Hekinan Municipal Hospital

Hekinan, Japan

Hekinan Municipal Hospital

Hekinan, Japan

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Ito E.,Nagoya University | Saito K.,Nagoya University | Nagatani T.,Nagoya University | Ishiyama J.,Shizuoka Saiseikai General Hospital | And 3 more authors.
World Neurosurgery | Year: 2010

Background: Intradural chordomas are rare and have been considered benign owing to the feasibility of complete resection and the display of lesser aggressive biologic behavior than typical chordomas. Case Description: We herein reported 2 cases of intradural cranial chordoma with aggressive biologic behavior. A tumor (anti-Ki-67 monoclonal antibody [MIB-1], 13.9%) in a 59-year-old woman was strongly adherent to the brainstem and involved the basilar artery and its branches. After subtotal removal, the remnant tumor was treated with stereotactic radiotherapy. A tumor (MIB-1, 6.2%) in a 75-year-old woman repeatedly recurred even after initial gross total removal. The recurrent chordomas were treated with γ-knife radiosurgery. Conclusion: The cases presented in this study indicate that intradural chordomas can also be aggressive such as typical chordomas. Long-term follow-ups with a large number of patients with this condition are essential for elucidating the prognosis of intradural chordomas. © 2010 Elsevier Inc. All rights reserved.


Yamada T.,Nagoya University | Yamada T.,Seirei Hamamatsu Hospital | Matsuyama M.,Aichi University | Yanagida T.,Aichi University | And 3 more authors.
International Journal of Experimental Pathology | Year: 2011

To confirm the existence of the cervical thymus and the development of cervical thymoma in thymoma-prone BUF/Mna (BUF) rats, we examined cervical organs and adjacent tissues, and thoracic thymic tissues of the three inbred strains, BUF, ACI/NMna (ACI), and WKY/NCrj (WKY), and 11 congenic strains, in which genetic regions of rat nude (Rnu), thymus enlargement-1 and thymus enlargement-2 (Ten1 and Ten2), thymoma susceptibility of rat-1 (Tsr1), atrophy of fast-twitch muscles-1 (Aftm1) and proteinuria of rat-1 (Pur1) were transferred into BUF, ACI or WKY rats. These organs and tissues were fixed en block in 10% formalin and cut coronally into four to six slices of 3-mm thickness, depending on the age of the rat, and embedded together in one block for each rat. Sections were cut and stained with haematoxylin and eosin and examined microscopically. Cervical thymuses were detected in 12-21% of rats from these inbred and congenic strains. No cervical thymuses were found in BUF-Rnu/Rnu rats, which were athymic. All of 42 BUF, 2 of 55 BUF-Rnu/+ and 28 of 33 ACI-Tsr1/Tsr1 rats survived more than 52weeks, and developed thoracic thymoma, but no cervical thymomas did. It is therefore clear that cervical thymuses behave differently from thoracic thymuses in spontaneous thymomagenesis in BUF rats. © 2011 The Authors. International Journal of Experimental Pathology © 2011 International Journal of Experimental Pathology.


PubMed | Nagoya University, Nagoya Memorial Hospital, Hekinan Municipal Hospital, Fujita Health University Hospital and Daido Hospital
Type: Journal Article | Journal: Journal of cardiology | Year: 2015

Many patients with atrial fibrillation (AF) and coronary artery stent deployment are given both antiplatelet drug and warfarin. Little information is available as to the relationship between the antithrombotic therapies in the late phase after stenting and the clinical outcomes of these patients. We examined the clinical outcomes of AF patients 12 months after coronary artery stenting.We retrospectively examined 146 patients and classified them into three groups according to the antithrombotic therapies [dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT) plus warfarin, and DAPT plus warfarin] 12 months after stenting. We defined the primary endpoint as Thrombolysis in Myocardial Infarction major bleeding and the secondary endpoint as a composite of adverse events (CAE: all-cause death, nonfatal myocardial infarction, intracranial bleeding, and cerebral infarction).During a median follow-up of 37 months, major bleeding and CAE were observed in 14 (9.6%) and 46 (31.5%) patients, respectively. DAPT plus warfarin was an independent risk factor for major bleeding in a multivariate Cox hazard regression model after adjustment for age, gender, and the type of AF (hazard ratio: 4.20; 95% confidence interval: 1.13-17.27; p=0.033). No significant clinical variables were found for CAE.Prolonged use of DAPT with warfarin significantly increases the risk of major bleeding in AF patients after coronary artery stenting. Individualized antithrombotic treatment is required in these patients to prevent major bleeding.


