Nantan General Hospital

Nantan, Japan

Nantan General Hospital

Nantan, Japan
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Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine | Shigemi K.,University of Fukui | Sawa T.,Kyoto Prefectural University of Medicine
Neuroscience Letters | Year: 2012

This study examined EEG under clinical anesthesia in neonates and infants, to clarify how growth affects EEG during anesthesia. Subjects comprised 62 neonates and infants. Patients were divided into four groups according to age: Group 1 (neonates), <1 month; Group 2, 1-2 months; Group 3, 3-5 months; and Group 4, 6 months to 2 years. Anesthesia was maintained with sevoflurane and fentanyl and/or caudal block. At four points of sevoflurane concentration (0.5%, 1%, 1.5%, and 2%), 90% spectral edge frequency (SEF90), burst suppression ratio (BSR), relative beta ratio (RBR) and approximate entropy (ApEn) were analyzed. In Group 4, SEF90, BSR, RBR and ApEn changes were dependent on the concentration of anesthesia, along with changes in sevoflurane concentration from 0.5% to 2% (from 14.3 (2.7) [mean (SD)] Hz to 8.2 (3.8) Hz, from 0.0 to 0.32 (0.36), from -1.58 (0.14) to -1.10 (0.15), and from 0.56 (0.25) to 0.24 (0.25) respectively; p< 0.05 each). Conversely, these processed EEG parameters in Group 1 showed little anesthesia-dependent change under sevoflurane concentrations between 0.5% and 2% (SEF90: 7.3 (1.2) Hz vs. 7.7 (2.1) Hz; BSR: 0.51 (0.20) vs. 0.62 (0.29); RBR: -1.00 (0.17) vs. -1.03 (0.27); ApEn: 0.32 (0.18) vs. 0.25 (0.14), respectively). The unique EEG features of neonates during anesthesia rapidly change to the usual anesthesia-dependent patterns seen in older children, with a boundary of 3-5 months old. In infants younger than 6 months old, neural network regulation reflected in EEG by anesthesia is weak. © 2012 Elsevier Ireland Ltd.

Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine | Mukai N.,Nantan General Hospital | Sawa T.,Kyoto Prefectural University of Medicine
Clinical Neurophysiology | Year: 2015

Objective: The Poincaré plot is a two-dimensional state-space approach, where a timed signal is plotted against itself after a time delay, enabling determination of the dynamic nature of signals. Quantification of the Poincaré plot is a candidate for estimating anesthesia-dependent changes in the electroencephalogram (EEG). Methods: In 20 patients, at four different states of anesthesia (0.5%, 1%, 2% and 3% sevoflurane), frontal EEG signals (10. s) were used to construct Poincaré plots. The plot pattern was quantified by the standard deviation of the voltage dispersion along the line of identity (SD2), the standard deviation perpendicular to the line of identity (SD1) and their ratio (SD1/SD2), and compared using spectral EEG features. Results: A significant stepwise decrease in the SD1/SD2 ratio was observed with each stepwise increase in sevoflurane concentration (p< 0.001 for each). From 0.5% to 3% sevoflurane anesthesia, the ratio of relative β power to δ power (β/. δ) was highly correlated with SD1/SD2 (R= 0.92). Conclusions: The Poincaré plot of the frontal EEG can detect the significant changes in the depth of anesthesia induced by different sevoflurane concentrations. Significance: The Poincaré plot is a useful technique for detecting the EEG changes induced by anesthesia. © 2014 International Federation of Clinical Neurophysiology.

Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine | Mukai N.,Nantan General Hospital | Sawa T.,Kyoto Prefectural University of Medicine
Clinical Neurophysiology | Year: 2014

Objective: Occipital electroencephalogram (EEG) activity is known to be different from the frontal EEG during wakefulness and anesthesia. However, less is known about occipital non-linear dynamics analyzed by EEG-bicoherence, which can reflect the oscillatory features that are dependent on thalamocortical modulation. Methods: Forty patients were anesthetized using sevoflurane (1% or 3%) combined with remifentanil. Frontal and occipital EEGs were simultaneously collected, and bicoherence was analyzed before and after induction of anesthesia. Results: Occipital awake EEGs often demonstrate a bicoherence α peak, differing from frontal awake EEGs in the absence of bicoherence growth. With 1% sevoflurane, occipital α bicoherence disappeared and frontal α bicoherence peaks appeared. Although 3% sevoflurane caused an increase in occipital δ-θ normalized power, similar to the frontal region (peak relative δ-θ power, 13.1. ±. 2.2% vs. 12.2. ±. 2.7%, p>. 0.05), occipital bicoherence showed no growth in any frequency area, contrasting with the frontal bicoherence spectrum with a conspicuous peak in the δ-θ area (19.8. ±. 8.9 vs. 43.6. ±. 13.8, p<. 0.05). Conclusions: The occipital bicoherence spectrum in the peri-anesthesia period is quite different from the frontal bicoherence spectrum, which is not usually obvious in the power spectrum. Significance: Nonlinear regulation of the occipital EEG is different from the frontal EEG during every stage of anesthesia. © 2013 International Federation of Clinical Neurophysiology.

