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Okayama-shi, Japan

Iwata H.,Nagoya City University | Baba Y.,Okayama Kyokuto Hospital | Shibamoto Y.,Yokohama CyberKnife Center
Neuro-Oncology | Year: 2011

The aim was to evaluate the clinical outcome of hypofractionated stereotactic radiotherapy (SRT) with CyberKnife for nonfunctioning pituitary adenoma. From October 2000 to March 2009, 100 patients with nonfunctioning pituitary adenoma were treated with hypofractionated SRT. Forty-three patients were male, and 57 were female. The patient's ages ranged from 16 to 82 years (median, 59 years). Five patients were medically inoperable, and 1 refused surgery; the remaining 94 were recurrent cases or those receiving postoperative adjuvant SRT. No patients had a history of previous cranial radiotherapy. Tumor volume ranged from 0.7 to 64.3 mL (median, 5.1 mL). The marginal doses were 17.0 to 21.0 Gy for the 3-fraction schedule and 22.0 to 25.0 Gy for the 5-fraction schedule. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for living patients was 33 months (range, 18-118.5 months). The 3-year overall survival and local control rates were 98% and 98%, respectively. In-field and out-field tumor regrowth were observed in 3 and 2 patients, respectively. Transient cyst enlargement occurred in 3 cases. A post-SRT grade 2 visual disorder occurred in 1 patient. Symptomatic post-SRT hypopituitarism was observed in 3 of 74 patients who had not received hormone replacement therapy after surgery. CyberKnife SRT involving 21 Gy in 3 fractions or 25 Gy in 5 fractions is safe and effective for surgical treatment of nonfunctioning pituitary adenoma. Hypofractionated SRT appears useful for protecting the visual nerve and neuroendocrine function, especially for tumors located near the optic pathways and large tumors. © 2011 The Author(s).

Kashihara K.,Okayama Kyokuto Hospital | Imamura T.,Okayama Kyokuto Hospital
Parkinsonism and Related Disorders | Year: 2012

Introduction: Parkinson's disease (PD) is often accompanied by postural disorders such as anterior and lateral flexion of the thoracolumbar spine and dropped head. We examined frequencies and clinical correlates of postural disorders in patients with PD. Methods: We interviewed 365 consecutive PD patients between 40 and 80 years of age, at Hoehn and Yahr stages 1, 2, 3 and 4, and evaluated postural deformities, including anterior and lateral flexion of the trunk and dropped head as well as other clinical characteristics. Control subjects were 65 age-matched patient spouses without neurological or spinal disorders. Results: There were no differences in age or sex between PD patients and controls. The frequencies of anterior and lateral flexion of the trunk were significantly higher in PD patients than in controls. The frequency and severity of anterior and lateral flexion and the incidence of dropped head increased as the disease progressed. Other factors related to anterior and lateral flexion included age, disease duration, lower MMSE score, lumbago and levodopa equivalent daily dose of dopaminergic drugs. Women tended to develop more severe anterior flexion than men. Anterior flexion severity also correlated with that of lateral flexion and the emergence of dropped head. Conclusions: Postural disorders are frequent complications in PD patients and their severity increases with disease progression. Advancing age and disease severity may be the major risks for developing postural disorders. © 2011 Elsevier Ltd.

Iwasaki K.,Okayama Kyokuto Hospital | Matsumoto T.,Okayama Kyokuto Hospital
Clinical Cardiology | Year: 2011

