Takagi Y.,Tohoku University |
Takahashi J.,Tohoku University |
Yasuda S.,National Cerebral and Cardiovascular Center |
Miyata S.,Tohoku University |
And 14 more authors.
Journal of the American College of Cardiology | Year: 2013
Objectives The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients. Background Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important. Methods The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n = 1,429; median 66 years; median follow-up 32 months) was utilized for score derivation. Results Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-segment elevation during angina, and beta-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0 to 2, n = 598), intermediate (score 3 to 5, n = 639) and high (score 6 or more, n = 192). The incidences of MACE in the low-, intermediate-, and high-risk patients were 2.5%, 7.0%, and 13.0%, respectively (p < 0.001). The Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively. Conclusions We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients. © 2013 by the American College of Cardiology Foundation.
Saeki T.,Red Cross |
Kawano M.,Kanazawa University |
Mizushima I.,Kanazawa University |
Yamamoto M.,Sapporo Medical University |
And 9 more authors.
Kidney International | Year: 2013
Long-term follow-up for IgG4-related kidney disease, including relapse information, is sparse. To gather data on this we retrospectively examined the clinical course of 43 patients with IgG4-related kidney disease, in which most patients were treated with, and maintained on, corticosteroids. One month after the start of treatment, most of the abnormal serology and radiology parameters had improved. In 34 of the steroid-treated patients whose follow-up period was more than 12 months (median 34 months), excluding one hemodialysis patient, the estimated glomerular filtration rate (eGFR) before treatment was over 60 ml/min in 14 patients (group A) and under 60 ml/min in 20 patients (group B). In group A, there was no difference between the eGFR before therapy and at the last review. In group B, the mean eGFR before treatment (34.1 ml/min) was significantly improved after 1 month (45.0 ml/min), and renal function was maintained at a similar level through last follow-up. Among 24 evaluated patients at the last review, however, renal atrophy had developed in 2 of 9 in group A and in 9 of 15 in group B. Relapse of IgG4-related lesions occurred in 8 of 40 treated patients. Thus, the response of IgG4-related kidney disease to corticosteroids is rapid, not total, and the recovery of renal function persists for a relatively long time under low-dose maintenance. A large-scale prospective study to formulate more useful treatment strategies is necessary. © 2013 International Society of Nephrology.
Imai N.,Niigata Prefectural Shibata Hospital |
Dohmae Y.,Niigata Prefectural Shibata Hospital |
Suda K.,Niigata University |
Miyasaka D.,Niigata University |
And 2 more authors.
Journal of Arthroplasty | Year: 2012
In this study, we evaluated the hemostatic effects of tranexamic acid (TNA), an antifibrinolytic drug, by examining the timing of its administration during total hip arthroplasty. One hundred seven patients being treated for osteoarthritis of the hip joint were randomly divided into 5 groups based on the timing of TNA administration. The intraoperative blood loss, postoperative blood loss, and hemoglobin of these patients who received TNA at different times during the procedure were monitored. We found that the intraoperative blood loss in the preoperative TNA administration groups was significantly lower than both control and postoperative TNA administration groups. Furthermore, 1 g TNA 10 minutes before surgery and 6 hours after the first administration was most effective for the reduction of blood loss during total hip arthroplasty. © 2012 Elsevier Inc.
Sato T.,Niigata Prefectural Shibata Hospital |
Ito T.,Niigata University |
Hirano T.,Niigata University |
Morita O.,Niigata Prefectural Shibata Hospital |
And 3 more authors.
