Kushiro City General Hospital

Kushiro, Japan

Kushiro City General Hospital

Kushiro, Japan
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Lovelock C.E.,University of Oxford | Cordonnier C.,Lille University Hospital Center | Naka H.,Suiseikai Kajikawa Hospital | Al-Shahi Salman R.,University of Edinburgh | And 8 more authors.
Stroke | Year: 2010

Background and Purpose: Cerebral microbleeds (MB) are potential risk factors for intracerebral hemorrhage (ICH), but it is unclear if they are a contraindication to using antithrombotic drugs. Insights could be gained by pooling data on MB frequency stratified by antithrombotic use in cohorts with ICH and ischemic stroke (IS)/transient ischemic attack (TIA). Methods: We performed a systematic review of published and unpublished data from cohorts with stroke or TIA to compare the presence of MB in: (1) antithrombotic users vs nonantithrombotic users with ICH; (2) antithrombotic users vs nonusers with IS/TIA; and (3) ICH vs ischemic events stratified by antithrombotic use. We also analyzed published and unpublished follow-up data to determine the risk of ICH in antithrombotic users with MB. RESULTS: In a pooled analysis of 1460 ICH and 3817 IS/TIA, MB were more frequent in ICH vs IS/TIA in all treatment groups, but the excess increased from 2.8 (odds ratio; range, 2.3-3.5) in nonantithrombotic users to 5.7 (range, 3.4-9.7) in antiplatelet users and 8.0 (range, 3.5-17.8) in warfarin users (P difference≤0.01). There was also an excess of MB in warfarin users vs nonusers with ICH (OR, 2.7; 95% CI, 1.6-4.4; P<0.001) but none in warfarin users with IS/TIA (OR, 1.3; 95% CI, 0.9-1.7; P≤0.33; P difference≤0.01). There was a smaller excess of MB in antiplatelet users vs nonusers with ICH (OR, 1.7; 95% CI, 1.3-2.3; P<0.001), but findings were similar for antiplatelet users with IS/TIA (OR, 1.4; 95% CI, 1.2-1.7; P<0.001; P difference=0.25). In pooled follow-up data for 768 antithrombotic users, presence of MB at baseline was associated with a substantially increased risk of subsequent ICH (OR, 12.1; 95% CI, 3.4-42.5; P<0.001). Conclusions: The excess of MB in warfarin users with ICH compared to other groups suggests that MB increase the risk of warfarin-associated ICH. Limited prospective data corroborate these findings, but larger prospective studies are urgently required. © 2010 American Heart Association, Inc.


Imaizumi T.,Kushiro City General Hospital | Inamura S.,Kushiro City General Hospital | Nomura T.,Kushiro City General Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Background White matter lesions (WML) have been reported to be a surrogate marker of stroke occurrences. To investigate the recurrent stroke types associated with WML, we prospectively observed recurrences in stroke patients. Methods We prospectively analyzed the types of stroke recurrence in 807 patients (351 women, 69.8 ± 12.0 years old) consecutively admitted to our hospital with strokes from April 2004 to October 2009. WML were graded using Fazekas grades. Recurrence-free rate curves were generated by the Kaplan-Meier method using the log-rank test. Results The follow-up period was 31.6 ± 22.2 (range.5-71) months. During this period, 111 strokes recurred. The incidence of all stroke recurrences in 223 patients with grades 2 and 3 was 6.0% per year, which was significantly higher than that seen in 287 patients with grade 0 (2.1% per year, P =.006) and 297 patients with grade 1 (4.3% per year, P <.0001). The incidences of intracerebral hemorrhages (ICHs), lacunar infarctions, and atherothrombotic infarctions in patients with grades 2 and 3 were 1.2, 1.4, and 2.4% per year, respectively, which were higher than those seen in patients with grade 0 (.3%, P =.004;.2%, P =.002; and.9% per year, P =.010) but not similar to those in patients with grade 1 (.9%, P =.180;.9%, P =.161; and 1.4% per year, P =.249). There was no significant difference among grades 0, 1, 2, and 3 in incidence of stroke recurrences presenting as cardioembolic infarctions. Conclusions The presence of high-grade WML elevated the rate of stroke recurrences presenting as ICHs, lacunar infarctions, and atherothrombotic infarctions but not as cardioembolic infarctions. © 2014 by National Stroke Association.


