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Hasebe H.,Shizuoka Saiseikai General Hospital | Yoshida K.,Ibaraki Prefectural Central Hospital | Yoshida K.,University of Tsukuba | Iida M.,Shizuoka Saiseikai General Hospital | And 3 more authors.
Heart Rhythm | Year: 2016

Background A left-to-right dominant frequency (DF) gradient commonly exists in paroxysmal atrial fibrillation (AF). AF initiated by right atrial (RA) ectopy (AF-RAE) is rare. Objective This study aimed to investigate characteristics of AF-RAE using pharmacological maneuvers and spectral analysis. Methods Seventy-nine consecutive patients referred for catheter ablation of paroxysmal AF were enrolled. Infusions of isoproterenol and adenosine triphosphate (ATP) were used to induce AF. Patients with AF-RAE and patients with AF initiated only by pulmonary vein (PV) ectopies were classified into the RA-ectopy group (n = 7[9%]) and PV-ectopy group (n = 32[41%]), respectively. ATP was also injected during ongoing AF to unmask the driver of AF. High RA, coronary sinus, and PV-left atrial junction electrograms and electrocardiogram lead V1 underwent spectral analyses. Results Patients in the RA-ectopy group were younger (51 ± 13 years vs 63 ± 7 years; P =.01) and more commonly had a family history of AF (71% vs 9%; P <.001) than patients in the PV-ectopy group. There was a baseline right-to-left DF gradient in the RA-ectopy group (PV-left atrial junction: 6.0 ± 0.4 Hz; coronary sinus: 5.7 ± 0.6 Hz; RA: 7.3 ± 0.8 Hz; P <.05) in contrast to a left-to-right DF gradient in the PV-ectopy group (5.9 ± 0.8, 5.3 ± 0.7, 5.2 ± 0.8 Hz; P <.01). ATP injection predominantly increased the DF of the high RA in the RA-ectopy group and augmented a right-to-left DF gradient (7.9 ± 1.8, 7.6 ± 1.0, 10.7 ± 0.7 Hz; P <.001), whereas it augmented a left-to-right DF gradient in the PV-ectopy group (7.9 ± 1.0, 6.4 ± 0.5, 6.6 ± 1.2 Hz; P <.05). Conclusion A rare type of paroxysmal AF initiated by RA ectopy may be maintained by a reentrant driver localized in the RA (so-called RA fibrillation). © 2016 Heart Rhythm Society.


Shigematsu T.,Wakayama Medical University | Tokumoto A.,Kamifukubara Clinic | Nakaoka A.,San in Rosai General Hospital | Arisaka H.,Ibaraki Prefectural Central Hospital
Therapeutic Apheresis and Dialysis | Year: 2011

Lanthanum carbonate (LC), a newly developed non-calcium-containing phosphate binder, has been shown to possess high phosphate-binding capacity and safety when used for hyperphosphatemia in patients with chronic kidney disease undergoing dialysis. The effects of LC on bone metabolism in Japanese dialysis patients have not been investigated; therefore, we performed histomorphometric analysis on bone from dialysis patients with hyperphosphatemia. This was a prospective, open-label study in Japanese chronic kidney disease patients on dialysis, with a flexible daily dosage of 750-4500mg to achieve target phosphorus levels of 3.5-5.5mg/dL (1.10-1.78mmol/L). Bone biopsy samples for histomorphometric analysis were obtained at baseline and after treatment with LC. The median bone lanthanum level increased during the LC treatment from 54.1μg/kg at baseline to 4270.9μg/kg at three years. After one year of treatment with LC, two cases with an initial classification of osteitis fibrosa improved toward normal bone turnover. The diagnosis of normal remained the same for up to three years. We also noted that two cases with a baseline classification of adynamic bone disease improved after one year, and was maintained for three years. Our data suggest that LC is effective not only for treating hyperphosphatemia, but also for improving renal osteodystrophy in Japanese dialysis patients. © 2010 The Authors. Journal compilation © 2010 International Society for Apheresis.


Abe D.,Ibaraki Prefectural Central Hospital | Sato A.,University of Tsukuba | Hoshi T.,University of Tsukuba | Kakefuda Y.,Tsukuba Medical Center Hospital | And 6 more authors.
Circulation Journal | Year: 2014

