Okayama Saiseikai General Hospital

Okayama-shi, Japan

Okayama Saiseikai General Hospital

Okayama-shi, Japan

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Nakamura K.,Okayama University of Science | Oe H.,Okayama University of Science | Kihara H.,Kihara Cardiovascular Clinic | Shimada K.,Osaka City University | And 8 more authors.
Cardiovascular Diabetology | Year: 2014

Background: Alpha glucosidase inhibitor (GI) attenuates postprandial hyperglycemia (PPH) and reduces the risk of cardiovascular events in patients with impaired glucose tolerance or type 2 diabetes. Dipeptidyl peptidase 4 (DPP-4) inhibitors also attenuate PPH. PPH is one of the factors leading to endothelial dysfunction which is an early event in the pathogenesis of atherosclerosis. Furthermore, DPP-4 inhibitors protect endothelial function through a GLP-1-dependent mechanism. However, the impact of these two types of drugs on endothelial dysfunction in patients with type 2 diabetes has not been fully elucidated. We compared the effects of sitagliptin, a DPP-4 inhibitor, and voglibose, an alpha GI, on endothelial function in patients with diabetes.Methods: We conducted a randomized prospective multicenter study in 66 patients with type 2 diabetes who did not achieve the treatment goal with sulfonylurea, metformin or pioglitazone treatment; 31 patients received sitagliptin treatment and 35 patients, voglibose treatment. The flow-mediated dilatation (FMD) of the brachial artery was measured in the fasting state at baseline and after 12 weeks of treatment. The primary endpoint was a change in FMD (ΔFMD) from the baseline to the end of follow-up. The effects of sitagliptin and voglibose on FMD were assessed by ANCOVA after adjustment for the baseline FMD, age, sex, current smoking, diabetes duration and body mass index. Secondary efficacy measures included changes in HbA1c, GIP, GLP-1, C-peptide, CD34, lipid profile, oxidative stress markers, inflammatory markers and eGFR and any adverse events.Results: ΔFMD was significantly improved after 12 weeks of treatment in both groups, and there was no significant difference in ΔFMD between the two groups. There were no significant differences in changes in HbA1c, GIP, GLP-1, C-peptide, lipid profile, oxidative stress marker, inflammatory marker and eGFR between the two groups. Compared with voglibose, sitagliptin significantly increased the circulating CD34, a marker of endothelial progenitor cells. Adverse events were observed in 5 patients in only the voglibose group (diarrhea 1, nausea 1, edema 2 and abdominal fullness 1).Conclusions: Sitagliptin improved endothelial dysfunction just as well as voglibose in patients with type 2 diabetes. Sitagliptin had protective effects on endothelial function without adverse events. © 2014 Nakamura et al.; licensee BioMed Central Ltd.


Kajitani N.,Okayama University of Science | Shikata K.,Okayama University of Science | Nakamura A.,Osafune Clinic | Nakatou T.,Okayama Saiseikai General Hospital | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Aim: This study aimed to evaluate the change of serum levels of proinflammatory molecules in patients with type 2 diabetes and clarify the involvement of these molecules in diabetic nephropathy and atherosclerosis. Methods: Sixty-six Japanese type 2 diabetic patients (T2DM) and 39 healthy control subjects were enrolled. We assessed clinical parameters, urinary albumin excretion rate (AER), brachial-ankle pulse wave velocity (baPWV), intima media thickness (IMT) and serum levels of proinflammatory molecules. Results: Serum levels of IL-6, IP-10 and MCP-1 were significantly higher in T2DM than in control subjects. In T2DM, serum levels of high-sensitivity (hs) CRP, IP-10, hsTNF-α, VCAM-1 and E-selectin were positively correlated with AER. Serum levels of IP-10, hsTNF-α and VCAM-1 were positively correlated with baPWV. Serum levels of hsCRP, IL-6, IP-10 and hsTNF-α were positively correlated with IMT. Multiple linear regression analysis revealed that serum levels of hsTNF-α were independently associated with AER (β=0.235, P=0.038) and serum levels of IP-10 were independently associated with baPWV (β=0.209, P=0.047) and IMT (β=0.303, P=0.032). Conclusion: Our results suggest that low-grade inflammation, microinflammation, may be a common risk factor for diabetic nephropathy and atherosclerosis in Japanese type 2 diabetic patients. © 2010 Elsevier Ireland Ltd.


