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Suzuki T.,National Hospital Organization Chiba Medical Center | Suzuki T.,University of Pittsburgh | Suzuki T.,Chiba Medical Center | Numata T.,National Hospital Organization Chiba Medical Center | Shibuya M.,National Hospital Organization Chiba Medical Center
Laryngoscope | Year: 2011

Objective It is important to identify and save the normal parathyroid glands during head and neck surgery because of their role in regulating the blood calcium level, yet it is often difficult to localize normal parathyroid glands during surgery. Fluorescence-guided parathyroidectomy in patients with hyperparathyroidism has already proved useful. However, there are few reports of fluorescence-guided localization of normal parathyroid glands in humans. We investigated the utility of fluorescence-guided localization of normal parathyroid glands during thyroidectomy and completed a spectral fluorescence analysis of the accumulation of 5-aminolevulinic acid metabolites in the parathyroid glands. Methods Eight patients with benign thyroid disease and five with malignant thyroid tumors were given 20 mg/kg body weight of 5-aminolevulinic acid orally 5 hours before surgery. After the posterior surface of the thyroid gland was exposed and the recurrent laryngeal nerve was identified, we illuminated the area with a violet-blue light of 405 nm. Tissues showing red fluorescence were biopsied to analyze the spectral fluorescence. Results Under the violet-blue light, normal parathyroid glands showed red fluorescence, while the surrounding structures such as the thyroid gland, muscles, and fat remained nonfluorescent. The spectral peak was observed at 635 nm indicating 5-aminolevulinic acid metabolites. Histopathologically, the biopsied tissue corresponded to normal parathyroid glands. Conclusions 5-Aminolevulinic acid is useful to localize the normal parathyroid glands during thyroid surgery in humans. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.


Hiruma K.,Tokyo Metropolitan Komagome Hospital | Numata T.,National Hospital Organization Chiba Medical Center
Auris Nasus Larynx | Year: 2010

Objective: To describe the diagnostic means and therapy employed in three cases of extracranial carotid aneurysms. Methods: Retrospective analysis of three cases. Results: For the diagnosis we obtained real-time pictures of each aneurysm by color Doppler ultrasonography before the angiography. Based on the result of cerebral collateral flow evaluation, ligation of both ends of the aneurysm was performed in one case, embolization of the artery in another, and resection of the aneurysm in the other; vascular reconstruction was not necessary. Although a carotid artery balloon occlusion test must be done before the operation, color Doppler ultrasonography and/or a transcranial color Doppler-guided Matas' test were performed instead, because these patients needed immediate management. Conclusion: The diagnostic procedures were very useful to decide what action to take in such urgent cases. © 2009 Elsevier Ireland Ltd. All rights reserved.


Tokuyama H.,Chiba University | Tokuyama H.,National Hospital Organization Chiba Medical Center | Kawamura H.,Chiba University | Fujimoto M.,Chiba University | And 5 more authors.
Diabetes Research and Clinical Practice | Year: 2013

A potential adverse effect of dipeptidyl peptidase-4 inhibitors (DPP-4i) on the pancreas remains controversial. We evaluated the DPP-4i effects on pancreatic amylase and lipase activity in patients with type 2 diabetes. These enzymes were slightly but significantly increased, suggesting DPP-4i cause a low-grade inflammatory change in the exocrine pancreas. © 2013 Elsevier Ireland Ltd.


Nakamura J.,Chiba Childrens Hospital | Nakamura J.,Chiba University | Ohtori S.,Chiba University | Sakamoto M.,Chiba Kaihin Municipal Hospital | And 3 more authors.
Clinical and Experimental Rheumatology | Year: 2010

Objective: Systemic lupus erythematosus (SLE) patients are at high risk of developing osteonecrosis, as they require corticosteroid therapy for life. The purpose of this study was to use periodic MRI analysis to clarify (1) the incidence of new osteonecrosis associated with long-term corticosteroid therapy in SLE patients, and (2) the risk factors for delayed osteonecrosis in SLE patients. Methods: We prospectively studied 291 joints (134 hips and 157 knees) in 106 SLE patients without osteonecrosis after initial corticosteroid therapy, with a mean follow-up period of 13.6 years and a follow-up rate of 71%. All patients had undergone periodic MRI examination of the hip and knee joints for >10 years. Results: New osteonecrosis developed in 6 joints (3%) and only occurred after SLE recurrence in association with increased corticosteroid doses (to>30 mg/day [p=0.008]). New lesions were delayed for a mean 5.9 years after initial corticosteroid administration. The mean time from SLE recurrence to appearance of new lesions was 6.2 months. SLE recurrence occurred in 131 joints (45%), while SLE was well controlled in 160 joints (55%). Conclusion: We suggest that with respect to long-term effects, total cumulative dose and duration of corticosteroid therapy do not contribute to osteonecrosis. However, SLE recurrence is a risk factor for new osteonecrosis. We recommend MRI screening for osteonecrosis at SLE recurrence. © Copyright Clinical and Experimental Rheumatology 2010.


