Tokyo Saiseikai Central Hospital

Tokyo, Japan

Tokyo Saiseikai Central Hospital

Tokyo, Japan
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Higuchi S.,Kyorin University | Kabeya Y.,Tokai University | Kato K.,Tokyo Saiseikai Central Hospital
Atherosclerosis | Year: 2017

Background and aims The severity of obesity is evaluated by visceral-to-subcutaneous fat ratio (VS ratio), which may be useful for predicting atherosclerosis. However, it is unclear how VS ratio affects different types of cerebrovascular lesions. This study was conducted to evaluate the clinical impact of visceral fat accumulation on the cerebrovascular lesions. Methods This cross-sectional study included 980 apparently healthy Japanese adults who underwent a health check-up program focused toward atherosclerosis, between 2011 and 2014. Visceral and subcutaneous fat accumulation was measured using abdominal computed tomography, and its relation to cerebrovascular disease was surveyed. Results Visceral and subcutaneous fat accumulation was 88 ± 50 cm2 and 141 ± 77 cm2, respectively. VS ratio was 0.69 ± 0.38. Intimal thickening in the carotid arteries was detected in 849 cases (86.6%) and stenosis was observed in seven (0.7%). Brain magnetic resonance imaging showed white matter hyperintensities regarded as ischemic changes in 196 subjects (20.0%). Multiple logistic regression analysis adjusted for age, gender, diabetes mellitus, dyslipidemia, hypertension, and hyperuricemia showed that a 0.1 increase in VS ratio was related to the presence of ischemic changes [odds ratio (OR): 1.05, 95% CI: 1.01–1.10, p = 0.009], cerebral artery stenosis or occlusion (OR: 1.14, 95% CI: 1.03–1.25, p = 0.007), and cervical plaque (OR: 1.09, 95% CI: 1.05–1.13, p < 0.001). Conclusions VS ratio was independently associated with both large and small vessel lesions in apparently healthy subjects. © 2017 Elsevier B.V.

Adachi T.,Tokyo Saiseikai Central Hospital | Hoshino H.,Tokyo Saiseikai Central Hospital | Takagi M.,Tokyo Saiseikai Central Hospital | Fujioka S.,Saiseikai Misumi Hospital
Cerebrovascular Diseases Extra | Year: 2017

Background: Patients undergoing anticoagulation therapy often experience intracerebral hemorrhages (ICHs), and warfarin in particular is known to increase hematoma expansion in ICHs, which results in a poor outcome. Recent studies reported that, in comparison with warfarin, direct oral anticoagulants (DOACs) cause fewer ICHs with better functional outcome. However, since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs, we aimed to compare the volume, hematoma expansion, and outcomes associated with ICHs treated with DOACs and warfarin. Methods: We performed a prospective multicenter cross-sectional study. The subjects included patients with acute ICHs who received either DOACs or warfarin. We evaluated the clinical characteristics, and measured initial and follow-up ICH volumes. The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups. Mortality and modified Rankin score at discharge were evaluated as outcomes. Results: There were 18 patients in the DOAC group and 71 in the warfarin group. The baseline characteristics were similar between the 2 groups. Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group (6.2 vs. 24.2 mL, respectively; p = 0.04). In cases involving follow-up computed tomography scanning, the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group (initial: DOACs 4.4 vs. warfarin 13.5 mL; follow-up: 5.0 vs. 18.4 mL, respectively; p = 0.05). Further, the hematoma in ICHs associated with DOACs did not expand. Although the mortality of ICHs associated with DOACs (11%) was lower than that associated with warfarin (24%), this difference was not statistically significant. The univariate analysis showed that the anticoagulant type (DOACs vs. warfarin) and sex (male vs. female) were associated with ICH volume. The multivariable linear regression showed that the use of DOACs (compared to warfarin; β: –0.23, p = 0.03) and female sex (compared to male; β: –0.25, p = 0.02) were associated with a small hematoma volume. Conclusions: Based on the results of the present study, in terms of the risks associated with ICHs, the use of DOACs appears to be safer than warfarin for anticoagulation therapy. Further studies are required to validate these findings. © 2017 The Author(s)?. Published by S. Karger AG, Basel

Toyoda K.,Japan National Cardiovascular Center Research Institute | Uchiyama S.,International University of Health and Welfare | Hoshino H.,Tokyo Saiseikai Central Hospital | Kimura K.,Nippon Medical School | And 4 more authors.
International Journal of Stroke | Year: 2015

