Inohara T.,Keio University |
Kohsaka S.,Keio University |
Miyata H.,University of Tokyo |
Ueda I.,Keio University |
And 7 more authors.
JACC: Cardiovascular Interventions | Year: 2014
Objectives The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (PCI) in Japan and clarify the association between trends of pre-procedural noninvasive testing and changes in appropriateness ratings.Background Although PCI appropriateness criteria are widely used for quality-of-care improvement, they have not been validated internationally. Furthermore, the correlation of appropriateness ratings with implementation of newly developed noninvasive testing is unclear.Methods We assigned an appropriateness rating to 11,258 consecutive PCIs registered in the Japanese Cardiovascular Database according to appropriateness use criteria developed in 2009 (AUC/2009) and the 2012 revised version (AUC/2012). Trends of pre-procedural noninvasive testing and appropriateness ratings were plotted; logistic regression was performed to identify inappropriate PCI predictors.Results In nonacute settings, 15% of PCIs were rated inappropriate under AUC/2009, and this percent increased to 30.7% under AUC/2012 criteria. This was mostly because of the focused update of AUC, in which the patients were newly classified as inappropriate if they lacked proximal left anterior descending lesions and did not undergo pre-procedural noninvasive testing. However, these cases were simply not rated under AUC/2009. The amount of inappropriate PCIs increased over 5 years, proportional to the increase in coronary computed tomography angiography use. Use of coronary computed tomography angiography was independently associated with inappropriate PCIs (odds ratio: 1.33; p = 0.027).Conclusions In a multicenter, Japanese PCI registry, approximately one-sixth of nonacute PCIs were rated as inappropriate under AUC/2009, increasing to approximately one-third under the revised AUC/2012. This significant gap may reflect a needed shift in appropriateness recognition of methods for noninvasive pre-procedural evaluation of coronary artery disease. © 2014 American College of Cardiology Foundation.
Yoshida K.,Tokyo Metropolitan Childrens Medical Center |
Adachi Y.,University of Toyama |
Akashi M.,Saitama City Hospital |
Itazawa T.,University of Toyama |
And 4 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2013
Background Patients allergic to pollen have been known to become more symptomatic during pollen season compared with the nonpollen season. However, there are few studies regarding whether higher exposure to pollen might increase the prevalence of allergic diseases. Methods An ecological analysis was conducted to evaluate whether pollen exposure is associated with the prevalence of allergic diseases in schoolchildren. Pollen count data of Japanese cedar (Cryptomeria japonica) and Japanese cypress (Chamaecyparis obtusa), which are the major pollen allergens in Japan, were obtained from each prefecture. The prevalence of allergic diseases in schoolchildren in each prefecture was based on a nationwide cross-sectional survey using the International Study of Asthma and Allergies in Childhood questionnaire. Results After omitting three prefectures where pollen data were not available, data of 44 prefectures were analysed. The prevalence of allergic rhinoconjunctivitis in children aged 6-7 years was positively associated with both cedar and cypress pollen counts (P = 0.01, both), whereas the prevalence of allergic rhinoconjunctivitis in children aged 13-14 years was positively associated with only cypress pollen counts (P = 0.003). Furthermore, the prevalence of asthma was positively associated with cedar pollen counts in 6- to 7-year-old children (P = 0.003) but not cypress pollen counts in either age group. Conclusions There are ecological associations between pollen counts and the prevalence of allergic diseases in Japanese schoolchildren. Further studies are needed to determine whether the difference between the effects of cedar and cypress pollens is attributable to pollen counts or allergenicity. © 2013 John Wiley & Sons A/S.
Kojima A.,Saitama City Hospital |
Okui S.,Saitama City Hospital |
Onozuka S.,Keio University
Neurologia Medico-Chirurgica | Year: 2010
A 34-year-old female presented with subarachnoid hemorrhage caused by the rupture of a right vertebral artery (VA) dissecting aneurysm. The affected site, including the aneurysm and parent artery, was successfully occluded with detachable coils. Follow-up angiography performed 28 days after the endovascular treatment revealed recanalization of the parent artery. We decided to treat the patient conservatively without further intervention because the aneurysm had been completely occluded. Magnetic resonance imaging showed a normal VA configuration with a minor irregularity of the affected wall at 6 years after onset. Rebleeding tends to occur during the acute stage because spontaneous healing of the dissecting vascular wall typically occurs within one month after onset. Our case suggests that additional intervention is unnecessary during the chronic stage once the aneurysm has been occluded and no further signs of the development of VA dissection are found.
Maisawa K.,Saitama City Hospital
Asian cardiovascular & thoracic annals | Year: 2013
many studies have shown that oral beta blockers reduce the incidence of atrial fibrillation after coronary artery bypass. The goal of this study was to determine whether landiolol, an intravenous beta blocker, reduces the incidence of atrial fibrillation after off-pump coronary artery bypass. 39 consecutive patients were given landiolol after coronary artery bypass, and 20 who were not given landiolol served as a control group. Landiolol was intravenously administered at 1 μg.kg(-1).min(-1) in the intensive care unit. the mean dose of landiolol was 2.3 ± 1.2 1 μg.kg(-1).min(-1). The incidence of atrial fibrillation during intensive care unit stay was significantly lower in the landiolol group compared to the control group: 2.6% (1/39) vs. 20% (4/20). Heart rate after landiolol administration was significantly lower than that before administration, whereas landiolol had no effect on blood pressure. C-reactive protein and creatine kinase levels 7 days after surgery were significantly lower in the landiolol group. continuous administration of landiolol at a low dose after off-pump coronary artery bypass reduced the incidence of atrial fibrillation.
