Higashihiroshima Medical Center

Higashihiroshima, Japan

Higashihiroshima Medical Center

Higashihiroshima, Japan
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Shimizu K.,Higashihiroshima Medical Center | Sadatomo T.,Higashihiroshima Medical Center | Hara T.,Higashihiroshima Medical Center | Ohba H.,Higashihiroshima Medical Center | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2017

Background: Chronic expanding intracerebral hematoma is a well-known complication of spontaneous intracerebral hemorrhage. However, because chronic expanding intracerebral hematoma is relatively rare, it has not been studied systemically. The purpose of this study was to characterize a patient population with chronic expanding intracerebral hematoma, and to identify the predictive factors for it. Methods: We retrospectively evaluated 112 patients with spontaneous putaminal hemorrhage who were treated at our institution between January 1, 2010 and December 31, 2015. Data on age, sex, Glasgow Coma Scale score, presence of intraventricular hemorrhage, and intracerebral hemorrhage volume were collected, and their predictive values for chronic expanding intracerebral hematoma were investigated. We also evaluated the predictive value of a characteristic radiological finding at onset called the "layer sign," which was represented as a fluid level adjacent to the clot. Results: Chronic expanding intracerebral hematoma was observed in 4 patients (4.9%) with spontaneous intracerebral hemorrhage. Only the layer sign was significantly related to chronic expanding intracerebral hematoma (P = .003), and was found to be independently associated with chronic expanding intracerebral hematoma in a multivariate analysis (odds ratio, 18.6; 95% confidence interval, 1.19-291.0; P = .037). Conclusions: The frequency of chronic expanding intracerebral hematoma in those with spontaneous intracerebral hemorrhage was estimated at 4.9%. The layer sign was a useful factor for predicting chronic expanding intracerebral hematoma. © 2017 National Stroke Association.


PubMed | Red Cross, Hiroshimakinen Hospital, Higashihiroshima Medical Center, Hiroshima City Asa Citizens Hospital and 9 more.
Type: Journal Article | Journal: Journal of gastroenterology | Year: 2016

The risk for lymph node metastasis and the prognostic significance of pedunculated-type T1 colorectal carcinomas (CRCs) require further study. We aimed to assess the validity of the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines based on long-term outcomes of pedunculated-type T1 CRCs.In this multicenter retrospective cohort study, we examined 176 patients who underwent resection endoscopically or surgically at 14 institutions between January 1990 and December 2010. Patients meeting the JSCCR curative criteria were defined as endoscopically curable (e-curable) and those who did not were non-e-curable. We evaluated the prognosis of 116 patients (58 e-curable, 58 non-e-curable) who were observed for>5years after treatment.Overall incidence of lymph node metastasis was 5% (4/81; 95% confidence interval 1.4-12%: three cases of submucosal invasion depth1000m [stalk invasion] and lymphatic invasion, one case of head invasion and budding grade 2/3). There was no local or metastatic recurrence in the e-curable patients, but six of them died of another cause (observation period, 80months). There was no local recurrence in the non-e-curable patients; however, distant metastasis was observed in one patient. Death due to the primary disease was not observed in non-e-curable patients, but six of them died of another cause (observation period, 72months).Our data support the validity of the JSCCR curative criteria for pedunculated-type T1 CRCs. Endoscopic resection cannot be considered curative for pedunculated-type T1 CRC with head invasion alone.


Taguchi A.,Matsumoto Dental University | Miki M.,Matsumoto Dental University | Muto A.,Matsumoto Dental University | Kubokawa K.,Matsumoto Dental University | And 3 more authors.
Gerontology | Year: 2013

