Kataoka K.,Otsu Municipal Hospital |
Sakagami J.,Kyoto Prefectural University of Medicine |
Hirota M.,Tohoku University |
Masamune A.,Tohoku University |
Shimosegawa T.,Tohoku University
Pancreas | Year: 2014
OBJECTIVE: Most patients with chronic pancreatitis develop intractable abdominal pain and malnutrition. A low-fat diet is one of the options used to manage intractable abdominal pain and malnutrition. However, few reports have examined the pain-suppression effect. To investigate the effects of oral ingestion of a low-fat elemental diet composed of purified amino acids on pain and nutritional status in patients with chronic pancreatitis, a multicenter prospective study was conducted. METHODS: Patients with chronic pancreatitis with symptoms of abdominal pain were enrolled. In addition to meals, patients ingested a low-fat elemental diet composed of purified amino acids for 12 weeks. Before and after treatment, patients were asked to indicate their pain grade using a 100-mm horizontal visual analog scale, and nutritional indices, including body mass index and blood levels of pancreatic enzymes, were measured. RESULTS: A total of 596 patients were eligible for analysis. Marked pain reduction was observed with a significant decrease of the mean visual analog scale score by 32.9 mm from 52.9 mm after 12 weeks (P < 0.001). There were also significant improvements in nutritional indices. CONCLUSIONS: An oral low-fat elemental diet composed of purified amino acids, which requires no special treatment procedures, may improve patients' quality of life. © 2014 by Lippincott Williams & Wilkins.
Imaizumi K.,Kyoto Prefectural University of Medicine |
Imaizumi K.,Olympus Corporation |
Harada Y.,Kyoto Prefectural University of Medicine |
Wakabayashi N.,Otsu Municipal Hospital |
And 5 more authors.
Gastrointestinal Endoscopy | Year: 2012
The mucosal layer of the colon contains metabolism-related fluorophores, such as reduced nicotinamide adenine dinucleotide (NADH), which might have the potential to serve as biomarkers for detecting neoplasia. To examine NADH fluorescence in human colonic adenoma while eliminating the effect of hemoglobin absorption and to develop a novel imaging technique for precise detection of adenomas. Cross-sectional study. A total of 66 endoscopically resected colonic polyps were investigated. After serial acquisition of autofluorescence images between 450 and 490 nm illuminated with dual-wavelength excitation at 365 nm (F 365ex) and 405 nm (F 405ex) on cross sections of the samples, ratio images were created by dividing F 365ex by F 405ex. The excitation-emission wavelength combinations in F 365ex and F 405ex were optimized for NADH fluorescence and reference fluorescence. The F 365ex/F 405ex ratio in the tumorous (T) and normal (N) mucosa. F 365ex/F 405ex ratio images showed a 1.81- and 1.12-fold higher signal intensity in the adenomas and hyperplastic polyps, respectively, than in the adjacent normal mucosa. The ratio between signal intensities in tumorous mucosa and normal mucosa in F 365ex/F 405ex ratio images for tubular adenomas was significantly higher than that for hyperplastic polyps. The signal intensity in F 365ex/F 405ex ratio images was not correlated with the hemoglobin concentration index evaluated by reflection images at 550 nm and 610 nm. Diminutive adenomas (<5 mm) and large adenomas were well discriminated in F 365ex/F 405ex ratio images. Ex vivo experiment. These results suggest that the precise measurement of NADH fluorescence intensity together with eliminating the influence of blood hemoglobin concentration serves as a method for visualizing colonic adenomas and that the dual-wavelength excitation method is a promising technique applicable to endoscopic detection of early colonic adenomas. © 2012 American Society for Gastrointestinal Endoscopy.
Kawanabe Y.,University of Toledo |
Kawanabe Y.,Otsu Municipal Hospital |
Takahashi M.,University of Toledo |
Jin X.,University of Toledo |
And 4 more authors.
PLoS ONE | Year: 2012
Cilostazol is a phosphodiesterase inhibitor that has been shown to inhibit platelet activation. Endothelin is known to be the most potent endogenous growth promoting and vasoactive peptide. In patients and animal models with stroke, the level of circulating endothelin increases and complicates the recovery progress contributed by vascular constriction (an immediate pathology) and vascular proliferation (a long-term pathology). However, the effects of cilostazol on endothelin have not been explored. To demonstrate the dual-antagonizing effects of cilostazol on vasoconstriction and cell proliferation induced by endothelin, we used primary culture of mouse vascular smooth muscle cells in vitro, mouse femoral artery ex vivo, and intracranial basilar artery ex vivo. We show that the dual-inhibition effects of cilostazol are mediated by blocking endothelin-induced extracellular calcium influx. Although cilostazol does not inhibit endothelin-induced intraorganellar calcium release, blockade of extracellular calcium influx is sufficient to blunt endothelin-induced vasoconstriction. We also show that cilostazol inhibits endothelin-induced cellular proliferation by blocking extracellular calcium influx. Inhibition of cAMP-dependent protein kinase (PKA) can block anti-proliferation activity of cilostazol, confirming the downstream role of PKA in cellular proliferation. To further demonstrate the selectivity of the dual-antagonizing effects of cilostazol, we used a different phosphodiesterase inhibitor. Interestingly, sildenafil inhibits endothelin-induced vasoconstriction but not cellular proliferation in smooth muscle cells. For the first time, we show selective dual-antagonizing effects of cilostazol on endothelin. We propose that cilostazol is an excellent candidate to treat endothelin-associated diseases, such as stroke. © 2012 Kawanabe et al.
