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Koike H.,Yamashiro Public Hospital
Neurologia Medico-Chirurgica | Year: 2014

Gastrointestinal stromal tumors (GISTs) are rare malignant tumors and only a few reported cases of brain metastases can be found. Introduction of a new molecular targeted agent, imatinib mesylate in the last decade has dramatically changed the treatment strategy and prognosis. However, imatinib is usually ineffective for brain metastasis from GISTs. The authors present the case of multiple brain metastases from jejunal GIST. The brain metastasis in the right prefrontal gyrus was detected 20 months after resection of the primary lesion when left hemiparesis began although the patient was on imatinib. Then the patient began taking sunitinib instead of imatinib, and the lesion shrunk and the symptom improved. However, after the dose reduction due to side effects, a new brain metastasis was found and this time, stereotactic radiation was effectively done. Sunitinib is one of the promising receptor tyrosine kinase inhibitors used for metastatic renal cell carcinomas or imatinib-refractory GISTs. Sunitinib is thought to penetrate bloodbrain barrier, and recent reports indicate effectiveness to brain metastasis. To the authors’ knowledge, this is the first report of brain metastases from jejunal GIST responding to sunitinib therapy. © 2014 by The Japan Neurosurgical Society.


Tanaka M.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Okada H.,Kyoto Prefectural University of Medicine | Senmaru T.,Kyoto Prefectural University of Medicine | And 8 more authors.
Atherosclerosis | Year: 2014

Objective: Chronic kidney disease (CKD) is a worldwide public health problem. It is very important to identify the factors that affect CKD. Previous studies have reported that serum bilirubin concentration was positively correlated with renal function in a cross-sectional study. The aim of this study was to investigate the relationship between serum bilirubin concentration and the progression of CKD. Methods: A cohort study was performed on a consecutive series of 2784 subjects without CKD, defined as estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2, at baseline. We analyzed the relationship between serum total bilirubin concentration at baseline and new-onset CKD in the general population. Results: We followed the subjects for a median period of 7.7 years. There were 1157 females and 1627 males, and 231 females and 370 males developed CKD during this period. Multiple Cox regression analyses revealed that serum total bilirubin concentration (hazard ratio (HR) per 1.0μmol/L increase 0.97 (95% CI 0.95-0.99), P=0.0084) in addition to age, gamma-glutamyl transpeptidase (GGT), uric acid (UA), creatinine and medication for hypertension in men and serum total bilirubin concentration (HR per 1.0μmol/L increase 0.96 (95% CI 0.93-1.00), P=0.0309) in addition to age, GGT, alanine aminotransferase, UA, creatinine and medication for dyslipidemia in women were independent predictors of new-onset CKD, after adjusting for confounders. Conclusion: Our study demonstrated that serum total bilirubin concentration could be a novel risk factor for the progression of CKD, defined as eGFR <60ml/min/1.73m2, in the general population. © 2014 Elsevier Ireland Ltd.


Tanaka M.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Tomiyasu K.-I.,Yamashiro Public Hospital | Akabame S.,Yamashiro Public Hospital | And 5 more authors.
Hypertension Research | Year: 2012

Recent studies suggested that allergic disorders and increased eosinophil count were associated with atherosclerosis. The purpose of this study was to assess the relationship between eosinophil count and coronary artery calcification (CAC). We performed a cross-sectional study in 1363 consecutive participants with clinical suspicion of coronary heart disease (CHD). We evaluated the relationships between CAC score determined by multislice CT and peripheral eosinophil count as well as major cardiovascular risk factors, including age, body mass index, smoking status, hypertension, dyslipidemia, diabetes mellitus (DM), high-sensitivity C-reactive protein and estimated glomerular filtration rate (eGFR). Sex (P=0.0004), hypertension (P0.=0002), dyslipidemia (P=0.0004) and DM (P=0.0061) were associated with log(CAC1), respectively. Positive correlations were found between log(CAC1), and age (r0.325, P<0.0001) and eosinophil count (r=0.165, P<0.0001). Negative correlations were found between log(CAC1) and eGFR (r=0.166, P<0.0001). Multivariate linear regression analysis demonstrated that age (Β0.314, P=0.0001), sex (Β0.124, P<0.0001), hypertension (Β0.084, P=0.0008), DM (Β0.108, P=0.0001), eGFR (Β0.079, P=0.0021) and eosinophil count (Β0.147, P<0.0001) were independent determinants of log(CAC1). In conclusion, eosinophil count correlated positively with CAC in participants with clinical suspicion of CHD. © 2012 The Japanese Society of Hypertension All rights reserved.


