Kochi Medical School Hospital

Kochi, Japan

Kochi Medical School Hospital

Kochi, Japan
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Miyamura M.,Kochi Medical School Hospital | Yokota J.,Kochi Medical School Hospital | Saibara T.,Kochi Medical School
Yakugaku Zasshi | Year: 2016

Nonalcoholic steatohepatitis (NASH) is a chronic progressive liver disease characterized by intense liver steatosis accompanied by hepatocyte destruction, inflammation and fibrous, despite little or no history of alcoholic consumption. There are also cases of drug-induced secondary steatohepatitis. Drug-induced steatohepatitis is a relatively rare type of drug-induced liver disease, but close attention to the possible onset of steatohepatitis is needed when drugs with the potential to induce fatty liver are prescribed for long term use. Estrogen is a factor indispensable to smooth fatty acid β-oxidation in hepatocytes. However, treatment with Tamoxifen markedly suppresses fatty acid β-oxidation in the liver. As free fatty acids are toxic, their accumulation results in the activation of alternative fatty acid oxidation pathways mediated by CYP2E1 in cytosol and lipid peroxidases in peroxisomes in hepatocytes. CYP2E1 enhances lipid peroxidation and dicarboxylic acid synthesis via the activation of fatty acid ω-oxidation that injures mitochondria and results in the emergence of ballooned hepatocytes. In such cases, the attenuation of alternative fatty acid oxidation pathways could have some beneficial effects on mitochondrial injury, since fibrates (PPAR-α ligands) are potent enough to stimulate neutral fat consumption through the activation of peroxisomal fatty acid β-oxidation. Fortunately, fibrates attenuate serum estrogen levels by afecting estrogen receptor expression, so the co-administration of ibrates with Tamoxifen is expected to exert higher efficacy in breast cancer patients with Tamoxifen-induced hepatic steatosis. © 2016 The Pharmaceutical Society of Japan.


Yokota J.,Kochi Medical School Hospital
Yakugaku Zasshi | Year: 2017

The super-aging society in Japan is currently experiencing growing demand for treatments that improve health and longevity. To develop new high-functional foods and search for pharmaceutical candidates among foods and natural products, it is necessary to promote organic collaboration among researchers in pharmacy, medicine, nutrition, and other fields to encourage joint utilization of their technologies. Recently, attempts have been made to use numerous foods and natural products to prevent or treat diseases based on scientific evidence. We have been endeavoring to develop preventive medicines from foods and natural ingredients by engaging in relevant activities such as screening these substances to determine the structures of their eŠective ingredients, verifying pharmacological activities, and conducting clinical trials. In this study, the eŠectiveness of Goishi tea (postfermented tea) and Flos Lonicerae (Japanese honeysuckle) for metabolic syndrome and hepatic disorders, respectively, was explored. Multicomponent foods and natural ingredients have diverse eŠects produced by the actions of individual components as well as the interactions among diŠerent components. Additionally, when using natural ingredients and similar materials, it is necessary to consider the diŠerent extraction efficiencies of various methods and their absorption, deposition, metabolism, and excretion after consumption. The influence of intestinal bacteria and other factors is also critical. In our study, the administration of Goishi tea and Flos Lonicerae in animal models of disease demonstrated high functionality. Based on these findings, we plan to conduct further investigations, including clinical studies in human participants, focusing on the potential usefulness of Goishi tea and Flos Lonicerae as functional foods. © 2017 The Pharmaceutical Society of Japan.


