Tokyo Metropolitan Tama Medical Center

Tokyo, Japan

Tokyo Metropolitan Tama Medical Center

Tokyo, Japan
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Nakajima N.,Kitamurayama Hospital | Ueda M.,Tokyo Metropolitan Tama Medical Center
Clinical Toxicology | Year: 2016

Abstract: Context:Paralepistopsis acromelalga, formerly known as Clitocybe acromelalga, is a rare poisonous mushroom. The mycotoxins in this mushroom cause symptoms resembling those of erythromelalgia; however, its pathogenesis remains unclear. In this report, a patient who received nicotinic acid treatment for P. acromelalga poisoning and radiological evaluation for erythromelalgia has been presented. Case detail: A 59-year-old woman was hospitalized for redness, swelling, and burning pain in her extremities that rendered difficulty in walking, and a diagnosis of P. acromelalga poisoning was made by detailed interview and mushroom identification. She was treated with intravenous nicotinic acid for 17 days followed by oral nicotinic acid amide for 2 months. She exhibited rapid symptomatic improvement and walked independently after 11 days of initial treatment. Initial MRI of her feet revealed toe-dominated subcutaneous thickening. After nicotinic acid treatment, those radiological findings improved dramatically. Discussion: The subcutaneous thickening evident on MRI indicated P. acromelalga poisoning-induced erythromelalgia involved subcutaneous inflammatory edema. The typical duration of edema without treatment is more than a month. The improvement on MRI after nicotinic acid treatment indicated that the adequate vasodilation induced by nicotinic acid contributed to resolution of the symptoms. Nicotinic acid was associated with the improvement of the edematous changes caused by the P. acromelalga intoxication. © 2016 Informa UK Limited, trading as Taylor & Francis Group.


Morikane K.,Yamagata University | Honda H.,Tokyo Metropolitan Tama Medical Center | Yamagishi T.,Japan National Institute of Infectious Diseases | Suzuki S.,Japan National Institute of Infectious Diseases
Infection Control and Hospital Epidemiology | Year: 2014

objective. Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). This study aims to assess factors associated with SSI after colorectal surgery in Japan, using a Japanese national database for HAIs. design. A retrospective nationwide surveillance-based study. setting. Japanese healthcare facilities. methods. Data on colon and rectal surgeries performed from 2008 through 2010 were extracted from a national monitoring system for healthcare-associated infections, the Japan Nosocomial Infections Surveillance (JANIS). Factors associated with SSI after colon and rectal surgery were assessed using multivariate logistic regression. results. The cumulative incidence of SSI for colon and rectal surgery was 15.0% (6,691 of 44,751) and 17.8% (3,230 of 18,187), respectively. Traditional risk factors included in the National Nosocomial Infections Surveillance (NNIS) modified risk index were significant in predicting SSI in the final model for both colon and rectal surgery. Among the additional variables routinely collected in JANIS were factors independently associated with the development of SSI, such as male sex (adjusted odds ratio [aOR], 1.20 [95% confidence interval (CI), 1.14-1.27]), ileostomy or colostomy placement (aOR, 1.13 [95% CI, 1.04-1.21]), emergency operation (aOR, 1.40 [95% CI, 1.29- 1.52]), and multiple procedures (aOR, 1.22 [95% CI, 1.13-1.33]) for colon surgery as well as male sex (aOR, 1.43 [95% CI, 1.31-1.55]), ileostomy or colostomy placement (aOR, 1,63 [95% CI, 1.51-1.79]), and emergency operation (aOR, 1.43 [95% CI, 1.20-1.72]) for rectal surgery. conclusions. For colorectal operations, inclusion of additional variables routinely collected in JANIS can more accurately predict SSI risk than can the NNIS risk index alone. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.


Takeuchi H.,Tokyo Metropolitan Tama Medical Center
Journal of Computer Assisted Tomography | Year: 2017

OBJECTIVE: We compared iodine concentration in pulmonary ground-glass opacity on iodine density images of contrast-enhanced chest dual-energy computed tomography (DECT) between patients with cardiogenic pulmonary edema (CPE) and acute interstitial lung disease (AILD). METHODS: Five of 12 patients who underwent contrast-enhanced chest DECT to exclude pulmonary embolism were clinically diagnosed with CPE and 7, with AILD. We compared the mean CT value on monochromatic images at 65 keV and iodine concentration on iodine density images between the affected and normal areas. RESULTS: The mean iodine concentrations were comparable between the affected and normal areas (P = 0.3048) in patients with CPE and were significantly higher in the affected than in the normal areas in those with AILD (P < 0.0001). CONCLUSIONS: Measurement of iodine concentration in pulmonary ground-glass opacity of contrast-enhanced chest DECT has the potential to help distinguish CPE and AILD. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.