Arimura T.,Tokyo Medical and Dental University | Takeya R.,Kyushu University | Ishikawa T.,Tokyo Medical and Dental University | Yamano T.,Kyoto Prefectural University of Medicine | And 5 more authors.
Circulation Journal | Year: 2013

Background: Dilated cardiomyopathy (DCM) is characterized by a dilated left ventricular cavity with systolic dysfunction manifested by heart failure. It has been revealed that mutations in genes for cytoskeleton or sarcomere proteins cause DCM. However, the disease-causing mutations can be found only in far less than half of patients with a family history, indicating that there should be other disease genes for DCM. Formin homology 2 domain containing 3 (FHOD3) is a sarcomeric protein expressed in the heart that plays an essential role in sarcomere organization during myofibrillogenesis. The purpose of this study was to explore a possible novel disease gene for DCM. Methods and Results: We analyzed 48 Japanese familial DCM patients for mutations in FHOD3, and a missense variant, Tyr1249Asn, which was predicted to modify the 3D structure and damage protein function, was found in a case with adult-onset DCM. Functional studies revealed that the DCM-associated mutation significantly reduced the ability to induce actin dynamics-dependent activation of serum response factor, although no remarkable change in the cellular localization was induced in neonatal rat cardiomyocytes transfected with a mutant construct of FHOD3. Conclusions: The DCM-associated FHOD3 variant may cause DCM by interfering with actin filament assembly.

Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine
Journal of Clinical Anesthesia | Year: 2016

Recently, NuVasive NV-M5 nerve monitoring system, a new transcranial motor–evoked potential (TcMEP) monitor, has been introduced with the spread of flank-approach spinal operations such as extreme lateral interbody fusion, to prevent nerve damage. Conventional TcMEP monitors use changes in MEP wave patterns, such as amplitude and/or latency, whereas the NV-M5 nerve monitor system first measures the MEP baseline waveform from the transcranial-evoked potential then measures the electric current necessary to obtain the standard of the previous baseline wave pattern at subsequent monitoring times. The NV-M5 monitor determines nerve damage according to the increase in necessary electric current threshold. The NV-M5 monitor also uses a local electrical stimulation mode to monitor the safety of setting screws into the lumbar vertebrae. In this way, various electrical stimulations with various durations and frequencies are used, and electrical noise may result in unpredictable interference with cardiac pacemakers. We performed anesthetic management of extreme lateral interbody fusion surgery using the NV-M5 in a patient with an implanted pacemaker, during which TcMEP stimulation caused interference with the implanted pacemaker. © 2016 Elsevier Inc.

Ochi Y.,Research Institute for Production Development | Kajita Y.,Nantan General Hospital | Hachiya T.,Midorigaoka Hospital | Arata N.,National Center for Child Health and Development | Hamaoki M.,Yamasa Ltd
Endocrine, Metabolic and Immune Disorders - Drug Targets | Year: 2013

Previously, we reported the conversion phenomenon (CP) of thyroid blocking antibody (TBAb) to thyroid stimulating antibody (TSAb) by induced cAMP production during incubation of TBAb-bound porcine thyroid cells (PTC) with rabbit anti-IgG Ab. In the present experiment we examined the CP by TBAb-positive sera with high TSH binding inhibitor immunoglobulin (TBII) activity in primary hypothyroidism. Two patients with extremely high TBII patients; patient No.1 (35 yo male) with TSH 26.5μU/ml, TSAb negative, TBII 4,600 U/L, TBAb100% and patient No.2 (40 yo female) with TSH 4.5μU/ml, TSAb negative, TBII 1,620 U/L, TBAb 99.8% were examined. Cyclic AMP production was examined by 2nd incubation (3h) of anti-IgG Ab with TBAb-bound PTC that was made by 1st incubation (0.5h) of TBAbpositive serum and PTC. When sera (0.001-0.05 ml) of patient No.1 and No.2 were tested, cAMP production showed 980- 3,700% and 570-3,000% in a dose-dependent manner, respectively. Cyclic AMP production was also observed by anti- IgG fragments Ab [(Fab')2, Fab and light chain]. Cyclic AMP production by anti-F(ab')2 was higher than anti-Fab Ab, and cAMP by anti-κ Ab was significantly higher (>3 fold) than anti-λ Ab. Cyclic AMP production by TBAb-positive sera with high TBII activity (35-270 U/L) showed a correlation with serum TBII activity (R=0.76). The fact that all high TBAb-positive sera show the CP of TBAb to TSAb suggests that TSAb activity may be present in TBAb molecule and TBAb may be the precursor of TSAb. © 2013 Bentham Science Publishers.

