Sanda City Hospital

Sanda, Japan

Sanda City Hospital

Sanda, Japan
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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 | 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.


Umakoshi H.,National Hospital Organization Kyoto Medical Center | Tanase-Nakao K.,National Hospital Organization Kyoto Medical Center | Wada N.,Sapporo City Hospital | Ichijo T.,Saiseikai Yokohama City Toubu Hospital | And 14 more authors.
Clinical Endocrinology | Year: 2015

Objectives 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. Aim 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. Design and patients 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 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). 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 = 0·01). Conclusions 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. © 2015 John Wiley & Sons Ltd.


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.


Hirano H.,Steel Memorial Hirohata Hospital | Hirano H.,Toneyama National Hospital | Matsushita K.,Kyoritsu Hospital | Okimura A.,Steel Memorial Hirohata Hospital | And 3 more authors.
Anticancer Research | Year: 2014

Background/Aim: Survivin is expressed in the nucleus and/or cytoplasm of various types of malignant tumor cells. Nuclear survivin is indispensable for complete mitosis, while cytoplasmic survivin functions as an apoptosis inhibitor. We examined the difference in the survivin expression among stromal cells of fibroadenoma, and benign and malignant phyllodes tumors. Materials and Methods: Tumor sections were immunohistochemically stained with an anti-human survivin antibody and the labeling index of survivin was calculated. Results: In stromal cells of all tumors, survivin was expressed in the nuclei but not in the cytoplasm. The labeling indices of the stromal cells in five malignant phyllodes tumors (20.5±3.0) were significantly greater than those observed in eight fibroadenomas (1.9±0.6) or nine benign phyllodes tumors (3.0±0.9). Conclusion: In the present study it was shown that stromal cells in malignant phyllodes tumors express nuclear survivin more extensively than stromal cells in benign phyllodes tumors or fibroadenomas.


PubMed | Hyogo College of Medicine, Sanda City Hospital and Steel Memorial Hirohata Hospital
Type: Journal Article | Journal: Anticancer research | Year: 2014

To clarify the mechanism underlying the formation of a sarcomatous component of ovarian carcinosarcoma, we investigated the expression of adhesion molecules and the proliferative activity of carcinosarcomas.We immunohistochemically examined the expression of E-cadherin and -catenin, and the Ki-67 labeling index (Ki-67 LI) in six carcinosarcomas containing endometrioid carcinoma as a carcinomatous component.The sarcomatous components of the carcinosarcomas did not express E-cadherin or -catenin. All carcinomatous components expressed these molecules but the expression was reduced compared to that in endometrioid ovarian carcinomas. In five of the six carcinosarcomas, the Ki-67 LI of the sarcomatous component was less than that of the carcinomatous component.The present results suggest that a carcinomatous component transforms more easily than an ordinary endometrioid carcinoma from the viewpoint of the cell adhesion, and cells in a carcinomatous component continuously transform into sarcomatous cells during the growth of carcinosarcoma.


Konishi T.,Hyogo College of Medicine | Tsuda T.,Hyogo College of Medicine | Sakaguchi Y.,Hyogo College of Medicine | Imai Y.,Hyogo College of Medicine | And 4 more authors.
Journal of Dermatology | Year: 2014

Netherton syndrome (NS) is a rare autosomal recessive disorder which is caused by mutations in the SPINK5 gene encoding the serine-protease inhibitor LEKTI. Characteristic symptoms of NS include erythroderma with diffuse desquamation, hair abnormalities and atopic manifestations. Here, we report two Japanese patients with NS, one of whom had a novel mutation in the SPINK5 gene which leads to p.C367Lfs*3. The upregulation of interleukin-33 (IL-33) was evident in basal and thickened lower spinous layers of the epidermis in those cases. This suggests that IL-33 may be involved in the pathophysiology of NS as well as in atopic dermatitis. © 2014 Japanese Dermatological Association.

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