PubMed | National Hospital Organization Chiba Medical Center, Chiba University, Chiba Childrens Hospital and Sainou Hospital
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Experimental animal study.We aimed to determine the optimal dose of a single direct injection of the tumor necrosis factor (TNF)- inhibitor, etanercept, by using the rat model of degenerative intervertebral disc from injury.The pain-related peptide expression was suppressed in the etanercept (100 g and 1,000 g)-administered groups in a dose-dependent manner.The neurotracer FluoroGold (FG) was applied to the surfaces of L4/5 discs to label their innervating dorsal root ganglion (DRG) neurons (n=50). Ten rats were included in the nonpunctured disc sham surgery control group, whereas the other 40 were included in the experimental group in which intervertebral discs were punctured with a 23-gauge needle. Saline or etanercept (10 g, 100 g, or 1,000 g) was injected into the punctured discs (n=10 for each treatment). After 14 days of surgery, DRGs from L1 to L6 were harvested, sectioned, and immunostained for calcitonin gene-related peptide (CGRP). The proportion of FG-labeled CGRP-immunoreactive DRG neurons was evaluated in all the groups.There were no significant differences between the puncture+saline group and the puncture+10-g etanercept group (p >0.05). However, a significant decrease in the percentage of FG and CGRP double-positive cells in FG-positive cells was observed in the etanercept (100 g and 1,000 g)-administered groups in a dose-dependent manner (p <0.05).When a low dose of the TNF- inhibitor (10 g of etanercept) was directly administered to the rat intervertebral disc in the rat model of degenerative intervertebral disc from injury, no suppressive effect on the pain-related peptide expression was observed. However, when a higher dose of etanercept (100 g and 1,000 g) was administered, the pain-related peptide expression was suppressed in a dose-dependent manner.


PubMed | National Hospital Organization Chiba Medical Center, Chiba University, Chiba Childrens Hospital and Sainou Hospital
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Retrospective study.To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain.Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging.Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed.No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001).Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent the transition of acute low back pain to chronic low back pain.


PubMed | National Hospital Organization Chiba Medical Center and Chiba University
Type: Journal Article | Journal: Histology and histopathology | Year: 2016

Pulmonary arterial hypertension (PAH) is characterized by obstructive lesions and vasoconstriction of the pulmonary arteries. Early therapeutic interventions with vasodilator drugs are thought to be beneficial in PAH. However, it remains unknown whether the severity of intimal obstruction is associated with increased pulmonary arterial pressure and whether reduction of vasoconstriction in the earlier stage by these drugs has a beneficial effect. Therefore, the aims of this study were to investigate these issues in a rat model of severe PAH. Methods A rat model of severe PAH was created by injection of a vascular endothelial growth factor receptor blocker in combination with hypoxia for the first 3 weeks followed by normoxia for the next 9 weeks. To assess intimal obstruction, the pulmonary artery occlusion index (PAOI) was developed to digitize all lesions. The small pulmonary arteries were assessed by this index, and the association between right ventricular systolic pressure (RVSP) and PAOI was investigated. An endothelin receptor antagonist, ambrisentan, was administered by gavage to rats during either hypoxia (Prevention study group, n=25) or normoxia (Early treatment group, n=15).PAOI showed a positive correlation with RVSP, and both RVSP and PAOI increased gradually over time. There were no severe occlusive lesions in either group, but the density of partially occlusive lesions was significantly decreased in the Prevention study group.A novel PAOI index was developed, and this index was strongly correlated with RVSP. Furthermore, ambrisentan reduced luminal occlusive lesions more effectively when treatment was given during the first 2 weeks of hypoxia.


