Kato A.,Kawasaki Municipal Tama Hospital |
Morishima H.,Kawasaki Municipal Tama Hospital |
Nagashima G.,Kawasaki Municipal Tama Hospital
Japanese Journal of Neurosurgery | Year: 2017
We report a case of brain edema immediately after cranioplasty. A 57-year-old woman underwent surgical clipping for subarachnoid hemorrhage and decompressive craniectomy. She had cranioplasty on the 83rd hospital day. Although the surgery was completed uneventfully, CT of the head showed brainstem edema immediately after the cranioplasty. The brainstem edema developed into cerebral and cerebellar edema, and ultimately brain death. We considered that a bone defect and midline shift may have caused asymptomatic sinking skin flap syndrome (SSFS). We considered further that the cause of the brain edema could have been deterioration of autoregulation, reperfusion, negative pressure by subgaleal drain, venous stasis, or SSFS. The fatality rate due to brain edema that occurs immediately after cranioplasty is high. Cranioplasty is a relatively simple surgery; however, complications include seizure, infection, and epidural hematoma. It should also be kept in mind that brain edema may occur, and these complications must be explained to the families as an informed consent before surgery. © 2017, Japanese Congress of Neurological Surgeons. All rights reserved.
Matsuzaki K.,Kawasaki Municipal Tama Hospital |
Upton D.,University of Worcester
International Wound Journal | Year: 2013
This review and case study report considers the evidence to indicate that the progress of wound healing is negatively affected by the presence of stressors and in circumstances where patients are in painIt considers the relationship between perceptions of pain, stress and delayed wound healing with a specific focus on guidance for clinical practiceIt is appreciated that although the literature has examined these issues in the management of acute wounds, demonstrating that psychological stress can have detrimental effects on the wound-healing process, the evidence to support this link in relation to chronic wounds is limitedThe review considers evidence indicating that punch biopsy wounds heal more slowly in subjects under stress on account of caring for family members with long-term illnesses and also considers briefly the relationship between cortisol secretion in response to stress and the consequent influences on cytokine levels and the wound-healing process. © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.
PubMed | Showa University, Tokyo Women's Medical University and Kawasaki Municipal Tama Hospital
Type: | Journal: Nephrology (Carlton, Vic.) | Year: 2016
Immunoglobulin (Ig) A nephropathy (IgAN) is a known autoimmune disease due to abnormal glycosylation of IgA1, and occasionally, IgG co-deposition occurs. The prognosis of IgG co-deposition with IgAN is adverse, as shown in the previous studies. However, in the clinical setting, monoclonality of IgG co-deposition with IgAN has not been observed. We describe a case of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) combined with IgAN in a renal allograft. A-21-year-old man developed end-stage renal failure with unknown aetiology and underwent living-donor kidney transplantation from his mother 2years after being diagnosed. One year after kidney transplantation, proteinuria 2+ and haematuria 2+ were detected; allograft biopsy revealed mesangial IgA and C3 deposits, indicating a diagnosis of IgAN. After tonsillectomy and steroid pulse therapy, proteinuria and haematuria resolved. However, 4years after transplantation, pedal oedema, proteinuria (6.89g/day) and allograft dysfunction (serum creatinine (sCr) 203.3mol/L) appeared. A second allograft biopsy showed mesangial expansion and focal segmental proliferative endocapillary lesions with IgA1 and monoclonal IgG1 depositions. Electron microscopic analysis revealed a massive amount of deposits, located in the mesangial and subendothelial lesions. A diagnosis of PGNMID complicated with IgAN was made, and rituximab and plasmapheresis were added to steroid pulse therapy. With this treatment, proteinuria was alleviated to 0.5g/day, and the allograft dysfunction recovered to sCr 132.6mol/L. This case suggests a necessity for investigation of PGNMID and IgA nephropathy in renal allografts to detect monoclonal Ig deposition disease.
