Ijinkai Takeda General Hospital

Kyoto, Japan

Ijinkai Takeda General Hospital

Kyoto, Japan
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Akao M.,National Hospital Organization Kyoto Medical Center | Chun Y.-H.,Ijinkai Takeda General Hospital | Wada H.,National Hospital Organization Kyoto Medical Center | Esato M.,Ijinkai Takeda General Hospital | And 5 more authors.
Journal of Cardiology | Year: 2013

Background: Atrial fibrillation (AF) increases the risks of stroke and death, and the prevalence of AF is increasing significantly. Until recently, warfarin was the only oral anticoagulant for stroke prevention, but novel anticoagulants are now under development. Methods and results: The Fushimi AF Registry is a community-based survey of AF patients. We aimed to enroll all of the AF patients in Fushimi-ku, which is located at the southern end of the city of Kyoto. Fushimi-ku is densely populated with a total population of 283,000, and is assumed to represent a typical urban community in Japan. On the basis of the general prevalence of AF in the Japanese (0.6%), we estimated the total number of AF patients as 1700. A total of 76 institutions, a large proportion of which were private clinics, participated in the study. At present, we have enrolled 3183 patients from March 2011 to June 2012 (approximately 1.12% of total population). The mean age was 74.2. ±. 11.0 years, and 59.3% of subjects were male. The mean body weight was 58.5. ±. 13.2. kg, and the proportions with a body weight of less than 50. kg and 60. kg were 25.7% and 55.0%, respectively. The type of AF was paroxysmal in 46.0%, persistent in 7.3%, and permanent in 46.7%. Major co-existing diseases were hypertension (60.6%), heart failure (27.9%), diabetes (23.2%), stroke (19.4%), coronary artery disease (15.0%), myocardial infarction (6.4%), dyslipidemia (42.4%), and chronic kidney disease (26.4%). The mean CHADS2 score was 2.09. ±. 1.35: 0 in 11.8% of patients, 1 in 27.1%, and 2 in 29.1%. Warfarin was prescribed in only 48.5% of patients, whereas anti-platelet drugs, mainly aspirin, were prescribed for more than 30% of the patients. Conclusions: The Fushimi AF Registry provides a unique snapshot of current AF management in an urban community in Japan. © 2013 Japanese College of Cardiology.


Akao M.,National Hospital Organization Kyoto Medical CenterKyoto | Abe M.,National Hospital Organization Kyoto Medical CenterKyoto | Chun Y.-H.,Ijinkai Takeda General Hospital | Esato M.,Ijinkai Takeda General Hospital | And 3 more authors.
Circulation Journal | Year: 2014

Methods and Results: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, a typical urban community in Japan with a total population of 283,000. Of the 3,282 patients enrolled by October 2012, 1-year follow-up was completed for 2,914 patients. OAC, mainly warfarin, were given to 1,546 patients (53.1%); overused for low-risk patients, and underused for patients at risk, based on the guidelines. Moreover, warfarin was sometimes given at a sub-therapeutic dose; only 54.4% of patients were within the optimal therapeutic range. The 1-year outcomes revealed that the incidences of both stroke and major bleeding were equivalent between patients taking OAC and those without; major clinical events were as follows: (OAC vs. non-OAC) stroke 2.7% vs. 2.8%, ischemic stroke 2.1% vs. 2.0% and major bleeding 1.4% vs. 1.5% (NS for all).Background: Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly, and increases the risk of stroke. Oral anticoagulants (OAC) are highly effective in preventing stroke, and there are evidence-based guidelines for the optimal use of OAC in patients with AF.Conclusions: The Fushimi AF Registry provides a unique snapshot of current AF management in an urban community in Japan. The present study reveals inappropriate use of OAC for patients with AF, indicating discordance between guideline recommendations and real-world clinical practice. © 2014 THE JAPANESE CIRCULATION SOCIETY.


Nomura T.,Ijinkai Takeda General Hospital | Nomura T.,Kyoto University | Kabashima K.,Ijinkai Takeda General Hospital | Miyachi Y.,Kyoto University
Journal of Dermatological Science | Year: 2014

Skin protects body from continual attack by microbial pathogens and environmental factors. Such barrier function of skin is achieved by multiple components including immune system, which is mainly regulated by lymphocytes. T lymphocytes (T cells) that express T cell receptor (TCR) α and β chains (αβT cells) control the strength and the type of immune response. CD4T cell population consists of helper T (Th) cell-subsets and immunosuppressive regulatory T (Treg) cells. Th1 cells produce IFN-γ and protect against intracellular pathogens. Th2 cells produce IL-4 family cytokines and participate in allergic skin diseases, including atopic dermatitis (AD). Th17 cells secrete IL-17, recruit granulocytes to fight against extracellular microorganisms, and play a role in psoriasis and AD. Th22 cells produce IL-22 that activates epithelial cells and mediates acanthosis in psoriasis and AD. On the other hand, Foxp3+ Treg cells attenuate immune responses partly via TGF-β or IL-10. Tissue resident memory T (Trm) cells in the skin-most of which are epidermal CD8T cells-constitute the first line of the defense against repeated infections. CD8 T cells are also engaged in psoriasis, lichen planus, and drug eruptions. Skin harbors innate-like αβT cells such as natural killer T (NKT) cells as well, whose function is not fully revealed. Understanding these αβT cells helps to comprehend skin diseases. © 2014 Japanese Society for Investigative Dermatology.


