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Kusuyama T.,Tsukazaki Hospital | Iida H.,Tsukazaki Hospital | Mitsui H.,Tsukazaki Hospital
Catheterization and Cardiovascular Interventions | Year: 2012

Carbon dioxide digital subtraction angiography (CO2 DSA) is a useful and safe alternative for patients with renal dysfunction or allergies to iodinated contrast medium. However, CO2 DSA image quality is worse than that of angiography with iodinated contrast medium, primarily because of movement during imaging and stent struts. In angioplasty of arteries of the lower extremities, CO2 DSA cannot be used to sufficiently evaluate target lesions and determine the most efficient intervention. However, in the current case report, we describe a patient with severe allergies to iodinated contrast medium (Stevens-Johnson syndrome), because of which we were unable to use any iodinated contrast medium when conducting angioplasty. Therefore, we used intravascular ultrasound (IVUS), which facilitated the complete observation of the target lesion after stent implantation without requiring iodinated contrast medium. In this case, IVUS was used to complement the diagnostic capabilities of CO2 DSA. © 2012 Wiley Periodicals, Inc.

Ohsugi H.,Tsukazaki Hospital | Ikuno Y.,Osaka University | Oshima K.,Tsukazaki Hospital | Yamauchi T.,Tsukazaki Hospital | Tabuchi H.,Tsukazaki Hospital
American Journal of Ophthalmology | Year: 2014

Purpose To investigate the morphologic characteristics of macular complications of dome-shaped maculas using swept-source optical coherence tomography (OCT). Design Retrospective observational case series. Methods Axial length measurements and swept-source OCT were performed in 49 highly myopic eyes (in 5 male and 30 female subjects) with dome-shaped maculas. We classified the dome patterns and measured the central retinal thickness, central choroidal thickness, central scleral thickness, and the macular bulge height, and assessed the associations of these parameters with macular complications. Results The central scleral thickness was significantly negatively correlated with age and the axial length. We classified the eyes into 3 groups: 6 with choroidal neovascularization (CNV group), 8 with retinal pigment epithelial detachment (PED group; 5 with serous retinal detachment), and 35 with no complications (no complications group). Nine eyes had a round dome and 40 had horizontally oriented oval-shaped domes. There were no significant differences in the frequency of macular complications between these patterns. The CNV group was significantly older and had a longer axial length than the other groups. The PED group had significantly larger values for both the central scleral thickness and bulge height than the other groups. The central choroidal thickness was significantly thinner in the CNV group than in the no complications group. Conclusion A dome-shaped macula results from relative thickening of the macular sclera, and this may lead to PED. Thinning of the sclera owing to long-term changes and elongation of the axis may develop CNV and cause visual impairment. © 2014 by Elsevier Inc. All rights reserved.

Nakao Y.,Tsukazaki Hospital | Suda K.,Spinal Cord Injury Center Hokkaido Chuo Rosai Hospital | Shimokawa N.,Tsukazaki Hospital | Fu Y.,Tsukazaki Hospital
Spinal Cord | Year: 2012

Study design: Case control. Objective: To clarify the predictors of low blood pressure (BP) and hyponatremia after spinal cord injury (SCI) and to discuss their pathophysiology. Setting: A SCI center in Japan. Methods: Age, gender, initial ASIA impairment scale (AIS) score, BP, blood electrolytes (sodium, K and Cl) and biochemical markers were evaluated at 1 month after injury. Risk factors of low BP and hyponatremia were analyzed using uni- and multivariate logistic regression models. Results: This study comprised of 172 SCI patients. Initial AIS score (Odds ratio (OR): 1.24, 95% confidence intervals (CI) 1.13-1.49, P-value <0.01) and hyponatremia (OR: 3.71, 95%CI 1.27-6.96, P<0.01) were the most important risk factors of low BP. As a second step, risk factors of hyponatremia were initial AIS score (OR: 1.36, 95%CI 1.08-2.78, P<0.01) and age (OR: 1.55, 95%CI 1.17-2.93, P<0.01). Conclusions: In acute and subacute period, the more severe SCI and lower AIS score patients have the more frequently low BP and/or hyponatremia do appear. © 2012 International Spinal Cord Society All rights reserved.