PubMed | Showa University, Tokyo Women's Medical University, Toda Chuo General Hospital and Kawasaki Municipal Tama Hospital
Type: | Journal: Nephrology (Carlton, Vic.) | Year: 2016
We carried out a clinicopathological analysis of cases presenting with interstitial fibrosis and tubular atrophy (IF/TA) after renal transplantation in an attempt to clarify the mechanisms underlying the development and prognostic significance of IF/TA.IF/TA was diagnosed in 35 renal allograft biopsy specimens (BS) obtained from 35 renal transplant recipients under follow up at the Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, between January 2014 and March 2015.IF/TA was diagnosed at a median of 39.9months after the transplantation. Among the 35 patients with IF/TA, 19 (54%) had a history of acute rejection. Among the 35 BS showing evidence of IF/TA, the IF/TA was grade I in 25, grade II in 9, and grade III in 1. Arteriosclerosis of the middle-sized arteries was observed in 30 BS (86%). We then classified the 35 BS showing evidence of IF/TA according to their overall histopathological features, as follows; IF/TA alone (6 BS; 17%), IF/TA+medullary ray injury (12 BS; 34%), and IF/TA+rejection (12 BS; 34%). Loss of the renal allograft occurred during the observation period in one of the patients (3%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 15 patients (43%).The results of our study suggests that rejection contributes to IF/TA in 30-40% of cases, medullary ray injury in 30-40% of cases, and nonspecific injury in 20% of cases. IF/TA contributes significantly to deterioration of renal allograft function.
PubMed | Kawasaki Municipal Tama Hospital, Shiga University of Medical Science, Jikei University School of Medicine, Osaka University and 8 more.
Type: | Journal: Radiological physics and technology | Year: 2016
The goal of this study is to develop a more appropriate shielding calculation method for computed tomography (CT) in comparison with the Japanese conventional (JC) method and the National Council on Radiation Protection and Measurements (NCRP)-dose length product (DLP) method. Scattered dose distributions were measured in a CT room with 18 scanners (16 scanners in the case of the JC method) for one week during routine clinical use. The radiation doses were calculated for the same period using the JC and NCRP-DLP methods. The mean (NCRP-DLP-calculated dose)/(measured dose) ratios in each direction ranged from 1.70.6 to 5524 (meanstandard deviation). The NCRP-DLP method underestimated the dose at 3.4% in fewer shielding directions without the gantry and a subject, and the minimum (NCRP-DLP-calculated dose)/(measured dose) ratio was 0.6. The reduction factors were 0.0360.014 and 0.240.061 for the gantry and couch directions, respectively. The (JC-calculated dose)/(measured dose) ratios ranged from 118.7 to 404340. The air kerma scatter factor is expected to be twice as high as that calculated with the NCRP-DLP method and the reduction factors are expected to be 0.1 and 0.4 for the gantry and couch directions, respectively. We, therefore, propose a more appropriate method, the Japanese-DLP method, which resolves the issues of possible underestimation of the scattered radiation and overestimation of the reduction factors in the gantry and couch directions.
