Koseiren Tsurumi Hospital

Beppu, Japan

Koseiren Tsurumi Hospital

Beppu, Japan

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Hidaka S.,Koseiren Tsurumi Hospital | Kawabata Y.,Kinki University | Nakayama T.,Koseiren Tsurumi Hospital | Kashima J.,Koseiren Tsurumi Hospital | And 9 more authors.
Journal of the Japan Diabetes Society | Year: 2013

An 81-year-old female was diagnosed with Hashimoto's thyroiditis in 1998. In 2002, she developed diabetes mellitus with blood glucose and HbAlc levels of 508 mg/d/ and 12.1 % (JDS), respectively. Initially, she was treated with insulin and subsequently with oral hypoglycemic agents, achieving improved blood glucose control. In 2005, pancytopenia was noticed, and a diagnosis of myelodysplastic syndrome was made. In 2008, due to poor glycemic control, the treatment was switched to insulin therapy. In 2009, she was admitted to our hospital because of progressive anemia and poor glycemic control, and the further analyses confirmed a diagnosis of type 1 diabetes mellitus with low endogenous insulin and a positive anti-GAD antibody titer. After being discharged, the patient showed macrocytic anemia with low serum VitB12 and autoantibodies against intrinsic factor and gastric parietal cells, resulting in a diagnosis of pernicious anemia. The co-existence of type 1 diabetes, Hashimoto's thyroiditis and pernicious anemia indicates the presence of polyglandular autoimmune syndrome type III-A. We herein report a rare case of polyglandular autoimmune syndrome type IIIA associated with a strong family history of autoimmune thyroid diseases complicated with myelodysplastic syndrome, which has accumulating evidence of an association with autoimmunity. The analyses of HLA and CTLA4 genotypes, as well as a literature review, are described.


Tamura A.,Oita University | Watanabe T.,Oita Nakamura Hospital | Ishihara M.,Hiroshima City Hospital | Ando S.,Saiseikai Futsukaichi Hospital | And 9 more authors.
American Journal of Cardiology | Year: 2011

Several studies have examined the ability of electrocardiography to differentiate between takotsubo cardiomyopathy (TC) and anterior wall acute ST-segment elevation myocardial infarction (AA-STEMI). In those studies, the magnitude of ST-segment elevation was not measured at the J point. The American Heart Association, American College of Cardiology Foundation, and Heart Rhythm Society guidelines recommend that the magnitude of ST-segment elevation should be measured at the J point. Accordingly, the aim of this study was to retrospectively examine whether electrocardiography, using the magnitude of ST-segment elevation measured at the J point, could differentiate 62 patients with TC from 280 with AA-STEMI. Patients with AA-STEMI were divided into following subgroups: 140 with left anterior descending coronary artery occlusions proximal to the first diagonal branch (AA-STEMI-P), 120 with left anterior descending occlusions distal to the first diagonal branch and proximal to the second diagonal branch (AA-STEMI-M), and 20 with left anterior descending occlusions distal to the second diagonal branch (AA-STEMI-D). TC had a much lower prevalence of ST-segment elevation ≥1 mm in lead V1 (19.4%) compared to AA-STEMI (80.4%, p <0.01), AA-STEMI-P (80.7%, p <0.01), AA-STEMI-M (80%, p <0.01), and AA-STEMI-D (80%, p <0.01). ST-segment elevation ≥1 mm in ≥1 of leads V3 to V5 without ST-segment elevation ≥1 mm in lead V1 identified TC with sensitivity of 74.2% and specificity of 80.6%. Furthermore, this criterion could differentiate TC from each AA-STEMI subgroup, with similar diagnostic values. In conclusion, using the magnitude of ST-segment elevation measured at the J point, a new electrocardiographic criterion is proposed with an acceptable ability to differentiate TC from AA-STEMI. © 2011 Elsevier Inc. All rights reserved.