Sumigama S.,Nagoya University | Sugiyama C.,Gifu Prefectural Tajimi Hospital | Kotani T.,Nagoya University | Hayakawa H.,Kasugai Municipal Hospital | And 15 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2014

Objective To clarify the effects of uterine myometrial suture techniques at prior caesarean section on the incidence of pathologically diagnosed placenta accreta in placenta praevia with prior caesarean section (PPPC). Design Case-control study. Setting Eleven tertiary referral hospitals in central Japan. Population A total of 98 cases of placenta praevia, a history of one or more prior caesarean sections, and a history of uterine transverse incision and usage of only absorbable thread for myometrial sutures at the prior caesarean section. Exclusions were a history of myomectomy or Strassmann's operation. Methods Cases were grouped into a pathologically diagnosed placenta accreta group (38 cases) and a no accreta group (60 cases). Clinical characteristics including uterine suture methods at prior caesarean section were compared (single-layer versus double-layer closure; continuous versus interrupted sutures in the inner myometrial layer). Main outcome measure The incidence of placenta accreta. Results No difference was found comparing single-layer with double-layer closure in the incidence of placenta accreta (37.1 versus 39.7%, P = 0.805); however, a significant difference was found comparing continuous with interrupted sutures (58.1 versus 29.9%, P = 0.008). Multivariable logistic regression analysis with stepwise selection for the eight factors meeting the criterion of P < 0.10 in univariate analysis was used, and four independent factors were selected, as follows: gravidity ≥ 3 (adjusted odds ratio, aOR, 3.4, 95% confidence interval, 95% CI, 0.99-11.6, P = 0.050); total praevia (versus non-total, aOR 18.4, 95% CI 3.2-107.0, P = 0.001); anterior/centre placenta (versus posterior, aOR 16.4, 95% CI 3.7-72.2, P < 0.001); and continuous sutures (versus interrupted, aOR 6.0, 95% CI 1.4-25.2, P = 0.015). Conclusions In this limited study, a history of continuous sutures on the inner side of the uterine wall showed potential to influence the development of placenta accreta in PPPC patients. © 2014 Royal College of Obstetricians and Gynaecologists.


Matsubara N.,Nagoya University | Miyachi S.,Nagoya University | Tsukamoto N.,Hekinan Municipal Hospital | Kojima T.,Red Cross | And 6 more authors.
Acta Neurochirurgica | Year: 2013

Background: Acute cervical carotid artery occlusion presents with a severe neurological deficit and is associated with unfavorable outcomes. In this study, the authors report their experience with patients having had acute ischemic stroke due to cervical carotid occlusion, who underwent endovascular intervention. Method: Sixteen acute cervical carotid occlusion patients (15 males and 1 female; mean age 67.7 years) were treated by endovascularly between January 2009 and November 2012. Clinical, procedural, and angiographic data were retrospectively evaluated. Successful intracranial recanalization was based on thrombolysis in cerebral infarction score of 2B-3. A favorable outcome was defined as a modified Rankin Scale score of 0-2 at 90 days. Findings: The average score of National Institutes of Health Stroke Scale before treatment was 15.9. Ten of 16 patients (63 %) were associated with intracranial tandem occlusion. Ten (63 %) cases were caused by atherosclerotic, 4 (25 %) by atrial fibrillation (AF), and 2 (13 %) by dissection. Thirteen of 16 (81 %) achieved successful cervical recanalization and 7 of 16 (44 %) patients obtained sufficient cervical and intracranial perfusion. As a result, 5 of 16 (31 %) patients demonstrated favorable outcomes. Five of seven patients (71 %) with successful cervical and intracranial recanalization presented favorable outcomes. In contrast, none of the patients without cervical or intracranial recanalization presented favorable outcomes. Three of 6 (50 %) patients initially without intracranial occlusion showed favorable outcomes, but only 2 of 10 (20 %) patients associated with intracranial occlusion had favorable outcomes. On the aspect of etiology, in atherosclerotic cases, 4 of 10 (40 %) showed favorable outcomes. However, all four AF cases deteriorated into poor outcomes. Conclusions: This study demonstrated the feasibility of endovascular intervention for acute cervical carotid artery occlusion. Although treatment for tandem occlusion and AF cases is an issue that should be resolved, intervention must be encouraged. Successful cervical and intracranial revascularization will be essential for favorable outcomes. © 2013 Springer-Verlag Wien.


