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Fukamizu S.,Tokyo Metropolitan Hiroo Hospital | Sakurada H.,Tokyo Metropolitan Health and Medical Treatment Corporation | Hayashi T.,Tokyo Metropolitan Hiroo Hospital | Hojo R.,Tokyo Metropolitan Hiroo Hospital | And 6 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2013

Introduction: Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation; however, few reports describe left atrial MRAT involving the regions of spontaneous scarring. Here, we describe left atrial MRAT in patients without prior cardiac surgery or catheter ablation (CA) and discuss the clinical and electrophysiological characteristics of tachycardia and outcome of CA. Methods and Results: An electrophysiological study and CA were performed in 6 patients (3 men; age 76 ± 6 years) with MRAT originating from the left atrial anterior wall (LAAW). No patient had a history of cardiac surgery or CA in the left atrium. Spontaneous scars (areas with bipolar voltage ≤ 0.05 mV) were observed in all patients. The activation map showed a figure-eight circuit with loops around the mitral annulus (4 counterclockwise and 2 clockwise) and a low-voltage area with LAAW scarring. The mean tachycardia cycle length was 303 ± 49 milliseconds. The conduction velocity was significantly slower in the isthmus between the scar in the LAAW and the mitral annulus than in the lateral mitral annulus (0.17 ± 0.05 m/s vs 0.94 ± 0.35 m/s; P = 0.003). Successful ablation of the isthmus caused interruption of the tachycardia and rendered it noninducible in all patients. Conclusion: Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure-eight configuration. Radiofrequency CA is a feasible and effective treatment in such cases. © 2012 Wiley Periodicals, Inc.


Matsumoto A.,Tokyo Metropolitan Hiroo Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

A 70-year-old man was admitted to our hospital for examination of an abnormal shadow found on a chest radiograph. Chest CT showed a nodular shadow in the left upper lobe S1+2. We diagnosed non-small cell lung cancer (squamous cell carcinoma) clinical stage T4N2M1. Chemotherapy consisting of carboplatin and weekly paclitaxel was begun. After the second course of chemotherapy, another nodular shadow with small cavities in the left lower lobe S6 was seen, and which then increased in size. Bronchial lavage revealed a diagnosis of non-tubercular mycobacteriosis (Mycobacterium intracellulare). Anti-NTM chemotherapy consisting of rifampicin, ethambutol and clarithromycin was started in addition to anticancer chemotherapy, without severe side effects. Although there are some reports of the co-occurrence of lung cancer and non-tuberculous mycobacteriosis, this apparently rare case involved the appearance of a solitary nodule with a cavity caused by pulmonary non-tuberculous mycobacteriosis during anticancer chemotherapy.


Tsujioka Y.,Tokyo Metropolitan Hiroo Hospital
Japanese Journal of Clinical Radiology | Year: 2013

Primary renal angiosarcoma is so rare that only about 40 cases have been reported. We describe a case of renal angiosarcoma which developed intraperitoneal bleeding due to peritoneal dissemination. There have been no reports that speculate about the imaging findings of renal angiosarcoma, but many of reported cases showed expansive growth. But in this case, the tumor grew invasively into the perirenal space, which is different from cases reported so far. We report herein this very rare case and speculate about the imaging findings.


Nishizaki M.,Yokohama Minami Kyosai Hospital | Sakurada H.,Tokyo Metropolitan Hiroo Hospital | Yamawake N.,Yokohama Minami Kyosai Hospital | Ueda-Tatsumoto A.,Tokyo Metropolitan Hiroo Hospital | Hiraoka M.,Tokyo Medical and Dental University
Circulation Journal | Year: 2010