Kondou S.,Koseiren Tsurumi Hospital | Kondou S.,Usuki Cosmos Hospital | Hidaka S.,Koseiren Tsurumi Hospital | Kashima J.,Koseiren Tsurumi Hospital | And 5 more authors.
Journal of the Japan Diabetes Society | Year: 2013

On March 8th, 2007, an 89-year-old woman visited the hospital because of impaired consciousness. She was examined in the Department of Neurosurgery, and no abnormalities were found by physical examination or brain MRI. However, because she had a blood glucose level of 37 mg/dZ, she was treated with an intravenous glucose infusion. Improvement of the glucose levels and symptoms were rapidly noticed after the treatment, and the patient was discharged. The next day, in the early morning, the patient presented to the ER complaining of similar neurological symptoms; an analysis of her blood glucose levels revealed hypoglycemia, and the patient was admitted for treatment and further evaluation. Hyperinsulinemia of 30151 μ U/ml during hypoglycemia, anti-insulin antibodies of 62.5 %, no history of exogenous insulin use and a carrier state of DRB1 * 04: 06, an HLA type commonly observed in patients with insulin autoimmune syndrome (IAS), confirmed the diagnosis of IAS, which made our patient the oldest ever diagnosed with IAS in Japan. In a previous report of 212 IAS cases from 1970 to 1993, there were no differences in the incidence between genders. However, this time we reported 120 IAS cases from 1994 to 2010, and the female cases of IAS have been increasing; this has been linked with the use of α lipoic acid, a known risk factor for drug-related IAS. Moreover, among the 120 cases, 17 cases were reported from elderly patients aged 75 or over, and interestingly, there were no cases of typical drug-related IAS induced by a lipoic acid or thiamazole; thereby, a lower incidence of drug-related - IAS was noted in these patients compared with that in the younger patients. A corresponding bibliographic analysis accompanies this report.


Tamura A.,Oita University | Torigoe K.,Oita University | Goto Y.,Koseiren Tsurumi Hospital | Naono S.,Koseiren Tsurumi Hospital | And 3 more authors.
American Journal of Cardiology | Year: 2014

Obtaining a right-chest electrocardiogram is essential for diagnosing concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions. A software program to synthesize right-chest electrocardiographic waveforms from 12-lead electrocardiographic waveforms is available in Japan. However, its reliability has not been fully investigated. Accordingly, the aim of this study was to examine the reliability of ST-segment shifts in the synthesized V3R to V5R leads. ST-segment shifts in actual and synthesized V3R to V5R leads were compared during the last 10 seconds of 131 balloon inflations while performing elective percutaneous coronary intervention in 56 patients with coronary artery disease. ST-segment shifts in the actual and synthesized V3R, V4R, and V5R leads were correlated (r = 0.96, p <0.001, r = 0.94, p <0.001, and r = 0.91, p <0.001, respectively). A Bland-Altman analysis showed that the bias between ST-segment shifts in the actual and synthesized V3R to V5R leads was -3.1, -5.4, and -4.2 μV, respectively, while the limits of agreement between the ST-segment shifts in the actual and synthesized V3R to V5R leads were -59.2 to 52.9, -61.9 to 51.1, and -59.7 to 51.3 μV, respectively. The κ coefficients for ST-segment elevation of ≥50 and ≥100 μV in the actual and synthesized V3R, V4R, and V5R leads were 0.83 and 0.81, 0.66 and 0.83, and 0.57 and 0.80, respectively. In conclusion, these results indicate that ST-segment shifts in the synthesized V3R to V5R leads have acceptable reliability, suggesting that synthesized right-chest electrocardiography can be used to diagnose concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions. © 2014 Elsevier Inc. All rights reserved.


Tamura A.,Oita University | Naono S.,Koseiren Tsurumi Hospital | Torigoe K.,Oita University | Hino M.,Oita University | And 4 more authors.
American Journal of Cardiology | Year: 2013

