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Kumamoto-shi, Japan

Ichikado K.,Saiseikai Kumamoto Hospital
Japanese Journal of Anesthesiology | Year: 2013

The clinical criteria of acute respiratory distress syndrome (ARDS) defined by the American-European Consensus Conference (AECC) in 1994 was relevant to clinical practice, trials, and researches for two decades. However, a number of issues with the AECC definition have become apparent. The updated and revised criteria of "The Berlin definition", addressing the limitations of the previous AECC definition, were published in 2012. In the first section of this manuscript, the Berlin definition based on data using patients-level meta-analysis of 4188 patients with ARDS, was reviewed. In the second section, the clinical significance and limitation of radiographic imaging, especially, high-resolution CT (HRCT) findings in ARDS were addressed. Although the early exudative phase of ARDS can not be detected even by HRCT, pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, along with ventilator dependency and its associated outcomes. Source

Tanaka H.,Saiseikai Kumamoto Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

The patient was a 49-year-old man who was diagnosed as having gastric cancer and was suspected of having lymph node metastasis on computed tomography( CT) scans. He received neoadjuvant chemotherapy with S-1 and cisplatin (CDDP). He underwent total gastrectomy after 2 courses of neoadjuvant chemotherapy. The pathological effect was Grade 1b. The patient was treated with oral S-1 as postoperative adjuvant chemotherapy on an outpatient basis, and there are no signs of recurrence as of 3 years and 10 months after surgery. Source

Nishigami K.,Saiseikai Kumamoto Hospital
Journal of Echocardiography | Year: 2014

Introduction: Takayasu arteritis is an important differential diagnosis in young female patients presenting with fever, fatigue, hypertension, and/or neck pain.Echocardiographic features: Aortic arch branch vessels are frequently affected and the carotid artery can have diffuse, homogeneous wall thickening, known as the ‘macaroni sign’. The descending aorta can be stenotic with ‘pseudo-coarctation’.Conclusion: Cardiovascular echo plays an important role in the screening and characterization of arterial lesions in patients with Takayasu arteritis. © 2014, Japanese Society of Echocardiography. Source

Diffuse alveolar damage (DAD) is the pathologic feature of rapidly progressive lung diseases, including acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis. The clinical significance and limitation of high-resolution computed tomography (HRCT) findings in these diseases were reviewed. The HRCT findings correlate well with pathologic phases (exudative, proliferative, and fibrotic) of DAD, although it cannot detect early exudative phase. Traction bronchiolectasis or bronchiectasis within areas of increased attenuation on HRCT scan is a sign of progression from the exudative to the proliferative and fibrotic phase of DAD. Extensive abnormalities seen on HRCT scans, which are indicative of fibroproliferative changes, were independently predictive of poor prognosis in patients with clinically early acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis. © 2014 Elsevier Inc. Source

Ichikado K.,Saiseikai Kumamoto Hospital
Japanese Journal of Chest Diseases | Year: 2014

There has been little medicational benefit for survival of ARDS through several clinical trials in which the severity had not been taken into account The newly revised "Berlin Definition" of ARDS identifies 3 categories of severity depending on oxygenation as mild, moderate, and severe and has proposed increasing intensity of treatment intervention according to the severity. From clinico-pathological studies of autopsy cases diagnosed by Berlin definition, pathological phases of ARDS (exudative, proliferative, and fibrotic) may impact the response to treatment and the recognition of fibroproliferative phase which is more likely untreatable will be increasing interest. High-resolution CT findings corresponded to the pathological phases of ARDS could be helpful in judging the progression of fibroproliferative phase. A future direction of clinical trials in ARDS should be based on the severity and the pathological phases on HRCT. © 2014 The Japanese Journal of Chest Diseases. Source

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