Kagawa National Childrens Hospital

Kagawa, Japan

Kagawa National Childrens Hospital

Kagawa, Japan

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Kuboi T.,Tokyo Metropolitan Childrens Medical Center | Kuboi T.,Kagawa National Childrens Hospital | Kusaka T.,Kagawa University | Okazaki K.,Kagawa National Childrens Hospital | And 4 more authors.
Pediatrics International | Year: 2013

Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Selective head cooling was provided for 72 h after birth. SCFN developed on the patient's cheeks and back at the age of 21 days. Thus, SCFN may be caused by selective head cooling, similarly to whole-body cooling. Pediatrics International © 2013 Japan Pediatric Society.


Tsurusawa M.,Aichi Medical University | Shimomura Y.,Aichi Medical University | Asami K.,Niigata Cancer Center Hospital | Kikuta A.,Fukushima Medical School | And 7 more authors.
Leukemia | Year: 2010

We analyzed the long-term outcomes of 1021 patients with acute lymphoblastic leukemia (ALL), enrolled in four successive clinical trials (ALL811, ALL841, ALL874 and ALL911) between 1981 and 1993. All patients received risk-adopted therapy according to leukocyte count and age at the time of diagnosis. The median follow-up durations of the four studies were 17.8 years in ALL811, 15.5 years in ALL841, 11.9 years in ALL874 and 15.8 years in ALL911. Patients event-free survival (EFS) and overall survival (OS) rates at 12 years were 41.0 and 54.3% in ALL811, 50.2 and 60.2% in ALL841, 57.3 and 64.7% in ALL874, and 63.4 and 71.7% in ALL911, respectively. Thus, cure can become a reality for about 70% of children with ALL. There is, however, still a significant difference in survival outcomes according to risk group. Late effects were observed in 70 patients out of 834 (8.4%); hepatitis and short stature were most commonly reported. Reduction of late adverse effects for all patients and development of new treatment strategies for very-high-risk patients are major issues for upcoming trials to address. © 2010 Macmillan Publishers Limited All rights reserved.


Okazaki K.,Kagawa National Childrens Hospital | Kusaka T.,Kagawa University | Kondo M.,Tokyo Metropolitan Childrens Medical Center | Kozawa K.,Japan Institute for Environmental Sciences | And 2 more authors.
Cytokine | Year: 2012

Objective: Granulocyte-colony stimulating factor (G-CSF) and vascular endothelial growth factor (VEGF) are thought to be associated with the pathophysiology of perinatal asphyxia. To clarify any such association, we analyzed the serum levels in neonates with perinatal asphyxia treated with head cooling. Study design: Temporal alterations of serum G-CSF and VEGF levels were measured within 24 h of birth in five neonatal cases of severe asphyxia treated with head cooling, five neonatal cases without head cooling, and four healthy neonatal cases. Results: G-CSF in sera markedly increased and sustained in severely asphyxiated neonates treated with head cooling, while VEGF decreased and remained low. Conclusion: G-CSF and VEGF levels in sera might be associated with an early phase of brain protection after birth in severe asphyxia treated with head cooling. © 2012 Elsevier Ltd.


Kageji T.,Kagawa National Childrens Hospital | Mizobuchi Y.,Kagawa National Childrens Hospital | Nagahiro S.,Kagawa National Childrens Hospital | Nakagawa Y.,Tokushima University | Kumada H.,University of Tsukuba
Applied Radiation and Isotopes | Year: 2011

The purpose of this study was to compare the radiation dose between long-survivors and non-long-survivors in patients with glioblatoma (GBM) treated with boron neutron capture therapy (BNCT). Among 23 GBM patients treated with BNCT, there were five patients who survived more than three years after diagnosis. The physical and weighted dose of the minimum gross tumor volume (GTV) of long-survivors was much higher than that of non-long survivors with significant statistical differences. © 2011 Elsevier Ltd.