Shimokawa N.,Tsukazaki Hospital | Takami T.,Osaka City University
Neurosurgical Review | Year: 2016

Cervical pedicle screw (CPS) may be the biomechanically best system for posterior cervical segmental fixation, but may carry a surgery-related risk. The purpose of this study was to evaluate the safety of CPS placement using computer navigation system for posterior cervical instrumented fixation and discuss its complication avoidance and management. Posterior cervical instrumented fixation using CPS was performed in a total of 128 patients during the period between 2007 and 2015. Intraoperative image guidance was achieved using a preoperative 3D CT-based or an intraoperative 3D CT-based navigation system. A total of 762 CPSs were placed in the spine level of C2 to Th3. The radiological accuracy of CPS placement was evaluated using postoperative CT. Accuracy of CPS placement using a preoperative 3D CT-based navigation system was 93.6 % (423 of 452 screws) in grade 0; the screw was completely contained in the pedicle, and accuracy of CPS placement using an intraoperative 3D CT-based navigation system was a little bit improved to 97.1 % (301 of 310 screws) in grade 0. CPS misplacement (more than half of screw) was 3.3 % (15 of 452 screws) using a preoperative 3D CT-based navigation system, and CPS misplacement (more than half of screw) was 0.6 % (2 of 310 screws) using an intraoperative 3D CT-based navigation system. In total, 38 screws (5.0 %) were found to perforate the cortex of pedicle, although any neural or vascular complications closely associated with CPS placement were not encountered. Twenty nine of 38 screws (76.3 %) were found to perforate laterally, and seven screws (18.4 %) were found to perforate medially. Image-guided CPS placement has been an important advancement to secure the safe surgery, although the use of CPS placement needs to be carefully determined based on the individual pathology. © 2016 The Author(s)

Kato Y.,Tsukazaki Hospital | Yamamoto Y.,Kochi University | Tabuchi H.,Tsukazaki Hospital | Fukushima A.,Kochi University
Japanese Journal of Ophthalmology | Year: 2013

Objective: To examine using the folds of the retinal pigment epithelium (RPE) to diagnose Vogt-Koyanagi-Harada (VKH) disease. Methods: Retrospective clinical review of 57 Japanese patients between July 2005 and April 2009. Optical coherence tomography (OCT), fundus photographs and fluorescein angiography (FA) were studied to investigate Kendall's coefficients of concordance in seven findings by four ophthalmologists. The sensitivity and specificity of each finding were examined to confirm its efficacy. Each result was defined as positive when more than three of the ophthalmologists judged that the finding existed. Results: The folds of the RPE on OCT were observed in 30/42 (71.4 %) eyes having VKH disease, but none in the other 72 eyes. Kendall's coefficient of concordance in the detection of the folds of the RPE was 0.90 and was the highest among all other findings. Sensitivity was higher in the detection of the RPE folds on OCT and in optic nerve staining on FA than other findings and the specificity was 100 % for the RPE folds and 26.7 % for the optic nerve staining. Conclusion: The detection of the folds of the RPE on OCT is a simple and effective method to help diagnose VKH disease at its acute stage which does not require pupil dilation. © 2012 Japanese Ophthalmological Society.

