Matsubara Y.,Sapporo Higashi Tokushukai Hospital
Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2016
Aortoenteric fistula (AEF) is a life-threatening condition that can present with gastrointestinal (GI) bleeding. AEFs have been classified into primary and secondary types. Primary AEF (PAEF) is a direct communication between the aorta and the GI tract. Secondary AEF (SAEF) is the result of a previous abdominal aortic aneurysm repair involving placement of a synthetic aortic graft. Diagnosis of AEF, especially PAEF, is difficult largely because AEF is so rarely encountered in practice. Computed tomography (CT) and endoscopic gastroduodenoscopy (EGD) are most frequently used to diagnose AEF, with abdominal contrast-enhanced CT being the preferred initial diagnostic test of choice. Although EGD can exclude other common causes of GI hemorrhage, it cannot be used to rule out AEF when another source of bleeding is identified, as the two conditions can coexist. We discuss here two patients with GI bleeding who were diagnosed as PAEF and SAEF. We tried to diagnose and treat with EGD, but failed. That bleeding was due to an AEF became evident when abdominal CT scans revealed direct extravasation of contrast media from the abdominal aorta into the GI tract. The lack of awareness of AEF, coupled with the inaccessibility to the distal duodenum via EGD, were probably responsible for initial misdiagnosis and delay of appropriate management. We suggest that the diagnosis of AEF remains dependent on the clinician's heightened suspicion.
Endo T.,Health Sciences University of Hokkaido |
Hayasaka M.,Sapporo Higashi Tokushukai Hospital |
Hisamichi Y.,Health Sciences University of Hokkaido |
Kimura O.,Health Sciences University of Hokkaido
Marine Pollution Bulletin | Year: 2013
We analyzed stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) as well as mercury (Hg) concentration in the scalp hair of Japanese who consumed whale meat and those who did not, and investigated the relationships among the δ13C and δ15N values and Hg concentration. The average δ15N and δ13C values of whale meat-eaters (10.11‰ and -18.5‰) were significantly higher than those of non-eaters (9.28‰ and -18.9‰), respectively. The average Hg concentration of whale meat-eaters (20.6μg/g) was significantly higher than that of non-eaters (2.20μg/g). Significant positive correlations were found between the δ13C and δ15N values and between the δ15N value and Hg concentration in the hair of whale meat-eaters, while the correlation between the δ15N value and Hg concentration was not statistically significant in the non-eaters. The consumption of whale meat may increase Hg concentration as well as δ15N and δ13C values in scalp hair. © 2013 Elsevier Ltd.
Stone P.H.,Harvard University |
Saito S.,Shonan Kamakura General Hospital |
Takahashi S.,Harvard University |
Takahashi S.,Shonan Kamakura General Hospital |
And 23 more authors.
Circulation | Year: 2012
BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.
Circulating interleukin 6 and albumin, and infliximab levels are good predictors of recovering efficacy after dose escalation infliximab therapy in patients with loss of response to treatment for Crohns disease: A Prospective Clinical Trial
Suzuki Y.,Toho University |
Matsui T.,Fukuoka University |
Ito H.,Kinshukai Infusion Clinic |
Ashida T.,Sapporo Higashi Tokushukai Hospital |
And 7 more authors.
Inflammatory Bowel Diseases | Year: 2015
Background: We aimed to clarify the efficacy, safety, and factors associated with remission on dose escalation in patients with Crohn's disease showing loss of response (LOR) to infliximab treatment of 5 mg/kg at 8-week intervals in a clinical trial. Methods: Thirty-nine patients with LOR to 5 mg/kg infliximab therapy started treatment with 10 mg/kg per 8 weeks. LOR was defined as both a Crohn's Disease Activity Index of ≥175 at 8 weeks after infusion of 5 mg/kg infliximab and a Crohn's Disease Activity Index increase of ≥50 from 4 to 8 weeks after infusion. Results: At week 8 after the first infusion of 10 mg/kg, median (95% confidence interval) reduction in Crohn's Disease Activity Index of 33 patients evaluated was 95.0 (70.0-134.0), meeting the primary endpoint. Remission rate at week 40 was 41% (16 of 39), with correlation noted between remission achievement and serum infliximab level (P = 0.036). Univariate analysis revealed that "infliximab trough level ≥1 µg/mL," "interleukin 6 level ≤2.41 pg/mL," and "albumin level ≥3.8 g/dL" before dose escalation were significantly associated with remission at week 40 (P =0.017, P =0.011, and P =0.019, respectively), and these variables were correlated with each other (all: P < 0.001). The cutoff infliximab level for remission was 0.42 µg/mL in receiver operating characteristic curve analysis. No adverse events related to dose escalation were observed. Conclusions: Doubling the infliximab dose safely led to remission in patients with Crohn's disease with LOR to 5 mg/kg treatment. Remission was associated with pre-escalation levels of infliximab, interleukin 6, and albumin. Our findings suggest that dose escalation while maintaining a certain level of infliximab is important in achieving remission. © 2015 Crohn's & Colitis Foundation of America, Inc.