Background: To evaluate the incidence and clinical predictors of contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI), unstable angina pectoris/non-STEMI (UAP/ NSTEMI), and stable AP (SAP) undergoing percutaneous coronary intervention (PCI). Methods and Results: We enrolled 1,954 patients (SAP, n=1,222; UAP/NSTEMI, n=277; STEMI, n=455) who underwent PCI. Patients were categorized according to contrast media volume/estimated glomerular filtration rate ratio (CV/eGFR low: <2.0, mid: 2.0-2.9, high: ≥3.0). CI-AKI was defined as an increase in serum creatinine of 0.5 mg/dl or 25% within 1 week from contrast-medium injection. The incidence of CI-AKI was highest among the STEMI patients (SAP, 4.24%; UAP/NSTEMI, 10.7%; STEMI, 16.1%, P<0.01). Significant predictors of CI-AKI were emergency PCI (odds ratio [OR] 3.70; 95% confidence interval [CI] 2.55-5.37; P<0.001), ejection fraction <40% (OR 2.04; 95% CI 1.24-3.36; P=0.005), and hemoglobin <10 g/dl (OR 0.02; 95% CI 1.17-4.55; P=0.02) after multivariate logistic regression analysis. In the SAP group, a CV/eGFR ratio ≥3.0 was a significant predictor of CI-AKI (P=0.048), but not in UAP/NSTEMI and STEMI patients. Conclusions: UAP/NSTEMI and STEMI patients undergoing emergency PCI were at high risk for CI-AKI regardless of CV/eGFR ratio. Minimizing the dose of contrast medium based on eGFR might be valuable in reducing the risk of CI-AKI in SAP patients.


Naruse Y.,University of Tsukuba | Sato A.,University of Tsukuba | Hoshi T.,University of Tsukuba | Takeyasu N.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Cardiovascular Interventions | Year: 2013

Background-Triple antithrombotic therapy increases the risk of bleeding events in patients undergoing percutaneous coronary intervention. However, it remains unclear whether good control of percent time in therapeutic range is associated with reduced occurrence of bleeding complications in patients undergoing triple antithrombotic therapy. Methods and Results-This study included 2648 patients (70±11 years; 2037 men) who underwent percutaneous coronary intervention with stent in the Ibaraki Cardiovascular Assessment Study registry and received dual antiplatelet therapy with or without warfarin. Clinical end points were defined as the occurrence of major bleeding complications (MBC), major adverse cardiac and cerebrovascular event, and all-cause death. Among these 2648 patients, 182 (7%) patients received warfarin. After a median follow-up period of 25 months (interquartile range, 15-35 months), MBC had occurred in 48 (2%) patients, major adverse cardiac and cerebrovascular event in 484 (18%) patients, and all-cause death in 206 (8%) patients. Multivariable Cox regression analysis revealed that triple antithrombotic therapy was the independent predictor for the occurrence of MBC (hazard ratio, 7.25; 95% confidence interval, 3.05-17.21; P<0.001). The time in therapeutic range value did not differ between the patients with and without MBC occurrence (83% [interquartile range, 50%-90%] versus 75% [interquartile range, 58%-87%]; P=0.7). However, the mean international normalized ratio of prothrombin time at the time of MBC occurrence was 3.3±2.1. Triple antithrombotic therapy did not have a predictive value for the occurrence of all-cause death (P=0.1) and stroke (P=0.2). Conclusions-Triple antithrombotic therapy predisposes patients to an increased risk of MBC regardless of the time in therapeutic range. © 2013 American Heart Association, Inc.


Nagai K.,Ibaraki Prefectural Central Hospital | Aadachi K.,University of Tsukuba | Saito H.,Ibaraki Prefectural Central Hospital
International Journal of Clinical Oncology | Year: 2010

We present the case of a huge pedunculated benign mesenchymal myxoid tumor that developed on the right labia majora of a 48-year-old-woman. The excised mass weighed 4534 g and was 23 cm in diameter; the cut surface was yellowish and elastic. Microscopic examination revealed spindle and plump oval tumor cells arranged with abundant capillary vessels in an edematous stroma. Immunohistochemical staining showed that the tumor cells were positive for vimentin, desmin, estrogen receptor, and progesterone receptor, but negative for α-smooth muscle actin, CD34, CD45, CD68, and S-100. Based on these features, the pathological diagnosis was angiomyofibroblastoma. A pedunculated angiomyofibroblastoma is extremely rare and, to the best of our knowledge, this is the biggest such tumor in terms of size and weight reported to date. It is especially important in such a huge mass greater than 10 cm that angiomyofibroblastoma is differentiated from aggressive angiomyxoma, which is a deeply invasive and recurrent neoplasm. © 2010 Japan Society of Clinical Oncology.


Satoh T.,University of Tsukuba | Yoshikawa H.,Ibaraki Prefectural Central Hospital
Japanese Journal of Clinical Oncology | Year: 2016

Discussion of fertility-sparing treatment is an important part of pretreatment counseling for young patients with early epithelial ovarian cancer. As a result of late childbearing nowadays, fertility preservation has become a major issue in ovarian cancer patients. The purpose of this review is to update current knowledge on fertility-sparing treatment for early stage epithelial ovarian cancer, which may be useful for pretreatment counseling for reproductive-age patients. The multicenter study data on the fertility-sparing treatment published by Japan Clinical Oncology Group in 2010 confirmed that fertility-sparing surgery is a safe treatment for Stage IA patients with non-clear cell histology and Grade 1 or 2 and suggested that Stage IA patients with clear cell histology and Stage IC patients with non-clear cell histology and Grade 1 or 2 can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy. In the current review, we added the recent case series and review, and discussed the fertility-sparing treatment on young patients with early epithelial ovarian cancer. We need not to change the proposal by the Japan Clinical Oncology Group study, but we should wait for the results of an ongoing prospective study to strongly recommend the proposal of the Japan Clinical Oncology Group study. © The Author 2016. Published by Oxford University Press. All rights reserved.