Ohsugi H.,Tsukazaki Hospital | Ikuno Y.,Osaka University | Ohara Z.,Tsukazaki Hospital | Imamura H.,Tsukazaki Hospital | And 4 more authors.
Journal of Cataract and Refractive Surgery | Year: 2014

Purpose To evaluate changes in choroidal thickness before and after cataract surgery and factors affecting the changes. Setting Tsukazaki Hospital, Himeji, Japan. Design Prospective interventional study. Methods Patients having cataract surgery without other eye pathology were studied. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), axial length (AL), and enhanced-depth-imaging optical coherence tomography (OCT) were measured preoperatively. The choroidal thickness was measured at 5 points (subfoveal and 1.5 mm nasal, temporal, superior, and inferior to the fovea) using the OCT device's software. Enhanced-depth-imaging OCT and IOP measurements were obtained 3 days, 1 and 3 weeks, and 3 and 6 months postoperatively and compared with the baseline values. Stepwise analysis determined which factors (ie, age, CDVA, preoperative IOP, AL, operative time, changes in IOP) were associated with changes in choroidal thickness. Results One hundred eyes were analyzed. The postoperative IOP significantly decreased at 3 weeks, 3 months, and 6 months. The postoperative choroidal thickness significantly increased at the foveal and inferior regions throughout the follow-up; at the nasal region at 3 days, 1 week, and 6 months; at the temporal region at 1 week; and at the superior region at 6 months. These changes negatively correlated with those in IOP early after surgery. The changes in choroidal thickness later negatively correlated with the AL in all regions. Conclusion Cataract surgery caused changes in choroidal thickness. The AL and changes in the IOP are critical for evaluating the changes in choroidal thickness. © 2013 ASCRS and ESCRS.

Tabuchi H.,Tsukazaki Hospital | Kiuchi Y.,Hiroshima University | Ohsugi H.,Tsukazaki Hospital | Nakakura S.,Tsukazaki Hospital | Han Z.,Tsukazaki Hospital
Canadian Journal of Ophthalmology | Year: 2011

Objective: To investigate the relationship between the biophysical properties of the cornea and eye on the intraocular pressure (IOP) and ocular pulse amplitude (OPA) before and after cataract surgery. Design: Intervention study. Participants: The left eyes of 311 patients. Methods: The left eyes of 338 patients undergoing cataract surgery without other eye pathology were studied. IOP and OPA were recorded by dynamic contour tonometry (DCT) 1 week before and 14 weeks after cataract surgery. The axial length, corneal curvature, central corneal thickness, anterior chamber depth, and anterior chamber angle were measured 1 week before cataract surgery. Multiple regression analyses of these factors to the preoperative OPA were performed. The difference between the pre- and postoperative IOP and OPA were investigated by paired t tests. Results: Three hundred and eleven of 338 eyes were analyzed. The preoperative OPA was negatively correlated with axial length (β = -0.24, p < 0.0001) and positively correlated with the preoperative IOP (β = 0.13, p < 0.0001). The average OPA was significantly decreased after cataract surgery (p < 0.0001). The mean change in postoperative OPA was -0.45 ± 0.63 mm Hg (95% CI -0.52 to -0.38 mm Hg). Conclusions: The preoperative OPA was negatively correlated with axial length as reported. A significant decrease in OPA was observed after the cataract surgery. © 2011 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Sueda S.,Ehime Prefectural Niihama Hospital | Kohno H.,Tsukazaki Hospital
Journal of Cardiology | Year: 2016

Pharmacological spasm provocation tests are invasive methods and we always have the potential to encounter complications when performing these tests. In 1980, Buxton et al. reported three deaths when they performed intravenous ergonovine testing. However, we now employ the intracoronary ergonovine test instead of the intravenous injection of ergonovine from a safety procedure point of view. Past serious major complications of intravenous ergonovine tests, intracoronary ergonovine tests, and intracoronary acetylcholine tests were 0.31% (26/8419), 0.51% (11/2173), and 0.95% (148/15,527), respectively. Selective intracoronary testing had the serious major complications in 0.89% of patients including just one death (0.006%) and two acute myocardial infarctions (0.01%). Selective spasm provocation tests had no additional risks compared with performing diagnostic coronary angiography alone. In the Western countries, the pharmacological spasm provocation tests are not familiar in the clinic except for some specialized institutions. We need international clinical studies using the same protocol of spasm provocation tests to compare the frequency, clinical features, and prognosis of acetylcholine- or ergonovine-provoked coronary spasm between Western and Asian countries. And we hope that Western guidelines give spasm provocation testing a class I indication similar to Japanese Circulation Society guidelines because coronary artery spasm may have fewer racial differences and borders. © 2016 Japanese College of Cardiology.

