Hakodate Municipal Hospital

Hakodate, Japan

Hakodate Municipal Hospital

Hakodate, Japan
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Stone P.H.,Harvard University | Saito S.,Shonan Kamakura General Hospital | Takahashi S.,Harvard University | Takahashi S.,Shonan Kamakura General Hospital | And 23 more authors.
Circulation | Year: 2012

BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.

Sakushima K.,Hokkaido University | Yabe I.,Hokkaido University | Nakano F.,Red Cross | Yoshida K.,Red Cross | And 4 more authors.
Journal of Neurology | Year: 2011

The diagnosis of neurosarcoidosis is often difficult; the imaging signs of spinal cord sarcoidosis sometimes mimic those of cervical spondylotic myelopathy, which is common in elderly persons. We examined the characteristics of spinal cord sarcoidosis in Japanese patients with neurosarcoidosis. This case series identified patients with neurosarcoidosis at four general hospitals and one university hospital from April 1998 to September 2010. All diagnoses were based on the diagnostic criteria proposed by Zajicek et al. Seventeen patients (nine men and eight women) were involved: six patients with spinal cord lesions accompanied by cervical spondylosis, five with cerebral lesions, three with cranial nerve lesions, two with meningitis, and one with nerve root lesions. Patients with spinal cord sarcoidosis had a higher onset age, longer duration from onset to diagnosis, reduced leukocytosis in the cerebrospinal fluid (CSF), and lower angiotensin-converting enzyme (ACE) levels in the CSF. The results of this study indicate that diagnosis of spinal cord sarcoidosis requires careful evaluation. © 2011 Springer-Verlag.

Uehara M.,Hakodate Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

Pulmonary trunk aneurysm is generally associated with congenital cardiac defects, pulmonary hypertension, or infection. Idiopathic pulmonary trunk aneurysm without any associated diseases is a rare lesion and has seldom been reported. Here, we report a case of a 68-year-old woman with idiopathic pulmonary trunk aneurysm. The maximum diameter of the aneurysm was 53 mm while she was 142 cm in height. We successfully performed aneurysmorrhaphy and her postoperative course was uneventful. Aneurysmorrhaphy was an effective technique for idiopathic pulmonary trunk aneurysm without pulmonary hypertention.

Baba T.,Hakodate Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 63-year-old male patient was admitted to the hospital complaining of chest pain. He had undergone aorto-bifemoral bypass and percutaneous coronary intervention due to Leriche syndrome and ischemic heart disease. Radiological examination revealed complete obstruction of the right coronary artery(#2) as well as the bypass graft. He was successfully treated with the simultaneous operation of coronary artery bypass grafting( CABG) and ascending aorta to bifemoral artery bypass.

Ujihira K.,Hakodate Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

Aneurysms of the aortic arch are technically challenging to repair with thoracic endovascular aneurysm repair (TEVAR). Various optional techniques such as debranching or hybrid TEVAR enable landing zones to extend, however, there is still room for improvement. We have performed total debranching to facilitate TEVAR with adequate central neck length more than 2.5 cm. In summary our procedure has 3 features:mini-thoracotomy to minimize its surgical stress which might cause post-operative respiratory failure, side-to-side anastomosis of trifurcated graft with ascending aorta to avoid its kinking after chest closure, and the usage of Pruitt-Inahara shunt tube during anastomoses of the carotid artery.

Mawatari T.,Hakodate Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A pedicled pericardial fat pad (PPFP) is often used in pulmonary resection to reinforce bronchial sutures. Here, we assessed the significance of PPFP by serial chest computed tomography (CT). Ten cases in which bronchial stump were covered with a PPFP in the past 6 years were reviewed. The procedures were pneumonectomy (3), lobectomy (6), and a segmentectomy. According to the CT value evaluated serially PPFP was recognized as fat tissue until 1~2 postoperative months. No cases of bronchopleural fistulae was encountered in this series. The coverage of the sutures with the PPFP was thought to contribute to the prevention of bronchial fistula by staying around bronchial stump for at least 1 to 2 months.