Rationale and aims: Monotherapy with antiplatelet agents is only modestly effective in secondary prevention of ischemic stroke (IS), particularly in patients with multiple risk factors such as cervicocephalic arterial stenosis, diabetes, and hypertension. While dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduced IS recurrence, particularly in the early stages after IS, it increased the risk of bleeding. Compared with aspirin, cilostazol prevented IS recurrence without increasing the incidence of serious bleeds. In patients with intracranial arterial stenosis, no significant increase in bleeding events was observed for DAPT with cilostazol and aspirin, compared to that for aspirin monotherapy. DAPT involving cilostazol may therefore be safer than conventional DAPT. These findings prompted us to conduct the Cilostazol Stroke Prevention Study for Antiplatelet Combination (; identifier: NCT01995370) to evaluate the safety and efficacy of DAPT involving cilostazol for secondary IS prevention, in comparison with that of antiplatelet monotherapy. Design: The is a multicenter, randomized, open-label, parallel-group trial. A total of 4000 high-risk patients with noncardioembolic IS will be randomized 8-180 days after onset to receive aspirin or clopidogrel monotherapy, or DAPT with cilostazol and aspirin or clopidogrel for at least one-year. Study outcomes: The primary outcome is IS recurrence. Secondary outcomes are composite occurrences of any stroke, death from any cause, myocardial infarction, vascular death, and other vascular events. Discussion: The is expected to provide evidence indicating whether secondary IS prevention in high-risk patients can be improved by using DAPT involving cilostazol. © 2014 The Authors.

Shinohara Y.,The Mutual | Katayama Y.,Nippon Medical School | Uchiyama S.,Tokyo Women's Medical University | Yamaguchi T.,Japan National Cardiovascular Center Research Institute | And 13 more authors.
The Lancet Neurology | Year: 2010

Background: The antiplatelet drug cilostazol is efficacious for prevention of stroke recurrence compared with placebo. We designed the second Cilostazol Stroke Prevention Study (CSPS 2) to establish non-inferiority of cilostazol versus aspirin for prevention of stroke, and to compare the efficacy and safety of cilostazol and aspirin in patients with non-cardioembolic ischaemic stroke. Methods: Patients aged 20-79 years who had had a cerebral infarction within the previous 26 weeks were enrolled at 278 sites in Japan and allocated to receive 100 mg cilostazol twice daily or 81 mg aspirin once daily for 1-5 years. Patients were allocated according to a computer-generated randomisation sequence by means of a dynamic balancing method using patient information obtained at registration. All patients, study personnel, investigators, and the sponsor were masked to treatment allocation. The primary endpoint was the first occurrence of stroke (cerebral infarction, cerebral haemorrhage, or subarachnoid haemorrhage). The predefined margin of non-inferiority was an upper 95% CI limit for the hazard ratio of 1·33. Analyses were by full-analysis set. This trial is registered with, number NCT00234065. Findings: Between December, 2003, and October, 2006, 2757 patients were enrolled and randomly allocated to receive cilostazol (n=1379) or aspirin (n=1378), of whom 1337 on cilostazol and 1335 on aspirin were included in analyses; mean follow-up was 29 months (SD 16). The primary endpoint occurred at yearly rates of 2·76% (n=82) in the cilostazol group and 3·71% (n=119) in the aspirin group (hazard ratio 0·743, 95% CI 0·564-0·981; p=0·0357). Haemorrhagic events (cerebral haemorrhage, subarachnoid haemorrhage, or haemorrhage requiring hospital admission) occurred in fewer patients on cilostazol (0·77%, n=23) than on aspirin (1·78%, n=57; 0·458, 0·296-0·711; p=0·0004), but headache, diarrhoea, palpitation, dizziness, and tachycardia were more frequent in the cilostazol group than in the aspirin group. Interpretation: Cilostazol seems to be non-inferior, and might be superior, to aspirin for prevention of stroke after an ischaemic stroke, and was associated with fewer haemorrhagic events. Therefore, cilostazol could be used for prevention of stroke in patients with non-cardioembolic stroke. Funding: Otsuka Pharmaceutical. © 2010 Elsevier Ltd.

