Social Insurance Kinan Hospital

Medicine, Japan

Social Insurance Kinan Hospital

Medicine, Japan

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Otsuka K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Social Insurance Kinan Hospital | Nakanishi K.,Osaka City University | And 4 more authors.
JACC: Cardiovascular Imaging | Year: 2013

Objectives: The aim of this study was to determine the predictive value of the napkin-ring sign on coronary computed tomography angiography (CTA) for future acute coronary syndrome (ACS) events in patients with coronary artery disease. Background: Recent studies have reported a close association between the napkin-ring sign on coronary CTA and thin-cap fibroatheroma. Methods: The subjects of this prospective study were 895 consecutive patients who underwent coronary CTA examination and were followed for >1 year. The primary endpoint was an ACS event (cardiac death, nonfatal myocardial infarction, or unstable angina pectoris). The coronary CTA analysis included the presence of obstructive plaque, positive remodeling (PR), low-attenuation plaque (LAP), and the napkin-ring sign. The napkin-ring sign was defined by the following criteria: 1) the presence of a ring of high attenuation around certain coronary artery plaques; and 2) attenuation of the ring presenting higher than those of the adjacent plaque and no >130 Hounsfield units. Results: Of the 12,727 segments, 1,174 plaques were observed, including plaques with PR in 130 segments (1.0%), LAP in 107 segments (0.8%), and napkin-ring signs in 45 segments (0.4%). Thirty-six of the 45 plaques with napkin-ring signs (80%) overlapped with those showing either PR or LAP. During the follow-up period (2.3 ± 0.8 years), 24 patients (2.6%) experienced ACS events, and plaques developed in 41% with a napkin-ring sign. Segment-based Cox proportional hazards models analysis showed that PR (p < 0.001), LAP (p = 0.007), and the napkin-ring sign (p < 0.0001) were independent predictive factors for future ACS events. Kaplan-Meier analysis demonstrated that plaques with napkin-ring signs showed a higher risk of ACS events compared with those without a napkin-ring sign. Conclusions: The present study demonstrated for the first time that the napkin-ring sign demonstrated on coronary CTA was strongly associated with future ACS events, independent of other high-risk coronary CTA features. Detection of the napkin-ring sign could help identify coronary artery disease patients at high risk of future ACS events. © 2013 American College of Cardiology Foundation.


Nakanishi K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Nishinomiya Watanabe Cardiovascular Center | Otsuka K.,Osaka City University | And 5 more authors.
Circulation Journal | Year: 2012

Background: Atrial fibrillation (AF) is associated with considerable morbidity and mortality in patients with coronary artery disease (CAD). Epicardial adipose tissue (EAT) is recognized as an important inflammatory tissue that may exert deleterious effects on the adjacent left atrial (LA) wall. Multidetector computed tomography (MDCT) can accurately assess EAT's volume and distribution. This study used MDCT to investigate the effect of peri-atrial EAT on new-onset nonvalvular AF. Methods and Results: The study group consisted of 279 patients (176 men; age, 65±10 years) with no history of AF who underwent MDCT examination for evaluation of CAD. EAT was automatically identified on the basis of threshold attenuation values of -30 to -250 Hounsfield units. EAT volume was calculated as the sum of EAT area and subsequently divided into peri-atrial and peri-ventricular EAT. During follow-up of 3.3±1.0 years, AF occurred in 17 (6.1%) patients. Cox proportional hazards regression analysis indicated that male sex, and the LA and periatrial EAT volumes (P=0.03, P<0.001, and P<0.001, respectively) were independent predictors for future AF. The sensitivity and specificity for the prediction of AF using a peri-atrial EAT volume index of ≥27ml/m2 were 88% and 92%, respectively. Conclusions: This is the first study demonstrating that peri-atrial EAT volume estimated by MDCT excellently predicted the development of new-onset AF in patients with CAD, independent of LA enlargement.


Otsuka K.,Osaka University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Social Insurance Kinan Hospital | Nakanishi K.,Osaka University | And 4 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014

