Nara Prefecture General Medical Center

Nara Prefecture, Japan

Nara Prefecture General Medical Center

Nara Prefecture, Japan
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Sekine Y.,Nara Prefecture General Medical Center | Nishina T.,Nara Prefecture General Medical Center | Ueda Y.,Nara Prefecture General Medical Center
Interactive Cardiovascular and Thoracic Surgery | Year: 2017

A 69-year-old man was admitted to our hospital with acute epigastric discomfort and subsequent paraplegia. Computed tomography revealed acute type B aortic dissection with a thrombosed false lumen. Magnetic resonance imaging did not reveal spinal cord infarction. Paraplegia resolved completely within 1 h. However, on the following day, the patient developed motor impairment in the left leg, sensory disorder of the bilateral legs and urinary retention. The symptoms gradually improved with conservative medical therapy. Magnetic resonance imaging on hospitalization Day 20 revealed spinal cord infarction limited to the right posterior area at level T7/T8 and the conus medullaris. The patient was discharged 44 days after admission. The presented case is notable for its atypical presentation of spinal cord infarction resulting from acute aortic dissection. The aetiology of neurological symptoms, especially that of lower extremity monoplegia, remained undiagnosed. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.


PubMed | Hirao Hospital, Nara Prefecture General Medical Center, Saiseikai Chuwa Hospital, Nara Medical University and 2 more.
Type: | Journal: Neurourology and urodynamics | Year: 2016

We aimed to compare the efficacy and safety of mirabegron, a 3-adrenoceptor agonist, and imidafenacin, an anticholinergic agent, in overactive bladder patients.We conducted a multicenter, prospective randomized cross-over study at 5 hospitals in Japan from December 2012 to June 2015. We enrolled female patients with overactive bladder aged 50 years, who had never received treatment for the condition. The patients were assigned to Group A or B. Group A patients were administered mirabegron (50mg per day) for 8 weeks, followed by a 2-week washout period, and then imidafenacin (0.2mg per day) for 8 weeks. This order of drug administration was reversed in Group B.A total of 33 and 18 patients in Group A and 37 and 26 patients in Group B continued to receive treatment at weeks 8 and 18, respectively. Mirabegron administration significantly improved overactive bladder symptom score (OABSS), the urinary frequency per 24hr, voided volume per micturition, and number of nocturia episodes per night at week 8. Moreover, imidafenacin administration improved all these variables, except for the number of nocturia episodes per night at week 8. No significant difference was observed in the drug effects between mirabegron and imidafenacin. Although imidafenacin administration significantly increased the scores for dry mouth, blurred vision, and constipation, mirabegron administration did not.Mirabegron and imidafenacin have the same efficacy. Imidafenacin administration is associated with a higher rate of dry mouth, blurred vision, and constipation as compared to mirabegron administration. Neurourol. Urodynam. 2016 Wiley Periodicals, Inc.


Mizuno T.,Gifu University | Suzuki N.,Gifu University | Makino H.,Gifu University | Furui T.,Gifu University | And 12 more authors.
Gynecologic Oncology | Year: 2015

Objective. In ovarian cancer cases, recurrence after chemotherapy is frequently observed, suggesting the involvement of ovarian cancer stem-like cells (CSCs). The chemoresistance of ovarian clear cell carcinomas is particularly strong in comparison to other epithelial ovarian cancer subtypes. We investigated the relationship between a CSC marker, aldehyde dehydrogenase 1 (ALDH1), and clinical prognosis using ovarian clear cell carcinoma tissue samples. Furthermore, we investigated the antioxidant mechanism by which CSCs maintain a lower reactive oxygen species (ROS) level, which provides protection from chemotherapeutic agents. Methods. Immunohistochemical stainingwas performed to examine the CSC markers (CD133, CD44, ALDH1) using ovarian clear cell carcinoma tissue samples (n=81). Clear cell carcinoma cell lines (KOC-7C, OVTOKO) are separated into the ALDH-high and ALDH-low populations by ALDEFLUOR assay and fluorescence-activated cell sorting (FACS). We compared the intracellular ROS level, mRNA level of the antioxidant enzymes and Nrf2 expression of the two populations. Results. High ALDH1 expression levels are related to advanced stage in clear cell carcinoma cases. ALDH1 expression significantly reduced progression free survival. Other markers are not related to clinical stage and prognosis. ALDH-high cells contained a lower ROS level than ALDH-low cells. Antioxidant enzymes were upregulated in ALDH-high cells. ALDH-high cells showed increased expression of Nrf2, a key transcriptional factor of the antioxidant system. Conclusions. ALDH-positive CSCs might have increased Nrf2-induced antioxidant scavengers, which lower ROS level relevant to chemoresistance in ovarian clear cell carcinoma. © 2014 Elsevier Inc.


PubMed | Nara Prefecture General Medical Center, Otemae Hospital and Nara Medical University
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Case-control study.To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI).SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation.We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/L at 4 days postoperatively. Statistical analysis was via Fishers exact test and a p-value of <0.05 was considered significant.In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6.A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/L at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis.


PubMed | Nara Prefecture General Medical Center, Otemae Hospital and Nara Medical University
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Case control study.To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis.SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial.We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/L at 4 days postoperatively.Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/L at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (A lymphocyte count of <1,000/L at 4 days postoperatively is the most significant laboratory marker for early detection of SSI.


