Hyogo Brain and Heart Center at Himeji

Japan

Hyogo Brain and Heart Center at Himeji

Japan
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Ishihara M.,Hyogo Cancer Center | Ishihara M.,Kanazawa University | Onoguchi M.,Kanazawa University | Taniguchi Y.,Hyogo Brain and Heart Center at Himeji | Shibutani T.,Kanazawa University
International Journal of Cardiovascular Imaging | Year: 2017

The aim of this study was to clarify the differences in thallium-201–chloride (thallium-201) myocardial perfusion imaging (MPI) scans evaluated by conventional anger-type single-photon emission computed tomography (conventional SPECT) versus cadmium–zinc–telluride SPECT (CZT SPECT) imaging in normal databases for different ethnic groups. MPI scans from 81 consecutive Japanese patients were examined using conventional SPECT and CZT SPECT and analyzed with the pre-installed quantitative perfusion SPECT (QPS) software. We compared the summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for the two SPECT devices. For a normal MPI reference, we usually use Japanese databases for MPI created by the Japanese Society of Nuclear Medicine, which can be used with conventional SPECT but not with CZT SPECT. In this study, we used new Japanese normal databases constructed in our institution to compare conventional and CZT SPECT. Compared with conventional SPECT, CZT SPECT showed lower SSS (p < 0.001), SRS (p = 0.001), and SDS (p = 0.189) using the pre-installed SPECT database. In contrast, CZT SPECT showed no significant difference from conventional SPECT in QPS analysis using the normal databases from our institution. Myocardial perfusion analyses by CZT SPECT should be evaluated using normal databases based on the ethnic group being evaluated. © 2017 Springer Science+Business Media B.V.


Saji N.,Kawasaki Medical School | Kimura K.,Kawasaki Medical School | Kawarai T.,Hyogo Brain and Heart Center at Himeji | Shimizu H.,Hyogo Brain and Heart Center at Himeji | Kita Y.,Hyogo Brain and Heart Center at Himeji
Stroke | Year: 2012

Background and Purpose-The mechanism of progressive neurological deficit (PND) in patients with ischemic stroke remains unclear. The aim of this study was to clarify whether arterial stiffness, a marker of vascular endothelial impairment and arteriosclerosis, is associated with PND in patients with acute deep subcortical infarction. Methods-We evaluated 156 consecutive first-ever ischemic stroke patients with acute deep subcortical infarction. PND was defined as an increment of 2 points in the National Institute of Health Stroke Scale score or an increase of 1 point in the limb weakness score within 7 days of stroke onset. Patients were assessed for risk factors, and infarct size was measured on initial diffusion-weighted magnetic resonance imaging. We measured brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness. We divided patients into 2 groups according to the presence or absence of PND to compare their clinical characteristics. Results-Fifty-two patients (33%) had PND, and baPWV was significantly higher in patients with than in those without PND. The baPWV cut-off value for PND was 18.24 m/s, with 90% sensitivity and 47% specificity. In multivariable logistic regression analysis, high baPWV (18.24 m/s; odds ratio, 8.22; 95% confidence interval, 2.55-31.9), large infarct size (15 mm; odds ratio, 2.76; 95% confidence interval, 1.01-7.92), and 3 infarct slices on serial axial diffusion-weighted imaging (odds ratio, 3.38; 95% confidence interval, 1.22-10.0) were independently associated with PND. Conclusions-Arterial stiffness indicated by baPWV is independently associated with PND in patients with acute deep subcortical infarction. © 2012 American Heart Association, Inc.


Saji N.,Kawasaki Medical School | Saji N.,Hyogo Brain and Heart Center at Himeji | Kimura K.,Kawasaki Medical School | Shimizu H.,Hyogo Brain and Heart Center at Himeji | Kita Y.,Hyogo Brain and Heart Center at Himeji
Internal Medicine | Year: 2012

