National Hospital Organization Kumamoto Medical Center

Kumamoto-shi, Japan

National Hospital Organization Kumamoto Medical Center

Kumamoto-shi, Japan
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Sone H.,Niigata University | Sone H.,University of Tsukuba | Tanaka S.,Kyoto University | Suzuki S.,Ohta General Hospital | And 9 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: Our aim was to clarify the association between leisure-time physical activity (LTPA) and cardiovascular events and total mortality in a nationwide cohort of Japanese diabetic patients. Methods: Eligible patients (1,702) with type 2 diabetes (mean age, 58.5 years; 47% women) from 59 institutes were followed for a median of 8.05 years. A comprehensive lifestyle survey including LTPA and occupation was performed using standardised questionnaires. Outcome was occurrence of coronary heart disease (CHD), stroke and total mortality. The adjusted HR and 95% CI were calculated by Cox regression analysis. Results: A significant reduction in HR in patients in the top (≥15.4 metabolic equivalents [MET] h/week) vs the bottom tertile (≤3.7 MET h/week) of LTPA, adjusted by age, sex and diabetes duration, was observed in stroke (HR 0.55, 95% CI 0.32, 0.94) and total mortality (HR 0.49, 95% CI 0.26, 0.91) but not in CHD (HR 0.77, 95% CI 0.48, 1.25). The HR for stroke became borderline significant or nonsignificant after adjustment for lifestyle or clinical variables including diet or serum lipids. The significantly reduced total mortality by LTPA was independent of these variables and seemed not to be, at least mainly, attributed to reduced cardiovascular disease. Conclusions/interpretation: In Japanese persons with type 2 diabetes, LTPA of 15.4 MET h/week or more was associated with a significantly lower risk of stroke partly through ameliorating combinations of cardiovascular risk factors. It was also associated with significantly reduced total mortality but independently of cardiovascular risk factors or events. These findings, implying differences from Western diabetic populations, should be considered in the clinical management of East Asians with diabetes. © 2013 Springer-Verlag Berlin Heidelberg.


Haga Y.,National Hospital Organization Kumamoto Medical Center | Haga Y.,Kumamoto University | Wada Y.,National Hospital Organization Himeji Medical Center | Takeuchi H.,National Hospital Organization Iwakuni Clinical Center | And 3 more authors.
Gastric Cancer | Year: 2012

Background We recently modified our prediction scoring system "Estimation of Physiologic Ability and Surgical Stress" and have designated the current version mE-PASS. This scoring system has been designed to obtain predicted postoperative mortality rates before surgery and this study was performed to assess its usefulness in elective surgery for gastric carcinoma. Methods We investigated seven variables for mE-PASS and evaluated the postoperative course in 3,449 patients who underwent elective surgery for gastric carcinoma in Japan between August 20, 1987 and April 9, 2007, in order to quantify the predicted in-hospital mortality rates (R). The calibration and discrimination power of R were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC), respectively. The ratios of observed-to-estimated mortality rates (OE ratios) were quantified as a measure of quality. Results The overall postoperative morbidity and mortality rates were 19.0 and 2.0%, respectively. R demonstrated good power in calibration (χ 2 value, 12.5; df 8; P = 0.89) as well as discrimination (AUC, 95% confidence intervals: 0.80, 0.75-0.85). The OE ratios between hospitals ranged from 0.44 to 1.8. Overall, the OE ratios seemed to improve with time (OE ratio, 95% confidence intervals: 1.3, 0.73-2.4 for the early period between 1987 and 2000; 1.0, 0.59-1.7 for the middle period between 2001 and 2004; and 0.65, 0.36-1.2 for the late period between 2005 and 2007). Conclusion Based on these findings, mE-PASS might be useful for medical decision-making and for assessing the quality of care in elective surgery for gastric carcinoma. © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2011.


Arita I.,National Hospital Organization Kumamoto Medical Center
Japanese Journal of Infectious Diseases | Year: 2011

This year 2010 marks the 30th anniversary of smallpox eradication, as declared by the WHO Assembly in 1980. As someone who worked for this program for many years, I would like to present my recollection of how it succeeded and what lessons can be learnt, with the added benefit of hindsight. The program achieved the global unification of mankind despite differences in race, nationality, religion, and politics, and research contributed significantly to building the effective strategy that ultimately led to success. These lessons should be useful in a designing a planning solution for many of the problems we face in today's changing world, including problems regarding health security and even those in current and future socioeconomic regions.


