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Miki K.,Tokyo Medical and Dental University | Tomita M.,Tokyo Medical and Dental University | Kamata T.,Red Cross | Fujigasaki H.,Tokyo Metropolitan Bokutoh Hospital
Stroke | Year: 2013

BACKGROUND AND PURPOSE - : Prominent posterior cerebral artery (PCA) laterality upon 3-dimensional time-of-flight magnetic resonance angiography is often encountered in patients with middle cerebral artery occlusion. We hypothesized that this sign is correlated with improved functional outcome in patients with middle cerebral artery occlusion treated with intravenous recombinant tissue plasminogen activator. METHODS - : Fifty acute ischemic stroke patients with middle cerebral artery occlusion were treated with intravenous recombinant tissue plasminogen activator from April 2007 to October 2009. All patients routinely underwent initial (first 3 hours) magnetic resonance scans on admission, and additional follow-up (14-21 days after stroke onset) computed tomography scans. Two film readers blinded to all clinical information assessed the presence or absence of PCA laterality on magnetic resonance angiography. We retrospectively analyzed the clinical and radiologic data on all patients. RESULTS - : Out of 50 patients, 20 showed PCA laterality on magnetic resonance angiography. National Institute of Health Stroke Scale score 7 days after stroke onset was significantly lower (P=0.007), and infarct volume on follow-up computed tomography was significantly smaller (P=0.009) in patients with PCA laterality than in patients without this sign. Multivariate logistic regression analyses showed an adjusted odds ratio of 8.49 for a favorable outcome (modified Rankin Scale score 0-1 at 6 months) in patients with PCA laterality (95% CI: 1.82 to 55.8, P=0.005). CONCLUSIONS - : The presence of PCA laterality on magnetic resonance angiography before intravenous recombinant tissue plasminogen activator can be used as a predictor of favorable functional outcome in patients with middle cerebral artery occlusion, probably due to improvement of recanalization rate. © 2012 American Heart Association, Inc.


Aosaki T.,Tokyo Metropolitan University | Miura M.,Tokyo Metropolitan University | Suzuki T.,Tokyo Metropolitan Bokutoh Hospital | Nishimura K.,Juntendo University | Masuda M.,Tokyo Metropolitan University
Geriatrics and Gerontology International | Year: 2010

The imbalance between cholinergic activity and dopaminergic activity in the striatum causes a variety of neurological disorders, such as Parkinson's disease. During sensorimotor learning, the arrival of a conditioned stimulus reporting a reward evokes a pause response in the firing of the tonically active cholinergic interneurons in targeted areas of the striatum, whereas the same stimulus triggers an increase in the firing frequency of the dopaminergic neurons in the substantia nigra pars compacta. The pause response of the cholinergic interneurons begins with an initial depolarizing phase followed by a pause in spike firing and ensuing rebound excitation. The timing of the pause phase coincides well with the surge in dopaminergic firing, indicating that a dramatic rise in dopamine (DA) release occurs while nicotinic receptors remain unbound by acetylcholine. The pause response begins with dopamine D5 receptor-dependent synaptic plasticity in the cholinergic neurons and an increased GABAergic IPSP, which is followed by a long pause in firing through D2 and D5 receptor-dependent modulation of ion channels. Inactivation of muscarinic receptors on the projection neurons eventually yields endocannabinoid-mediated, dopamine-dependent long-term depression in the medium spiny projection neurons. Breakdown of acetylcholine-dopamine balance hampers proper functioning of the cortico-basal ganglia-thalamocortical loop circuits. In Parkinson's disease, dopamine depletion blocks autoinhibition of acetylcholine release through muscarinic autoreceptors, leading to excessive acetylcholine release which eventually prunes spines of the indirect-pathway projection neurons of the striatum and thus interrupts information transfer from motor command centers in the cerebral cortex. © 2010 Japan Geriatrics Society.


Tamura A.,Tokyo Metropolitan Bokutoh Hospital | Shida D.,National Cancer Center Hospital | Tsutsumi K.,Tokyo Metropolitan Bokutoh Hospital
BMC Surgery | Year: 2013

Background: Ventriculoperitoneal shunt (VPS) placement is an established procedure for the treatment of hydrocephalus of diverse etiologies in children and adults. Abdominal cerebrospinal fluid pseudocyst, which is potentially life threatening, is a rare complication and usually occurs during childhood. However, with increasing longevity following successful treatment, it can also occur in adults. Case presentation. Here we describe a 22-year-old man who was admitted to our hospital because of diffuse abdominal distention. A VPS was placed 21 years earlier to treat hydrocephalus secondary to spina bifida. Abdominal computed tomography (CT) revealed a homogeneous low-density fluid collection adjacent to the VPS catheter tip, causing stomach obstruction. Thus a peritoneal pseudocyst around VPS was suspected and emergency laparotomy was performed. The large mass was localized in the left upper abdomen between the stomach and mesentery of the transverse colon, exactly at the omental bursa. The cystic mass was opened and 1500 ml of clear fluid was drained; the distal end of the VPS was repositioned outside the mass. Thus, an abdominal cerebrospinal fluid pseudocyst as a complication of VPS was diagnosed. Conclusion: Gastroenterological surgeons should be aware of this possible complication, and this complication should be considered during differential diagnosis of an acute abdomen complaint. © 2013 Tamura et al.; licensee BioMed Central Ltd.


