Iida Municipal Hospital

Nagano-shi, Japan

Iida Municipal Hospital

Nagano-shi, Japan

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Sofuni A.,Tokyo Medical University | Maguchi H.,Teine Keijinkai Hospital | Mukai T.,Gifu Municipal Hospital | Kawakami H.,Hokkaido University | And 8 more authors.
Clinical Gastroenterology and Hepatology | Year: 2011

Background & Aims: Pancreatitis is the most common and potentially serious complication of post-endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is caused mostly by postprocedural papillary edema and retention of pancreatic juice. We conducted a randomized controlled trial to determine whether placement of a temporary-type, pancreatic duct stent prevents PEP and to identify risk factors for PEP. Methods: We analyzed data from 426 consecutive patients who underwent ERCP-related procedures at 37 endoscopic units. The patients were assigned randomly to groups that received stents (S group, n = 213) or did not (nS group, n = 213). The stent used was temporary, 5F in diameter, 3 cm long, and straight with an unflanged inner end. Results: The overall frequency of PEP was 11.3%. The frequencies of PEP in the S and nS groups were 7.9% and 15.2%, respectively; the lower incidence of PEP in the S group was statistically significant based on the full analysis set (P = .021), although there was no statistically significant differences in an intention-to-treat analysis (P = .076). There were significant differences in PEP incidence between groups in multivariate analysis for the following risk factors: pancreatography first, nonplacement of a pancreatic duct stent after ERCP, procedure time of 30 minutes or more, sampling of pancreatic tissue by any method, intraductal ultrasonography, and difficulty of cannulation (≥15 min). Patients with more than 3 risk factors had a significantly greater incidence of pancreatitis. Conclusions: Placement of a pancreatic duct stent reduces the incidence of PEP. Several risk factors are associated with PEP. © 2011 AGA Institute.


Asami K.,National Hospital Organization Kinki | Koizumi T.,Shinshu University | Hirai K.,Nagano Municipal Hospital | Ameshima S.,University of Fukui | And 5 more authors.
Clinical Lung Cancer | Year: 2011

Introduction: Feasibility of gefitinib therapy in elderly patients with nonsmall-cell lung cancer is uncertain. This phase II study aimed to investigate the efficacy and usefulness of gefitinib therapy as a first-line treatment for elderly patients who have advanced lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutations. Patients and Methods: We enrolled chemotherapy-nave advanced lung adenocarcinoma patients aged 75 years or older. Patients were administered gefitinib (250 mg) once daily until progression or unacceptable toxicity. The primary endpoint was response rate (RR), and secondary endpoints were disease control rate (DCR; defined as complete response [CR] plus partial response [PR] plus stable disease [SD]), progression-free survival (PFS), overall survival (OS), and toxicity profile. Results: Between April 2008 and November 2009, 17 lung adenocarcinoma patients were enrolled. Overall RR was 59% (95% confidence interval [CI]: 33% to 81%), with 2 patients achieving CR and 8 PR. SD was noted in 5 patients, and DCR was 88% (95% CI: 62% to 98%). Median PFS was 12.9 months (95% CI: 2.2 to 23.6 months), and median OS had not yet been reached. Major grade 3 toxicities were skin rash (12%) and increased levels of aspartate aminotransferase or alanine aminotransferase (18%). Conclusion: First-line treatment with gefitinib was effective and well-tolerated in elderly patients with EGFR mutations. © 2011 Elsevier Inc.


PubMed | Shinshu University, Komoro Kosei General Hospital, Shinonoi General Hospital, Saku Medical Center and 10 more.
Type: | Journal: International journal of cardiology | Year: 2017

Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (75years old) with multi-vessel CAD.The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke).Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p<0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015).Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.


Ke H.,Sun Yat Sen University | Suzuki A.,Shinshu University | Suzuki A.,Iida Municipal Hospital | Miyamoto T.,Shinshu University | And 2 more authors.
Molecular and Cellular Endocrinology | Year: 2015

Catechol estrogens, such as 4-hydroxyestradiol (4-OHE2), are estrogen metabolites that form DNA adducts and may induce mutations and subsequent cell transformation in mammary cells; however, little is known about their roles in endometrial carcinogenesis. Furthermore, it remains unclear whether 4-OHE2 is able to induce DNA damage on specific genes involved in carcinogenesis or a 'pro'-mutation status such as microsatellite instability (MSI). Therefore, we modified terminal transferase-dependent PCR by the application of a capillary sequencer to detect DNA damage at the single base level. Using this method, we demonstrated that 4-OHE2 directly induced DNA damage on codon 130/131 in exon 5 of PTEN, which is a mutation hot spot for PTEN in endometrial carcinoma. Whereas, both estradiol and 4-OHE2 treatment did not affect MSI status in immortalized endometrial glandular cells. 4-OHE2 might contribute to endometrial carcinogenesis by inducing PTEN mutation on codon 130/131. © 2014 Elsevier Ireland Ltd.


