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Tamura H.,Yamagata University | Watanabe T.,Yamagata University | Hirono O.,Yamagata Prefectural Shinjo Hospital | Nishiyama S.,Yamagata University | And 7 more authors.
Journal of the American Society of Echocardiography | Year: 2010

Background: Atrial fibrillation is associated with ischemic stroke because of thrombi that form within the left atrial appendage (LAA). The aim of this study was to develop a new parameter for LAA function that is easily performed using transthoracic echocardiography (TTE). Methods: TTE and transesophageal echocardiography were performed in 106 patients with stroke. LAA wall motion velocity (TTE-LAWV) was measured using Doppler tissue imaging at the LAA tip. Results: TTE-LAWV was significantly lower in patients with atrial fibrillation and LAA thrombus than in those with atrial fibrillation and no LAA thrombus and in sinus rhythm (7.5 ± 1.9 vs 10.0 ± 3.4 and 13.8 ± 5.7 cm/s, respectively, P < .05). TTE-LAWV was significantly correlated with LAA emptying flow velocity (R = 0.462, P < .05). The multivariate logistic regression analysis showed that TTE-LAWV < 8.7 cm/s was an independent predictor of LAA thrombus formation (odds ratio, 9.473; 95% confidence interval, 1.172-76.55; P < .05). Conclusion: TTE-LAWV can noninvasively evaluate LAA dysfunction and assist in the detection of LAA thrombus. © 2010 American Society of Echocardiography. Source


Tamura H.,Yamagata University | Watanabe T.,Yamagata University | Nishiyama S.,Yamagata University | Sasaki S.,Yamagata University | And 9 more authors.
Journal of Cardiology | Year: 2012

Background: It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. The atrium is the main source of brain natriuretic peptide (BNP) in patients with atrial fibrillation (AF). We hypothesized that the plasma BNP level would be a sensitive predictor of LAA dysfunction in patients with acute ischemic stroke. Methods and results: Transesophageal echocardiography was performed and plasma BNP levels were measured in 223 patients (145 males, age 69. ±. 14 years), within 7 days after the onset of acute ischemic stroke. None of the patients had a history of congestive heart failure. LAA thrombus was detected in 23 of 77 (30%) patients with AF. Plasma BNP levels were markedly higher in patients with cardioembolic stroke compared to those without (144. pg/ml vs. 35. pg/ml, p<. 0.05). Plasma BNP levels were significantly correlated with LAA emptying flow velocity regardless of sinus rhythm (R= -0.352) or AF (R= -0.436). Furthermore, among patients with cardioembolic stroke, plasma BNP levels were markedly higher in patients with cardiogenic stroke, as diagnosed by transesophageal echocardiography, than in those with cryptogenic stroke (193 pg/ml vs. 14 pg/ml, p< 0.05). Multivariate logistic regression analysis showed that a BNP concentration >90 pg/ml was an independent predictor of cardiogenic stroke (odds ratio 41.39, 95% confidence interval 1.28-138; p= 0.0358). Conclusion: Elevated plasma BNP concentrations may be a reliable surrogate marker for the prediction of LAA dysfunction and cardiogenic stroke in patients with acute ischemic stroke. © 2012 Japanese College of Cardiology. Source


Kanno M.,Yamagata University | Nagasawa M.,Yamagata University | Suzuki M.,Yamagata Prefectural Shinjo Hospital | Yamashita H.,Yamagata University
Japanese Journal of Ophthalmology | Year: 2010

Purpose: To measure peripapillary retinal nerve fiber layer (RNFL) thickness in healthy Japanese individuals using optical coherence tomography (OCT). Methods: OCT was used to measure the eyes of 460 healthy Japanese volunteers aged 20 to 84. One eye of each individual was selected for the statistical analysis. Results|The average circumpapillary (cp) RNFL thickness of all eyes was 111.8 ± 10.0 μm. A statistically significant negative correlation was found between the average cp RNFL thickness and age. For every decade increase in age, the average cp RNFL thickness decreased by approximately 2.2 μm. The average cp RNFL thickness was estimated to decrease by 0.18% per year. The age-associated reduction in cp RNFL thickness was particularly noted in the inferior-temporal to superior-temporal segments: Conclusions: Age-related cp RNFL loss varies according to segment. When OCT is used to evaluate cp RNFL thickness, regional and age-related differences need to be taken into consideration. © 2010 Japanese Ophthalmological Society (JOS). Source


Hattori K.,Yamagata Prefectural Shinjo Hospital | Sano H.,Tohoku University | Komatsuda T.,North Sendai Orthopaedic Clinic | Saijo Y.,Tohoku University | And 2 more authors.
Journal of Orthopaedic Science | Year: 2010

Background. Previous epidemiological studies revealed that anterior cruciate ligament (ACL) injuries were more frequently seen in female athletes than in male athletes. To elucidate the pathogenetic roles of estrogen in ACL ruptures, the elasticity of ACL tissue was measured using a scanning acoustic microscope (SAM) in an estrogen-controlled animal model. Methods. A total of 40 ovariectomized Japanese white rabbits were randomly divided into four groups according to the administered dose of 17β-estradiol (groups L, M, H, and C). Injection of 17β-estradiol was performed 1, 2, 3, and 4 weeks after surgery, and doses in groups L, M, and H were 50, 100, and 500 μg/kg, respectively. Group C received no estradiol. Only groups L, M, and C were used for current analyses because their mean serum estrogen levels were within the physiological range (groups C, L, M, and H: 37, 50, 60, and 231 pg/ml, respectively). Five weeks after ovariectomy, the lateral portion of the ligament was harvested. Specimens were fixed with 10% neutralized formalin and embedded in paraffin. Then, 10 μm thick sections were cut perpendicular to the ligament fibers for routine histological staining and measurement with SAM. Results. The mean tissue sound speeds of groups C, L, and M were 1727 ± 32, 1683 ± 53, and 1665 ± 63 m/s, respectively. Group M presented significantly lower tissue sound speed than group C (P = 0.021). Furthermore, a negative correlation was found between the mean serum estrogen level and mean tissue sound speed of the ACL among all animals in groups C, L, and M (r = -0.47, P = 0.016). Conclusion. The results of the present study indicated that estrogen altered the tissue elasticity of rabbit ACL. Estrogen may constitute one of the pathogenetic factors in ACL rupture in female athletes. © The Japanese Orthopaedic Association. Source


Igarashi A.,Yamagata Prefectural Shinjo Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

Case 1 was a 73-year-old woman admitted to our hospital due to bilateral pneumonia with respiratory failure. Real-time reverse transcription polymerase chain reaction (RRT-PCR) analysis confirmed 2009 H1N1 influenza infection. Streptococcus pneumoniae was confirmed from sputum culture and a urine antigen test on admission. She was treated with antiviral drugs and antibiotics, and improved gradually. Case 2 was a 66-year-old woman admitted to our hospital due to suspected acute exacerbation of interstitial pneumonitis. RRT-PCR analysis confirmed 2009 H1N1 influenza infection, and methicillin-resistant Staphylococcus aureus was cultured from her sputum. Mixed pneumonia due to influenza virus, bacteria and fungus was suspected. Although she was treated with medicines for these pathogens, she died from respiratory failure. An autopsy confirmed primary viral pneumonia, Pseudomonas aeruginosa pneumonia and invasive pulmonary aspergillosis. Not only viral pneumonia, but also mixed infections due to bacteria or fungus, might influence the prognosis of 2009 H1N1 influenza infection. These cases indicate the importance of early identification of complicating pathogens and treatment in 2009 H1N1 influenza infection. Source

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