Mibu K.,Kochi Medical School Hospital | Yatabe T.,Kochi Medical School | Hanazaki K.,Kochi Medical School
Journal of Artificial Organs | Year: 2012

Blood glucose management is one of the important therapies in the intensive care unit (ICU). However, blood glucose management using the sliding-scale method increases the workload of ICU nurses. An artificial pancreas, STG-22, has been developed to continuously monitor blood glucose levels and to maintain them at appropriate levels. In this study, we examined the hypothesis that compared to conventional methods, blood glucose management using the STG-22 reduces the workload of ICU nurses and has a positive impact on awareness regarding the management of blood glucose. This study included 45 patients who underwent elective surgery and were treated at the ICU postoperatively. The patients were separated into the following two groups: (1) blood glucose was maintained using the STG-22 (AP group) and (2) blood glucose was maintained using the sliding-scale method (SS group). In addition, a questionnaire was developed for an awareness survey of ICU nurses (N = 20). The frequency of blood sampling and number of double checks were significantly lower in the AP group (1.3 ± 1.4 vs. 8.9 ± 8.1 times/admission, P < 0.001; 1.0 ± 1.4 vs. 9.8 ± 8.5 times/admission, P < 0.001). The time needed for glucose management per admission was significantly shorter in the AP group (9 ± 13 vs. 27 ± 24 min/admission; P = 0.003). Use of STG-22 for glucose management in the ICU increased the degree of attention given by nurses to glucose management and contributed to an improved sense of security. In conclusion, using the STG-22 in the ICU reduces the workload of ICU nurses compared to using the sliding-scale method. It also contributed to the reduction of the ICU nurses' anxiety related to the management of blood glucose. © 2011 The Japanese Society for Artificial Organs.


Mitsukawa N.,Chiba University | Saiga A.,St Marys Hospital | Akita S.,Chiba University | Kubota Y.,Chiba University | And 2 more authors.
Annals of Plastic Surgery | Year: 2015

One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.


Kamouchi M.,Kyushu University | Kumagai N.,Kochi Medical School Hospital | Okada Y.,National Hospital Organization Kyushu Medical Center | Origasa H.,University of Toyama | And 2 more authors.
Cerebrovascular Diseases | Year: 2012

Background: Currently, there are only a few risk scores to predict long-term recurrence of ischemic stroke and no risk score has been developed for the Asian population. The aim of the present study was to develop a new risk score to predict 1-year recurrence in Japanese patients with ischemic stroke and compare it with the other ones. Methods: Data used in this analysis were extracted from the Fukuoka stroke registry (FSR) database, including 3,067 Japanese patients who experienced ischemic stroke. FSR is a multicenter, hospital-based, prospective registry of Japanese patients with acute stroke. Associations between potential clinical variables that could be involved in the increase of risk and recurrence of ischemic stroke within 1 year after initial stroke onset were evaluated using univariate and multivariate analyses. To calculate risk scores, weighted points proportionally based on standardized coefficient values were assigned to variables that were identified to be significant risks for recurrence by multivariate analysis. The Hosmer-Lemeshow goodness-of-fit test was used to test agreement between a predicted outcome using a model and an actual observed outcome. Kaplan-Meier analysis was used to estimate average cumulative recurrence rates within three risk groups. Intergroup comparisons in recurrence rate among the risk groups were performed using a log-rank test. Results: Univariate and multivariate analyses identified nine significant predictors for 1-year recurrence, to which we assigned the following points: age (65-74 years, 1 point; ≥75 years, 2 points), hypertension (1 point), diabetes mellitus (1 point), smoker (1 point), atrial fibrillation (1 point), cardiac diseases (1 point), chronic kidney disease (1 point), nonlacunar stroke (1 point), and previous ischemic stroke (2 points). The Hosmer-Lemeshow goodness-of-fit test demonstrated good agreement between the observed and predicted recurrence rate (χ2 = 2.30, p = 0.97). The ROC curve for the risk score models showed acceptable discriminant power with a C-statistic of 0.636 (95% confidence interval: 0.573-0.698). Trends toward increased risk of recurrence with higher scores were observed. The 1-year recurrence rates were 2.93, 5.83 and 7.96% in low- (≤3 points), intermediate (4-5 points), and high-risk groups (≥6 points), respectively. Kaplan-Meier curves with log-rank test showed a significant difference in recurrence among the three risk groups (p < 0.0001). Conclusions: A new risk score was developed and successfully validated. Our results suggest that this simple risk score enables clinicians to assess 1-year recurrence risk in Japanese patients with ischemic stroke. Copyright © 2012 S. Karger AG, Basel.