Naruse Y.,University of Tsukuba | Tada H.,University of Tsukuba | Harimura Y.,Tsukuba Medical Center Hospital | Hayashi M.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background-Recent evidence has linked early repolarization (ER) to idiopathic ventricular fibrillation (VF) in patients without structural heart disease. However, no studies have clarified whether or not there is an association between ER and the VF occurrences after the onset of an acute myocardial infarction (AMI). Methods and Results-This study retrospectively included 220 consecutive patients with an AMI (57 female; mean age, 69±11 years) in whom the 12-lead ECGs before the AMI onset could be evaluated. The patients were classified on the basis of a VF occurrence within 48 hours after the AMI onset. Early repolarization was defined as an elevation of the QRS-ST junction of >0.1 mV from baseline in at least 2 inferior or lateral leads, manifested as QRS slurring or notching. Twenty-one (10%) patients had a VF occurrence within 48 hours of the AMI onset. A multivariate analysis revealed that ER (odds ratio [OR], 7.31; 95% confidence interval [CI], 2.21-24.14; P<0.01), a time from the onset to admission of <180 minutes (OR, 3.77; 95% CI, 1.13-12.59; P<0.05), and a Killip class greater than I (OR, 13.60; 95% CI, 3.43-53.99; P<0.001) were independent predictors of VF occurrences. As features of the ER pattern, a J-point elevation in the inferior leads, greater magnitude of the J-point elevation, notched morphology of the ER, and ER with a horizontal/descending ST segment, all were significantly associated with a VF occurrence. Conclusions-The presence of ER increased the risk of VF occurrences within 48 hours after the AMI onset. Clinical Trial Registration Information-http://www.umin.ac. jp; Identifier: UMIN000005533. © 2012 American Heart Association, Inc.


Hiyama T.,Ibaraki Prefectural Central Hospital
Japanese Journal of Clinical Radiology | Year: 2015

Differentiating papillitis from papillary carcinoma has been reported difficult. We experienced a case of duodenal papillitis showing target-like enhancement on CT scans suggesting papillitis rather than carcinoma. A 60-year-old female with liver dysfunction undertook CT scans which demonstrated swelling of the papilla with target-like enhancement. After failed endoscopic sphincterotomy, surgical papillectomy was performed according to the CT findings. Adenomyomatous papillitis was diagnosed pathologically: gland proliferation around the duct and peripherally thickened smooth muscle corresponded to the inner and outer target-like enhancement, respectively.


Sato M.,Ibaraki Prefectural Central Hospital
Clinical nuclear medicine | Year: 2011

We report a case of mucinous cystic neoplasm which showed FDG accumulation in its cyst wall. MRI revealed that this tumor had repeated intracystic hemorrhage. Inhomogeneous FDG accumulation was found in the cyst wall. The epithelium was focally denuded and ovarian-like stroma with macrophage migration, which phagocytosed red blood cells, and fibrosis were recognized on histopathological examination. These histopathological findings suggested that FDG accumulates not in the monolayer epithelium but in ovarian-like stroma with macrophage migration and fibrosis. Macrophage migration and fibrosis were considered to have contributed to FDG accumulation in this mucinous cystic neoplasm.


Fukumitsu N.,Ibaraki Prefectural Central Hospital | Hayashi Y.,Ibaraki Prefectural Central Hospital
Japanese Journal of Radiology | Year: 2014

Purpose: To develop an objective and less invasive method for evaluating breath-hold status, and to investigate breath-hold reproducibility during voluntary breath-holding irradiation.Materials and methods: We enrolled 20 patients who were treated using a voluntary breath-holding technique. Four or five sessions of cone beam computed tomography (CT) were performed during the radiotherapy session. An image of the lung with respiratory tract was extracted from the CT findings. The rigid registration of subsequent CT findings was completed using the first fraction CT findings. Next, subsequent CT images already subjected to rigid registration were deformed using the first CT images. We compared the differences in the subsequent CT images before and after the deformable registration.Conclusion: This method we have developed may have great potential for the objective verification of breath-hold reproducibility in a less invasive manner. This method assumed that the voluntary breath-hold status was reproducible enough at a clinically satisfactory level.Results: We were able to complete the method to evaluate breath-hold status without having to consider set-up uncertainty, manual processes, visual estimates, or excessive patient cooperation. Tumor dislocation was almost within 3 mm in all directions and deformation was much smaller than 30 % period of free breathing. © 2014, Japan Radiological Society.

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