Hiratsuka Kyosai Hospital

Hiratsuka, Japan

Hiratsuka Kyosai Hospital

Hiratsuka, Japan
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Inoue Y.,Hiratsuka Kyosai Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

Reversed halo sign (RHS) is often seen in computed tomography (CT) scans of cryptogenic organizing pneumonia (COP). To investigate its clinical features, we retrospectively reviewed 30 cases of COP in 13 men and 17 women, whose age range 28 to 73, with a mean of 58.4 years. All diagnoses were made with transbronchial lung biopsy (TBLB), but it took an average of 24.8 days from the first visit until the diagnosis of COP. RHS was seen in 7 cases (23%) and multiple RHSs were seen in 3 cases. We treated 5 cases (71%) with steroids. Their CT images showed parenchymal abnormalities which started as nodular lesions, then enlarged, and then the central lesion changed into ground-glass opacities, until finally, RHS was formed. The presence of RHS does not necessarily indicate a marked difference in the clinical course of COP. In conclusion, in the present series RHS was a phase of the clinical course of COP, and was useful to diagnose COP.

Ogawa A.,National Hospital Organization Okayama Medical Center | Yamadori I.,National Hospital Organization Okayama Medical Center | Matsubara O.,Hiratsuka Kyosai Hospital | Matsubara H.,National Hospital Organization Okayama Medical Center
Internal Medicine | Year: 2013

Pulmonary tumor thrombotic microangiopathy is a lethal, yet difficult to diagnose, complication of gastrointestinal carcinoma. Even if properly diagnosed, there is no treatment, especially after a circulatory collapse. We herein report a case of pulmonary tumor thrombotic microangiopathy with circulatory failure due to pulmonary hypertension. The patient was temporarily successfully treated with imatinib, an inhibitor of the platelet-derived growth factor receptor. Pulmonary hypertension was dramatically ameliorated and the patient was able to be weaned from percutaneous cardiopulmonary support within 20 days of treatment. Imatinib may be effective for ameliorating pulmonary hypertension that is caused by pulmonary tumor thrombotic microangiopathy. © 2013 The Japanese Society of Internal Medicine.

Johkura K.,Hiratsuka Kyosai Hospital
Neuro-Ophthalmology Japan | Year: 2012

Vertical eye deviation in hypoxic coma is considered rare. Nevertheless, in a consecutive series of 50 post-resuscitation comatose patients, we found that 28 (56.0%) developed tonic upward or downward eye deviation. We suggest that both the upward and ownward deviations resulted from diffuse cerebro-cerebellar damage sparing the brainstem. Upward deviation is an early sign, whereas downward deviation appears later, and generally implies a transition to the vegetative state.

Choe H.,Yokohama City University | Sakano H.,Hiratsuka Kyosai Hospital | Takigami H.,Hiratsuka Kyosai Hospital | Inaba Y.,Hiratsuka Kyosai Hospital | And 2 more authors.
Journal of Hand Surgery | Year: 2013

Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered. © 2013 American Society for Surgery of the Hand.

Johkura K.,Hiratsuka Kyosai Hospital
Brain and Nerve | Year: 2013

Vertigo or dizziness is primarily caused by peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) and vestibular neuritis. BPPV can be diagnosed from associated positional torsional or direction-changing horizontal nystagmus and can be treated with canalith repositioning procedures. In contrast, vestibular neuritis and other acute peripheral vestibulopathies can be diagnosed from associated unidirectional horizontal nystagmus. Evaluation of nystagmus is essential for the diagnosis of peripheral vestibular disorders. Vertigo/dizziness caused by disorders in the brainstem or upper cerebellum is usually associated with other neurological signs or symptoms, such as motor palsy, sensory deficit, dysarthria, ocular motor palsy, and limb ataxia. In contrast, vertigo/dizziness caused by disorders in the lower cerebellum is not associated with these signs or symptoms; however, truncal ataxia becomes apparent in a standing position. Small lesions in the lower cerebellum can rarely cause unidirectional horizontal nystagmus directed toward the side of the lesions or direction-changing apogeotropic positional nystagmus; both types of nystagmus are enhanced when a patient lies on the non-affected side. This positional enhancement suggests that the same pathogenetic mechanism is involved in both types of nystagmus. The cerebellar lesions may disinhibit both semicircular-ocular and otolith-ocular reflexes. Semicircular-ocular reflex-dominant disinhibitions may result in the ipsilateral horizontal nystagmus, whereas otolith-ocular reflex-dominant disinhibitions may result in the direction-changing apogeotropic positional nystagmus.

Kurata K.,Hiratsuka Kyosai Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 69-year-old man complained of fever in September 2009, after returning from Vietnam where he has been working for 20 years. He had diabetes mellitus and was on diabetic oral medication. He was examined at a nearby hospital, and found out to have pneumonia with cavity formation in the right upper lobe which was found out to be not due to tuberculosis. Although the patient once recovered with antibacterial medicine, after a few months, in January 2010, he was admitted to our hospital because of recurrent fever. Computed tomography revealed multiple pulmonary nodules which were thought to be pulmonary emboli, as well as subcutaneous abscess, spleen abscess, and kidney abscess. Blood test showed that he also had DIC. As Burkholderia pseudomallei was cultured from the subcutaneous abscess and blood, was diagnosed as melioidosis. The patient was treated with meropenem for 8 weeks, and then a maintenance oral antibacterial medicine was continued for the next 6 months. The patient fully recovered after those treatments and has not relapsed since then. This is the ninth case report of melioidosis in Japan which is an imported infectious disease.