Previous investigations have demonstrated the presence of gender differences in the symptoms of angina pectoris and acute coronary syndrome. However, most of these investigations have had certain limitations, including being retrospective, an interview-related bias, a various duration of myocardial ischemia, and a lack of multivariate analysis, all of which would have affected the results. Accordingly, we prospectively examined the presence or absence of chest pain and non-chest pain symptoms during a 60-second balloon inflation in the setting of percutaneous coronary intervention, which provides a unique model of transient myocardial ischemia, in 110 men and 80 women with coronary artery disease. Chest pain and/or non-chest pain symptoms (occipital pain, jaw pain, neck/throat pain, shoulder pain, upper arm pain, back pain, and nausea) were observed during the balloon inflation in 72 men and 52 women. In the 124 patients with any symptoms during the balloon inflation, non-chest pain symptoms were more common in women than in men (31% vs 14%, p = 0.02); however, the incidence of chest pain did not differ between the men and women. After adjustment for covariables, including age, body mass index, hypertension, diabetes mellitus, current smoking, previous myocardial infarction, target vessels, β-blocker use, and calcium antagonist use, female gender remained significantly associated with non-chest pain symptoms (odds ratio 3.3, 95% confidence interval 1.2 to 9.9, p = 0.02). In conclusion, non-chest pain symptoms during the 60-second balloon occlusion of the coronary artery were more common in women than in men, supporting the presence of the gender difference in myocardial ischemic symptoms. © 2013 Elsevier Inc. All rights reserved.


Maeda S.,Oita University | Tamura A.,Oita University | Kawano Y.,Oita University | Naono S.,Koseiren Tsurumi Hospital | And 2 more authors.
Journal of Cardiology Cases | Year: 2014

We herein report the case of a 72-year-old female with a lateral wall acute myocardial infarction (MI) complicated by takotsubo cardiomyopathy (TC). The patient presented with "severe" chest pain lasting for one hour. She did not experience any obvious emotional or physical stress preceding the chest pain. An admission electrocardiogram showed ST-segment elevation in leads I, aVL, and V6 and ST-segment depression in leads II, III, aVF, and V1. Emergent coronary angiography showed total occlusion of the obtuse marginal branch. Subsequently, primary percutaneous old balloon angioplasty followed by everolimus-eluting stenting was performed. Left ventriculography performed immediately after final coronary angiography revealed hypokinesis in the lateral wall and mid-ventricular ballooning. The electrocardiographic findings and left ventricular wall motion later normalized. Cardiac magnetic resonance imaging showed late gadolinium enhancement in the lateral wall. In conclusion, to the best of our knowledge, this is the second case report of TC triggered by an acute MI, which provides further evidence that an acute MI can potentially trigger TC.<. Learning objective: Takotsubo cardiomyopathy (TC) usually develops after exposure to an acute emotional or physical stressor in postmenopausal females. There is only one case report of TC triggered by an acute myocardial infarction (MI), a condition that is frequently associated with emotional stress. This second case report of TC triggered by an acute MI provides further evidence that an acute MI can potentially trigger TC.>. © 2013 Japanese College of Cardiology.


PubMed | Oita University and Koseiren Tsurumi Hospital
Type: Journal Article | Journal: The American journal of cardiology | Year: 2014

Obtaining a right-chest electrocardiogram is essential for diagnosing concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions. A software program to synthesize right-chest electrocardiographic waveforms from 12-lead electrocardiographic waveforms is available in Japan. However, its reliability has not been fully investigated. Accordingly, the aim of this study was to examine the reliability of ST-segment shifts in the synthesized V3R to V5R leads. ST-segment shifts in actual and synthesized V3R to V5R leads were compared during the last 10 seconds of 131 balloon inflations while performing elective percutaneous coronary intervention in 56 patients with coronary artery disease. ST-segment shifts in the actual and synthesized V3R, V4R, and V5R leads were correlated (r = 0.96, p <0.001, r = 0.94, p <0.001, and r = 0.91, p <0.001, respectively). A Bland-Altman analysis showed that the bias between ST-segment shifts in the actual and synthesized V3R to V5R leads was -3.1, -5.4, and -4.2 V, respectively, while the limits of agreement between the ST-segment shifts in the actual and synthesized V3R to V5R leads were -59.2 to 52.9, -61.9 to 51.1, and -59.7 to 51.3 V, respectively. The coefficients for ST-segment elevation of 50 and 100 V in the actual and synthesized V3R, V4R, and V5R leads were 0.83 and 0.81, 0.66 and 0.83, and 0.57 and 0.80, respectively. In conclusion, these results indicate that ST-segment shifts in the synthesized V3R to V5R leads have acceptable reliability, suggesting that synthesized right-chest electrocardiography can be used to diagnose concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions.

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