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Yamaguchi T.,EP Expert Doctors Team Tsuchiya | Tsuchiya T.,EP Expert Doctors Team Tsuchiya | Nagamoto Y.,Saga Prefectural Hospital Koseikan | Miyamoto K.,National Cerebral and Cardiovascular Center | And 3 more authors.
Europace | Year: 2014

AimsTo examine the impact of left atrial (LA) low-voltage zones (LVZs) on atrial fibrillation (AF) recurrence after pulmonary vein antrum isolation (PVAI) without LA substrate modification.Methods and resultsSeventy-six patients with AF (paroxysmal/persistent 65/11) were prospectively enroled. Left atrial voltage maps were constructed during sinus rhythm using NavX to identify LVZs (<0.5 mV), and PVAI without any LA substrate modification was performed using an open-irrigation catheter. After PVAI, 20 mg of adenosine triphosphate (ATP) was injected. Adenosine triphosphate-induced PV reconnections were eliminated by touch-up ablation when unmasked. Voltage maps revealed LVZs in 24 patients (32%) and no LVZs in 52 (68%). During 24 ± 7 months of follow-up, 15 patients (63%) with LVZs and 10 (19%) without had AF recurrences off antiarrhythmic drugs (log-rank P < 0.001). A multivariate logistic regression analysis revealed that LVZ areas [odds ratio (OR): 1.12 per 1 cm2, 95% confidence interval (CI): 1.04-1.23, P = 0.001] and ATP-induced reconnection (OR: 2.08, 95% CI: 1.01-4.91, P = 0.046) were significant predictors of recurrence. In those with LVZs, the LVZ area was strongly correlated with the LA body volume (r = 0.81, P < 0.001) and a unique predictor of recurrence (OR: 1.17 per 1 cm 2, 95% CI: 1.01-1.55, P = 0.031), while in those without an LVZ, ATP-induced PV reconnection was a unique predictor (OR: 3.24, 95% CI: 1.15-15.39, P = 0.025).ConclusionThe LVZ area was an independent predictor of recurrence after PVAI without any LA substrate modification. Adenosine triphosphate-induced PV reconnection was also an independent predictor, especially in those without LVZs. © The Author 2013.


Ikeda M.,Saga Prefectural Hospital Koseikan | Tanaka H.,Saga Prefectural Hospital Koseikan | Sadamatsu K.,Saga Prefectural Hospital Koseikan
Cardiovascular Revascularization Medicine | Year: 2011

Diffuse alveolar hemorrhage after percutaneous coronary intervention is a rare complication that has been mostly reported in association with glycoprotein IIb/IIIa inhibitors. We herein report a case of a 64-year-old male who developed a diffuse pulmonary hemorrhage after coronary stent implantation for ST-elevation myocardial infarction. Diagnostic bronchoscopy determined the hemorrhage to be a bland pulmonary hemorrhage, and this pattern suggested that combination therapy with aspirin and ticlopidine was therefore the most likely cause. The combination of aspirin and thienopyridine agents is a routine therapeutic protocol for patients after coronary stent implantation. Therefore, physicians should be aware that this dual antiplatelet therapy might sometimes induce fatal complications. © 2011 Elsevier Inc.


Otsuka T.,Saga Prefectural Hospital Koseikan | Kawazoe S.,Saga Prefectural Hospital Koseikan | Nakashita S.,Saga Prefectural Hospital Koseikan | Kamachi S.,Saga Prefectural Hospital Koseikan | And 7 more authors.
Journal of Gastroenterology | Year: 2012

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac or indomethacin) have shown promising prophylactic activity in post-ERCP pancreatitis (PEP). However, the 100-mg dose is higher than that ordinarily used in Japan. Methods: We performed a prospective randomized controlled study to evaluate the efficacy of low-dose rectal diclofenac for the prevention of PEP. Patients who were scheduled to undergo ERCP were randomized to receive a saline infusion either with 50 mg of rectal diclofenac (diclofenac group) or without (control group) 30 min before ERCP. The dose of diclofenac was reduced to 25 mg in patients weighing <50 kg. The primary outcome measure was the occurrence of PEP. Results: Enrollment was terminated early because the planned interim analysis found a statistically significant intergroup difference in the occurrence of PEP. A total of 104 patients were eligible for this study; 51 patients received rectal diclofenac. Twelve patients (11.5%) developed PEP: 3.9% (2/51) in the diclofenac group and 18.9% (10/53) in the control group (p = 0.017). After ERCP, the incidence of hyperamylasemia was not significantly different between the two groups. Post-ERCP pain was significantly more frequent in the control group than in the diclofenac group (37.7 vs. 7.8%, respectively; p < 0.001). There were no adverse events related to diclofenac. Conclusions: Low-dose rectal diclofenac can prevent PEP. © Springer 2012.


