Kagoshima-shi, Japan
Kagoshima-shi, Japan

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Miyata M.,Kagoshima University | Ikeda Y.,Kagoshima University | Nakamura S.,Heiwadai Memorial Hospital | Sasaki T.,Makurazaki City Hospital | And 11 more authors.
Circulation Journal | Year: 2012

Background: The purpose of this study was to analyze the effect of valsartan on abnormal adipocyte metabolism and prothrombotic state in hypertensive patients with metabolic syndrome (MetS). Methods and Results: We conducted a multicenter, prospective, randomized, parallel-group controlled trial in 150 hypertensive patients with MetS. They were randomly assigned to receive either 80-160mg valsartan per day (valsartan group, n=79) or other conventional treatment without a renin-angiotensin system (RAS) inhibitor (non-RAS inhibitor group, n=71). After 1 year, there were no significant differences between the 2 groups in the changes in systolic and diastolic blood pressures (valsartan: 153±15/86±15 to 138±16/77±12mmHg; non-RAS inhibitor: 150±14/82±15 to 137±15/76±10mmHg). There was a significant difference in the change in the levels of plasminogen activator inhibitor-1 (PAI-1) between the 2 groups after 1 year (valsartan: 3.7±3.2ng/ml; non-RAS inhibitor: 5.8±3.3ng/ml, P=0.04). There was no significant difference between groups in the change in the concentration of adiponectin after 1 year (valsartan: 0.3±0.4μg/ml; non-RAS inhibitor: 0.9±0.4μg/ml, P=0.22). The animal study showed aortic PAI-1 protein expression was reduced in double knockout mice of angiotensin II type 1a receptor and apolipoprotein E (apoE) compared with the apoE knockout mice. Conclusions: Valsartan reduced plasma PAI-1 levels compared to non-RAS inhibitor in hypertensive patients with MetS, which suggests it may be useful for improving fibrinolytic function.

Yonezawa K.,Hakodate National Hospital | Fuse J.,Tokyo Medical Center | Shimizu N.,Tokyo Metropolitan Childrens Medical Center | Hayashi T.,Osaka Medical College | And 7 more authors.
Circulation Journal | Year: 2011

Background: In-hospital cardiopulmonary arrest (CPA) is an important issue, but data in Japan are limited. Methods and Results: To investigate in-hospital CPA, we conducted a prospective multicenter observational registry of in-hospital CPA and resuscitation in Japan (J-RCPR). During January 2008 to December 2009, patients were registered from 12 participating hospitals. All patients, visitors and employees within the facility campus who experience a cardiopulmonary resuscitation event defined as either a pulseless or a pulse with inadequate perfusion requiring chest compressions and/or defibrillation of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) were registered. Data were collected in 6 major categories of variables: facility data, patient demographic data, pre-event data, event data, outcome data, and quality improvement data. Data for 491 adults were analyzed. The prevalence of pulseless VT/VF as first documented rhythm was 28.1%, asystole was 29.5% and pulseless electrical activity was 41.1%. Immediate causes of event were arrhythmia 30.6%, acute respiratory insufficiency 26.7%, and hypotension 15.7%. Return of spontaneous circulation was 64.7%; the proportion of survival 24 h after CPA was 49.8%, the proportion of survival to hospital discharge was 27.8% and proportion of favorable neurological outcome at 30 days was 21.4%. Conclusions: This is the first report of the registry for in-hospital CPA in Japan and shows that the registry provides important observational data.

PubMed | Red Cross, Kobe City Medical Center General Hospital, Nakamura Memorial Hospital, Kyushu Medical Center and 13 more.
Type: Journal Article | Journal: International journal of stroke : official journal of the International Stroke Society | Year: 2015

Large clinical trials are lack of data on non-vitamin K antagonist oral anticoagulants for acute stroke patients.To evaluate the choice of oral anticoagulants at acute hospital discharge in stroke patients with nonvalvular atrial fibrillation and clarify the underlying characteristics potentially affecting that choice using the multicenter Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry (ClinicalTrials.gov NCT01581502).The study included 1192 acute ischemic stroke/transient ischemic attack patients with nonvalvular atrial fibrillation (527 women, 77799 years old) between September 2011 and March 2014, during which three nonvitamin K antagonist oral anticoagulant oral anticoagulants were approved for clinical use. Oral anticoagulant choice at hospital discharge (median 23-day stay) was assessed.Warfarin was chosen for 650 patients, dabigatran for 203, rivaroxaban for 238, and apixaban for 25. Over the three 10-month observation periods, patients taking warfarin gradually decreased to 465% and those taking nonvitamin K antagonist oral anticoagulants increased to 480%. As compared with warfarin users, patients taking nonvitamin K antagonist oral anticoagulants included more men, were younger, more frequently had small infarcts, and had lower scores for poststroke CHADS2 , CHA2 DS2 -VASc, and HAS-BLED, admission National Institutes of Health stroke scale, and discharge modified Rankin Scale. Nonvitamin K antagonist oral anticoagulants were started at a median of four-days after stroke onset without early intracranial hemorrhage. Patients starting nonvitamin K antagonist oral anticoagulants earlier had smaller infarcts and lower scores for the admission National Institutes of Health stroke scale and the discharge modified Rankin Scale than those starting later. Choice of nonvitamin K antagonist oral anticoagulants was independently associated with 20-day or shorter hospitalization (OR 246, 95% CI 187-324).Warfarin use at acute hospital discharge was still common in the initial years after approval of nonvitamin K antagonist oral anticoagulants, although nonvitamin K antagonist oral anticoagulant users increased gradually. The index stroke was milder and ischemia-risk indices were lower in nonvitamin K antagonist oral anticoagulant users than in warfarin users. Early initiation of nonvitamin K antagonist oral anticoagulants seemed safe.

