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PubMed | Ichinomiyanishi Hospital, Nagoya University and Meijo University
Type: Journal Article | Journal: Medical & biological engineering & computing | Year: 2016

This paper presents a novel hybrid medical stent device. This hybrid stent device formed by fractal mesh structures provides a flow-diverting effect and stent-assisted coil embolization. Flow-diverter stents decrease blood flow into an aneurysm to prevent its rupture. In general, the mesh size of a flow-diverter stent needs to be small enough to prevent blood flow into the aneurysm. Conventional flow-diverter stents are not available for stent-assisted coil embolization, which is an effective method for aneurysm occlusion, because the mesh size is too small to insert a micro-catheter for coil embolization. The proposed hybrid stent device is capable of stent-assisted coil embolization while simultaneously providing a flow-diverting effect. The fractal stent device is composed of mesh structures with fine and rough mesh areas. The rough mesh area can be used to insert a micro-catheter for stent-assisted coil embolization. Flow-diverting effects of two fractal stent designs were composed to three commercially available stent designs. Flow-diverting effects were analyzed using computational fluid dynamics (CFD) analysis and particle image velocimetry (PIV) experiment. Based on the CFD and PIV results, the fractal stent devices reduce the flow velocity inside an aneurism just as much as the commercially available flow-diverting stents while allowing stent-assisted coil embolization.


PubMed | Ichinomiyanishi Hospital and Tottori University
Type: Journal Article | Journal: Yonago acta medica | Year: 2016

Breast ultrasound findings regarding tumor margins are crucial in judging whether a tumor is malignant or benign. However, the relationships between the margins and clinicopathological characteristics remain largely unknown. In this study, we examined the clinicopathological characteristics of patients with invasive ductal carcinoma whose ultrasound images showed either well-defined and rough or indistinct margins.Of all consecutive patients diagnosed with invasive ductal carcinoma at the Division of Breast and Endocrine Surgery of Tottori University Hospital from January 2012 to December 2014, 122 patients whose ultrasound images showed either well-defined and rough or indistinct tumor margins were included in this study. Mammography and ultrasound images taken at the initial examination were reviewed. Patients were divided into two groups based on ultrasound findings of the tumor margins: the well-defined and rough group and the indistinct group. The relationships among ultrasound findings, mammography findings and clinicopathological findings were investigated in the two groups.The well-defined and rough group was more likely to contain solid-tubular carcinoma, while the indistinct group was more likely to contain scirrhous carcinoma. The MIB-1 index was higher in the well-defined and rough group than in the indistinct group. Additionally, the proportion of patients with nuclear grade 3, estrogen receptor-negative/progesterone receptor-negative, and triple-negative breast cancer was greater in the well-defined and rough group than in the indistinct group.Invasive ductal carcinomas with well-defined and rough margins on ultrasound were likely to be malignant and proliferative than those with indistinct margins.


Aoyama K.,Ichinomiyanishi Hospital | Fushimi Y.,Ichinomiyanishi Hospital | Fushimi Y.,Kyoto University | Okada T.,Kyoto University | And 4 more authors.
European Radiology | Year: 2012

Objectives To detect symptomatic hemispheres during the postoperative course of subarachnoid haemorrhage (SAH) using arterial spin labelling (ASL). Methods Eighteen patients with aneurysmal SAH were included; four exhibited symptomatic vasospasm postoperatively. All patients underwent ASL on days 9-10 (single time-point ASL). Nine patients underwent serial measurements of ASL (serial ASL) on days 1-2, 9-10 and 13-21, and seven patients also underwent imaging on days 4-7. CBF in the posterior part of the MCA territory was measured, and the ipsilateral/contralateral ratio of CBF was calculated. Differences between symptomatic hemispheres and others underwent ROC analysis. Results Single time-point ASL revealed that CBFday9-10 and CBF i/c-day9-10 were significantly lower in symptomatic hemispheres than in asymptomatic hemispheres (P<0.001). Serial ASL was significantly decreased on CBFday4-7 compared with CBFday1-2 and on CBF day9-10 compared with CBFday4-7, and significantly increased on CBFday13-21 compared with CBFday9-10. ROC analysis of single time-point ASL revealed that AUC for CBFday9-10 was 0.95, significantly higher than CBFi/c-day9-10 (P<0.001). ROC analysis of serialASL showed that AUC for CBFday9-10 was 0.93 and significantly higher than CBFday9-10/day1-2 and CBF i/c-day9-10 (P<0.001). Conclusions Single time-point ASL revealed significant CBF reduction in symptomatic hemispheres comparedwith asymptomatic hemispheres. Serial ASL showed time-dependent CBF changes after SAH. Key Points • MR arterial spin labelling (ASL) can non-invasively assess cerebral blood flow (CBF) • ASL revealed significant CBF reduction in symptomatic hemispheres compared with asymptomatic hemispheres • Serial ASL measurements enable observation of timedependent CBF changes after SAH • ASL is non- invasive and suitable for serial repeated examinations. © European Society of Radiology 2012.