Kawabata H.,Kyoto University | Kotani S.-I.,Kyoto University | Matsumura Y.,Kyoto University | Kondo T.,Kyoto University | And 4 more authors.
Internal Medicine | Year: 2013

We herein describe an unusual case of multicentric Castleman's disease accompanied by thrombocytopenia, ascites, renal failure and myelofibrosis in a Japanese woman. The patient was initially diagnosed as having myelodysplastic syndrome with myelofibrosis. The general condition of the patient deteriorated rapidly; however, treatment with tocilizumab, an anti-interleukin-6 receptor antibody, together with corticosteroids dramatically improved her symptoms. The clinical features of this case were similar to those of three cases previously reported by Takai et al. (Rinsho Ketsueki, 2010, 51:320-5), which were determined to be thrombocytopenia, anasarca, fever, reticulin myelofibrosis and organomegaly (TAFRO) syndrome, a possibly distinct clinical entity. © 2013 The Japanese Society of Internal Medicine.


Kanno T.,Ijinkai Takeda General Hospital | Kubota M.,Ijinkai Takeda General Hospital | Sakamoto H.,Kyoto University | Nishiyama R.,Ijinkai Takeda General Hospital | And 3 more authors.
Urology | Year: 2014

Objective To assess the efficacy of ultrasonography (US) for detecting renal stone using noncontrast enhanced computed tomography (NCCT) as a standard reference. Methods We performed a retrospective study of 428 patients who underwent NCCT and US imaging on the same day from January 2009 to September 2011. The sensitivity of US to detect each individual stone and at least 1 stone per kidney was evaluated. The detection rates according to the location and stone size were also examined. We compared the sizes of stones determined in the longest axis of NCCT and US, and performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Results Of 856 kidneys, NCCT detected 474 stones in 361 kidneys, whereas US detected 332 stones of 474 stones detected by NCCT, yielding a sensitivity of 70.0% and a specificity of 94.4%. Similarly, US alone detected at least 1 stone in 285 kidneys, yielding a sensitivity of 78.9% and a specificity of 83.7%. Expectedly, the detection rate for the left upper calyx was lower than that for other sites (P =.002), and the detection rate increased with stone size. Furthermore, stone sizes obtained by US were positively correlated with those obtained by CT, and stone size measurement by NCCT and US was concordant in 240 of 332 cases (72%). Importantly, stone size was only a factor that affected renal stone diagnosis using US. Conclusion US is an effective imaging modality for detecting renal stones. © 2014 Elsevier Inc.


Nomura T.,Ijinkai Takeda General Hospital | Nomura T.,Kyoto University | Kabashima K.,Kyoto University | Miyachi Y.,Kyoto University
Journal of Dermatological Science | Year: 2014

Skin protects body from continual attack by microbial pathogens and environmental factors. Such barrier function of skin is achieved by multiple components including immune system, which is mainly regulated by lymphocytes. T lymphocytes (T cells) that express T cell receptor (TCR) α and β chains (αβT cells) control the strength and the type of immune response. CD4T cell population consists of helper T (Th) cell-subsets and immunosuppressive regulatory T (Treg) cells. Th1 cells produce IFN-γ and protect against intracellular pathogens. Th2 cells produce IL-4 family cytokines and participate in allergic skin diseases, including atopic dermatitis (AD). Th17 cells secrete IL-17, recruit granulocytes to fight against extracellular microorganisms, and play a role in psoriasis and AD. Th22 cells produce IL-22 that activates epithelial cells and mediates acanthosis in psoriasis and AD. On the other hand, Foxp3+ Treg cells attenuate immune responses partly via TGF-β or IL-10. Tissue resident memory T (Trm) cells in the skin-most of which are epidermal CD8T cells-constitute the first line of the defense against repeated infections. CD8 T cells are also engaged in psoriasis, lichen planus, and drug eruptions. Skin harbors innate-like αβT cells such as natural killer T (NKT) cells as well, whose function is not fully revealed. Understanding these αβT cells helps to comprehend skin diseases. © 2014 Japanese Society for Investigative Dermatology.