The type 1 ST-segment elevation is diagnostic for Brugada syndrome (BS) and its presence may sometimes be associated with a high risk of arrhythmic events. The type 1 ECG is also known to be unmasked by administration of sodium-channel blockers in equivocal or suspected cases of BS, and the drug-challenge test is frequently used in the diagnostic approach. In large cohort studies the spontaneous appearance of the type 1 ECG with symptoms of aborted sudden death or unexplained syncope are indicative of a poor prognosis for patients with BS compared with not having clinical symptoms. Therefore, the spontaneous type 1 ECG appears to represent an important predictive sign for cardiac events. It is unknown, however, whether or not the drug-induced type 1 ECG is as useful as the spontaneous type 1 for predicting cardiac events in asymptomatic subjects showing non-type 1 ECG. Review of the literature for large cohort studies indicates that there is a low incidence of arrhythmic events in asymptomatic patients with either the spontaneous or drug-induced type 1 ECG compared with symptomatic subjects, and the drug-induced type1 ECG in asymptomatic patients does not add to an increase in arrhythmic risk. Therefore, drug testing to unmask the type 1 ECG in asymptomatic patients with a non-type 1 BS ECG does not have an additional value for risk stratification of cardiac events, although it might be useful in symptomatic patients showing only the non-type 1 ECG.


Saito E.,Tokyo Metropolitan Hiroo Hospital
Journal of atherosclerosis and thrombosis | Year: 2011

In obesity, fatty acid composition is altered with reduced docosahexaenoic acid (DHA) levels. Desaturating enzymes, stearoyl-CoA desaturase (SCD), delta-6 desaturase (D6D) and delta-5 desaturase (D5D) modulate fatty acid composition and are thus associated with the development of metabolic syndrome. The aim of this study was to identify the relationships among DHA content, desaturase indices and the components of metabolic syndrome in childhood obesity. Thirty-two obese children (27 male, 5 female) aged 12.0±2.6 years (mean±SD), with a relative body weight greater than 120% of the standard weight for sex, age and height, were recruited. Fatty acid composition of plasma phospholipids was analyzed by gas chromatography, and the desaturase indices were assessed: SCD (16:1n-7/16:0 and 18:1n-9/18:0), D6D (20:3n-6/18:2n-6) and D5D (20:4n-6/20:3n-6). No sex difference was observed in fatty acid composition. DHA content tended to have an inverse association with body mass index (BMI) (r=-0.337, p=0.0592), and correlated significantly with very low-density lipoprotein-triglyceride (r=-0.558, p=0.0057). In addition, DHA content had significant negative relationships with SCD indices (SCD16; r=-0.373, p=0.0357 and SCD18; r=-0.580, p=0.0005), which correlated positively with BMI(r=0.439, p=0.0120, r=0.353, p=0.0473, respectively), but had no association with D5D or D6D. DHA content in obese children was independent of the desaturation of alpha-linolenic acid. Reduced DHA content was associated with increased SCD index, and might contribute to the development of metabolic syndrome. Dietary management including fatty acids is suggested to be important to prevent and better manage obesity.


Tanabe Y.,Tokyo Metropolitan Hiroo Hospital | Tejima T.,Tokyo Metropolitan Hiroo Hospital | Sakurada H.,Tokyo Metropolitan Hiroo Hospital
Catheterization and Cardiovascular Interventions | Year: 2013

Coronary artery fistulas are rare anomalies that are very rarely accompanied by an aneurysm. The minimally invasive method of percutaneous transradial embolization, using a thin guiding catheter, was used to treat a coronary artery fistula with an associated giant aneurysm. This technique, not previously described for this type of application, is presented as a case report. The successful outcome of this procedure demonstrated that transradial coronary interventions are useful for treating coronary artery fistulas with an associated giant aneurysm, especially in patients at high risk for conventional surgery or transfemoral interventions. © 2012 Wiley Periodicals, Inc.


Oda G.,Tokyo Metropolitan Hiroo Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

This case concerns a 78-year-old man, who was diagnosed with lung cancer at the age of 73. He underwent right lobectomy and lymph node dissection, and pathological analysis revealed a poorly differentiated adenocarcinoma, pT1N0M0 pStage IA. 15 months after surgery, computed tomography showed recurrence of lung cancer at the apex of thoracic cavity. He underwent radiation to the recurrence site, and 33 months after surgery, fluorodeoxyglucose uptake was observed at the axillary and infraclavicular lymph nodes in positron emission tomography examination. Treatment with pemetrexed was started because carcinomatous pericarditis was also found. Although pericardial effusion disappeared, the patient complained of the enlarged size of the axillary and infraclavicular lymph nodes and severe numbness in an arm. Beyond lymph node involvement, no other metastatic sites were found. An operation was performed to relieve the pain and the pathological analysis of lymph nodes showed metastases of lung cancer. The operation successfully reduced the pain experienced by the patient. There has been no further recurrence in the 9 months following surgery. Axillary lymph node metastasis is thought to be a distant metastasis; however, this is a case where local control was needed and was effective.


