PubMed | Red Cross, Saiseikai Tondabayashi Hospital, Akashi Medical Center, Hiroshima General Hospital of West Japan Railway Company and 6 more.
Type: Journal Article | Journal: Clinical endocrinology | Year: 2016
In adrenal vein sampling (AVS) for patients with primary aldosteronism, the contralateral ratio of aldosterone/cortisol (A/C) between the nondominant adrenal vein and the inferior vena cava is one of the best criteria for determining lateralized aldosterone secretion. Despite successful cannulation in some patients, the A/C ratios in the adrenal veins are bilaterally lower than that in the inferior vena cava (bilateral aldosterone suppression; BAS).To investigate the prevalence of BAS in AVS and how to resolve this condition.Retrospective study involving nine referral centres.Four hundred and ninety-one patients who were confirmed as having primary aldosteronism and had an AVS between January 2006 and December 2013.The prevalence of BAS before and after ACTH stimulation was compared. In addition, we investigated other methods for overcoming BAS.In 304 patients with successful AVS before ACTH stimulation, BAS was observed in 29 (95%). BAS was resolved after ACTH stimulation in 22 patients. In 276 patients with successful AVS both before and after ACTH stimulation, the frequency of BAS was significantly reduced after ACTH (87% vs 25%, P < 001). In a few patients, BAS was also resolved by adding a sampling point at the common trunk of the left adrenal vein and by an alternative drainage vein from the adrenal tumour.BAS sometimes occurs in AVS without ACTH stimulation. ACTH stimulation significantly reduces BAS with a single AVS procedure.
PubMed | Ageo Central General Hospital, Saiseikai Tondabayashi Hospital, Daiichi Sankyo, Waseda University and 6 more.
Type: | Journal: Cardiovascular intervention and therapeutics | Year: 2017
Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that prasugrel may be associated with a higher risk of de novo and recurrent bleeding events compared with clopidogrel in Japanese patients undergoing percutaneous coronary intervention (PCI). In this review, we evaluate the risk of bleeding in Japanese patients treated with prasugrel at the doses (loading/maintenance doses: 20/3.75mg) adjusted for Japanese patients, evaluate the risk factors for bleeding in Japanese patients, and examine whether patients with a bleeding event are at increased risk of recurrent bleeding. This review covers published data and new analyses of the PRASFIT (PRASugrel compared with clopidogrel For Japanese patIenTs) trials of patients undergoing PCI for acute coronary syndrome or elective reasons. The bleeding risk with prasugrel was similar to that observed with the standard dose of clopidogrel (300/75mg), including when bleeding events were re-classified using the Bleeding Academic Research Consortium criteria. The pharmacodynamics of prasugrel was not associated with the risk of bleeding events. The main risk factors for bleeding events were female sex, low body weight, advanced age, and presence of diabetes mellitus. Use of a radial puncture site was associated with a lower risk of bleeding during PCI than a femoral puncture site. Finally, the frequency and severity of recurrent bleeding events during continued treatment were similar between prasugrel and clopidogrel. In summary, this review provides important insights into the risk and types of bleeding events in prasugrel-treated patients.Trial registration numbers: JapicCTI-101339 and JapicCTI-111550.
PubMed | Red Cross, National Hospital Organisation, Saiseikai Tondabayashi Hospital, Akashi Medical Center and 6 more.
Type: Journal Article | Journal: Clinical endocrinology | Year: 2016
Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized.To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients.Retrospective study in nine referral centres.Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included.Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results.Subtype diagnosis using common trunk and central vein was discordant in 10 (46%) of the 217 patients ( = 087, P < 005). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/6) by common trunk data, and 83% (5/6) by central vein data.In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required.
Taguchi T.,Osaka University |
Nakayama T.,Sakai Municipal Hospital |
Masuda N.,Osaka National Hospital |
Yoshidome K.,Osaka Police Hospital |
And 6 more authors.
Chemotherapy | Year: 2010
Background: Capecitabine is an established therapy for metastatic breast cancer. In Japan, a 4 weekly regimen is often used, but data for this schedule in the first-line setting are lacking. Methods: Metastatic breast cancer patients who had received no chemotherapy for recurrent disease received capecitabine 825 mg/m2 twice daily, on days 1-21 of a 28-day cycle until disease progression or unacceptable toxicity. The primary endpoint was response rate. Results: In 33 eligible patients, median age was 53 years (range 27-73). Prior adjuvant therapy included an anthracycline in 90% and a taxane in 40%. The response rate was 18%; a further 24% had stable disease for ≥6 months. Median progression-free and overall survival were 6.9 and 24.8 months, respectively. The only grade 3 events were neutropenia (6%) and hand-foot syndrome (15%). Conclusions: These preliminary results confirm previous data showing that a lower capecitabine dose is an active and well-tolerated first-line therapy for metastatic breast cancer. Copyright © 2010 S. Karger AG, Basel.