AimsIncreasing clinical evidence has emphasized the importance of coronary plaque characteristics, rather than the severity of luminal narrowing on acute coronary syndrome (ACS) outcome. Computed tomographic coronary angiography (CTCA) is a unique, non-invasive approach for assessing plaque characteristics. This study was prospectively designed to investigate the prognostic value of physiologically non-obstructive but a vulnerable coronary plaque on CTCA for predicting future ACS events.Methods and resultsThis study consisted of 543 patients who had undergone CTCA and had normal findings on exercise-stress myocardial perfusion single-photon emission computed tomography. CTCA analysis included the presence of >50% luminal stenosis and vulnerable features including positive remodelling (PR), low-Attenuation plaque, and ring-like sign. The primary endpoint was ACS events including cardiac death, non-fatal myocardial infarction, and unstable angina. The mean follow-up period was 3.4 ± 0.8 years. The 3-year cumulative event rate was 1.2% per year, and 87% of ACS events occurred in plaques with at least one of vulnerable features. In patient-based multivariate analysis, the presence of plaque with vulnerable features on CTCA was a significant predictor for future ACS events (P = 0.001). Patients with vulnerable plaque had worse ACS outcomes compared with those without vulnerable plaques (3-year cumulative event rate; 3.2 per year vs. 0.8%, P < 0.001).ConclusionThis study demonstrated that physiologically non-obstructive but vulnerable coronary plaques were associated with future ACS events. We should pay more attention to currently non-obstructive plaque but showing vulnerable morphologies on CTCA. © The Author 2013.


Tatsuno M.,Social Insurance Kinan Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 58-year-old man was given a diagnosis of urachal carcinoma and underwent a partial cystectomy with enbloc removal of the tumor and radical lymphadenectomy in 2006. In April 2009 he was admitted to our hospital because of hemoptysis and left chest pain. Chest CT showed a 4-cm mass shadow in the left S3 and nodular shadows in the right S1 and left S10. Flexible bronchoscopy demonstrated a tumorous lesion at the orifice of the left B3 bronchus. Although the cytological diagnosis suggested high-grade adenocarcinoma, the tumor was producing mucin and consisted of cells with anisonucleosis, which is not typical of primary lung adenocarcinoma. We then performed immunohistochemical and histological examination of a transbronchial lung biopsy specimen. The histological findings of the specimen were very similar to those of the previously resected urachal carcinoma. In addition, the tumor cells were negative for thyroid transcription factor-1 and surfactant precursor protein B, which are specific to primary lung adenocarcinoma. We therefore diagnosed metastatic pulmonary cancer from urachal carcinoma, which is a rare manifestation in bladder cancer. We report a rare case of metastatic pulmonary cancer from urachal carcinoma that required differentiation from primary lung adenocarcinoma in addition to a discussion of the literature.


Kitano N.,Wakayama Medical University | Suzuki H.,Wakayama Medical University | Takeuchi T.,Wakayama Medical University | Suenaga T.,Wakayama Medical University | And 4 more authors.
Journal of Epidemiology | Year: 2014

Background: To clarify the contribution of patient age to the development of coronary artery lesions (CALs) associated with Kawasaki disease (KD), epidemiologic features and prognostic factors were investigated using hospital-based complete enumeration surveys in a specific area. Methods: Consecutive KD cases identified between October 1999 and September 2012 in Wakayama Prefecture, Japan, were analyzed. The primary outcome measure was the presence/absence of CALs (giant aneurysm, mid- or small-sized aneurysm, and dilatation) on echocardiography 1 month after disease onset. Demographics and medical treatment factors were compared between the patients with and without CALs. Odds ratios (ORs) and 95% confidence intervals (CIs) of explanatory variables (age, gender, and factors related to high-dose intravenous immunoglobulin treatment) for the development of CALs were determined. Results: The median age of the 1415 patients (796 males, 619 females) was 25 months after excluding 2 children of foreign residents; 2.2% of the patients had a past history of KD, and 1.8% showed incomplete presentation. CALs were observed in 3.3% (4.0% of males, 2.3% of females; P = 0.080). The ORs of CALs among patients <11 months old (3.0, 95% CI 1.4-6.6) and those >48 months old (3.1, 95% CI 1.5-6.6) were significantly higher than values in 11- to 48-month-olds. Conclusions: The effect of patient age on the development of CALs was found to be U-shaped, with the bottom at ages 11 to 48 months. This finding was based on a 13-year cohort of consecutive KD cases in a specific area with little selection bias and is consistent with previously reported results. © 2014 Naomi Kitano et al.


Tamura T.,Social Insurance Kinan Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

The patient was a 70-year-old woman. She was admitted to our hospital complaining of fever and dyspnea. Chest CT scan showed a 50 x 30-mm tumorous shadow in S6 of the left lung and honeycomb lung in both lower lobes. As the result of cytodiagnosis with ultrasonic echo, adenocarcinoma was diagnosed. Clinical stage was IIIA (T3N2M0). We selected carboplatin and paclitaxel with bevacizumab as first-line chemotherapy, but at 7 days after the initiating it, the chest X-ray showed left pneumothorax. A chest drainage tube was placed in the left thoracic cavity. The patient was treated repeatedly pleurodesis with minocycline and OK-432. The pneumothorax required 3 weeks to cure. We selected carboplatin and paclitaxel without bevacizumab for the second course, and the pneumothorax did not recur. Pneumothorax was a serious adverse event associated with bevacizumab-containing chemotherapy. It is necessary to be aware of the possibility of pneumothorax when we treat lung adenocarcinoma with bevacizumab-containing chemotherapy.


