JR Tokyo General Hospital

Tokyo, Japan

JR Tokyo General Hospital

Tokyo, Japan
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Watanabe N.,Ito Hospital | Narimatsu H.,Yamagata University | Noh J.Y.,Ito Hospital | Yamaguchi T.,Tohoku University | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Although antithyroid drug (ATD)-induced hematopoietic damage is a significant concern, it has not been comprehensively investigated. Objective: Our objective was to describe the clinical features of ATD-induced hematopoietic damage. Design and Setting: This was a retrospective cohort study in Tokyo, Japan. Patients: Between January 1983 and December 2002, 50,385 patients at Ito Hospital were diagnosed with Graves' disease. We retrospectively reviewed their medical, pathological, and laboratory records between January 1983 and December 2010. Main Outcome: Incidence and clinical features of ATD-induced agranulocytosis and pancytopenia were evaluated. Results: Of 55 patients with documented hematopoietic damage, 50 had a granulocytosis and 5 had pancytopenia. All of them received ATD, either methimazole (n = 51) or propylthiouracil (n = 4). Median intervals between initiation of ATD therapy and the onset of agranulocytosis and pancytopenia were 69 d (range, 11-233 d) and 41 d (range, 32-97 d), respectively. Either anemia or thrombocytopenia was also documented in seven of the 50 patients with agranulocytosis. Agranulocytosis was the first manifestation of hematopoietic damage in four of the five patents with pancytopenia. Hematopoietic damage recovered with supportive measures including granulocyte colony-stimulating factor (n = 37), steroids (n = 10), and other supportive measures (n = 8) in 54 patients, whereas the remaining patient died of complications from infection. This study failed to identify the risk factors for ATD-induced hematopoietic damage. Conclusions: This study showed that ATD cause hematopoietic changes, which are occasionally severe and potentially fatal. The pathogenesis of agranulocytosis and pancytopenia might overlap, and additional studies are warranted to clarify this and to establish an optimal treatment strategy. Copyright © 2012 by The Endocrine Society.


Karasaki T.,JR Tokyo General Hospital | Tanaka M.,JR Tokyo General Hospital
Asian Cardiovascular and Thoracic Annals | Year: 2015

A 68-year-old man developed progressive vertigo, saccadic eye movements, and tremors. Computed tomography showed multiple lung nodules. Surgery was performed and the pathological diagnosis was large cell neuroendocrine carcinoma in the left upper lobe with ipsilobar metastases, and adenocarcinoma in the left lower lobe. The neurological symptoms resolved dramatically after complete resection of the tumors. Opsoclonus-myoclonus syndrome associated with non-small-cell lung carcinoma is extremely rare. Surgery should not be delayed if a complete resection is expected. © The Author(s) 2014.


Suzuki H.I.,University of Tokyo | Mihira H.,University of Tokyo | Watabe T.,University of Tokyo | Watabe T.,Japan Science and Technology Agency | And 3 more authors.
Nucleic Acids Research | Year: 2013

MicroRNAs (miRNAs) comprise a gene-regulatory network through sequence complementarity with target mRNAs. Previous studies have shown that mammalian miRNAs decrease many target mRNA levels and reduce protein production predominantly by target mRNA destabilization. However, it has not yet been fully assessed whether this scheme is widely applicable to more realistic conditions with multiple miRNA fluctuations. By combining two analytical frameworks for detecting the enrichment of gene sets, Gene Set Enrichment Analysis (GSEA) and Functional Assignment of miRNAs via Enrichment (FAME), we developed GSEA-FAME analysis (GFA), which enables the prediction of miRNA activities from mRNA expression data using rank-based enrichment analysis and weighted evaluation of miRNA-mRNA interactions. This cooperative approach delineated a better widespread correlation between miRNA expression levels and predicted miRNA activities in cancer transcriptomes, thereby providing proof-of-concept of the mRNA-destabilization scenario. In an integrative analysis of The Cancer Genome Atlas (TCGA) multidimensional data including profiles of both mRNA and miRNA, we also showed that GFA-based inference of miRNA activity could be used for the selection of prognostic miRNAs in the development of cancer survival prediction models. This approach proposes a next-generation strategy for the interpretation of miRNA function and identification of target miRNAs as biomarkers and therapeutic targets. © The Author(s) 2013.


Sugimoto K.,JR Tokyo General Hospital
Japanese Journal of Anesthesiology | Year: 2016

The risk of thromboembolic event increases in patients who discontinue antithrombotic therapy, and there is no need to discontinue nonsteroidal antiinflammatory drugs (NSAIDs), including low dose aspirin prior to interventional procedures. In contrast, low-molecular-weight heparin (LMWH) or unfractionated heparin can be discontinued 12 hours prior to interventional procedures. Warfarin should be discontinued and international normalized ratio (INR) should be normalized to 1.4 or less for high risk procedures and 2 or less for low risk procedures. Necessity of discontinuation of platelet aggregation inhibitors depends on the patient's condition, the planned procedure, risk factors, and the cardiologist's opinion. © 2016, Kokuseido Publishing Co. Ltd. All rights reserved.