Higuchi S.,Tokyo Saiseikai Central Hospital | Takahashi T.,Tokyo Saiseikai Central Hospital | Kabeya Y.,Tokyo Saiseikai Central Hospital | Hasegawa T.,Tokyo Saiseikai Central Hospital | And 2 more authors.
Circulation Journal | Year: 2014

Background: The J wave is an ECG marker of ventricular fibrillation. However, the prevalence and clinical implications of J waves in hypothermic patients remain unclear. Methods and Results: We evaluated the clinical characteristics and ECGs of patients who were admitted for accidental hypothermia (<35.0°C). J waves were defined as notches or slurs in the terminal part of the QRS complex with an amplitude ≥0.1 mV. We analyzed the prevalence of J waves and the relationship between body temperature (BT) and J wave amplitude. We also examined the augmentation of J waves following variable R-R intervals in patients with atrial fibrillation. Furthermore, we assessed the incidence of ventricular arrhythmias. A total of 60 hypothermic patients were recruited (mean age, 64±9 years; 97% male). The mean BT was 31.3°C (range, 29.4-33.5°C). J waves, which disappeared after rewarming, were observed in 30 patients (50%), with a higher frequency in patients with lower BT. Higher amplitude of J waves was associated with lower BT (P<0.001). Of the 8 patients with J waves and atrial fibrillation, 4 exhibited an augmentation of J waves following a short R-R interval. Only 1 patient with J waves developed ventricular tachycardia during rewarming. Conclusions: The prevalence of J waves and their amplitude increased with the severity of hypothermia. The temporal development of J waves might not be associated with fatal arrhythmic events.

Inagaki N.,Kyoto University | Atsumi Y.,Tokyo Saiseikai Central Hospital | Oura T.,Eli Lilly and Company | Saito H.,Eli Lilly and Company | Imaoka T.,Eli Lilly and Company
Clinical Therapeutics | Year: 2012

Background: Exenatide once weekly (QW) is an extended-release formulation of exenatide, a glucagon-like peptide-1 receptor agonist that reportedly improves glycemic control in patients with type 2 diabetes. Objective: The goal of this study was to test the hypothesis that exenatide QW is noninferior to insulin glargine, as measured by change in glycosylated hemoglobin (HbA1c) from baseline to end point (week 26 [primary end point]) in Japanese patients with type 2 diabetes who have inadequate glycemic control with oral antidiabetes drugs. Methods: In this open-label, parallel-group, multicenter, noninferiority registration study, patients were randomized (1:1) to add exenatide QW (2 mg) or once-daily insulin glargine (starting dose, 4 U) to their current oral antidiabetes drug treatment. The primary analysis was change in HbA1c from baseline to end point, evaluated by using a last-observation-carried-forward ANCOVA model, with a predefined noninferiority margin of 0.4%. Secondary analyses (a priori) included analysis of superiority for between-group comparisons of change in weight and the proportion of patients reaching HbA1c target levels of ≤7.0% or ≤6.5%. Results: The baseline characteristics of the exenatide QW (215 patients) and insulin glargine (212 patients) treatment groups were similar: mean (SD) age, 57 (10) years and 56 (11) years, respectively; 66.0% and 69.8% male; mean HbA1c, 8.5% (0.82%) and 8.5% (0.79%); and mean weight, 69.9 (13.2) kg and 71.0 (13.9) kg. Exenatide QW was statistically noninferior to insulin glargine for the change in HbA1c from baseline to end point (least squares mean difference, -0.43% [95% CI, -0.59 to -0.26]; P < 0.001), with the 95% CI upper limit less than the predefined noninferiority margin (0.4%). A significantly greater proportion of patients receiving exenatide QW compared with insulin glargine achieved HbA1c target levels of ≤7.0% (89 of 211 [42.2%] vs 44 of 210 [21.0%]) or ≤6.5% (44 of 214 [20.6%] vs 9 of 212 [4.2%]) at end point (P < 0.001 for both). Patient weight was reduced with exenatide QW compared with insulin glargine at end point (least squares mean difference, -2.01 kg [95% CI, -2.46 to -1.56]; P < 0.001). Exenatide QW was well tolerated, with a lower risk of hypoglycemia compared with insulin glargine but a higher incidence of injection-site induration. Conclusions: Exenatide QW was statistically noninferior to insulin glargine for the change in HbA1c from baseline to end point; these results suggest that exenatide QW may provide an effective alternative treatment for Japanese patients who require additional therapy to control their diabetes. identifier: NCT00935532. © 2012 Elsevier HS Journals, Inc..

