Itabashi Chuo Medical Center

Tokyo, Japan

Itabashi Chuo Medical Center

Tokyo, Japan
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Tsukamoto Y.,Itabashi Chuo Medical Center
Clinical calcium | Year: 2014

"Thinking Global! Acting Local" has been used to express a principle in implementing global guidelines in local. In case of KDIGO 2009 CKD-MBD guideline, Japanese Society of Dialysis Therapy followed the principal part of its global one and published 2012 CKD-MBD guideline for Japanese users. In this guideline, JSDT recommended very different PTH target from the KDIGO and emphasized the parathyroid interventions in their recommendation. Is it a right recommendation as for "Acting Local" ? We should be very careful to implement an opinion-base or low-level evidence-base recommendation to increase a clinical usefulness of guideline.

Kobayashi H.,Nihon University | Kobayashi Y.,St. Marianna University School of Medicine | Yokoe I.,Itabashi Chuo Medical Center | Akashi Y.,Nihon University | And 3 more authors.
Arthritis Care and Research | Year: 2017

Objective: Myocardial dysfunction and heart failure (HF) are increased in rheumatoid arthritis (RA), yet there are few studies of the myocardium in RA. Methods: RA patients with no known heart disease or risk factors underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). Images were assessed for left-ventricular (LV) structural and functional parameters and for myocardial late gadolinium enhancement (LGE; an indicator of myocardial fibrosis) and T2-weighted imaging (an indicator of active inflammation). We modeled the associations between RA characteristics and N-terminal pro–brain natriuretic protein (NT-proBNP) levels with LGE and T2-weighted imaging. We also assessed whether LGE and/or T2-weighted imaging were associated with abnormal LV structure or dysfunction. Results: A total of 60 RA patients were studied. LGE was present in 19 (32%) and T2-weighted imaging in 7 (12%), 5 of whom also had LGE. After adjustment for relevant confounders, higher odds of LGE with each swollen joint (odds ratio [OR] 1.87, P = 0.008), each log unit higher C-reactive protein level (OR 3.36, P = 0.047), and each log unit higher NT-proBNP (OR 20.61, P = 0.009) were found. NT-proBNP was also significantly higher (135%) among those with T2-weighted imaging than in those without T2-weighted imaging or LGE. Higher LV mass index and LV mass:end diastolic volume ratio were observed in those with T2-weighted imaging than in those with no myocardial abnormalities and in those with LGE without T2-weighted imaging; however, ejection fraction was not reduced in those with either LGE or T2-weighted imaging. Conclusion: These data suggest that cardiac MRI findings indicating myocardial inflammation/fibrosis are correlated with RA disease activity and alterations in myocardial structure known to precede clinical HF. © 2016, American College of Rheumatology

Imai E.,Itabashi Chuo Medical Center | Kaneko S.,Itabashi Chuo Medical Center | Tsukamoto Y.,Itabashi Chuo Medical Center
Clinical Nephrology | Year: 2017

A 38-year-old Japanese man who had undergone clipping surgery for a ruptured aneurysm of the anterior communicating artery 2 days prior, suddenly developed refractory hypernatremia (serum sodium (Na) 156 - 162 mmol/L). Symptoms included low plasma vasopressin, fluctuating urine osmolality (120 - 710 mOsm/kg) and lack of thirst, all suggesting adipsic diabetes insipidus (ADI). Hypernatremia was corrected by scheduled water intake with desmopressin administration. During 1-year follow-up after the surgery, his serum Na level normalized despite the suspension of desmopressin, but neither thirst nor osmolality- dependent vasopressin release recovered. Meanwhile, his urine osmolality shifted to a constant high level. The present case suggests that renal compensatory adaptation, apparently independent of the circulating vasopressin level, plays a major role in water handling in longitudinal ADI. © 2017 Dustri-Verlag Dr. K. Feistle.

Kanenishi K.,Kagawa University | Hanaoka U.,Kagawa University | Noguchi J.,Kagawa Prefectural College of Health Sciences | Marumo G.,Itabashi Chuo Medical Center | Hata T.,Kagawa University
International Journal of Gynecology and Obstetrics | Year: 2013

