Takeda Hospital

Takedamachi, Japan

Takeda Hospital

Takedamachi, Japan
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Yamamoto Y.,Kyoto Katsura Hospital | Nagakane Y.,Red Cross | Tomii Y.,Kyoto Katsura Hospital | Toda S.,Kyoto Katsura Hospital | Akiguchi I.,Takeda Hospital
Journal of Neurology | Year: 2017

As the corticospinal tracts cross the lenticulostriate artery (LSA) territory at the posterior segment, we hypothesized that posteriorly located infarctions of the LSA may be associated with progressive motor deficits. We prospectively studied 519 consecutive patients with LSA infarctions who entered our hospital within 24 h after onset. We categorized patients into two groups in terms of progress: no progress and progress. Progress was defined as worsening by 1 point or more in the National Institutes of Health Stroke Scale (NIHSS), some of which recovered afterward or thoroughly progressed. LSA infarctions on the first DWI were divided into proximal type and distal (group 1) type. The proximal type was further divided into anterior (group 2), intermediate (group 3) and posterior (group 4) type according to the middle point of antero-posterior diameter of the lateral ventricle. There were 109 patients who showed progress that accounted for 21.0% of all patients. The number of patients who progressed is as follows: distal type 65 (23.8%), anterior type 31 (36.0%), intermediate type 26 (56.5%) and posterior type 97 (85.0%). The Cochran–Armitage test showed a significant increase through group 1 to group 4 (p < 0.0001). Independent predictive factors for progress were male (OR 0.57, p = 0.0107), higher NIHSS on admission (≥4) (OR 3.02, p < 0.0001), intermediate proximal type (OR 3.3, p = 0.0007) and posterior proximal type (OR 16.4, p < 0.0001). The more posterior the infarct location, the more frequent was the progress that occurred, probably due to the anatomical fact that corticospinal tracts crossed the LSA territory at the posterosuperior quadrant. © 2017 Springer-Verlag Berlin Heidelberg


Watanabe T.,Uji Takeda Hospital | Watanabe T.,Shiga University of Medical Science | Shiino A.,Shiga University of Medical Science | Akiguchi I.,Uji Takeda Hospital | Akiguchi I.,Takeda Hospital
Neurobiology of Learning and Memory | Year: 2012

In patients with amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD), previous studies have reported the decrease of N-acetylaspartate (NAA) concentration and the increase of myo-inositol (MI) concentration using proton magnetic resonance spectroscopy (1H-MRS). However, it remains to be investigated what aspects of cognition these metabolite changes reflect. In this study we evaluated the correlations between the subtests of Wechsler Memory Scale-Revised (WMS-R) and the concentrations of NAA and MI. The study group was composed of 42 patients with aMCI and 67 patients with AD. 1H-MR spectra with a single voxel-point resolved spectroscopy (PRESS) at a short echo time were acquired from the bilateral hippocampi and posterior cingulate gyrus. Positive correlations were shown between the NAA concentration in the left hippocampus and verbal memory, visual memory, general memory, attention and delayed recall; and furthermore, between the NAA concentration in the right hippocampus and verbal memory and general memory. Negative correlations were shown between the MI concentration in the left hippocampus and verbal memory, general memory, and delayed recall, and between the MI concentration in the right hippocampus and verbal memory. There was no significant correlation between any subtest of WMS-R and these two metabolite concentrations in the posterior cingulate gyrus. These findings suggest that bilateral, especially left hippocampal NAA and MI concentrations are associated with memory dysfunction observed in patients with aMCI and AD. In contrast, NAA and MI concentrations in the posterior cingulate gyrus may be less related to memory function than those in the hippocampus. © 2012 Elsevier Inc.


Takeuchi H.,National Hospital Organization Minami Kyoto National Hospital | Kawasaki T.,Takeda Hospital | Shigematsu K.,National Hospital Organization Minami Kyoto National Hospital | Kawamura K.,National Hospital Organization Minami Kyoto National Hospital | Oka N.,National Hospital Organization Minami Kyoto National Hospital
Clinical Rheumatology | Year: 2017

To clarify the roles of neutrophils in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitic neuropathy, we studied neutrophil extracellular traps (NETs) in peripheral nerve vasculitis. Stored nerve samples from 17 patients with microscopic polyangiitis (MPA) were immunohistochemically analyzed using antibodies for citrullinated histone H3 (citH3) and various neutrophil enzymes. We defined merged citH3 and extracellularly released myeloperoxidase (MPO) as NET formation. We also compared NET formation between MPO-ANCA-positive/negative MPA and rheumatoid arthritis (RA)-associated vasculitic neuropathy. NETs were identified mostly in vasculitic small arterioles of 6 of 12 MPO-ANCA-positive MPA patients, and their frequency was higher (p < 0.05) than in ANCA-negative patients. NETs were not found in vasculitic neuropathy with RA or patients with chronic inflammatory demyelinating polyradiculoneuropathy. NETs were also observed in the peripheral nervous system of MPA patients as well as in the lung and kidney. These results suggest that NETs may be involved in the pathogenesis of MPA neuropathy. © 2017 International League of Associations for Rheumatology (ILAR)