Kunii N.,University of Tokyo | Kamada K.,University of Tokyo | Kamada K.,Tokyo Metropolitan Tama Medical Center | Ota T.,University of Tokyo | And 2 more authors.
NeuroImage | Year: 2013

High gamma activity (HGA) has been shown to be positively correlated with blood oxygenation level-dependent (BOLD) responses in the primary cortices with simple tasks. It is, however, an open question whether the correlation is simply applied to the association areas related to higher cognitive functions. The aim of this study is to investigate quantitative correlation between HGA and BOLD and their spatial and temporal profiles during semantic processing. Thirteen patients with intractable epilepsy underwent fMRI and electrocorticography (ECoG) with a word interpretation task to evoke language-related responses. Percent signal change of BOLD was calculated at each site of ECoG electrode, which has power amplification of high gamma band (60-120. Hz) activity. We transformed locations of individual electrodes and brains to a universal coordination using SPM8 and made the quantitative comparisons on a template brain. HGAs were increased in several language-related areas such as the inferior frontal and middle temporal gyri and were positively correlated with BOLD responses. The most striking finding was different temporal dynamics of HGAs in the different brain regions. Whereas the frontal lobe showed longer-lasting HGA, the HGA-intensity on the temporal lobe quickly declined. The different temporal dynamics of HGA might explain why routine language-fMRI hardly detected BOLD in the temporal lobe. This study clarified different neural oscillation and BOLD response in various brain regions during semantic processing and will facilitate practical utilization of fMRI for evaluating higher-order cognitive functions not only in basic neuroscience, but also in clinical practice. © 2012 Elsevier Inc..


Honda H.,Tokyo Metropolitan Tama Medical Center | Honda H.,Teine Keijinkai Medical Center | Yamazaki A.,Teine Keijinkai Medical Center | Sato Y.,Teine Keijinkai Medical Center | Dubberke E.R.,University of Washington
Anaerobe | Year: 2014

Background: Although increases in Clostridium difficile infection (CDI) incidence and severity have been observed in numerous countries, the incidence of CDI in Japan remains unclear. The goal of this study was to determine the incidence and outcomes of CDI at a Japanese tertiary care center. Materials and methods: Retrospective cohort study in patients with CDI was conducted at a 550-bed, tertiary care, academic center in Sapporo, Japan from September 2010 through August 2012. CDI cases diagnosed by enzyme immunoassays were categorized per internationally recognized surveillance definitions. Data on demographic characteristics, medication exposures, CDI presentation, and CDI treatment were collected on all CDI cases. Factors associated with 30-day all-cause mortality after the completion of CDI treatment were also investigated. Results: There were 32,296 admissions and 350,074 patient-days from 22,863 patients during the study period; 126 patients were diagnosed with CDI. The median age of CDI case patients was 78 years. Healthcare facility-onset (HO) CDI accounted for 86.5% of CDI cases, with a HO-CDI incidence of 3.11 cases per 10,000 patient-days. Three patients underwent surgery for CDI (2.4%) and 19 patients (15%) died within a 30 days of completing CDI treatment. Factors independently associated with mortality were diabetes mellitus and shock at time of CDI diagnosis. Conclusions: The CDI incidence was lower than that typically reported from North American hospitals, but the proportion of patients requiring surgical therapy and dying within 30 days of CDI in non-outbreak settings was higher. More study is needed to determine why CDI incidence is low relative to CDI-associated outcomes in Japan. © 2013 Elsevier Ltd.


Isogai T.,University of Tokyo | Isogai T.,Tokyo Metropolitan Tama Medical Center | Matsui H.,University of Tokyo | Tanaka H.,Tokyo Metropolitan Tama Medical Center | And 2 more authors.
Heart | Year: 2016

Objective A catecholamine-mediated mechanism has been implicated in the pathogenesis of Takotsubo cardiomyopathy (TC). However, the impact of ß-blockers in acute-phase management of TC remains uncertain. This study aimed to examine whether early ß-blocker use in TC was associated with lower in-hospital mortality. Methods This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with TC aged =20 years who were admitted to acute-care hospitals between 2010 and 2014 were identified. Thirty-day inhospital mortality was compared between patients who started ß-blocker therapy on hospitalisation day 1 or 2 (early ß-blocker group) and those who did not receive a ß-blocker during hospitalisation (control group) using propensity score-matching and instrumental variable analyses. Results Of 2672 eligible patients (female, 81.5%; 423 early ß-blocker therapy, 2249 controls) from 615 hospitals, 1:4 propensity score-matching created a cohort of 2110 patients (422 early ß-blocker therapy, 1688 controls). There was no significant difference in 30-day in-hospital mortality between the early ß-blocker group and control group (2.4% vs 2.0%, p=0.703; risk difference, 0.4%; 95% CI, -1.2% to 2.0%). Logistic regression analysis did not show a significant association between early ß-blocker use and 30-day in-hospital mortality (OR, 1.17; 95% CI 0.58 to 2.37). Instrumental variable analysis also found that early ß-blocker use was not associated with lower 30-day in-hospital mortality (risk difference, 1.2%; 95% CI -3.1% to 5.5%). Conclusions This study found no significant association between early ß-blocker use and in-hospital mortality in patients with TC. © 2016 BMJ Publishing Group Ltd & British Cardiovascular Society.


