Hirakata, Japan
Hirakata, Japan

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Murata S.,Hirakata City Hospital | Inoue K.,Hirakata City Hospital | Aomatsu T.,Osaka Medical College | Yoden A.,Osaka Medical College | Tamai H.,Osaka Medical College
Journal of Clinical Biochemistry and Nutrition | Year: 2017

Carnitine is an essential nutrient for the mitochondrial transport of fatty acids. Carnitine deficiency causes a variety of symptoms in multiple organs. Patients with severe motor and intellectual disabilities often have carnitine deficiency. This study aimed to determine the correlation between constipation and carnitine deficiency in them. Patients with severe motor and intellectual disabilities at our hospital were retrospectively reviewed. The correlation between level of free carnitine and severity of constipation was examined. Constipation and non-constipation groups were compared for age; sex; body mass index; bed rest period; use of anti-epileptic drugs, valproate sodium, or enteral nutrition; and serum levels of albumin, pre-albumin, totalcholesterol, free carnitine, folic acid, and trace elements. Moreover, severity of constipation before and after carnitine supplementation was assessed. Twenty-seven patients were enrolled. Of these, 14 were assigned to the constipation group and 13 to the non-constipation group. The free carnitine level was significantly correlated with severity of constipation (R = 0.7604, p<0.01). Free carnitine was significantly lower in the constipation compared with the non-constipation group (p<0.01). No other significant differences between the groups were found. The severity of constipation was significantly relieved after carnitine supplementation (p<0.001). In conclusion, carnitine supplementation could reduce the severity of constipation. © 2017 JCBN.


PubMed | Hirakata City Hospital and Osaka Medical College
Type: Journal Article | Journal: Brain & development | Year: 2016

The goals of this study, conducted in our secondary emergency care hospital, were to assess the effectiveness of targeted temperature management (TTM) for acute encephalopathy secondary to status epilepticus and to consider appropriate adaptations for use of TTM in this setting.Medical records of patients admitted with acute encephalopathy to Hirakata City Hospital between January 2010 and December 2014 were retrospectively reviewed. Cases treated with TTM (36 C) and methylprednisolone pulse (MP) therapy (TTM/MP) were compared with those treated with conventional MP regarding clinical courses and outcomes.In total, 20 children were retrospectively enrolled. In the TTM/MP group (10 cases) all survived intact. In the MP group (10 cases), 4 cases were left with neurological sequelae. Furthermore, in the TTM/MP group, the body temperature dropped more quickly. For pediatricians in this secondary emergency hospital, implementing the body temperature management system was not difficult. There were no complications caused by hypothermia.Use of TTM as the initial treatment for acute encephalopathy in the early-onset stage is possible in a secondary emergency care hospital. However, some acute encephalopathy cases are the so-called fulminant type; DIC or shock develops soon after onset and so it is sometimes difficult to introduce TTM. Fulminant-type patients should be transported to tertiary emergency care hospitals. Secondary emergency care hospitals must carefully select cases for TTM, keeping the possibility of transport to a tertiary emergency hospital in mind at all times.


Shimojima K.,Tokyo Women's Medical University | Mano T.,Research Institute for Maternal and Child Health | Kashiwagi M.,Hirakata City Hospital | Tanabe T.,Tanabe Kadobayashi Childrens Clinic | And 4 more authors.
European Journal of Medical Genetics | Year: 2012

Pelizaeus-Merzbacher disease (PMD; MIM#312080) is a rare X-linked leukodystrophy presenting with motor developmental delay associated with spasticity and nystagmus. PMD is mainly caused by abnormalities in the proteolipid protein 1 gene (PLP1), most frequently due to duplications of chromosomal segments including PLP1. In this study, a 9-year-old male patient manifesting severe developmental delay and spasticity was analyzed for PLP1 alteration, and triplication of PLP1 was identified. Further examination revealed an underlying genomic organization, duplication-inverted triplication-duplication (DUP-TRP/INV-DUP), in which a triplicated segment was nested between 2 junctions. One of the 2 junctions was caused by inverted homologous regions, and the other was caused by non-homologous end-joining. PMD patients with PLP1 duplications usually show milder-classical forms of the disease compared with patients with PLP1 missense mutations manifesting severe connatal forms. The present patient showed severe phenotypic features that represent an intermediate form of PMD between classical and connatal forms. This is the first report of a patient with PLP1 triplication caused by a DUP-TRP/INV-DUP structure. This study adds additional evidence about the consequences of PLP1 triplication. © 2012 Elsevier Masson SAS.