Kageyama T.,Tenri Hospital | Komori M.,Kyoto University | Miyamoto K.,Kinki University | Ozaki A.,Kitano Hospital | And 6 more authors.
Journal of Neurology | Year: 2013

Neuromyelitis optica (NMO) and associated NMO spectrum disorders (NMOSDs) are neuroinflammatory diseases that frequently result in severe neurological disabilities. The aim of this study was to explore additional treatment options for NMO/NMOSD patients who are seropositive for anti-aquaporin 4 (AQP4) antibodies. We retrospectively evaluated the efficacy of immunosuppressants for NMO/NMOSDs by reviewing the clinical records of 52 patients confirmed as seropositive for anti-AQP4 antibodies. Of the 52 patients, 26 (23 women, three men) had received at least one kind of immunosuppressant other than corticosteroids. After eliminating ineligible cases, we evaluated the following 24 treatments in 22 patients (20 women, two men) that used azathioprine (AZA) (n = 9), cyclophosphamide (n = 1), cyclosporine A (CyA) (n = 9), tacrolimus (n = 2), methotrexate (n = 1), and mizoribine (n = 2). Both AZA and CyA treatments allowed us to decrease the median dose of the coadministered prednisone without affecting the expanded disability severity scale scores. In patients with relapsing-remitting courses, the annual relapse rate decreased from 1.7 (1.2-2.7) to 0.47 (0.36-0.59) after AZA treatments (n = 6, P = 0.028), and also showed a significant decrease from 2.7 (1.8-4.3) to 0.38 (0-0.97) after CyA treatment (n = 8, P = 0.012). These results indicate that CyA as well as AZA may help stabilize the disease activity in NMO/NMOSD patients seropositive for anti-AQP4 antibodies. This is the first case series study demonstrating the efficacy of CyA for the treatment of NMO/NMOSDs. © 2012 Springer-Verlag Berlin Heidelberg.


Watanabe T.,Uji Takeda Hospital | Watanabe T.,Shiga University of Medical Science | Shiino A.,Shiga University of Medical Science | Akiguchi I.,Uji Takeda Hospital | Akiguchi I.,Takeda Hospital
Dementia and Geriatric Cognitive Disorders | Year: 2010

Background/Aims: Amnesic mild cognitive impairment (aMCI) is thought to represent a transitional state between healthy aging and very mild Alzheimer's disease (AD). It is very important to diagnose aMCI for early treatment. In order to investigate biochemical changes in aMCI, we measured metabolite concentrations using proton magnetic resonance spectroscopy (1H-MRS) from patients with aMCI and compared the results with healthy controls (HCs) and patients with AD. Methods: The subjects were 52 HCs, 70 AD patients and 47 aMCI patients. 1H-MR spectra with single-voxel point-resolved spectroscopy at a short echo time (TE) were acquired from 8 volumes of interest in the brain. Results: The bilateral hippocampal N-acetylaspartate (NAA) concentrations from aMCI patients showed intermediate values, which were lower than those from HC subjects but higher than those from AD patients. The patients with aMCI also had lower concentrations of NAA than HCs in the bilateral posterior periventricular and deep white matters (PDWM) and posterior cingulate gyrus and had lower levels of choline compounds in the left posterior PDWM. Conclusion: Using a single-voxel 1H-MRS at a short TE, we revealed that absolute quantification is useful to detect the characteristic patterns of metabolite concentrations in patients with aMCI as compared with AD patients and HCs. Copyright © 2010 S. Karger AG, Basel.


Veda Y.,Takeda Hospital
Japanese Journal of Clinical Radiology | Year: 2013

Non-contrast MR venography with Time-SLIP (time-spatial labeling inversion pulse) were performed in 24 patients and 29 healthy volunteers to assess left ovarian vein reflux. This MR imaging method that demonstrated left ovarian vein in 76.2% and the reflux in 31.3% is thought to be one of noninvasive technique that allows visualization of left ovarian vein reflux.


