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Terui K.,Hidaka General Hospital | Obayashi S.,Hidaka General Hospital | Shimizu M.,Hidaka General Hospital | Ozaki F.,Hidaka General Hospital | And 3 more authors.
Neurological Surgery | Year: 2010

Cerebral aneurysms arising from fenestration of the horizontal (A 1) segment in the anterior cerebral artery (ACA) are very rare. In this paper, we report our case, discuss radiological features, and review previous cases. A 70-year-old male was referred to our hospital presenting with memory disturbance. His unruptured cerebral aneurysm in the A1 segment was incidentally found by magnetic resonance angiography (MRA). Three dimensional computed tomographic angiography (3D-CTA) demonstrated this aneurysm arising from fenestration of the A1 segment. Surgical neck clipping was performed via the pterional approach, while sacrificing one pair of the A1 segment. The patient's post operative course was uneventful. Only 14 cases with an aneurysm arising from fenestration of the A1 segment have been reported previously. In the present case, 3D-CTA was very useful for finding out where the aneurysm arose from, and we also had to be careful about perforating arteries from the A1 segment during the surgery. Source


Enomoto T.,A+ Network | Sowa M.,Hidaka General Hospital | Nishimori K.,Hidaka General Hospital | Shimazu S.,Kitade Hospital | And 9 more authors.
Allergology International | Year: 2014

Background: Probiotic administration may be a useful method for preventing allergies in infants; however, there have been controversial results about the efficacy. We investigated the effects of bifidobacterial supplementation on the risk of developing allergic diseases in the Japanese population.Methods: In an open trial, we gave Bifidobacterium breve M-16V and Bifidobacterium longum BB536 prenatally to 130 mothers beginning 1 month prior to delivery and postnatally to their infants for 6 months. Another 36 mother-infant pairs served as controls and did not receive the bifidobacterial supplementation. Development of allergic symptoms in the infants was assessed at 4, 10 and 18 months of age. Fecal samples were collected from the mothers and infants.Results: The risk of developing eczema[1]atopic dermatitis (AD) during the first 18 months of life was significantly reduced in infants in the probiotic group (OR: 0.231 [95% CI: 0.084-0.628] and 0.304 [0.105-0.892] at 10 and 18 months of age, respectively). Pyrosequencing analyses indicated an altered composition of the fecal microbiota at 4 months for infants who developed eczema[1]AD at 4 and 10 months of age. The proportion of Proteobacteria was significantly lower (P = 0.007) in mothers at the time of delivery who received the supplementation when compared with the control group and was positively correlated (r = 0.283, P = 0.024) with that of infants at 4 months of age. No adverse effects were related to the use of probiotics.Conclusions: These data suggest that the prenatal and postnatal supplementation of bifidobacteria is effective in primary preventing allergic diseases. Some limited changes in the composition of fecal microbiota by the bifidobacterial supplementation were observed. © 2014 Japanese Society of Allergology. Source


Cho T.,Matsushita Memorial Hospital | Komasawa N.,Osaka Medical College | Haba M.,Hidaka General Hospital | Fujiwara S.,Osaka Medical College | And 2 more authors.
American Journal of Emergency Medicine | Year: 2016

Purpose Recent guidelines for cardiopulmonary resuscitation emphasize that all rescuers should minimize the interruption of chest compressions, even for intravenous access. We assessed the utility of needle guides during ultrasound-guided central venous catheterization (US-CVC) with chest compressions via simulation. Methods Twenty-five anesthesiologists with more than 2 years of experience performed US-CVC on a manikin with or without a needle guide and with or without chest compressions. Insertion success rate within 2 minutes, insertion time, and subjective difficulty of venous puncture or guide wire insertion were measured. Results In normal trials, 1 participant failed US-CVC without compressions, whereas 6 failed with compressions (P =.04). In needle-guided trials, all participants succeeded without compressions, whereas only 1 failed with compressions (P =.31). Insertion time was significantly longer with chest compressions in both normal and needle-guided trials (P <.001, each). Ultrasound-guided central venous catheterization insertion time in normal trials was significantly longer than in needle-guided trials with compressions (P <.001). Difficulty of operation on a visual analog scale for venous puncture or guide wire insertion was significantly higher in normal trials than in needle-guided trials with compressions. Conclusion Needle guides shortened the insertion time and improved the success rate of US-CVC during chest compressions by anesthesiologists in simulations. © 2016 Elsevier Inc. All rights reserved. Source


Suzuki H.,Wakayama Medical University | Terai M.,Tokyo Womens Medical University | Hamada H.,Tokyo Womens Medical University | Honda T.,Tokyo Womens Medical University | And 14 more authors.
Pediatric Infectious Disease Journal | Year: 2011

BACKGROUND: There are still no definite treatments for refractory Kawasaki disease (KD). In this pilot study, we evaluated the use of cyclosporin A (CyA) treatment in patients with refractory KD. METHODS: We prospectively collected clinical data of CyA treatment (4-8 mg/kg/d, oral administration) for refractory KD patients using the same protocol among several hospitals. Refractory KD is defined as the persistence or recurrence of fever (37.5°C or more of an axillary temperature) at the end of the second intravenous immunoglobulin (2 g/kg) following the initial one. RESULTS: Subjects were enrolled out of 329 KD patients who were admitted to our 8 hospitals between January 2008 and June 2010. Among a total of 28 patients of refractory KD treated with CyA, 18 (64.3%) responded promptly to be afebrile within 3 days and had decreased C-reactive protein levels, the other 4 became afebrile within 4 to 5 days. However, 6 patients (21.4%) failed to become afebrile within 5 days after the start of CyA and/or high fever returned after becoming afebrile within 5 days. Although hyperkalemia developed in 9 patients at 3 to 7 days after the start of CyA treatment, there were no serious adverse effects such as arrhythmias. Four patients (1.2%), 2 before and the other 2 after the start of CyA treatment, developed coronary arterial lesions. CONCLUSION: CyA treatment is considered safe and well tolerated, and a promising option for patients with refractory KD. Further investigations will be needed to clarify optimal dose, safety, and timing of CyA treatment. Copyright © 2011 by Lippincott Williams & Wilkins. Source


Onouchi Y.,RIKEN | Onouchi Y.,Chiba University | Ozaki K.,RIKEN | Burns J.C.,University of California at San Diego | And 59 more authors.
Nature Genetics | Year: 2012

We performed a genome-wide association study (GWAS) of Kawasaki disease in Japanese subjects using data from 428 individuals with Kawasaki disease (cases) and 3,379 controls genotyped at 473,803 SNPs. We validated the association results in two independent replication panels totaling 754 cases and 947 controls. We observed significant associations in the FAM167A-BLK region at 8p22-23 (rs2254546, P = 8.2 × 10 -21), in the human leukocyte antigen (HLA) region at 6p21.3 (rs2857151, P = 4.6 × 10 -11) and in the CD40 region at 20q13 (rs4813003, P = 4.8 × 10 -8). We also replicated the association of a functional SNP of FCGR2A (rs1801274, P = 1.6 × 10 -6) identified in a recently reported GWAS of Kawasaki disease. Our findings provide new insights into the pathogenesis and pathophysiology of Kawasaki disease. © 2012 Nature America, Inc. All rights reserved. Source

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