Saiseikai Kumamoto Hospital

Minami-rinkan, Japan

Saiseikai Kumamoto Hospital

Minami-rinkan, Japan
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Sakowitz O.W.,University of Heidelberg | Santos E.,University of Heidelberg | Krajewski K.L.,University of Heidelberg | Hertle D.N.,University of Heidelberg | And 2 more authors.
Stroke | Year: 2013

Background and Purpose-: We studied the dynamics of extracellular brain tissue concentrations of glucose, lactate, pyruvate, and glutamate during the occurrence of spreading depolarizations (SDs) in patients with aneurysmal subarachnoid hemorrhage. Methods-: In this prospective observational study, patients with aneurysmal subarachnoid hemorrhage received multimodal cerebral monitoring, including intracranial pressure, cerebral microdialysis, and subdural electrocorticography. Results-: Seven of the 17 recruited patients had intracerebral hemorrhage, acute ischemia and severe brain oedema leading to acute ischemic neurological deficits associated with early disturbance of metabolism at the recording site. They displayed a total of 130 SDs. The remaining 10 patients without acute ischemic neurological deficits exhibited 138 single SDs and 68 SDs in clusters. In patients without acute ischemic neurological deficits, clustered SDs were associated with a significant transient decrease in glucose and increase in lactate compared with baseline during the first 140 minutes after SDs. Moreover, the number of clustered SDs correlated with the outcome (R=-0.659; P<0.01). CONCLUSION-: SDs can propagate in nonischemic human brain tissue. Clusters of SDs are related to metabolic changes suggestive of ongoing secondary damage in primarily nonischemic brain tissue. © 2012 American Heart Association, Inc.


Teruya A.,Saiseikai Kumamoto Hospital | Kawamura K.,Saiseikai Kumamoto Hospital | Ichikado K.,Saiseikai Kumamoto Hospital | Sato S.,Tokai University | And 2 more authors.
Chest | Year: 2013

Clinically amyopathic dermatomyositis (CADM), a subtype of dermatomyositis with subtle or no muscle involvement, is occasionally accompanied by fatal, rapidly progressive interstitial lung disease (RP-ILD) that is resistant to aggressive immunosuppressive therapy. The presence of anti-CADM-140/MDA5 antibodies is diagnostic for patients with dermatomyositis (particularly CADM) and is known to be strongly associated with the pathogenesis, disease activity, and mortality of RP-ILD. Polymyxin-B direct hemoperfusion (PMX-DHP), originally developed for the removal of endotoxin, has been demonstrated to be effective for treating various types of acute respiratory failure. We describe a patient with amyopathic dermatomyositis who developed RP-ILD characterized by elevated anti-CADM-140/MDA5 autoantibodies, was resistant to combined steroid and immunosuppressant therapy, and was treated successfully with PMX-DHP. To our knowledge, this is the first case to indicate a serial reduction of anti-CADM-140/MDA5 autoantibodies, associated with clinical improvement, following PMX-DHP. Early intervention using PMX-DHP may improve the prognosis of RP-ILD accompanied by CADM. © 2013 American College of Chest Physicians.


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.


Field T.S.,University of British Columbia | Nakajima M.,Saiseikai Kumamoto Hospital | Benavente O.R.,University of British Columbia
Current Treatment Options in Cardiovascular Medicine | Year: 2013

Opinion statement: Though antiplatelet agents are the mainstay of antithrombotic therapy for secondary prevention of noncardioembolic cerebral ischemic events, the efficacy of combination aspirin and clopidogrel has yet to be clarified by clinical trials. Current evidence suggests that there is no role for long-term combination of aspirin/clopidogrel for secondary stroke prevention. Recent preliminary data from the CHANCE (Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events) trial suggests that stroke recurrence at 90 days is reduced by a short course (21 days) of combination aspirin/clopidogrel initiated within 24 hours of minor stroke or TIA (Transient Ischemic Attack) compared with aspirin alone [1••] (Table 1). Other ongoing trials, which are also investigating the role of short-term combination antiplatelet therapy initiated immediately after minor stroke and TIA, will determine if these findings will be replicated. © 2013 Springer Science+Business Media New York.


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.


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.


Focus assessed transthoracic echocardiography and focused cardiac ultrasound are point-of-care echo protocols for the evaluation of cardiac disease in the emergency room; however, these protocols may not adequately assess aortic dissection, pulmonary embolism, and acute coronary syndrome in patients with killer chest pain. Here, I present an echocardiography protocol focused on screening for these critical cardiovascular diseases. This protocol (termed EASY screening) consists of the assessment of effusion in the pericardial space, aortic abnormalities, the size and shape of the ventricles and asynergy of the left ventricle. Aortic dissection is suggested by positive findings for effusion and/or abnormal aortic findings. Pulmonary embolism is suggested by a dilated right ventricle and a D-shaped left ventricle in the short-axis view. Acute coronary syndrome is suggested by asynergy of left ventricular wall motion. EASY screening may facilitate the assessment of aortic dissection, pulmonary embolism and acute coronary syndrome in patients presenting to the emergency room with killer chest pain. © 2015, Japanese Society of Echocardiography.


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

Diffuse alveolar damage (DAD) is one of pathological features of rapidly progressive lung diseases including ARDS, acute exacerbation of idiopathic pulmonary fibrosis (IPF), and fatal interstitial pneumonia with clinically amyopathic dermatomyositis (CADM). The clinical significance and limitation of CT or high-resolution CT (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 are signs of progression from the exudative to the fibroproliferative and fibrotic of DAD. Extensive HRCT abnormalities indicative of fibroproliferative changes were independently predictive of poor prognosis in patients with clinically early ARDS, AIP, and acute exacerbation of IPF. Such findings were also associated with ventilator dependency and its associated complications (ventilator associated pneumonia, ventilator-associated lung injury, barotraumas) in ARDS. The findings of lower consolidation or ground-glass attenuation without reticular opacities or architectural distortion such as traction bronchiectasis are characteristic for patients with CADM. Although it depends on the primary disease, the extent of increased attenuation with traction bronchiectasis on HRCT is associated with poor prognoses in ARDS and the "Imitators".


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.


Ichikado K.,Saiseikai Kumamoto Hospital
Japanese Journal of Clinical Radiology | Year: 2014

Interstitial pneumonias are associated with various etiologies such as systemic diseases, drug, radiation, and unknown cause. The prognoses depend on the histo-pathological classification of interstitial pneumonia regardless of the etiology. The therapeutic limitation of anti-inflammatory drugs including corticosteroids and immunosuppressants for patients with fibrosing interstitial pneumonias has been recognized. The directionality of the development of the therapeutic drug goes to anti-fibrotic or molecular-targeting therapy from conventional anti-inflammation.

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