Social Insurance Chuo General Hospital

Chūō-ku, Japan

Social Insurance Chuo General Hospital

Chūō-ku, Japan

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Suzuki Y.,Toho University | Motoya S.,Sapporo Kosei General Hospital | Takazoe M.,Social Insurance Chuo General Hospital | Kosaka T.,Yamakawa Clinic | And 3 more authors.
Journal of Crohn's and Colitis | Year: 2013

Background and aims: Current treatments for Japanese patients with active Crohn's disease have not proved optimal, and new treatment options are required. The present study therefore evaluated the efficacy and tolerability of oral budesonide in Japanese patients with mild-to-moderate active Crohn's disease. Methods: In this multicentre, double-blind, randomized, parallel-group, Phase II study, patients (18-65. years) with baseline Crohn's Disease Activity Index (CDAI) score. ≥. 200 were randomized to once-daily (od) oral budesonide 9. mg or 15. mg, or matching placebo, for 8. weeks. Concomitant therapy with sulfasalazine or 5-aminosalicylic acid, and nutritional therapy, was allowed. The rate of remission (defined as CDAI score. ≤. 150) after 8. weeks' treatment (primary variable), health-related quality of life (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ]), and tolerability were assessed. Results: 77 patients were randomized and 63 completed the study. The proportion of budesonide-treated patients with remission after 8. weeks' treatment was higher compared with placebo (23.1%, 28.0%, and 11.5% for budesonide 9. mg, 15. mg, and placebo, respectively; no significant difference). The mean change from baseline to week 8 in CDAI total score (-. 48.0, -. 58.2, and -. 27.2, respectively) and IBDQ total score (10.8, 23.2, and 6.5, respectively) was greater for budesonide-treated patients than placebo recipients. While budesonide 9. mg and 15. mg demonstrated similar efficacy, budesonide 9. mg caused fewer drug- and glucocorticosteroid-related adverse events and less adrenal suppression. © 2012 European Crohn's and Colitis Organisation.


Saito T.,Social Insurance Chuo General Hospital | Watanabe M.,Japan National Cardiovascular Center Research Institute | Nishida J.,Social Insurance Chuo General Hospital | Izumi T.,Social Insurance Chuo General Hospital | And 7 more authors.
Archives of Internal Medicine | Year: 2011

Background: Previous studies demonstrated that intensive lifestyle modification can prevent type 2 diabetes mellitus among those with impaired glucose tolerance, but similar beneficial results have not been proved among those with impaired fasting glucose levels. We investigated the efficacy of lifestyle modification on type 2 diabetes incidence among those with impaired fasting glucose levels. Methods: The present study was an unmasked, multicenter, randomized, controlled trial. A total of 641 overweight Japanese (aged 30-60 years) with impaired fasting glucose levels were recruited nationwide in Japan and randomly assigned to a frequent intervention group (n=311) or a control group (n=330). For 36 months after randomization, the frequent intervention group received individual instructions and follow-up support for lifestyle modification from the medical staff 9 times. The control group received similar individual instructions 4 times at 12-month intervals during the same period. The primary outcome was type 2 diabetes incidence in annual 75-g oral glucose tolerance tests, diagnosed according to World Health Organization criteria. Results: There were no significant differences between the allocation groups in baseline characteristics and dropout rates. Estimated cumulative incidences of type 2 diabetes were 12.2% in the frequent intervention group and 16.6% in the control group. Overall, the adjusted hazard ratio in the frequent intervention group was 0.56 (95% confidence interval, 0.36-0.87). In the post hoc subgroup analyses, the hazard ratio reduced to 0.41 (95% confidence interval, 0.24-0.69) among participants with impaired glucose tolerance at baseline, and to 0.24 (0.12-0.48) among those with baseline hemoglobin A1c levels of 5.6% or more (the Japan Diabetes Society method). Such risk reduction was not observed among those with isolated impaired fasting glucose findings or baseline hemoglobin A1c levels of less than 5.6%. Conclusions: Lifestyle modifications can prevent type 2 diabetes among overweight Japanese with impaired fasting glucose levels. In addition, identifying individuals with more deteriorated glycemic status by using 75-g oral glucose tolerance test findings or, especially, measurement of hemoglobin A1c levels, could enhance the efficacy of lifestyle modifications. Trial Registration: umin.ac.jp/ctr Identifier: UMIN000001959. ©2011 American Medical Association. All rights reserved.