Koh M.,Hirakata City Hospital | Shinohara J.,Hirakata City Hospital | Hongo Y.,Hirakata City Hospital | Okazaki T.,Hirakata City Hospital | And 2 more authors.
Hepatology Research | Year: 2013

We herein report a case of a pregnant Chinese woman who suffered an acute exacerbation of hepatitis B. The patient's liver enzymes became elevated toward the end of the first trimester. She was treated with lamivudine, interferon (IFN)-β and steroids early in the second trimester. After this treatment regimen was initiated, aminotransferase levels rapidly normalized within 4weeks. IFN-β and steroids were administrated for 2weeks in the second trimester, while the administration of lamivudine continued until delivery. The spontaneous delivery of a female baby weighing 2984g occurred at 37weeks of gestation. A neonatal examination revealed no congenital anomalies, and fetal growth was found to be within normal reference ranges. The infant received simultaneous active and passive hepatitis B virus immunization within 12h of delivery and completed the hepatitis B vaccine schedule at 2, 3 and 5months of age. The infant was successfully prevented from contracting hepatitis B virus. This case suggests that combination therapy with lamivudine, IFN-β and steroids may be safely used during the second trimester to treat acute exacerbations of hepatitis B. © 2013 The Japan Society of Hepatology.


Tanabe T.,Hirakata City Hospital | Hara K.,Hirakata City Hospital | Nakajima M.,Hirakata City Hospital | Shimakawa S.,Osaka Medical College | Tamai H.,Osaka Medical College
Brain and Development | Year: 2010

We investigated the clinical courses of children with influenza infection, who showed abnormal behavior, who were treated with oseltamivir (Tamiflu ®). Subjects: The subjects were 22 children, 2-15 (mean±SD, 6.6±3.2) years old, admitted to our hospital during the 2004-2005, 2005-2006, and 2006-2007 influenza seasons. Abnormal behavior appeared before treatment with oseltamivir in 13 children (pre-Tami group), and after administration of the medication in 9 (post-Tami group). All patients continued to receive oseltamivir for 3-5 days after admission. Results: Meaningless speech and movements without a specific purpose were the most frequent abnormal behavior (16 children), while illusions, delusions, and misidentifying awareness were the second most common (14 children). Sensations of marked fear and excitement were recognized in 6 children. One child rushed up and down the stairs unconsciously, raising concern that a serious accident might occur. All patients showed a favorable clinical course, without worsening of neurological symptoms or the development of encephalopathy, and outcomes were good. The clinical course, number of recurrences of abnormal behavior, and outcome were similar in the pre-Tami and post-Tami groups. Conclusions: Our observations suggest that oseltamivir is not a prerequisite for the development of abnormal behavior and does not worsen the clinical manifestations of abnormal behaviors, although further investigations are needed to determine whether oseltamivir is necessary, or even useful, for patients with influenza virus encephalopathy. © 2009 Elsevier B.V.


Tanabe T.,Hirakata City Hospital | Hara K.,Hirakata City Hospital | Shimakawa S.,Osaka Medical College | Fukui M.,Osaka Medical College | Tamai H.,Osaka Medical College
Epilepsia | Year: 2011

The factors that contribute to hippocampal damage as a sequela, and its frequency, in patients experiencing febrile status epilepticus, remain unknown. Of the 472 patients with febrile seizures admitted to our hospital between February 2004 and August 2008, 77 had prolonged seizures. Among them, 59 underwent magnetic resonance imaging (MRI). A 21-month-old girl showed hippocampal changes after her first episode of febrile status epilepticus. The seizure lasted about 35 min, with eye deviation to the right and ictal rhythmic discharges in the left hemisphere. MRI at 72 h after the seizure revealed high-signal intensities in T2 and fluid-attenuated inversion recovery (FLAIR) images of the left hippocampus. Left hippocampal volume diminished over the next several months suggesting the occurrence of neuronal cell death. In no other cases, not even those with longer seizure durations, did significant hippocampal changes develop. The frequency of hippocampal damage was 1.7% in this case series. The involvement of factors other than seizure duration merits further study. © Wiley Periodicals, Inc. 2011 International League Against Epilepsy.


Ishiro M.,Osaka Medical College | Takaya R.,Osaka Medical College | Mori Y.,Saiseikai Suita Hospital | Takitani K.,Osaka Medical College | And 4 more authors.
Annals of Nutrition and Metabolism | Year: 2013

Background: Hyperuricemia in adults is known to be associated with hypertension, the metabolic syndrome and cardiovascular disease. The purpose of this study was to elucidate the factors associated with hyperuricemia in obese children and early adolescents and to investigate the threshold serum level of uric acid (UA) for the metabolic syndrome in children. Methods: We assessed anthropometric measurements, blood pressure, body composition and biochemical data in 1,559 obese children. To assess endothelial dysfunction, flow-mediated dilatation (FMD) was measured in 92 children. The correlations between serum UA levels and various parameters were examined. The threshold serum UA level for the metabolic syndrome was calculated by receiver-operating characteristic (ROC) curve analysis. Results: Serum UA levels were positively correlated with lipids in both boys and girls, and they were inversely correlated with FMD in the boys but not the girls. The threshold serum UA level for the metabolic syndrome was 5.25 mg/dl in boys and 5.05 mg/dl in girls. However, the specificity and sensitivity of ROC curve analysis are not so striking. Conclusion: The correlation between UA and FMD showed gender differences and might be affected by the hormonal status. The cutoff level of serum UA as a marker of the metabolic syndrome in obese children was affected by both age and gender. Copyright © 2013 S. Karger AG, Basel.