Background: Poor oral health is associated with an increased risk of dementia in the elderly. One possible pathway linking these two phenomena is lacunar infarction, a potential cause of dementia. An association between poor oral health and an increased risk of ischaemic stroke has been recognised through the oral infection-inflammation pathway. However, little is known about whether poor oral health is associated with the progression of lacunar infarction. Objective: We examined the association between variables related to oral health and lacunar infarction, as detected by magnetic resonance imaging (MRI). Methods: A total of 110 subjects (52 men, 58 women), aged 27-76 years, who visited our periodontology clinic participated in this study. The subjects underwent dental radiography, periodontal examinations and brain MRI. One experienced specialist in cardiovascular disease and one experienced neurosurgeon determined the number of lacunar infarctions on brain MRI. Periodontologists performed clinical periodontal examinations. Variables related to oral health were determined from the radiographs by an oral radiologist. Information on the subjects' lifestyles and disease histories were obtained using a structured questionnaire and confirmed by clinical records. Adjacent categories logit regression analysis with backward elimination was used to determine variables associated with three groups based on the number of lacunar infarctions. Results: Of the 110 subjects, 61 had lacunar infarctions. Nineteen had multiple (≥7) lesions. Aging (p = 0.0004), increased time spent in physical activity per day (p = 0.042), the presence of hypertension (p = 0.006), the absence of hyperlipidaemia (p = 0.045), the presence of diabetes mellitus (p = 0.025) and low alveolar bone height (p = 0.026) were significantly associated with an increased number of lacunar infarctions in the final regression model. The significance of hyperlipidaemia and alveolar bone height disappeared in an unadjusted model. An increased pocket depth, which indicates current periodontal disease progression, tended to be associated with an increased number of lacunar infarctions (p = 0.058). This tendency did not disappear in an unadjusted model. Conclusion: Our results suggest that lacunar infarction may be associated with current periodontal disease in Japanese adults. Copyright © 2013 S. Karger AG, Basel.


Niimoto T.,Higashihiroshima Medical Center | Deie M.,Hiroshima University | Adachi N.,Hiroshima University | Usman M.A.,Hiroshima University | Ochi M.,Hiroshima University
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Purpose The aims of the present controlled clinical study were to (1) compare patella laxity determined in the outpatient clinic with that in anaesthetized patients and (2) evaluate patella laxity before and after lateral release. Method The study evaluated data on 33 knees from 33 patients (average age 19.7 years) between 2007 and 2011. All patients were diagnosed with recurrent dislocation of the patella. Patellar stability was evaluated in each patient thrice: patellas were first imaged in the outpatient clinic prior to surgery at 45° knee flexion with 20 N stress from the medial to lateral side and from the lateral to medial side; then, at the time of surgery, patella stress images were obtained in the same manner before and after the lateral release procedure. Radiological assessments were performed using the medial stress shift ratio (MSSR) and lateral stress shift ratio (LSSR). Results There were no significant differences in the LSSR and MSSR before surgery (outpatient data) and in anaesthetized patients before the lateral release procedure. Furthermore, there was no significant difference in MSSR at the time of surgery before and after the lateral release procedure. However, LSSR increased significantly after the lateral release procedure. Conclusion The results of the present study suggest that quantitative patella stress radiography in the outpatient clinic is useful when it comes to investigating laxity of the patella, and that lateral release significantly increases lateral, but not medial, laxity in patients with recurrent patellar dislocation. Level of evidence IV. © 2014 Springer-Verlag Berlin Heidelberg.


Suda K.,Aichi Cancer Center Hospital | Suda K.,Kyushu University | Murakami I.,Higashihiroshima Medical Center | Katayama T.,Aichi Cancer Center Hospital | And 6 more authors.
Clinical Cancer Research | Year: 2010

Purpose: In epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy for lung cancer patients, acquired resistance develops almost inevitably and this limits the improvement in patient outcomes. EGFR T790M mutation and MET amplification are the two main mechanisms underlying this resistance, but the relationship between these two mechanisms is unclear. In this study, we explored their relationship using in vitro models and autopsy specimens. Experimental Design: Erlotinib-resistant HCC827 (HCC827ER) cells were developed by chronic exposure to erlotinib at increasing concentrations. HCC827EPR cells were also developed by chronic exposure to erlotinib in the presence of PHA-665,752 (a MET TKI). The erlotinib-resistant mechanisms of these cells were analyzed. In addition, 33 autopsy tumor samples from 6 lung adenocarcinoma patients harboring multiple gefitinib-refractory tumors were analyzed. Results: HCC827ER developed MET amplification, and clinically relevant resistance occurred at ≥4-fold MET gene copy number gain (CNG). By contrast, HCC827EPR developed T790M without MET CNG. Of six patients harboring gefitinib-refractory tumors, three exhibited T790M only, one exhibited MET amplification only, and the other two exhibited T790M and/or MET amplification depending on the lesion sites. In these gefitinib-refractory tumors, T790M developed in 93% (14 of 15) of tumors without MET gene CNGs, in 80% (4 of 5) of tumors with moderate MET gene CNGs (<4-fold), and in only 8% (1 of 13) of tumors with MET amplification (≥4-fold). Conclusions: These results indicate a reciprocal and complementary relationship between T790M and MET amplification and the necessity of concurrent inhibition of both for further improving patient outcomes. ©2010 AACR.