Nozaki H.,Niigata University | Sekine Y.,Niigata University | Fukutake T.,Kameda Medical Center | Nishimoto Y.,Keio University | And 7 more authors.
Neurology | Year: 2015

Objectives: The objective of this study was to clarify the characteristic brain MRI findings for genetically diagnosed CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy). Methods: Seven patients with CARASIL carrying HTRA1 mutations (representing 6 Japanese families) were included in this study. Eighteen brain MRIs were reviewed and evaluated with a new rating scale based on scoring for abnormal hyperintense lesions and atrophy. Results: At the last follow-up MRI, all patients had hyperintense lesions on T2-weighted images of the frontal white matter, anterior temporal lobe, external capsules, and thalami. Patients with longer time from the onset of cognitive impairment had higher MRI severity score. The atrophy advanced, followed by white matter lesion progression. During the early stage, hyperintense lesions were observed in the frontal white matter, external capsule, and pons. During the late stage, the arc-shaped hyperintense lesion from the pons to the middle cerebellar peduncles, which we designated the "arc sign," became evident. The arc sign was a characteristic finding for CARASIL in the advanced stage. Conclusions: These characteristic MRI findings for CARASIL are useful for selecting patients for genetic testing. The rating scale correlates well with disease duration and might be useful for assessing disease progression. © © 2015 American Academy of Neurology.


Shimodaira M.,Iida Municipal Hospital | Shimodaira M.,Nihon University | Niwa T.,Iida Municipal Hospital | Nakajima K.,Iida Municipal Hospital | And 3 more authors.
Platelets | Year: 2014

Mean platelet volume (MPV) can reflect platelet activity. Furthermore, high MPV is associated with thrombogenic activation and increased risk of cardiovascular disease. MPV of subjects with hypertension, hyperglycemia, or hyperlipidemia is higher compared with that of normal subjects. In contrast, the relationship between MPV and uric acid (UA) is poorly understood. The present study aims to evaluate the relationship between MPV and serum UA levels in both genders. We retrospectively studied 2104 Japanese subjects (1221 males, 883 females) undergoing general health examinations. Age, gender, body mass index (BMI), blood pressure (BP), smoking habits, alcohol intake, lipid profiles, fasting plasma glucose (FPG), high-sensitivity C-reactive protein, serum UA levels and MPV were evaluated. On the basis of the serum UA levels, the subjects were categorized into the following tertiles: 1st (Q1), 2nd (Q2), and 3rd (Q3). In males, a univariate analysis revealed that age, FPG and systolic and diastolic BP were significantly associated with MPV; in addition to these parameters, in females, UA and LDL-cholesterol correlate with MPV. Furthermore, in females, a stepwise linear regression analysis showed a significant positive correlation between UA and MPV (β=0.059, p=0.008). MPV in females increased gradually based on the serum UA tertile, despite adjusting for confounding variables (Q1, Q2, and Q3 values were 9.88±0.70, 9.95±0.73, and 10.00±0.77 fL, respectively; p<0.039). The serum UA levels were found to be a key determinant of MPV in females. © 2014 Informa UK Ltd. All rights reserved.


Shimodaira M.,Iida Municipal Hospital | Shimodaira M.,Nihon University | Niwa T.,Iida Municipal Hospital | Nakajima K.,Iida Municipal Hospital | And 3 more authors.
Annals of Nutrition and Metabolism | Year: 2014

Background/Aims: Increased triglyceride (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels are considered risk factors for diabetes among prediabetic subjects. In this study, we retrospectively investigated the relationship between lipid profiles and the rate of change in early-phase insulin secretion in prediabetic subjects. Methods: To evaluate insulin secretion, 50 prediabetic subjects underwent a 75-gram oral glucose tolerance test at the beginning of the study (baseline), and they were reexamined after a 2-year interval. The results were expressed as insulinogenic index (IGI) and disposition index (DI). Results: The lipid profiles and indices of insulin secretion had not significantly changed over 2 years. However, Pearson's correlation analyses indicated that the rate of change in IGI and DI was negatively correlated with log-transformed baseline TG level, but not with baseline HDL-C level. Multiple linear regression analysis confirmed that the rate of change in IGI and DI was negatively correlated with the log-transformed baseline TG level (β = -0.38, p = 0.006, and β = -0.39, p = 0.006, respectively). Conclusions: Baseline TG level of prediabetic subjects appeared to be associated with rate of change in IGI and DI over a 2-year period, indicating that TG levels among prediabetic subjects should be carefully monitored. © 2014 S. Karger AG, Basel.


