Showa Inan General Hospital

Komagane, Japan

Showa Inan General Hospital

Komagane, Japan
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Nakamura Y.,Shinshu University | Nakamura Y.,Showa Inan General Hospital | Ikegami S.,Shinshu University | Uchiyama S.,Shinshu University | Kato H.,Shinshu University
Open Rheumatology Journal | Year: 2013

Objectives: In this study, we aimed to investigate whether joint pain is derived from cartilage or bone alterations. Methods: We reviewed 23 hip joints of 21 patients with primary hip osteoarthritis (OA), which were classified into Kellgren-Laurence (KL) grading I to IV. Plain radiographs and magnetic resonance imaging (MRI) were obtained from all of the 23 joints. Two of the 21 patients had bilateral hip OA. Pain was assessed based on the pain scale of Denis. A Welch t test was performed for age, height, weight, body mass index, bone mineral density, and a Mann-Whitney U test was performed for KL grading. Results: Four of 8 hip joints with pain and OA showed broad signal changes detected by MRI. Fourteen hip joints without pain, but with OA did not show broad signal changes by MRI. Collectively, MRI analyses showed that broad signal changes in OA cases without joint pain or with a slight degree of joint pain were not observed, while broad signal changes were observed in OA cases with deteriorated joint pain. Conclusion: Our findings suggest that hip joint pain might be associated with bone signal alterations in the hips of OA patients. © Kamimura et al.; Licensee Bentham Open.


Delaurier A.,University of Oregon | Nakamura Y.,Showa Inan General Hospital | Braasch I.,University of Oregon | Khanna V.,University of Oregon | And 4 more authors.
BMC Developmental Biology | Year: 2012

Background: Histone deacetylase-4 (Hdac4) is a class II histone deacetylase that inhibits the activity of transcription factors. In humans, HDAC4 deficiency is associated with non-syndromic oral clefts and brachydactyly mental retardation syndrome (BDMR) with craniofacial abnormalities. Results: We identify hdac4 in zebrafish and characterize its function in craniofacial morphogenesis. The gene is present as a single copy, and the deduced Hdac4 protein sequence shares all known functional domains with human HDAC4. The zebrafish hdac4 transcript is widely present in migratory cranial neural crest (CNC) cells of the embryo, including populations migrating around the eye, which previously have been shown to contribute to the formation of the palatal skeleton of the early larva. Embryos injected with hdac4 morpholinos (MO) have reduced or absent CNC populations that normally migrate medial to the eye. CNC-derived palatal precursor cells do not recover at the post-migratory stage, and subsequently we found that defects in the developing cartilaginous palatal skeleton correlate with reduction or absence of early CNC cells. Palatal skeletal defects prominently include a shortened, clefted, or missing ethmoid plate, and are associated with a shortening of the face of young larvae. Conclusions: Our results demonstrate that Hdac4 is a regulator of CNC-derived palatal skeletal precursors during early embryogenesis. Cleft palate resulting from HDAC4 mutations in human patients may result from defects in a homologous CNC progenitor cell population. © 2012 DeLaurier et al.; licensee BioMed Central Ltd.


Horiuchi A.,Showa Inan General Hospital | Tanaka N.,U.S. National Institutes of Health
World Journal of Gastroenterology | Year: 2014

Colonoscopy with polypectomy has been shown to reduce the risk of colon cancer. The critical element in the quality of colonoscopy in terms of polyp detection and removal continues to be the performance of the endoscopist, independent of patient-related factors. Improved results in terms of polyp detection and complete removal have implications regarding the development of screening and surveillance intervals and the reduction of interval cancers after negative colonoscopy. Advances in colonoscopy techniques such as high-definition colonoscopy, hood-assisted colonoscopy and dye-based chromoendoscopy have improved the detection of small and flat-type colorectal polyps. Virtual chromoendoscopy has not proven to improve polyp detection but may be useful to predict polyp pathology. The majority of polyps can be removed endoscopically. Available polypectomy techniques include cold forceps polypectomy, cold snare polypectomy, conventional polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection. The preferred choice depends on the polyp size and characteristics. Other useful techniques include colonoscopic hemostasis for acute colonic diverticular bleeding, endoscopic decompression using colonoscopic stenting, and transanal tube placement for colorectal obstruction. Here we review the current knowledge concerning the improvement of quality measures in colonoscopy and colonoscopy-related therapeutic interventions. © 2014 Baishideng Publishing Group Inc. All rights reserved.


