Ishida T.,Fukushima Medical University |
Asano F.,Gifu Prefectural General Medical Center |
Yamazaki K.,Hokkaido University |
Shinagawa N.,Hokkaido University |
And 4 more authors.
Thorax | Year: 2011
Background: Bronchoscopy using endobronchial ultrasound (EBUS) can help to diagnose small peripheral pulmonary lesions. However, although biopsy sites can be confirmed, a bronchoscope cannot be guided in EBUS. Virtual bronchoscopic navigation (VBN) can guide a bronchoscope with virtual images, but its value has not been confirmed. Methods: This prospective multicentre study examines the value of VBN-assisted EBUS for diagnosing small peripheral pulmonary lesions. 199 patients with small peripheral pulmonary lesions (diameter ≤30 mm) were randomly assigned to VBN-assisted (VBNA) or non-VBN-assisted (NVBNA) groups. A bronchoscope was introduced into the target bronchus of the VBNA group using the VBN system. Sites of specimen sampling were verified using EBUS with a guide sheath under fluoroscopy. Results: The diagnostic yield was higher for the VBNA than for the NVBNA group (80.4% vs 67.0%; p=0.032). The duration of the examination and time elapsed until the start of sample collection were reduced in the VBNA compared with the NVBNA group (median (range), 24.0 (8.7-47.0) vs 26.2 (11.6-58.6) min, p=0.016) and 8.1 (2.8-39.2) vs 9.8 (2.3-42.3) min, p=0.045, respectively). The only adverse event was mild pneumothorax in a patient from the NVBNA group. Conclusions: The diagnostic yield for small peripheral pulmonary lesions is increased when VBN is combined with EBUS. Clinical trial number: UMIN000000569.
Sato M.,Fukushima Medical University |
Ito M.,Soma General Hospital |
Suzuki S.,Ohara General Hospital |
Sakuma H.,Hoshi General Hospital |
And 7 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2015
We estimated the efficacy of the current single administration of peramivir on the basis of peramivir pharmacokinetics in the upper respiratory tract (URT) and determined the predictive peramivir concentration-time curve to assess its efficacy against viruses with decreased susceptibility to neuraminidase inhibitors. Serum, nasal swab, or aspiration samples were collected from 28 patients treated with 10 mg/kg body weight peramivir. The sequential influenza viral RNA load and susceptibility after peramivir administration were measured using a quantitative real-time reverse transcription-PCR and neuraminidase inhibition assay. The peramivir concentrations in the serum and URT after a single administration at 10 mg/kg were measured, and the predictive blood and URT peramivir concentration-time curves were determined to assess various administration regimens against resistant variants. The peramivir concentration decreased to < 0.1% of the maximum concentration of drug in serum (Cmax) at 24 h after administration. Rapid elimination of peramivir from the URT by 48 h after administration may contribute to an increase in the influenza A viral load after day 3 but not to a decrease in the influenza B viral load, despite the absence of a decrease in the susceptibility to peramivir. A longer maintenance of a high level of peramivir in the URT is expected by divided administration rather than once-daily administration. When no clinical improvement is observed in patients with normal susceptibility influenza A and B, peramivir readministration should be considered. In severe cases caused by resistant variants, better inhibitory effectiveness and less frequent adverse events are expected by divided administration rather than once-daily administration with an increased dosage. Copyright © 2015, American Society for Microbiology.
Kano M.,Ohara General Hospital |
Hasegawa H.,Fukushima Medical University
British Journal of Oral and Maxillofacial Surgery | Year: 2016
Cricotracheostomy is suitable for use in high-risk situations when urgent endotracheal intubation and conventional open tracheostomy cannot be achieved. We successfully removed the anterior portion of the cricoid cartilage to establish access to the airways in seven patients with cancer of the head and neck without complications, and the stomas were closed in three patients who had no stenosis of the larynx. © 2016 The British Association of Oral and Maxillofacial Surgeons.
Hasegawa H.,Fukushima Medical University |
Kano M.,Ohara General Hospital |
Satou E.,Ohara General Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2010
We report the case of a 25-year-old man with defects in the nasal septum and maxillopalatine bone and an oronasal fistula. © 2009 The British Association of Oral and Maxillofacial Surgeons.
PubMed | Fukushima Medical University and Ohara General Hospital
Type: Journal Article | Journal: Surgical case reports | Year: 2016
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal-dominant inherited disorder that is classically characterized by the presence of neoplastic lesions of the parathyroid glands, the anterior pituitary gland, and the pancreas. However, MEN1 with concomitant pheochromocytoma is extremely rare.We report a case of MEN1 concomitant with pheochromocytoma. A 44-year-old Japanese man, who had undergone total parathyroidectomy due to primary hyperparathyroidism at the age of 18, was referred to our hospital with a complaint of a large abdominal tumor. He was diagnosed as having a giant insulinoma (maximum diameter 18cm) in the pancreatic tail, five other non-functional neuroendocrine tumors in the pancreatic body and tail, multiple liver metastases of pancreatic neuroendocrine tumors, a pituitary prolactinoma, non-functional adrenal cortical adenomas, a pheochromocytoma in addition to a subcutaneous neurofibroma, and a cutaneous fibroma. The genetic screening revealed a deletion mutation at codons 83-84 in exon 2 of the MEN1 gene. He underwent distal pancreatectomy, splenectomy, cholecystectomy, right adrenalectomy, abdominal subcutaneous tumor excision, and cutaneous tumor biopsy for the purpose of tumor volume reduction. Extended right posterior segmentectomy with partial hepatectomy of S2, S3, and S8 was performed to resect residual tumors 9months after the initial surgery. Although a newly formed liver metastasis was found 19months after the hepatectomy, he is still alive 4years and 4months after the initial surgery.We reported an extremely rare case of giant insulinoma and simultaneous occurrence of pheochromocytoma and adrenal cortical adenoma in the ipsilateral adrenal gland in a patient clinically and genetically diagnosed as having MEN1.