Miyahara H.,Tokyo Metropolitan Bokutoh Hospital | Shida D.,National Cancer Center Hospital | Matsunaga H.,Tokyo Metropolitan Bokutoh Hospital | Takahama Y.,Tokyo Metropolitan Bokutoh Hospital | Miyamoto S.,Tokyo Metropolitan Bokutoh Hospital
World Journal of Gastroenterology | Year: 2013

Emphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis and pneumoperitoneum is also rare. We herein describe a case of emphysematous cholecystitis with massive gas in the abdominal cavity. A 77-year-old male presented with epigastric pain and lassitude lasting for one week. A computed tomography scan demonstrated massive gas in the abdominal cavity. Gas was also detectable inside the gallbladder. Massive ascites as well as a pleural effusion were also detected. Under the diagnosis of perforation of the digestive tract, we performed emergency surgery. Beyond our expectations, the perforation site was not in the alimentary tract, but rather in the gallbladder. We then diagnosed the patient with emphysematous cholecystitis with perforation, and performed cholecystectomy. A pathological examination of the resected gallbladder revealed necrosis in the mucosa and thinning of the wall. Cultures of the ascites detected Clostridium perfringens, a gas-producing microorganism. © 2013 Baishideng. All rights reserved.


Sasaki N.,Tokyo Metropolitan Bokutoh Hospital | Mizutani S.,Tokyo Metropolitan Bokutoh Hospital | Kakuda W.,Jikei University School of Medicine | Abo M.,Jikei University School of Medicine
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

Background: Recently, high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and low-frequency rTMS (LF-rTMS) are reported to improve motor function significantly in chronic hemiparetic stroke patients. However, few studies have investigated the safety and efficacy of these rTMS modalities introduced during the early phase of stroke. The purpose of this study was to clarify the rTMS modality that is more beneficial for upper limb hemiparesis in the early phase of stroke using a randomized controlled trial. Methods: Twenty-nine patients with a hemispheric stroke lesion in the early phase of stroke were examined. Patients were randomly assigned into 3 groups: the HF-rTMS group (10 Hz rTMS to the lesional hemisphere [n = 9]), the LF-rTMS group (1 Hz rTMS to the nonlesional hemisphere [n = 11]), and the sham stimulation group [n = 9]). Patients received sessions for 5 consecutive days. Grip strength and tapping frequency were assessed before and after the intervention. Motor improvement of the affected upper limb after intervention was compared among the 3 groups. Results: All patients completed the 5-day protocol. Both the HF-rTMS and LF-rTMS groups had significant increases in both grip strength and tapping frequency. Comparison of the extent of improvement showed a more significant increase in grip strength and tapping frequency in the HF-rTMS group compared to the sham stimulation group (each P <.05), and no difference between the LF-rTMS group and the sham stimulation group. Conclusions: HF-rTMS applied to the lesional hemisphere in the early phase of stroke was more beneficial for motor improvement of the affected upper limb than LF-rTMS. © 2013 by National Stroke Association.


Ohyagi M.,Tokyo Metropolitan Bokutoh Hospital | Nakamura K.,Tokyo Metropolitan Bokutoh Hospital | Watanabe M.,Tokyo Metropolitan Bokutoh Hospital | Fujigasaki H.,Tokyo Metropolitan Bokutoh Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Left atrial appendage (LAA) thrombus is associated with atrial fibrillation (AF) and is a powerful predictor of cardiogenic thromboembolism. Warfarin is an established anticoagulant therapy for patients with LAA thrombus to prevent thromboembolic complications. Apixaban is superior to warfarin in the prevention of thromboembolic complications in patients with AF, and there are case reports showing apixaban-associated resolution of LAA thrombus; however, the efficacy and safety of apixaban for the treatment of LAA thrombus remains unproven. Here we report a patient who experienced embolic stroke while taking apixaban for the treatment of LAA thrombus. Thrombolysis therapy was initiated at the onset of stroke and the patient recovered remarkably. Apixaban is known to make thrombi mobile and/ or fragile by shifting the coagulation/fibrinolysis balance to a relative predominance of fibrinolytic activity; therefore, it is necessary to monitor for thromboembolic complications after the initiation of apixaban for the treatment of pre-existing LAA thrombus. © 2015 by National Stroke Association.


