Miyakonojo Medical Association Hospital

Miyakonojō, Japan

Miyakonojo Medical Association Hospital

Miyakonojō, Japan

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Ikushima I.,Miyakonojo Medical Association Hospital | Yonenaga K.,Miyakonojo Medical Association Hospital
Acta Radiologica | Year: 2013

Background: The placement of detachable coil has become the alternative method of treating visceral arterial aneurysms (VAAs). Imaging follow-up is necessary after coil embolization because of frequent incomplete occlusion. Purpose: To compare contrast-enhanced magnetic resonance angiography (CE-MRA) at 3T with a reference standard of digital subtraction angiography (DSA) for the evaluation of VAAs after coil embolization. Material and Methods: We treated 15 patients with VAA with coil embolization; eight had splenic artery aneurysms and seven had renal artery aneurysms. We packed the aneurysmal sac preserving native arterial circulation. For follow-up, all patients underwent CE-MRA at 3T and DSA. The results were classified according to coil occlusion: Class 1, complete occlusion; Class 2, residual neck; Class 3, aneurysmal filling. Results: CE-MRA revealed 11 complete occlusions and four residual necks. DSA follow-up showed 12 complete occlusions and three residual necks. No aneurysmal filling occurred after treatment. Comparison of CE-MRA and DSA findings showed 93% agreement (14/15). CE-MRA allowed the detection of a residual neck in one misclassified case in which DSA showed occlusion. Coil-related artifacts were minimal and did not interfere with evaluation of the occlusion status of the VAAs. Conclusion: CE-MRA at 3T provides high-quality images equivalent to DSA for the evaluation of VAAs after coil embolization. We suggest that CE-MRA at 3T might be used as the primary method for follow-up of VAAs after coil embolization.


PubMed | Miyakonojo Medical Association Hospital
Type: Comparative Study | Journal: Acta radiologica (Stockholm, Sweden : 1987) | Year: 2014

The placement of detachable coil has become the alternative method of treating visceral arterial aneurysms (VAAs). Imaging follow-up is necessary after coil embolization because of frequent incomplete occlusion.To compare contrast-enhanced magnetic resonance angiography (CE-MRA) at 3T with a reference standard of digital subtraction angiography (DSA) for the evaluation of VAAs after coil embolization.We treated 15 patients with VAA with coil embolization; eight had splenic artery aneurysms and seven had renal artery aneurysms. We packed the aneurysmal sac preserving native arterial circulation. For follow-up, all patients underwent CE-MRA at 3T and DSA. The results were classified according to coil occlusion: Class 1, complete occlusion; Class 2, residual neck; Class 3, aneurysmal filling.CE-MRA revealed 11 complete occlusions and four residual necks. DSA follow-up showed 12 complete occlusions and three residual necks. No aneurysmal filling occurred after treatment. Comparison of CE-MRA and DSA findings showed 93% agreement (14/15). CE-MRA allowed the detection of a residual neck in one misclassified case in which DSA showed occlusion. Coil-related artifacts were minimal and did not interfere with evaluation of the occlusion status of the VAAs.CE-MRA at 3T provides high-quality images equivalent to DSA for the evaluation of VAAs after coil embolization. We suggest that CE-MRA at 3T might be used as the primary method for follow-up of VAAs after coil embolization.


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.


Ikushima I.,Miyakonojo Medical Association Hospital | Higashi S.,Medical City East Hospital | Ishii A.,Medical City East Hospital | Seguchi K.,Medical City East Hospital | And 3 more authors.
CardioVascular and Interventional Radiology | Year: 2011

Purpose: We have previously reported the clinical efficacy of water-in-oil-in-water (W/O/W) emulsion containing anticancer agent. The purpose of this study was to evaluate the safety and effectiveness of transcatheter arterial infusion (TAI) of W/O/W emulsion via a cystic artery for hepatocellular carcinoma (HCC). Methods: TAI of a W/O/W emulsion was performed at our institute in five patients with Stage III or IV HCC with blood supply from the cystic artery. In all patients, 2-12 ml W/O/W emulsion was infused via a cystic artery. Therapeutic effects and complications were evaluated in these patients. Results: Of the five patients treated, one achieved a complete response and two achieved a partial response. After treatment, acute cholecystitis or gallbladder ischemia that required treatment was not encountered in any patient. Conclusions: W/O/W emulsion can be safely infused via a cystic artery without major complications; it is a good therapeutic option for the patients with advanced HCC fed by a cystic artery. © 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).


Yamasaki K.,University of Miyazaki | Yokogami K.,University of Miyazaki | Ohta H.,Miyakonojo Medical Association Hospital | Yamashita S.,University of Miyazaki | And 3 more authors.
Brain Tumor Pathology | Year: 2014

Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and fatal disease characterized by diffuse infiltration of the leptomeninges by neoplastic glial cells without evidence of tumor in the brain parenchyma or spinal cord. We report a 60-year-old man with PDLG. He suffered transient right hemiparesis and generalized seizures. MRI showed diffuse leptomeningeal thickening and enhancement throughout the brain and spinal cord without any intraaxial involvement. Biopsy resulted in a diagnosis of glioblastoma with methylated MGMT promoter and wild-type IDH1. He underwent craniospinal radiotherapy and temozolomide treatment but despite concomitant adjuvant therapy he died 8 months after initial presentation. © 2014 The Japan Society of Brain Tumor Pathology.


Ichiro I.,Miyakonojo Medical Association Hospital | Shushi H.,Medical City East Hospital | Akihiko I.,Medical City East Hospital | Yasuhiko I.,Miyakonojo Medical Association Hospital | Yasuyuki Y.,Kumamoto University
Journal of Vascular and Interventional Radiology | Year: 2011

Purpose: To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. Materials and Methods: During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. Results: The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. Conclusions: A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. © 2011 SIR.


Niibo T.,Miyakonojo Regional Medical Center | Niibo T.,Miyakonojo Medical Association Hospital | Ohta H.,Miyakonojo Medical Association Hospital | Yonenaga K.,Miyakonojo Regional Medical Center | And 3 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.


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.


PubMed | Miyakonojo Medical Association Hospital
Type: | Journal: Medical devices (Auckland, N.Z.) | Year: 2012

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.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.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).This retrospective study showed that cilostazol significantly reduces in-stent stenosis after SFA stent placement compared with ticlopidine.


PubMed | Miyakonojo Medical Association Hospital
Type: Clinical Trial | Journal: The British journal of radiology | Year: 2012

We have previously reported the clinical efficacy of water-in-oil-in-water (W/O/W) emulsions, particularly for non-selective transcatheter arterial infusion (TAI) therapy. W/O/W emulsions limit damage to normal hepatic parenchyma, because of their minimal embolic effect on peripheral arteries and slow release of anticancer agent. The purpose of this study was to evaluate the safety and effectiveness of ultraselective TAI (UTI) of a W/O/W emulsion for hepatocellular carcinoma (HCC).11 patients with Stage I-III small HCCs (<5 cm) underwent UTI with a W/O/W emulsion at our institute. Response was assessed using the Response Evaluation Criteria in Solid Tumors. Disease-free survival time was estimated using the Kaplan-Meier method.All 10 patients, excluding a patient who underwent a hepatectomy after UTI, achieved complete response. The 6, 12 and 30 month cumulative disease-free survival rates for the 10 patients were 100%, 90% and 60%, respectively. The patient who underwent hepatectomy after UTI developed complete necrosis of the HCC and peritumoral non-tumorous liver parenchyma.UTI therapy using a W/O/W emulsion for patients with small HCCs results in a good local response.

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