Toyama-shi, Japan
Toyama-shi, Japan

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Fukui N.,National Hospital Organization | Watanabe Y.,Teikyo University | Nakano T.,Tamana Central Hospital | Sawaguchi T.,Toyama City Hospital | Matsushita T.,Teikyo University
Journal of Orthopaedic Trauma | Year: 2012

Objectives: To investigate the predictors of functional outcome and changes in the basic activities of daily living in older adults who sustained hip fractures, considering the level of ambulatory ability before injury. Design: A prospective observational cohort study. Setting: One university hospital and 13 community teaching hospitals. Patients: A consecutive cohort of 650 patients who underwent surgery for a hip fracture between December 2004 and January 2006. Main Outcome Measures: Recovery of ambulatory ability and independence in activities of daily living 6 and 12 months after surgery. Results: Ambulatory ability recovered to the prefracture level in approximately half of the patients 6 months after surgery, and those ratios changed little in the next 6 months. In patients who were community ambulators before fractures, the independence in bathing before fractures was a strong predictor of ambulatory ability after surgery, but this was not the case in the former household ambulator group. The attainment of assisted ambulation with a walking cane at hospital discharge was a reliable predictor of ambulatory ability in both former community ambulator and household ambulator groups. Conclusions: Ambulatory ability after hip fractures was considered to be determined within 6 months after surgery. There was some difference in prognostic factors for ambulatory ability according to the level of mobility before fractures. The attainment of single cane (T-cane) gait at hospital discharge can serve as a reliable predictor of ambulatory ability after fractures, irrespective of the level of mobility before the injury. Copyright © 2012 by Lippincott Williams & Wilkins.

Hashimoto I.,Toyama City Hospital | Watanabe K.,Toyama City Hospital
Echocardiography | Year: 2016

The aim of our study was to evaluate the geometry-related right ventricular (RV) systolic function under normal hemodynamics by assessing the longitudinal and the radial RV contractions in children. We examined 953 healthy children. We measured tricuspid annular plane systolic excursion (TAPSE), RV anterior wall displacement from the interventricular septum (RVWD), and RV to left ventricular diameter ratio (RV/LV ratio) using M-mode echocardiography. The z-values were calculated as geometrical parameters of the TAPSE (z-TAPSE), the RVWD (z-RVWD), and the RV/LV ratio (z-RV/LV). The RV stroke volume (RVSV) was measured using Doppler echocardiography and standardized using the z-value (z-RVSV). The z-TAPSE was no or weakly negatively correlated with both the z-RVWD (r = -0.18, P < 0.0001) and the z-RV/LV (r = -0.12, P < 0.0001). In contrast, the z-RV/LV correlated positively with the z-RVWD (r = 0.61, P < 0.0001). The z-RVSV correlated only with the z-TAPSE (r = 0.30, P < 0.0001). Although the radial RV motion increases with the progression of RV dilatation, the RVSV is not associated with radial RV motion. In contrast, the RVSV relates to the longitudinal RV motion independently of the radial RV motion under the normal physiological condition. We presume that the RV contraction patterns change related to the RV geometry under various hemodynamic conditions. © 2016, Wiley Periodicals, Inc.

Toge M.,Toyama City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 61-year-old man was pointed out a solitary nodule located in the left lung (S9) measuring 18 × 29 mm in size along with lymphadenopathy by chest computed tomography (CT). Positron emission tomography( PET) scan showed a positive sign corresponding to the nodule[ standardized uptake value (SUV) max 5.8]. No diagnostic material was obtained from the transbronchial tumor biopsy, since it was difficult to rule out malignancy, surgical biopsy was performed with sampling of mediastinal lymph nodes. Histopathological examination showed marked infiltration of inflammatory cells, many of which were demonstrated to be immunoglobulin (Ig) G4-positive plasma cells by immunohistochemical staining. Hence, IgG4-related inflammatory pseudotumor of the lung was diagnosed.