Objective The aim of this hospital-based cohort study was to clarify the independent association between silent brain infarct (SBI) and arterial stiffness indicated by brachial-ankle pulse wave velocity (baPWV) including the cutoff value for SBI. Methods We studied 240 consecutive patients (mean age 69 years) with no history of stroke. We assessed the presence of SBI, white matter hyperintensities (WMHs), and risk factors. Arterial stiffness was evaluated using baPWV. We measured the intima-media thickness of the common carotid artery (CCAIMT) using carotid ultrasonography. We divided patients into two groups according to the presence or absence of SBI, and compared clinical characteristics between the two groups. Results In multivariable analysis, increased baPWV [by 1 m/s; odds ratio (OR) 1.13, 95% confidence interval (CI) 1.02-1.25] was independently associated with SBI. The baPWV cutoff value for SBI was 17.49 m/s. Patients with baPWV≥17.49 m/s had a higher possibility of the presence of SBI (OR 2.30, 95% CI 1.02- 5.34) compared with patients with baPWV <17.49 m/s. Furthermore, the adjusted OR for the presence of SBI of the combination of baPWV≥17.49 m/s and CCAIMT≥1.1 mm (OR 2.73, 95% CI 1.24-6.11) was higher compared with that of baPWV≥17.49 m/s (OR 2.47, 95% CI 1.11-5.65). Conclusion Arterial stiffness is independently associated with SBI. Measurement of baPWV can indicate the presence of SBI, especially in patients with baPWV≥17.49 m/s. © 2012 The Japanese Society of Internal Medicine.


Saji N.,Kawasaki Medical School | Saji N.,Hyogo Brain and Heart Center at Himeji | Kimura K.,Kawasaki Medical School | Shimizu H.,Hyogo Brain and Heart Center at Himeji | Kita Y.,Hyogo Brain and Heart Center at Himeji
Hypertension Research | Year: 2012

It is still unclear whether silent brain infarct (SBI) and white-matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scans are associated with cardio-ankle vascular index (CAVI), a novel parameter of arterial stiffness. We studied 220 consecutive patients (mean age, 69 years) without a history of stroke or transient ischemic attack. Patients were assessed for the presence of SBI, WMHs and risk factors. Arterial stiffness was evaluated using CAVI. Patients were categorized into one of two groups according to the presence or absence of SBI and WMHs, and clinical characteristics were compared between the two groups. CAVI was significantly higher in patients with SBI or in patients with WMHs than in those without those respective findings. The CAVI cutoff values for detection of SBI and WMHs were 9.2 and 8.9, respectively. On multivariable analyses, CAVI, a one point increase in CAVI: odds ratio (OR), 1.25; 95% confidence interval (CI), 1.01-1.56; CAVI≥9.2: OR, 2.34; 95% CI, 1.16-5.02, was independently associated with SBI, however, CAVI was not independently associated with WMHs. Patients with CAVI ≥9.2 had higher OR for the presence of both SBI and WMHs (OR, 2.57; 95% CI, 1.15-5.98) when compared with patients with CAVI <9.2 after adjustment for age and sex. SBI is independently associated with arterial stiffness indicated by CAVI. © 2012 The Japanese Society of Hypertension All rights reserved.


Suzuki S.,Keio University | Baba A.,Kitasato University | Kaida K.,National Defense Medical College | Utsugisawa K.,Hanamaki General Hospital | And 6 more authors.
European Journal of Neurology | Year: 2014

Background and purpose: There is no general consensus as to whether autoimmune myasthenia gravis (MG) is associated with heart diseases, despite the fact that myocarditis, a serious cardiac involvement treatable by immunotherapy, is a complication of MG. It has been observed previously that MG patients with clinically suspected myocarditis had anti-Kv1.4 antibodies. The purpose of this study was to disclose the association between anti-Kv1.4 antibodies and cardiac involvements in MG patients. Methods: Anti-Kv1.4 antibody was detected by an immunoprecipitation assay using 35S-labeled rhabdomyosarcome cellular extract as the antigen source. Cardiac findings including electrocardiography (ECG) and clinical features of clinically suspected myocarditis in MG patients with anti-Kv1.4 antibodies were investigated. Ultrasound echocardiography (UCG) of ex vivo chick embryos was performed to determine the suppressive effects of sera with or without anti-Kv1.4 antibodies on heart muscle functions. Results: Seventy (10.8%) of 650 MG patients had anti-Kv1.4 antibodies and 60% of them had abnormal ECG findings with high frequencies of T-wave abnormality and QT prolongation. Clinically suspected myocarditis was found in eight MG patients with anti-Kv1.4 antibodies but in none of the MG patients without anti-Kv1.4 antibodies. Most patients showed rapid deterioration with lethal arrhythmias such as ventricular tachycardia, sick sinus syndrome, or complete atrial ventricular block and severe heart failure. It was concluded using UCG of ex vivo chick embryos that MG serum with anti-Kv1.4 antibodies suppressed heart muscle functions. Conclusion: It has been demonstrated that anti-Kv1.4 antibodies are possible markers for cardiac involvements in MG patients. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.