European Spine Journal | Year: 2011
A cross-sectional study that targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective of the study was to evaluate the association between sports activities and low back pain (LBP) in childhood and adolescence in Japan. Regarding risk factors of LBP, a large number of studies have been conducted that have examined gender differences, height and weight, body mass index, sports time, differences in lifestyle, family history, and mental factors; however, no definitive conclusion has yet been made. A questionnaire survey was conducted using 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067). 26,766 pupils who were determined to have valid responses (valid response rate 61.3%) were analyzed. Among the 26,766 pupils with valid responses, 2,591 (9.7%) had LBP at the time of the survey, and 8,588 (32.1%) had a history of LBP. The pupils were divided between those who did not participate in sports activities except the physical education in school (No sports group: 5,486, 20.5%) and those who participated in sports activities (Sports group: 21,280, 79.5%), and the difference in lifetime prevalence between No sports group and Sports group was examined. The odds ratio for LBP according to sports activity was calculated by multiple logistic regression analysis adjusted for gender, age, and body mass index. In addition, the severity of LBP was divided into three levels (Level 1: no limitation in any activity, Level 2: necessary to refrain from participating in sports and physical activities, and Level 3: necessary to be absent from school), and Levels 2 and 3 were defined as severe LBP; the severity was compared between No sports group and Sports group and in each sport's items. Moreover, in Sports group, the amount of time spent participating in sports activities were divided into three groups (Group 1: less than 6 h per week, Group 2: 6-12 h per week, and Group 3: 12.1 h per week or more), and the dose-response between the amount of time spent participating in sports activities and the occurrence of LBP were compared. In No sports group, 21.3% experienced a history of LBP; in Sports group, 34.9% experienced LBP (P < 0.001). In comparison to No sports group, the odds ratio was significantly higher for Sports group (1.57), and also significantly higher for most of the sports items. The severity of LBP was significantly higher in Sports group (20.1 vs. 3.2%, P < 0.001). The amount of time spent participating in sports activities averaged 9.8 h per week, and a history of LBP significantly increased in the group which spent a longer time participating in sports activities (odds ratio 1.43 in Group 3). These findings suggest that sports activity is possible risk factors for the occurrence of LBP, and it might increase the risk for LBP in childhood and adolescence. © 2010 Springer-Verlag.
Natsui M.,Niigata Prefectural Shibata Hospital |
Honma T.,Niigata Prefectural Shibata Hospital |
Genda T.,Juntendo University |
Nakadaira H.,Niigata Seiryo University
European Journal of Gastroenterology and Hepatology | Year: 2011
BACKGROUND AND STUDY AIMS: Although endoscopic papillary balloon dilation (EPBD) has appeared with the expectation of better preserving sphincter of Oddi function than endoscopic sphincterotomy (EST), whether it can more effectively prevent bacterial contamination of the biliary tract than EST is controversial. To address this issue, we investigated the bacterial flora in the bile after the two procedures. PATIENTS AND METHODS: Eighty-six patients were alternately allocated to EPBD or EST. Blood-liver function tests, ultrasonography, and endoscopic retrograde cholangiopancreatography were performed 6 months and 2 years after EPBD or EST, and the bile was sampled for bacterial culture during endoscopic retrograde cholangiopancreatography. Bactobilia and late complications were prospectively compared between the two procedures. RESULTS: Overall, no significant difference was found in the incidence of bactobilia between EPBD and EST at the two examination points. Limiting stone diameter to 8 mm or less, there was a trend toward lower rate of bactobilia in the EPBD group 2 years later although the statistical significance disappeared after correction for multiple comparisons. The absence rate of late complications after EPBD was higher than that after EST, but there was no significant difference between the two procedures, both for the overall patients and for the patients with small stones. CONCLUSION: EPBD has a possibility of suppressing bacterial contamination of the biliary tract compared with EST in patients with small stones. A large, long-term follow-up, randomized, controlled trial is necessary to clarify whether this benefit of EPBD reduces late complications. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Sugimoto A.,Niigata Prefectural Shibata Hospital
General thoracic and cardiovascular surgery | Year: 2010
A 70-year-old woman without any previous history of heart disease was referred to our hospital for repeated chest discomfort. She had experienced temporary hemiparesis because of a cerebral infarction of unknown etiology. Clinical evaluations were all within normal limits except for echocardiography. There was a mobile tumor in her ascending aorta, about 15 mm in diameter, adhering to a part of the right coronary cusp on its aortic side. Urgent surgery was performed. The tumor was attached to the edge of the right coronary cusp and excised with a part of the right coronary cusp, which was then repaired. Histological examination revealed the tumor to be a papillary fibroelastoma. The chest discomfort responsible for admission disappeared after the operation. In patients with events that may be embolic in nature and are not explained by other cardiovascular or neurological diseases, a cardiac source of emboli should be considered.
Natsui M.,Niigata Prefectural Shibata Hospital |
Saito Y.,Niigata Prefectural Shibata Hospital |
Abe S.,Niigata Prefectural Shibata Hospital |
Iwanaga A.,Niigata Prefectural Shibata Hospital |
And 3 more authors.