Kanno T.,Ijinkai Takeda General Hospital | Matsuda A.,Kyoto University | Sakamoto H.,Kyoto University | Higashi Y.,Ijinkai Takeda General Hospital | Yamada H.,Ijinkai Takeda General Hospital
International Journal of Urology | Year: 2013

Objectives: An obstructed, infected kidney combined with ureteral stones can be lethal, and requires urgent drainage and complete stone removal. However, the optimal method of stone removal, and its safety and efficacy have yet to be conclusively established. The aim of this study was to determine the safety and efficacy of carrying out ureteroscopy after kidney drainage for septic patients with obstructing stones. Methods: From January 2004 to September 2011, 88 patients underwent stone removal by either ureteroscopy (n=48) or extracorporeal shock wave lithotripsy (n=40) after drainage of obstructive pyelonephritis. Patients' characteristics were analyzed, and treatment outcomes between the ureteroscopy and extracorporeal shock wave lithotripsy groups were compared. The outcomes of ureteroscopy carried out during the same period between patients with preoperative obstructive pyelonephritis and those without were also compared. Results: Obstructed, infected kidneys were decompressed with retrograde ureteral stenting, except for two and three cases treated with nephrostomy in the ureteroscopy and extracorporeal shock wave lithotripsy groups, respectively. The severity of preoperative pyelonephritis was similar in both groups. Importantly, the success rate was 67.5% for extracorporeal shock wave lithotripsy and 98% for ureteroscopy (P<0.001). Likewise, the retreatment and auxiliary procedure rates were significantly greater in the extracorporeal shock wave lithotripsy group than in the ureteroscopy group (90% vs 0% and 32.5% vs 2%, respectively). Furthermore, patients treated by ureteroscopy with or without preoperative pyelonephritis had similar stone-free and ureteroscopy complication rates (97% vs 93%, and 10% vs 12%). Conclusions: Ureteroscopy after drainage of an obstructed infected kidney can be a safe and effective option, as it seems to not be associated with an increased risk of complications. © 2013 The Japanese Urological Association.


Kanno T.,Ijinkai Takeda General Hospital | Kubota M.,Ijinkai Takeda General Hospital | Sakamoto H.,Kyoto University | Nishiyama R.,Ijinkai Takeda General Hospital | And 3 more authors.
Urology | Year: 2014

Objective To assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non-contrast-enhanced computed tomography (NCCT) as a standard reference. Materials and Methods From January 2009 to September 2011, 428 patients underwent both NCCT and US on the same day. The sensitivity and specificity of US to detect ureteral stone was evaluated. The detection rates using US imaging were examined according to location and stone size. The sizes of stones determined in the longest axis of NCCT and US were compared. We also performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Moreover, the factors that may affect the detection of ureteral stone by US were analyzed. Results Out of 856 ureters, NCCT could detect 171 stones in 169 patients, whereas US could detect 98 stones, yielding a sensitivity of 57.3% and a specificity of 97.5%. Expectedly, detection rate of US increased with stone size but was lower for distal ureter. With hydronephrosis, the sensitivity of US improved from 57.3% to 81.3%. Stone sizes measured by US correlated positively with those by computed tomography, and were concordant with those of NCCT in 68 of 98 patients (69.4%). Interestingly, stone size and the presence of hydronephrosis were factors that independently affected ureteral stone detection by US. Conclusion These results indicate that US may be useful as an initial imaging modality for detecting ureteral stone. © 2014 Elsevier Inc. All Rights Reserved.


PubMed | Ijinkai Takeda General Hospital
Type: Journal Article | Journal: Nihon Hinyokika Gakkai zasshi. The japanese journal of urology | Year: 2017

(Objectives) Laparoscopic radical nephrectomy (LRN) is now a standard care for the treatment of renal tumors, but the limitation of LRN for large tumors remains to be elucidated. In this study, we examined the safety and efficacy of LRN for >7 cm renal tumors including tumors >10 cm. (Patients and methods) From March 2001 to September 2014, 167 patients received laparoscopic surgery for renal tumors at our institution. Of these, 126 patients (4.0 cm: 64 cases, 4.1-7.0 cm: 40 cases, 7.1-10.0 cm: 12 cases, >10.0 cm: 10 cases) underwent LRN. Treatment outcomes including surgical and oncological outcomes among each stage were compared. (Results) Operating time for 7.1-10.0 cm tumors were similar to that <7 cm tumors but that for >10 cm tumors was significantly longer than that <10 cm tumors. There was no significant difference among each stage in terms of complication rate. As expected, recurrence-free survival rate for >10 cm tumors were worse than <10 cm tumors. (Conclusions) Our data suggests that LRN for large tumors >7 cm can be performed safely, but LRN for >10 cm tumors are technically demanding and require longer operation time.


PubMed | Ijinkai Takeda General Hospital
Type: Journal Article | Journal: Nihon Hinyokika Gakkai zasshi. The japanese journal of urology | Year: 2017

(Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status 3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.

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