Komukai K.,Wakayama Medical University | Kubo T.,Wakayama Medical University | Kitabata H.,Wakayama Medical University | Matsuo Y.,Wakayama Medical University | And 16 more authors.
Journal of the American College of Cardiology | Year: 2014

Background The detailed mechanism of plaque stabilization by statin therapy is not fully understood. Objectives The aim of this study was to assess the effect of lipid-lowering therapy with 20 mg/day of atorvastatin versus 5 mg/day of atorvastatin on fibrous cap thickness in coronary atherosclerotic plaques by using optical coherence tomography (OCT). Methods Seventy patients with unstable angina pectoris and untreated dyslipidemia were randomized to either 20 mg/day or 5 mg/day of atorvastatin therapy. OCT was performed to assess intermediate nonculprit lesions at baseline and 12-month follow-up. Results Serum low-density lipoprotein cholesterol level was significantly lower during therapy with 20 mg/day compared with 5 mg/day of atorvastatin (69 mg/dl vs. 78 mg/dl; p = 0.039). The increase in fibrous cap thickness was significantly greater with 20 mg/day compared with 5 mg/day of atorvastatin (69% vs. 17%; p < 0.001). The increase in fibrous cap thickness correlated with the decrease in serum levels of low-density lipoprotein cholesterol (R = -0.450; p < 0.001), malondialdehyde-modified low-density lipoprotein (R = -0.283; p = 0.029), high-sensitivity C-reactive protein (R = -0.276; p = 0.033), and matrix metalloproteinase-9 (R = -0.502; p < 0.001), and the decrease in grade of OCT-derived macrophages (R = -0.415; p = 0.003). Conclusions Atorvastatin therapy at 20 mg/day provided a greater increase in fibrous cap thickness in coronary plaques compared with 5 mg/day of atorvastatin. The increase of fibrous cap was associated with the decrease in serum atherogenic lipoproteins and inflammatory biomarkers during atorvastatin therapy. (Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography: The EASY-FIT Study; NCT00700037) © 2014 American College of Cardiology Foundation.


Komasawa N.,Osaka Medical College | Ueki R.,Hyogo College of Medicine | Kaminoh Y.,Social Insurance Kinan Hospital | Nishi S.-I.,Hyogo College of Medicine
American Journal of Perinatology | Year: 2015

ObjectiveRecent guidelines for neonatal cardiopulmonary resuscitation emphasize the importance of adequate ventilation. In cases of failed resuscitation with positive pressure ventilation, tracheal intubation and chest compressions are recommended. The present study compared the utility of the Miller laryngoscope (Mil) and the videolaryngoscope Pentax-AWS Airway Scope (AWS; Hoya, Tokyo, Japan) with an infant or neonatal-sized Intlock (AWS-N; Pentax) during chest compressions on a neonatal manikin. Study DesignA total of 23 novice doctors performed tracheal intubation on a neonatal manikin using the Mil and AWS-N, with or without chest compressions. ResultsIn the Mil trials, all participants secured the airway without chest compressions, but nine failed with compressions (p<0.001). In AWS-N trials, all participants succeeded regardless of whether chest compressions were performed or not. Intubation time was significantly longer with chest compressions with the Mil (p<0.001), but not with the AWS-N. Laryngoscopy difficulty, as assessed by a visual analog scale (VAS), increased significantly with chest compressions with the Mil, but not with the AWS-N, while the VAS for tube passage through the glottis increased with compressions with the Mil, but not with the AWS-N. ConclusionThe AWS-N is an effective device for endotracheal intubation during chest compressions in neonatal simulations performed by novice doctors. © 2015 Elsevier Ltd.All rights reserved.


Komasawa N.,Osaka Medical College | Ueki R.,Hyogo College of Medicine | Kaminoh Y.,Social Insurance Kinan Hospital | Nishi S.-I.,Hyogo College of Medicine
Journal of Anesthesia | Year: 2014

Results: Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18).Conclusions: This simulation study revealed the utility of intubating SGDs for airway management during chest compression.Purpose: In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i® (aura-i), air-Q® (air-Q), i-gel® (i-gel), and Fastrack® (Fastrack), during cardiopulmonary resuscitation using a manikin.Methods: Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded. © 2014, Japanese Society of Anesthesiologists.


Sakagoshi N.,Social Insurance Kinan Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011

The blood spurting from the ascending aorta is uncomfortable for cardiac surgeons. To protect the surgeons' faces from this spurting blood, we use a longitudinal half of a plastic bottle, which is semi see-through. While the assistant is holding this device above the ascending aorta, the surgeons can proceed the operation with good surgical view.

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