Maisawa K.,Saitama City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012
A 74-year-old man was admitted to hospital because of sudden onset of chest pain and dyspnea. The chest X-ray film revealed left hemothorax. Chest computed tomographic (CT) scan confirmed left hemothorax and excluded the possibility of aortic dissection and aneurysm of the aorta. But the presence of some vascular mass, about 20 mm in diameter, was suspected at subcarina. Three-dimensional (3D) -CT confirmed a definitive diagnosis of ruptured bronchial artery aneurysm. Bronchial artery embolization (BAE) was performed. We report a case of ruptured bronchial artery aneurysm complicated by life-threatening massive bleeding and resembling a clinical picture of aortic dissection.
Akashi M.,Saitama City Hospital
Japanese Journal of Allergology | Year: 2016
Anaphylaxis is a severe allergic reaction that is rapid in onset and might cause death. Although wheezes, dyspnea or loss of consciousness are known to occur with severe allergic reactions with IgE-mediated food allergy, reports of apnea attack associated with IgE-mediated food allergy are rare. In this case, 9-year-old boy with IgE-mediated wheat allergy experienced apnea attack with strong desaturation after an immediate allergic reaction including erythema, abdominal pain, vomiting, and anaphylactic shock. The patient had asphyxia and cyanosis confirmed by medical staff when his oxygen saturation decreased to the 60% level, and he had occasional asphyxia over 10 seconds with no thoracic motion after a desaturation episode. Central apnea attack might be occurred in patient with IgE-mediated food allergy. However, the exact mechanism responsible remains unknown and further research is needed. © 2016 Japanese Society of Allergology.
Kojima A.,Saitama City Hospital
Interventional Neuroradiology | Year: 2015
A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult. © The Author(s) 2015.
Shigeta K.,Saitama City Hospital |
Baba H.,Saitama City Hospital |
Yamafuji K.,Saitama City Hospital |
Kaneda H.,Saitama City Hospital |
And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2014
Background: Acute colorectal obstruction requires immediate surgical treatment. Although one-stage surgery with transanal drainage tubes (TDT) is reportedly safe and feasible, the long-term outcome of this procedure remains unclear. Aim: To assess the outcome of one-stage surgery using TDT in the acute left colon or rectal obstructions due to colorectal carcinomas. Methods: Clinicopathological data were recorded from patients with colorectal cancer with acute obstructions between 2006 and 2013. Results: A total of 43 patients were enrolled including 29 males and 14 females. Among 39 patients, TDT was successful in 33 (84 %) and was incomplete in 6. Thus, 33 patients received one-stage surgery with TDT decompression, and 9 patients, including 6 with incomplete decompression, received one-stage surgery with no decompression. No significant differences in clinicopathological factors were observed between decompression and non-decompression groups. Adjusted analyses revealed that decompression using TDT was significantly associated with OS (hazard ratio 0.24; 95 % confidence interval, 0.08-0.72; p = 0.01). Furthermore, OS in the TDT decompression group was significantly longer than that in the non-decompression group (p = 0.01). Conclusions: One-stage surgery with decompression using TDT may be effective to avoid stomas and to improve overall survival in patients with obstructing colorectal cancers. © 2014 The Society for Surgery of the Alimentary Tract.
Tanikawa H.,Saitama City Hospital |
Sato T.,Saitama City Hospital |
Nagafuchi M.,Saitama City Hospital |
Takeda K.,Saitama City Hospital |
And 2 more authors.
Journal of Arthroplasty | Year: 2014
We conducted a prospective randomized controlled trial to test the null hypothesis that there is no difference between sciatic nerve block (SNB) and local infiltration of analgesia (LIA) regarding postoperative analgesia after total knee arthroplasty (TKA), when administrated in addition to femoral nerve block (FNB). Forty-six patients scheduled for TKA were randomized into two groups: concomitant administration of FNB and SNB or FNB and LIA. Average pain scores during the first 21. days after surgery were similar in the two groups and remained at low level. There was no significant difference in the need for adjuvant analgesics, patient satisfaction level, the time to achieve rehabilitation goals, and length of hospital stay. The LIA offers a potentially safer alternative to SNB as an adjunct to FNB. © 2014 Elsevier Inc.
Semba J.,Saitama City Hospital
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica | Year: 2011
The spectrum concept of mental disorders means that a series of diseases consists of several subtypes, each of which overlap in their symptoms or etiologies. One of the most accepted spectrum concepts is a "bipolar spectrum". The bipolar spectrum concept has clinical validity of the diagnosis and treatment of the patients with bipolarity features in their course and symptoms. However, this concept may confuse categorical distinctions of mood disorders and lead over-diagnose of bipolar disorders. The over-diagnosis of bipolar spectrum may cause over-prescription of mood stabilizers. The medicalization of "normal mood swing" might also occur. In these years, several anticonvulsants and second generation antipsychotics acquired a new indication as a "mood stabilizer". If the marketing of mood stabilizer is hidden behind the expansion of bipolar spectrum, clinicians should assess the clinical validity of this concept more carefully.