Ghosh S.,Sapporo Medical University | Gatheru Z.,Gynae paed Medical Center | Gatheru Z.,Kenya Medical Research Institute | Nyangao J.,Kenya Medical Research Institute | And 3 more authors.
Journal of Medical Virology | Year: 2011

Group A rotavirus (GAR) G8P[1] strains, found sometimes in cattle, have been reported rarely from humans. Therefore, analysis of the full genomes of human G8P[1] strains are of significance in the context of studies on interspecies transmission of rotaviruses. However, to date, only partial-length nucleotide sequences are available for the 11 genes of a single human G8P[1] strain, while the partial sequences of two other strains have been reported. The present study reports the first complete genome sequence of a human G8P[1] strain, B12, detected from an asymptomatic infant in Kenya in 1987. By nucleotide sequence identities and phylogenetic analyses, the full-length nucleotide sequences of VP7-VP4-VP6-VP1-VP2-VP3-NSP1-NSP2-NSP3-NSP4-NSP5 genes of strain B12 were assigned to G8-P[1]-I2-R2-C2-M2-A3-N2-T6-E2-H3 genotypes, respectively. Each of the 11 genes of strain B12 appeared to be more related to cognate genes of artiodactyl (ruminant and/or camelid) and/or artiodactyl-derived human GAR strains than those of most other rotaviruses. Strain B12 exhibited low levels of genetic relatedness to canonical human GAR strains, such as Wa and DS-1, ruling out the possibility of its origin from reassortment events between artiodactyl-like human and true human strains. These observations suggest that strain B12 might have been directly transmitted from artiodactyls to humans. Unhygienic conditions and close proximity of humans to livestock at the sampling site might have facilitated this rare event. This is the first report on a full genomic analysis of a rotavirus strain from Kenya. To our knowledge, strain B12 might be the oldest G8 strain characterized molecularly from the Africa continent. © 2010 Wiley-Liss, Inc.


Morita S.,Kushiro City General Hospital | Suzuki M.,Kushiro City General Hospital | Iizuka K.,Kushiro City General Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2010

Objective: The present study aimed to investigate the etiology, symptoms, diagnosis and prognosis of pediatric patients with non-organic hearing loss (NOHL), and to heighten awareness of this disorder among physicians. Methods: Between January 2000 and July 2009, we retrospectively reviewed the medical records of 47 pediatric patients (aged 6-18 years of age) diagnosed with NOHL. The diagnosis was made when there were audiometric discrepancies between the subjective and objective hearing thresholds of the patient in the absence of any organic disease. Results: Eighteen patients presented with unilateral hearing loss, and 29 showed bilateral hearing loss. Five patients received steroid treatment before the correct diagnosis was made, and six had secretory otitis media and underwent a tympanostomy tube placement. Conclusion: If physicians are unaware of the possibility of NOHL; they may misdiagnose children with idiopathic sudden sensorineural hearing loss and administer high-dose steroid treatments or exploratory tympanotomies. Otoacoustic emissions are abolished when NOHL patients have secretory otitis media. In these cases, after tympanostomy tube placement, they should undergo objective electrophysiologic examinations to reevaluate NOHL. © 2010 Elsevier Ireland Ltd.


Morita S.,Kushiro City General Hospital | Suzuki M.,Kushiro City General Hospital | Iizuka K.,Kushiro City General Hospital
ORL | Year: 2010

Purpose of the Study: We aimed to compare the short-term outcome of patients with acute low-tone sensorineural hearing loss (ALHL) treated with steroid alone, diuretics alone or combination treatment. Procedures: Between April 2000 and March 2009, we retrospectively reviewed the medical records of 156 patients with a diagnosis of ALHL. All patients were followed up until improvement or for 8 weeks from the initial examination. Patients were treated with steroid alone (n = 49), diuretics alone (n = 40), combination treatment (n = 46) or they received neither steroid nor diuretics (n = 21). Results: The steroid-diuretic combination therapy for ALHL showed significantly better results than the steroid or diuretic treatments alone (p < 0.05). There were no clinically significant differences in the outcome between the steroid- and diuretic-alone treatments. Conclusion and Message: The etiology of ALHL is described as both an endolymphatic hydrops and an autoimmunological mechanism so that, as expected, the steroid-diuretic combination therapy was more effective than the steroid or diuretic treatments alone. Copyright © 2010 S. Karger AG, Basel.


