Kawasaki, Japan
Kawasaki, Japan

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Okura N.,Tokyo Women's Medical University | Ogawa H.,Tokyo Women's Medical University | Katoh J.,Shim Matsudo Chuo General Hospital | Yamauchi T.,Sagamino Hospital | Hagiwara N.,Tokyo Women's Medical University
International Journal of Cardiology | Year: 2012

Background: The long-term prognosis of patients with acute myocardial infarction (AMI) in the contemporary acute revascularization era is not fully understood. Methods: To clarify long-term prognosis and prognostic factors of AMI patients in a real-world setting, we consecutively registered 3021 patients with AMI (mean age 69 years, 70.7% male) who were admitted to 17 participating medical institutions and followed up prospectively. The outcome measure was death from any cause. Results: Among 3021 patients, 629 patients had non-ST elevation MI (non-STEMI). During the index hospitalization, coronary angioplasty and thrombolytic therapy were performed in 58.1% and 16.3% of patients, respectively. During hospitalization, 285 patients (9.4%) died. Among 2736 patients (90.6%) who were discharged alive and followed for a median of 4.3 years (follow-up rate, 97.1%), 434 patients (15.9%) died. Among them, 250 (57.6%) died from non-cardiac causes. Compared with STEMI patients, non-STEMI patients suffered significantly more adverse outcomes. Advanced age and non-STEMI disease were associated with poorer outcomes. Multivariate analysis revealed that diabetes mellitus, acute-phase heart failure (Killip functional class ≥ 2), higher serum creatinine level (≥ 1.2 mg/dl), and advanced age (≥ 70 years and ≥ 80 years) at the onset of the AMI were independent poor prognostic factors (hazard ratios, 1.07, 2.53, 1.89, 2.50, and 6.80 respectively). Conclusions: AMI patients in the era of acute revascularization have favorable long-term prognoses, and a large proportion of late deaths are non-cardiac in nature. The establishment of an optimal management strategy for elderly AMI patients, AMI patients with diabetes, and non-ST elevation AMI patients are essential. © 2011 Elsevier Ireland Ltd. All rights reserved.


Maejima H.,Kitasato University | Katayama C.,Kitasato University | Taniguchi T.,Kitasato University | Aki R.,Kitasato University | And 7 more authors.
Journal of Dermatology | Year: 2016

The early psoriatic arthritis screening questionnaire (EARP) is a simple and fast method for the identification of arthritis in patients with psoriasis. We established the Japanese version of the EARP (J-EARP) questionnaire, which includes 10 items with two choices for each. This study aimed to evaluate the utility of the J-EARP questionnaire. A total of 90 psoriasis patients, 19 psoriatic arthritis (PsA) patients and 71 psoriasis patients without joint involvement, were administered the J-EARP questionnaire. The diagnostic accuracy of the J-EARP questionnaire for the diagnosis of PsA and early-stage PsA was compared by receiver-operator curve (ROC) analysis. The J-EARP questionnaire showed similar ROC characteristics to those of the original version of the EARP (specificity 97.2% and 91.6% and sensitivity 97.2% and 85.2%, respectively) in PsA patients using the cut-off value of 3 for the J-EARP questionnaire, which was the same as that used for the original EARP questionnaire. The scores of the J-EARP questionnaire in early-stage PsA patients (<1 year from onset) were significantly higher than in those of psoriasis patients, but not lower than in those of later stage (≥1 year from onset) PsA patients. The J-EARP questionnaire is simple and fast to administer and has been proven to be robust for the identification of PsA. The J-EARP questionnaire is a useful diagnostic tool for early-stage PsA patients. © 2015 Japanese Dermatological Association.


Takeshima T.,National Hospital Organization | Kawai M.,National Hospital Organization | Hirai K.,National Hospital Organization | Sato K.,Sagamihara Sato Clinic | Mochizuki Y.,Sagamino Hospital
Japanese Journal of Clinical Urology | Year: 2010

A 35-year-old man with a complaint of right scrotal swelling was referred to our hospital. He had received testicular sperm extraction several times due to azoospermia. He received a high orchiectomy, and the pathological findings showed the tumor was pure seminoma. From the normal testicular tissue, sperm cells were extracted. Intracytoplasmic sperm injection was performed but the fertilization was not accomplished.