Sano T.,Otsu Municipal Hospital |
Nakashima M.,Kyoto University |
Haitani T.,Otsu Municipal Hospital |
Kajita Y.,Otsu Municipal Hospital |
Shichiri Y.,Otsu Municipal Hospital
International Journal of Urology | Year: 2012
The objective of the present study was to assess the efficacy of posterior reconstruction of Denonvilliers' musculofascial plate for restoring urinary continence after laparoscopic radical prostatectomy. A total of 48 consecutive patients who underwent laparoscopic radical prostatectomy were retrospectively reviewed. Of them, 23 underwent laparoscopic radical prostatectomy without posterior reconstruction of Denonvilliers' musculofascial plate (group1) and 25 underwent laparoscopic radical prostatectomy with posterior reconstruction of Denonvilliers' musculofascial plate (group2). Patients' demographics were analyzed and continence rates between the two groups at 1, 3, 6 and 12months after surgery were compared. Patients in group2 had significantly larger prostates than in group1. There were no significant differences between the two groups in terms of the other patient characteristics. The urinary continence rates were significantly higher in group2 than in group1 at 1, 3 and 12months after surgery, and the rates of severe incontinence were significantly lower in group2 at all time-points considered. These findings suggest that posterior reconstruction of Denonvilliers' musculofascial plate helps in restoring early continence and decreasing severe incontinence in patients undergoing laparoscopic radical prostatectomy. © 2012 The Japanese Urological Association.
Yamao Y.,Kyoto University |
Takagi Y.,Kyoto University |
Kawauchi T.,Kyoto University |
Arakawa Y.,Kyoto University |
And 2 more authors.
Spine | Year: 2015
Study design. A case report. Objective. We report a case of spontaneous spinal epidural hematoma with 3 bleeding episodes and discuss the surgical management of recurrent spontaneous spinal epidural hematoma. Summary of Background Data. Spontaneous spinal epidural hematoma is a rare condition that causes spinal cord compression and neurological deficits. However, the cause of bleeding remains unclear and recurrent bleeding is very seldom reported. Methods. A 39-year-old female patient was referred to Kyoto University hospital with sudden back and right upper extremity pain. She was also treated conservatively at the local hospital 19 and 4 months previously because of same episodes. Magnetic resonance images demonstrated right spinal epidural hematoma at the C6-T1 level. In the first 2 episodes, magnetic resonance images revealed spinal epidural hematomas at exactly the same level. Results. In the third episode, the patient's neurological condition was not worse than it had been in the first 2 episodes, and we initially managed her conservatively. To identify the cause of the hematoma, surgery was performed 15 days after the third onset. Microscopic examination revealed the development of a venous plexus around the old hematoma in the dorsal epidural space. The patient was discharged without any further neurological deficits, and recurrent bleeding has not occurred for 6 months after surgery. Conclusion. This is the first report of operative and histological observation of recurrent spontaneous spinal epidural hematoma caused by a posterior venous plexus. In a case of recurrent spontaneous spinal epidural hematoma, surgery might be necessary to prevent further hematomas. © 2015, Wolters Kluwer Health, Inc.
Hirayama K.,Otsu Municipal Hospital |
Masui K.,Otsu Municipal Hospital |
Hamada A.,Otsu Municipal Hospital |
Shichiri Y.,Otsu Municipal Hospital |
And 2 more authors.
Urology | Year: 2015
Objective To investigate factors predicting that combination therapy would be insufficient in terms of efficacy, necessitating conversion to surgical intervention, in patients with lower urinary tract symptoms and/or benign prostatic enlargement. Materials and Methods In total, 218 patients given combination therapy for 6 months or more were enrolled in our study. Candidate factors for surgical intervention before dutasteride administration were statistically analyzed. We also examined the proportion of stromal components in resected specimens of the intravesical prostatic protrusion (IPP) portion using the point-counting technique according to IPP grades. Results Combination therapy was effective and was thus continued in 172 patients, whereas 46 required surgical intervention. The comparison between these two groups, by multivariate analysis, revealed significant differences in IPP and total International Prostate Symptom Score (IPSS). IPP (odds ratio 1.133, P <.001) was the strongest independent factor predicting conversion to surgical intervention. Receiver operating characteristic analysis identified the optimal cutoff value of IPP to be 8 mm (area under the curve: 0.9). This value yielded a sensitivity of 91% and a specificity of 72%. In addition, the mean proportion of stromal components in resected specimens of IPP according to IPP grades was grade I: 96.7%, grade II: 57.8%, and grade III: 21.4% (P <.001 for all), respectively. Conclusion Our results suggest that in lower urinary tract symptoms and/or benign prostatic enlargement associated with severe IPP, combination therapy might have insufficient efficacy due to a low proportion of stromal components, necessitating conversion to surgical intervention. © 2015 Elsevier Inc. All Rights Reserved.