Background: Many studies have investigated tricuspid annular plane systolic excursion (TAPSE) as a longitudinal right ventricular (RV) contraction. The aim of this study was to clarify the mechanism of RV systolic function compared with longitudinal and radial RV contractions in healthy children. Methods and Results: A total of 815 consecutive healthy children and adolescents were enrolled. We measured TAPSE on M-mode echocardiography as a longitudinal RV contraction. RV wall displacement (RVWD) toward the center of the left ventricle (LV) was measured in the short-axis view on M-mode echocardiography. RV stroke volume (RVSV) was obtained using pulse Doppler echocardiography as an indicator of RV global systolic function. RVSV and TAPSE had a positive but non-linear correlation with a definite inflection point around 15 mm of TAPSE. Subjects were stratified into 2 groups according to TAPSE (≤15 mm or >15 mm). In subjects with TAPSE ≤15 mm, RVWD and TAPSE were identified as independent predictors of RVSV. In contrast, in subjects with TAPSE >15 mm, TAPSE were identified as an independent predictor of RVSV. Conclusions: Normal RV contraction pattern shifts from radial to longitudinal directions at approximately 15 mm of TAPSE. RVSV is primarily generated by longitudinal contraction, but in neonates, RVSV is supported not only by longitudinal contraction but also by radial contraction.

Segawa M.,Toyama City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 36-year-old man was admitted to our hospital for examination of a nodular shadow in the left lung. Chest 3-dimensional computed tomography (3D-CT) revealed a pulmonary arteriovenous fistula (PAVF) of 21 mm in diameter composed of the feeding artery (A4) and the draining vein (V4) in the left S4. Abdominal enhanced CT revealed multiple hepatic arteriovenous fistula. Brain CT revealed a cavernous hemangioma in right occipital cerebrum. He had a family history, habitual epistaxis, and oral telangiectasia and was diagnosed as Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia:HHT). According to his family history, PAVF was likely to be a risk factor of brain infarction and abscess, and the wedge resection of the lingual lobe was performed to remove PAVF.

Kodama K.,Toyama City Hospital | Noda T.,Toyama City Hospital | Motoi I.,Toyama City Hospital
Indian Journal of Urology | Year: 2013

We report a case of acute aortic dissection leading to compression of the left renal vein (LRV), thereby resulting in the nutcracker phenomenon. A 49-year-old previously healthy woman presented with intermittent gross hematuria and mild left flank pain of five days' duration. Laboratory examinations were within normal limits, except for the elevated C-reactive protein. Cystoscopy revealed bleeding from the left ureteral orifice. Contrast-enhanced computed tomography demonstrated acute Type B aortic dissection and compression of LRV between the enlarged aorta and superior mesenteric artery with an associated dilatation of the left gonadal vein as a collateral circulation.

Hashimoto I.,Toyama City Hospital | Watanabe K.,Toyama City Hospital | Kaneda H.,Toyama City Hospital
Pediatrics International | Year: 2015

Background The aim of this study was to establish growth-related standard values and z-values for tricuspid annular plane systolic excursion (TAPSE) for Japanese children. Method We examined 953 consecutive healthy children and adolescents, ranging from newborn to 22.7 years of age (mean age, 4.4 ± 4.0 years). TAPSE was measured as the longitudinal tricuspid valve annular motion from the apex on M-mode echocardiography. The right ventricular (RV) stroke volume (RVSV) divided by the body surface area (RVSV/BSA) was used as an independent indicator of body size. RVSV was determined from the recordings of the ejection blood flow velocity and the diameter at the level of the pulmonary orifice in the RV outflow tract. Results TAPSE had positive correlations with age and BSA, ranging from 6.0 to 31.4 mm (mean, 19.1 ± 4.4 mm). The z-values ranged from -3.63 to 3.17. There was no significant difference in TAPSE between the genders (male, 19.0 ± 4.6 mm; female, 19.1 ± 4.2 mm). The z-values positively correlated with RVSV/BSA. Conclusions Growth-related normal TAPSE was studied in healthy Japanese children to obtain the TAPSE z-value. TAPSE z-value is one of the parameters that can be used to assess RV systolic function independent of body size. © 2014 Japan Pediatric Society.