PubMed | Fukushima Medical University and Ohara General Hospital
Type: | Journal: The British journal of oral & maxillofacial surgery | Year: 2016
Cricotracheostomy is suitable for use in high-risk situations when urgent endotracheal intubation and conventional open tracheostomy cannot be achieved. We successfully removed the anterior portion of the cricoid cartilage to establish access to the airways in seven patients with cancer of the head and neck without complications, and the stomas were closed in three patients who had no stenosis of the larynx.
PubMed | Fukushima Medical University, University of Ryukyus and Ohara General Hospital
Type: | Journal: European journal of radiology | Year: 2017
Using 4-dimensional dynamic-ventilatory scanning by a 320-row computed tomography (CT) scanner, we performed a quantitative assessment of parietal pleural invasion and adhesion by peripheral (subpleural) lung cancers.Sixteen patients with subpleural lung cancer underwent dynamic-ventilation CT during free breathing. Neither parietal pleural invasion nor adhesion was subsequently confirmed by surgery in 10 patients, whereas the other 6 patients were judged to have parietal pleural invasion or adhesion. Using research software, we tracked the movements of the cancer and of an adjacent structure such as the rib or aorta, and converted the data to 3-dimensional loci. The following quantitative indices were compared by the Mann-Whitney test: cross-correlation coefficient between time curves for the distances moved from the inspiratory frame by the cancer and the adjacent structure, the ratio of the total movement distances (cancer/adjacent structure), and the cosine similarities between the inspiratory and expiratory vectors (from the cancer to the adjacent structure) and between vectors of the cancer and of the adjacent structure (from inspiratory to expiratory frames).Generally, the movements of the loci of the lung cancer and the adjacent structure were similar in patients with parietal pleural invasion/adhesion, while they were independent in patients without. There were significant differences in all the parameters between the two patient groups (cross-correlation coefficient and the movement distance ratio, P<0.01; cosine similarities, P<0.05).These observations suggest that quantitative indices by dynamic-ventilation CT can be utilized as a novel imaging approach for the preoperative assessment of parietal pleural invasion/adhesion.
Shibusa T.,Ohara General Hospital |
Onuma K.,Iwaki Kyoritsu General Hospital
Japanese Journal of Chest Diseases | Year: 2015
We observed a case of drug-induced lung injury following levofloxacin (LVFX) administration. A 39-year-old man who underwent surgery due to a hemorrhoid was treated with LVFX after the operation. Chest radiographs showed diffuse, small, patchy infiltration shadows in both lungs after the treatment. Furthermore, bronchoalveolar lavage fluid (BALF) analysis revealed an increase in lymphocytes. A drug lymphocyte stimulation test (DLST) for LVFX yielded positive results. The chest radiographs did not show a pulmonary edema shadow, shift infested infiltration shadow, and diffuse ground glass opacities. However, the radiographs showed diffuse patchy infiltrate shadows in both lower lung fields, and a chest CT scan demonstrated OP pattern shadows. © 2015, Kokuseido Publishing Co. Ltd. All rights reserved.
PubMed | St. Marianna University School of Medicine, University of Ryukyus and Ohara General Hospital
Type: | Journal: International journal of chronic obstructive pulmonary disease | Year: 2016
Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers.This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearmans rank correlation analysis.On the time curve for the MLD, the -MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (=-0.56 to -0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation.Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patients spirometric values.
Takano A.,Gifu University |
Takano A.,Japan National Institute of Infectious Diseases |
Goka K.,Japan National Institute of Environmental Studies |
Une Y.,Azabu University |
And 7 more authors.
Environmental Microbiology | Year: 2010
The members of the genus Borrelia are transmitted by arthropods and known to be infectious to vertebrates. Here we found isolates and DNAs belonging to the Borrelia turcica and unknown Borrelia species from imported reptiles and their ectoparasites. The Borrelia strains were isolated from blood and multiple organs of exotic tortoises, and were experimentally infectious to captive-bred tortoises. These findings suggest that these tortoises may be a candidate as the reservoir host of the Borrelia species. In this study, the Borrelia strains were also isolated from and/or detected in hard-bodied ticks, Amblyomma ticks and Hyalomma ticks. In some of these ticks, immunofluorescence imaging analysis revealed that the Borrelia had also invaded into the tick salivary glands. Accordingly, these ticks were expected to be a potential vector of the Borrelia species. Sequencing analyses of both housekeeping genes (flaB gene, gyrB gene and 16S rDNA gene) and 23S rRNA gene-16S rRNA gene intergenic spacer region revealed that these Borrelia strains formed a monophyletic group that was independent from two other Borrelia groups, Lyme disease Borrelia and relapsing fever Borrelia. From these results, the novel group of Borrelia comprises the third major group of arthropod-transmitted borreliae identified to date. © 2009 Society for Applied Microbiology and Blackwell Publishing Ltd.