Matsuyama M.,Hekinan Municipal Hospital | Matsuyama M.,Aichi University | Sugiura S.,Hekinan Municipal Hospital | Kakita A.,Hekinan Municipal Hospital | And 2 more authors.
Pathology Research and Practice | Year: 2011

We report a case of splenic tumor associated with severe hypoglycemia. The patient was a 69-year-old man with a large splenic tumor. He had suffered from relapsing hypoglycemic attacks and the lowest serum glucose level (4. mg/dl). He died 34 months after the onset of symptoms of left abdominal pain. Autopsy revealed large tumors in the spleen, 3 medium sized tumors in the lungs, and several small tumors in the liver. Microscopic studies of the splenic tumors revealed a hepatocellular carcinoma which showed a strongly positive reaction against anti-PIVKA-II and anti-" hepatocyte" antibodies. Several bile ductules thought to be heterotopic remnants of the liver tissues were found in the capsule of the spleen, adjoining the splenic tumor. It was suggested that the tumor originated from one of these ductules. Electron microscopic analysis showed numerous endocrine-like granules of every tumor cell, and 87-165 times stronger mRNA expression of insulin-like growth factor-II was measured in the tumor tissues when compared with normal liver tissue. Owing to these results, we believe that this is the first report of hepatocellular carcinoma that had developed from a liver tissue in the spleen. © 2010 Elsevier GmbH.


Hayashi N.,Hekinan Municipal Hospital | Okumura A.,Juntendo University | Kubota T.,Anjo Kosei Hospital | Tsuji T.,Okazaki City Hospital | And 5 more authors.
Brain and Development | Year: 2012

Objectives: Acute encephalopathy with reduced subcortical diffusion (AED) covers a spectrum including not only typical acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) but also atypical AESD with monophasic clinical course, or more severe subtypes. Aim of this study is to analyze prognostic factors of AED. Materials & methods: We recruited 33 children with AED, that is, widespread diffusion restriction in cortical and subcortical structures. Their clinical courses, laboratory data, MRI, and the efficacy of treatment were analyzed retrospectively. Results: Of the 33 children, 20 were males and the mean age at diagnosis was 22. months. Eighteen children had good outcome and 15 had poor outcome. Univariate analysis showed loss of consciousness 24. h after the onset, prolonged seizure at the onset, and mechanical ventilation to be weak predictors of poor outcome. Maximal aspartate aminotransferase, alanine aminotransferase, and creatinine kinase levels were significantly higher in the poor outcome group. Multivariate analysis showed loss of consciousness 24. h after the onset and prolonged seizure at the onset to be poor predictors of AED. Treatment with steroids and/or immunoglobulins did not result in better outcome. Conclusion: Prolonged seizure at the onset and loss of consciousness 24. h after the onset were seen at early stages of severe AED. Using these features, a prospective study of early intervention in AED should be conducted to further analyze the efficacy of its treatment. © 2011 The Japanese Society of Child Neurology.