Miyajima E.,Kitasato University | Miyajima E.,Sagamino Hospital | Tsunoda M.,Kitasato University | Sugiura Y.,Kitasato University | And 6 more authors.
Tokai Journal of Experimental and Clinical Medicine | Year: 2015

Objective: The study group for sick house syndrome (SHS) in Japan has proposed the classifications, definition and diagnostic criteria for chemical-associated SHS. We compared the physicians’ diagnoses to the diagnoses based on the patients’ interview sheets including diagnostic criteria only. Methods: We examined 287 patients with complaints of SHS-like symptoms. We also checked determinations of chemical substances in the patients’ homes. Results: A total of 76.0% of the patients were diagnosed as having SHS. Physicians diagnosed 87.6% of those patients as having chemical-associated SHS based on SHS classifications, definition and diagnostic criteria. Based on the patients’ interview sheets, 50.3% of the patients who were diagnosed as chemical-associated SHS corresponded to the diagnostic criteria. The 51 of those chemical-associated SHS patients had answered that the chemical substance levels in their homes had been checked, and 20 of those patients answered that at least one of the chemical substance levels was above that set in the guideline by the Japanese Ministry of Health, Labour and Welfare. Conclusions: Physicians should use all of the classifications, definition and diagnostic criteria. Even if the chemical levels in the home are under the guideline levels, the diagnosis of chemical-associated SHS should not be excluded. © 2015, Tokai University School of Medicine. All rights reserved.


Hayashi K.,Sagamino Hospital | Oshida S.,Sagamino Hospital | Nemoto K.,Sagamino Hospital | Habiro T.,Sagamino Hospital | And 3 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2014

The patient was a 43-year-old single woman. Her family history included schizophrenia in her mother and manic-depression in her father. Remicade® (infliximab) had been administered for 3 years to treat rheumatoid arthritis. The patient initially Presented to our hospital with dyspnea. Computed tomography revealed left-sided breast cancer associated with multiple bone tumors and multiple pulmonary nodules. A poorly mobile mass with an ulcer was found in left breast. Core-needle biopsy and fluorescent in situ hybridization (FISH) revealed an invasive ductal carcinoma that was positive for estrogen and Progesterone receptors and human epidermal growth factor receptor 2 (HER2, 2+). The clinical diagnosis was Stage IV T4bN3M1 cancer (metastases to the lungs, liver, and bone). Because of the presence of bone metastasis, the patient was admitted and she received complete bed rest as supportive therapy. However, the patient decided to receive treatment on an outpatient basis after carefully discussing the following points: 1) treatment of pulmonary metastasis with dyspnea should receive priority; 2) anticancer agents not causing nausea were required; 3) the risk of bone fractures as a complication (spinal cord injury); 4) how she wanted to spend the limited time available with her family; and 5) how the patient wanted to.


Oshida S.,Sagamino Hospital | Hayashi K.,Sagamino Hospital | Habiro T.,Sagamino Hospital | Nemoto K.,Sagamino Hospital | And 2 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2014

The patient was a 53-year-old woman in whom ultrasonography of the breast revealed a lobular mass, 14 mm in diameter, in the right AB region. Spindle cells were obtained on fine-needle aspiration biopsy, but it was not possible to diagnose whether the tumor was benign or malignant. Contrast-enhanced magnetic resonance imaging showed a mass with a cystic component that was darkly stained in the early phase. Needle biopsy showed a dense proliferation of atypical spindle cells with no distinct epithelial-like arrangement. The differential diagnosis included mesenchymal malignant tumors such as fibrosarcoma, some phyllodes tumors, and epithelial tumors with sarcomatoid differentiation. Immunostaining revealed that the tumor was cytokeratin (AE1/AE3)-negative, partially CAM 5.2-positive, p63-positive, S100-negative, SMA-positive, partially vimentin-positive, with a Ki-67 index of 80% and negativity for ER, PgR, and HER2. Spindle-cell carcinoma was thus diagnosed. A partial right mastectomy with sentinel lymph-node biopsy was performed. Immunostaining of the resected specimen confirmed spindle cell carcinoma. The General Rules for Clinical and Pathological Recording of Breast Cancer classify spindle cell carcinoma as a special type of invasive cancer with a sarcomatoid structure, consisting of spindle-shaped cancer cells. This type of carcinoma is extremely rare, accounting for less than 1% of all breast cancers.

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