Kouseikai Hospital

Nagasaki-shi, Japan

Kouseikai Hospital

Nagasaki-shi, Japan

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PubMed | Sasebo City General Hospital, Shunkaikai Inoue Hospital, Eisai Co., National Hospital Organization Ureshino Medical Center and 4 more.
Type: Journal Article | Journal: BMC gastroenterology | Year: 2016

There are few reports of the efficacy of adalimumab (ADA) for clinical remission and preventing postoperative recurrence in Crohns disease (CD) in Asian real practice settings. We conducted a Japanese multicenter retrospective observational study.We evaluated patients with CD who were treated with ADA at 11 medical institutions in Japan to investigate the clinical efficacy of remission up to 52weeks and the associated factors to achieve remission with a CD Activity Index (CDAI)<150. The effects of preventing postoperative recurrence were also evaluated.In 62 patients, the remission rates were 33.9, 74.2, 75.8, 77.4, and 66.1% at 0, 4, 12, 26, and 52weeks, respectively. Although 10 patients discontinued treatment due to primary nonresponse, secondary nonresponse, or adverse events, the ongoing treatment rate at 52weeks was 83.9%. Comparison of remission and non-remission on univariate analysis identified colonic type and baseline CDAI value as significant associated factors (P<0.05). In 16 patients who received ADA to prevent postoperative recurrence, the clinical remission maintenance rate was 93.8% and the mucosal healing rate was 64.3% during a mean postoperative follow-up period of 32.3months.ADA effectively induced remission and prevented postoperative recurrence in patients with CD in a real practice setting.


PubMed | Nagoya City University, Kouseikai Hospital and Shizuoka City Shimizu Hospital
Type: Journal Article | Journal: The British journal of radiology | Year: 2015

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.12 patients with haemoptysis, 8 males and 4 females with a median 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, haemoptysis-free 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 24h of BAE. Recurrent haemoptysis was defined as a total of >30ml of bleeding per day.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.BAE using the triaxial system and NBCA appears to be a useful and safe procedure for haemoptysis.The triaxial system contributes to safe and effective BAE using NBCA.


Ichinose K.,Nagasaki University | Ohtsubo T.,Kouseikai Hospital | Kawakami A.,Nagasaki University
Japanese Journal of Nephrology | Year: 2014

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.


PubMed | Nippon Medical School and Kouseikai Hospital
Type: Journal Article | Journal: Case reports in gastroenterology | Year: 2014

Ehlers-Danlos syndrome, vascular type (vEDS) (MIM #130050) is an autosomal dominant disorder caused by mutation in the type III collagen gene, COL3A1, leading to fragility of blood vessels, bowel and uterus that leads to spontaneous rupture. We report a previously undiagnosed vEDS patient with bowel complications. A 20-year-old female patient was referred to our hospital with abdominal pain. Computed tomography showed notable dilatation of the sigmoid colon with intraperitoneal fluid. Laparotomy revealed dilatation of the sigmoid colon, breakdown of serosa and muscularis propria of the sigmoid colon with impending perforation, and intra-abdominal hemorrhage caused by breakdown of the mesenterium. Resection of the sigmoid colon with Hartmanns pouch and an end colostomy were performed. Physical examination showed joint hypermobility, translucent skin with venous prominence and facial structure abnormalities. Genetic analysis using cDNA extracted from the patients fibroblasts by reverse transcriptase polymerase chain reaction direct sequencing showed a missense mutation within the triple helix region of COL3A1 (c.2150 G>A; Gly717Asp).


Hisamatsu H.,Kouseikai Hospital | Yamashita S.,Kouseikai Hospital
Acta Urologica Japonica | Year: 2010

We report a rare case of lung cancer with cavitation that was caused by metastasis of urothelial carcinoma. A 73-year-old woman was admitted to our hospital with macrohematuria and general fatigue in September 2003. Computed tomography revealed a left ureter tumor, which was removed by left nephroureterectomy in October 2003. However, a part of the ureter could not be resected because of the adhesion that had occurred after a previous operation. The patient was diagnosed with sigmoid colon cancer, and she underwent sigmoidectomy and resection of the remaining part of the ureter in August 2004. Subsequently, transurethral resection was performed several times for bladder tumor. The pathological diagnosis in February 2005 was pT2. Cisplatin-based intra-arterial chemotherapy was performed because it was not possible to perform a cystectomy due to the poor performance status. In March 2006, computed tomography of the chest revealed a mass shadow with a cavity in the left lower lung field. This was diagnosed as primary or metastatic lung cancer and was treated by left lower lobectomy in November 2006. On the basis of the pathological findings, we diagnosed the mass as metastatic tumor secondary to the urothelial carcinoma. Despite general chemotherapy, the patient's condition deteriorated, and the patient died 1 year later.


Hisamatsu H.,Kouseikai Hospital | Yamashita S.,Kouseikai Hospital
Acta Urologica Japonica | Year: 2010

We determined the clinical efficacy of a loading dose of tamsulosin (0.2-0.3 mg) in patients with benign prostate hyperplasia (BPH). Tamsulosin was administered at a dose of 0.3 mg to 26 patients with BPH and moderate or severe urinary disturbance, as determined on the basis of the international prostate symptom score (I-PSS) and quality of life (QOL) severity. The I-PSS and QOL index were caluculated before and at the end of the 12-week administration period. The total I-PSS and QOL index were significantly decreased at 12 weeks compared with the baseline (p = 0.003, and p = 0,011, respectively). Significant differences were observed in the changes in 3 I-PSS items (stream, p = 0.042 ; nocturia, p = 0.012 ; urgency, p = 0.003). On the basis of these findings, we conclude that the administration of 0.3 mg tamsulosin to patients with BPH improves the scores of objective indexes, and may specifically ameliorate urinary storage symptoms.


A 55-year-old man was admitted with cough and sputum. Computed tomography revealed a left renal tumor, 7 cm in diameter, and multiple lung tumors with left pleural effusion. We considered nephrectomy impossible given his poor performance status. He received 500 × 104 IU/day of interferon alpha subcutaneously three times a week. Five months after the start of interferon alpha therapy, the renal and lung tumors were markedly reduced in size. Because of improvement of his condition and downsizing of tumors, radical nephrectomy was performed. In addition, interferon alpha therapy was continued for seven more months. At that point, all metastatic pulmonary lesions but one had disappeared. Interferon alpha therapy was then continued for one more year. About five years after the first admission, he is alive without evidence of disease.


Itou C.,Tokai University | Koizumi J.,Tokai University | Hashimoto T.,Kouseikai Hospital | Myojin K.,Tokai University | And 3 more authors.
American Journal of Roentgenology | Year: 2015

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.


Sato M.,Kouseikai Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

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.


PubMed | Kouseikai Hospital and Tokai University
Type: Journal Article | Journal: AJR. American journal of roentgenology | Year: 2015

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.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.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.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.

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