Akita S.,Chiba University | Mitsukawa N.,Chiba University | Kazama T.,Chiba University | Kuriyama M.,Kochi Medical School Hospital | And 6 more authors.
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Background: Lymphoscintigraphy is the gold-standard examination for extremity lymphoedema. Indocyanine green lymphography may be useful for diagnosis as well. We compared the utility of these two examination methods for patients with suspected extremity lymphoedema and for those in whom surgical treatment of lymphoedema was under consideration. Methods: A total of 169 extremities with lymphoedema secondary to lymph node dissection and 65 extremities with idiopathic oedema (suspected primary lymphoedema) were evaluated; the utility of indocyanine green lymphography for diagnosis was compared with lymphoscintigraphy. Regression analysis between lymphoscintigraphy type and indocyanine green lymphography stage was conducted in the secondary lymphoedema group. Results: In secondary oedema, the sensitivity of indocyanine green lymphography, compared with lymphoscintigraphy, was 0.972, the specificity was 0.548 and the accuracy was 0.816. When patients with lymphoscintigraphy type I and indocyanine green lymphography stage I were regarded as negative, the sensitivity of the indocyanine green lymphography was 0.978, the specificity was 0.925 and the accuracy was 0.953. There was a significant positive correlation between the lymphoscintigraphy type and the indocyanine green lymphography stage. In idiopathic oedema, the sensitivity of indocyanine green lymphography was 0.974, the specificity was 0.778 and the accuracy was 0.892. Conclusion: In secondary lymphoedema, earlier and less severe dysfunction could be detected by indocyanine green lymphography. Indocyanine green lymphography is recommended to determine patients' suitability for lymphaticovenular anastomosis, because the diagnostic ability of the test and its evaluation capability for disease severity is similar to lymphoscintigraphy but with less invasiveness and a lower cost. To detect primary lymphoedema, indocyanine green lymphography should be used first as a screening examination; when the results are positive, lymphoscintigraphy is useful to obtain further information. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons.Published by Elsevier Ltd. All rights reserved.


Akita S.,Chiba Cancer Center | Mitsukawa N.,Chiba University | Kuriyama M.,Kochi Medical School Hospital | Hasegawa M.,Chiba University | And 5 more authors.
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2014

Background: The best therapeutic approach for patients with sub-clinical lymphoedema and symptomatic early-stage lymphoedema has not been determined yet. Methods: The prognosis of lymphatic function after lymphadenectomy for gynaecological cancer was observed in a cohort study of 192 lower limbs. Lymphatic function was evaluated by indocyanine green lymphography. Splash patterns were examined to determine if patients with this pattern tended to progress to symptomatic lymphoedema, and the efficacy of the compression therapy was also investigated. We also investigated the efficacy of lymphaticovenular anastomosis (LVA) in patients who exhibited a stardust pattern. Results: Patients with splash patterns on lymphography may progress to symptomatic lymphoedema with a significantly higher frequency compared with the others, with a relative ratio of 1.62. Compression therapy did not slow the progression of patients with splash patterns to stardust patterns. LVA for the patients who had recently shown stardust patterns eliminated the need for compression therapy in 44.8% of patients. Conclusion: Patients with splash patterns should be followed up carefully for sub-clinical lymphoedema. However, there is no method to completely prevent these patients from developing stardust patterns associated with symptomatic lymphoedema. When patients become symptomatic, their lymphatic function may be improved by LVA. However, the limited effectiveness of this procedure should be clearly explained to patients before surgery. © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Kawano T.,Kochi Medical School | Taniwaki M.,Kochi Medical School Hospital | Ogata K.,Kochi Medical School Hospital | Sakamoto M.,Kochi Medical School Hospital | Yokoyama M.,Kochi Medical School
Journal of Anesthesia | Year: 2014