Objective To assess the frequency of fetal facial expressions at 25-27 weeks of gestation using 4D ultrasound. Methods Twenty-four normal fetuses were examined using 4D ultrasound. The face of each fetus was recorded continuously for 15 minutes. The frequencies of tongue expulsion, yawning, sucking, mouthing, blinking, scowling, and smiling were assessed and compared with those observed at 28-34 weeks of gestation in a previous study. Results Mouthing was the most common facial expression at 25-27 weeks of gestation; the frequency of mouthing was significantly higher than that of the other 6 facial expressions (P < 0.05). Yawning was significantly more frequent than the other facial expressions, apart from mouthing (P < 0.05). The frequencies of yawning, smiling, tongue expulsion, sucking, and blinking differed significantly between 25-27 and 28-34 weeks (P < 0.05). Conclusion The results indicate that facial expressions can be used as an indicator of normal fetal neurologic development from the second to the third trimester. 4D ultrasound may be a valuable tool for assessing fetal neurobehavioral development during gestation. © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Hata T.,Kagawa University | Hanaoka U.,Kagawa University | Mashima M.,Kagawa University | Ishimura M.,GE Yokogawa Medical Systems | And 2 more authors.
Journal of Medical Ultrasonics | Year: 2013

Background: Our objective was to present our experience of fetal facial expressions reconstructed employing the four-dimensional (4D) HDlive rendering mode. Methods: A total of 23 normal fetuses at 18-36 weeks' gestation were studied using the 4D HDlive rendering mode. Results: The 4D HDlive rendering mode provided extraordinarily realistic features of the fetal face. In particular, blinking, mouthing, swallowing, yawning, tongue expulsion, and sucking were clearly noted. Moreover, various realistic fetal emotional expressions such as smiling-like and crying-like movements were recognized. The 4D HDlive rendered images of fetal facial expressions seem to be more readily discernible than those obtained by conventional 4D ultrasonography. Conclusion: Observation of facial expressions using the 4D HDlive rendering mode is considered to reflect the normal and abnormal neurological development of the fetus. Therefore, the 4D HDlive rendering mode may assist in evaluation of fetal brain function, and offer potential advantages relative to conventional 4D ultrasonography. © 2013 The Japan Society of Ultrasonics in Medicine.

Nakamura T.,Tokyo Women's Medical University | Nakamura T.,Itabashi Chuo Medical Center | Tsuruta S.,Itabashi Chuo Medical Center | Uchiyama S.,Tokyo Women's Medical University
Journal of the Neurological Sciences | Year: 2012

Recent randomized trials have shown that cilostazol is superior to aspirin for secondary stroke prevention. We hypothesized that combining cilostazol with aspirin is more effective than aspirin alone in patients with acute ischemic stroke. This randomized study compared the effects of oral aspirin alone to aspirin plus cilostazol in patients with non-cardioembolic ischemic stroke within 48 h of stroke onset. NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were checked before and after 14 days and 6 months of drug administration. The primary and secondary endpoints were neurological deterioration or stroke recurrence (NIHSS score ≥ 1) within 14 days and 6 months, respectively. For statistical analysis, on-treatment analysis was conducted. Seventy-six patients were enrolled in the study. The primary endpoint was significantly higher in the aspirin group than in the aspirin plus cilostazol group (28% vs. 6%, relative risk (RR): 0.21, 95% confidence intervals (CI): 0.05-0.87, p = 0.013). Among the patients who did not reach these endpoints, the mean improvement in the NIHSS score at day 14 tended to be better (- 1.8 ± 1.2 vs. - 1.2 ± 1.0, p = 0.078) and the frequency of the favorable functional status of mRS 0-1 at month 6 was significantly higher (RR: 1.48, 95% CI: 1.07-2.06, p = 0.0048) in the aspirin plus cilostazol group than in the aspirin group. Patients treated with aspirin plus cilostazol during the acute phase of stroke had less neurological deterioration and more favorable functional status than those treated with aspirin alone. © 2011 Elsevier B.V. All rights reserved.

Nakamura T.,Tokyo Women's Medical University | Nakamura T.,Itabashi Chuo Medical Center | Tsutsumi Y.,Tokyo Women's Medical University | Shimizu Y.,Tokyo Women's Medical University | Uchiyama S.,Tokyo Women's Medical University
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

