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Ōsaka, Japan

To examine the relationship between the extent of subarachnoid hemorrhage and intraocular hemorrhages in patients with subarachnoid hemorrhage. A total, of 63 patients (25 men and 38 women, mean age 58 years). The subarachnoid hemorrhage quantity was graded according to the Fisher scale and compared with hemorrhages in the ocular fundus. Either vitreous or preretinal hemorrhages in either one or both eyes (vitreous hemorrhages) were present in 16 patients (25%). Retinal hemorrhages in either one or both eyes (retinal hemorrhages) were present in 12 patients (19%). Intraocular hemorrhage was absent in the other 35 patients (56%). The incidence of vitreous hemorrhage tended to be higher than the incidence of retinal hemorrhage or of the absence of hemorrhage as the rate of subarachnoid hemorrhage increased (Kruskal-Wallis, p < 0.05). There was no significant correlation between retinal hemorrhages and the absence of hemorrhage in the Fisher grade IV chi2, p > 0.05). The onset of vitreous hemorrhage appears to be related to the extent of subarachnoid hemorrhage but the onset of retinal hemorrhage is not.

A left superior vena cava can be a cause of cardiac rhythm or conduction abnormalities, and can also be the arrhythmogenic source of atrial fibrillation (AF) with connections to the coronary sinus and left atrium. In the present study, we report a case with a macro re-entrant atrial tachycardia that coursed through the left superior vena cava after a previous AF ablation, which successfully ablated paroxysmal AF. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Fujii M.,Osaka Medical College | Egashira Y.,Osaka Medical College | Akutagawa H.,Osaka Medical College | Nishida T.,Osaka Medical College | And 4 more authors.
Gastric Cancer | Year: 2013

Background: There are currently no universally accepted indications and criteria for additional gastrectomy after endoscopic resection of submucosally invasive cancer. The purpose of the present study was to establish accurate indications and criteria for such additional gastrectomy on the basis of lymph node metastasis risk. Methods: We investigated 130 submucosally invasive gastric cancers and analyzed the pathological risk factors for lymph node metastasis. The tumors were evaluated for pathological factors in the area of invasion, and factors were compared between the cases with lymph node metastasis and those without. Results: Univariate logistic regression analysis showed that tumor minor axis length, depth of invasion, histological classification of the area of submucosal invasion, absence of lymphoid infiltration, ulceration or scar in the lesion, and lymphatic and venous invasion are statistically significant risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the absence of lymphoid infiltration and the presence of lymphatic invasion are statistically significant as risk factors for lymph node metastasis. Conclusions: We present a scoring system on the basis of the pathological criteria tested in this study. Our findings enable more accurate identification of patients who should undergo additional gastrectomy after endoscopic resection. © 2012 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

Inoue K.,Japan National Cardiovascular Center Research Institute | Kurotobi T.,Shiroyama Hospital | Kimura R.,Japan National Cardiovascular Center Research Institute | Toyoshima Y.,Japan National Cardiovascular Center Research Institute | And 9 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background-We investigated the possibility that a frequent trigger action might play a role in the development of persistent atrial fibrillation (PeAF) and the presence of a substrate. Methods and Results-In 263 consecutive patients who underwent catheter ablation (CA) for PeAF, electric cardioversion was performed at the beginning of the procedure to determine the presence or absence of an immediate recurrence of AF (IRAF). We defined an IRAF as a reproducible AF recurrence within 90 s after restoration of sinus rhythm by electric cardioversion. We performed a mean±SD of 1.3±0.5 sessions of CA, including pulmonary vein isolation and ablation of the premature atrial contractions that triggered the IRAF (IRAF triggers), and observed the patients for 17 (10-27) months. An IRAF was observed in 70 patients (27%), but we could not ablate the IRAF triggers in 16 (23%) of these IRAF patients. The recurrence rate of PeAF was higher in patients with an unsuccessful IRAF trigger ablation than in those with successful IRAF trigger ablation (63% versus 11%; P<0.001). A multivariable analysis also revealed that an unsuccessful IRAF trigger ablation was 1 of the independent predictors of recurrent PeAF (odds ratio, 10.9; 95% CI, 3.4 -36.7). Conclusions-In the PeAF patients with an IRAF, successful elimination of the IRAF triggers, in addition to pulmonary vein isolation, resulted in a successful CA. These results imply that such triggers play a major role in the AF persistence in these PeAF patients. © 2012 American Heart Association, Inc.

Kondo A.,Shiroyama Hospital
Japanese Journal of Neurosurgery | Year: 2010

Microvascular decompression surgery (MVD) for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia is well known to be associated with low mortality and morbidity rates when performed at specialized institutes. Although MVD is now popular and widely performed at various institutes, the surgical results are not always reliable. Satisfactory results of MVD should be a complete and permanent cure of symptoms without any complications or recurrence and accordingly, the results of such a functional neurosurgery should be judged and evaluated not only by the surgical cure rate, but also with consideration of the postoperative sequelae. Therefore, members of the Society of MVD in Japan have tried to standardize the results of MVD in order to appropriately judge the surgical results and furthermore, the Society has tried to raise the quality of surgery of all MVD surgeons. The standardized result of MVD will finally be used to inform patients and it also will make doctors, who still have a little knowledge of MVD, acquainted with the effectiveness of MVD.

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