With the aim to optimize surgical safety, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSCL) in 2008. The SSCL has been piloted in many countries worldwide and shown to improve both safety attitudes within surgical teams and patient outcomes. In the study reported here we investigated whether implementation of the SSCL improved the teamwork and safety climate at a single university hospital in Japan. All surgical teams at the hospital implemented the SSCL in all surgical procedures with strict adherence to the SSCL implementation manual developed by WHO. Changes in safety attitudes were evaluated using the modified operating-room version of the Safety Attitudes Questionnaire (SAQ). A before and after design was used, with the questionnaire administered before and 3 months after SSCL implementation. Our analysis revealed that the mean scores on the SAQ had significantly improved 3 months after implementation of the SSCL compared to those before implementation. This finding implies that effective implementation of the SSCL could improve patient outcomes in Japan, similar to the findings of the WHO pilot study. © 2013 Japanese Society of Anesthesiologists.


PubMed | Kochi Medical School Hospital
Type: Journal Article | Journal: Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan | Year: 2016

Nonalcoholic steatohepatitis (NASH) is a chronic progressive liver disease characterized by intense liver steatosis accompanied by hepatocyte destruction, inflammation and fibrous, despite little or no history of alcoholic consumption. There are also cases of drug-induced secondary steatohepatitis. Drug-induced steatohepatitis is a relatively rare type of drug-induced liver disease, but close attention to the possible onset of steatohepatitis is needed when drugs with the potential to induce fatty liver are prescribed for long term use. Estrogen is a factor indispensable to smooth fatty acid -oxidation in hepatocytes. However, treatment with Tamoxifen markedly suppresses fatty acid -oxidation in the liver. As free fatty acids are toxic, their accumulation results in the activation of alternative fatty acid oxidation pathways mediated by CYP2E1 in cytosol and lipid peroxidases in peroxisomes in hepatocytes. CYP2E1 enhances lipid peroxidation and dicarboxylic acid synthesis via the activation of fatty acid -oxidation that injures mitochondria and results in the emergence of ballooned hepatocytes. In such cases, the attenuation of alternative fatty acid oxidation pathways could have some beneficial effects on mitochondrial injury, since fibrates (PPAR- ligands) are potent enough to stimulate neutral fat consumption through the activation of peroxisomal fatty acid -oxidation. Fortunately, fibrates attenuate serum estrogen levels by affecting estrogen receptor expression, so the co-administration of fibrates with Tamoxifen is expected to exert higher efficacy in breast cancer patients with Tamoxifen-induced hepatic steatosis.


PubMed | Kochi University, University of Tokyo and Kochi Medical School Hospital
Type: | Journal: Surgery today | Year: 2017

To establish the safety of laparoscopic-assisted colorectal resection for colorectal cancer in elderly patients aged80years.Data were obtained from a chart review of patients who underwent colorectal cancer resection between 2009 and 2014 in Kochi Medical School. The effect of patient age on the extent of lymph node dissection and operative safety was assessed by comparing the short-term results of elderly patients with those of younger patients after propensity score matching.Of a total of 506 patients with colorectal cancer, 398 underwent laparoscopic surgery and 23% of these patients were aged80years old. The elderly patients tended to have poorer general condition and larger tumors, although no significant differences were found in tumor invasion, lymph node metastasis, or synchronous distant metastasis between the groups. After adjustment for preoperative factors, we noted that the elderly patients tended to undergo less aggressive surgical resection (P=0.01). Further analysis after including surgical factors for propensity score matching revealed a similar rate of complications in the two groups (24 vs. 25%, respectively; P=0.85), and similar postoperative death rates and length of postoperative hospital stay.The findings of the present study demonstrate that laparoscopic surgery for colorectal cancer should not be avoided based on simply the age of the patient.

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