Orita Y.,Okayama Saiseikai General Hospital | Sugitani I.,Cancer Institute Hospital | Matsuura M.,Cancer Institute | Ushijima M.,Cancer Institute | And 3 more authors.
Surgery | Year: 2010

Background: The treatment of bone metastasis in association with thyroid cancer represents a difficult challenge. Given the paucity of patients with bone metastasis and the difficulty of treating this disease, few studies have investigated the clinical features and prognostic factors of bone metastasis from differentiated thyroid cancer. Methods: During the 31-year-period from 1976 to 2006, a total of 1,398 patients underwent initial thyroidectomy at Cancer Institute Hospital for differentiated thyroid carcinomas, including standard papillary thyroid carcinoma, papillary microcarcinoma (primary tumor diameter ≤1.0 cm), and follicular thyroid carcinoma. Among these, 25 (2%) patients displayed bone metastasis at initial presentation (synchronous) and 27 patients showed bone metastasis during follow-up (metachronous). The records for these 52 patients were reviewed retrospectively to identify prognostic factors and analyze treatment strategies. Results: Univariate analysis for disease-specific survival indicated metachronous bone metastasis and the presence of distant metastasis at sites other than bone as indicators of significantly worse prognosis. The type of cancer (papillary thyroid carcinoma versus follicular thyroid carcinoma) was not a significant indicator of prognosis; however, patients with papillary microcarcinoma showed significantly worse survival than patients with standard papillary and follicular thyroid carcinoma. A significant survival advantage was observed among patients who underwent radioactive iodine therapy, and better prognosis seemed to be obtained with greater doses of radioactive iodine. Operative resection of metastatic bone lesions also seemed to be associated with better prognosis. A multivariate analysis for disease-specific survival identified the coexistence of distant metastasis at sites other than bone as the only independent variable indicative of poor prognosis. Conclusion: In the absence of definitive, effective treatments for this disease, radioactive iodine therapy combined with resection of bone metastasis, wherever possible, seems to represent the most potent therapy available. Although bone metastasis is a strong sign of poor prognosis, early detection and administration of appropriate therapy using radioactive iodine seems likely to improve the survival rate and quality of life in patients with bone metastasis from differentiated thyroid carcinoma. © 2010 Mosby, Inc. All rights reserved.


Orita Y.,Okayama Saiseikai General Hospital | Sugitani I.,Cancer Institute Hospital | Toda K.,Cancer Institute Hospital | Manabe J.,Cancer Institute Hospital | Fujimoto Y.,Cancer Institute Hospital
Thyroid | Year: 2011

Background: Currently bisphosphonates are often administered to patients with osteolytic bone metastases from several neoplasms. Based on favorable experience in other cancers with bone metastases and the lack of effective treatment, we started to use zoledronic acid (ZA), a recently developed synthetic bisphosphonate drug, in the treatment of this disease. In the present study, we retrospectively evaluated the efficacy of ZA for bone metastases from differentiated thyroid carcinoma. Methods: The study consisted of 50 patients with bone metastases from differentiated thyroid carcinoma treated at the Cancer Institute Hospital of Tokyo between 1976 and 2008. Among them, 28 patients who did not undergo bisphosphonate therapy were defined as group A and 22 patients who received ZA therapy were defined as group B. The primary efficacy endpoint for ZA treatment was the reduction in the percentage of patients who developed skeletal-related events (SREs), including bone fracture, spinal cord compression, and hypercalcemia. A secondary endpoint was the interval between a presentation of bone metastases and appearance of SREs. Results: SREs occurred in significantly lower frequency in group B (3 of 22 patients, 14%) than group A (14 of 28 patients, 50%) (p = 0.007). The use of ZA significantly retarded the onset of the first SRE (p = 0.04). Two group-B patients developed bisphosphonate-related osteonecrosis of the jaw. Conclusion: Treatment with ZA was effective in reducing SREs or delaying their appearance in patients with bone metastases from differentiated thyroid carcinoma. © Copyright 2011, Mary Ann Liebert, Inc. 2011.


Tanaka H.,Okayama Saiseikai General Hospital
Clinical calcium | Year: 2010

Osteogenesis imperfecta (OI) is characterized by its bone fragility. But the spectrum of the severity of the fragility is widely distributed. Recently, amino-bisphosphonate has been introduced into the treatment of the bone fragility of OI. Apparently, the treatment may reduce the frequency of the fractures in severe form of OI. However, its efficacy has not been supported by strong evidences, such as randomized controlled clinical trial. This section describes the pathophysiology and new pathogenetic mechanism of OI, and describes recent evidence for the efficacy of BP treatment in OI.


