Okayama-shi, Japan
Okayama-shi, Japan

Time filter

Source Type

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).


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 | Imamura T.,Okayama Kyokuto Hospital | Shinya T.,Okayama Kyokuto Hospital
Parkinsonism and Related Disorders | Year: 2010

We investigated cardiac uptake of 123I-metaiodobenzylguanidine (MIBG) in patients with REM sleep behavior disorder (RBD) and compared the findings with those of idiopathic Parkinson's disease (IPD). Thirteen RBD, 222 IPD and 50 controls underwent cardiac 123I-MIBG scintigraphy. Resulting heart-to-mediastinum (H/M) ratios were significantly lower in patients with RBD and IPD as compared to the control ratios. H/M ratios were lower for delayed than for early images in patients with RBD and IPD; whereas, the controls had higher ratios for delayed images. H/M ratios were significantly lower for patients with RBD than for those with IPD at Hoehn and Yahr stages 1 and 2. Disease duration did not differ between the two groups. Our study revealed that cardiac 123I-MIBG uptake was more markedly reduced in patients with RBD than in those with early stage IPD. RBD may not necessarily be a prodromal condition of IPD with respect to cardiac 123I-MIBG uptake results. © 2010 Elsevier Ltd.


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
International Journal of Cardiovascular Imaging | Year: 2016

We studied the dynamic change of high-risk plaque detected by coronary computed tomographic angiography (CCTA) in patients with subclinical coronary artery disease. We analyzed paired CCTA findings in 103 patients. The follow-up period was 1.37 ± 0.49 years. We studied the prevalence and change of high-risk plaque (HRP) defined as positive remodeling, low attenuation plaque, spotty calcification, or napkin-ring sign. Of 413 plaques detected by CCTA, thirty-seven patients had 47 HRP at baseline. At follow-up, eight patients showed disappearance of HRP. Sixty-six patients had no HRP at baseline. At follow-up, new HRP was detected in 12 patients. As a whole, 20 patients (19.4 %) showed appearance or disappearance of HRP. For 29 patients with persistent HRP, five of twenty-one patients with one HRP at baseline showed two HRP at follow-up. Five of eight patients with two HRP at baseline showed one HRP at follow-up. As a whole, in 27 % of patients with persistent HRP, the number of HRP changed. These changes were neither associated with statin use nor location of the HRP. Our results showed that about 20 % of patients showed appearance or disappearance of HRP 1 year later. In addition, in 27 % of patients with persistent HRP, the number of HRP increased or decreased. These results suggest a dynamic nature of HRP. © 2016 Springer Science+Business Media Dordrecht


Kashihara K.,Okayama Kyokuto Hospital | Hanaoka A.,Okayama Kyokuto Hospital | Imamura T.,Okayama Kyokuto Hospital
Internal Medicine | Year: 2011

Objective Patients with Parkinson's disease (PD) frequently complain of a diminished sense of smell. Less frequently, they may complain of taste impairment. In the present study, we investigated the symptoms, frequency, and severity of taste impairment as well as smell impairment in PD patients and compared the results with those of age- and sex-matched healthy controls. Patients and Methods We interviewed 285 PD patients (120 men, 165 women) without dementia or nasal problems. Control subjects comprised 61 (20 men, 41 women) healthy spouses of the PD patients. Alteration of smell and taste sense lasting more than 3 months was defined as abnormal. Results One hundred and sixteen patients with PD complained of smell impairment and 26 complained of taste impairment. Only 5 controls complained of smell impairment, and no control subjects reported taste impairment. Taste impairment was more marked in patients with smell impairment. Impaired taste included diminished taste perception in 21 patients, altered sense of taste in 4 patients and burning mouth in 1 patient. Conclusion Taste as well as smell perception is impaired in patients with PD. The frequency of smell and taste impairments tended to increase with disease progression. © 2011 The Japanese Society of Internal Medicine.