Chiba N.,Takeda Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

We report 2 patients with lung cancer accompanied by active pulmonary tuberculosis. Case1 was a 82-year-old woman with stage I A bronchioloalveolar carcinoma and tuberculosis in right upper lobe. Right upper lobectomy was performed after the histological diagnosis of lung cancer by intraoperative frozen section. Case2 was a 69-year-old man with papillary adenocarcinoma in right lower lobe and tuberculosis in bilateral upper lobe. Partial resection in right lower lobe was performed for diagnosis of lung cancer. Smear-positive tuberculosis was diagnosed by sputum examination after the operation. Post-operative anti-tuberculosis chemotherapy was added in both patients.


Shiino A.,Shiga University of Medical Science | Watanabe T.,Takeda Hospital | Shirakashi Y.,Shiga University of Medical Science | Kotani E.,Shiga University of Medical Science | And 4 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2012

Alzheimer's disease (AD) and subcortical ischemic vascular dementia (SIVD) have overlapping pathologies and risk factors, but their underlying neurodegenerative mechanisms are basically different. We performed magnetic resonance spectroscopy (MRS) to study metabolite differences between the two diseases in vivo. The subjects were 31 patients with SIVD and 99 with AD. Additionally, 45 elderly subjects were recruited as controls. We measured N-acetylaspartate (NAA), glutamine and glutamate (Glx), and myoinositol (mIns) concentration quantitatively using a 1.5-T MR scanner. N-acetylaspartate and Glx concentrations decreased in the hippocampus and cingulate/precuneal cortices (PCC) in both AD and SIVD patients, and the NAA decrease in the hippocampus was more prominent in AD than in SIVD. Interestingly, the pattern of mIns concentration changes differed between the two disorders; mIns was increased in AD but not increased in SIVD. If one differentiates between AD and SIVD by the mIns concentration in the hippocampus, the area under the receiver operating characteristic curve was 0.95, suggesting a high potential for discrimination. Our results suggest that proton MRS can provide useful information to differentiate between AD and SIVD. The difference of mIns concentrations in the hippocampus and PCC seems to reflect the different neurodegenerative mechanisms of the two disorders. © 2012 ISCBFM All rights reserved.


Oka N.,Nho Minami Kyoto National Hospital | Kawasaki T.,Takeda Hospital | Matsui M.,Nho Utano National Hospital | Shigematsu K.,Nho Minami Kyoto National Hospital | And 2 more authors.
Modern Rheumatology | Year: 2011

The aim of this study was to clarify the differences in the pathogenesis of neuropathy between myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-positive and -negative patients with Churg-Strauss syndrome (CSS). Eight MPO-ANCA-positive and 14 MPO-ANCA-negative patients were included. In addition to the standard histology, nerve biopsies were examined, employing immunohistochemistry for eosinophil major basic protein and electron microscopy. The groups did not differ significantly in clinical profiles, including the peak disability score and number of blood eosinophils. In nerve biopsies, necrotizing vasculitis was found in 63% (5/8) of the ANCA-positive and 21% (3/14) of the ANCA-negative patients. Fibrinoid necrosis of vessel walls was noted in 4 ANCA-positive patients (50%), and in one ANCA-negative patient (p = 0039). In contrast, a large number of eosinophilic infiltrations in the epineurium was shown in 36% (5/14) of the ANCA-negative patients, with no eosinophilic infiltrations shown in ANCA-positive patients. In 3 ANCA-negative patients, endoneurial eosinophils were seen where focal axonal loss and capillary dilatation were occasionally noted. There may be 2 pathogenetic mechanisms of neuropathy with CSS: ANCA-related vascular fibrinoid necrosis, and a toxic eosinophilic effect on nerve fibers which is independent of ANCA. Therapy targeting activated eosinophils may be a possible treatment for intractable neuropathy of CSS. © 2010 Japan College of Rheumatology.


PubMed | Takeda Hospital and National Hospital Organization Minami Kyoto National Hospital
Type: | Journal: Clinical rheumatology | Year: 2017

To clarify the roles of neutrophils in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitic neuropathy, we studied neutrophil extracellular traps (NETs) in peripheral nerve vasculitis. Stored nerve samples from 17 patients with microscopic polyangiitis (MPA) were immunohistochemically analyzed using antibodies for citrullinated histone H3 (citH3) and various neutrophil enzymes. We defined merged citH3 and extracellularly released myeloperoxidase (MPO) as NET formation. We also compared NET formation between MPO-ANCA-positive/negative MPA and rheumatoid arthritis (RA)-associated vasculitic neuropathy. NETs were identified mostly in vasculitic small arterioles of 6 of 12 MPO-ANCA-positive MPA patients, and their frequency was higher (p<0.05) than in ANCA-negative patients. NETs were not found in vasculitic neuropathy with RA or patients with chronic inflammatory demyelinating polyradiculoneuropathy. NETs were also observed in the peripheral nervous system of MPA patients as well as in the lung and kidney. These results suggest that NETs may be involved in the pathogenesis of MPA neuropathy.

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