Kageji T.,Kagawa National Childrens Hospital | Mizobuchi Y.,Kagawa National Childrens Hospital | Nagahiro S.,Kagawa National Childrens Hospital | Nakagawa Y.,Tokushima University | Kumada H.,University of Tsukuba
Applied Radiation and Isotopes | Year: 2011

The purpose of this study was to evaluate the clinical outcome of BSH-based intra-operative BNCT (IO-BNCT) and BSH and BPA-based non-operative BNCT (NO-BNCT). We have treated 23 glioblastoma patients with BNCT without any additional chemotherapy since 1998. The median survival time (MST) of BNCT was 19.5 months, and 2-year, 3-year and 5-year survival rates were 26.1%, 17.4% and 5.8%, respectively. This clinical result of BNCT in patients with GBM is superior to that of single treatment of conventional radiotherapy compared with historical data of conventional treatment. © 2011 Elsevier Ltd.


Kurobe H.,Tokushima University | Tominaga T.,Kagawa National Childrens Hospital | Tominaga T.,Ehime Prefectural Central Hospital | Sugano M.,Tokushima University | And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Objective: Thymectomy is often performed to secure an operative field in surgery for congenital heart defects in early infancy. However, how neonatal thymectomy affects the subsequent development of the immune system in humans remains unclear. We monitored patients for 3 years from the time of thymectomy that was performed during cardiac surgery in early infancy. Methods: For up to 3 years, we monitored the number of circulating lymphocytes and the clinical course of the children who underwent complete (n = 17), partial, and no (n = 15) thymectomy during congenital heart defect surgery performed at less than 3 months of age. The titers of immunoglobulin-G produced in response to vaccinated viruses and phytohemagglutinin responses were also measured. Results: Six months after surgery, the number of T cells, including CD4+ and CD8+ subpopulations, decreased in patients with complete but not partial thymectomy. The reduction in T-cell number persisted for 3 years, whereas the number of B cells did not change. In patients with complete thymectomy, the titers of immunoglobulin-G produced in response to vaccinated measles and rubella viruses were reduced, whereas the phytohemagglutinin-induced proliferation of T cells was not impaired. In addition, hospitalization frequency associated with infectious diseases increased in patients with complete but not partial thymectomy. Conclusions: The results revealed that complete thymectomy in early infancy reduces the number of circulating T cells and T-cell-mediated immune responses for at least 3 years, suggesting that the thymus should be at least partially preserved during surgery in early infancy to maintain protective immunity. Copyright © 2013 by The American Association for Thoracic Surgery.


Kawano H.,National Hospital Organization Zentsuji Hospital | Kawano H.,Tokushima Prefectural Central Hospital | Matsumoto T.,National Hospital Organization Zentsuji Hospital | Hamaguchi E.,National Hospital Organization Zentsuji Hospital | And 5 more authors.
Minerva Anestesiologica | Year: 2015

Background. Postoperative opioid analgesia increases the incidence of postoperative nausea and vomiting (PONV). We investigated whether a combination of the neurokinin-1 antagonist aprepitant and dexamethasone decreases PONV incidence compared with dexamethasone alone in high-risk patients receiving continuous epidural fentanyl. Methods. Sixty nonsmoking female patients scheduled for elective knee osteoarthritis surgery were randomly allocated to receive oral aprepitant 80 mg (aprepitant+dexamethasone group, N.=30) 2 h before anesthesia induction or no oral aprepitant (dexamethasone group, N.=30). All patients received intravenous dexamethasone 8 mg immediately before anesthesia induction. Anesthesia was maintained with remifentanil and sevoflurane. Continuous infusion of epidural analgesia, including fentanyl, was provided during and after surgery. We assessed complete response (no PONV and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity scale, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery. Results. The cumulative incidence of vomiting at 24 h was 3% in the aprepitant+dexamethasone group and 27% in the dexamethasone group (P=0.011). The incidence and frequency of vomiting in the late postoperative period was also significantly lower in the aprepitant+dexamethasone group than in the dexamethasone group. However, there were no significant group differences in the proportion of patients who experienced a complete response, the incidence and severity of nausea, and rescue antiemetic use at 24 h. Conclusion. The combination of aprepitant and dexamethasone was more effective in preventing postoperative vomiting compared with dexamethasone alone in patients at high-risk of PONV from continuous epidural fentanyl analgesia. COPYRIGHT© 2015 EDIZIONI MINERVA MEDICA.


