis was 70%, a higher yield than that obtained with conventional transbronchial biopsy. Each technique has advantages and disadvantages, and the investigation of appropriate combinations corresponding to individual cases is necessary. © 2015 The Japanese Respiratory Society.


Asano F.,Gifu Prefectural General Medical Center
Clinics in Chest Medicine | Year: 2010

Virtual bronchoscopic navigation (VBN) is a method for the guidance of a bronchoscope to peripheral lesions using virtual bronchoscopy (VB) images of the bronchial path. Irrespective of the bronchoscopist's skill level, the bronchoscope can be readily guided to the target in a short time. A system to automatically search for the bronchial path to the target has been developed and clinically applied; this system produces VB images of the path to the fourth- to twelfth- (median, sixth-) generation bronchi, and displays the VB images simultaneously with real bronchoscopic images. In this article, the author discusses VBN and the automatic VBN system, reviews the published literature, and describes its usefulness and limitations. © 2010 Elsevier Inc. All rights reserved.


Nagasawa H.,Gifu Prefectural General Medical Center
Cardiology in the Young | Year: 2014

Background Awareness about normal cardiac volumes in the neonatal period is very important for understanding the cardiac function; however, the small cardiac size of neonates makes it difficult to perform invasive examinations. Three-dimensional echocardiography is used to evaluate cardiac volumes in children. However, no studies using this method have examined left ventricular volumes in neonates during the early neonatal period. Methods The study group consisted of 255 normal neonates. Comparisons of the stroke volume calculated according to the velocity-time integral and Pombo method were made. Results The volumes in both end-diastole and end-systole and the stroke volume gradually decreased over time after birth. Participants with continuous a persistent ductus arteriosus flow had higher stroke volumes than those without persistent ductus arteriosus. The average end-diastolic volume per body surface area (m2) was 30.61 ml/m2 in boys and 29.80 ml/m2 in girls, whereas the ventricular end-systolic volume was 12.89 ml/m2 in boys and 12.80 ml/m2 in girls among the participants without persistent ductus arteriosus. The average stroke volume was 17.70 ml/m 2 in boys and 17.00 ml/m2 in girls. Statistically significant gender differences were observed in the end-diastolic volume (p = 0.0053), stroke volume (p < 0.0001), and ejection fraction (p = 0.039). The cardiac index was calculated to be 2.04 L/minute/m2 in boys and 1.95 L/minute/m2 in girls, which was significantly lower than that calculated using the velocity-time integral and Pombo method (p < 0.0001). Conclusions Significant gender differences in the end-diastolic volume, stroke volume, and ejection fraction at birth were revealed. The cardiac index in the early neonatal period was found to be relatively smaller than what had previously been recognised. © Cambridge University Press 2013.


Komura S.,Gifu Prefectural General Medical Center | Yokoi T.,Gifu Prefectural General Medical Center | Nonomura H.,Gifu Prefectural General Medical Center
Archives of Orthopaedic and Trauma Surgery | Year: 2011

Fracture-dislocations of the proximal interphalangeal joint are challenging to treat, since it is difficult to achieve both rigid fixation and early joint motion simultaneously. Palmar fracture-dislocations of the proximal interphalangeal joint are less frequent injuries and a small number of treatment methods have been reported. We describe here a patient with a chronic palmar fracture-dislocation of the proximal interphalangeal joint, who was treated with a new surgical technique. In the surgery, a mini hook plate that was made by adapting a 1.5 mm AO hand modular system straight plate was used. Despite the thinness of the fragment, rigid fixation was achieved, resulting in early active motion. At final follow up, the active ranges of motion were 0°-100° at the proximal and 0°-80° at the distal interphalangeal joint, and there were no complications. This technique may become a useful surgical method to treat palmar fracture-dislocations of the proximal interphalangeal joint. © Springer-Verlag 2010.


Background: Many studies have reported on the estimation of the development of left ventricular dimensions in children by using two-dimensional echocardiography and formulated equations to evaluate normal cardiac dimensions. We reported that height is the most simple and useful index to evaluate the normal dimensions of the left ventricle in children. Disparities have been detected between the normal dimensions estimated from these formulae and real dimensions in infants less than 1 year of age and neonates, by using body weight or body surface area as an index. Our objective is to assess the normal size of left ventricular end-diastolic dimension in infants less than 1 year of age and neonates, including premature neonates, by two-dimensional echocardiography by using height as an index.Methods and results The study group consisted of 243 infants, 123 males, and 120 females without congenital cardiac disease. The regression equation for the relationship between left ventricular end-diastolic dimension (Y) and height was Y (millimetre) = 0.352 × height (centimetre) + 1.86 in mature neonates and infants with height of less than 75 centimetres, whereas that in premature neonates was Y (millimetre) = 0.495 × height (centimetre) 5.43. No significant differences were observed in the infants on the basis of sex. Conclusions The regression equations reported in the previous studies cannot be applied to data obtained from infants. In addition, three different formulae, one for each group of infants by using height as an index can be usefully applied for practical purposes. Copyright © Cambridge University Press 2010.

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