Shimodaira M.,Iida Municipal Hospital | Shimodaira M.,Nihon University | Niwa T.,Iida Municipal Hospital | Nakajima K.,Iida Municipal Hospital | And 3 more authors.
Cardiovascular Diabetology | Year: 2013

Background: Prediabetes is an independent risk factor for cardiovascular diseases. Mean platelet volume (MPV) can reflect platelet activity, and high MPV is associated with thrombogenic activation and an increased risk of cardiovascular disease. In diabetic patients, MPV is higher when compared with normal subjects. However, the relationship between MPV and prediabetes is poorly understood. The purpose of the present study was to compare MPV in prediabetic and normoglycemic subjects, and to evaluate the relationship between MPV and fasting plasma glucose (FPG) levels in these two groups.Methods: We retrospectively studied 1876 Japanese subjects who had undergone health checks at Iida Municipal Hospital. Age, sex, body mass index (BMI), blood pressure, medical history, smoking habits, alcohol intake, lipid profiles, FPG levels, and MPV were evaluated. Subjects were categorized into four groups according to FPG: Q1 (70 mg/dL ≤ FPG < 90 mg/dL, n = 467), Q2 (90 mg/dL ≤ FPG < 95 mg/dl, n = 457), Q3 (95 mg/dL ≤ FPG < 100 mg/dL, n = 442), and Q4 (100 mg/dL ≤ FPG < 126 mg/dL, n = 512). Q1, Q2, and Q3 were defined as normal FPG groups and Q4 was defined as prediabetic group.Results: The MPV increased with the increasing FPG levels, in the following order: Q1 (9.89 ± 0.68 fl), Q2 (9.97 ± 0.69 fl), Q3 (10.02 ± 0.72 fl), and Q4 (10.12 ± 0.69 fl). After adjusting for the confounding parameters, MPV of the prediabetic group was higher than that in other groups (P < 0.001 for Q4 vs. Q1 and Q2, and P < 0.05 for Q4 vs. Q3). MPV in the high-normal glucose group (Q3) was significantly higher than in the low-normal glucose group (Q1). MPV was independently and positively associated with FPG, not only in prediabetic subjects but also in normal FPG subjects (β = 0.020 and β = 0.006, respectively).Conclusions: MPV in patients with prediabetes was higher than that in normal subjects, and was positively associated with FPG levels in prediabetic and normal subjects. © 2013 Shimodaira et al.; licensee BioMed Central Ltd.


Shimodaira M.,Iida Municipal Hospital | Kitano T.,Iida Municipal Hospital | Kibata M.,Iida Municipal Hospital | Shirahata K.,Iida Municipal Hospital
BMC Research Notes | Year: 2013

Background: Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation. A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient's left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion: Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma. © 2013 Shimodaira et al.; licensee BioMed Central Ltd.


Shimodaira M.,Iida Municipal Hospital | Niwa T.,Iida Municipal Hospital | Nakajima K.,Iida Municipal Hospital | Kobayashi M.,Iida Municipal Hospital
Endocrine Practice | Year: 2014

Objective: The diagnosis of pheochromocytoma in patients receiving levodopa is challenging because the standard diagnostic biochemical tests may be confounded by dopaminergic therapy. We aim to showcase our experience with the diagnosis of pheochromocytoma in a patient with a known case of Parkinson's disease who was receiving levodopa.Methods: We present the case of an elderly male who was diagnosed as having pheochromocytoma while receiving dopaminergic therapy for Parkinson's disease.Results: A 75-year-old man presented with vague abdominal symptoms. Computed tomography revealed a 3.5 × 3.2 cm right adrenal mass with a well-defined margin. As revealed by magnetic resonance imaging, the mass was hypointense on T1-weighted and hyperintense on T2-weighted images. Biochemical tests revealed elevated levels of urinary dopamine, which was considered to be caused by levodopa therapy. However, concurrent elevation in urinary adrenaline and his metanephrine and vanillylmandelic acid levels suggested an underlying case of pheochromocytoma. An 123I- metaiodobenzylguanidine (123I-MIBG) scintigraphy scan performed under levodopa therapy showed positive tracer uptake in the right adrenal gland. Histopathology of the adrenalectomy specimen confirmed the diagnosis of pheochromocytoma.Conclusion: Our experience with the present case indicates that although the standard diagnostic biochemical tests for pheochromocytoma may be confounded by dopaminergic therapy, 123I-MIBG scintigraphy has diagnostic value for confirming pheochromocytoma even in patients receiving dopaminergic therapy. © 2014 AACE.

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