Kumamoto Chuo Hospital

Kumamoto-shi, Japan

Kumamoto Chuo Hospital

Kumamoto-shi, Japan

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Ito A.,Kurume University | Goto T.,Kumamoto Chuo Hospital | Maekawa K.,Kumamoto Chuo Hospital | Baba T.,Kumamoto Chuo Hospital | And 2 more authors.
Journal of Anesthesia | Year: 2012

Purpose Elderly patients with multiple infarctions revealed a high prevalence of postoperative stroke after coronary artery bypass grafting (CABG). However, postoperative neurological complications and characteristics of silent brain infarction (SBI) have not been evaluated in elderly patients undergoing CABG. Methods Four hundred forty-nine patients (C60 years old) scheduled for CABG underwent cerebral magnetic resonance imaging (MRI) and MR angiography preoperatively to assess cerebral infarctions and carotid and intracranial artery stenosis. Atherosclerosis of the ascending aorta was assessed by epiaortic ultrasound during surgery. Patients were sorted by their history of cerebrovascular disease (CVD) and the presence of infarction by MRI: SBI (infarction without CVD), BI (symptomatic brain infarction; CVD and infarction), and controls (no findings of either CVD or infarction). Results SBI was found in 35.5% of the 449 patients and increased with age. The prevalence of pre-existing multiple infarctions was less frequent in SBI than in BI. The incidence of postoperative stroke and cognitive dysfunction was 1.3% and 4.9% in controls (n = 225), 5.7% and 15.2% in SBI (n = 158), and 9.1% and 18.2% in BI (n = 66). Patients with SBI were older and had more renal dysfunction and preoperative cognitive impairment. Stepwise logistic regression demonstrated that age, renal dysfunction, preoperative cognitive impairment, atherosclerosis of the ascending aorta, and intracranial arterial stenosis were associated significantly with SBI. Conclusion Patients with SBI were ranked at moderate risk of neurological complications after CABG between control and BI. Increased age, renal dysfunction, and preoperative cognitive impairment appeared to be strongly associated with SBI. © 2012 Japanese Society of Anesthesiologists.


Otomo S.,Kumamoto Chuo Hospital
Interactive cardiovascular and thoracic surgery | Year: 2013

Delirium is a common and critical clinical syndrome in older patients. We examined whether abnormalities in the brain that could be assessed by magnetic resonance imaging predisposed patients to develop delirium after coronary artery bypass graft surgery. We also analysed the association between delirium and cognitive dysfunction after coronary artery bypass graft surgery. Data were collected prospectively on 153 patients aged 60 years or older who consecutively underwent elective isolated coronary artery bypass graft surgery. All patients were assessed for prior cerebral infarctions and craniocervical artery stenosis by magnetic resonance imaging (MRI) and angiography of their brains. Atherosclerosis of the ascending aorta was examined by epiaortic ultrasound at the time of surgery. Individual cognitive status was measured using four tests in all the patients before surgery and on the seventh postoperative day. A single psychiatrist diagnosed delirium using the Diagnostic and Statistical Manual of Mental Disorders 4th edition IV criteria. Postoperative delirium occurred in 16 patients (10.5%). Compared with patients who did not develop postoperative delirium, delirious patients had significantly higher rates of peripheral artery disease, preoperative decline in global cognitive function and pre-existing multiple cerebral infarctions on MRI. In addition, 9 (56%) of the delirious patients suffered postoperative cognitive dysfunction. Stepwise logistic regression analysis found significant independent predictors of postoperative delirium to be preoperative cerebral infarcts on MRI (odds ratio [OR], 2.26; 95% confidence interval [CI] 1.10-4.78), preoperative decline in global cognitive function (OR 4.54; 95% CI 1.21-16.51) and atherosclerosis of the ascending aorta (OR 2.44; 95% CI 1.03-5.62). Our findings suggested that postoperative delirium was associated with pre-existing multiple cerebral infarctions on MRI, preoperative decline in global cognitive function and ascending aortic atherosclerosis in elderly patients undergoing coronary artery bypass graft surgery and increased risk of postoperative cognitive dysfunction.


