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Kaida T.,Miyata Eye Hospital | Nakamura Y.,Miyata Eye Hospital | Miyata K.,Miyata Eye Hospital | Aihara M.,University of Tokyo | And 2 more authors.
Folia Japonica de Ophthalmologica Clinica | Year: 2011

Background: Many cases of spontaneous carotid cavernous fistula (CCF) develop in middle-aged females. We experienced the case of a young female patient with direct type CCF who showed spontaneously occurring severe retrobulbar hemorrhage. Case report: A 20-year-old female complained of a sudden onset of severe retrobulbar hemorrhage, black eye, and exophthalmos in the right. Right intra carotid angiography showed a direct CCF, where abnormal blood flow drained into the engorged superior ophthalmic vein from the cavernous sinus. During her follow-up, her mother developed a typical CCF leading to subarachnoid hemorrhage. These unexpected events suggest this family had Ehlers-Danlos syndrome (EDS) type IV. Conclusion: If a young patient develops spontaneous CCF without trauma, care should be taken for the possibility of EDS type IV, characterized by fragile vessels considering family and past history. Source


Niibo T.,Miyakonojo Regional Medical Center | Ohta H.,Miyakonojo Medical Association Hospital | Yonenaga K.,Miyakonojo Regional Medical Center | Ikushima I.,Miyakonojo Regional Medical Center | And 2 more authors.
Stroke | Year: 2013

Background and Purpose - We assigned a threshold to arterial spin-labeling (ASL) perfusion-weighted images (PWI) from patients with acute ischemic stroke and compared them with dynamic susceptibility contrast perfusion images to examine whether mismatch can be determined. Methods - Pseudocontinuous ASL was combined with dynamic susceptibility contrast PWI in 23 patients with acute ischemic stroke. Scans were obtained within 24 hours of symptom onset. PWI volumes were defined by ASL cerebral blood flow (<15, <20, and <25 mL/100 g per minute) and dynamic susceptibility contrast-mean transit time (MTT) thresholds (>10 s) that show a strong association with cerebral blood flow <20 mL/100 g per minute in Xenon CT studies. Agreement between the ASL-diffusion-weighted imaging and MTT-diffusion-weighted imaging mismatch and the correlation between penumbra salvage and infarct growth, defined as the difference between the baseline PWI and the baseline diffusion-weighted imaging lesion, respectively, and the final infarct volume were assessed. Results - The lesion volumes defined by MTT>10 s and ASL<20 mL/100 g per minute showed an excellent correlation. There was 100% agreement on the mismatch status between MTT>10 s and ASL<20 mL/100 g per minute. The correlation between infarct growth and penumbra salvage volume was significantly better for PWI lesions defined by ASL<20 mL/100 g per minute and MTT>10 s. Conclusions - In acute ischemic stroke, PWI lesions based on ASL threshold of <20 mL/100 g per minute can provide a reliable estimate of mismatch in correspondence at MTT threshold of >10 s. © 2013 American Heart Association, Inc. Source


Kosaka M.,Fukuoka Sanno Hospital | Yamamichi K.,Miyakonojo Medical Association Hospital | Irie H.,Fukuoka Sanno Hospital | Goto A.,Fukuoka Sanno Hospital
Japanese Journal of Plastic Surgery | Year: 2014

We experienced two cases of lower leg muscle hernia, which is unfamiliar to skin surgeons because only a few cases have been reported in the Japanese literature. Case 1 : A 33-year-old woman had a vanishing subcutaneous mass on her left lower leg that appeared in the standing position without any cause. She complained of radiating pain distal from the nodule. Ultrasonography and magnetic resonance imaging were performed to obtain a compartmentalized anatomic approach according to the location of signal abnormalities in subcutaneous fat, superficial and deep fascia, and muscle. Under general anesthesia, the ruptured fascia of the peroneus brevis was sutured directly without excessive tension. The subcutaneous mass disappeared without any complications. Case 2 : A 53-year-old woman had an asymptomatic subcutaneous mass on her right lower leg that appeared in the standing position. She had participated in baseball, kendo, and ballet for several decades. Magnetic resonance imaging revealed ruptured fascia of the peroneus brevis. Because the mass was asymptomatic, conservative therapy that included wearing a pressure stocking was selected.Herein, we have discussed treatment alternatives for this condition that is particularly unusual in the Japanese population. Source


Ikushima I.,Miyakonojo Medical Association Hospital | Hirai T.,Kumamoto University | Ishii A.,Medical City East Hospital | Iryo Y.,Miyakonojo Medical Association Hospital | Yamashita Y.,Kumamoto University
Journal of Vascular and Interventional Radiology | Year: 2011

The present report describes a technique of simultaneous confluent balloon inflation in cases in which conventional subintimal angioplasty failed. Eight patients with peripheral vascular occlusive disease (n = 4 each with iliac arterial lesions and superficial femoral arterial lesions) of clinical category 35 received treatment with the confluent two-balloon technique. Recanalization was successfully completed with this technique in all eight patients, without any major complications. All patients with claudication and rest pain were relieved of their symptoms, and both patients with ulcers showed improvement. © 2011 SIR. Source


Ikushima I.,Miyakonojo Medical Association Hospital | Yonenaga K.,Miyakonojo Medical Association Hospital | Iwakiri H.,Miyakonojo Medical Association Hospital | Nagoshi H.,Miyakonojo Medical Association Hospital | And 2 more authors.
Medical Devices: Evidence and Research | Year: 2011

Purpose: The purpose of this study was to assess the preventive effect of cilostazol on in-stent restenosis in patients after superficial femoral artery (SFA) stent placement. Materials and methods: Of 28 patients with peripheral arterial disease, who had successfully undergone stent implantation, 15 received cilostazol and 13 received ticlopidine. Primary patency rates were retrospectively analyzed by means of Kaplan-Meier survival curves, with differences between the two medication groups compared by log-rank test. A multivariate Cox proportional hazards model was applied to assess the effect of cilostazol versus ticlopidine on primary patency. Results: The cilostazol group had significantly better primary patency rates than the ticlopidine group. Cumulative primary patency rates at 12 and 24 months after stent placement were, respectively, 100% and 75% in the cilostazol group versus 39% and 30% in the ticlopidine group (P = 0.0073, log-rank test). In a multivariate Cox proportional hazards model with adjustment for potentially confounding factors, including history of diabetes, cumulative stent length, and poor runoff, patients receiving cilostazol had significantly reduced risk of restenosis (hazard ratio 5.4; P = 0.042). Conclusion: This retrospective study showed that cilostazol significantly reduces in-stent stenosis after SFA stent placement compared with ticlopidine. © 2011 Ikushima et al, publisher and licensee Dove Medical Press Ltd. Source

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