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.

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.

PubMed | Itabashi Chuo Medical Center, Inagi Municipal Hospital and National Cancer Center
Type: Journal Article | Journal: Medical physics | Year: 2017

CyberKnife irradiation is composed of tiny-size, multiple and intensity-modulated beams compared to conventional linacs. Few of the publications for Independent dose calculation verification for CyberKnife have been reported. In this study, we evaluated the feasibility of independent dose verification for CyberKnife treatment as Secondary check.The followings were measured: test plans using some static and single beams, clinical plans in a phantom and using patients CT. 75 patient plans were collected from several treatment sites of brain, lung, liver and bone. In the test plans and the phantom plans, a pinpoint ion-chamber measurement was performed to assess dose deviation for a treatment planning system (TPS) and an independent verification program of Simple MU Analysis (SMU). In the clinical plans, dose deviation between the SMU and the TPS was performed.In test plan, the dose deviations were 3.34.5%, and 4.14.4% for the TPS and the SMU, respectively. In the phantom measurements for the clinical plans, the dose deviations were -0.23.6% for the TPS and -2.34.8% for the SMU. In the clinical plans using the patients CT, the dose deviations were -3.02.1% (Mean1SD). The systematic difference was partially derived from inverse square law and penumbra calculation.The independent dose calculation for CyberKnife shows -3.04.2% (Mean2SD) and our study, the confidence limit was achieved within 5% of the tolerance level from AAPM task group 114 for non-IMRT treatment. Thus, it may be feasible to use independent dose calculation verification for CyberKnife treatment as the secondary check. This research is partially supported by Japan Agency for Medical Research and Development (AMED).

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.

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: 2010

The ACCESS (Acute Candesartan Cilexetil Therapy in Stroke Survivors) study found that administration of candesartan in the acute phase of stroke confers a long-term benefit in patients who have sustained acute ischemic stroke. This treatment did not significantly reduce blood pressure (BP) during the acute phase, however. We assessed the short-term safety of reducing BP with renin-angiotensin system blockade in hypertensive patients who sustained acute ischemic stroke. Our randomized study compared the effects of 14 days of oral candesartan (4 mg/day), perindopril (4 mg/day), or conventional therapy (topical nitrate only when systolic BP (SBP) was ≥220 mm Hg or diastolic BP (DBP) was ≥120 mm Hg) administered to hypertensive patients within 72 hours of the onset of minor ischemic stroke. We assessed neurologic symptoms using the National Institutes of Health Stroke Scale and the modified Rankin Scale within 72 hours of stroke onset before and after drug therapy. A total of 40 patients completed the protocol. Therapy with candesartan and perindopril reduced SBP/DBP values by 23/11 mm Hg (SBP, P < .01; DBP, P = .07) and 14/0 mm Hg (SBP, P = .07), respectively, compared with conventional treatment. Neurologic symptoms worsened in 2 patients who received perindopril, which has no statistical significance, despite the BP reduction in patients given candesartan or perindopril. Our findings indicate that low doses of candesartan or perindopril safely reduce SBP in hypertensive patients with acute ischemic stroke. © 2010 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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