Takeuchi N.,Saga Prefectural Hospital Koseikan
Fukuoka igaku zasshi = Hukuoka acta medica | Year: 2011

A 91-year-old female sustained injuries to her left forearm while walking across a crosswalk. X-rays showed left radial shaft and ulna shaft fractures, and the injury was a type IIIB open fracture. On the day of admission, irrigation and debridement of the open wound, and temporary fixation of the radius and ulna using an external fixator and a Kirschner wire were peformed. Six days after the surgery, we used negative pressure wound therapy (NPWT) using the V.A.C.ATS system for the open wound. Thirteen days after the first surgery, definitive fixation was performed by using locking compression plates, and full thickness skin grafting was undertaken for the open wound. NPWT is a treatment that accelerates the wound healing process through the delivery of continuous subatmospheric pressure within a closed environment. In our case, we could reduce the healing period of the soft tissue and could convert to the definitive fixation in a timely fashion. NPWT is thought to be a useful adjunct in the management of the soft tissues of open fractures.


Kajihara T.,Saga Prefectural Hospital Koseikan
Japanese Journal of Clinical Radiology | Year: 2013

We report a case of calcified gastric cancer in a 69-year-old woman. The current dynamic CT showed multiple punctate calcifications in the thickened gastric wall. The CT taken 16 months before had also shown slight calcifications in the thickened gastric wall. Histological examination of the gastric tumor showed gastric adeno carcinoma with calcified deposits in the mucin pool, which suggested ontogenic calcification. If we had paid more attention to the calcifications in the thickened gastric wall at the previous CT, we might have reached the diagnosis earlier.


Nakamura T.,Saga University | Sueoka-Aragane N.,Saga University | Iwanaga K.,Saga University | Iwanaga K.,Saga Prefectural Hospital Koseikan | And 8 more authors.
Journal of Thoracic Oncology | Year: 2012

INTRODUCTION:: Detection of epidermal growth factor receptor (EGFR) mutations is indispensable to determine an appropriate lung cancer treatment. Although retreatment often prolongs survival, how to select the appropriate population for retreatment has not been clarified. METHODS:: We used novel methods to identify EGFR mutations: wild inhibiting polymerase chain reaction (PCR) and quenched probe system (WIP-QP) for exon 19 deletions and mutation-biased PCR and quenched probe system for L858R. After the detection limits were determined, we examined DNA isolated from lung cancer specimens and circulating plasma DNA samples of 39 adenocarcinoma patients whose primary tumors harbored EGFR exon 19 deletions or L858R. RESULTS:: Detection limit was 0.005 to 0.04 ng in genomic DNA and 0.1% to 0.3% in mutant plasmids. The results of cancer tissue specimens were identical to those with existing systems (nucleic acid-locked nucleic acid PCR clamp or cycleave PCR), except for two samples that showed both exon 19 deletions and L858R. One of the two samples was confirmed to harbor L858R mutation by allele-specific oligonucleotide PCR; the other one did not. Exon 19 deletions and L858R were detected in 44.7% and 8.7% of patients, using plasma DNA, among those who carried the identical abnormalities in primary tumors all of cases that evidenced pathological stage IV except for one patient, suggesting that EGFR mutations might be preferentially detected in plasma DNA obtained from patients in advanced stages. Serial monitoring of these mutations with T790M, a gate keeper mutation, demonstrated correlation with disease state. CONCLUSIONS:: Our novel detection systems for EGFR mutations could be useful not only at the beginning of treatment but also for monitoring using plasma DNA for deciding appropriate treatment, including rechallenge with EGFR-tyrosine kinase inhibitors. Copyright © 2012 by the International Association for the Study of Lung Cancer.


Yoshida K.,Saga Prefectural Hospital Koseikan | Sadamatsu K.,Saga Prefectural Hospital Koseikan
Cardiovascular Revascularization Medicine | Year: 2012

An increasing number of studies have reported intimal atherosclerotic changes, or neoatherosclerosis in the late phase after bare metal stent implantation, however, only a few reports have showed the presence of severe intimal calcification in a bare metal stent. We herein report a case of a 68-year-old male with severely calcified neointima occurring 9 years after the bare metal stent implantation. Pre-procedural coronary computed tomography angiography and peri-procedural intravascular ultrasound demonstrated severe calcification within the in-stent restenotic lesion. Although the pre-dilation balloon ruptured due to the calcification, the lesion was nevertheless successfully dilated with the stent. Calcified lesions often require complex techniques, and we therefore should be aware of the potential occurrence of a severely calcified neointima in coronary stents, and performing coronary computed tomography angiography in advance is a great help for performing effective coronary intervention. © 2012 Elsevier Inc..