Ohsugi H.,Tsukazaki Hospital | Ikuno Y.,Osaka University | Oshima K.,Tsukazaki Hospital | Tabuchi H.,Tsukazaki Hospital
Optometry and Vision Science | Year: 2013

PURPOSE: Myopic chorioretinal atrophy is a debilitating condition that causes severe loss of primary vision. However, its mechanisms and pathologic course are not well understood. We performed volumetric measurements of the posterior choroid via three-dimensional analysis of the choroid in patients with high myopia to understand its structure, and we compared the measurements with those of normal subjects. METHODS: Twenty-five highly myopic but otherwise normal eyes and 25 nonmyopic eyes were evaluated. Enhanced depth imaging optical coherence tomography (EDI-OCT) was performed using 20 × 20-degree raster scans consisting of 25 high-speed line scans. Three-dimensional retinal and choroidal thickness maps were produced from the EDI-OCT data. For the quantitative analyses, the macula was divided into nine regions, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) layout, and the mean retinal and choroidal thicknesses of each region were obtained. RESULTS: The choroidal thicknesses at all regions in the high-myopia group were significantly smaller than those in the normal refractive group (p < 0.0001). The foveal choroidal thickness was the greatest in the normal group but not in the high-myopia group. In the high-myopia group, the choroidal thickness at the fovea was significantly greater than that at the outer nasal quadrants (p < 0.0001) but significantly smaller than that at the outer superior (p < 0.0001) quadrants. CONCLUSIONS: Three-dimensional choroidal thickness maps obtained via EDI-OCT are useful for quantifying choroid thickness in subjects with high myopia more accurately. Copyright © 2013 American Academy of Optometry.

Yamauchi T.,Tsukazaki Hospital | Tabuchi H.,Tsukazaki Hospital | Takase K.,Tsukazaki Hospital | Ohsugi H.,Tsukazaki Hospital | And 2 more authors.
PLoS ONE | Year: 2013

Purpose:To compare the visual performance of multifocal intraocular lenses (IOLs) and monofocal IOLs made of the same material.Methods:The subjects included patients implanted with either Tecnis® monofocal IOLs (ZA9003 or ZCB00) or Tecnis® multifocal IOLs (ZMA00 or ZMB00) bilaterally. We conducted a retrospective study comparing the two types of IOLs. The multifocal group included 46 patients who were implanted with Tecnis® multifocal IOLs bilaterally. The monofocal group was an age- and sex-matched control group, and included 85 patients who were implanted with Tecnis® monofocal IOLs bilaterally. Lens opacity grading, the radius of corneal curvature, corneal astigmatism, axial length and the refractive status were measured preoperatively. Pupil size, ocular aberrometry, distance, intermediate and near visual acuity, contrast sensitivity with and without glare and the responses to a quality-of-vision questionnaire were evaluated pre- and postoperatively.Results:The uncorrected near visual acuity was significantly better in the multifocal group, whereas both the corrected intermediate and near visual acuity were better in the monofocal group. Contrast sensitivity (with and without glare) was significantly better in the monofocal group. The rate of spectacle dependency was significantly lower in the multifocal group. There were no significant differences between the two groups regarding most items of the postoperative quality-of-vision questionnaire (VFQ-25), with the exception that the patients in the monofocal group reported fewer problems with nighttime driving.Conclusions:The multifocal IOLs used in this study reduced spectacle dependency more so than monofocal IOLs and did not compromise the subjective visual function, with the exception of nighttime driving. © 2013 Yamauchi et al.

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