Oda S.,Kumamoto University | Utsunomiya D.,Kumamoto University | Funama Y.,Kumamoto University | Katahira K.,Kumamoto Chuo Hospital | And 7 more authors.
Academic Radiology | Year: 2014

Rationale and Objectives: To investigate whether "full" iterative reconstruction, a knowledge-based iterative model reconstruction (IMR),enables radiation dose reduction by 80% at cardiac computed tomography (CT). Materials and Methods: A total of 23 patients (15 men, eight women; mean age 64.3 ± 13.4 years) who underwent retrospectively electrocardiography-gated cardiac CT with dose modulation were evaluated. We compared full-dose (FD; 730 mAs) images reconstructed with filtered back projection (FBP) technique and the low-dose (LD; 146 mAs) images reconstructed with FBP and IMR techniques. Objective and subjective image quality parameters were compared among the three different CT images. Results: There was no significant difference in the CT attenuation among the three reconstructions. The mean image noise of LD-IMR (18.3± 10.6 Hounsfield units [HU]) was significantly lowest among the three reconstructions (41.9 ± 15.3 HU for FD-FBP and 109.9 ± 42.6 HU for LD-FBP; P < .01). The contrast-to-noise ratio of LD-IMR was better than that of FD-FBP and LD-FBP (P < .01). Visual evaluation score was also highest for LD-IMR. Conclusions: The IMR can provide improved image quality at super-low-dose cardiac CT with 20% of the standard tube current. © 2014 AUR.


Yuki H.,Kumamoto University | Utsunomiya D.,Kumamoto University | Funama Y.,Kumamoto University | Tokuyasu S.,Philips | And 6 more authors.
Journal of Cardiovascular Computed Tomography | Year: 2014

Background: Most current iterative reconstruction algorithms for CT imaging are a mixture of iterative reconstruction and filtered back projection. The value of "fully" iterative reconstruction in coronary CT angiography remains poorly understood. Objective: We aimed to assess the value of the knowledge-based iterative model reconstruction (IMR) algorithm on the qualitative and quantitative image quality at 256-slice cardiac CT. Methods: We enrolled 21 patients (mean age: 69 ± 11 years) who underwent retrospectively ECG gated coronary CT anhgiography at 100 kVp tube voltage. Images were reconstructed with the filtered back projection (FBP), hybrid iterative reconstruction (IR), and IMR algorithms. CT attenuation and the contrast-to-noise ratio (CNR) of the coronary arteries were calculated. With the use of a 4-point scale, 2 reviewers visually evaluated the coronary arteries and cardiac structures. Results: The mean CT attenuation of the proximal coronary arteries was 369.3 ± 73.6 HU, 363.9 ± 75.3 HU, and 363.3 ± 74.5 HU, respectively, for FBP, hybrid IR, and IMR and was not significantly different. The image noise of the proximal coronary arteries was significantly lower with IMR (11.3 ± 2.8 HU) than FBP (51.9 ± 12.9 HU) and hybrid IR (23.2 ± 5.2 HU). The mean CNR of the proximal coronary arteries was 9.4 ± 2.4, 20.2 ± 4.7, and 41.8 ± 9.5 with FBP, hybrid IR and IMR, respectively; it was significantly higher with IMR. The best subjective image quality for coronary vessels was obtained with IMR (proximal vessels: FBP, 2.6 ± 0.5; hybrid IR, 3.4 ± 0.5; IMR, 3.8 ± 0.4; distal vessels: FBP, 2.3 ± 0.5; hybrid IR. 3.1 ± 0.5; IMR, 3.7 ± 0.5). IMR also yielded the best visualization for cardiac systems, that is myocardium and heart valves. Conclusion: The novel knowledge-based IMR algorithm yields significantly improved CNR and better subjective image quality of coronary vessels and cardiac systems with reliable CT number measurements for cardiac CT imaging. © 2014 Society of Cardiovascular Computed Tomography.


Masuda Y.,Kumamoto Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

Situs inversus, which occurs in 1-2 of every 10,000 births, is a congenital malformation in which the thoracic and abdominal viscera are arranged in partial on complete mirror image of the normal anatomy. In the case of situs inversus, special attention must be taken in performing surgery. We present a surgical case of primary lung cancer in an 81-year-old patient with situs inversus totalis. During surgery, we used the Univent bronchial tube for one-lung ventilation. The appearance of the right lung and the arrangement of the pulmonary vessels and the bronchi corresponded to those normally found on the right side was noted at left thoracotomy. Left middle lobectomy and partial resection of left upper lung were successfully performed. In lung resection for situs inversus, it is important to be aware the mirrorimage anatomy. The three dimensional computed tomography (3D-CT) images were useful for preoperative evaluation of vessel variation.


Goto T.,Itoh Dento Maxillofacial Hospital | Maekawa K.,Kumamoto Chuo Hospital
Journal of Anesthesia | Year: 2014

Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients. © 2013 Japanese Society of Anesthesiologists.


Marutsuka T.,Kumamoto Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 62-year-old man, with chronic renal failure and receiving hemodialysis, pointed out to have an abnormal shadow on a chest X-ray. A chest computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) examination showed a 6 cm size mass lesion in the middle of left thoracic cavity. Confirmed diagnosis was not obtained by needle biopsies. Left upper lobectomy was performed on suspicion of a lung cancer. Histopathologically, fungal hyphae were detected in these surgical specimens and it was diagnosed as pulmonary mucormycosis caused by Rhizopus species.


