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Hiramori S.,Kokura Memorial Hospital | Soga Y.,Kokura Memorial Hospital | Tomoi Y.,Kokura Memorial Hospital | Tosaka A.,Kawakita General Hospital
Journal of Vascular Surgery | Year: 2014

Background We conceived a new method, runoff grade, to evaluate runoff after endovascular therapy (EVT). We evaluated the validity of using runoff score based on angiographic findings. Methods The subjects were 859 consecutive patients (males, 69%; mean age, 73.0 ± 9.0 years) who underwent EVT for de novo femoropopliteal lesions at Kokura Memorial Hospital. We evaluated the postprocedural tibial runoff, named it runoff grade, classified it into 0 through 2, and retrospectively assessed the relationship with the outcome of EVT. Primary, secondary, and assisted primary patency rates and freedom from major adverse limb events (MALE) were compared between runoff grades. Results The mean follow-up period was 31 ± 25 months. The lesion length was 91.5 ± 83.0 mm. The rate of stent use was 52.0%. The primary patency rates at 1, 2, and 3 years were 68.1%, 59.1%, and 53.9%; the secondary patency rates were 90.9%, 88.1%, and 85.9%; the assisted primary patency rates were 79.4%, 72.6%, and 68.5%; and freedom from MALE was 72.5%, 64.8%, and 61.0%, respectively. The primary patency rates at 1, 2, and 3 years were significantly lower in the runoff grade 0 group than in the other groups (55.5% vs 66.7% and 75.6%; 35.8% vs 57.6% and 69.2%; 35.8% vs 53.3% and 60.9% for grade 0, 1, 2, respectively; log-rank, P <.0001). Secondary patency rate (78.5% vs 91.8% and 91.8%; 76.3% vs 88.6% and 89.9%; 72.8% vs 86.3% and 88.2%, respectively; P =.015), assisted primary patency rate (67.0% vs 78.5% and 85.1%; 56.9% vs 71.6% and 79.3%; 47.6% vs 68.0% and 74.8%; respectively, P =.0002), and freedom from MALE (60.8% vs 71.2% and 79.4%; 44.3% vs 64.0% and 72.6%; 36.6% vs 60.7% and 68.5%, respectively; P <.0001) were also similar. After adjustment for age, gender, diabetes, hemodialysis, critical limb ischemia, TransAtlantic Inter-Society Consenus II classification, and stent use, runoff grade was an independent predictor of primary patency. Conclusions Vessels with runoff grade 0 had significantly worse cumulative outcomes. Our results suggested that runoff grade seemed to play an important role to keep the primary patency. © 2014 by the Society for Vascular Surgery. Source


Shinoda T.,Kawakita General Hospital | Koda Y.,Koda Medical Clinic
Contributions to Nephrology | Year: 2011

Japanese hemodialysis (HD) patients have two remarkable characteristics, that is they have a longer period of chronic HD and better clinical outcome than American and European HD patients. This might be partly explained by the very low prevalence of renal transplantation in Japan. As a result, younger HD patients without serious comorbid conditions, whose prognosis should be good, have not been transplanted but have been treated by chronic HD therapy for a long period. Other potential explanations might be higher prevalence of biocompatible high-flux membrane dialyzers and lower prevalence of arteriovenous graft in Japan than Western countries. Although online hemodiafiltration has potential advantage over high-flux HD, the impact of this therapy has not been evident because of its low prevalence in chronic dialysis therapy in Japan. Copyright © 2011 S. Karger AG, Basel. Source