Matsuzaki K.,Kawasaki Municipal Tama Hospital |
Matsuzaki K.,St. Marianna University School of Medicine |
Kumagai N.,St. Marianna University School of Medicine
European Journal of Plastic Surgery | Year: 2013
Background: Vitiligo is an acquired depigmentation of the skin characterized by white spots with well-defined margins, causing psychological stress in patients due to cosmetic concerns. We examined 27 patients who underwent vitiligo treatment using autologous cultured keratinocytes. Methods: The study comprised 20 patients with segmental vitiligo and seven patients with generalized vitiligo, and they were followed up for at least 1 year postoperatively. In all 27 cases, topical steroid or ultraviolet therapy had been previously performed by dermatologists, but this treatment had been ineffective. The patients' vitiligo had stabilized. The patients were treated using keratinocytes obtained from primary culture using Green's techniques or from first passage. Dispase treatment was used to detach the stratified cultured epithelial sheets from their culture dishes. The detached sheets shrank to approximately one half to two thirds of their original size on the culture dish. After the recipient site was completely epithelialized, the skin was exposed to sunlight. Results: For patients with segmental vitiligo, 12 had a good therapeutic outcome (90 % or more repigmentation) after the first surgery. This number increased to 14 when patients with multiple surgeries were included. There were six patients with fair outcomes (50-90 % repigmentation), and no patients with poor outcomes (50 % or less repigmentation). For patients with generalized vitiligo, no patients had a good outcome despite multiple surgeries. There were three patients with fair outcomes, and four patients with no change outcomes. Conclusions: Cultured keratinocyte grafting was a more effective treatment for segmental vitiligo than for generalized vitiligo. Level of Evidence: Level IV, therapeutic study. © 2013 The Author(s).
PubMed | Kawasaki Municipal Tama Hospital, Noborito Clinic and St. Marianna University School of Medicine
Type: | Journal: Hemodialysis international. International Symposium on Home Hemodialysis | Year: 2016
Vascular access intervention therapy (VAIVT) has been positioned as the first choice of treatment for stenosis lesions frequently observed in arteriovenous fistula (AVF) for hemodialysis patients in Japan. Furthermore, increased blood flow can provide a stable dialysis. In contrast, it has been reported that excess blood flow of AVF causes high-output heart failure. Although VAIVT is used to increase blood flow of AVF, the impact of VAIVT on cardiac load has been rarely reported. We examined the factors associated with cardiac load in hemodialysis patients undergoing VAIVT by measuring levels of human atrial natriuretic polypeptide (hANP) and brain natriuretic peptide (BNP) before and after VAIVT. Data were extracted on hemodialysis patients who underwent measurements of hANP and BNP in before and after VAIVT at our facility and related facilities between February 2014 and December 2014. Nineteeen patients (median age, 73.0 [66.5-80.5] years; male, 52.6%; 36.8% with diabetes; median duration of dialysis treatment, 50.0 [21-109] months) were enrolled in this study. Flow volume of AVF was higher after VAIVT than that before VAIVT (442.0 vs. 758.0 mL/minute, P<0.001). Moreover, resistance index (RI) of AVF after VAIVT was lower than that before VAIVT (0.61 vs. 0.53, P<0.01). Although hANP did not change before and after VAIVT (55.6 vs. 54.9 pg/mL, P=0.099), BNP after VAIVT was significantly higher than that before VAIVT (145.2 vs. 175.0 pg/mL, P<0.05). Factors correlated with the increase in BNP were flow volume of AVF before VAIVT (r=-0.458, P=0.049) and levels of BNP before VAIVT (r=0.472, P=0.041). There was no significant correlation between the increase in hANP with flow volume of AVF before VAIVT, levels of hANP before VAIVT. Patients with high levels of BNP and low flow volume of AVF before VAIVT were considered to have a high risk of developing heart failure after VAIVT.
Takeichi H.,Tokai University |
Kawaguchi A.T.,Tokai University |
Murayama C.,Tokai University |
Koike J.,Tokai University |
And 2 more authors.