Hoshino H.,Tokyo Saiseikai Central Hospital | Itoh Y.,Keio University | Yamada S.,Keio University | Suzuki N.,Keio University
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

Background: A recent worldwide disease registration study has revealed a high prevalence of polyvascular diseases in stroke patients. However, although a poor clinical outcome of patients with polyvascular disease has been reported, there have been few reports on clinical features of peripheral artery disease (PAD) in stroke patients. We assessed the prevalence, demographics, characteristics, and risk factors of PAD in Japanese stroke patients. Methods: One hundred and one consecutive chronic stroke patients in an outpatient clinic underwent ankle-brachial index (ABI) screening tests. PAD was diagnosed when the ABI was <0.9. Results: Abnormal ABI was found in 19 patients (18.8%). Eleven patients were asymptomatic, and 8 patients had symptoms of intermittent claudication. Gender, prevalence of hypertension, and dyslipidemia and alcohol intake were not different between the patients with PAD and those without PAD. Prevalence of diabetes mellitus (63.6%) was higher in the patients with asymptomatic PAD. Among the clinical subtypes of stroke, the patients with atherothrombotic infarction had a higher prevalence of PAD. Conclusions: The prevalence of PAD in stroke patients was 18.8%. Approximately 60% of the patients had no symptoms related to PAD. Diabetes mellitus was associated with higher prevalence of asymptomatic PAD among Japanese stroke patients. © 2013 by National Stroke Association.

Chiba T.,Teikyo University | Konoeda F.,Tokyo Saiseikai Central Hospital | Higashihara M.,Tokyo Metropolitan Geriatric Hospital | Kamiya H.,Teikyo University | And 3 more authors.
Clinical Neurophysiology | Year: 2015

Objective: C8-dominant innervation of ulnar-innervated and T1-dominant innervation of median-innervated intrinsic hand muscles have been suggested, although less is known regarding forearm muscles. We aimed to determine myotomal innervation of the forearm muscles based on the clinical and electromyographial findings of patients with C8 or T1 lesions. Methods: Medical Research Council scale and EMG findings were retrospectively reviewed in 16 patients with C8 lesions (2 postmedian sternotomy C8 plexopathy and 14 C8 radiculopathy) and 9 patients with T1-dominant lesions (8 true neurogenic thoracic outlet syndrome and 1 T1 radiculopathy). Results: Clinical and EMG findings revealed T1-dominant innervation of the flexor digitorum superficialis, flexor digitorum profundus of the index finger, abductor pollicis brevis, and flexor pollicis longus muscles, and C8-dominant innervation of the flexor carpi ulnaris, flexor digitorum profundus of the little finger, and digit extensors innervated by the posterior interosseous nerve. The first dorsal interosseous, and abductor digiti minimi muscles seem to be innervated by both C8 and T1 roots. Conclusions: C8-dominant innervation of ulnar-innervated muscles and T1-dominant innervation of median-innervated muscles are also evident for forearm flexor muscles. Significance: Such an additional evidence for myotomal innervation will improve localization in clinical as well as electrophysiological diagnoses. © 2014 International Federation of Clinical Neurophysiology.

Hoshino H.,Tokyo Saiseikai Central Hospital | Izawa Y.,Keio University | Suzuki N.,Keio University
Neurologia Medico-Chirurgica | Year: 2012

To clarify the clinical features of moyamoya disease in Japan, 941 patients with definite moyamoya disease were analyzed from the databases constructed by the Research Committee on Moyamoya Disease, established by the Ministry of Health, Labour and Welfare. Moyamoya disease occurs much more frequently among women than men, with a female-to-male ratio of 1.98. A family history of the disease was observed in 14.9%. The age at onset was characterized by two peaks: one at 5-9 years and another lower peak at around 40 years. Initial clinical features were transient ischemic attack in 46%, infarction in 20%, hemorrhage in 21%, headache in 6%, and epilepsy in 4%. The distribution of the age at onset showed one peak at around 40 years in patients with hemorrhage but two peaks in patients with ischemia.

Taniyama D.,Tokyo Saiseikai Central Hospital
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2013

We report herein on a rare case of tetanus originating from ulcerated breast cancer. A 60-year-old homeless woman was admitted to our hospital because of lockjaw. On admission, a physical examination revealed tachypnea, trismus, opisthotonus and an ulcerated right breast. There was no other skin soft tissue damage. A diagnosis of tetanus was entertained from the lockjaw and opisthotonus. Tetanus globulin, tetanus toxoid, penicillin and respiratory support were initiated. Later, a right total mastectomy was performed, and the diagnosis of breast cancer was made, however, gram positive bacilli were not detected and Clostridiuum tetani (C. tetani) was not cultured. It is conceivable that the ulcerated breast was contaminated with C. tetani due to the patients living conditions.

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