Kusaba H.,Kyushu University | Esaki T.,National Kyushu Cancer Center | Futami K.,Fukuoka University | Tanaka S.,Fukuoka University | And 11 more authors.
Cancer Science | Year: 2010

The combination of an oral fluoropyrimidine derivative, S-1, and irinotecan is expected to be a promising regimen for advanced colorectal cancer. This study was performed to determine the maximum tolerated dose (MTD) and recommended dose (RD) of irinotecan combined with S-1 in a 3-week cycle regimen and to observe the safety and efficacy for patients with previously untreated advanced colorectal cancer. Eighty milligrams per m2 of S-1 was given orally for 14 consecutive days and escalated doses of irinotecan were administered on days 1 and 8 every 3 weeks in the phase I trial. Forty patients were treated at the RD during the phase II trial. Forty-three patients were enrolled between February 2005 and March 2007. The dose-limiting toxicity was diarrhea and abdominal pain. The MTD of irinotecan was 100 mg/m2 and the RD was determined to be 80 mg/m2 of irinotecan combined with 80 mg/m2 of S-1. The phase II trial showed that 22 of 40 patients achieved a complete or partial response and eight had stable disease. The overall response rate was 55.0%. The median progression-free survival time and median survival time were 6.7 and 21 months, respectively. There were no treatment-related deaths. The main toxicities were leukopenia, neutropenia, anorexia and diarrhea. This study suggests the combination of irinotecan and S-1 repeated every 3 weeks is tolerable and effective for patients with previously untreated advanced colorectal cancer. (Cancer Sci 2010; 101: 2591-2595) © 2010 Japanese Cancer Association.

PubMed | Shinshu University, Fukuoka University, Toyama Prefectural Central Hospital, Niigata Cancer Center Hospital and 8 more.
Type: Journal Article | Journal: Journal of dermatological science | Year: 2015

The importance of the genetic background of melanoma cells to the individual susceptibility to treatment has become apparent. In Caucasians, BRAF mutations are frequently detected in lesions on the skin of younger patients compared to NRAS and KIT mutations. However, clinical and pathological characteristics associated with BRAF, NRAS and KIT mutations have not been fully evaluated in East Asians.To clarify clinical and pathological characteristics associated with BRAF, NRAS and KIT mutations in Japanese melanoma patients.Clinical data were retrospectively collected from 11 hospitals in Japan. BRAF, NRAS and KIT mutations were evaluated with polymerase chain reaction and Sanger sequencing. The relationships between these gene mutations and pathological and clinical findings were analyzed.The number of cases examined was 171 (primary: 135, metastases: 11, paired: 25), and all were Japanese patients. The detection rates of BRAF, NRAS and KIT mutations were 30.4%, 12.3% and 12.9%, respectively. Compared with the wild type, the presence of BRAF mutations was significantly associated with younger age (median, 50.0 years vs. 70.0 years, p<0.001). BRAF mutation was frequently detected in the lesions of the scalp (80%; 4/5), trunk (72.0%; 18/25), extremities (56.7%; 17/30) and neck (44.4%; 4/9), and the least prevalent were the face (22.2%; 2/9), nail (12.5%; 3/24), palm or sole (8.9%; 4/45) and mucosa (0%). NRAS mutations were prevalent in the face (33.3%) and palm or sole (20.0%), and the median age of these patients was 70.5 years. A KIT mutation was observed in the nail apparatus (25%), palm or sole (15.6%) and mucosa (18.2%). The median age of the patients with a KIT mutation was 63.0 years. Heterogeneity of mutations between primary and metastatic lesions was detected in six of 25 cases (24%). Solar elastosis was identified in 12 of 71 cases (15.3%), among which four cases harbored BRAF(V600E) (2 cases), BRAF(V600K), NRAS(Q61K) or NRAS(Q61L), respectively.Some clinical characteristics associated with BRAF, NRAS and KIT mutations were observed in Japanese patients, and we observed both similarities to and differences from those of Caucasians. Our findings could provide useful information in efforts to clarify the tumor genesis of malignant melanomas.