Artificial Organs | Year: 2014
Liposome-encapsulated hemoglobin (LEH) has been reported to accelerate wound healing in the stomach and skin in an experimental setting. LEH was tested in bronchial anastomotic healing after radiation and pneumonectomy in the rat. Sprague-Dawley rats (n=61) received preoperative radiation (20Gy) to the chest and underwent left pneumonectomy with bronchial stump closure using the Sweet method 4 days later, when they were randomized to receive intravenous infusion of LEH with high O2 affinity (P50O2=17mmHg, 10mL/kg, n=32) or saline (n=29). Additional rats (n=18) were treated in the same way without preoperative radiation. Bronchial anastomotic healing was evaluated 2 days after surgery by determining the bursting pressure and infiltration of neutrophils, monocytes, and macrophages. Bronchial bursting pressure was elevated in the rats receiving LEH both in the unirradiated group (LEH 212±78 vs. saline 135±63mmHg, P<0.05) and in rats with preoperative radiation (LEH 162±48 vs. saline 116±56mmHg, P<0.01). Moreover, the percentage of rats with bursting pressure <100mmHg tended to be smaller in the unirradiated group (LEH 1/9 [11.1%] vs. saline 4/9 [44.4%], NS) and was significantly reduced in irradiated animals (LEH 3/32 [9.4%] vs. saline 11/29 [38%], P<0.05). There were no morphological differences except for macrophage infiltration to the anastomotic area, which was significantly prominent in the LEH-treated rats (P<0.05) regardless of the presence or absence of preoperative irradiation (IR). The results suggest that LEH with high O2 affinity may improve mechanical strength and morphological findings in bronchial anastomosis in rats regardless of the presence or absence of preoperative IR. The irradiated rats later treated with LEH had equivalent or better bronchial healing than that of saline-treated naïve animals undergoing pneumonectomy alone. © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
Matsuzaki K.,Kawasaki Municipal Tama Hospital
Japanese Journal of Plastic Surgery | Year: 2012
As a guideline to the treatment of chronic wounds including pressure ulcers, Wound Bed Preparation (WBP) was proposed in 2000. Meanwhile, the Japanese Society of Pressure Ulcers issued the guideline for the prevention and management of pressure ulcers in 2009. Clinical questions, such as "What kind of wound dressing should be used" for the prevention of pressure ulcers, superficial pressure ulcers, and deep pressure ulcers, are provided with statements of recommendation and the degree of recommendation in the guideline. For deep pressure ulcers, statements of recommendation and the degree of recommendation are described by subdividing into 6 items of "removal of necrotic tissues," "control of infection and inflammation, " "exudates control, " "treatment of pocket wounds, " "scale-down of wounds, " and "facilitating granulation. " In this article, we reviewed the role of wound dressing expected in the treatment of pressure ulcers, in accordance with the concepts of the guideline and WBP, also bearing in mind the uniqueness of the mechanism of development for pressure ulcers which is different from other chronic wounds.
PubMed | Kawasaki Municipal Tama Hospital
Type: Journal Article | Journal: No shinkei geka. Neurological surgery | Year: 2016
Background:Sinking skin flap syndrome(SSFS)manifests as subjective symptoms, such as headache, dizziness, and undue fatigability, in addition to neurologic symptoms, such as hemiplegia, aphasia, and perceived failure, when the skin over a bone defect sinks in the weeks or months following a decompressive craniectomy. Indeed, these symptoms can improve after a cranioplasty. Case presentation:A 58-year-old woman presented with a disturbance of consciousness. She was found to have a subarachnoid hemorrhage due to a ruptured right middle cerebral artery aneurysm. She underwent a craniotomy with clipping of the affected artery and a decompressive craniectomy on the same day. Post-operatively, the disturbance of consciousness improved, but the left-sided paralysis persisted. She complained of intractable headaches, was disoriented, and a lack of spontaneity emerged as the skin over the bone defect sank. She underwent cranioplasty on the 43rd day after admission, and the symptoms resolved promptly after surgery. Rehabilitation was canceled at the onset of symptoms, but resumed after the symptoms improved. Based on perfusion MRI, the cerebral blood flow(CBF):cerebral blood volume(CBV)ratio of the affected side increased before and after surgery compared with the healthy side. A lumboperitoneal shunt was placed on the 52nd day after admission to manage the hydrocephalus. She was discharged from the hospital with higher brain dysfunction and a mild state of paralysis. Conclusion:The timing of cranioplasty in patients with SSFS has not yet been established, but surgery should be performed before symptoms appear because SSFS impairs rehabilitative efforts.