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Nakata T.,Sapporo Medical University | Hashimoto A.,Sapporo Medical University | Matsuki T.,Steel Memorial Muroran Hospital | Yoshinaga K.,Hokkaido University | And 2 more authors.
International Journal of Cardiovascular Imaging | Year: 2013

Quantitative SPECT analysis contributes to the diagnostic and prognostic assessment of coronary artery disease. A novel automated scoring system (heart score view) can provide identical quantitative information to that determined by expert visual analysis. The aim of the present study is to evaluate the prognostic value of the automated SPECT scoring system when applied to stress thallium and resting beta-methyl-iodophenyl pentadecanoic acid (BMIPP) SPECT images. After a preliminary validation of the automated system by comparison with expert visual analyses, outcome data from 151 consecutive patients with suspected or known coronary artery disease without prior myocardial infarction were analyzed using automated SPECT scores on stress thallium and resting BMIPP images. The software quantified abnormalities as summed stress (SSS), summed rest and summed difference scores for stress thallium and as summed BMIPP scores (SBS). Cardiac events occurred over a period of 48 months in 29 (19.2 %) patients with diabetes mellitus, a lower left ventricular ejection fraction (LVEF) and more abnormal scores for thallium and BMIPP. Multivariate predictors of all cardiac events included diabetes mellitus and thallium SSS. The global Chi-square value was significantly increased when SSS was added to the clinical information (diabetes mellitus and LVEF). Negative predictive values of thallium SSS and SBS were almost identical at 84 % for all cardiac events and 98 % for hard cardiac events. Automatically quantified perfusion and BMIPP scores are related to cardiac events and these values can improve the risk stratification of coronary patients particularly when stress thallium imaging is combined with clinical information. © 2012 The Author(s).

Hayashi T.,Sapporo Medical University | Kawakami H.,Hokkaido University | Osanai M.,Center for Gastroenterology | Ishiwatari H.,Sapporo Medical University | And 7 more authors.
Clinical Gastroenterology and Hepatology | Year: 2015

Background & Aims: Endoscopic sphincterotomy (ES) is performed routinely before self-expandable metallic stents (SEMS) are placed in malignant distal biliary strictures to prevent postprocedural pancreatitis. However, it is not clear whether ES actually prevents pancreatitis or affects other adverse events (AEs). We conducted a noninferiority trial to examine the necessity of ES before SEMS placement. Methods: Two hundred patients with distal biliary strictures caused by unresectable pancreatic cancer were assigned randomly to groups that received ES or did not receive ES (non-ES) before SEMS placement, at 25 hospitals in Hokkaido, Japan, from August 2010 through November 2012. The primary outcome was early AEs (≤30 d) specifically related to the presence or absence of ES (pancreatitis, bleeding, or perforation). Secondary outcomes measured included the effect of ES omission on time to SEMS dysfunction and patient survival times. Results: The proportions of patients with early AEs were 9.2% in the non-ES group and 10.4% in the ES group (a difference of 1.2%, noninferior). The median times to SEMS dysfunction was longer than 594 days in the non-ES group and 541 days in the ES group (P= .88). The median overall survival times were 202 in the ES group vs 255 days in the non-ES group; P= .20). Conclusions: ES before SEMS does not affect the incidence of AEs, SEMS patency, or patient survival times. Our data provide no evidence for a benefit of ES to patients undergoing SEMS placement forabiliary stricture caused by pancreatic cancer. UMIN clinical trials registry number:000004044. © 2015 AGA Institute.

Kotani Y.,Steel Memorial Muroran Hospital | Takahata M.,Hokkaido University | Abumi K.,Hokkaido University | Ito M.,Hokkaido University | And 2 more authors.
Spine Journal | Year: 2013

Background context: In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. Purpose: We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. Study design: Case report and literature review. Patient sample: Two patients with combined OLF and OPLL. Outcome measures: Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. Methods: A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. Results: In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. Conclusions: We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Kazuno K.,Steel Memorial Muroran Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 78-year-old female presented with a chief complaint of palpitations. She was diagnosed with a large unruptured aneurysm of the sinus of Valsalva accompanying aortic regurgitation and right coronary artery ostial stenosis. When the aneurysm was resected following cardiac arrest, it was found to be an aneurysm with the right Valsalva sinus at the orifice. Root replacement was not required because there was no aortic annular dilatation. Patch closure as well as aortic valve replacement were conducted. The right coronary artery was diverged from the aneurysm and the aperture thereof was severely stenosed. Therefore, bypass surgery was additionally conducted. Postoperative course was uneventful. An unruptured aneurysm of the sinus of Valsalva, which is a relatively rare disease, is asymptomatic in many cases and tends to have grown large when found. Because the postoperative results were relatively good, we believe that surgery should be performed at an early stage in order to avoid rupture.

Ikeda K.,Steel Memorial Muroran Hospital | Baba T.,Sapporo Medical University | Morishita M.,Sapporo Medical University | Honnma H.,Kamiya Ladies Clinic Sapporo | And 3 more authors.
Journal of Ovarian Research | Year: 2014

Background: Hyperandrogenism is the primary manifestation of polycystic ovary syndrome (PCOS), which appears to be caused by excess exposure to androgen. As such, androgenized animal models have been developed and investigated to study the etiology of PCOS. Anti-Mullerian hormone (AMH) is known to be associated with follicle growth, and its levels are two to three times higher in women with PCOS than in those with normal ovaries. We studied how duration of androgen administration affects folliculogenesis and AMH expression. Methods. We divided 30 immature (3-week-old) Sprague Dawley rats into six groups. Three groups were injected each evening with dehydroepiandrosterone (DHEA) (6 mg/100 g body weight/0.2 ml sesame oil) for 7, 15 or 30 days, respectively. The three control groups were injected with 0.2 ml of sesame oil for the corresponding lengths of time. Resected ovaries were sectioned and examined to determine follicle numbers at each developmental stage, and immunostained to assess AMH expression. Results: On day 7, follicle numbers and AMH expression levels at each developmental stage of follicle growth were similar in the respective control and DHEA groups. On day 15, the total follicle number (P = 0.041), the percentage of primordial follicles (P = 0.039) and AMH expression were significantly greater in the DHEA than the control group. On day 30, the percentages of primordial (P = 0.005), primary (P = 0.0002) and atretic (P = 0.03) follicles were significantly greater in the DHEA group, whereas the percentage of intermediary follicles (early pre-antral, late preantral, and early antral follicles) was significantly lower in the DHEA group (P = <0.0001). AMH expression in DHEA-treated rats on day 30 was seen exclusively in the primordial (P = 0.0413) and late antral follicles (p = 0.028). Conclusions: Androgen administration increases AMH production in a process that regulates the growth of primordial follicles. That is, androgen-induced AMH expression provides local negative feedback to folliculogenesis augmented by androgen. © 2014 Ikeda et al.; licensee BioMed Central Ltd.

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