Shibamoto K.,Ichinomiyanishi Hospital | Aoyama K.,Ichinomiyanishi Hospital | Taki H.,Ichinomiyanishi Hospital | Miyasaki A.,Ichinomiyanishi Hospital
Neurologia Medico-Chirurgica | Year: 2012

A 31-year-old male presenting with intracranial hemorrhage manifesting as deep coma and anisocoria underwent immediate emergency surgery. Three-dimensional computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery (MCA) and perfusion CT immediately after the surgery suggested severe hypoperfusion in the right MCA territory. Postoperative angiography demonstrated right unilateral moyamoya disease. We predicted that brain edema and intracranial pressure (ICP) elevation occurring after the hemorrhage might result in cerebral infarction. Hyperosmotic drugs were contraindicated by dehydration. Therefore, therapeutic hypothermia was induced that controlled the ICP. We considered that the increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessel comprised the pathogenesis of acute cerebral ischemia after intracranial bleeding. Cerebral hemodynamics should be evaluated during the acute phase of cerebral hemorrhage to prevent subsequent cerebral infarction.


Kawakami T.,Ichinomiyanishi Hospital | Tanaka N.,Ichinomiyanishi Hospital | Ishihara H.,Ichinomiyanishi Hospital | Ohno H.,Ichinomiyanishi Hospital
Thrombosis Journal | Year: 2015

Warfarin, dabigatran, and apixaban are used for preventing ischemic stroke due to non-valvular atrial fibrillation (NVAF). However, it is often challenging to select the appropriate anticoagulant. We present the case of a 70-year-old male patient with persistent NVAF who developed pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and left atrial thrombus during anticoagulant therapy with warfarin. Intravenous recombinant tissue plasminogen activator was administered during his acute PTE. Heparin and apixaban were administered over 28days; heparin was discontinued after the DVT resolved, while apixaban was administered to prevent ischemic stroke. Two days after heparin was discontinued, the patient experienced an ischemic stroke. Dabigatran was administered for secondary ischemic stroke prevention. Soluble fibrin (SF) levels remained elevated during treatment with heparin and apixaban and returned to normal after apixaban was replaced with dabigatran. Monitoring of SF may be useful as an index for selection of anticoagulants. © 2015 Kawakami et al.


Kawakami T.,Ichinomiyanishi Hospital | Kobayakawa H.,Ichinomiyanishi Hospital | Ohno H.,Ichinomiyanishi Hospital | Tanaka N.,Ichinomiyanishi Hospital | Ishihara H.,Ichinomiyanishi Hospital
Thrombosis Journal | Year: 2013

Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of novel oral anticoagulants (NOAC) and is superior to warfarin in preventing stroke or systemic embolism, causes less bleeding, and results in lower mortality in patients with atrial fibrillation. There are few reports of resolution of LAA thrombus with other NOAC. We present a 72-year-old male patient with persistent atrial fibrillation associated with left atrial thrombus. Sixteen days of apixaban treatment showed complete thrombus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT). © 2013 Kawakami et al.; licensee BioMed Central Ltd.


PubMed | Ichinomiyanishi Hospital
Type: Controlled Clinical Trial | Journal: Pacing and clinical electrophysiology : PACE | Year: 2014

Coronary artery spasm has recently been reported as a complication of the ablation of atrial fibrillation (AF). It may be induced by cardiac autonomic nervous dysfunction during radiofrequency catheter ablation of AF. However, the underlying mechanism is not clear. We hypothesized that patients with paroxysmal AF coincidentally exhibit coronary artery spasm.A total of 51 patients were enrolled in a case control study to clarify the relationship between paroxysmal AF and coronary artery spasm. We evaluated 17 patients with paroxysmal AF (AF group) and 34 patients without paroxysmal AF (control group). Drug-induced coronary artery spasm provocation tests were performed by intracoronary administration of acetylcholine or ergonovine.The AF group consisted of nine males and eight females, mean age 67 10 years. The control group consisted of 16 males and 18 females, mean age 60 14 years. In the AF group, coronary artery spasm was induced in 13 patients (76.5%) before AF ablation. In the control group, coronary artery spasm was induced in three patients (8.8%). Coronary artery spasm was more frequently induced in patients with AF (76.5% vs 8.8%; odds ratio, 33.583; 95% confidence interval, 6.5732-171.58; P < 0.0001). In the AF group, ventricular fibrillation and AF were recorded immediately after right coronary artery spasm induction in one patient.Paroxysmal AF patients have high positive rates of drug-provoked coronary artery spasm. Patients with paroxysmal AF may coincidentally exhibit coronary artery spasm.