The presence of ulcerated carotid plaques is a risk factor for ischemic stroke, which is associated with thromboembolism. We evaluated the relationship between ulcerated carotid plaques and cerebrovascular events in patients with acute ischemic stroke or transient ischemic attack. We extracted 48 consecutive patients with ulcerated carotid plaques from a cohort of 1111 patients with acute ischemic stroke or transient ischemic attack. All patients were evaluated by carotid ultrasonography and diffusion-weighted magnetic resonance imaging. We defined thromboembolic events by excluding potential cardiac sources of embolism, stroke in posterior circulation, contralateral lesions, and single and small (<1.5 cm) subcortical lesions, and we considered the remaining patients with cortical lesions or multiple or large subcortical lesions as having experienced a thromboembolic cerebrovascular event. We compared ultrasonographic findings in the patients with and those without a thromboembolic cerebrovascular event. A relationship with thromboembolic events was suspected in 10 patients (21%) with ulcerated carotid plaques. The proportion of smokers was significantly higher in the group of patients with a thromboembolic event (90% vs 53%; P =.03). Logistic regression demonstrated a significant association between thromboembolic events and the presence of echolucent ulcerated plaques (odds ratio, 9.34, 95% confidence interval, 1.65-53.0), even though maximum intima-media thickness and other variables of ulcerated plaques (eg, depth of ulcers, thickness of the plaque, or the degree of stenosis) did not differ significantly between the 2 groups. Our findings indicate that although cerebrovascular events are closely associated with echolucent ulcerated carotid plaques, the prevalence of thromboembolism was not very high (∼20%) in our cohort of Japanese patients with ulcerated carotid plaques. © 2013 by National Stroke Association.

In the KDIGO CKD-MBD guideline, the disorder "renal osteodystrophy" is defined as bone histological changes, which can be diagnosed only by bone biopsy. New bone diagnosis method, "TMV classification" is introduced instead of classical classification system. In order to diagnose TMV classification, undecalcified bone specimen after tetracycline double labeling is required. In TMV classification, "T" stands for bone turnover and is evaluated by bone formation rate (BFR/BS) or activation frequency (Acf) . "M" stands for bone mineralization and is evaluated by mean osteoid thickness (O.Th) and mineralization lag time (Mlt) . "V" stands for cancellous bone volume and is diagnosed by total bone volume (BV/TV) .

Kobayashi Y.,St. Marianna University School of Medicine | Giles J.T.,Johns Hopkins University | Hirano M.,Tokyo Medical University | Yokoe I.,Itabashi Chuo Medical Center | And 4 more authors.
Arthritis Research and Therapy | Year: 2010

Introduction: Rheumatoid arthritis (RA) is a multi-organ inflammatory disorder associated with high cardiovascular morbidity and mortality. We sought to assess cardiac involvement using a comprehensive cardiac magnetic resonance imaging (cMRI) approach and to determine its association with disease characteristics in RA patients without symptomatic cardiac disease.Methods: RA patients with no history and/or clinical findings of systemic or pulmonary hypertension, coronary artery disease, severe valvular heart disease, atrial fibrillation, diabetes mellitus, or echocardiographic abnormalities underwent contrast-enhanced cMRI on a 1.5T scanner. Adenosine triphosphate was used to assess perfusion defects due to microvascular impairment or ischemia, and delayed enhanced imaging was obtained for the assessment of myocardial inflammation/fibrosis. We explored the associations of cMRI abnormalities with RA disease activity and severity measures.Results: Eighteen patients (78% female) with a mean age of 57 ± 10 years were studied. Eight patients (45%) demonstrated a myocardial abnormality. Perfusion defects under pharmacologic stress were seen in two patients (11%), one of whom had a circumferential subendocardial perfusion defect and one had a non-segmental subendocardial perfusion defect. Seven patients (39%) were found to have delayed enhancement, only one of whom also demonstrated a perfusion defect. Mean disease activity score (DAS)28 was significantly higher in the group with delayed enhancement compared to the group without by an average of 1.32 DAS28 units (4.77 vs. 3.44 units, respectively; P = 0.011). Corresponding trends to statistical significance were noted in systemic inflammatory markers, with both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) quantitatively higher in the group with delayed enhancement. Other RA characteristics, such as disease duration, autoantibody status, and current treatments were not significantly associated with cardiac involvement.Conclusions: Myocardial abnormalities, as detected by cMRI, were frequent in RA patients without known cardiac disease. Abnormal cMRI findings were associated with higher RA disease activity, suggesting a role for inflammation in the pathogenesis of myocardial involvement in RA. © 2010 Kobayashi et al.; licensee BioMed Central Ltd.

Nakashima M.,Itabashi Chuo Medical Center
Therapeutic Research | Year: 2011

Upper limbs swelling and jugular vein dilatation are well known complication caused by obstruction or stenosis of subclavian vein, after implantation of pacing lead. We experienced one case of subacute transient left external jugular vein dilatation without left limb swelling after pacemaker implantation. Postoperative venography revealed no obstruction nor stenosis in both subclavian and external jugular vein. External jugular vein dilatation might be resulting from displacement of subclavian vein concomitant with pacing lead insertion.

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