Sakuragi T.,Saga Prefectural Hospital Koseikan | Ohteki H.,Saga Prefectural Hospital Koseikan
General Thoracic and Cardiovascular Surgery | Year: 2012

We describe a simple technique of controlling air leakage from the lung parenchyma using BiClamp®. The device creates appropriate protein coagulation at an air leakage point of the lung parenchyma. The leakage point and adjacent area are grasped with BiClamp® forceps and coagulated without tissue carbonization. After the procedure, no air leakage was recognized under airway pressure test of 15-20 cmH2O. This method is easy to handle, especially in video-assisted thoracic surgery lobectomy with an economical advantage as "Ecosurgery". © The Japanese Association for Thoracic Surgery 2012.


Yakabe T.,Saga University | Nakafusa Y.,Red Cross | Sumi K.,Saga University | Miyoshi A.,Saga University | And 4 more authors.
Annals of Surgical Oncology | Year: 2010

Background: We evaluated the efficiency of CEA and CA19-9 as tools for diagnosing recurrence in the postoperative surveillance of colorectal cancer. Materials and Methods: A total of 227 patients who underwent curative resection for colorectal cancer between 1999 and 2003 at our hospital received complete follow-up according to the schedule determined prospectively. Using receiver operating characteristic (ROC) analysis, performance of postoperative values of CEA or CA19-9 for detecting recurrence was assessed. Results: The sensitivity (1.000) and specificity (0.978) of the postoperative values of CEA in the high preoperative CEA group were very high. Even in the normal preoperative CEA group, the area under the curve (AUC) of the ROC curve of CEA (0.740, 95% confidence interval [95% CI], 0.628-0.852) was significantly larger than 0.5 (P < 0.001). The postoperative values of CA19-9 showed high sensitivity (0.833) and specificity (0.900) in the high preoperative CA19-9 group, while the AUC of the ROC curve of the normal preoperative group was as small as 0.510 (95% CI, 0.376-0.644). In the high preoperative CA19-9 group, however, there was no significant difference between the AUC of CA19-9 (0.904, 95% CI, 0.786-1.000) and that of CEA (0.869, 95% CI, 0.744-0.994) (P = 0.334). Conclusions: The measurement of CEA is an efficient way to detect recurrence. The efficiency of measuring CA19-9 for the purpose of detecting recurrence is low, especially in patients with a normal level of preoperative CA19-9. Even in patients with a high preoperative level of CA19-9, CEA might be able to fill the role of CA19-9. © 2010 Society of Surgical Oncology.


Higuchi O.,University of Toyama | Adachi Y.,University of Toyama | Adachi Y.S.,University of Toyama | Taneichi H.,University of Toyama | And 2 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Objective: To evaluate parents' knowledge regarding foreign body aspiration (FBA) and determine the factors that are associated with lack of knowledge. Methods: An 8-item questionnaire regarding knowledge of FBA was developed and distributed at regular check-ups for children younger than 24 months old. Results: Out of the 1766 questionnaires distributed, 1603 were recovered and most of them (1539) were answered by mothers. After omitting 49 questionnaires with incomplete data, 1490 questionnaires answered by mothers were analyzed. Only 4.3% [95% CI 3.3-5.3] of mothers did not recognize a small toy as a cause of FBA, while 20.2% [95% CI 18.2-22.2] did not know that peanuts and other nuts can be causes of FBA, and 48.1% [95% CI 45.5-50.6] did not know that they should not give peanuts to a child younger than 3 years old. Regarding clinical signs, 27.7% [95% CI 25.4-30.0] and 41.8% [95% CI 39.3-44.3] of mothers did not know that sudden choking and sudden coughing were symptoms suggesting FBA, respectively. Being a mother with a child younger than 12 months old and being a mother with a first child were independent risk factors for lack of knowledge about FBA, regardless of the age of the mother. Conclusions: A substantial number of mothers lack knowledge regarding FBA. To prevent FBA and to make timely diagnoses, parents, especially mothers with children younger than 12 months old and mothers with a first child should be given adequate information. © 2012 Elsevier Ireland Ltd.

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