Ota Y.,Toranomon Hospital | Iihara K.,Social Insurance Chuo General Hospital | Ryu T.,Social Insurance Chuo General Hospital | Morikawa T.,University of Tokyo | Fukayama M.,University of Tokyo
International Journal of Clinical and Experimental Pathology | Year: 2013

Metastatic seminoma can potentially be confused with lymphoma in a lymph node biopsy. Here, we re-port a case in which the immunohistochemistry of CD10 was a pitfall in the differential diagnosis of a metastatic seminoma, and further present a brief study of CD10 expression in a seminoma series. A 67-year-old man, who had a history of lobectomy of the lung due to squamous cell carcinoma 2 years prior, showed lymphadenopathy of the neck and the paraaorta on follow-up study by fluorodeoxyglucose-positron emission computer tomography scan. The biopsy of the cervical node demonstrated infiltration of large atypical cells. The results of the screening immunohistochemistry were CD20(-), CD3(-), CD10(+), CD30(-), AE1/AE3(-), and placental alkaline phosphatase(-), providing the impression of CD10-positive lymphoma. However, the following studies revealed germ cell character-istics [OCT3/4(+), SALL4(+), and CLDN6(+)], confirming the diagnosis of seminoma. We further evaluated CD10 expression in a series of seminomas (n=16). Strong positivity was observed in 14 cases; partial and weak positivity, in 2 cases. These findings should be considered in the differential diagnosis of seminoma.


Yamazaki K.,RIKEN | Umeno J.,RIKEN | Umeno J.,Kyushu University | Takahashi A.,RIKEN | And 23 more authors.
Gastroenterology | Year: 2013

Background & Aims: Crohn's disease is an inflammatory bowel disease induced by multiple genetic and environmental factors. Genome-wide association studies have identified genetic factors that affect the risk for Crohn's disease in European populations, but information from other ethnic groups is scarce. We therefore investigated genetic factors associated with Crohn's disease in the Japanese population. Methods: We performed a genome-wide association study with 372 individuals with Crohn's disease (cases) and 3389 controls, all from the Japanese population. To confirm identified associations, we performed a replication study with an independent panel of 1151 Crohn's disease cases and 15,800 controls. We also performed an association analysis using genome-wide genotype imputation in the discovery cohort. Results: We confirmed associations of Crohn's disease with variants in MHC (rs7765379, P = 2.11 × 10 -59), TNFSF15 (rs6478106, P = 3.87 × 10-45), and STAT3 (rs9891119, P = 2.24 × 10-14). We identified 2 new susceptibility loci: on chromosome 4p14 (rs1487630, P = 2.40 × 10 -11; odds ratio, 1.33), and in the SLC25A15-ELF1-WBP4 region on 13q14 (rs7329174 in ELF1, P = 5.12 × 10-9; odds ratio, 1.27). Conclusions: In a genome-wide association study, we identified 2 new susceptibility loci for Crohn's disease in a Japanese population. These findings could increase our understanding of the pathogenesis of Crohn's disease. © 2013 AGA Institute.