Imaizumi T.,Kushiro City General Hospital | Inamura S.,Kushiro City General Hospital | Kohama I.,Kushiro City General Hospital | Yoshifuji K.,Kushiro City General Hospital | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Background Lobar microbleeds (MBs) are occasionally visible on gradient-echo T2*-weighted (T2*-w) magnetic resonance imagings (MRIs) in patients with deep intracerebral hemorrhages (ICHs). This study investigated the contribution of nascent lobar MBs to occurrences of deep ICHs. Methods We prospectively analyzed nascent lobar MBs in patients admitted to our hospital who were treated with index strokes between April 2004 and November 2009. Numbers of nascent lobar MBs were counted on T2*-w MRI scans around 1 year after index strokes and compared with previous MRIs on admission. Deep ICH occurrence-free rate curves were generated by the Kaplan-Meier method using the log-rank test. The odds ratio (OR) for deep ICH occurrence was derived from a multivariate logistic regression model using nascent lobar MBs and risk factors. Results We investigated MRIs (interscan interval: 14.6 ± 5.9 months) of 508 patients (207 women, 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-w MRIs demonstrated 157 nascent lobar MBs in 62 of 508 patients. The occurrence rate of deep ICHs (1.9% per year) was significantly higher in patients with nascent lobar MBs than in those without (.5% per year, P =.012). Multivariate analyses revealed that the rate of nascent lobar MBs was significantly elevated in patients with deep ICH-type stroke recurrences (OR: 3.85, P =.020), adjusted by the presence of hypertension, diabetes mellitus, use of antithrombotic drugs, severity of white matter lesions, age, and gender. Conclusions Though a cohort study limited the power of analyses, our findings suggested that lobar MBs might be associated with deep ICH. © 2014 by National Stroke Association.


Imaizumi T.,Kushiro City General Hospital | Inamura S.,Kushiro City General Hospital | Nomura T.,Kushiro City General Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Background This study investigated the contribution of deep cerebral microbleeds (MBs) to stroke recurrences in patients with histories of deep intracerebral hemorrhages (ICHs) or lacunar infarctions (LIs). Methods We prospectively analyzed stroke recurrences in patients admitted to our hospital who were treated for deep ICHs or LIs between April 2004 and December 2011. The number of deep MBs was counted on admission. Stroke recurrence-free rate curves were generated with the Kaplan-Meier method using the log-rank test. The odds ratios (ORs) for recurrent strokes were derived using multivariate logistic regression models, based on deep MBs and risk factors. Results We evaluated magnetic resonance images or the recurrences of 231 deep-ICH patients (92 women, 68.0 ± 12.0 years old) and 309 LI patients (140 women, 70.7 ± 11.7 years old). The incidences of deep ICHs (1.5%/year) and LIs (2.1%/year) presenting as stroke recurrences were significantly larger in LI patients with deep MBs than in those without (.01 [P =.0001] and.08%/year [P =.005], respectively). However, there was no significant difference between deep-ICH patients with and without MBs in terms of incidence of recurrences. Multivariate analyses revealed that deep MBs independently and significantly elevated the rate of deep ICHs (OR, 19.0; P =.007) or LIs (OR, 3.62; P =.008) presenting as recurrences in LI patients, but not in deep-ICH patients, when adjusted for stroke risk factors. Conclusions There may be differences between patients with deep ICHs and those with LIs in terms of the contribution of deep MBs to stroke recurrence. © 2015 National Stroke Association.