Digestive Endoscopy | Year: 2013
Aim We recently reported that endoscopic papillary balloon dilation (EPBD) might suppress biliary bacterial contamination better than endoscopic sphincterotomy (EST) in patients with small bile duct stones (diameter ≤8 mm). In the present study, we evaluated immediate and long-term outcomes of endoscopic papillary balloon dilation with regard to stone size. Methods We allocated 474 patients alternately to the two procedures. The patients were classified according to stone diameter (≤8 mm or >8 mm) and outcomes (i.e. complete stone removal, early complications, and late complications) were compared. The predictive risk factors for late complications were also investigated. Results In patients with small stones, complete stone removal rate and early complication rate were similar between the two procedures; the incidence of pancreatitis was higher after EPBD, although the difference was not significant. Late complication rate and stone recurrence rate were significantly lower after EPBD than after EST (5.3% vs 17.3%, P = 0.009; 4.4% vs 12.7%; P = 0.048, respectively). In patients with large stones who underwent EPBD complete stone removal rate and late complication rate were lower, but the incidence of pancreatitis was higher. However, these differences were not statistically significant. Multivariate analysis showed that the increased risk of bactobilia following EPBD for large stones or EST, and the gallbladder with stones in situ were independent risk factors for late complications. Conclusions EPBD produced significantly better long-term outcomes than EST in patients with small bile duct stones. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.
Sato T.,Niigata Prefectural Shibata Hospital
Clinical calcium | Year: 2010
Previously, there was few data as for low back pain (LBP) in childhood and adolescent in Japan, we conducted a cross-sectional study a total of 43,630 pupils, including all elementary school students from the 4(th) to 6(th) grade and all junior high students from the 1(st) to 3(rd) year in Niigata City to examine the detail of LBP. The point prevalence was 10.2% (52.3% male and 47.7% female) and the lifetime prevalence was 28.8% (48.5% male and 51.5% female) and there was a tendency to have more severe LBP in both cases who experienced pain for more than 1 month and those with recurrent low back pain. In comparison to the pupils who did not participate in sports activities, the odds ratio with LBP was significantly higher in the pupils who participated in sports activities (1.57) . This suggests that sports activity may be one of the risk factors for the occurrence of LBP in childhood and adolescence.
Kurabe S.,Niigata Prefectural Shibata Hospital |
Ozawa T.,Niigata Prefectural Shibata Hospital |
Watanabe T.,Niigata Prefectural Shibata Hospital |
Aiba T.,Niigata Prefectural Shibata Hospital
Acta Neurochirurgica | Year: 2010
Background The incidences of chronic subdural hematoma (CSDH) will probably increase with the aging of the population; thus, postoperative care of elderly CSDH patients may play a more important role in surgical management. The aim of this study was to evaluate the efficacy of and adverse effects after postoperative early mobilization (EM) for elderly CSDH patients. Methods This is a single-institution historical control study. One hundred eighty-two patients with CSDH aged 65 years and older underwent one burr-hole surgery between 2001 and 2008. This institution has prospectively conducted an EM protocol after surgery since 2005. The emphasis of the EM was helping patients not only to an upright position but also to walk beginning the day of operation. The incidences of postoperative complications and recurrence of CSDH were compared between the EM group (n=91; 76.5±6.5 years old) and a delayed mobilization (DM) group (n=91; 77.9±7.5 years old). Results Postoperative complications, such as pneumonia and urinary tract infection, was observed in 24 (26.4%) in the DM group and 11 (12.1%) in the EM group (p<0.05). The rate of recurrence did not differ between the two groups (6.6% and 8.8%, respectively; p=0.58). Conclusions The results suggest that EM after one burr-hole surgery prevents postoperative complications without increasing the risk of recurrence in CSDH patients ≥65 years of age. Copyright © Springer-Verlag 2010.
Aiba T.,Niigata Prefectural Shibata Hospital
Neurological Surgery | Year: 2015
We retrospectively investigated 459 computed tomography (CT) scans of head injuries in children who were 7 years of age or younger that we experienced at our institute from 2008 to 2014, and investigated whether or not the algorithm created by the Pediatric Emergency Care Applied Research Network and the guidelines by the National Institute for Health and Care Excellence, which are the standards for CT scans of head injuries in infants, are adequate. As a result, all 12 cases that required surgery or resulted in serious brain damage fell into the category for CT recommendation according to both standards. Although several cases that fell into the category for consideration of CT involved intracranial lesions, all such cases were mild. There were some cases with negligible CT findings that were excluded by both standards. We believe that adapting these standards is significant for reducing the degree to which children are exposed to irradiation.