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Nagasaki-shi, Japan

Sato M.,Kouseikai Hospital
Kyobu geka. The Japanese journal of thoracic surgery

We report the significance of preoperative ultrasound evaluation of the forearm arteries in coronary artery bypass grafting (CABG). Ultrasound evaluation was performed in 288 arms with negative Allen's test between August 2004 and July 2007. The diameter, the level of atherosclerotic changes and calcifications, and systolic velocities were evaluated in radial artery (RA) and ulnar artery (UA). The diameter of RA was 2.6 +/- 0.5 mm, and in 30 arms it was smaller than 2 mm. There were 2 occlusions, 4 stenoses, and 20 arteriosclerotic changes in RA. There were 1 occlusion, 8 stenoses, and 4 arteriosclerotic changes in UA. Since there were some overlaps in small diameter and poor qualities of RA and UA, 55 arms (19%) were considered not to qualify as candidates for RA harvest. Pre-operative ultrasound evaluation of the forearm arteries allows safer radial artery harvest and should be performed even in patients with negative Allen' s test. Source

Itou C.,Tokai University | Koizumi J.,Tokai University | Hashimoto T.,Kouseikai Hospital | Myojin K.,Tokai University | And 3 more authors.
American Journal of Roentgenology

OBJECTIVE. The purpose of this study was to evaluate the clinical results of the management of gastric varices by balloon-occluded retrograde transvenous obliteration with polidocanol foam versus ethanolamine oleate. MATERIALS AND METHODS. Twenty patients treated with ethanolamine oleate and 21 patients treated with polidocanol foam were enrolled in this study. Early therapeutic effects were assessed mainly by dynamic contrast-enhanced CT. Subjective symptoms, objective findings associated with the procedures, and changes in laboratory data during the obliteration process were evaluated. Rebleeding from gastric varices was assessed after the procedures. RESULTS. Complete obliteration was confirmed in all but one case of early recanalization after treatment with polidocanol foam. One patient died of acute respiratory distress syndrome after treatment with ethanolamine oleate. The total sclerosant volume was significantly lower for 3% polidocanol foam (13.5 ± 6.8 mL) than for 5% ethanolamine oleate (30.6 ± 15.6 mL) (p < 0.01). Polidocanol foam caused fewer severe reactions, including pain, during and after injection. High body temperature, hemoglobinuria, and reactive pleural effusion were not observed with polidocanol foam. The variance in laboratory data values associated with hemolysis was significantly greater with ethanolamine oleate. No postprocedural rebleeding from the gastric varices was observed during a median follow-up time of 39.5 months after procedures with ethanolamine oleate and 34 months after procedures with polidocanol foam. CONCLUSION. Polidocanol foam can achieve obliteration of gastric varices comparable to that of ethanolamine oleate but with a significantly lower sclerosant dose and reduced risk of hemolysis-induced complications and harmful reactions, including pain and fever. © American Roentgen Ray Society. Source

Shimohira M.,Nagoya City University | Hashimoto T.,Kouseikai Hospital | Abematsu S.,Shizuoka City Shimizu Hospital | Hashizume T.,Nagoya City University | And 4 more authors.
British Journal of Radiology

Objective: The application of bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial (triaxial) system consisting of a 4-Fr catheter, 2.7-Fr microcatheter and 1.9-Fr no-taper microcatheter has been developed. The aim of the present study was to evaluate the usefulness of the triaxial system in BAE using NBCA. Methods: 12 patients with haemoptysis, 8 males and 4 femaleswith amedian age of 64 years (range, 49-88 years), underwent BAE between August 2012 and October 2014. Medical records and images were reviewed, and the technical success rate, clinical success rate, haemoptysisfree rate and complications were evaluated. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography, whereas clinical success was defined as the cessation of haemoptysis within 24 h of BAE. Recurrent haemoptysis was defined as a total of >30 ml of bleeding per day. Results: The target artery was embolized successfully in all patients, and the technical success rate was 100% (12/12). The cessation of haemoptysis was achieved in 11 out of 12 patients within 24h, and thus, the clinical success rate was 92% (11/12). The 6-, 12- and 24-month haemoptysis-free rates were 89%, 89% and 76%, respectively. No patients exhibited any signs of complications such as spinal ischaemia. Conclusion: BAE using the triaxial system and NBCA appears to be a useful and safe procedure for haemoptysis. Advances in knowledge: The triaxial system contributes to safe and effective BAE using NBCA. © 2015 The Authors. Published by the British Institute of Radiology. Source

Ichinose K.,Nagasaki University | Ohtsubo T.,Kouseikai Hospital | Kawakami A.,Nagasaki University
Japanese Journal of Nephrology

A 57-year old male patient was admitted to our hospital because of severe vomiting and abdominal pain with massive ascites. He had been diagnosed as mixed connective tissue disease in 1997 and lupus nephritis ISN III (A/C) + V in 2003. Treatment was started with intravenous steroid pulse therapy combined with an immunosuppressant resulting in improvement of his proteinuria and serological activity. In 2008, the disease activity flared and he was admitted to our hospital with nephrotic syndrome. Hemodialysis was unavoidable, despite treatment with intravenous steroid pulse therapy and plasma exchange. We continued to treat him with oral prednisolone and tacrolimus. However, for personal reasons, he terminated tacrolimus treatment and massive ascites remained because of insufficient hemodialysis. Since the end of 2011, he suffered repeated abdominal pain with ileus and encapsulating peritoneal sclerosis (EPS) was detected. In February 2013, he underwent synechotomy for EPS. Here, we present a rare case of EPS in a hemodialysis patient. Source

Morimitsu H.,Morimitsu Urological Clinic | Hisamatsu H.,Kouseikai Hospital | Yamashita S.,Kouseikai Hospital | Syuu I.,Oomura City Hospital
Nishinihon Journal of Urology

This is a randomized open-label trial to compare solifenacin succinate (SOL: 5 mg, once-daily) and imidafenacin (IMI: 0.2 mg, twice-daily), in female patients with overactive bladder syndrome (OAB). In total, 56 patients were allocated to SOL-G or IMI-G (n = 28 per group) and treated for 8 weeks. Efficacy was evaluated by Overactive Bladder Symptom Score (OABSS) and BPH impact index (BIT) before and after treatment. In addition, adverse effects, satisfaction with the treatment and the preference to continue treatment were considered. Improvement of OABSS and BII was significant for each group, but the change in each item (except Q2: night urination) and Total-OABSS were significantly greater in SOL-G compared with IMI-G. The preference to continue treatment was not significant between SOL-G and IMI-G. Serious adverse events were not reported in either group. Satisfaction with the treatment was significantly higher for SOL-G (95%) than for IMI-G (66.7%). Both SOL and IMI significantly improved OAB. SOL exhibits better efficacy than IMI, but the tolerability of both drugs was equivalent. Those factors appear to have influenced the superior evaluation of SOL. Source

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