Komura K.,Osaka Medical College | Inamoto T.,Osaka Medical College | Black P.C.,University of British Columbia | Koyama K.,Osaka Medical College | And 3 more authors.
Nutrition and Cancer | Year: 2011

We investigated the prognostic value of BMI (body mass index) in Asian patients with RCC (renal cell carcinoma). We evaluated 170 Asian patients who underwent surgery for localized RCC (pathologic T1-4 tumors in the absence of nodal or distant metastases) between 1996 and 2004 at our institution. Patients were stratified by BMI: 22 or less vs. greater than 22. Overall, CSS (cancer-specific survival) and RFS (recurrence-free survival) was estimated using the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. The mean age and BMI of all patients was 62.4 ± 11.4 yr and 23.1 ± 3.2 kg/m 2, respectively. Patients' population consisted of 114 (67.1%) men and 56 (32.9%) women. The median follow-up was 50 mo. The BMI was less than 22 in 83 (49%) patients and greater than 22 in 87 (51%). There was a trend toward worse Eastern Cooperative Oncology Group (ECOG) performance status, less likely to have an incidentaloma, higher pathological stage, and more frequent microvascular invasion with lower BMI. Only the correlations between BMI and ECOG performance status (P = 0.003) and pathological stage (P = 0.015) were statistically significant. Of other relevant factors including gender, mode of presentation, ECOG performance status, C-reactive protein, histological type, Fuhrman nuclear grade, microvascular invasion, pathological stage, and adjuvant cytokine therapy, smaller BMI remained an independent predictor for worse CSS (44.5 mo vs. 56.0 mo, P = 0.041, HR = 10.99) and RFS (43.0 mo vs. 55.0 mo, P = 0.03, HR = 2.653), but not for OS (overall survival) (46.0 mo vs. 55.5 mo, P = 0.13, HR = 2.217) on multivariate analysis. Our findings identify increasing BMI in the Asian population as an independent predictor for favorable CSS and RFS in patients with RCC treated by surgery. Further studies, including a multiinstitutional, prospective Asian cohort, are required to confirm these findings. Copyright © 2011, Taylor & Francis Group, LLC.


Inamoto T.,Osaka Medical College | Komura K.,Osaka Medical College | Watsuji T.,Hirakata City Hospital | Azuma H.,Osaka Medical College
International Journal of Clinical Oncology | Year: 2012

Purpose We studied the prognostic value of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) of the kidney and ureter. Methods We evaluated 153 patients who underwent surgery for UTUC (any T stage, N0-1, M0) between 1996 and 2009 at our institution. Of the 153 patients screened for the study, 103 patients were found to have comprehensive clinical and pathologic data available, and were included in the analysis. Patients were stratified by BMI = 22 kg/m2 or greater versus less than 22. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival was estimated using the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. Results The mean age and BMI of all patients was 68.62 ± 10.06 years and 22.97 ± 3.44 kg/m2, respectively. The patient population comprised 71 (68.9%) males and 32 (31.1%) females. The BMI was <22 in 38 (36.9%) patients and >22 in 65 (63.1%). The differences between BMI categories in gender (p = 0.013) was statistically significant, but not in other relevant parameters. The median follow-up was 29 months (interquartile range 14-63). Among other relevant descriptive preoperative characteristics, including gender, age, bladder tumor at diagnosis, tumor focality, and tumor side, smaller BMI remained an independent predictor for worse CSS (p = 0.047, HR 2.210) on multivariate analysis. Conclusions Our findings identify increasing BMI as an independent predictor for favorable OS and CSS in patients with UTUC. © 2011 CARS.


PubMed | Hirakata City Hospital
Type: Journal Article | Journal: Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2016

Iterative reconstruction techniques, such as adaptive statistical iterative reconstruction (ASiR), improve the contrast-to-noise ratio of computed tomography (CT) images; however, underlying anatomical structures may nevertheless hamper detectability of low-contrast areas in clinical situations, despite using such a technique. We therefore conducted a phantom study to investigate the efficacy of ASiR in improving the detectability of low-contrast areas in the presence of brain anatomical structures. We developed dedicated head phantoms simulating hyperacute cerebral infarction and confirmed that their CT numbers were sufficiently reproducible and that observer performance in detecting low-contrast areas using these phantoms more closely resembled that in clinical situations than that using a simple phantom. The efficacy of ASiR in improving low-contrast detectability was evaluated via receiver operating characteristics analysis. The mean area under the curve (AUC) values at ASiR blend rates of 0%, 30%, 60%, and 100% were 0.57, 0.57, 0.59, and 0.59 at 200 mA; 0.83, 0.84, 0.84, and 0.90 at 500 mA; and 0.79, 0.77, 0.76, and 0.79 at 800 mA, respectively. No significant differences were noted in AUC values among ASiR blend rates at any mA setting, suggesting that ASiR does not improve the detectability of subtle low-contrast lesions seen in hyperacute cerebral infarction in clinical situations.

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