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Saitama, Japan

Nishiyama N.,Keio University | Sato T.,Keio University | Aizawa Y.,Keio University | Nakagawa S.,National Center for Child Health and Development | Kanki H.,Saitama City Hospital
American Journal of Emergency Medicine | Year: 2012

During therapeutic hypothermia, QT interval is prolonged. In patients with congenital long QT syndrome (LQTs), a longer QT interval was associated with significantly increased risk of cardiac arrest (CA). Therefore, therapeutic hypothermia may have proarrhythmic effects in survivors of CA due to congenital LQTs. A 27-year-old man was resuscitated from CA due to congenital LQTs type 3 and Brugada syndrome. Torsade de pointes (TdP) recurred spontaneously on admission (body temperature, 36.9°C). During mild hypothermia therapy, QTc increased from 499 (36.9°C) to 667 milliseconds (33.8°C), although TdP was not induced. A 13-year-old boy with congenital LQTs type 1 underwent therapeutic hypothermia after resuscitation. Short-acting ?-blocker was administered intravenously during this treatment. The QTc increased from 534 (36.4°C) to 626 milliseconds (34.3°C). However, TdP did not recur during mild hypothermia therapy. In both patients, electrolyte abnormalities were checked frequently and corrected immediately. QT prolongation remained a couple of days after completion of rewarming. The withdrawal of sedative drugs and extubation were not pursued before QT shortening reached to a plateau. Both patients were fully recovered from neurologic damage. During therapeutic hypothermia, QT interval was extremely prolonged, although TdP did not recur in 2 patients with congenital LQTs. Therapeutic hypothermia may be beneficial for comatose survivors of CA due to LQTs. © 2012 Elsevier Inc. All rights reserved.

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.

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.

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.

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