Ichise Y.,Showa Inan General Hospital | Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital | Nakayama Y.,Shinshu University | And 2 more authors.
Digestion | Year: 2011

Background and Aim: The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms. Methods: Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group). The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding. Results: Eighty patients were randomized: cold group, n = 40 (101 polyps) and conventional group, n = 40 (104 polyps). The patients' demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. conventional polypectomy (18 vs. 25 min, p < 0.0001). Complete polyp retrieval rates were identical [96% (97/101) vs. 96% (100/104)]. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy (i.e. 20%; 8/40) than with cold polypectomy (i.e. 2.5%; 1/40; p = 0.029). Conclusion: Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms. The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps. Copyright © 2011 S. Karger AG, Basel.


Nakagawa M.,Shinshu University | Tojo K.,Shinshu University | Sekijima Y.,Shinshu University | Yamazaki K.-H.,Showa Inan General Hospital | Ikeda S.-I.,Shinshu University
Amyloid | Year: 2012

We describe a rare complication, systemic arterial thromboembolism, seen in two patients with senile systemic amyloidosis (SSA). Case 1 was a 73-year-old man who was tentatively diagnosed as having cardiac amyloidosis. Five months later, he was afflicted by severe left flank pain. CT disclosed renal infarction and then he received endomyocardial biopsy and the transthyretin (TTR) gene analysis, leading to the final diagnosis of SSA. Case 2 was an 88-year-old woman who had been definitively diagnosed as having SSA-related heart failure with atrial fibrillation two years before. She was transferred to the emergency room in our hospital and enhanced CT revealed complete occlusions of the left internal carotid and left vertebral arteries, both subclavian arteries, and the left renal and left internal iliac arteries. Paying much attention to intracardiac thrombosis might be necessary in taking care of SSA patients. © 2012 Informa UK, Ltd.


Sakamoto T.,Showa Inan General Hospital | Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital
Canadian Journal of Gastroenterology | Year: 2013

background: Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia. objective: To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia. Methods: EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration/aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods. Results: During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration/aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods. Conclusions: Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia. © 2013 Pulsus Group Inc. All rights reserved.


Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital | Kajiyama M.,Showa Inan General Hospital | Kato N.,Showa Inan General Hospital | And 3 more authors.
Gastrointestinal Endoscopy | Year: 2010

Background: Endoscopic biliary stenting with a plastic stent is often performed to prevent impaction of common bile duct (CBD) stones. The therapeutic effect of a plastic stent placement in terms of reduction in stone size and number has not been established. Objective: The aim of this study was to study the effect of biliary stenting as therapy for CBD stones. Design: Retrospective study. Setting: Municipal hospital outpatients. Interventions: Patients with large (≥20 mm) and/or multiple (≥3) stones had placement of a 7F double-pigtail plastic stent without stone extraction at the initial ERCP. Approximately 2 months later, stone removal was attempted. The number and size of CBD stones before and after stent placement, stone clearance, complications, and 180-day mortality were evaluated. Results: Forty patients were studied. Stent placement averaged 65 days (range, 50-82 days). The median number (interquartile range) of stones per patient fell after stent placement (4.0 [3.0] before vs. 2.0 [1.0] after; P < .0001). Characteristically, larger stones became smaller and small stones disappeared (ie, the median stone index decreased from 4.6 [3.0] to 2.0 [1.5]; P < .0001). Stone clearance at the second ERCP was achieved in 37 out of 40 patients (93%). Complications included cholangitis (13%) and pancreatitis (5%) after the second ERCP. No 180-day mortality occurred. Limitations: A retrospective, single-center study. Conclusions: Stent placement for 2 months was associated with large and/or multiple CBD stones becoming smaller and/or disappearing without any complications. Stenting followed by a wait period may assist in difficult CBD stone removal. © 2010 American Society for Gastrointestinal Endoscopy.


Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital | Nakayama Y.,Shinshu University | Kajiyama M.,Showa Inan General Hospital | And 3 more authors.
Gastrointestinal Endoscopy | Year: 2014