Shogo N.,Sapporo Higashi Tokushukai Hospital |
Yasuhide N.,Japan National Cardiovascular Center Research Institute |
Hatsue I.-U.,Japan National Cardiovascular Center Research Institute |
Yoshida M.,Nozaki Tokushukai Hospital
Clinical Neurology and Neurosurgery | Year: 2014
Purpose The treatment of large or giant cerebral aneurysms by surgical and/or endovascular techniques is difficult and poses relatively high risks. Therefore, a microporous self-expanding (hybrid) stent graft composed of a thin, expandable, segmented polyurethane (SPU) membrane with micropores and a drug-delivery system was developed. Materials and methods A commercially available, self-expanding carotid stent was covered with a thin microporous SPU membrane fabricated by the dip-coating method and the excimer laser ablation technique, with an intraluminal coating of argatroban. Experimentally fabricated lateral-wall aneurysms in canine carotid arteries using venous pouches were occluded with the hybrid stent graft (bale-shaped pore density of 23.6%) on one side and a bare-metal stent on the other side without systemic antiplatelet therapy. Results Angiography at 1, 6, and 12 months of stenting revealed that all arteries were patent without marked stenosis without systemic antiplatelet therapy. All aneurysms treated with hybrid stent grafts remained occluded throughout the 12-month period, while among those treated by bare-metal stents, 2 of 3 aneurysms were occluded at 6 months (67%) and only 1 of 3 aneurysms were occluded at 12 months (33%). Histology revealed that the novel hybrid stent graft had less intimal hyperplasia than the bare-metal stent. The hybrid stent graft was useful for the successful occlusion of these canine carotid aneurysms, even at 12 months. Conclusions The novel hybrid stent grafts are expected to overcome the disadvantages of fully covered stent grafts and simple bare-metal stents, while combining both their merits, and appear to be useful in the treatment of large or giant cerebral aneurysms. © 2014 Elsevier B.V.
Kimura O.,Health Sciences University of Hokkaido |
Tsukagoshi K.,Hijirigaoka Hospital |
Hayasaka M.,Sapporo Higashi Tokushukai Hospital |
Endo T.,Health Sciences University of Hokkaido
Archives of Toxicology | Year: 2012
We investigated whether the uptake of triclopyr (3, 5, 6-trichloro-2- pyridinyloxyacetic acid) and dicamba (3,6-dichloro-2-methoxybenzoic acid) across the apical membrane of Caco-2 cells was mediated via proton-linked monocarboxylic acid transporters (MCTs). The uptake of triclopyr from the apical membranes was fast, pH-, temperature-, and concentration dependent, required metabolic energy to proceed, and was competitively inhibited by monocarboxylic acids such as benzoic acid and ferulic acid (substrates of l-lactic acid-insensitive MCTs), but not by l-lactic acid. Thus, the uptake of triclopyr in Caco-2 cells appears to be mediated mainly via l-lactic acid-insensitive MCTs. In contrast, the uptake of dicamba (a benzoic acid derivative) was slow, and it was both pH- and temperature dependent. Coincubation with ferulic acid did not decrease the uptake of dicamba, although coincubation with benzoic acid moderately decreased it. The uptake of dicamba appears to be mediated mainly via passive diffusion, which is in contrast to the uptake of benzoic acid via MCTs. We speculate that the substituted groups in dicamba may inhibit uptake via MCTs. © 2011 Springer-Verlag.
Hashidomi H.,Sapporo Higashi Tokushukai Hospital |
Saito S.,Sapporo Higashi Tokushukai Hospital
Journal of Interventional Cardiology | Year: 2011
Microcatheters are often used for percutaneous coronary intervention via the retrograde approach through a collateral channel for chronic total occlusion lesions. Recently, we encountered an alarming case in which a septal collateral artery was dilated after the removal of a microcatheter. This dilated septal artery ruptured spontaneously and resulted in a cardiac tamponade, which was successfully treated by pericardiocentesis and coil embolization. © 2010, Wiley Periodicals, Inc.