Mineoka Y.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Tanaka M.,Kyoto Prefectural University of Medicine | Tomiyasu K.-I.,Yamashiro Public Hospital | And 6 more authors.
Heart and Vessels | Year: 2012

Early detection of atherosclerosis is important for patients with type 2 diabetes mellitus because cardiovascular disease (CVD) is a main cause of death in these people. In this study, we investigated the relationship between an arterial stiffness parameter called cardio-ankle vascular index (CAVI) and coronary artery calcification (CAC). We performed a cross-sectional study in 371 type 2 diabetic patients with clinical suspicion of coronary heart disease (CHD). We evaluated the relationships between CAVI and CAC score determined by multislice computed tomography as well as major cardiovascular risk factors, including age, body mass index, hemoglobinA1c and the Framingham CHD risk score. CAVI was correlated with age (r = 0.301, p<0.0001), uric acid (r = 0.236, p<0.0001),estimated glomerular filtration rate (r = -0.145, p = 0.0166), CHD risk score (r = 0.327, p<0.0001) and log (CAC + 1) (r = 0.303, p<0.0001). The area under the receiver operating characteristic curve for CAVI was higher than that of CHD risk score in predicting CAC>0, CAC ≥100, CAC ≥400, or CAC ≥1000. CAVI is positivelycorrelated with CAC, and is considered to be a useful method to detect CAC. © 2011 Springer.


Okada H.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Tanaka M.,Kyoto Prefectural University of Medicine | Matsumoto S.,Kyoto Prefectural University of Medicine | And 6 more authors.
Hypertension Research | Year: 2013

Recent studies have suggested that variability in the systolic blood pressure (SBP) is a risk factor for cardiovascular disease (CVD). The aim of this study was to investigate the relationship between variability in the SBP and the progression of coronary artery calcification (CAC), which is a useful marker for CVD. We measured SBP in 164 consecutive patients at every visit over the course of a year and calculated the coefficient of variation and s.d. of the SBP. We performed a follow-up study using multislice computed tomography to assess the progression of the CAC score, the mean interval of which was 3.93±1.36 years. We then evaluated the relationship between variability in the SBP and progression of the CAC score. The coefficient of variation for the SBP correlated positively with the progression of the CAC score (r=0.4382, P<0.0001). Multiple regression analysis demonstrated that the coefficient of variation of the SBP (β=0.3826, P<0.0001) was independently associated with the progression of the CAC score. The visit-to-visit variability in SBP could be a novel risk factor for the progression of CAC. © 2013 The Japanese Society of Hypertension. All rights reserved.


PubMed | Yamashiro Public Hospital, Kyoto Prefectural University of Medicine and Oike Clinic
Type: Journal Article | Journal: Atherosclerosis | Year: 2014

Chronic kidney disease (CKD) is a worldwide public health problem. It is very important to identify the factors that affect CKD. Previous studies have reported that serum bilirubin concentration was positively correlated with renal function in a cross-sectional study. The aim of this study was to investigate the relationship between serum bilirubin concentration and the progression of CKD.A cohort study was performed on a consecutive series of 2784 subjects without CKD, defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2), at baseline. We analyzed the relationship between serum total bilirubin concentration at baseline and new-onset CKD in the general population.We followed the subjects for a median period of 7.7 years. There were 1157 females and 1627 males, and 231 females and 370 males developed CKD during this period. Multiple Cox regression analyses revealed that serum total bilirubin concentration (hazard ratio (HR) per 1.0 mol/L increase 0.97 (95% CI 0.95-0.99), P = 0.0084) in addition to age, gamma-glutamyl transpeptidase (GGT), uric acid (UA), creatinine and medication for hypertension in men and serum total bilirubin concentration (HR per 1.0 mol/L increase 0.96 (95% CI 0.93-1.00), P = 0.0309) in addition to age, GGT, alanine aminotransferase, UA, creatinine and medication for dyslipidemia in women were independent predictors of new-onset CKD, after adjusting for confounders.Our study demonstrated that serum total bilirubin concentration could be a novel risk factor for the progression of CKD, defined as eGFR <60 ml/min/1.73 m(2), in the general population.