Background The bleeding risk after cold snare polypectomy in anticoagulated patients is not known. Objective To compare the bleeding risk after cold snare polypectomy or conventional polypectomy for small colorectal polyps in anticoagulated patients. Design Prospective randomized controlled study. Setting Municipal hospital in Japan. Interventions Anticoagulated patients with colorectal polyps up to 10 mm in diameter were enrolled. Patients were randomized to polypectomy with either cold snare technique (Cold group) or conventional polypectomy (Conventional group) without discontinuation of warfarin. The primary outcome measure was delayed bleeding (ie, requiring endoscopic intervention within 2 weeks after polypectomy). Secondary outcome measures were immediate bleeding and retrieval rate of colorectal polyps. Results Seventy patients were randomized (159 polyps): Cold group (n = 35, 78 polyps) and Conventional group (n = 35; 81 polyps). The patients' demographic characteristics including international normalized ratio and the number, size, and shape of polyps removed were similar between the 2 techniques. Immediate bleeding during the procedure was more common with conventional polypectomy (23% [8/35]) compared with cold polypectomy (5.7% [2/35]) (P =.042). No delayed bleeding occurred in the Cold group, whereas 5 patients (14%) required endoscopic hemostasis in the Conventional group (P =.027). Complete polyp retrieval rates were identical (94% [73/78] vs 93% [75/81]). The presence of histologically demonstrated injured arteries in the submucosal layer with cold snare was significantly less than with conventional snare (22% vs 39%, P =.023). Limitation Small sample size, single-center study. Conclusions Delayed bleeding requiring hemostasis occurred significantly less commonly after cold snare polypectomy than conventional polypectomy despite continuation of anticoagulants. Cold snare polypectomy is preferred for removal of small colorectal polyps in anticoagulated patients. (Clinical trial registration number: NCT 01553565.).


Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital | Nakayama Y.,Shinshu University | Fujii H.,Showa Inan General Hospital | And 4 more authors.
Gastrointestinal Endoscopy | Year: 2012

Background: It is commonly recommended that patients refrain from driving for 24 hours after endoscopy for which sedation is given. Objective: The aim of this study was to evaluate psychomotor recovery and blood propofol concentrations after colonoscopy with propofol sedation to determine whether driving might be safe. Design: A prospective, consecutive study. Setting: Municipal hospital outpatients. Patients: This study involved 48 consecutive patients scheduled for colonoscopy with propofol sedation. Intervention: Patient clinical features, psychomotor recovery, and blood concentrations of propofol were assessed. Psychomotor recovery was assessed before colonoscopy and 1 and 2 hours after colonoscopy by using the number connection test and a driving simulator test. Main Outcome Measurements: Clinical features, psychomotor recovery, and blood concentration of propofol. Results: All patients successfully completed the post-sedation assessments. Although there was a significant difference in results of the number connection test between before colonoscopy and 1 hour after colonoscopy, all number connection test results were within normal limits (<40 seconds). Scores were as follows: mean time (standard deviation) before colonoscopy, 32.2 (2.0) seconds (range 29-36 seconds) versus after colonoscopy, 32.7 (2.0) seconds (range 27-38 seconds); P =.0019. Driving skills had recovered to the baseline levels 1 hour after colonoscopy. Scores were as follows: tracking error (%) before colonoscopy, 45.0 (5.6) versus after colonoscopy, 46.0 (5.5); P =.61; accelerating reaction time in seconds before colonoscopy, 0.65 (0.15) versus after colonoscopy, 0.62 (0.14); P =.40; braking reaction time in seconds before colonoscopy, 0.58 (0.13) versus after colonoscopy, 0.61 (0.13); P =.50. Limitations: Small sample size, single-center study. Conclusion: Although consistent findings on the number connection test and driving simulation (psychomotor recovery) test are present as early as 1 hour after propofol sedation, a study of additional numbers of patients as well as different patient populations are needed before these results can be universally recommended. © 2012 American Society for Gastrointestinal Endoscopy.


Horiuchi A.,Showa Inan General Hospital | Nakayama Y.,Showa Inan General Hospital | Nakayama Y.,Shinshu University | Kato N.,Showa Inan General Hospital | And 3 more authors.
Clinical Gastroenterology and Hepatology | Year: 2010

Background & Aims: Colonoscopy, using either a transparent retractable extension device or narrow band imaging, is thought to improve colon adenoma detection. We compared the abilities of a transparent retractable extension device and narrow band imaging to detect colorectal adenomas. Methods: One hundred and seven patients with colonic adenomas that were detected by traditional colonoscopy were randomly assigned to groups that underwent a second colonoscopy that used either a transparent retractable extension or narrow band imaging; adenomas were removed. The principal outcome parameters were the number, size, shape, and location of adenomas detected. The patients' demographic characteristics, indications for colonoscopy, and cecal intubation times were similar between groups. Results: Use of the transparent retractable extension resulted in detection of 31% more adenomas than the initial procedure (P < .0001). The majority of newly discovered adenomas were sessile (79%; 26/33) and less than 5 mm in size (73%; 24/33). There was no significant increase in adenoma detection (5%) between first colonoscopy and second colonoscopy using narrow band imaging. Additional adenomas were found in 40.7% of patients that were examined using the transparent hood (22/54) versus 13.2% of those examined using narrow band imaging (7/53) (P = .0028). Conclusions: Colonoscopy with a transparent retractable extension significantly improved the adenoma detection rate compared with repeat colonoscopy using narrow band imaging. © 2010 AGA Institute.

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