Imaizumi T.,Kushiro City General Hospital | Inamura S.,Kushiro City General Hospital | Kohama I.,Kushiro City General Hospital | Yoshifuji K.,Kushiro City General Hospital | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Background: Cerebral microbleeds (MBs) on gradient echo T2 â̂ --weighted magnetic resonance imaging (MRI) scans are associated with the severity of cerebral microangiopathies. This study investigated the contributions of nascent deep MBs to stroke recurrence. Methods: We prospectively analyzed nascent deep MBs in patients admitted to our hospital who were treated for index strokes between April 2004 and November 2009. The number of nascent deep MBs was counted on T2 â̂ --weighted MRI scans around 1 year after the index strokes, and compared to previous MRIs on admission. Stroke recurrence-free rate curves were generated using the Kaplan-Meier method using the log-rank test. The odds ratio for nascent deep MBs was derived using a multivariate logistic regression model that was based on recurrent strokes and other risk factors. Results: We evaluated the MRIs (interval between MRIs 14.6 ± 5.9 months) of 508 patients (207 women; 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-weighted MRI scans revealed 256 nascent deep MBs in 116 of 508 patients. The incidence of deep intracerebral hemorrhage was significantly greater in patients with nascent deep MBs than those without (2.0% vs 0.4% per year, respectively; P <.0001). Multivariate analyses revealed that the rate of nascent deep MBs was significantly elevated in patients whose stroke recurrences took the form of deep intracerebral hemorrhages (odds ratio 5.41; P =.007), when adjusted for hypertension, preexisting MBs, and other risk factors. Conclusions: Our findings suggested that nascent deep MBs might be associated with stroke recurrence, in particular with deep intracerebral hemorrhage. © 2014 by National Stroke Association.


Morita S.,Kushiro City General Hospital | Mizoguchi K.,Kushiro City General Hospital | Suzuki M.,Kushiro City General Hospital | Iizuka K.,Kushiro City General Hospital
World Journal of Surgery | Year: 2010

Background The aim of this study was to evaluate the accuracy of [ 18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of lymph node metastasis in patients with papillary thyroid carcinoma. Methods In a prospective study performed between January 2007 and December 2009, 74 patients with a diagnosis of papillary thyroid carcinoma confirmed by fine-needle aspiration biopsy were referred to our institution for surgery. Preoperative assessment of metastasis in the central and lateral cervical lymph nodes was done using [18F]- fluoro-2-deoxy-D-glucose- positron emission tomography/ computed tomography, ultrasonography, and enhanced computed tomography. The results for each level of cervical node assessed using these methods were correlated with the pathology reports after surgery. We determined the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the three methods for all levels of cervical lymph node. Results There were no significant differences in the diagnostic results obtained by [18F]-fluoro-2-deoxy-D-glucose- positron emission tomography/computed tomography and enhanced computed tomography. However, ultrasonography images gave significantly better results than either [ 18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography or enhanced computed tomography alone in identifying metastases on the basis of the level of cervical lymph node. In addition, the overall diagnostic accuracy tended to be higher for the lateral compartment than for the central compartment. Conclusions Preoperative assessment by ultrasonography of metastases in the central and lateral cervical lymph nodes might be the best methodology for determining the extent of surgical resection required to removemetastatic lymph nodes adequately in patients with papillary thyroid carcinoma. © The Author(s) 2010.


Morita S.,Kushiro City General Hospital | Suzuki M.,Kushiro City General Hospital | Iizuka K.,Kushiro City General Hospital
Auris Nasus Larynx | Year: 2011

Objective: To heighten physician awareness of false-negative diffusion-weighted (DW) magnetic-resonance imaging findings in patients with acute cerebellar infarction and the importance of periodically observing nystagmus after symptom onset. Methods: Between April 2007 and March 2010, we retrospectively reviewed the medical records of eight patients who had all complained of severe isolated vertigo or dizziness, and had visited an emergency department within 2-6. h of its onset. Intracranial findings on initial magnetic resonance imaging (MRI) were normal. All patients had consulted our department for peripheral vestibular disorders. We periodically observed spontaneous and positional nystagmus 6-24. h after symptom onset. Results: In three of the patients, the direction and/or type of nystagmus changed periodically. In four of the patients, severe vertigo, nausea, and vomiting persisted after the nystagmus had been resolved. A repeat MR examination was performed 24. h after symptom onset because of the atypical pattern of nystagmus for benign peripheral vestibular disorders, at which point cerebellar infarction was detected. Conclusions: Physicians who examine patients with acute severe isolated vertigo or dizziness should consider the possibility of false-negative DW MRI findings in case of hyperacute ischemic stroke. It is important to observe the nystagmus periodically after onset. The MR examination should be repeated more than 24. h after symptom onset in patients with an atypical pattern of nystagmus for benign peripheral vestibular disorders. © 2011 Elsevier Ireland Ltd.

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