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Miyahara M.,Okanami General Hospital
BMJ case reports | Year: 2013

This report presents a case of atypical Kawasaki disease (KD) in a 4-year-old boy developing with severe colitis accompanied by frequent diarrhoea and hypokalemic dehydration. Abdominal ultrasonography showed findings of left colon mucosal thickening and prominent dilatation of the colon. Antibiotic treatment was not effective. Some symptoms of KD appeared with progression of the illness. Intravenous immunoglobulin (IVIG) was administered based on a diagnosis of incomplete KD on the ninth day of the illness. The patient became afebrile soon after IVIG therapy. Diarrhoea and other symptoms dramatically subsided. The patient has recovered during the 3-month follow-up and repeated echocardiograms were normal. Source


Miyahara M.,Okanami General Hospital | Hirayama M.,Mie University
BMJ Case Reports | Year: 2013

This report presents a case of atypical Kawasaki disease (KD) in a 4-year-old boy developing with severe colitis accompanied by frequent diarrhoea and hypokalemic dehydration. Abdominal ultrasonography showed findings of left colon mucosal thickening and prominent dilatation of the colon. Antibiotic treatment was not effective. Some symptoms of KD appeared with progression of the illness. Intravenous immunoglobulin (IVIG) was administered based on a diagnosis of incomplete KD on the ninth day of the illness. The patient became afebrile soon after IVIG therapy. Diarrhoea and other symptoms dramatically subsided. The patient has recovered during the 3-month follow-up and repeated echocardiograms were normal. Copyright © 2013 BMJ Publishing Group. Source


Tarumi T.,Mie University | Takebayashi S.,Mie University | Fujita M.,Kyoto University | Nakano T.,Mie University | And 2 more authors.
Europace | Year: 2010

AimsMyocardial ischaemia and angina have been demonstrated in patients with hypertrophic cardiomyopathy (HCM). We hypothesized that left ventricular (LV) systolic or diastolic dysfunction would be provocated by pacing tachycardia in patients with HCM.Methods and resultsWe investigated LV global and regional systolic and diastolic function in 17 patients with HCM without LV outflow obstruction and 7 normal subjects by analysing LV angiograms and simultaneously obtained high-fidelity LV pressures before and after rapid cardiac pacing (150 b.p.m.). Biplane LV silhouettes were digitized frame by frame (50 frames/s). To quantify regional dynamics, the ventricular area of the right anterior oblique projection was divided into six sections originating from the midpoint of the long axis at end-diastole. There were no significant changes in LV function after pacing in normal subjects. In HCM, the ejection fractions remained unchanged. However, LV end-diastolic pressures rose (+12 mmHg, P < 0.01), and the time constants of isovolumic pressure decay were significantly increased (T1/2: +5.2 ms, P < 0.01; T1/e: +6.8 ms, P < 0.01). The LV global diastolic pressure-volume relationships and regional diastolic pressure-area relationships of regional myocardium shifted upward (indicating decreased diastolic distensibility) in all patients. These diastolic abnormalities were not accompanied by regional asynchrony or asynergy.ConclusionMost patients with HCM have a reduced reactive capacity to chronotropic stress, which is haemodynamically characterized by evenly distributed diastolic dysfunction. In contrast with coronary artery disease, these diastolic abnormalities were not accompanied by systolic dysfunction, regional asynchrony, asynergy, or inhomogenous diastolic distensibility. © The Author 2010. Source


Iemura J.,Okanami General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 81-year-old female developed diaphragm twitching 2 days after the intravenous implantation of pacemaker (DDD mode) with passive fixation leads. A computed tomography (CT) and fluoroscopy revealed the lead perforating the interventricular septum and the ventricular wall without any sign of pericardial effusion. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured myocardium was repaired with a U stitch reinforced by Teflon-feltstrips. New epicardial leads were fixed on the right atrial wall and on the inferior wall of the right ventricle. The patient had been doing well until 86-year-old, when she died of myelodysplastic syndrome. Source


Osawa S.,Okanami General Hospital | Oshima Y.,Vitreoretina and Cataract Surgery Center
Developments in Ophthalmology | Year: 2014

Ten years or more have passed since the current concept of 25-gauge transconjunctival sutureless vitrectomy with a trocar-cannula system emerged. There is no doubt that current microincision vitrectomy surgery with 25- or 23-gauge instrumentation has simplified the vitrectomy procedure and has provided numerous potential advantages over traditional 20-gauge surgery. The established theory regarding surgical wounds is that 'much smaller is better'. Along with the development of new-generation vitrectomy machines with ergonomic instruments, surgeons have been shifting dramatically from 20-gauge systems to 23- and 25-gauge systems over the last years. Thanks to recent innovations and improvements in high-end multifunctional vitrectomy machines and ultrahigh-speed cutters, the development of powerful light sources, and wide-angle viewing systems, several new techniques have also encouraged us to launch the development of a 27-gauge vitrectomy system over the past several years. Similar to the recent evolution in 23- and 25-gauge systems, further development and refinement of the functionality of instruments with a gauge of 27 or more are under way and will continue over the coming years, which in the future will allow us to establish this system for ultra-minimally invasive surgery for the full spectrum of vitreoretinal pathologies. © 2014 S. Karger AG, Basel. Source

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