PubMed | Ichinomiyanishi Hospital
Type: Journal Article | Journal: Thrombosis journal | Year: 2013

Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of novel oral anticoagulants (NOAC) and is superior to warfarin in preventing stroke or systemic embolism, causes less bleeding, and results in lower mortality in patients with atrial fibrillation. There are few reports of resolution of LAA thrombus with other NOAC. We present a 72-year-old male patient with persistent atrial fibrillation associated with left atrial thrombus. Sixteen days of apixaban treatment showed complete thrombus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT).


PubMed | Ichinomiyanishi Hospital
Type: Clinical Trial | Journal: Pacing and clinical electrophysiology : PACE | Year: 2013

The relationship between the anatomical location of right ventricular pacing site and paced QRS duration is unclear. In this study, we aimed to investigate the relationship between right ventricular pacing site and paced QRS duration using cardiac angiography.Fifty patients were implanted with pacemakers. The right ventricular lead position was determined from the findings of cardiac angiography and the paced QRS duration was measured. Cardiac angiography was used to display the right ventriculogram (RVG) and the left ventriculogram (LVG). The RVG view was divided into three areas and the LVG view was divided into four areas.The paced QRS duration value was significantly longer in the right ventricular apex area compared with the outflow and inflow areas (160 15 ms vs 140 15 ms, P = 0.02, and vs 133 17 ms, P < 0.001, respectively), but those values were not statistically significantly different between the right ventricular outflow and the right ventricular inflow areas (140 15 ms vs 133 17 ms, P = 0.187). When assessed with LVG views, there were the statistically significant differences in the paced QRS duration values in all areas except the apex area. (LV mid-anterior: 147 11 ms vs LV base: 127 13 ms, P < 0.001, and vs LV mid-septum: 129 12 ms, P = 0.001, respectively.)Cardiac angiography showed that there was a relationship between the anatomical right ventricular pacing site and paced QRS duration. Cardiac angiography can help determine the areas that produce shorter paced QRS duration.


PubMed | Ichinomiyanishi Hospital
Type: Journal Article | Journal: Internal medicine (Tokyo, Japan) | Year: 2016

Objective The aim of this study was to determine whether nocturnal hypoglycemia may be predicted according to morning glucose levels. Methods We retrospectively evaluated 106 patients with type 2 diabetes who underwent continuous glucose monitoring during admission. The pre-breakfast glucose level (Pre-breakfast level), highest postprandial glucose level within 3 hours after breakfast (Highest level), time from the start of breakfast to the highest postprandial glucose level (Highest time), difference between the pre-breakfast and highest postprandial breakfast glucose levels (Increase), area under the glucose curve (180 mg/dL) within 3 hours after breakfast (Morning AUC), post-breakfast glucose gradient (Gradient), and the increase-to-pre-breakfast ratio (Increase/Pre-breakfast) were calculated. The subjects were divided into hypoglycemic and non-hypoglycemic patients and compared for the above parameters using the t-test. A receiver operating characteristic analysis was used to determine the optimal cut-off values to predict nocturnal hypoglycemia (Hypoglycemia). Results Twenty-eight patients (26.4%) had hypoglycemia. The Pre-breakfast levels were significantly lower in patients with hypoglycemia than those without (p=0.03). The Increases were significantly higher in patients with hypoglycemia than those without (p=0.047). The Increase/Pre-breakfast ratio were significantly larger in patients with hypoglycemia than those without (p=0.0002). Their cut-off values were as follows (level, sensitivity, specificity, and area under the curve): 123 mg/dL, 0.89, 0.55, and 0.78 (p<0.0001); 90.5 mg/dL, 0.75, 0.64, and 0.76 (p<0.0001); and 90.2%, 0.75, 0.76, and 0.78 (p<0.0001), respectively. Conclusion Major increases between the pre- and post-breakfast glucose levels may predict nocturnal hypoglycemia in patients with type 2 diabetes.

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