Kobari General Hospital

Chiba, Japan

Kobari General Hospital

Chiba, Japan

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A 67-year-old woman was detected stage III B adenocarcinoma of the left lung, with epidermal growth factor receptor(EGFR) -mutation. Since chest computed tomography showed enlarged lymph nodes in stations 7 and 1R-4R, radiochemotherapy was recommended. However, she declined radiochemotherapy and the chemotherapy after tumor reduction surgery was chosen. She underwent resection of the left lower lobe and lingular segment, and mediastinal lymph node dissection through a posterolateral thoracotomy by extended bronchoplasty(type C) due to the extranodal invasion of lymph nodes to the lingular segmental bronchus. At postoperative day 21, she underwent right superior mediastinal lymph node dissection through a median sternotomy. Postoperatively, she received 6 cycles of chemotherapy with carboplatin plus paclitaxel followed by gefitinib. 1.5 years later, gamma knife surgery was done for multiple cerebral metastases, followed by 4 cycles of chemotherapy with cisplatin plus pemetrexed and then erlotinib. Six years after surgery, she is surviving without any evidence of disease recurrence. Tumor reduction surgery, when followed by chemotherapy, for EGFR-mutant lung adenocarcinoma is likely to lead to long-term survival.

Kubota A.,Kubota Clinic of Internal Medicine | Kubota A.,Kansai Electric Power Co. | Yabe D.,Kansai Electric Power Co. | Kanamori A.,Kanamori Diabetes Clinic | And 7 more authors.
Journal of Diabetes Investigation | Year: 2014

We analyzed the changes of glycemic control over 12 months and the factors influencing blood glucose in 162 Japanese patients with type 2 diabetes having inadequate glycemic control despite sulfonylurea-based therapy who received add-on sitagliptin. Hemoglobin A1c (HbA1c) decreased significantly after 4 weeks of treatment, and this improvement was maintained for 1 year, although HbA1c was slightly higher in week 52 than in week 24. Comparison of the patients showing a ≥0.4% increase of HbA1c between weeks 24 and 52 (n = 57) with the others (n = 105) showed a significant difference in the change of bodyweight, as well as the dose of glibenclamide (both P < 0.01). Although combined therapy with sitagliptin and a sulfonylurea seems to be effective for at least 1 year, blood glucose levels are more likely to increase again in patients who show greater weight gain after 24 weeks of treatment and those receiving a higher dose of glibenclamide. © 2014 The Authors.

Saito T.,Kobari General Hospital | Ohnuma K.,Juntendo University | Suzuki H.,Kitakashiwa Suzuki Clinic | Dang N.H.,University of Florida | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2013

Dipeptidyl peptidase-4 inhibitors (DPP-4Is) inhibit the inactivation of incretin hormones while also affecting the immune system, since CD26/DPP-4 is involved in immune regulation. The current study shows that the use of DPP-4Is as therapy for type 2 diabetes patients may induce joint symptoms with decrease in plasma SDF-1α level. © 2013 Elsevier Ireland Ltd.

Kubota A.,Kubota Clinic of Internal Medicine | Matsuba I.,Matsuba Clinic | Saito T.,Kobari General Hospital | Nabe K.,Kubota Clinic of Internal Medicine | Seino Y.,Kansai Electric Power Co.
Journal of Diabetes Investigation | Year: 2011

We carried out a retrospective analysis of 40 Japanese patients with type2 diabetes mellitus who received sitagliptin. Glycated hemoglobin (HbA1c) and fasting plasma glucose were significantly decreased from 7.53±0.65% and 155.2±29.4mg/dL at baseline to 6.80±0.60% (P<0.01) and 131.2±22.3mg/dL (P<0.01) at week20, respectively. β-Cell function was evaluated by the secretory units of islets in transplantation (SUIT) index, which was significantly increased from 28.5±14.0 at baseline to 38.6±17.0 at week20 (P<0.01). Multivariate analysis was carried out between ΔHbA1c and several parameters (age, the duration of diabetes, body mass index, triglyceride [TG], C-peptide [CPR], ΔCPR, HbA1c [baseline] and ΔSUIT), which showed HbA1c (baseline; β=0.580, P<0.001) and ΔSUIT (β=0.308, P<0.05) as significant independent determinants of ΔHbA1c. These two variables explained 53% of the variance in HbA1c response. These results suggest that SUIT index can be a clinical marker for the efficacy of sitagliptin in treatment of diabetes mellitus. © 2011 Asian Association for the Study of Diabetes and Blackwell Publishing Asia Pty Ltd.

PubMed | Kanagawa Childrens Medical Center, Sensory Medical, Keio University, Kobari General Hospital and 2 more.
Type: | Journal: The Laryngoscope | Year: 2016

To determine the frequency of the incomplete partition type III anomaly and the genetic and clinical features associated with POU3F4 mutations in children with hearing loss.Retrospective case series from 2000 to 2014 at the National Hospital Organization Tokyo Medical Center and collaborating hospitals.A total of 1,004 patients (from 938 families) who had hearing loss by 10 years of age and had undergone computed tomography scanning of their temporal bones were enrolled in this genetic, clinical, and radiological study.The incomplete partition type III anomaly was identified in six patients (0.6%), each of whom had an enlargement of the vestibular aqueduct at the end close to the vestibule. The six patients also had POU3F4 variants, and a genetic analysis revealed frameshift deletions in three patients, a missense variant in two patients of the same family, and a large deletion in one patient. Three of the six patients with POU3F4 variants were sporadic cases, and in one patient the genetic mutation occurred de novo.It was indicated that POU3F4 mutations can be predicted by incomplete partition type III anomaly by radiological examination of the inner ear. All six of the patients showed mixed hearing loss, but none showed fluctuations in hearing, which may be related to the lack of vestibular aqueduct enlargement at the operculum.4 Laryngoscope, 2016.