Fujiwara M.,Hiroshima University | Nakano Y.,Hiroshima University | Hidaka T.,Hiroshima University | Oda N.,Hiroshima City Asa Hospital | And 10 more authors.
Circulation Journal | Year: 2014

Background: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery and results in increased health-care utilization. This study identified new transthoracic echocardiographic predictors of POAF using an index of the total atrial conduction time derived on tissue Doppler imaging (PA-TDI duration) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods and Results: A total of 88 patients undergoing isolated OPCAB were enrolled. They were examined preoperatively on transthoracic echocardiography with tissue Doppler evaluations and monitored postoperatively with continuous electrocardiographic telemetry for 7 days. POAF occurred in 35 patients (39.8%). Patients with POAF had a significantly longer duration of hospital stay than those without (44.9±6.2 vs. 37.3±3.3 days, P=0.04). Multivariate analysis showed that PA-TDI duration (odds ratio [OR], 1.11; 95% confidence interval [CI]: 1.06-1.16; P=0.0001) and left atrial volume index (LAVI; OR, 1.11; 95% CI: 1.02-1.20; P=0.01) were independent predictors of POAF. Moreover, PA-TDI duration was more reliable, given an area under the receiver operating characteristic curve of 0.85 (sensitivity, 74.3%; specificity, 86.8%). Conclusions: PA-TDI duration was an independent predictor of POAF following OPCAB. Awareness of risk of POAF may lead to the prevention of POAF, a rapid response to POAF, shortened hospital stay, and improved prognosis.


Sadatomo T.,Higashihiroshima Medical Center | Yuki K.,Higashihiroshima Medical Center | Migita K.,Higashihiroshima Medical Center | Imada Y.,Higashihiroshima Medical Center | And 2 more authors.
Neurosurgical Review | Year: 2013

The objectives of this study were to elucidate the normal anatomy of middle cerebral artery (MCA) bifurcations and to analyze the differences in patients with MCA aneurysms. In the present study, 62 patients underwent three-dimensional magnetic resonance angiography, and no intracranial lesions were noted. The widths of M1 and the superior and inferior M2 branches, as well as their respective lateral angles, were measured. These values were used to calculate the daughter artery ratio (DA ratio; width of larger M2/width of smaller M2) and the lateral angle ratio (LA ratio; lateral angle between M1 and larger M2/lateral angle between M1 and smaller M2). The DA and LA ratios of 54 MCA aneurysm patients (34 with ruptured aneurysms, 20 with unruptured aneurysms) were also calculated, using three-dimensional digital subtraction angiography, and compared with the normal values. In normal patients, the widths of M1 and the branches of M2, the lateral angles, and the LA and DA ratios were not significantly different between the right and left sides. The bilateral superior and inferior lateral angles of normal MCAs were significantly wider than those of MCAs with aneurysms. The DA ratio was 1.5 ± 0.4 in normal MCAs and 1.7 ± 0.7 in MCAs with aneurysms; this difference was significant (p < 0.05). The LA ratio was 1.3 ± 0.4 in normal MCAs and 2.1 ± 1.4 in MCAs with aneurysms; these values were also significantly different (p < 0.01). Normal cerebral artery bifurcations show close to symmetric structure in the M2 branches and the lateral angles, whereas aneurysmal MCAs do not show this symmetry. © 2013 Springer-Verlag Berlin Heidelberg.


