Kumamoto Rosai Hospital

Kumamoto-shi, Japan

Kumamoto Rosai Hospital

Kumamoto-shi, Japan
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Stone P.H.,Harvard University | Saito S.,Shonan Kamakura General Hospital | Takahashi S.,Harvard University | Takahashi S.,Shonan Kamakura General Hospital | And 23 more authors.
Circulation | Year: 2012

BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.


Inaba T.,Kumamoto Rosai Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2010

A 91-year-old woman with adenoid cystic carcinoma of the base of the tongue was reported. She presented with a large painless mass in the throat, and computed tomography revealed a well-defined tabulated tumor measuring 48 mm in diameter arising from the base of the tongue. The tumor was successfully resected via transoral approach using an ultrasonic scalpel. Because the tumor invasion of the surrounding tissue was limited, the surgical defect was relatively small and no reconstructive procedure was performed. The tumor was histopathologically diagnosed as adenoid cystic carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the fourth postoperative day. The patient was currently free from disease 14 months after surgery.


Kadokawa Y.,Kumamoto Rosai Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2010

We report two cases of mucosa-associated lymphoid tissue (MALT) lymphoma of the head and neck. The first case was a 21-year-old woman with Sjögren's syndrome who developed left-sided parotid MALT lymphoma. She underwent resection of the tumor with preservation of the facial nerve followed by 3 courses of chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. The second case was a 48-year-old man with epipharyngeal MALT lymphoma. He underwent resection of the tumor followed by 4 courses of rituximab administration and radiotherapy of 30 Gy. Complete remission was achieved in both patients, and no evidence of recurrence was observed in 20- and 12-month follow-up periods, respectively. The clinical characteristics, pathology and treatment of MALT lymphoma of the head and neck were bibliographically reviewed.


Tsujita K.,Kumamoto University | Sugiyama S.,Jinnouchi Hospital | Sumida H.,Kumamoto Central Hospital | Shimomura H.,Fukuoka Tokushukai Medical Center | And 23 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Despite standard statin therapy, a majority of patients retain a high "residual risk" of cardiovascular events. Objectives The aim of this study was to evaluate the effects of ezetimibe plus atorvastatin versus atorvastatin monotherapy on the lipid profile and coronary atherosclerosis in Japanese patients who underwent percutaneous coronary intervention (PCI). Methods This trial was a prospective, randomized, controlled, multicenter study. Eligible patients who underwent PCI were randomly assigned to atorvastatin alone or atorvastatin plus ezetimibe (10 mg) daily. Atorvastatin was uptitrated with a treatment goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dl. Serial volumetric intravascular ultrasound was performed at baseline and again at 9 to 12 months to quantify the coronary plaque response in 202 patients. Results The combination of atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy (63.2 ± 16.3 mg/dl vs. 73.3 ± 20.3 mg/dl; p < 0.001). For the absolute change in percent atheroma volume (PAV), the mean difference between the 2 groups (-1.538%; 95% confidence interval [CI]: -3.079% to 0.003%) did not exceed the pre-defined noninferiority margin of 3%, but the absolute change in PAV did show superiority for the dual lipid-lowering strategy (-1.4%; 95% CI: -3.4% to -0.1% vs. -0.3%; 95% CI: -1.9% to 0.9% with atorvastatin alone; p = 0.001). For PAV, a significantly greater percentage of patients who received atorvastatin/ezetimibe showed coronary plaque regression (78% vs. 58%; p = 0.004). Both strategies had acceptable side effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events. Conclusions Compared with standard statin monotherapy, the combination of statin plus ezetimibe showed greater coronary plaque regression, which might be attributed to cholesterol absorption inhibition-induced aggressive lipid lowering. (Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound [PRECISE-IVUS]; NCT01043380) © 2015 American College of Cardiology Foundation.


Nakajima M.,Kumamoto Rosai Hospital | Hirano T.,Kumamoto University | Terasaki T.,Red Cross | Uchino M.,Kumamoto University
Internal Medicine | Year: 2010

Diffusion-weighted imaging can depict secondary signal changes of the substantia nigra in patients with ipsilateral striatal infarction. We report four patients who demonstrated obvious signal changes of the substantia nigra in the subacute phase of stroke. Embolic stroke was diagnosed in all of the cases, and none of the patients presented clinical deterioration in their course. Embolic mechanism might be more closely related to the secondary change of the substantia nigra than thrombosis. The relationship between secondary nigral degeneration and stroke etiology or between the nigral lesions and recanalization of the middle cerebral artery remains unclear. © 2010 The Japanese Society of Internal Medicine.


Tohya T.,Kumamoto Rosai Hospital | Tajima T.,Kumamoto Rosai Hospital
European Journal of Gynaecological Oncology | Year: 2011

We report here the case of a 30-year-old woman with a decidualized ovarian endometriotic cyst (DOEC) during pregnancy mimicking malignancy occurring after fertility-preserving surgery for ovarian carcinoma arising from an endometriotic cyst. Intracystic excrescences appeared in the left ovarian endometriotic cyst at five weeks and three days of gestation. The serum CA-125 level rose to 676.7 U/ml (normal, 0-35). Based on these findings, ovarian carcinoma arising from the left ovarian cyst was strongly suspected. Frequent sonographic examinations revealed that the sizes and quality of the intracystic excrescences remained essentially unchanged. The cyst was evaluated for DOEC during pregnancy. The patient eventually delivered a male infant by normal vaginal delivery. After the delivery, the intracystic excrescences in the left ovarian endometriotic cyst disappeared. Close observation may be a reasonable alternative to antepartum surgery in patients with a DOEC during pregnancy.