Hagino H.,Tottori University | Sawaguchi T.,Toyama City Hospital | Endo N.,Niigata University | Ito Y.,Tottori University | And 2 more authors.
Calcified Tissue International | Year: 2012

We investigated the incidence of additional fractures and the rate of prescription of osteoporotic pharmacotherapy after an initial hip fracture. We surveyed female patients aged 65 and over who sustained their first hip fracture between January 1, 2006, and December 31, 2007, treated at 25 hospitals in five geographic areas in Japan. Data for 1 year after the first hip fracture were collected from medical records, and questionnaires were mailed to all patients. In total, 2,663 patients were enrolled, and 335 patients were excluded based on exclusion criteria. The analysis was performed on 2,328 patients. During the 1-year follow-up period 160 fractures occurred in 153 patients and 77 subsequent hip fractures occurred in 77 patients. The incidence of all additional fractures among patients who sustained their first hip fracture was 70 (per 1,000 person-year) and that for second hip fracture was 34. In comparison to the general population, women ≥65 years of age who sustained an initial hip fracture were four times as likely to sustain an additional hip fracture. Antiosteoporosis pharmacotherapy was prescribed for 436 patients (18.7%), while 1,240 patients (53.3%) did not receive any treatment during the 1-year period. Patients who have sustained one hip fracture have a higher risk of a second hip fracture compared to the general population, and most of these women receive no pharmaceutical treatment for osteoporosis. © 2011 Springer Science+Business Media, LLC.

Background The purpose of our study was to explore the pumping mechanism of the left ventricle (LV) and to examine the role of longitudinal LV contraction in LV stroke volume (LVSV) compared to a radial LV contraction. Methods and Results We examined 890 consecutive children without structural heart disease including 395 patients with a history of Kawasaki disease (KD). We measured the mitral annular plane systolic excursion (MAPSE), the LV end-diastolic and end-systolic dimension (LVDd), the LV radial wall displacement (LVRWD) and the LV stroke volume (LVSV). The LVSV was determined by the Doppler method. The z-values of MAPSE, LVDd, LVRWD and LVSV were calculated by the mean values and standard deviations (SDs) based upon BSA every 0.1 m2. We evaluated the relationship between the z-LVSV and the geometrical factors. The z-value of the MAPSE was the most powerful determinant for the z-values of the LVSV of all of the geometrical factors (β = 0.36, P < 0.0001). However, the z-values of the LVRWD did not contribute to those of the LVSV. Conclusions The longitudinal LV contraction contributes more to the LVSV than the radial LV contraction, even in subjects without heart failure. Evaluation of longitudinal LV contraction using the MAPSE z-value is useful for assessing global LV function in children with various body sizes. © 2015, Wiley Periodicals, Inc.

Takanashi J.-I.,Kameda Medical Center | Taneichi H.,University of Toyama | Misaki T.,Japan National Institute of Infectious Diseases | Yahata Y.,Japan National Institute of Infectious Diseases | And 6 more authors.
Neurology | Year: 2014

Objective: To elucidate the clinical and radiologic features and analyze factors associated with neurologic outcomes of encephalopathy secondary to Shiga toxin-producing Escherichia coli (STEC) O111. Methods: We reviewed medical records and neuroimaging in 22 patients with neurologic symptoms among 86 with STEC O111 infection. Results: Twenty-one (6 males and 15 females, 10 children and 11 adults) of the 22 patients were diagnosed with encephalopathy. All patients with encephalopathy also presented with hemolyticuremic syndrome. Five patients died, from day 1 to 6 months (days 1-5 in 4 patients), due to progressive encephalopathy with severe cerebral edema observed in neuroimaging (4 patients). Fifteen of the 16 surviving patients clinically recovered completely. Statistical analysis revealed differences between patients with poor (n = 6) and good (n = 15) outcomes in the interval from hemolytic-uremic syndrome presentation to encephalopathy, creatinine levels, and the methylprednisolone administration ratio. Conclusion: We note a high incidence of encephalopathy in the Toyama STEC O111 outbreak. All fatal cases resulted from progressive encephalopathy. Methylprednisolone pulse therapy represents a possible therapeutic choice. Classification of evidence: This study provides Class III evidence that methylprednisolone pulse therapy increases the probability of a good outcome for patients with encephalopathy associated with STEC O111.

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