Johkura K.,Hiratsuka Kyosai Hospital | Nakae Y.,Hiratsuka Kyosai Hospital | Kudo Y.,Yokohama City University | Yoshida T.N.,Yokohama City University | Kuroiwa Y.,Yokohama City University
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: The relationship between the MR imaging features and clinical outcomes in patients with hypoglycemic encephalopathy has always been evaluated retrospectively. The aim of this study was to prospectively evaluate whether MR imaging features of patients presenting with hypoglycemic coma are predictive of short-term (1-week) outcomes. MATERIALS AND METHODS: Subjects were 36 consecutive patients with hypoglycemia who were in a comatose state on arrival at our hospital from April 2006 to March 2010. MR imaging findings on arrival in relation to the patients' clinical course after glucose infusion were evaluated. RESULTS: Thirteen of the 36 patients showed no MR imaging abnormalities on arrival. DWI revealed focal lesions involving the internal capsule in 13 patients and lesions involving bilateral hemispheric white matter in 10 patients. After glucose administration, the patients without lesions and patients with focal internal capsule lesions recovered completely within 1 day. However, patients with diffuse white matter lesions did not recover even within 1 week despite glucose administration. There was no statistical difference in the initial blood glucose levels among patients with the various types of MR imaging findings. CONCLUSIONS: On early MR imaging, hypoglycemic brain injury may first appear in the internal capsule and then spread into the hemispheric white matter. The absence of a lesion or the presence of a focal internal capsule lesion may suggest a good outcome. However, diffuse hemispheric white matter lesions may indicate a poor 1-week outcome.

Shimizu K.,Hiratsuka Kyosai Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 60-year-old woman was given a diagnosis of Churg-Strauss syndrome (CSS) in 2000 because of peripheral blood eosinophilia, eosinophilic pneumonia, asthma, polyarticular pain, and limb numbness. She was treated with prednisolone (PSL), and the above symptoms improved but then relapsed on tapering of PSL. In September 2009, after 7 days of tapering of PSL to 5mg/day, the patient developed a subarachnoid hemorrhage and was admitted. MRA and cerebral angiography revealed no aneurysm; the source of bleeding could not be determined, but her symptoms indicated a benign course. A chest X-ray 27 days after admission showed left diaphragmatic elevation, and left phrenic nerve paralysis was diagnosed by a phrenic nerve stimulation test. Peripheral blood eosinophilia had progressed gradually during the admission period, and although it is rare for subarachnoid hemorrhage and phrenic nerve paralysis to be associated with CSS, we regarded these as vasculitis symptoms related to CSS.

Fujita H.,Hiratsuka Kyosai Hospital | Matsuoka S.,Matsuoka Clinic | Awazu M.,Keio University
Pediatric Nephrology | Year: 2012

Background Prehypertension is defined as blood pressure (BP) ≥90th percentile, or ≥120/80 mmHg, but <95th per-centile for age, sex, and height. Since the definition is made by conventional BP measurements and office BP can be quite variable, we studied whether prehypertension could be differentiated by ambulatory BP monitoring from normo-tension or hypertension (HTN) in children and adolescents. Methods One hundred and fifty-eight children (84 boys and 74 girls, aged 6-17 years, median 12) were studied. According to the office BP values, they were divided into normo-tension (80), prehypertension (20), and HTN (58). Results Systolic BP index and systolic daytime ambulatory BP (ABP) were significantly higher in prehypertensive patients than in normotensives and lower than hypertensives. When daytime ABP was used to diagnose HTN, four nor-motensive (5.0%), four prehypertensive (20.0%), and 27 hypertensive (46.6%) patients had HTN. Thus, in patients with prehypertension, the prevalence of masked HTN is significantly higher than in those with normotension. On the other hand, the prevalence of daytime ambulatory HTN is significantly lower, i.e., white-coat effect is more frequent, compared with hypertensive patients. Conclusion Prehypertension lies between normotension and HTN in ABP values as well and is a good candidate for identifying masked HTN. Our data emphasize the importance of identifying prehypertension in children and adolescents. © 2011 IPNA.

Niwa A.,Hiratsuka Kyosai Hospital | Nakamura M.,Mie University | Harada N.,Compliance Assurance | Musha T.,Compliance Assurance
Circulation Journal | Year: 2012

Background: In Japan, the safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator for acute pulmonary embolism (PE) in the real world remain unclear. Methods and Results: A total of 1,254 patients with acute PE covered by the post-marketing surveillance of thrombolytic therapy using monteplase were divided into 3 groups: cardiopulmonary arrest (CPA)/collapse group (n=85); massive group, patients with unstable hemodynamics without CPA/collapse (n=217); and submassive group, patients with stable hemodynamics and right ventricular dysfunction (RVD) (n=465). In the efficacy analysis of 767 cases, the response rate to monteplase was 94.6% according to pulmonary circulation assessment and 93.3% according to clinical efficacy judged by symptoms and signs. Overall survival rates at 30 days after monteplase administration were 89.2% overall, 41.2% for the CPA/collapse group, 93.0% for the massive group, and 96.3% for the submassive group. When the safety of monteplase was analyzed in 1,241 cases, severe bleeding complications occurred in 100 patients (8.1%). Intracranial hemorrhage (ICH) occurred in 21 patients (1.7%), but no significant independent predictors were found in multivariate analysis. Conclusions: Thrombolytic therapy is highly effective in Japanese acute PE patients and offers acceptable safety, but attention is needed regarding severe bleeding complications, including ICH.

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