Nakazato T.,National Hospital Organization Chiba Medical Center | Ikehira H.,National Hospital Organization Chiba East Hospital | Imasawa T.,National Hospital Organization Chiba East Hospital
Clinical and Experimental Nephrology | Year: 2016

Background: The determinants of renal shape are not well established. The purpose of this study was to investigate the relationship between the renal shape, as measured by ultrasound, and the clinical characteristics in chronic kidney disease (CKD) patients. Methods: The study included 121 CKD patients who had undergone kidney biopsy. The renal shape was defined by: (1) the renal shape index: renal length/(renal width + renal thickness) and (2) the renal width/length. IgA nephritis patients (excluding patients with diabetes), comprised the largest subgroup (n = 49) and were analyzed separately. Results: The correlation analyses and two-sample Student’s t test results showed that age, eGFR, BMI, cortex volume fraction measured by MRI (cortex volume/renal volume), percentage of global sclerosis, weight, sex, hypertension and diabetes were significantly correlated with the renal shape in both kidneys. In a stepwise multiple linear regression analysis, old age and high BMI were independently associated with plump kidney. As for the left renal shape index, low cortex volume fraction was also independently associated with plump kidney. In the IgA nephritis patient subgroup, the cortex volume fraction was the most significant factor contributing to the left renal shape index (r = 0.50, p < 0.01) and the width/length (r = −0.47, p < 0.01). Conclusion: Age and BMI were stronger determinants of renal shape than renal function in CKD patients. The left renal cortex volume fraction was also an independent determinant and a more important factor in IgA nephritis patients. © 2016 Japanese Society of Nephrology


Imasawa T.,National Hospital Organization Chiba East Hospital | Nakazato T.,National Hospital Organization Chiba Medical Center
Japanese Journal of Nephrology | Year: 2010

To improve chronic kidney disease (CKD) outcomes, board-certified nephrologists of the Japanese Society of Nephrology (certified nephrologists) are anticipated to play an important role in community medicine and establish an effective cooperative relationship with primary care physicians. We analyzed the present status of certified nephrologists in each prefecture of Japan based on national data. As a result, in 2008, the maximum number of certified nephrologists per population among the 47 prefectures was 5.3 times higher than the minimum number. The rate of increase was not high in prefectures with a small number of certified nephrologists per population, which indicates that the disparities among the prefectures will persist in the future. To analyze how certified nephrologists participate in the community medicine of the 47 prefectures of Japan, we performed an ecological regression study. At first, it was shown that the number of certified nephrologists per resident population according to prefectures in 2007 had no significant correlation with the annual amount paid for angiotensin converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), calcium channel-blocker (CCB), or erythropoiesis stimulating agent (ESA) per resident. Furthermore, to determine what parameters had a significant correlation with the incidence of dialysis in each prefecture, simple linear regression analysis was firs performed. As a result, parameters with a significant correlation were the average age of the inhabitants, and the annual amounts paid for ARB, ARB plus ACEI, CCB, and ESA per resident. Furthermore, multiple regression analysis revealed that there were two variables included in the final model which could explain the low incidence of dialysis in each prefecture. One was the annual amount of ESA used for predialysis CKD patients, and the other was the number of certified nephrologists per population. Based on these findings, although our ecological study cannot identify causation, we predict that certified nephrologists can effectively prevent the progression of CKD, and an increase in certified nephrologists will decrease the incidence of dialyis.


PubMed | National Hospital Organization Chiba East Hospital and National Hospital Organization Chiba Medical Center
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2016

The determinants of renal shape are not well established. The purpose of this study was to investigate the relationship between the renal shape, as measured by ultrasound, and the clinical characteristics in chronic kidney disease (CKD) patients.The study included 121 CKD patients who had undergone kidney biopsy. The renal shape was defined by: (1) the renal shape index: renal length/(renal width+renal thickness) and (2) the renal width/length. IgA nephritis patients (excluding patients with diabetes), comprised the largest subgroup (n=49) and were analyzed separately.The correlation analyses and two-sample Students t test results showed that age, eGFR, BMI, cortex volume fraction measured by MRI (cortex volume/renal volume), percentage of global sclerosis, weight, sex, hypertension and diabetes were significantly correlated with the renal shape in both kidneys. In a stepwise multiple linear regression analysis, old age and high BMI were independently associated with plump kidney. As for the left renal shape index, low cortex volume fraction was also independently associated with plump kidney. In the IgA nephritis patient subgroup, the cortex volume fraction was the most significant factor contributing to the left renal shape index (r=0.50, p<0.01) and the width/length (r=-0.47, p<0.01).Age and BMI were stronger determinants of renal shape than renal function in CKD patients. The left renal cortex volume fraction was also an independent determinant and a more important factor in IgA nephritis patients.

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