Fujiwara K.,Tokyo Metropolitan Bokutoh Hospital
Neurological Surgery | Year: 2014

Mild traumatic brain injuries, if repeated, can cause permanent brain damage, or even death I examined five published documents (three judicial decisions, one official injury report, and one book) to analyze incidents in which high school students who, while practicing judo, experienced acute subdural hematoma (ASDH) with grave outcomes, despite the fact that they had been examined by neurosurgeons. The five students, first-grade boy and girl of junior high school and two first-grade boys and one second-grade girl of senior high school, were hit on the head during extracurricular judo practice and were taken to the neurosurgery department of different hospitals. They were all novices or unskilled players The initial diagnoses were ASDH in three cases, concussion in one, and headache in one Although the surgeons, except in one case, prohibited the students from returning to play, the juveniles resumed judo practice soon Some of them complained of continued headaches, but they kept practicing Between 17 and 82 days after the first injury, they received the fateful hits to their heads, and they were brought to the emergency rooms MRI and CT revealed ASDH in all ; two of them died, and the other three remain in persistent vegetative state Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first.


Kobayashi K.,Tokyo Metropolitan Bokutoh Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2011

We encountered a patient with cold agglutinin disease (CAD) that worsened after Salmonella gastroenteritis. A 52-year-old male complained pain in the left fingers with cyanosis and was admitted in a local hospital. After treatment for ischemia, he demonstrated diarrhea with fever. Because of progressive anemia, he was referred to our hospital. Salmonella gastroenteritis was diagnosed based on the results of microbiological examination. Severe hemolysis was noted at admission, and Coombs test was positive (IgG-, C3d+). Cold agglutinin titer was elevated (x256). There were no findings of malignancy or infection demonstrating CA. A diagnosis of CAD with Salmonella gastroenteritis was made. Because spherocytosis was noted during admission, we measured the mean channel fluorescence (MCF) of eosin-5-maleimide (EMA) in erythrocytes from patients. MCF of EMA of the patient's erythrocytes was similar to that of normal subjects. Therefore, we concluded that coexisting hereditary spherocytosis was unlikely. We also examined the in vitro hemolytic effect of Salmonella infection on his blood and on blood from normal subjects. Treatment with Salmonella enteritidis isolated from this patient was found to induce hemolysis in the patient's blood, but not in blood from a normal subject. Moreover, treatment with Salmonella increased the titer of cold agglutinin in vitro. These data suggested that Salmonella infection might worsen hemolysis in CAD.


Ishikawa S.,Tokyo Metropolitan Bokutoh Hospital | Katayama Y.,Tokyo Metropolitan Bokutoh Hospital | Mishima H.,Tokyo Metropolitan Bokutoh Hospital | Ohnishi K.,Tokyo Metropolitan Bokutoh Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2013

A 71-year old male who underwent total aortic arch replacement using a newly developed uncoated vascular prosthesis (Triplex®) developed postoperative mediastinitis due to a methicillin-resistant Staphylococcus infection. The Triplex® vascular prosthesis has a unique three-layer structure with a non-porous elastomer middle layer material and has several advantages over more traditional prosthesis, namely, good manipulability, good patency, dilatation resistance, and low inflammatory tissue reaction. This is the first reported case of a postoperative prosthesis infection that was successfully treated by omentum wrapping and closed irrigation with triphenylmethane dye. Bacterial cultures of blood samples were negative throughout the course of treatment, and 8 months after the initial operation. Computer tomographs revealed no evidence of infection or anastomotic pseudoaneurysms. In conclusion, the combination of omentum wrapping and the closed irrigation procedure using triphenylmethane dye can be considered to be an effective treatment for Triplex® graft infection. © 2012 The Author.


Fujita H.,Tokyo Metropolitan Bokutoh Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2012

Polycythemia vera (PV) is characterized by low serum total cholesterol despite its association with vascular events such as myocardial and cerebral infarction. Serum cholesterol level has not been used as a diagnostic criterion for PV since the 2008 revision of the WHO classification. Therefore, we revisited the relationship between serum lipid profile, including total cholesterol level, and erythrocytosis. The medical records of 34 erythrocytosis patients (hemoglobin : men, > 18.5 g/dL ; women, > 16.5 g/dL) collected between August 2005 and December 2011 were reviewed for age, gender, and lipid profiles. The diagnoses of PV and non-PV erythrocytosis were confirmed and the in vitro efflux of cholesterol into plasma in whole blood examined. The serum levels of total cholesterol, low-density-lipoprotein cholesterol (LDL-Ch), and apolipoproteins A1 and B were lower in PV than in non-PV patients. The in vitro release of cholesterol into the plasma was greater in PV patients than in non-PV and non-polycythemic subjects. Serum total cholesterol, LDL-Ch, and apolipoproteins A1 and B levels are lower in patients with PV than in those with non-PV erythrocytosis. The hypocholesterolemia associated with PV may be attributable to the sequestration of circulating cholesterol into the increased number of erythrocytes.

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