An isolated posterior spinal aneurysm resection in which intraoperative electrophysiological monitoring was successfully used to locate the lesion and to detect the possibility of ischemic complications
Takata M.,Otsu Municipal Hospital |
Takayama M.,Otsu Municipal Hospital |
Yokoyama Y.,Otsu Municipal Hospital |
Hayashi H.,Otsu Municipal Hospital |
Kishida N.,Otsu Municipal Hospital
Spine | Year: 2016
Study Design. A case report. Objective. To report the successful use of electrophysiological monitoring in the surgical resection of a ruptured spinal artery (SA) aneurysm to locate the lesion, and to predict ischemic complications. Summary of Background Data. Isolated aneurysm of the posterior SA is an extremely rare event without established treatment and diagnosis procedures. Reports describing the surgical intervention of aneurysm of the posterior SA using electrophysiological monitoring are scant. Methods. We performed the surgical resection of a dissected posterior SA aneurysm in an older patient who presented with spinal subarachnoid hemorrhage using intraoperative electrophysiological monitoring. Results. Intraoperatively, motor evoked potentials decreased over 50% when a distal site of the lesion was clipped, indicating that site was the posterior SA. This lead to further investigation of the vascular anatomy around the lesion, which revealed the descending part of the posterior SA buried deeply in a thick thrombus. Clipping and resection were successful, and ischemia of the posterior SA was avoided. The postoperative clinical course was good, and there was no recurrence or long-term squeal. Conclusion. Electrophysiological monitoring might be useful when intraoperative anatomical findings of the hemodynamic structure are inadequate. Moreover, in our case, intraoperative changes in motor evoked potentials indicated the risk to occlude one of posterior SAs, although it is said that posterior circulation of spinal cord has ischemic tolerance. © 2016, Wolters Kluwer Health, Inc. All rights reserved.
Takahashi Y.,Otsu Municipal Hospital
The journal of obstetrics and gynaecology research | Year: 2011
We present a rare case of alpha-fetoprotein (AFP) producing ovarian clear cell carcinoma. This is the first report of a clear cell ovarian carcinoma with hepatoid carcinoma arising from endometriosis. A 54-year-old menopausal woman had a primary ovarian carcinoma of International Federation of Gynecology and Obstetrics stage IIIc. Serum level of AFP was 4195 ng/mL. Histological examination revealed clear cell adenocarcinoma arising from endometriosis with hepatoid carcinoma. Metastatic liver and lymph node tumors were found after 25 months from the first surgery. However, the patient's serum AFP was within normal limits. The recurrent and metastatic tumors disappeared in response to combined liposomal doxorubicin and carboplatin chemotherapy. She has had a disease-free survival of 4 years. In conclusion, the patient had a clear cell ovarian carcinoma with hepatoid carcinoma arising clearly from endometriosis. The recurrent tumors did not show a component of hepatoid carcinoma. Therefore, it is possible to expect better survival with good sensitivity to chemotherapy. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.
Kino A.,Otsu Municipal Hospital
Japanese Journal of Anesthesiology | Year: 2011
We report a case where "laryngospasm notch" technique was used in a patient to initiate spontaneous respiration during general anesthesia. The patient was a 43-year-old woman who underwent conization. A ProSeal laryngeal mask airway was inserted after induction of general anesthesia. General anesthesia was maintained with sevoflurane (1.7-2%) and fentanyl. Surgical course was uneventful until the patient became unable to breathe towards the end of surgery. Positive-pressure ventilation was applied, but the patient could not be ventilated. "Laryngospasm notch" technique was performed by applying digital pressure in front of the tragus of the ears, and the patient began to breathe spontaneously. We describe our experience with the "laryngospasm notch" technique applied to the front of the tragus of the ears to treat laryngospasm.
Takahashi Y.,Otsu Municipal Hospital
The journal of obstetrics and gynaecology research | Year: 2011
Glassy cell carcinoma of the uterine cervix (GCC) is a rare form of cervical carcinoma that is characterized by aggressiveness and poor prognosis. We reviewed a variety of clinicopathological features, treatment strategies, and outcomes in three women with GCC. The three patients were successfully treated by radical hysterectomy with pelvic/para-aortic lymphadenectomy. The patients had stage Ib1, stage IIa, and stage Ib2 tumors without lymph node metastases. A 44-year-old woman with stage Ib1 tumor did not undergo adjuvant chemotherapy or radiation therapy. She had recurrent pelvic tumors 12 months after surgery, and died 6 months after the recurrent disease. The histological findings of her cervix, which were different from the other two patients, did not show the marked infiltration of eosinophils. The other two patients with stage Ib2 and IIa tumors underwent adjuvant chemotherapy with paclitaxel and carboplatin, and had disease-free survival for 4.5 and 9 years. We think that all patients with GCC of stage Ib1 or more should undergo adjuvant chemotherapy of paclitaxel and carboplatin or other adjuvant therapies. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.