Suzuki H.I.,Massachusetts Institute of Technology | Suzuki H.I.,University of Tokyo | Katsura A.,University of Tokyo | Yasuda T.,University of Tokyo | And 4 more authors.
Nature Structural and Molecular Biology | Year: 2015

Asymmetric selection of single-stranded guide RNAs from double-stranded RNA precursors is crucial in RNA silencing-mediated gene regulation. However, the precise mechanisms of small-RNA asymmetry are unclear, especially because asymmetric selection can still occur when the putative asymmetry sensors Drosophila R2D2 and mammalian Dicer are depleted. Here we report a direct contribution of mammalian Argonaute 2 (Ago2) to microRNA (miRNA) asymmetry. Ago2 selects strands with 5′-uridine or 5′-adenosine and thermodynamically unstable 5′ ends in parallel through its two sensor regions, which contact the 5′ nucleobases and 5′-phosphates of prospective guide strands. Hence, miRNA asymmetry shows superposed patterns reflecting 5′-end nucleotide identity ('digital' pattern) and thermodynamic stability ('analog' pattern). Furthermore, we demonstrate that cancer-associated miRNA variations reprogram asymmetric selection. Finally, our study presents a model of this universal principle, to aid in comprehensive understanding of miRNA function and development of new RNA-silencing therapies in precision medicine. © 2015 Nature America, Inc. All rights reserved.


Miura T.,University of Tokyo | Miura T.,JR Tokyo General Hospital
Journal of Hand Surgery | Year: 2013

Purpose To describe surgical outcomes of a series of patients with bony mallet fingers treated by a modified extension blocking technique with external fixation. Methods We developed an external fixator that was attached to the extension block pin. Dorsal rotation of the dorsal fragment during reduction was prevented with 1 or 2 additional pins abutted on the fragment through the fixator. We reviewed 12 consecutive patients with mallet finger fractures who were treated surgically with the external fixator. The mean age of the patients was 33 years (range, 15-60 y). Results Rotation of the fragment during reduction was well controlled in all patients. All fractures united at an average of 5 weeks after surgery. Average extension lag was 2 and active flexion was 74. No patient reported pain at a final follow-up of 4 months (range, 3-8 mo). According to the Crawford rating scale, 10 patients were classified as excellent and 2 were good. Conclusions Our modification of the extension block method prevented dorsal rotation of the fragment during reduction and resulted in early union. Type of study/level of evidence Therapeutic IV. © 2013 by the American Society for Surgery of the Hand. All rights reserved.


Kinoshita T.,The Surgical Center | Iwamoto E.,The Surgical Center | Tsuda H.,National Cancer Center Hospital | Seki K.,JR Tokyo General Hospital
Breast Cancer | Year: 2011

Purpose: To evaluate the safety and efficacy of radiofrequency ablation (RFA) as a local therapy for early breast carcinomas, we performed a phase I/II study at our institution. Patients and methods: Fifty patients with core-needle biopsy-proven breast carcinoma that was ≤3 cm in diameter on ultrasonography were enrolled in this study. Under ultrasound (US) guidance, the tumor and surrounding breast tissue were ablated with a saline-cooled RF electrode followed by immediate surgical resection. Resected specimens were examined by hematoxylin and eosin (H&E) staining and nicotinamide adenine dinucleotide (NADH) diaphorase staining to assess tumor viability. Results: Forty-nine patients completed the treatment. The mean tumor size was 1.70 cm. The mean ablation time was 8.7 min using a mean power of 48.5 W. Of the 49 treated patients, complete ablation was recognized in 30 patients (61%) by H&E staining and/or NADH diaphorase staining. The NADH viability staining was available for 38 patients, and in 29 (76.3%), there was no evidence of viable malignant cells. Of the 29 treated patients with breast carcinomas ≤2 cm in diameter examined by pathological examination, complete ablation was achieved in 24 patients (83%). Of the 26 treated patients with breast carcinomas without an extended intraductal component (EIC) according to pathological examination, complete ablation was determined in 22 patients (85%). RFA-related adverse events were observed in five cases: two with skin burn and three with muscle burns. Conclusion: RF ablation is a safe and promising minimally invasive treatment for small breast carcinomas with pathological tumor size ≤2 cm in diameter and without EIC. © 2010 The Japanese Breast Cancer Society.


Hanaoka K.,JR Tokyo General Hospital
Japanese Journal of Anesthesiology | Year: 2014

New diagnostic and therapeutic devices for patients with chronic intractable pain are used in Japan. The following articles describe topics of new diagnostic and therapeutic devices for patients with chronic intractable pain including thermography, functional MRI, device for the quantitative analysis of perception and pain sensation, epiduroscopy, device for phototherapy, Racz catheter and device for spinal cord stimulation (SCS).


Hanaoka K.,JR Tokyo General Hospital
Japanese Journal of Anesthesiology | Year: 2015

This article describes the first events of general anesthesia in the world by Tokumei Takamine in 1698 and Seishu Hanaoka in 1804, the establishment of anesthesiology in Japan including the meaning of a scientific society, the establishment of Japanese Society of Anesthesiologist and Department of Anesthesiology at University of Tokyo, past contributions to anesthesiology by Japanese anesthesiologists, and contributions to anesthesiology by Journal of Anesthesia and the Japanese Journal of Anesthesiology.


Hanaoka K.,JR Tokyo General Hospital
Japanese Journal of Anesthesiology | Year: 2016

Methods of pain treatment are various because of different mechanisms and causes of pain. However, we should recognize complications and side effects of these methods of pain treatment. In addition, we should understand the prevention and management of these complications and side effects. If patients develop side effects during pain treatment they may hesitate to continue to receive pain treatment. We must avoid these situations. In this special issue, the prevention and management of complications and side effects of pain treatment are described including nerve block such as stellate ganglion block, epidural block and nerve root block, and interventional methods such as spinal cord stimulation, thermocoagulation and pulse radiofrequency. Concerning drugs, opioid, non-opioid analgesics, antidepressants and anticoagulant are also discussed. © 2016, Kokuseido Publishing Co. Ltd. All rights reserved.

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