Shiroyama Hospital

Ōsaka, Japan

Shiroyama Hospital

Ōsaka, Japan
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Kaitani K.,Tenri Hospital | Kurotobi T.,Shiroyama Hospital | Kobori A.,Kobe City Medical Center General Hospital | Okajima K.,Himeji Cardiovascular Center | And 4 more authors.
Europace | Year: 2014

AimsIntravenous adenosine triphosphate (ATP) administration could reveal dormant conduction (DC) gaps on the ablation line of a pulmonary vein isolation (PVI). We compared the ATP-provoked DC sites in the initial PVI with the PV re-conduction sites in the second session in patients with paroxysmal atrial fibrillation (AF).Methods and resultsWe conducted a multicenter, observational study from a prospective registry undergoing AF ablation. A total of 110 consecutive drug-refractory paroxysmal AF patients were enroled in this study. Dormant conduction was detected by an ATP provocation of up to 40 mg during a continuous isoproterenol infusion (0.5-2 μg/min). The DC sites at each of the right and left PVs were precisely determined by using double spiral catheters under the guidance of a three-dimensional constructed anatomical mapping system. In the initial session, DC was observed in 35 patients (31.8%, 1.3 gaps/patient), and the sites of the DC were commonly observed in the carina region (43.5%). Atrial fibrillation recurrence was confirmed in 33 patients (30.0%) during follow-up (27.1 months), and a second session was performed in 24 of 33 patients (70.6%). In the second session, the re-conduction sites were also commonly observed in the carina region (59.5%).ConclusionThe carina region was still a dominant re-conduction site even after the elimination of any ATP-provoked DC in the index procedure. © The Author 2013.


Ishii D.,Japan National Cardiovascular Center Research Institute | Satow T.,Japan National Cardiovascular Center Research Institute | Murao K.,Shiroyama Hospital | Nishimura K.,Japan National Cardiovascular Center Research Institute | Iihara K.,Japan National Cardiovascular Center Research Institute
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Background Hypotension and bradycardia are known to occur frequently in carotid artery stenting (CAS), which may lead to postprocedural complications. The purpose of this retrospective study was to assess the efficacy of cilostazol, a phosphodiesterase 3 inhibitor, for preventing bradycardia and hypotension in the periprocedural period. Methods The study population comprised 53 patients (54 lesions) with carotid artery stenosis who underwent CAS at our institution between 2004 and 2008. The patients were categorized by the use (group C, n = 26) or nonuse of cilostazol (group N, n = 28). The incidences of intraprocedural and postprocedural hypotension and bradycardia in each group were statistically assessed. Results Intraprocedural hypotension and bradycardia occurred in 9 cases (34.6%) and 4 cases (15.3%) in group C and in 5 cases (17.9%) and 15 cases (53.6%) in group N, respectively. Postprocedural hypotension and bradycardia occurred in 4 cases (15.4%) and 0 cases in group C and in 1 case (3.6%) and 3 cases (10.7%) in group N, respectively. The incidence of intraprocedural bradycardia (IBc) was significantly lower in group C (P =.0035). Logistic regression analysis revealed that the use of cilostazol decreased the risk of IBc 99.5% (odds ratio [OR] =.01, 95% confidence interval [CI]: 5.46 × 10-6 to.04, P =.001) and distance from carotid bifurcation to maximum stenotic lesion was independently associated with IBc (OR =.46, 95% CI:.29-.74, P =.001). Conclusion Use of cilostazol was associated with a lower incidence of IBc. Cilostazol may be a useful drug for the prevention of this complication. © 2014 by National Stroke 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.


Ohta T.,Shiroyama Hospital | Murao K.,Shiroyama Hospital | Miyake K.,Shiroyama Hospital | Takemoto K.,Shiroyama Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

Background: Delirium is considered to worsen life prognosis in elderly patients with stroke. We examined the effects of the melatonin receptor agonist ramelteon for treating delirium in elderly stroke patients with insomnia in comparison to the other drugs. Methods: Elderly patients with delirium and insomnia after acute stroke who were treated with ramelteon (7 patients; mean age 76 years) and the other drugs (21 patients; mean age 77.3 years) between July 2011 and March 2012 at our hospital were retrospectively examined. Results: All patients treated with ramelteon had a significant improvement within a week and were started on early and aggressive rehabilitation. No patient experienced oversedation, neurologic deterioration, or any other worsening effect associated with ramelteon treatment. Conclusions: Melatonin receptor agonists may be effective for the treatment of delirium in elderly patients with acute stroke. © 2013 by National Stroke Association.


Kurotobi T.,Shiroyama Hospital | Shimada Y.,Shiroyama Hospital | Kino N.,Shiroyama Hospital | Ito K.,Shiroyama Hospital | And 6 more authors.
Heart Rhythm | Year: 2015

Background The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF). Objective The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes. Methods The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI. Results GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P =.002). Conclusion The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF. © 2015 Heart Rhythm Society.


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.


Sumioka S.,Shiroyama Hospital | Kondo A.,Shiroyama Hospital | Tanabe H.,Shiroyama Hospital | Yasuda S.,Shiroyama Hospital
Neurologia Medico-Chirurgica | Year: 2011

A 66-year-old man presented with typical right trigeminal neuralgia. Neuroimaging showed a small arteriovenous malformation (AVM) in the right cerebellopontine angle. Suboccipital craniotomy verified that the AVM was almost completely embedded in the root entry zone of the trigeminal nerve and the nerve axis was tilted infero-posteriorly. The patient obtained complete pain relief without sequelae after surgery by transposition of the superior cerebellar artery and correction of the tilted nerve axis. The nidus of the unresected AVM was obliterated by gamma knife radiosurgery. © 2011 by The Japan Neurosurgical Society.


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.


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.


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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