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Kawasaki, Japan

Naka T.,Kawasaki Saiwai Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2012

Recently, T 1 weighted image (T 1WI) has proven to be useful for diagnosing carotid plaque. This time, the image parameter of two-dimensional spin echo (2D SE) T 1WI was examined. Phantoms that imitated muscle and carotid plaque were made. Signal noise ratio (SNR) and the contrast of phantoms were examined when the flip angle (FA) of radio frequency (RF) pulse, repetition time (TR), and echo train length (ETL) was changed. A visual evaluation was done in a clinical case. Both SE and fast spin echo (FSE) SNR improved according to the extension of TR, and the contrast decreased. Moreover, the contrast improved when there was a lot of ETL and the FA of RF pulse. It is thought that this is because SNR and the contrast depend on the interrelation of TR, T 1 value, and the FA of RF pulse. When the FA of RF pulse was set to 70 degrees and the TR was set to 400 ms resulting from the phantom experiment, clinical cases obtained great results. This examination confirmed the utility of 2D SE in carotid plaque inspection. Source

Diffusion weighted imaging (DWI) using a low b value for examination of the body is not common, so we examined its usefulness. Phantom experiments were performed in which I changed the length of the echo time (TE), with and without short inversion time inversion recovery (STIR). The signal intensity of each phantom was reduced by using a longer TE or by combination with STIR, but contrast was improved. We noted a similar pattern in clinical cases, and concluded that the results of the phantom study and clinical cases indicated the potential usefulness of TE with moderate STIR. Low-b DWI using appropriate imaging parameters gave better results than high-b DWI followed by visual assessment. The T1 value of normal liver cells is shortened by incorporating gadolinium-ethoxybenzyl-diethylene-triaminepentaacetic acid (Gd-EOB-DTPA). Normal liver cells are close to the null point in STIR-low-b DWI under these conditions. The signal-to-noise ratio (SNR) of normal liver cells thus decreases, unlike that for tumors containing no normal liver cells, giving improved contrast. At high SNRs, the use of low-b DWI provides several advantages: the anatomical location structure is easy to identify, and there is less left lateral division of liver signal degradation. We thus conclude STIR-low-b DWI after injection of Gd-EOB-DTPA to be a useful technique. Source

Nagao K.,Nihon University | Nonogi H.,Shizuoka General Hospital | Gaieski D.F.,Thomas Jefferson University | Ito N.,Kawasaki Saiwai Hospital | And 6 more authors.
Circulation | Year: 2016

Background - During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Methods and Results - Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation. In each of 4 groups stratified by initial cardiac arrest rhythm (shockable versus nonshockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary end point, favorable 30-day neurological outcome after out-of-hospital cardiac arrest. Prehospital resuscitation duration to achieve prehospital return of spontaneous circulation ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838-0.844). Although the frequency of favorable neurological outcome was significantly different among the 4 groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group; P<0.001), minimum prehospital resuscitation duration did not differ widely among the 4 groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander resuscitation group). Conclusions - On the basis of time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with bystander-witnessed out-of-hospital cardiac arrest. © 2016 American Heart Association, Inc. Source

Mori Y.,Kawasaki Saiwai Hospital | Kamada T.,Kawasaki Saiwai Hospital | Ochiai R.,Toho University
European Journal of Anaesthesiology | Year: 2014

BACKGROUND Acute kidney injury (AKI) after surgery is associated with an increased risk of adverse events and death. Atrial natriuretic peptide (ANP) dilates the preglomerular renal arteries and inhibits the renin-angiotensin axis. A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery, but it is not known whether it reduces the incidence of AKI or the mortality rate. OBJECTIVE To evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest. DESIGN A randomised controlled study. SETTING Operating room and intensive care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan. PATIENTS Forty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm. INTERVENTION Patients were assigned randomly to receive a fixed dose of ANP (0.0125mgkg1 min1) or placebo. The infusion was started after induction of anaesthesia and continued for 24 h postoperatively. MAIN OUTCOME MEASURES The primary end-point was the incidence of AKI within 48 h after surgery. RESULTS AKI developed in 30% of patients who received ANP compared with 73% of patients who received placebo (P=0.014). Intraoperative urine output was almost 1 l greater in patients who received ANP (1865-1299 versus 991-480 ml in the control group, P=0.005). However, there were no differences in mean arterial pressure or number of episodes of hypotension between the groups. Length of hospital and intensive care stays were not significantly different, nor was there a difference in 30-day mortality. No patients required haemodialysis or continuous renal replacement therapy. CONCLUSION We found that an intravenous infusion of ANP at 0.0125mgkg1 min1 is an effective intervention for reducing the incidence of postoperative AKI, and appears to afford a degree of renal protection during and after cardiovascular surgery. © 2014 Copyright European Society of Anaesthesiology. Source

Koike Y.,Kawasaki Saiwai Hospital | Ishida K.,Kawasaki Saiwai Hospital | Hase S.,Kawasaki Saiwai Hospital | Kobayashi Y.,St. Marianna University School of Medicine | And 3 more authors.
Journal of Vascular and Interventional Radiology | Year: 2014

Purpose To assess the feasibility and diagnostic performance of dynamic volumetric computed tomography (CT) angiography with large-area detectors in the detection and classification of endoleaks after endovascular aneurysm repair (EVAR). Materials and Methods Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position was used to scan the entire stent graft with a 16-cm-area detector during the first follow-up examination after EVAR. There were 39 consecutive patients (36 men and 3 women; mean age, 74 y ± 8.7) examined with approximately 14-20 intermittent scans (temporal resolution, 2 s; scan range, 160 mm). The effective radiation dose, image quality, interobserver and intraobserver agreement for endoleak detection, and time delay between peak enhancement of the aorta and endoleaks were evaluated. Results All examinations with the patient in Fowler position enabled the entire stent graft to be scanned and were rated as diagnostic. The mean effective radiation dose was 13.1 mSv. Endoleaks were detected in eight patients (type Ia, n = 1; type II, n = 6; type III, n = 1). Interobserver agreement (κ = 0.794) and intraobserver agreement (κ = 1.00) for detection of endoleaks were excellent. The mean time delay between peak enhancement of the aorta and the endoleaks was significantly less for type I/III endoleaks (2.0 s ± 0) compared with type II endoleaks (5.3 s ± 1.0; P <.001). Conclusions Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position is feasible after EVAR. Dynamic information, including cine imaging, the timing of peak enhancement, and the Hounsfield units index, is useful in detecting and classifying endoleaks. © 2014 SIR. Source

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