Tanaka H.,Okayama Saiseikai General Hospital
Clinical calcium | Year: 2011

Bone mass during infantile period relates closely to adult bone mass and small bone mass in infancy has been thought as one of the risk factors for osteoporosis. Although bone mass accrual during infantile period is determined by perinatal condition, nutrition and endocrine factors, among these factors, infant growth at third trimester of pregnancy is important to determine life-long bone health. For nutritional factors, vitamin D and calcium are important. The effects of estrogen on infant bone are also discussed.


Tanaka H.,Okayama Saiseikai General Hospital
Clinical calcium | Year: 2010

FGFR3 has been establishing its position in growth plate cartilage after the identification as a responsible gene for achondroplasia. The major pathway of the pathogenesis in achondroplasia is the suppression of PTHrP-PTHR system, which is mainly mediated by ERK activation induced by constitutive active FGFR3. However, intracellular signaling system in FGFR3 is complex and the molecular pathogenesis of achondroplasia and related disorders has not been fully clarified. Especially, recently found human loss-of-function mutations in newly identified syndromes casted novel findings in the relation between phenotype and receptor function. In this review, I summarized recent consensus in the pathogenesis of FGFR3 related chondrodysplasia.


Noyama Y.,Okayama Saiseikai General Hospital
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2012

Hemophagocytic syndrome (HPS) is characterized by pancytopenia, liver dysfunction and coagulopathy, caused by activated T cells and macrophages following malignant lymphoma, infection of Epstein-Barr virus, collagen disease and others. We report a case of Epstein-Barr virus-associated HPS, in a patient complained of sore throat, high fever, and general fatigue. Laboratory data demonstrated pancytopenia, liver disfunction and monoclonal proliferation of EBV-infected T cells. Ferritin, LDH and sIL-2R were elevated. We suspected HPS and performed bone marrow aspiration cytology. It showed hemophagocytic cells. In this case, immunosuppressive therapy, steroid pulse and VP-16 chemotherapy were not effective, and she died of multiple organ failure with disseminated intravascular coagulopathy.


Yasui K.,Okayama Saiseikai General Hospital
Japanese Journal of Clinical Radiology | Year: 2016

We describe four cases of non-traumatic intramural duodenal hematoma of different etiology. They all presented to emergency room with progressive abdominal pain, nausea and vomiting. Two of them were in shock state. Early diagnosis is crucial because most patients are treated nonoperatively with a good outcome. Transluminal arterial embolization may be the treatment of choice in case of active arterial bleeding in the hematoma.


Hasegawa K.,Okayama University | Tanaka H.,Okayama University | Tanaka H.,Okayama Saiseikai General Hospital
Pediatrics International | Year: 2014

Short-limbed short stature is a heterogeneous condition that can result from many diseases such as bone disorder, metabolic disease, and multiple malformation syndrome. We conducted a questionnaire survey of council members of the Japanese Society of Pediatric Endocrinology and doctors of affiliated hospitals in 2010 to investigate short-limbed short stature. Among 91 hospitals, responses were obtained from 61 hospitals (67% response rate). This study also examined data of 193 short-limbed short stature patients, among whom FGFR3-related chondrodysplasia such as achondroplasia (n = 109; 56.5%) was found the most frequently. Second to achondroplasia, hypochondroplasia (n = 47; 24.4%) was the most frequently observed. Along with achondroplasia and hypochondroplasia, 31 patients with disorders of 13 other kinds and six undiagnosed patients were identified. Genetic testing for hypochondroplasia was conducted for only 27.7% of all hypochondroplasia patients, although hypochondroplasia is a heterogeneous condition with many causes, only one of which is FGFR3 mutation. We conducted a genetic analysis of 25 patients who had been clinically diagnosed as having "hypochondroplasia". In these patients, other diseases such as acromicric dysplasia, geleophysic dysplasia, and Aarskog-Scott syndrome were included in addition to FGFR3-related hypochondroplasia (n = 10). Clinical diagnosis of each disorder causing short-limbed short stature is difficult. Therefore, not only clinical diagnosis but also genetic diagnosis play an important role in the diagnosis of short-limb short stature. Diagnostic strategies must be created for each disorder. © 2014 Japan Pediatric Society.

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