Isomoto S.,Nara Prefecture General Medical Center | Tanaka Y.,Nara Medical University
Brain and Nerve | Year: 2014

Morton's disease refers to neuralgia at the web space of the toes with a pseudo-neuroma. It commonly occurs in the third web space of the foot in middle-aged and older women. The pseudo-neuroma is thought to be a secondary change after entrapment or repeated microtrauma. Patients complain of forefoot pain while walking. Typically, symptoms are caused by tight high-heeled shoes. The physical examination includes palpation of the web spaces and Mulder's test. Weight bearing foot radiographs are used to evaluate the deformity of the foot, especially at metatarsophalangeal (MTP) joints. MRI is useful for differential diagnosis of pseudo-neuroma, MTP joint arthritis, and interdigital bursitis. Conservative treatments are shoe modification, use of orthotic insoles, and injection of corticosteroids and local anesthesia. The injections are useful not only for the treatment but also for diagnosis of Morton's disease. If the local injection is not temporally effective, surgical treatment is not indicated. If the conservative treatment fails, surgical treatment is indicated. The most common surgery is excision of the pseudo-neuroma. The surgery is usually performed using a dorsal approach.


Fukui S.,Nara Prefecture General Medical Center | Aoki K.,Nara Medical University | Shimada K.,Nara Medical University | Samma S.,Nara Prefecture General Medical Center
Urology | Year: 2016

A 9-year-old boy was referred to us with an acute pain attack of the left scrotal contents. Ultrasonography showed a normal blood supply to the left testis, suggesting an incarcerated left inguinal hernia. Surgical exploration did not demonstrate an incarcerated left inguinal hernia. After exploration of the left testis, a dark red pedunculated cystic mass, separate from the left testis, was found to be twisted. Immunohistochemical studies of the excised cyst demonstrated torsion of the hernia sac of the peritoneum. In conclusion, we encountered a case of acute scrotum which was probably caused by torsion of the hernia sac. © 2016 Elsevier Inc. All rights reserved.


Minowa H.,Nara Prefecture General Medical Center
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Objective: The objective of this study is to present information on respiratory inhibition after crying (RIAC), feeding hypoxemia, and respiratory inhibition after gastroesophageal reflux (RIGER) to medical staff caring for infants.Methods: The author reviewed investigations of these conditions.Results: These conditions have been observed in full-term healthy infants, and they are accompanied clinically by central cyanosis and a decrease in SpO2 to less than 70%. These conditions are easily diagnosed using pulse oximetry. Among Japanese infants with a gestational age of 36 weeks or older, the incidence of RIAC and feeding hypoxemia is 24% and 32%, respectively. The incidence of RIGER is approximately 4%. Feeding hypoxemia occurs significantly more often during bottle-feeding than during breastfeeding. RIAC, feeding hypoxemia, and RIGER are significantly associated with each other. The risk factors are maternal smoking during pregnancy, threatened premature labor, twin gestation, asymmetric intrauterine growth restriction, and abnormal cranial ultrasound findings. Almost all infants recover from RIAC by day 7 after birth. Some infants with feeding hypoxemia require additional assistance and monitoring by nursing staff until the day of discharge.Conclusions: Medical staff caring for infants should note the presence of RIAC, feeding hypoxemia, and RIGER. © 2015 Taylor & Francis.


PubMed | Nara Prefecture General Medical Center
Type: Journal Article | Journal: Annals of surgical oncology | Year: 2016

Resectability of colorectal liver metastasis (CRLM) depends on major vascular involvement and is affected by chemotherapy-induced liver injury. Parenchyma-sparing with combined resection and reconstruction of involved vessels may expand the indications and safety of hepatectomy.Of 92 patients who underwent hepatectomy for CRLM, 15 underwent major vascular resection and reconstruction. The reconstructed vessels were the portal vein (PV) in five cases, the major hepatic vein (HV) in nine cases, and the inferior vena cava in six cases.All PV reconstructions were direct anastomoses. The HV was reconstructed with an autologous inferior mesenteric venous patch or an external iliac vein interposition graft. Total hepatic vascular exclusion was performed for six patients. Of nine patients with HV reconstruction, three had tumors involving all three major HVs, in whom the left HV was reconstructed as an only vein after extended right hepatectomy. In another six patients, multiple bilobar tumors or tumors in the liver that had chemotherapy-induced injuryinvolved one or two HVs. Parenchyma-sparing by reconstruction of the HV was performed to secure the residual liver function. The patients with vascular reconstruction had an operative time of 462111min and a blood loss of 1278528mL. No complication classified as Clavien-Dindo 3 or more developed. The median hospital stay was 17days (range 8-26days). The cumulative 5-year survival rate for all the patients was 54.6%, with no significant difference according to vascular reconstruction.Parenchyma-sparing hepatectomy combined with vascular reconstruction is a useful option to avoid major hepatectomy among various procedures for resection of CRLM with major vascular invasion.


PubMed | Nara Prefecture General Medical Center
Type: | Journal: Case reports in medicine | Year: 2016

A 64-year-old Japanese man had started molecular-targeted therapy with sunitinib for lymph node metastasis 5 years after nephrectomy for left renal cell carcinoma (clear cell carcinoma, G2, pT2N0M0). He was transported to our emergency department because of generalized tonic-clonic seizure, vision loss, and impaired consciousness with acute hypertension after 8 cycles of treatment (2 years after the initiation of sunitinib therapy, including a drug withdrawal period for one year). MRI of the brain (FLAIR images) showed multiple high-intensity lesions in the white matter of the occipital and cerebellar lobes, dorsal brain stem, and left thalamus. Reversible posterior leukoencephalopathy syndrome caused by sunitinib was suspected. In addition to the immediate discontinuation of sunitinib therapy, the administration of antihypertensive agents and anticonvulsants improved the clinical symptoms without neurological damage. Physicians should be aware that sunitinib causes reversible posterior leukoencephalopathy syndrome. The early recognition of reversible posterior leukoencephalopathy syndrome is critical to avoid irreversible neurological damage.

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