Okajima H.,Nishi Kobe Medical Center | Tanaka O.,Nishi Kobe Medical Center | Ushio M.,Kakogawa West City Hospital | Higuchi Y.,Nishi Kobe Medical Center | And 4 more authors.
Journal of Anesthesia | Year: 2015

Purpose: Both paravertebral block (PVB) and thoracic epidural block (TEB) are recommended for postoperative pain relief after lung surgery. The addition of fentanyl to the anesthetic solution became popular for TEB because of the stronger effects; however, there have been few comparable trials about the addition of fentanyl to PVB. The purpose of this study was thus to compare postoperative analgesia, side effects, and complications between ultrasound-guided PVB (USG-PVB) and TEB with the addition of fentanyl to ropivacaine after lung surgery. Methods: We examined 90 consecutive patients (age 18–75 years) scheduled for video-assisted thoracic surgery (VATS). In both groups, all blocks (four blocks in USG-PVB and one block in TEB) and one catheter insertion were performed preoperatively. Continuous postoperative infusion (0.1 % ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both groups. The recorded data included the verbal rating scale (VRS) for pain, blood pressure, side effects, complications for 2 days, and overall satisfaction score. Results: There was no difference in the frequency of taking supplemental analgesics (twice or more frequently), or in VRS. Hypotension occurred significantly more frequently in TEB (n = 7/33) than in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV and pruritus, as well as overall satisfaction score, were similar. There were no complications in both groups; however, the catheters migrated intrathoracically in four patients in PVB. Conclusion: USG-PVB achieved similar pain relief and lowered the incidence of hypotension compared with TEB. We conclude that both blocks with the same concentration of ropivacaine and fentanyl can provide adequate postoperative analgesia for VATS. © 2014, Japanese Society of Anesthesiologists.


Kawasaki R.,Hyogo Brain and Heart Center at Himeji | Sugimoto K.,Kobe University | Fujii M.,Kobe University | Miyamoto N.,Hyogo Brain and Heart Center at Himeji | And 3 more authors.
American Journal of Roentgenology | Year: 2013

OBJECTIVE. The purpose of this study was to assess the therapeutic effect of lymphangiography for refractory postoperative chylothorax and chylous ascites and analyze the relation between the clinical outcomes and radiologic findings or response to the preceding medical treatment. MATERIALS AND METHODS. Between January 2004 and June 2012, 14 patients underwent lymphangiography. All patients had been unresponsive to at least two medical treatments for 3-62 days (median, 13.5 days) before lymphangiography. Leaks were classified as major, minor, and undetectable on the basis of radiologic findings including CT and conventional radiography after lymphangiography. The clinical outcomes were correlated with the radiologic findings or the changes of the daily chylous output after the preceding medical treatments. RESULTS. The leaks were healed in nine of 14 patients (64.3%) by 3-29 days (median, 8 days) after lymphangiography. Healing was achieved for two of seven major leaks, and all of the minor leaks (n = 4) and undetectable leaks (n = 3) after lymphangiography. The remaining five major leaks were not healed after a median follow-up of 15 days. The daily output decreased more than half after medical treatment in seven of the 14 patients, and the leak was healed in six of these patients (85.7%) by 5-18 days (median, 10 days). CONCLUSION. Lymphangiography might be useful for the treatment of refractory postoperative chylothorax and chylous ascites. © American Roentgen Ray Society.