Tanaka R.,University of Tokyo | Takamoto M.,Tokyo Metropolitan Police Hospital | Komae K.,Kawakita General Hospital | Ohtomo K.,University of Tokyo | And 2 more authors.
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Purpose: To investigate the clinical features of psoriatic uveitis in Japanese patients. Methods: Clinical features of 13 consecutive patients with psoriatic uveitis treated at our facility were retrospectively examined using medical records. In this study, we collected data about psoriasis type, uveitis laterality, onset type, HLA types, visual acuity, ocular inflammation localization, anterior segment findings, funduscopy findings, complications, recurrence, and medical treatments for uveitis and skin diseases. Results: The cohort comprised ten males and three females (43.6 ± 7.1 years old), and types of psoriasis included psoriasis vulgaris (seven cases), psoriatic arthritis (four cases), pustular psoriasis (three cases) and psoriatic erythroderma (one case). Two cases represented complicated cases of pustular psoriasis and psoriatic arthritis. Seven cases were unilateral, and six cases were bilateral. All cases had acute non-granulomatous anterior uveitis, whereas panuveitis occurred in one case. Furthermore, macular edema and vascular leakage on fluorescein angiography occurred in four cases, and hyperemic disc occurred in two cases. Recurrence occurred in nine cases. In addition to topical corticosteroid treatment, eight cases underwent oral immunosuppressive treatment or biologics. All six cases undergoing HLA typing were HLA-A2 positive. Conclusions: Cases of psoriatic uveitis in Japan appear to present with acute non-granulomatous uveitis; other symptoms may include macular edema, retinal vasculitis, or hyperemic disc. © 2015, Springer-Verlag Berlin Heidelberg. Source


Ishikawa Y.,Nippon Medical School | Kiyama T.,Nippon Medical School | Haga Y.,Kumamoto Medical Center | Ishikawa M.,Red Cross | And 6 more authors.
Annals of Surgery | Year: 2010

Objective: To investigate whether maximal sterile barrier precautions (MSBPs) during central venous catheter (CVC) insertion are truly effective in preventing catheter-related bloodstream infections (CRBSIs) in patients in general surgical units. SUMMARY BACKGROUND DATA: The reported effectiveness of MSBPs was based on the Results: of a single-center randomized controlled trial by Raad et al and the majority of the patients (99%) in the study were chemotherapy outpatients. Methods: Between March 14, 2004 and December 28, 2006, the patients scheduled for CVC insertion in surgical units at 9 medical centers in Japan were randomly assigned to either an MSBP group (n = 211) or a standard sterile barrier precaution (SSBP) group (n = 213). This study was registered in the UMIN Clinical Trials Registry (registration ID number: UMIN000001400). Results: The median (range) duration of catheterization was 14 days (0-92 days) in the MSBP group and 14 days (0-112 days) in the SSBP group. There were 5 cases (2.4%) of CRBSI in the MSBP group and 6 cases (2.8%) in the SSBP group (relative risk, 0.84; 95% confidence interval, 0.26-2.7; P = 0.77). The rate of CRBSIs per 1000 catheter days was 1.5 in the MSBP group and 1.6 in the SSBP group. There were 8 cases (3.8%) of catheter-related infections in the MSBP group and 7 cases (3.3%) in the SSBP group (relative risk, 1.2; 95% confidence interval, 0.43-3.1; P = 0.78). The rate of catheter-related infection per 1000 catheter days was 2.4 in the MSBP group and 1.9 in the SSBP group. Conclusion This study is larger in sample size than the one performed by Raad et al and could not demonstrate better prevention of CRBSIs by MSBP compared with SSBP. A large randomized controlled trial or at least a meta-analysis of any other studies in the literature is necessary to reach to a Conclusion on this issue. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Yamashita H.,National Center for Global Health and Medicine | Suzuki A.,Kawakita General Hospital | Takahashi Y.,National Center for Global Health and Medicine | Kubota K.,National Center for Global Health and Medicine | And 2 more authors.
Annals of Nuclear Medicine | Year: 2012

We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with diffuse fluorodeoxyglucose (FDG) uptake in the lung by 18FDG-positron emission tomography/computed tomography (PET/CT). CT showed nodular shadow, whereas diffuse FDG uptake in PET/CT suggested IVLBCL in the lung. A random skin biopsy provided histological evidence of IVLBCL. The patient responded well to combination chemotherapy. Only two cases of IVLBCL in which diffuse pulmonary FDG uptake was demonstrated have been reported previously. FDG-PET/CT plus random skin biopsy may be useful for the early diagnosis of IVLBCL with pulmonary involvement even without convincing radiological findings in the lung. © The Japanese Society of Nuclear Medicine 2012. Source

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