Naganuma M.,Kumamoto Rosai Hospital | Isoda K.,Kumamoto Rosai Hospital | Ishizaki M.,Kumamoto Rosai Hospital | Ito K.,Kumamoto Rosai Hospital | And 2 more authors.
Internal Medicine | Year: 2011

A 60-year-old woman with a history of symptomatic seizures secondary to a subarachnoid hemorrhage was admitted to hospital because of a generalized seizure. The following day, her electrocardiogram showed negative T waves in II, III, aV F, and V 2-6, and the echocardiogram showed an impaired left ventricular ejection fraction with ventricular apical akinesia. Head magnetic resonance imaging showed no acute brain injury, but single photon emission computed tomography (SPECT) showed hyperperfusion which affected the left temporal cortex in particular. Hyperactivity of the temporal lobe might cause autonomic nervous system dysfunction and might be related to takotsubo cardiomyopathy. © 2011 The Japanese Society of Internal Medicine.


Yoshida M.,Kumamoto Rosai Hospital | Kudoh J.,Kumamoto Rosai Hospital | Homma Y.,University of Tokyo | Kawabe K.,Tokyo Teishin Hospital
International Journal of Urology | Year: 2012

Lower urinary tract symptoms associated with benign prostatic hyperplasia are highly prevalent in older men. Pharmacological treatment is the first-line treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia. The first choice in the pharmacological treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia is the α 1-adrenoceptor antagonists. Many α 1-adrenoceptor antagonists are available in the world. Silodosin is an α 1-adrenoceptor antagonist developed by Kissei Pharmaceutical, and has a specific selectivity for the α 1A-adrenoceptor subtype. By antagonizing α 1A-adrenoceptor in the prostate and urethra, silodosin causes smooth muscle relaxation in the lower urinary tract. As a result of the high affinity for the α 1A-adrenoceptor than for the α 1B-adrenoceptor, silodosin minimizes the propensity for blood pressure-related adverse effects caused by blockade of α 1B-adrenoceptor. The efficacy and safety of silodosin for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia was first reported by Japanese investigators in 2006. At present, silodosin is used in many countries. In the present review, we summarize the new clinical evidence for lower urinary tract symptoms associated with benign prostatic hyperplasia and introduce the data supporting the new clinical indications of silodosin. © 2012 The Japanese Urological Association.


Yoshida M.,Kumamoto Rosai Hospital | Kudoh J.,Kumamoto Rosai Hospital | Homma Y.,University of Tokyo | Kawabe K.,Tokyo Teishin Hospital
Clinical Interventions in Aging | Year: 2011

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are highly prevalent in older men. Medical therapy is the first-line treatment for LUTS associated with BPH. Mainstays in the treatment of male LUTS and clinical BPH are the α 1-adrenergic receptor antagonists. Silodosin is a new α 1-adrenergic receptor antagonist that is selective for the α 1A-adrenergic receptor. By antagonizing α 1A-adrenergic receptors in the prostate and urethra, silodosin causes smooth muscle relaxation in the lower urinary tract. Since silodosin has greater affinity for the α 1A-adrenergic receptor than for the α 1B-adrenergic receptor, it minimizes the propensity for blood pressure-related adverse effects caused by α 1B-adrenergic receptor blockade. In the clinical studies, patients receiving silodosin at a total daily dose of 8 mg exhibited significant improvements in the International Prostate Symptom Score and maximum urinary flow rate compared with those receiving placebo. Silodosin showed early onset of efficacy for both voiding and storage symptoms. Furthermore, long-term safety of silodosin was also demonstrated. Retrograde or abnormal ejaculation was the most commonly reported adverse effect. The incidence of orthostatic hypotension was low. In conclusion, silodosin, a novel selective α 1A-adrenergic receptor antagonist, was effective in general and without obtrusive side effects. This review provides clear evidence in support of the clinical usefulness of silodosin in the treatment of LUTS associated with BPH. © 2011 Yoshida et al, publisher and licensee Dove Medical Press Ltd.


PubMed | Kumamoto University, Kumamoto City Hospital and Kumamoto Rosai Hospital
Type: Journal Article | Journal: Palliative medicine | Year: 2016

Leptomeningeal metastasis-related hydrocephalus causes distress to patients with end-stage cancer through headache and other symptoms by elevating intracranial pressure, thus reducing quality of life. Ventriculoperitoneal shunt has been used as a treatment option in palliative care. We review four cases of patients who underwent lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus.All patients suffered from severe headache and nausea. The primary lesion was histologically diagnosed as lung adenocarcinoma in each case. The duration from diagnosis to onset of hydrocephalus symptoms ranged from 0 to 52 (mean 26) months. Cerebrospinal fluid pressure in every case was above the normal range due to high intracranial pressure. Case management: Conventional procedures for lumboperitoneal shunt were employed for all patients. Adjustable pressure valves were retrofitted into the shunt system. Case outcome: Three patients demonstrated significant improvement of clinical symptoms and quality of life after placement of lumboperitoneal shunts. In two cases, not only did performance status improve to independent daily activity but also comparatively long-term survival was achieved due to subsequent chemotherapies after surgery. No symptoms of peritoneal dissemination by floating cancer cells in cerebrospinal fluid were seen in any patients.Lumboperitoneal shunt appears to improve quality of life if the patient is suffering from symptoms of leptomeningeal metastasis-related hydrocephalus. Compared to ventriculoperitoneal shunt, lumboperitoneal shunt is less invasive and simpler, providing a suitable option for frail patients with end-stage cancer. Adjustable pressure shunt valves can cope with varying symptoms and ventricle sizes.

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