Background: The first-pass imaging of 64-multidetector computed tomography (MDCT) using pharmacological stress has been used to assess myocardial perfusion. However, detection of myocardial ischemia at rest using MDCT has yet to be elucidated. We studied the incidence of myocardial perfusion defect (MPD) by 64-MDCT at rest and the effect of coronary revascularization therapy on MPD in patients with coronary artery disease. Hypothesis: MPD by 64-MDCT at rest indicates myocardial ischemia. Methods: We studied 76 patients with coronary artery disease who underwent 64-MDCT before and after revascularization therapy and 55 patients who did not undergo revascularization therapy. According to percent diameter stenosis, we defined group A, B, C, and D to have stenosis between 70% and 90%, 50% and 69%, 30% and 49%, and 10% and 29%, respectively. We evaluated regional myocardial contrast enhancement by long and short axis planes. MPD was defined as hypoenhancement area of some extent with CT value <50 HU during diastole. Results: MPD was found in 60.0% and 32.4% of group A and B patients, respectively (P = 0.0176). The incidence was 4.8% and 0% in group C and D patients, respectively (P<0.0001 compared with group A and B). All patients in group A and B and 2 patients with MPD in group C underwent coronary revascularization therapy. MPD disappeared after revascularization therapy in all but 3 group A patients. No patients showed new MPD after revascularization therapy. Conclusions: Our results demonstrate that a significant percentage of patients with significant coronary artery stenosis show MPD by 64-MDCT at rest, and these MPDs may represent myocardial ischemia. © 2011 Wiley Periodicals, Inc.

Kashihara K.,Okayama Kyokuto Hospital | Ohno M.,Okayama Kyokuto Hospital | Takahashi Y.,National Epilepsy Center
Journal of the Neurological Sciences | Year: 2010

We report the longitudinal history of a 48-year-old, right-handed woman with Rasmussen's encephalitis (RE) who presented with seizures and cerebral atrophy confined to the left hemisphere, as well as with bilateral uveitis, during her 21-year disease course. Neurological symptoms included recurrent partial seizures with secondary generalized convulsions, reduced visual acuity of the left eye with optic atrophy, right hemianopsia, right hemiplegia and aphasia. MRI T2-weighted images revealed progressive atrophy and high signal intensity lesions localized in the left cerebral hemisphere. An interictal electroencephalogram showed slowing of background activities to 4-7 c/s and epileptiform discharges in the left hemisphere. Anti-glutamate receptor (GluR) ε2 IgG and IgM antibodies were detected in her serum. Our diagnosis was RE. Intravenous administration of high-dose methylpredonisolone immediately ameliorated her condition. Use of interferon β-1b, as well as immunosuppressants, appeared to reduce seizure frequency, prevented exacerbation of her other central nervous system symptoms and slowed development of brain hemiatrophy. Her case is notable because it was complicated with bilateral uveitis and managed favorably by immunotherapy. © 2010 Elsevier B.V. All rights reserved.

Iwasaki K.,Okayama Kyokuto Hospital | Matsumoto T.,Okayama Kyokuto Hospital
Coronary Artery Disease | Year: 2011

Objective: We analyzed the pressure drop pattern in patients with diffuse coronary artery disease and treated these patients according to their pressure drop pattern. Methods: We measured pullback coronary pressure from the distal to the proximal left anterior descending coronary artery in 83 patients with diffuse coronary artery disease. Coronary pressure pattern was divided into two types: the abrupt and gradual pressure drop patterns. Patients with an abrupt pressure drop pattern and fractional flow reserve less than 0.75 underwent coronary revascularization. Patients with gradual pressure drop pattern received medical therapy except five patients, who underwent coronary bypass surgery because of triple vessel disease. We followed these patients for 8-20 (14.3±4.6) months using the grading system of the Canadian Cardiovascular Society (CCS grade). Results: Abrupt pressure drop pattern was observed in 47 patients, whereas the remaining 36 patients showed gradual pressure drop pattern. Angiographic findings did not distinguish these pressure drop patterns. All patients with the abrupt pressure drop pattern except one showed symptomatic improvement (the CCS grade decreased from 2.64 ±0.76 to 1.09 ±0.35, P<0.01) in response to coronary revascularization. In patients with the gradual pressure drop pattern, 17 of 36 patients showed improvement of symptoms (the CCS grade decreased from 2.31 ±0.53 to 1.75 ±0.77, P<0.01). Conclusion: Coronary pressure measurement distinguished patients with abrupt pressure drop pattern from those with gradual pressure drop pattern, and the former group of patients benefited from coronary revascularization. Coron Artery Dis 22:81-86 © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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