Akiyama T.,Tokyo Metropolitan Hiroo Hospital | Yoneda M.,Yokohama City University | Maeda S.,Yokohama City University | Nakajima A.,Yokohama City University | And 2 more authors.
Digestion | Year: 2011

It still remains controversial whether simple obesity, as measured by the body mass index (BMI), is an independent risk factor for Barrett's esophagus (BE). Recent studies have shown abdominal obesity, as defined by the waist circumference (WC) and the waist-to-hip ratio (WHR), to be a risk factor for BE, independent of the BMI, with the association between BMI and BE being no longer observed after adjustment for the WC and WHR. Moreover, visceral obesity, as directly measured by the surface area of the visceral adipose tissue (VAT) on abdominal CT images, has also been reported to have an association with the risk of BE. In addition to the mechanical effects of abdominal obesity, that is, increase of the intra- abdominal pressure by the large amount of adipose tissue, circulating factors secreted from the VAT, such as tumor necrosis factor-α, interleukin-6, leptin, and adiponectin, have also been proposed to be pathogenetically linked to BE and esophageal adenocarcinoma. Obesity is associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal obesity, especially visceral obesity. This raises several questions regarding the pathogenesis of obesity-related BE. Larger studies with prospective enrollment of patients are required for further examination of this issue. Copyright © 2011 S. Karger AG, Basel.


Matsue Y.,Kameda Medical Center | Suzuki M.,Kameda Medical Center | Nishizaki M.,Yokohama Minami Kyosai Hospital | Hojo R.,Tokyo Metropolitan Hiroo Hospital | And 2 more authors.
Journal of the American College of Cardiology | Year: 2012

The present study was performed to investigate the clinical implications of an implantable cardioverter-defibrillator (ICD) in patients with vasospastic angina (VSA) resuscitated from lethal ventricular arrhythmia. The prognosis of VSA is known to be good with medication; however, ventricular arrhythmia and cardiopulmonary arrest are rare but life-threatening complications of this disease. The ICD is a proven modality for patients with ventricular arrhythmia, but the clinical implications in this population remain to be elucidated. We conducted a retrospective, observational, multicenter study involving patients with an ICD due to documented ventricular arrhythmia and VSA diagnosed by acetylcholine provocation test. All patients were followed up for appropriate ICD therapy, sudden cardiac arrest, or death from all causes. Twenty-three patients were included in the present study and completely followed up. All patients are still alive. During a follow-up of 2.9 years (median 2.1 years), 4 ventricular fibrillations and 1 episode of pulseless electrical activity occurred in 5 patients (21.7%). There were no statistically significant differences in patient characteristics between the recurrence and nonrecurrence groups, including medication, smoking status, and whether the patient was or was not free of symptoms after ICD implantation. Patients with VSA and lethal ventricular arrhythmia are a population at high risk for recurrence of cardiopulmonary arrest, and there is no reliable indicator for predicting recurrence of ventricular arrhythmia. Insertion of an ICD with medication for VSA is appropriate for this high-risk population. © 2012 American College of Cardiology Foundation.


Yamamoto Y.,Tokyo Metropolitan Hiroo Hospital
Rinsho byori. The Japanese journal of clinical pathology | Year: 2011

To support patient safety, we have established a new system that collates medical facility clinical records, examination results and orders, and implementation information comprehensively in real time, checks for consistency and validity, and sends warnings to the appropriate people at the appropriate time. Because our system actually corrects inaccurate operation information, it is different from most existing facilities for patient safety in that it reconstructs information independently from the HIS (Hospital Information System). We were permitted to send warning messages not only to the doctor who entered the orders, but also to the chief of medical staff and team members. For the warning method, we tried screen flashes and chimes, mobile phone messages, and high quality interactive voice responses. We also investigated the degree of message usefulness. Therein, by not relying on "authenticity" and "readability," but by exhaustively collecting and appropriately revising in alignment with the use of information, we have created an original system that collects accurate information. This original system was established by medical staff members. The appropriate revisions mentioned herein are items which meticulously reflect the medical professional's comments and selected operation and signify why a "Clinical Decision Support System created by medical staff" is necessary.

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