Ohtsuka T.,Tokyo Metropolitan Tama Medical Center | Ninomiya M.,Tokyo Metropolitan Tama Medical Center | Nonaka T.,Tokyo Metropolitan Tama Medical Center | Hisagi M.,Tokyo Metropolitan Tama Medical Center | And 2 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives: This study sought to evaluate thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation (AF). Background: Closing the left atrial appendage (LAA) is an efficacious alternative to oral anticoagulation as prevention against AF-induced thromboembolism, provided that the procedure is safe and complete. Methods: Thirty patients (mean age, 74 ± 5.0 years) who had had thromboembolisms were selected. A subgroup of 21 patients (mean age, 75 years; mean CHA 2DS2 VASc score, 4.5) urgently needed an alternative treatment to anticoagulation: warfarin was contraindicated due to hemorrhagic side effects in 13, the international normalized ratio was uncontrollable in 7, and transient ischemic attacks had developed immediately after the warfarin dose was reduced for oncological treatment in 1. The LAA was thoracoscopically excised with an endoscopic cutter. Results: Thoracoscopic appendectomy (mean operating time, 32 min, switched to mini-thoracotomy in 2 cases) led to no mortality and no major complications. Three-month post-operative 3-dimensional enhanced computed tomography, performed with patients' consent, confirmed the completeness of the appendectomy. Patients have been followed for 1 to 38 months (mean, 16 ± 9.7 months [18 ± 9.4 months for the subgroup]). One patient died of breast cancer 28 months after surgery. Despite discontinued anticoagulation, no patients have experienced recurrence of thromboembolism. Conclusions: Thoracoscopic stand-alone appendectomy is potentially safe and may allow surgeons to achieve relatively simple, complete LAA closure. Further experience may demonstrate this technique to be a viable option for thromboembolism prevention in nonvalvular AF. © 2013 American College of Cardiology Foundation.


Fuchigami T.,Tokyo Metropolitan Tama Medical Center
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2013

A 21-year-old female presented with a mass of the upper right neck. It was suspected a neurinoma of the vagus nerve by MRI and CT scan. The tumor was located in the higher position of bifurcation of common carotid artery. Intracapsular microscopic enucleation was performed under general anesthesia. We removed the tumor with the vagus nerve preserving the nerve function. Pathological diagnosis was neurinoma. She had no palsy of the vagus nerve after the surgery.


Kimura Y.,Tokyo Metropolitan Tama Medical Center
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2013

Desending necrotizing Mediastinitis (DMN) resulting from deep neck infections have a high mortality rate. It is necessary to diagnose DMN rapidly and accurately, as the delay of deagnosis and treatment could lead patients to unfortunate outcome. The dranage by thoracotectomy was the gold standard for DMN spread throughout the mediastinum. However, wereported two cases successfully drained by thoracoscopy, as similar reports have been increasing in recent years. The drainage by thoracoscopy for DMN couls be recommended for some case.


Honda H.,Tokyo Metropolitan Tama Medical Center | Dubberke E.R.,University of Washington
Current Opinion in Gastroenterology | Year: 2014

PURPOSE OF REVIEW: Clostridium difficile infection (CDI) is a growing concern and has a substantial impact on morbidity and mortality. Epidemiology of CDI has dramatically changed over the last decade. Diagnostic and treatment strategies are even more complicated given the wide variety of available diagnostic methods and the emergence of refractory or recurrent CDI. This review is intended to provide information on current CDI epidemiology and guidance for evidence-based diagnosis and management strategies. RECENT FINDINGS: Various studies from the United States, Europe, and Canada revealed increased incidence of CDI since 2000. Although CDI has long been associated with healthcare settings, recent studies indicate it is more common in the community than previously recognized. For diagnostic strategies, newer testing methods, including nucleic acid amplification tests, have enhanced sensitivity compared with toxin testing, but at the expense of decreased specificity. New agents for treating CDI are being developed and higher quality data to support fecal microbiota transplantation for treating recurrent CDI are emerging. SUMMARY: CDI epidemiology continues to evolve. Prompt recognition and an evidence-based treatment approach is the key to successfully manage CDI. Further, studies on diagnostic and therapeutic strategies are needed to further improve patient outcomes. © Lippincott Williams & Wilkins.

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