Kanda G.,Social Insurance Chuo General Hospital | Ryu T.,Social Insurance Chuo General Hospital | Shirai T.,Social Insurance Chuo General Hospital | Ijichi M.,Social Insurance Chuo General Hospital | And 3 more authors.
Internal Medicine | Year: 2011

IgG4-related disease is a recently recognized fibroinflammatory disorder characterized by extensive IgG4-positive plasma cell and lymphocyte infiltration of various organs. The pancreatic manifestation of IgG4-related disease is called autoimmune pancreatitis (AIP), in which autoimmune mechanisms are likely involved. On the other hand, some autoimmune and chronic inflammatory disorders, such as Sjögren's syndrome and rheumatoid arthritis, are associated with increased risks of non-Hodgkin lymphoma (NHL). There have been a few reports of cases with IgG4-related disease that had subsequently developed NHL, however, all of them suffered from B-cell lymphoma. We describe the first case of NHL, compatible with a subtype of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), which arose in IgG4-related sclerosing cholangitis. As patients with IgG4-related disease may be at an increased risk of developing NHL, such presentation during the follow-up of IgG4-related disease should be carefully scrutinized to exclude NHL. © 2011 The Japanese Society of Internal Medicine.


Nishigaki M.,University of Tokyo | Tokunaga-Nakawatase Y.,University of Tokyo | Nishida J.,Social Insurance Chuo General Hospital | Kazuma K.,University of Tokyo
Journal of Genetic Counseling | Year: 2014

The aim of this study is to investigate the effect of diabetes genetic counseling on attitudes toward diabetes and its heredity in relatives of type 2 diabetes patients. This study was an unmasked, randomized controlled trial at a medical check-up center in Japan. Subjects in this study are healthy adults between 30 and 60 years of age who have a family history of type 2 diabetes in their first degree relatives. Participants in the intervention group received a brief genetic counseling session for approximately 10 min. Genetic counseling was structured based on the Health Belief Model. Both intervention and control groups received a booklet for general diabetes prevention. Risk perception and recognition of diabetes, and attitude towards its prevention were measured at baseline, 1 week and 1 year after genetic counseling. Participants who received genetic counseling showed significantly higher recognition about their sense of control over diabetes onset than control group both at 1 week and 1 year after the session. On the other hand, anxiety about diabetes did not change significantly. The findings show that genetic counseling for diabetes at a medical check center helped adults with diabetes family history understand they are able to exert control over the onset of their disease through lifestyle modification. © 2014 National Society of Genetic Counselors, Inc.


Okada Y.,Yokohama Institute | Okada Y.,University of Tokyo | Yamazaki K.,RIKEN | Umeno J.,RIKEN | And 14 more authors.
Gastroenterology | Year: 2011

Background & Aims: There are many genetic factors that are associated with both ulcerative colitis (UC) and Crohn's disease (CD). However, genetic factors that have distinct effects on UC and CD have not been examined. Methods: We performed a comparative genome-wide association study (GWAS) and a replication study using data from 748 patients with UC and 979 with CD, selected from a Japanese population. We conducted high-resolution (4-digit) genotyping of human leukocyte antigen (HLA) alleles in patients with UC and CD and additional 905 healthy individuals (controls). We performed haplotype-based analysis using data from the GWAS and HLA alleles to associate them with UC or CD. Results: The comparative GWAS and the replication study identified significant associations in the major histocompatibility complex region at 6p21 with UC and CD (rs9271366, P = 1.6 × 1070; odds ratio [OR] = 4.44). Haplotype-based analysis in the major histocompatibility complex region showed that HLA-Cw (*)1202-B (*)5201-DRB1 (*)1502 haplotype was significantly associated with increased risk of UC compared with CD (P = 1.1 × 10-33; OR = 6.58), accounting for most of the associations observed in the GWAS. Compared with the controls, this HLA haplotype significantly increases susceptibility to UC (P = 4.0 × 10-21; OR = 2.65), but reduces risk for CD (P = 1.1 × 10-7; OR = 0.40). Distinct effects of this HLA haplotype on UC and CD were independent of other HLA alleles and haplotypes (P = 2.0 × 10-19 and P = 7.2 × 10-5, respectively). Conclusions: The HLA-Cw (*)1202-B (*)5201-DRB1 (*)1502 haplotype increases susceptibility to UC but reduces risk for CD, based on a GWAS of a Japanese population. © 2011 AGA Institute.