Morinaga S.,National Hospital Organization Kumamoto Medical Center
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2012

Idiopathic hypereosinophilic syndrome (IHES) in children is a rare disorder. A 1-year-old girl presented to our hospital for evaluation of eosinophilia. At the onset, her white blood cell count in peripheral blood was 70,600/μl with 74% eosinophils. She had a high fever and mild hepatomegaly but had no remarkable evidence of organ involvement by CT, MRI and ultrasonography. She was diagnosed with IHES without any evidence of secondary eosinophilia, expression of the FIP1L1-PDGFRα fusion transcript, chromosomal abnormalities, and aberrant T-cell populations. The serum IgE, vitamin B12, IL-5 and TARC levels were normal. Systemic administration of corticosteroid and suplatast tosilate resolved the symptoms promptly and resulted in improvement of eosinophilia.


Honda T.,National Hospital Organization Kumamoto Medical Center | Fujimoto K.,National Hospital Organization Kumamoto Medical Center | Miyao Y.,National Hospital Organization Kumamoto Medical Center | Koga H.,National Hospital Organization Kumamoto Medical Center | Hirata Y.,National Hospital Organization Kumamoto Medical Center
Cardiovascular Intervention and Therapeutics | Year: 2012

The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5. 5; P < 0. 05] and BMI (OR 0. 86; P < 0. 01) were risk factors for bleeding complications; and sheath size (OR 5. 2; P < 0. 05) and the lack of statin pretreatment (OR 0. 50; P < 0. 05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures. © 2012 Japanese Association of Cardiovascular Intervention and Therapeutics.


Morinaga S.,National Hospital Organization Kumamoto Medical Center
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2012

We report a case of a 1-year-old boy diagnosed with lupus anticoagulant-hypoprothrombinemia syndrome (LA-HPS), which is a rare disorder. His initial presentation of sinusitis was accompanied by hemorrhagic episodes including ecchymoses and epistaxis 6 months after antibiotic therapy. Laboratory results revealed prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) that did not correct with mixing studies. Factors II, VIII, IX, X, XI, and XII activities were 20%, 44%, 42.5%, 59%, 4%, and 10%, respectively. The Bethesda inhibitor assay showed inhibitors against multiple coagulation factor. APTT, mixing studies, diluted Russell's viper venom time, and the Bethesda inhibitor assay detected LA. LA-HPS with a suspected false-positive test for coagulation factor inhibitors was diagnosed. Bleeding stopped and results of coagulation studies returned to normal without therapy 2 months after onset of the disease.


Honda T.,National Hospital Organization Kumamoto Medical Center | Fujimoto K.,National Hospital Organization Kumamoto Medical Center | Miyao Y.,National Hospital Organization Kumamoto Medical Center | Koga H.,National Hospital Organization Kumamoto Medical Center | Ishii M.,National Hospital Organization Kumamoto Medical Center
Journal of Cardiology | Year: 2014

Background: Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Cigarette smoking is a coronary risk factor for AMI, although a "smoker's paradox" for AMI has been reported in Western countries. On the other hand, some researchers have reported that smoking is associated with subacute stent thrombosis (SAST) after AMI. However, the occurrence of this condition is not well documented in Japan. The aim of this study was to clarify how prior smoking status may affect prognosis, including SAST, in Japanese patients with AMI. Methods: A total of 266 consecutive patients with AMI were enrolled retrospectively in the study if they had undergone emergency coronary intervention (bare metal stent) within 24. h of symptom onset, and had a 5-10 month follow-up examination. The patients were divided into three groups based on their cigarette smoking status (non-smokers, past smokers, and current smokers). Results: Current smokers were significantly younger than the other two groups, although their levels of low density lipoprotein-cholesterol and triglyceride were significantly higher. White blood cell count and hemoglobin level on admission were also significantly higher in current smokers compared with the other two groups. The incidence of SAST was significantly higher in current smokers than in the other groups, although the occurrence of heart failure after AMI was similar in the three groups. On the other hand, improvement in left ventricular ejection fraction was observed in non-smokers and past smokers, but not in current smokers. Multiple logistic analysis revealed that current smoking was an independent risk factor for SAST (odds ratio 5.4; p< 0.05). Current smokers were about five times more likely to have a SAST compared with non-smokers. Conclusions: These findings indicate that current cigarette smoking predicts SAST after primary percutaneous coronary intervention for AMI in Japanese patients. © 2013 Japanese College of Cardiology.