Hayashi T.,Sapporo Medical University | Kawakami H.,Hokkaido University | Osanai M.,Teine Keijinkai Hospital | Ishiwatari H.,Sapporo Medical University | And 7 more authors.
Clinical Gastroenterology and Hepatology | Year: 2015

Background & Aims: Endoscopic sphincterotomy (ES) is performed routinely before self-expandable metallic stents (SEMS) are placed in malignant distal biliary strictures to prevent postprocedural pancreatitis. However, it is not clear whether ES actually prevents pancreatitis or affects other adverse events (AEs). We conducted a noninferiority trial to examine the necessity of ES before SEMS placement. Methods: Two hundred patients with distal biliary strictures caused by unresectable pancreatic cancer were assigned randomly to groups that received ES or did not receive ES (non-ES) before SEMS placement, at 25 hospitals in Hokkaido, Japan, from August 2010 through November 2012. The primary outcome was early AEs (≤30 d) specifically related to the presence or absence of ES (pancreatitis, bleeding, or perforation). Secondary outcomes measured included the effect of ES omission on time to SEMS dysfunction and patient survival times. Results: The proportions of patients with early AEs were 9.2% in the non-ES group and 10.4% in the ES group (a difference of 1.2%, noninferior). The median times to SEMS dysfunction was longer than 594 days in the non-ES group and 541 days in the ES group (P= .88). The median overall survival times were 202 in the ES group vs 255 days in the non-ES group; P= .20). Conclusions: ES before SEMS does not affect the incidence of AEs, SEMS patency, or patient survival times. Our data provide no evidence for a benefit of ES to patients undergoing SEMS placement forabiliary stricture caused by pancreatic cancer. UMIN clinical trials registry number:000004044. © 2015 AGA Institute.

Tsutsumi Y.,Hakodate Municipal Hospital | Shimono J.,Hakodate Municipal Hospital | Ohhigashi H.,Hakodate Municipal Hospital | Ito S.,Hakodate Municipal Hospital | And 2 more authors.
International Journal of Laboratory Hematology | Year: 2015

Introduction: Dabigatran is an oral intake thrombin inhibitor for preventive administration against stroke accompanied by atrial fibrillation. Although dabigatran causes prolonged activated partial thromboplastin time (APTT), the effect of dabigatran on each coagulation factor and coagulation factor inhibitor remains to be investigated. Our aim was to analyze the influence of dabigatran on coagulation factors and coagulation factor inhibitors. Methods: We administered dabigatran to 40 patients. In 26 of these 40, we analyzed the activity of several coagulation factors and their inhibitors. We used Fisher's exact test to determine statistical significance. Results: The activities of many coagulation factors changed during the dabigatran therapy. Factor II levels decreased in all patients showing prolongation of partial thromboplastin (PT) and APTT. The antifactor VIII inhibitor was positive in the majority of patients with prolonged PT and APTT, while activities of protein C, protein S, and antifactor IX inhibitor were not associated with PT and APTT prolongation. Conclusion: Dabigatran affects the activities of many coagulation factors, including factors II, V, VIII, and IX, as well as the antifactor VIII inhibitor. © 2014 John Wiley & Sons Ltd.

Nakamura M.,Hakodate Municipal Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2013

The purpose of this study was to optimize scan parameters for evaluation of carotid plaque characteristics by k-space trajectory (radial scan method), using a custom-made carotid plaque phantom. The phantom was composed of simulated sternocleidomastoid muscle and four types of carotid plaque. The effect of chemical shift artifact was compared using T1 weighted images (T1WI) of the phantom obtained with and without fat suppression, and using two types of k-space trajectory (the radial scan method and the Cartesian method). The ratio of signal intensity of simulated sternocleidomastoid muscle to the signal intensity of hematoma, blood (including heparin), lard, and mayonnaise was compared among various repetition times (TR) using T1WI and T2 weighted imaging (T2WI). In terms of chemical shift artifacts, image quality was improved using fat suppression for both the radial scan and Cartesian methods. In terms of signal ratio, the highest values were obtained for the radial scan method with TR of 500 ms for T1WI, and TR of 3000 ms for T2WI. For evaluation of carotid plaque characteristics using the radial scan method, chemical shift artifacts were reduced with fat suppression. Signal ratio was improved by optimizing the TR settings for T1WI and T2WI. These results suggest the potential for using magnetic resonance imaging for detailed evaluation of carotid plaque.

Vessel wall imaging using radial scanning does not use a blood flow suppression pulse with gated acquisition. It has been proposed that there may not be a flow void effect if the flow rate is slow; however, this has yet to be empirically tested. To clarify the relationship between the signal intensity of the vessel lumen and the blood flow rate in a flow phantom, we investigated the usefulness of vessel wall imaging at 3.0 tesla (T). We measured the signal intensity while changing the flow rate in the flow phantom. Radial scanning at 1.5 T showed sufficient flow voids at above medium flow rates. There was no significant difference in lumen signal intensity at the carotid artery flow rate. The signal intensity of the vessel lumen decreased sufficiently using the radial scan method at 3.0 T. We thus obtained sufficient flow void effects at the carotid artery flow rate. We conclude this technique to be useful for evaluating plaque if high contrast can be maintained for fixed tissue (such as plaque) and the vessel lumen.

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