Murakami M.,Kagawa National Childrens Hospital | Iwasa T.,Kagawa National Childrens Hospital | Iwasa T.,Tokushima University | Kiyokawa M.,Kagawa National Childrens Hospital | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2011

Purpose: To investigate the factors affecting the perinatal outcome in monochorionic diamniotic (MD) twins. Methods: We conducted a retrospective study of MD twins treated in our hospital between April 1, 2006 and February 28, 2010. The neonatal outcomes of MD twins conceived by assisted reproductive technology or ovulation induction were compared to the outcomes of those conceived naturally. Results: In MD twins with twin-to-twin transfusion syndrome (TTTS), fetoscopic laser photocoagulation (FLP) resulted in the survival of at least one twin. In naturally conceived MD twins with two live births, we found that there was a higher discordance rate and the incidence of intrauterine growth retardation was higher in twins born to nulliparous women than multiparous women. Conclusions: Further FLP treatment can be performed on twins with TTTS so that prognosis may be improved. Since the risk of discordant growth is significantly greater in twins of nulliparous women, they should be monitored more carefully than multiparous women. © 2010 Springer-Verlag.


Nakagawa Y.,Kyoto University | Yoshihara H.,Kyoto University | Nakagawa Y.,Kagawa National Childrens Hospital
Journal of Medical Systems | Year: 2011

A simple and fair benchmarking system or financial indicators for use on the clinical department level have been lacking to evaluate the management efficiency and activity of each clinical department or division of a hospital. New financial indicators have therefore been developed based on personnel costs. Indicator 1: The ratio of marginal profit after personnel cost per personnel cost (RMP). Indicator 2: The ratio of investment (=indirect cost) per personnel cost (RIP). The difference between RMP and RIP demonstrates the operation profit in US Dollars for personnel cost (OPP). A turning point in profitability similar to the break-even point (BEP) and break-even ratio (BER) could be also defined by the combination of the RMP and RIP. The merits of these two indicators are not only the ability to indicate the relationship between the medical profit and the investments in the hospital, but also the capability to demonstrate such indicators as BEP, BER and OPP on a single graph. The two indicators were applied to the hospitals in the National Hospital Organization and to the clinical department in one hospital. Using these two indicators, it was possible to evaluate the management efficiency and medical activity not only in the whole hospital but also in each department and DPC/DRG group. This will be of use to a manager of a hospital in checking the management efficiency of his/her hospital despite the variations among hospitals, departments and divisions. © 2009 Springer Science+Business Media, LLC.


Pooh R.K.,Clinical Research Institute of Fetal Medicine CRIFM | Pooh K.H.,Kagawa National Childrens Hospital
Donald School Journal of Ultrasound in Obstetrics and Gynecology | Year: 2011

Three-dimensional (3D) ultrasound is one of the most attractive modality in the field of fetal ultrasound imaging. In multiplanar imaging of the brain structure, it is possible to demonstrate not only the sagittal and coronal sections but also the axial section of the brain, which cannot be demonstrated from parietal direction by a conventional 2D transvaginal sonography. Parallel slicing provides a tomographic visualization of internal morphology similar to MR imaging. Fetal neuroimaging with advanced 3D ultrasound technology is easy, noninvasive and reproducible methods. It produces not only comprehensible images but also objective imaging data. It has been controversial whether ultrasound or MRI is more practical and effective in prenatal assessment of fetal CNS abnormalities. In the assessment of enlarged ventricles, no significant difference between dedicated neurosonography and MRI in detection of intracranial structure. However, MRI is superior to ultrasound in evaluation of the brainstem, posterior fossa and cortical development especially in the late pregnancy. Meanwhile, transvaginal high-frequent 3D ultrasound has superiority to MRI in detection of intracranial calcification, vascular anatomy, intratumoral vascularity, bony structure. For CNS anomaly screening scan, ultrasound is no doubt the first modality, and once CNS abnormality is suspicious, after considering each advantage and disadvantage of transvaginal 3D ultrasound and MRI, it is suggested to use those different technologies according to what to be detected and evaluated in each abnormal CNS case. Of course, those two technologies should be utilized as alternatives and complementaries as well. In terms of fetal neurological function analysis, four-dimensional ultrasound research on fetal behavior have been launched in multicenters, and it will be greatly expected to elucidate relations between antenatal behavior and postnatal neurological prognosis.

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