PubMed | Red Cross, Saiseikai Tondabayashi Hospital, Akashi Medical Center, Saiseikai Yokohama City Toubu Hospital and 6 more.
Type: | Journal: Journal of human hypertension | Year: 2016
Although laterality assessed by computed tomography (CT) in primary aldosteronism (PA) is not always concordant with that assessed by adrenal vein sampling (AVS), it is unclear whether all patients diagnosed with PA should undergo AVS for subtype classification. The aim of the current study was to investigate the accuracy of CT in subtype classification and to develop a prediction score for bilateral subtype in patients without adrenal tumour. As part of the WAVES-J study, 393 patients with PA were analysed. Subtyping using CT was concordant with that using AVS in 68% (269/393) of patients in the total sample, and in 38% (68/156) of patients with unilateral tumours, 56% (5/9) of patients with bilateral tumours and 89% (204/228) of patients without tumour. In patients without tumour, female gender, plasma aldosterone concentration (pgml
PubMed | Red Cross, Saiseikai Tondabayashi Hospital, Akashi Medical Center, National Hospital Organization Kyoto Medical Center and 8 more.
Type: Journal Article | Journal: Clinical endocrinology | Year: 2015
Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) 4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy.The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS.A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI<4 were included in the study. The patients were divided into Group A with CL suppression (n=16) and Group B (n=13) without CL suppression. Three outcome indices were assessed after 6months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia.The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P=02). The normalization of ARR was 100% in Group A and 46% in Group B (P=0004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P=001).In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.
Imanishi H.,Osaka City University |
Imanishi H.,Saiseikai Tondabayashi Hospital |
Tsuruta D.,Osaka City University |
Kobayashi H.,Osaka City University |
And 2 more authors.
Case Reports in Dermatology | Year: 2011
Ashy dermatosis is a typically asymptomatic disease of unknown origin that causes symmetrical gray spots to appear on the trunk and extremities. We report 2 cases of ashy dermatosis with unilateral distribution. To our knowledge, only 5 cases of ashy dermatosis with unilateral lesion have been reported so far. Case 1: an 11-year-old woman presented with asymptomatic slate-gray pigmented plaques on the left trunk and left upper arm. The skin biopsy specimen demonstrated a mild lymphohistiocytotic infiltrate in the upper dermis with epidermal and dermal melanosis. Q-Switched ruby laser did not improve such lesions. Case 2: a 21-year-old man was referred to our hospital because of asymptomatic slate-gray pigmented plaques on the left trunk and left upper arm. Histopathological findings were compatible with a mild lymphocytic infiltration with melanin incontinence in the upper dermis. The mechanism that governs unilateral distribution of ashy dermatosis, including in our cases, remains unclear. Copyright © 2011 S. Karger AG, Basel.
PubMed | Saiseikai Tondabayashi Hospital and Osaka City University
Type: Journal Article | Journal: Medical molecular morphology | Year: 2016
Elastofibroma is a rare tumour that occurs in the subscapular space, and it typically presents in middle-aged and older individuals. The aetiology of elastofibroma remains unknown. Recent, sporadic reports have shown, immunohistologically, that fibroblasts in elastofibroma may produce abnormal elastic and collagen fibres through the action of transforming growth factor-beta (TGF-), a factor that promotes fibroblast proliferation. However, that finding lacked quantitative measurements and controls. Therefore, in this study, we performed quantitative, immunohistochemical analyses of TGF-1 and basic fibroblast growth factor (bFGF) in three elastofibromas, and we compared them to ten dermatofibromas and keloids, and five normal skin. In elastofibroma specimens, 16-59% fibroblasts were positive for TGF-1 in the cytoplasm, compared to 96% in dermatofibroma, 93% in keloid and 2% in normal dermis specimens. Also, in elastofibroma specimens, 26-67% of fibroblasts were positive for bFGF in the cytoplasm, compared to 97% in dermatofibroma, 97% in keloid, and 22% in normal dermis specimens. Intriguingly, the tumour size and growth rate were proportional to the percentage of cells positive for bFGF. Finally, greater levels of bFGF expressions in fibroblasts were associated with larger sized elastofibromas. These results suggested that elastofibroma development depended on high expression of TGF-1 and bFGF.