Miyoshi H.,Higashihiroshima Medical Center | Miyoshi H.,Hiroshima University | Yamaoka K.,Hiroshima International University | Urabe S.,Hiroshima Prefectural Hospital | Kudo Y.,Hiroshima University
Reproductive Sciences | Year: 2012

Objective: The functional significance of purinergic P2 receptors in the myometrium is unclear. We previously reported the ATP-induced ionic currents in rat myometrial cells, causing uterine contractility. The aim of this study is to determine the main P2X receptors that carry the adenosine triphosphate (ATP)-induced currents. Study Design: We cloned predominantly expressed P2X7 receptors from rat myometrium and transfected into cultured COS-7 cells. Reconstructed P2X7 receptor currents were characterized using the whole-cell patch clamp method. Results: Extracellular ATP induced currents through P2X7 receptors with effective concentration (EC50) of 155 μmol/L, without desensitization. The myometrial P2X7 receptor was permeable to multiple monovalent cations with conductances ranked as K+>Cs+>Li+>Na+. It was activated by P2X receptor agonists, with effectiveness ranked as 20,30-O-(4-benzoylbenzoyl)-ATP (Bz-ATP)>>ATP>ab-methylene ATP (ab-MeATP)>2-methylthio ATP (2-MeSATP)>uridine triphosphate (UTP)>guanosine triphosphate (GTP)>adenosine diphosphate (ADP). These currents were blocked by selective P2X7 receptor antagonists and extracellular Mg2+. Conclusion: P2X7 receptors carry ATPinduced currents in rat myometrial cells. © 2012 The Author(s).


PubMed | Kindai University, Higashihiroshima Medical Center and Aurora University
Type: Journal Article | Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer | Year: 2016

EGFR gene somatic mutation is reportedly homogeneous. However, there are few data regarding theheterogeneity of expression of mutant EGFR protein and EGFR gene copy number, especially in extrathoracic lesions. These types of data may enhance our understanding of the biology of EGFR-mutated lung cancer andour understanding of the heterogeneous response patterns to EGFR TKIs.An 81-year-old never-smoking female with lung adenocarcinoma could not receive any systemic therapy because of her poor performance status. After her death, 15 tumor specimens from different sites were obtained byautopsy. Expression of mutant EGFR protein and EGFRgene copy numbers were assessed by immunohistochemical analysis and by silver in situ hybridization, respectively. Heterogeneity in these EGFR aberrations wascompared between metastatic sites (distant versus lymph node) or histological structures (micropapillary versus nonmicropapillary).All lesions showed positive staining for mutant EGFR protein, except for 40% of the papillary component in one of the pulmonary metastases (weak staining belowthe 1+ threshold). Expression of mutant-specific EGFR protein, evaluated by H-score, was significantly higher in the micropapillary components than in the nonmicropapillary components (Mann-Whitney U test, p=0.014). EGFR gene copy number was quite different between lesions but not correlated with histological structure or metastatic form. However, EGFR gene copy numbers were similar between histological structures in each lesion.These data indicate that expression of EGFR mutant protein and EGFR gene copy number do not change as a consequence of tumor progression. This also justifies using the biopsy specimens from metastases as a surrogate for primary tumors.


PubMed | Hiroshima University and Higashihiroshima Medical Center
Type: | Journal: Surgical neurology international | Year: 2016

As an extremely rare subtype of sarcoidosis that develops exclusively in the nervous system, isolated neurosarcoidosis is difficult to diagnose. In addition, its exact clinical features are not known.A 61-year-old man presented with right ear hearing loss, diplopia, and fever. Computed tomography (CT) and magnetic resonance imaging revealed mass lesions in the right cerebellum and left side body of the lateral ventricle. Neither systemic CT nor positron emission tomography revealed extracranial lesions. A neuroendoscopic biopsy was performed on the lateral ventricle lesion, and a histopathology analysis revealed epithelioid granulomatous inflammation. By systematic exclusion of other possible granulomatous diseases, isolated neurosarcoidosis was diagnosed. The lesions disappeared immediately upon corticosteroid (methylprednisolone) treatment and had not recurred as of a 12-month follow-up examination.Isolated neurosarcoidosis is difficult to diagnose. Successful diagnosis requires compatible clinical findings, histological demonstration of noncaseating granulomas, and exclusion of other granulomatous diseases. Isolated neurosarcoidosis has a relatively good clinical prognosis, which could be characteristic of the disease.

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