Matsubara N.,Nagoya University | Matsubara N.,Hekinan Municipal Hospital | Miyachi S.,Nagoya University | Tsukamoto N.,Hekinan Municipal Hospital | And 4 more authors.
Acta Neurochirurgica | Year: 2011

Background: Because of their fragile and thin wall, ruptured blood blister-like aneurysms (BBAs) at the anterior wall of the internal carotid artery (ICA) are difficult to manage, both surgically, as well as endovascularly. BBA is usually a tiny and broad-necked aneurysm, but it occasionally demonstrates a relatively saccular-like shape. In addition, the pseudoaneurysm sac often assumes a saccular shape. In this paper, the authors present their experience in treating these saccular-shaped BBAs endovascularly with coil packing. Method: Nine saccular-shaped ruptured BBAs in nine patients (one male and eight females; mean age 51.3 years, range 38-76) were treated with coil packing of the lesion between January 2006 and August 2010 in Nagoya University and its affiliated hospitals. Clinical, procedural, and angiographic data were retrospectively evaluated. Findings: Seven BBAs were treated by balloon-assisted coil embolization. Two remaining BBAs were embolized without balloon inflation, though a balloon catheter was on standby at the ICA. In one case, in which a saccular coil embolization could not be achieved, ICA trapping was performed. Three (33.3%) were treated in acute, two (22.2%) in subacute, and four (44.4%) in chronic period. One (11.1%) intraoperative rupture occurred. Six (66.7%) had excellent clinical outcomes, while two (22.2%) proved fatal outcomes. During the follow-up period (mean 18.9 months, range 4-48), two out of seven (28.6%) aneurysms presented an angiographical recurrence, but both were treated by coil embolization without complications. The remaining five (71.4%) aneurysms were completely resolved. Conclusions: Endovascular coil embolization can be considered as an alternative treatment option for selective saccular-shaped BBAs. © 2011 Springer-Verlag.


PubMed | Hekinan Municipal Hospital
Type: Journal Article | Journal: Brain & development | Year: 2012

Acute encephalopathy with reduced subcortical diffusion (AED) covers a spectrum including not only typical acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) but also atypical AESD with monophasic clinical course, or more severe subtypes. Aim of this study is to analyze prognostic factors of AED.We recruited 33 children with AED, that is, widespread diffusion restriction in cortical and subcortical structures. Their clinical courses, laboratory data, MRI, and the efficacy of treatment were analyzed retrospectively.Of the 33 children, 20 were males and the mean age at diagnosis was 22 months. Eighteen children had good outcome and 15 had poor outcome. Univariate analysis showed loss of consciousness 24 h after the onset, prolonged seizure at the onset, and mechanical ventilation to be weak predictors of poor outcome. Maximal aspartate aminotransferase, alanine aminotransferase, and creatinine kinase levels were significantly higher in the poor outcome group. Multivariate analysis showed loss of consciousness 24 h after the onset and prolonged seizure at the onset to be poor predictors of AED. Treatment with steroids and/or immunoglobulins did not result in better outcome.Prolonged seizure at the onset and loss of consciousness 24 h after the onset were seen at early stages of severe AED. Using these features, a prospective study of early intervention in AED should be conducted to further analyze the efficacy of its treatment.


PubMed | Hekinan Municipal Hospital
Type: Case Reports | Journal: No shinkei geka. Neurological surgery | Year: 2012

The authors report a case of intracardiac migration of a ventriculoatrial (VA) shunt catheter and transvenous retrieval of the migrated shunt catheter. A 67-year-old male, who had previously undergone a VA shunt for hydrocephalus after subarachnoid hemorrhage, presented disorientation, memory disturbance and gait disturbance without any cardiopulmonary symptom. Head CT scan revealed ventriculomegaly that indicated hydrocephalus due to shunt malfunction. Radiogram revealed that the caudal segment of the broken atrial catheter had migrated into the heart (right ventricle). The migrated shunt catheter was retrieved by a transfemoral approach with a pigtail catheter and a snare retriever catheter, although the rostral catheter segment partially remained because of tight adhesion. The VA shunt was then reconstructed. Postoperatively, symptoms due to recurrent hydrocephalus were markedly improved and the VA shunt functioned well. Transvenous catheter retrieval was a less invasive and effective method for VA shunt catheter migration.

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