Kashiwabara K.,National Hospital Organization Kumamoto Medical Center | Okamoto T.,National Hospital Organization Kumamoto Medical Center | Yamane H.,National Hospital Organization Kumamoto Medical Center
Respirology | Year: 2012

Background and objective: The aim of this study was to determine whether high levels of pleural adenosine deaminase (pADA) are predictive for tuberculosis when pleural effusions do not satisfy the criteria for lymphocytic effusions or show neutrophil predominance. Methods: This was a retrospective observational study of 147 consecutive patients with exudative pleural effusions that were diagnosed by analysis of fluid samples during a 3-year period from 1 April 2007 to 31 March 2010. Multiple linear correlation tests were used to assess clinical variables as possible predictors of high pADA levels. Results: High pleural LDH (pLDH) and pleural potassium (pK) levels were associated with high pADA levels (P < 0.0001). Although there was a linear correlation between pLDH and pADA levels in patients with parapneumonic effusions (PPE) (n = 75), tubercular effusions (n = 21), malignant effusions (n = 41) and miscellaneous effusions (n = 10), a significant linear correlation between pK and pADA levels was observed only in patients with PPE (φ = 0.525, P < 0.0001). When the cut-off value for pK was set at 5.0 mEq/L, pADA levels were >50 IU/L and pK levels were >5.0 mEq/L in only one patient (5%) in the tuberculosis group (n = 21) and 15 patients (12%, all with PPE) in the non-tuberculosis group (n = 126). Conclusions: When pK levels exceed 5.0 mEq/L, high pADA levels do not necessarily indicate the presence of tuberculous pleuritis. © 2011 Asian Pacific Society of Respirology.


Honda T.,National Hospital Organization Kumamoto Medical Center | Fujimoto K.,National Hospital Organization Kumamoto Medical Center | Miyao Y.,National Hospital Organization Kumamoto Medical Center
Postepy w Kardiologii Interwencyjnej | Year: 2013

We report two cases of successful percutaneous coronary intervention (PCI) using a 4-in-3 "Slender Mother and Child" PCI technique. In both cases, coronary angiography revealed severe stenosis of the right coronary artery (RCA). In both cases, 5-Fr sheathless guiding catheters were inserted into the RCA (virtual 3-Fr PCI) but stents could not pass through because of stents previously implanted at the proximal site of the target lesions. After 4-Fr straight "child" guiding catheters were inserted into the 5-Fr sheathless "slender mother" guiding catheters, they were deployed successfully at the target lesions. This system might be useful to improve stent delivery in virtual 3-Fr PCI.


Fujimoto K.,National Hospital Organization Kumamoto Medical Center | Fujimoto K.,Kumamoto University | Otsuka T.,National Hospital Organization Kumamoto Medical Center | Yoshizato K.,National Hospital Organization Kumamoto Medical Center | Kuratsu J.-I.,Kumamoto University
Clinical Neurology and Neurosurgery | Year: 2014

Objective Acute subdural hematoma (ASDH) usually requires emergency surgical decompression, but rare cases exhibit rapid spontaneous resolution. The aim of this retrospective study was to identify factors predictive of spontaneous ASDH resolution. Methods A total of 366 consecutive patients with ASDH treated between January 2006 and September 2012 were identified in our hospital database. Patients with ASDH clot thickness >10 mm in the frontoparietotemporal region and showing a midline shift >10 mm on the initial computed tomography (CT) scan were divided into two groups according to subsequent spontaneous resolution. Univariate and multivariate logistic regression analyses were used to identify factors predictive of rapid spontaneous ASDH resolution. Results Fifty-six ASDH patients met study criteria and 18 demonstrated rapid spontaneous resolution (32%). Majority of these patients were not operated because of poor prognosis/condition and in accordance to family wishes. Univariate analysis revealed significant differences in use of antiplatelet agents before head injury and in the incidence of a low-density band between the hematoma and inner wall of the skull bone on the initial CT. Use of antiplatelet agents before head injury (OR 19.6, 95% CI 1.5-260.1, p = 0.02) and the low-density band on CT images (OR 40.3, 95% CI 3.1-520.2, p = 0.005) were identified as independent predictive factors by multivariate analysis. Conclusions Our analysis suggested that use of antiplatelet agents before head injury and a low-density band between the hematoma and inner skull bone on CT images (indicative of cerebrospinal fluid infusion into the subdural space) increase the probability of rapid spontaneous resolution. © 2013 Elsevier B.V.

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