PubMed | Social Insurance Chuo General Hospital, Oita University of Nursing and Health Sciences and University of Tokyo
Type: Journal Article | Journal: Journal of medical ultrasonics (2001) | Year: 2016

To assess the utility of transperineal three-dimensional (3D) ultrasound for diagnosing anal sphincter defects and evaluating the function of the anal canal in women with anal incontinence.The study subjects were 13 women with anal incontinence. Symptoms of fecal incontinence were assessed by Wexner score. The anal canal of each woman was examined ultrasonically with both a convex transperineal 3D scanner and a radial transanal scanner to compare the accuracy of the two approaches for diagnosis of anal sphincter defects. The anorectal angle and the length of the anal canal were also measured by utilizing the functionality of the transperineal 3D ultrasound.The mean age was 58.914.9years (SD), and the mean Wexner score was 8.45.6. In terms of ultrasound diagnosis of anal sphincter defects, the two methods showed consistent results in each woman. The length of the portion where both the internal and external anal sphincters were intact was significantly correlated with the Wexner score, whereas the total length of the anal canal was not.Less invasive transperineal 3D ultrasound provides accurate evaluation of the internal and external anal sphincters in women with anal incontinence, and the method is potentially useful for detection of anal sphincter abnormalities.


Arimura Y.,Sapporo Medical University | Isshiki H.,Sapporo Medical University | Onodera K.,Sapporo Medical University | Nagaishi K.,Sapporo Medical University | And 10 more authors.
Journal of Gastroenterology | Year: 2014

Background: There are substantial differences in inflammatory bowel disease (IBD) genetics depending on the populations examined. We aimed to identify Japanese population-specific or true culprit susceptibility genes through a meta-analysis of past genetic studies of Japanese IBD. Methods: For this study, we reviewed 2,703 articles. The review process consisted of three screening stages: we initially searched for relevant studies and then relevant single nucleotide polymorphisms (SNPs). Finally, we adjusted them for the meta-analysis. To maximize our chances of analysis, we introduced proxy SNPs during the first stage. To minimize publication bias, no significant SNPs and solitary SNPs without pairs were combined to be reconsidered during the third stage. Additionally, two SNPs were newly genotyped. Finally, we conducted a meta-analysis of 37 published studies in 50 SNPs located at 22 loci corresponding to the total number of 4,853 Crohn's disease (CD), 5,612 ulcerative colitis (UC) patients, and 14,239 healthy controls. Results: We confirmed that the NKX2-3 polymorphism is associated with common susceptibility to IBD and that HLA-DRB1*0450 alleles increase susceptibility to CD but reduce risk for UC while HLA-DRB1*1502 alleles increase susceptibility to UC but reduce CD risk. Moreover, we found individual disease risk loci: TNFSF15 and TNFα to CD and HLA-B*5201, and NFKBIL1 to UC. The genetic risk of HLA was substantially high (odds ratios ranged from 1.54 to 2.69) while that of common susceptibility loci to IBD was modest (odds ratio ranged from 1.13 to 1.24). Conclusions: Results indicate that Japanese IBD susceptibility loci identified by the meta-analysis are closely associated with the HLA regions. © 2013 Springer.


Hatada Y.,Social Insurance Chuo General Hospital
Gastroenterological Endoscopy | Year: 2010

Aphthoid ulceration has been regarded as an early macroscopic feature of Crohn's disease (CD) and ulcerative colitis (UC). The important endoscopic findings in this condition are (1) redness and/or white coated change of the ulceration, (2) elevation of the area around the aphthae, and (3) the distributions of the aphthae. Indigo carmine dye spraying is useful for the careful observation of such ulcers. The characteristic findings in the case of early lesions in CD are mild elevation with central depression of the affected surface or ulceration and longitudinal distribution of ulcers, but these findings are not unique to inflammatory bowel disease. Histological findings such as non-caseating epithelioid granulomas provide colonoscopists useful information for the diagnosis of CD. When only aphthous lesions are detected, it is necessary to confirm the diagnosis of IBD, especially CD, on the basis of findings in the upper gastrointestinal tract and small intestine and extraintestinal manifestations.

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