Kawasaki R.,Hyogo Brain and Heart Center at Himeji | Miyamoto N.,Hyogo Brain and Heart Center at Himeji | Oki H.,Hyogo Brain and Heart Center at Himeji | Yamaguchi M.,Kobe University | And 3 more authors.
Journal of Vascular and Interventional Radiology | Year: 2014

Seven patients with superior mesenteric artery embolism were treated by aspiration with the use of a 6-F angled guiding sheath and a 6-F guiding catheter through an 8-F short sheath by direct advancement using a telescopic and "biting-off" technique. Aspiration of the trunk took between 30 and 60 minutes (median, 44.0 min), and total procedure time ranged from 34 to 94 minutes (median, 60 min). Five of six trunk lesions and six of nine branch lesions were successfully aspirated. One dissection was observed. Six patients underwent bowel resection. Two patients died and the remaining five survived for a median of 868.2 days without complications. © 2014 SIR.


Saji N.,Hyogo Brain and Heart Center at Himeji | Saji N.,Kobe University | Shimizu H.,Hyogo Brain and Heart Center at Himeji | Shimizu H.,Kobe University | And 4 more authors.
Neuroepidemiology | Year: 2011

Background: White matter hyperintensities (WMHs) are a risk factor for stroke. Their etiology is considered to be cerebral microvascular abnormality. However, the association between WMHs and arteriosclerosis is not yet clear. The aim of this hospital-based cohort study was to identify the arteriosclerotic characteristics associated with WMHs. Methods: We cross-sectionally included 240 consecutive patients with no history of stroke. We measured the brachial-ankle pulse wave velocity (baPWV), ankle brachial pressure index, and intima-media thickness of the common carotid artery, and we performed magnetic resonance brain imaging. WMHs were defined as periventricular hyperintensity (Fazekas grade ≥3) and/or separate deep white matter hyperintense signals (Fazekas grade ≥2). We determined the prevalence of WMHs, silent brain infarction (SBI), hypertension, hypercholesterolemia, diabetes mellitus, ischemic heart disease, and smoking. We compared 2 groups of patients, defined by the presence or absence of WMHs, using multiple logistic regression analyses. Results: In multivariable analysis, SBI (OR 3.38; 95% CI 1.52-7.72), hypertension (OR 2.23; 95% CI 1.03-5.15), female sex (OR 1.95; 95% CI 1.03-3.76), baPWV (OR 1.12; 95% CI 1.02-1.23), and age (OR 1.09; 95% CI 1.04-1.14) were independently associated with WMHs. Conclusions: An increased baPWV is associated with WMHs. Management of increased baPWV may help to prevent the progression of WMHs and stroke. © 2011 S. Karger AG, Basel.


Miyahara S.,Hyogo Brain and Heart Center at Himeji | Mukohara N.,Hyogo Brain and Heart Center at Himeji | Fukuzumi M.,Hyogo Brain and Heart Center at Himeji | Morimoto N.,Hyogo Brain and Heart Center at Himeji | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objective: Patients with Stanford type B dissection treated medically during the acute phase have a risk of surgery and aortic rupture during the chronic phase. We investigated the predictors for late aortic events by focusing on the false lumen status with computed tomography. Methods: A total of 160 patients were enrolled in the study, with a mean follow-up interval of 44.6 ± 25.4 months. Patients were divided into 3 groups according to the false lumen status at the time of onset: group T, thrombosed in 49 patients (30.6%); group U, thrombosed with ulcer-like projections in 52 patients (32.5%); and group P, patent in 59 patients (36.9%). Results: The mean aortic enlargement rate of groups U and P was greater than that of group T (0.40 ± 0.91 mm/month in group U, 0.44 ± 0.49 mm/month in group P, and -0.016 ± 0.23 mm/month in group T). The event-free rate in groups U and P was lower than in group T: 5-year event-free rates of 67.4% ± 8.2% in group U and 57.7% ± 10.9% in group P versus 95.0% ± 4.9% in group T (group T vs group U: P = .0011, group U vs group P: P = .96, group P vs group T: P = .0004). Cox regression analysis revealed that the false lumen status (patent or ulcer-like projections) (P = .029), maximum aortic diameter at onset (P < .0001), and patient age (P =.0069) were predictors of the late aortic events. Conclusions: In type B aortic dissection, a thrombosed false lumen with ulcer-like projections and a patent false lumen had an influence on late aortic dilation and late aortic events. Copyright © 2011 by The American Association for Thoracic Surgery.

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