Kashihara K.,Okayama Kyokuto Hospital | Shinya T.,Okayama Kyokuto Hospital | Higaki F.,Okayama Kyokuto Hospital
Internal Medicine | Year: 2011

Objective Diseases presenting extrapyramidal symptoms are accompanied by nigral cell loss. In the previous study, we demonstrated the reduction of the neuromelanin-positive volume of substantia nigra (SN) pars compacta (SNc) in patients with Parkinson's disease (PD) using 3-Tesla MRI. In the present study we investigated the neuromelanin-positive SNc volume in patients with the other parkinsonian disorders including multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) and compared the results with those with PD, spinocerebellar ataxia (SCA) and controls. Patients and Methods Axial T1-weighted (T1W) images were obtained with a 3-Tesla MRI scanner. The border of the neuromelanin-positive region of the SNc was traced manually on these images with a pentablet pointing device and the SNc volume was calculated. The SNc volumes of 28 patients with MSA, 11 patients with PSP and 10 patients with CBD were compared with those of 80 patients with PD, 9 patients with SCA and 54 patients who had suffered mild acute ischemic stroke as controls. The mean volumes for the left and right SN were used for statistical analyses. Results The volumes of the neuromelanin-positive SNc region in patients with MSA, PSP and CBD, but not SCA were reduced to the same extent as PD patients compared with controls. Conclusion Reduced volume of the neuromelanin-positive SNc region of patients with MSA, PSP and CBD was detected by neuromelanin MR imaging. Volumetric evaluation of neuromelanin MR imaging may provide a biomarker of nigral degeneration in patients with MSA, PSP and CBD as in patients with PD. © 2011 The Japanese Society of Internal Medicine.


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.


Kashihara K.,Okayama Kyokuto Hospital | Shinya T.,Okayama Kyokuto Hospital | Higaki F.,Okayama Kyokuto Hospital
Journal of Clinical Neuroscience | Year: 2011

Parkinson's disease (PD) is characterized by progressive degeneration of melanin-containing neurons in the substantia nigra pars compacta (SNc). Pathological change has not been detected by neuroimaging techniques in patients with PD in vivo. We examined 80 patients with PD to determine whether degeneration of the SNc is detectable in vivo by MRI. The age-matched controls consisted of 54 patients who had suffered mild acute ischemic stroke. Axial T1-weighted MRI were obtained with a 3-Tesla MRI scanner. The border of the neuromelanin-sensitive region in the SNc was traced manually on these images, and the volume of this area was calculated. The mean volumes for the left and right SNc were significantly reduced in patients with PD compared to the controls. Volume loss became marked in parallel with disease severity and duration. Neuromelanin MRI may be considered as a biomarker of nigral degeneration in patients with PD. © 2011 Elsevier Ltd. All rights reserved.


Tanaka R.,Okayama Kyokuto Hospital
Prehospital and Disaster Medicine | Year: 2015

Although it is well known that the Great East Japan Earthquake (March 11, 2011) resulted in a large number of disaster-related deaths, it is not common knowledge that the number of disaster-related deaths continues to increase, even four years after the earthquake, in Fukushima Prefecture, where the nuclear power plant accident occurred. There has been a lack of a minute and critical analysis for the causes for this continuous increase. In this report, the causes for the increase in disaster-related deaths in Fukushima Prefecture were analyzed by aggregating and comparing multiple data released by public organizations (the Reconstruction Agency, the National Police Agency, and Fukushima Prefecture), which may also have implications for developing response strategies to other disasters. The disaster-related death rate, the dead or missing rate, and the refugee rate (the number of disaster-related deaths, dead or missing persons, and refugees per 1,000 people) in each prefecture in stricken areas, and also each city, county, town, and village in Fukushima Prefecture, were calculated and compared with each other. The populations which were used for the calculation of each death rate in the area were based on the number of dead victims who had lived in the area when the earthquake occurred, regardless of where they were at the time of their death. The disaster-related death rate was higher than the dead or missing rate in the area around a stricken nuclear power plant in Fukushima Prefecture. These areas coincide exactly with the Areas under Evacuation Orders because of unsafe radiation levels. The external and internal radiation doses of most of the victims of the Great East Japan Earthquake have appeared not to be so high to harm their health, until now. The psychological stress associated with being displaced from one's home for a long time with an uncertain future may be the cause for these disaster-related deaths. There is an urgent need to recognize refugees' stressful situations, which could even cause death, and to provide them with high-quality medical treatment, including care for their long-term mental health. Tanaka R. © World Association for Disaster and Emergency Medicine 2015.

Loading Okayama Kyokuto Hospital collaborators
Loading Okayama Kyokuto Hospital collaborators