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Aoki T.,Tohoku University | Takahashi J.,Tohoku University | Fukumoto Y.,Tohoku University | Yasuda S.,National Cerebral and Cardiovascular Center Hospital | And 12 more authors.
Circulation Journal | Year: 2013

Background: We reported an increased occurrence of cardiovascular diseases (CVDs) after the Great East Japan Earthquake by examining ambulance records, but it had to be confirmed by cardiologists. Methods and Results: We enrolled patients admitted to the cardiology department of the 10 hospitals in the disaster area from 4 weeks prior to 15 weeks after March 11 in the years 2008-2011 (n=14,078). The weekly occurrence of several CVDs, including heart failure (HF), pulmonary thromboembolism (PTE) and infectious endocarditis (IE), was sharply and significantly increased after the Earthquake. Conclusions: The Disaster caused significantly increases in the occurrence of HF, PTE and IE. Source


Ichikawa H.,Tohoku University | Miyata G.,Tohoku University | Miyazaki S.,Iwate Prefectural Chubu Hospital | Onodera K.,Tohoku University | And 7 more authors.
Annals of Surgery | Year: 2013

OBJECTIVE: To estimate the oncological feasibility of thoracoscopic- assisted esophagectomy (TAE) for esophageal cancer and to clarify the prognostic impact of perioperative factors after TAE. BACKGROUND: Favorable perioperative outcomes of TAE versus open surgery have been demonstrated. However, survival data after TAE in a large cohort are limited, and no information on the prognostic influence of perioperative factors after TAE is available. METHODS: Prospectively collected data for 315 patients undergoing TAE for esophageal cancer were analyzed. Survival was compared with the Kaplan-Meier analysis and Cox regression analysis between 2 surgical approaches: thoracoscopic and hand-assisted laparoscopic esophagectomy (THLE) and thoracoscopic and open laparotomic esophagectomy (TOE). Factors affecting overall survival were identified with Cox multivariate regression analysis in the whole cohort and the THLE subgroup. RESULTS: THLE and TOE were performed in 153 and 162 patients, respectively. The overall 5-year survival of the whole cohort was 57.8%, with no difference between the THLE and the TOE group. Multivariate analysis of the 315 patients identified the following prognostic factors: blood loss, blood transfusion, intensive care unit stay, cardiovascular complications, pathological T and N stages, lymphatic invasion, intramural metastasis, and number of metastatic nodes. In the THLE subgroup, cerebral comorbidity, histological subtype, pathological T stage, and number of metastatic nodes were independent prognostic factors. CONCLUSIONS: TAE was oncologically feasible. Perioperative factors affected survival in the whole cohort, but did not in the THLE subgroup. However, the reduced perioperative factor effect in this subgroup would be small because the survival rates of the 2 surgical approaches were equal. Copyright © 2013 by Lippincott Williams & Wilkins. Source


Yoshida M.,Osaki Citizen Hospital | Ezura M.,Sendai Medical Center | Sasaki K.,Osaki Citizen Hospital | Chonan M.,Osaki Citizen Hospital | Mino M.,Osaki Citizen Hospital
Neurologia Medico-Chirurgica | Year: 2012

A 50-year-old man presented with an aneurysm arising from a fenestration of horizontal portion (A1) of the anterior cerebral artery manifesting as subarachnoid hemorrhage. Coil embolization was conducted and the aneurysm was occluded easily. Most reported cases of these types of aneurysms underwent direct surgery. Aneurysm arising from the A1 fenestration is rare, but the present case shows that coil embolization can be an effective treatment modality. Three-dimensional rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure. Source


Miura M.,Tohoku University | Sakata Y.,Tohoku University | Nochioka K.,Tohoku University | Takahashi J.,Tohoku University | And 7 more authors.
Circulation Journal | Year: 2013

Background: Elevated blood urea nitrogen (BUN) observed in patients hospitalized for acute heart failure syndrome (AHFS) may represent increased neurohumoral activation. The purpose of this study was to examine the prognostic impact of BUN changes during hospitalization on the long-term prognosis of AHFS patients. Methods and Results: The Tohoku Acute Heart Failure Registry (n=497) is a multicenter retrospective cohort study enrolling AHFS patients who were admitted in 2007. The 337 survivors (mean age, 76 years; 52% male) were divided into 3 groups according to tertiles of BUN change during hospitalization: Decreased (D-BUN, ΔBUN (BUN level at discharge-BUN level at hospitalization) ≤-1.63 mg/dl, n=112); Unchanged (U-BUN, ΔBUN -1.64 to 5.73 mg/dl, n=113); Increased (I-BUN, ΔBUN >5.73 mg/dl, n=112). The D-BUN group had higher prevalence of lowest glomerular filtration rate during hospitalization, whereas the I-BUN group had higher systolic blood pressure. During a median follow-up period of 2.3 years after discharge, the Kaplan-Meier curve showed that D-BUN and I-BUN had worse prognosis compared with U-BUN. Multivariable logistic model showed that all-cause death was more frequent in I-BUN (hazard ratio, 2.94; 95% confidence interval, 1.51-5.73; P<0.001). Subgroup analysis revealed that BUN increase during hospitalization was associated with all-cause death, regardless of renal function. Conclusions: AHFS patients with a BUN increase during hospitalization have worse long-term prognosis, independent of renal function. Source


Yoshida M.,Osaki Citizen Hospital | Ezura M.,Sendai Medical Center | Mino M.,Osaki Citizen Hospital
Neurologia Medico-Chirurgica | Year: 2011

A 60-year-old female presented with a carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy. Left internal carotid digital subtraction angiography showed a persistent primitive trigeminal artery (PPTA) near the CCF. Super-selective angiography showed direct shunt flow between the PPTA trunk aneurysm and the left cavernous sinus. The aneurysm was successfully occluded with detachable coils. The CCF disappeared and the PPTA was preserved. The abducens nerve paralysis had disappeared 6 months later. CCF caused by a PPTA trunk aneurysm is extremely rare. We speculate that the PPTA trunk aneurysm formed and then ruptured due to hemodynamic stress caused by hypoplasia of the basilar artery. Source

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