Yoshifuku K.,Kagoshima Medical Center | Nishimoto K.,Kagoshima Medical Center | Matsuzaki T.,Kagoshima Medical Center | Ushikai M.,Ushikai ENT Clinic
Journal of Otolaryngology of Japan | Year: 2015

We report herein on a case of a 74 year old male with neurally mediated syncope caused by cervical malignant lymphoma. He visited our hospital complaining of a rapidly-growing left cervical mass. I-oeal findings showed an elastic soft mass with tenderness in his cervical region. We performed an open biopsy and pathological diagnosis was diffuse large B-cell lymphoma, so we planned to treat him with CHOP therapy. But before chemotherapy, loss of consciousness occurred. This syncope was considered to be neurally mediated syncope caused by the compression of the carotid sinus by the cervical malignant lymphoma. His cervical malignant lymphoma rapidly shrank after CHOP therapy, and general fatigue and bradycardia decreased day by day. If cardiac pacemaker insertion is not enforced for a case of neurally mediated syncope, the frequency of the syncope increases. In this case the cervical tumor was reduced by CHOP therapy and the syncope and bradycardia disappeared. The patient was able to avoid cardiac pacemaker insertion.

Yoshifuku K.,Kagoshima Medical Center | Nishimoto K.,Kagoshima Medical Center | Matsuzaki T.,Kagoshima Medical Center | Matsushita S.,Kagoshima Medical Center
Journal of Otolaryngology of Japan | Year: 2015

Herein, wereport a caseofdrug-induced Stevens Johnson syndrome (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus was open and that the maxillary sinus mucosa was invaded by tumor. Biopsy revealed a histopathological diagnosis of squamous cell carcinoma. We therefore diagnosed the patient as a case of maxillary sinus carcinoma (T3N0M0) basedonthe CT, MRI and FDG-PET findings. During chemoradiotherapy for maxillary sinus cancer, the patient developed oral mucosal inflammation of progressively worsening severity; we initially thought that the symptom was a side effect of the treatment; however, several days later, skin lesions appeared throughout the body. We consulted a dermatologist, who suspected SJS. The patient was initiated on high-dose steroid therapy (steroid pulse therapy), and the symptoms improved. Because of SJS is a fatal drug eruption, early diagnosis and prompt treatment are important. In patients receiving chemoradiotherapy showing severe oral mucosal inflammation outside the irradiation area or oral mucosal inflammation associated with skin lesions throughout the body, it is necessary to bear in mind the possibility of SJS.

Yoshifuku K.,Kagoshima Medical Center | Nishimoto K.,Kagoshima Medical Center | Matsuzaki T.,Kagoshima Medical Center
Journal of Otolaryngology of Japan | Year: 2014

We report herein on a patient with unexpected trismus after the induction of general anesthesia due to temporomandibular arthrosis. A 30 year old man visited our hospital complaining of hematuria, and he was scheduled for bil tonsillectomy under general anesthesia. Preoperative examination revealed no evidence of difficult airway and no sign of trismus. Despite the administration of muscle relaxants, it was impossible to expand the operative field due to by trismus after the introduction of general anesthesia. Malignant hyperthermia was excluded, and the trismus was judged to be due to temporomandibular arthrosis. Manual repositioning was performed, trismus was improved and expansion of the surgical field became possible. During any head and neck surgical procedure, if an otolaryngologist should encounter trismus after the induction of general anesthesia, temporomandibular arthrosis should be borne in mind if temporomandibular arthrosis is diagnosed as the cause, manual repositioning should be employed as soon as possible.

Nishimoto K.,Kagoshima Medical Center | Tanimoto Y.,Kagoshima Medical Center | Matsuzaki T.,Kagoshima Medical Center | Ogita M.,Fujimoto General Hospital
Practica Oto-Rhino-Laryngologica | Year: 2013

Patients with carcinoma of the middle ear usually have a poor prognosis even after multidisciplinary treatment. We describe the rare case of a patient with bilateral middle ear carcinoma who was treated by stereotactic radiosurgery using the Cyberknife, and remained tumor free for more than five years after the therapy. The patient was sorely afflicted with persistent left otorrhea despite having undergone surgery for bilateral chronic otitis media and was diagnosed (confirmed by histopathological examination) as having carcinoma of the middle ear on the left side. FDG-PET imaging revealed accumulation in the right side ear also, however, the diagnosis of right middle ear carcinoma was finally made after five months by histopathological examination. He underwent stereotactic radiosurgery using the Cyberknife on two occasions, had no remarakable complications, and survived without tumor recurrence for more than five years. We suggest that stereotactic radiosurgery using the Cyberknife may be useful for the treatment of middle ear carcinoma, especially bilateral middle ear carcinoma, because of the reservation around the restriction by the surrounding organs.

PubMed | Kagoshima Medical Center
Type: Case Reports | Journal: Kyobu geka. The Japanese journal of thoracic surgery | Year: 2015

Effusive constrictive pericarditis is a rare clinical entity characterized by concurrent pericardial effusion and visceral pericardial constriction. The most effective therapy for this state is pericardiectomy with complete removal of the parietal and visceral membranes, although the perioperative mortality and morbidity can be high. We presented a case of a 45-year-old man in whom a visceral pericardiectomy with waffle procedure was successfully performed using an ultrasonic scalpel without use of cardiopulmonary bypass. His postoperative course was uneventful and cardiac hemodynamics restored to normal. There were no signs or symptoms of recurrence in 2 years of follow-up.

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