Ueki R.,Hyogo College of Medicine | Komasawa N.,Osaka Medical College | Nishimoto K.,Hyogo College of Medicine | Sugi T.,Yamashiro Public Hospital | And 2 more authors.
Journal of Anesthesia | Year: 2014

Purpose: The purpose of this study was to examine the utility of the Aintree Intubation Catheter (AIC) with three types of supraglottic airway devices for tracheal intubation (ISGAs) using a manikin. Methods: Participants were 21 anesthesiologists with more than 2 years of experience in clinical anesthesia. Three types of ISGAs were passed through the glottis: Fastrack-Single Use (FSU; size 4), air-Q (size 3.5), and i-gel (size 4). Participants attempted fiberoptic tracheal intubation with the ISGAs in random order. Success rate of tracheal intubation, intubation time, and collision with the glottis were recorded. Participants also evaluated the subjective difficulty of the entire intubation process and passing the tracheal tube through the glottis using a Visual Analogue Scale. Results: The FSU required a significantly longer time for intubation compared with the other two ISGAs (p < 0.05). AIC use did not significantly improve the success rate of intubation or shorten intubation times for any of the ISGAs. However, there were significantly more collisions with the glottis without AIC use for the FSU and air-Q compared to when they were used with the AIC (FSU, p = 0.015; air-Q, p = 0.025). Conclusion: Among the ISGAs tested, intubation took longer with the FSU, and the FSU had a higher failure rate than the other ISGAs. AIC significantly decreased the number of collisions with the FSU and air-Q. These findings suggest that the AIC is effective in reducing collisions with the tracheal tube and thus will reduce the risk of mechanical injury to the airway. © 2013 The Author(s).


Sonomura Y.,Yamashiro Public Hospital
Nippon Ganka Gakkai zasshi | Year: 2013

Punctal occlusion using a silicone plug is reported as an effective way of treating severe dry eye. The purpose of this study is to investigate the migration, extrusion rate and complications of the SuperEagle plug (Eagle Vision) This study involved 148 puncta in 64 eyes of 85 patients (13 eyes of 10 men, 72 eyes of 54 women; mean age: 57.8 +/- 16.6 years [mean +/- standard deviation]) with severe dry eye who underwent punctual occlusion using a SuperEagle plug during the period of May 2009 to September 2010 at our dry eye clinic. We investigated the intracanalicular migration rate, extrusion rate, granulation rate, accumulation of soft whitish material and enlargement of punctum size after extrusion. The migration rate was 0%. The extrusion rate was 57.4% during follow up periods. The average time to extrusion was 92.4 +/- 82.2 days, and the time until 50% of plugs were extruded was 154 days. Granulation was seen in 34.5% of the eyes. 52.9% of puncta that granulation was formed was completely occluded by granulation after extrusion. The accumulation of soft whitish material was not seen in any of the puncta. There was no significant change in the size of the puncta before insertion or after extrusion. The insertion of the SuperEagle plug was easy and without intracanalicular migration. Complete punctual occlusion by granulation after extrusion occurred.


PubMed | Yamashiro Public Hospital
Type: Case Reports | Journal: Neurologia medico-chirurgica | Year: 2014

Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patients external circumstances and unrelated to the patients internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/or corona radiata, resulting from vasospasm. To the authors knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing.


PubMed | Yamashiro Public Hospital
Type: Case Reports | Journal: Neurologia medico-chirurgica | Year: 2014

Gastrointestinal stromal tumors (GISTs) are rare malignant tumors and only a few reported cases of brain metastases can be found. Introduction of a new molecular targeted agent, imatinib mesylate in the last decade has dramatically changed the treatment strategy and prognosis. However, imatinib is usually ineffective for brain metastasis from GISTs. The authors present the case of multiple brain metastases from jejunal GIST. The brain metastasis in the right prefrontal gyrus was detected 20 months after resection of the primary lesion when left hemiparesis began although the patient was on imatinib. Then the patient began taking sunitinib instead of imatinib, and the lesion shrunk and the symptom improved. However, after the dose reduction due to side effects, a new brain metastasis was found and this time, stereotactic radiation was effectively done. Sunitinib is one of the promising receptor tyrosine kinase inhibitors used for metastatic renal cell carcinomas or imatinib-refractory GISTs. Sunitinib is thought to penetrate blood-brain barrier, and recent reports indicate effectiveness to brain metastasis. To the authors knowledge, this is the first report of brain metastases from jejunal GIST responding to sunitinib therapy.

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