Gala M.K.,Harvard University |
Mizukami Y.,Harvard University |
Mizukami Y.,Sapporo Higashi Tokushukai Hospital |
Le L.P.,Harvard University |
And 6 more authors.
Gastroenterology | Year: 2014
Background & Aims Little is known about the genetic factors that contribute to the development of sessile serrated adenomas (SSAs). SSAs contain somatic mutations in BRAF or KRAS early in development. However, evidence from humans and mouse models indicates that these mutations result in oncogene-induced senescence (OIS) of intestinal crypt cells. Progression to serrated neoplasia requires cells to escape OIS via inactivation of tumor suppressor pathways. We investigated whether subjects with multiple SSAs carry germline loss-of-function mutations (nonsense and splice site) in genes that regulate OIS: the p16-Rb and ATM-ATR DNA damage response pathways. Methods Through a bioinformatic analysis of the literature, we identified a set of genes that function at the main nodes of the p16-Rb and ATM-ATR DNA damage response pathways. We performed whole-exome sequencing of 20 unrelated subjects with multiple SSAs; most had features of serrated polyposis. We compared sequences with those from 4300 subjects matched for ethnicity (controls). We also used an integrative genomics approach to identify additional genes involved in senescence mechanisms. Results We identified mutations in genes that regulate senescence (ATM, PIF1, TELO2, XAF1, and RBL1) in 5 of 20 subjects with multiple SSAs (odds ratio, 3.0; 95% confidence interval, 0.9-8.9; P =.04). In 2 subjects, we found nonsense mutations in RNF43, indicating that it is also associated with multiple serrated polyps (odds ratio, 460; 95% confidence interval, 23.1-16,384; P = 6.8 × 10-5). In knockdown experiments with pancreatic duct cells exposed to UV light, RNF43 appeared to function as a regulator of ATM-ATR DNA damage response. Conclusions We associated germline loss-of-function variants in genes that regulate senescence pathways with the development of multiple SSAs. We identified RNF43 as a regulator of the DNA damage response and associated nonsense variants in this gene with a high risk of developing SSAs. © 2014 by the AGA Institute.
Kaneko A.,Tsumura and Co. |
Kono T.,Hokkaido University |
Kono T.,Sapporo Higashi Tokushukai Hospital |
Miura N.,Tsumura and Co. |
And 2 more authors.
Gastroenterology Research and Practice | Year: 2013
Purpose. Crohn's disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD), have histopathologically and immunologically different characteristics. We previously reported that a traditional Japanese medicine, daikenchuto (TU-100), ameliorated a trinitrobenzenesulfonic acid- (TNBS-) induced type-1 model colitis exhibiting histopathological features of CD through adrenomedullin (ADM) enhancement. Our current aims were to examine whether TU-100 ameliorates a type-2 model colitis that histologically resembles UC and identify the active ingredients. Methods. TU-100 was administered orally to mice with oxazolone- (OXN-) induced type-2 model colitis. The morbidity was evaluated by body weight loss and the macroscopic score of colonic lesions. ADM was quantified using an EIA kit. Results. TU-100 prevented weight loss and colon ulceration. ADM production by intestinal epithelial cells was increased by TU-100 addition. Screening to identify active ingredients showed that -shogaol and hydroxy α-sanshool enhanced ADM production. Conclusions. TU-100 exerted a protective effect in OXN-induced type-2 model colitis, indicating that TU-100 may be a beneficial agent for treatment of UC. © 2013 Atsushi Kaneko et al.
Kono T.,Sapporo Higashi Tokushukai Hospital
Nihon Geka Gakkai zasshi | Year: 2013
In contrast to conventional single-target drugs, multicomponent Kampo medicines are designed to achieve therapeutic effects through multiple drug targets. This article discusses recent advances in mechanistic studies and the clinical effects of eight representative Kampo formulations (Rikkunshito, Hangeshashinto, Daikenchuto, Goshajinkigan, Yokukansan, and the tonics Hochuekkito, Juzentaihoto, and Ninjinyoeito) for the treatment of adverse effects caused by anticancer drugs such as anorexia, oral mucositis, diarrhea, neurotoxicity, abnormal behavior, malaise, weakness, and thrombocytopenia, which Western pharmaceuticals fail to address adequately.