Osuka S.,University of Tsukuba | Osuka S.,Japan Society for the Promotion of Science | Matsushita A.,University of Tsukuba | Ishikawa E.,University of Tsukuba | And 7 more authors.
Journal of Neurosurgery | Year: 2012

Object. For several decades, clinicians have predicted intraparenchymal brain pressure or brain tissue compression indirectly based on the degree of distortion of the midline structures (midline shift) and ventricle wall (ventriculomegaly) observed on conventional MRI. However, this method has several limitations. Diffusion tensor imaging (DTI) is a novel MRI technique that can provide information about the microstructural properties of compressed tissue. In this study, the authors evaluated whether DTI can precisely define the degree of tissue compression in patients with chronic subdural hematoma (CSDH). Methods. The study sample consisted of 18 patients (mean age 71 years, 10 men and 8 women) with unilateral CSDH and 12 age-matched volunteers. Diffusion tensor imaging results were acquired before and after the surgical irrigation in the CSDH group. Subdural pressure during the operation was also measured. Fractional anisotropy (FA) values were evaluated at several locations, including the gray matter. Results. The FA values of the gray matter, especially in the caudate nucleus and putamen, were increased in the patients with CSDH compared with the control group. The change in FA data before and after surgery (DFA) correlated with the degree of tissue compression evaluated by measurement of the subdural pressure. Furthermore, the increased FA values in patients with CSDH decreased after surgery. Conclusions. These findings indicate that FA values of the gray matter, especially in the caudate nucleus and putamen, may be important markers of tissue compression. The assessment of FA values of the gray matter will result in a new, less-invasive diagnostic technique to evaluate the degree of brain compression.

Sasaki T.,Jikei University School of Medicine | Hiki Y.,Jikei University School of Medicine | Nagumo S.,Jikei University School of Medicine | Ikeda R.,Jikei University School of Medicine | And 6 more authors.
Diabetology International | Year: 2010

We describe the first case of a 63-year-old male patient with type 2 diabetes mellitus who was newly diagnosed with definitive rheumatoid arthritis (RA) 2 months after starting medication with a dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin. We subsequently performed a survey to determine if other such cases existed among patients who started taking sitagliptin at our university hospital and at hospitals in the Kashiwa and Noda districts. A survey of 147 patients treated with sitagliptin revealed an additional patient whose arthritis was also linked to the use of the DPP-4 inhibitor. This second patient had maintained her RA in a state of remission with diabetes for 15 years; however, 2 months after beginning sitagliptin therapy for control of diabetes, her arthritis relapsed as definitive RA. A recent study on patients with RA and on animals deficient in DPP-4 suggests that a decrease or absence of DPP-4 activity might be associated with cytokine-induced arthritis. On the other hand, a pooled analysis in the United States and a post-marketing monitoring in Japan have revealed that the occurrence of arthritis linked to pharmacologic inhibition of DPP-4 by sitagliptin is rare. Because DPP-4 might possibly be involved in the pathogenesis of RA, and the use of sitagliptin in our cases is linked to activation of RA, it is important to carefully follow patients treated with DPP-4 inhibitor to monitor for onset of RA, although the incidence rate of this adverse event is low. © 2010 The Japan Diabetes Society.

Nagano N.,Kobari General Hospital | Yamamoto T.,Juntendo University | Amano A.,Juntendo University | Kikuchi K.,Juntendo University
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.

PubMed | University of Tsukuba and Kobari General Hospital
Type: Journal Article | Journal: Surgical neurology international | Year: 2016

Paraplegia is mainly caused by spinal cord disease and rarely occurs due to head trauma. In this report, we describe a case of paraplegia caused by cerebral contusions in the bilateral precentral gyri.A 72-year-old man was admitted to our hospital with mildly impaired consciousness and severe pure motor paralysis in both legs. He was healthy until the morning of the day, but his wife found him injured in front of his house upon returning home. He had a subcutaneous hematoma in his occipital region, and seemed to have slipped by accident. Computed tomography of the brain and magnetic resonance imaging (MRI) of his spinal cord revealed no apparent cause of the paraplegia, although an MRI of his brain clearly revealed cerebral contusions in the bilateral precentral gyri. The cerebral contusion was diagnosed as the cause of pure motor paralysis of lower extremities. He received rehabilitation, and manual muscle testing of his legs revealed improvements. In the subacute phase, the precentral gyrus lesion disappeared on MRI.We must emphasize that cerebral contusion can be a differential diagnosis for paraplegia. In the acute phase, fluid-attenuated inversion recovery (FLAIR) MRI coronal and sagittal images are useful for identifying precentral gyri contusions. Paraplegia caused by a cerebral contusion may be misdiagnosed as a spinal concussion due to the disappearance of the precentral gyrus lesion on FLAIR MRI in the subacute phase.

PubMed | Kobari General Hospital
Type: Journal Article | Journal: Diabetes research and clinical practice | Year: 2013

Dipeptidyl peptidase-4 inhibitors (DPP-4Is) inhibit the inactivation of incretin hormones while also affecting the immune system, since CD26/DPP-4 is involved in immune regulation. The current study shows that the use of DPP-4Is as therapy for type 2 diabetes patients may induce joint symptoms with decrease in plasma SDF-1 level.

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