Katahira K.,Kumamoto Chuo Hospital | Takahara T.,University Utrecht | Kwee T.C.,University Utrecht | Oda S.,Kumamoto Chuo Hospital | And 6 more authors.
European Radiology | Year: 2011

Purpose: To assess the diagnostic performance of diffusion-weighted magnetic resonance (MR) imaging (DWI) for prostate cancer detection, using different b-values. Methods: A total of 201 patients who underwent MR imaging before total prostatectomy were evaluated. MR images were independently assessed by three radiologists. Three combinations of sequences were separately evaluated, as follows: group 1 [T2-weighted images (T2WI) alone], group 2 (T2WI and DWI with a b-value of 1,000 s/mm2), group 3 (T2WI and DWI with a b-value of 2,000 s/mm2). Whole-mount-section histopathological examination was the reference standard. Areas under the receiver operating characteristic curve (AUCs) and diagnostic performance parameters were determined. Results: The sensitivity, specificity, and AUC for the detection of prostate cancer were as follows: 52.2%, 80.7%, and 0.694 in group 1; 61.2%, 82.6%, and 0.755 in group 2; 73.2%, 89.7%, and 0.842 in group 3. Group 3 achieved the highest diagnostic performance, followed by group 2 (P∈<∈0.05). In the transition zone, the specificity was lower (P∈<∈0.001) for group 2 (82.2%) than for group 1 (86.2%). Conclusion: The addition of diffusion-weighted images with a b-value of 2,000 s/mm2 to T2WI can improve the diagnostic performance of MR imaging in prostate cancer detection. © 2010 European Society of Radiology.


Inaba M.,Kumamoto Chuo Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 76-year-old man who was taking prednisolone and methotrexate for rheumatoid arthritis presented with gastric ulcers. Chest X-ray images showed multiple pulmonary nodules. Transbronchial lung biopsy specimens showed lymphocytic infiltrates but no malignant cells. The radiographic findings gradually ameliorated over a month, but then deteriorated 5 months later. We performed video-assisted thoracoscopic biopsy of the left lung, and the biopsy specimens showed lymphocytic infiltration with necrosis, in which the atypical lymphocytes were positive for Epstein-Barr virus-encoded small RNAs in situ hybridization (EBER-ISH). A diagnosis of lymphomatoid granulomatosis was determined. One year before this diagnosis, the patient was found to have an inflammatory liver tumor that had disappeared spontaneously within a month. A new pathological review of the liver and stomach lesions demonstrated EBER-ISH-positive lymphocytes, and therefore we assumed that they were pathological features of lymphomatoid granulomatosis. The chest radiographic findings improved gradually after the discontinuation of methotrexate. We therefore suggest that methotrexate treatment may be associated with the development of lymphomatoid granulomatosis in patients with rheumatoid arthritis. Lymphoproliferative disorders, including lymphomatoid granulomatosis, should be considered in patients with rheumatoid arthritis who are receiving methotrexate.


Maekawa K.,Kumamoto University | Maekawa K.,Kumamoto Chuo Hospital | Baba T.,Kumamoto Chuo Hospital | Otomo S.,Kumamoto Chuo Hospital | And 2 more authors.
PLoS ONE | Year: 2014

Objectives: Postoperative cognitive dysfunction (POCD) is recognized as a complication in the elderly after cardiac surgery. Imaging of the brain provides evidence of neurodegeneration in elderly patients; however, abnormalities in brain structure and their relation to POCD are uncertain. This pilot study investigated whether loss of gray matter in the bilateral medial temporal lobe (MTL), seen in preoperative MRI, was associated with POCD. Methods: Data were collected prospectively on 28 elderly patients scheduled for elective cardiac surgery. MRI of the brains of all patients were assessed for prior cerebral infarctions, and carotid and intracranial arterial stenosis. Patients also completed six neuropsychological tests of memory, attention and executive function before and after surgery. POCD was defined as an individual decrease in more than two tests of at least 1 standard deviation from the group baseline mean for that test. The degree of gray matter loss in the MTL of each patient was calculated using voxel-based morphometry with three-dimensional, T1-weighted MRI. This represented the degree of gray matter change as a Z score. Results: Postoperative cognitive dysfunction was identified in 8 of the 28 patients (29%). Patients with POCD had significantly more white matter lesions on MRI, and greater loss of gray matter in the bilateral MTL (average Z score 2.0±0.9) than patients without POCD. An analysis by stepwise logistic regression identified gray matter loss in the MTL and cerebral infarctions on MRI as independent predictors of POCD. Conclusions: These preliminary findings suggested that reduced gray matter in the bilateral MTL and white matter lesions existed in brains of elderly cardiac surgery patients who experienced POCD. Additional studies with larger sample sizes are needed to confirm these findings. © 2014 Maekawa et al.

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