Ochi Y.,Research Institute for Production Development | Kajita Y.,Nantan General Hospital | achiya T.,Midorigaoka Hospital | amaoki M.,Yamasa Ltd
Endocrine Journal | Year: 2012

There are several reports that sera from Graves' patients contain heterophilic antibody (Ab) to animal IgG such as human anti-mouse antibody (HAMA). We examined the binding of TSAb and TBAb with heterophilic Ab. The binding of animal IgG with patient's IgG was examined by the inhibition of animal IgG on the binding of labeled bovine (b) IgG with patient's IgG. The binding to labeled bIgG was detected in the serum of 5 patients (2.7%) among 185 patients with Graves' disease. The binding of the labeled bIgG with patient's IgG was inhibited by animal serum or the crude IgG (45% ammonium sulfate fraction of serum) (such as dog, horse, bovine, porcine, goat, ovine, rabbit, guinea-pig, rat, mouse) except human, monkey and chick. This heterophilic Ab which had cross-reaction with mammalian IgG (except human, monkey) was used as human anti-animal IgG Ab. TBII and TSAb activity of TSAb-positive serum, and TBII activity of TBAb-positive serum were neutralized by incubation with this Ab-bound column. Partial purifcation of TSAb- or TBAb-IgG from Protein A-purifed TSAb- or TBAb-IgG was possible using this Ab-bound column. TBII and TSAb activity of TSAb-IgG and TBII activity of TBAb-IgG were neutralized by incubation with rabbit anti-human (h) IgG Ab (having cross-reaction with animal IgG). Further purification of Protein A-purifed TSAb-IgG or TBAb-IgG by rabbit anti-hIgG Ab-bound column was impossible. The binding of TSAb and TBAb with heterophlic Ab means that TSAb-and TBAb-specifc IgG have immunological similarity with mammalian species IgG compared to human IgG. © The Japan Endocrine Society.

Katsumi Y.,Nantan General Hospital | Otabe O.,Nantan General Hospital | Matsui F.,Nantan General Hospital | Kidowaki S.,Nantan General Hospital | And 3 more authors.
Pediatrics | Year: 2012

OBJECTIVE: The purpose of this study was to compare the efficiency and safety of a new neuraminidase inhibitor, laninamivir octanoate (LO), with zanamivir (ZN) in pediatric patients with influenza. METHODS: One hundred twelve pediatric patients ≤15 years, diagnosed with a rapid diagnostic test as having influenza from January to May 2011, were randomly assigned to the LO group or the ZN group, and their parents were asked to complete a questionnaire during the recovery at home. The LO group was instructed to inhale LO once (20 or 40 mg depending on age), and the ZN group was instructed to inhale ZN (20 mg) twice daily for 5 days. RESULTS: The LO group (n = 55) and the ZN group (n = 57) were well balanced. Finally, 44 patients in the LO group and 41 patients in the ZN group could be evaluated. Median times to fever resolution after initial treatment were 36 hours in the LO group and 37 hours in the ZN group. No differences were observed between the 2 groups with respect to the frequencies of asthmatic symptoms, pneumonia, gastrointestinal symptoms, or abnormal behaviors. Six younger children could not inhale LO well for technical reasons. CONCLUSIONS: Our data suggest that the efficiency and safety of LO are the same as those of ZN in pediatric patients with influenza but that LO may be more convenient than ZN because it requires only a single inhalation. However, younger patients may not inhale LO efficiently. Copyright © 2012 by the American Academy of Pediatrics.

Shiga T.,Nantan General Hospital | Mori M.,Nantan General Hospital | Hayashida T.,Nantan General Hospital | Fujiwara Y.,Nantan General Hospital | Ogura T.,Nantan General Hospital
Journal of Arthroplasty | Year: 2010

We report a rare case of a taper-locked femoral inner head that have been completely separated from the stem neck. A 76-year-old man who had hip fracture of the right hip had disassembly of inner head and stem neck after revision of bipolar hip prosthesis. This force could have been amplified by the pumping phenomenon generated after the revised inner head. We suspect the sealed air pushes back the stem neck, and unlocks the taper lock of the inner head, causing separation of the stem neck from the inner head. To prevent pumping phenomenon, we recommend manual testing of the taper lock to confirm that it has been assembled correctly and its integrity before implantation when the bloody and fatty membrane is adequately removed from stem neck. © 2010 Elsevier Inc.

Koida A.,Nantan General Hospital | Kayano K.,Nantan General Hospital | Matsumoto S.,Nantan General Hospital
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2016

Orbital complications of sinusitis manifested various eye symptoms such as eye pain and eyelid swelling, eye movement disorder and blindness. A delay in diagnosis and appropriate treatment may result in serious complications including blindness. We treated two cases of the orbital complications caused by acute sinusitis. Patient 1 was a 11-month-old girl who presented with subperiosteal abscess. Patient 2 was a 14-year-old boy who presented with eyelid cellulitis. Both patients underwent surgical treatment with ESS. They healed satisfactorily without sequelae.

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