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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. Source

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). Source

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. Source

Tanaka M.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Kuroda M.,Yamashiro Public Hospital | Yamazaki M.,Kyoto Prefectural University of Medicine | And 6 more authors.
Nutrition | Year: 2012

Objective: Under- and overnutrition are associated with a worse prognosis and constitute independent risk factors for morbidity and mortality. It is increasingly important to understand the factors that affect nutritional and metabolic statuses. The purpose of this study was to assess the relation between the pepsinogen I/II ratio and several biochemical markers. Methods: A cross-sectional study was performed in 1985 subjects who underwent a health screening test. Subjects had no medications for hyperuricemia, dyslipidemia, diabetes mellitus, or hypertension. All subjects were classified into two groups. Subjects with a pepsinogen I/II ratio below 3 were defined as having atrophic gastritis. The relations between the pepsinogen I/II ratio and several biochemical markers, including total cholesterol, triacylglycerol, uric acid, cholinesterase, and glucose levels, were evaluated. Results: The presence of atrophic gastritis was significantly associated with age, smoking status, alcohol consumption, body mass index, and triacylglycerol, uric acid, cholinesterase, and hemoglobin levels. Multiple linear regression analysis demonstrated that the pepsinogen I/II ratio was an independent determinant of glucose level (β = 0.104, P < 0.0001), triacylglycerol level (β = 0.072, P = 0.0014), uric acid level (β = 0.048, P = 0.0138), and hemoglobin (β = 0.037, P = 0.0429) after adjustments for age, sex, smoking status, alcohol consumption, and body mass index. Conclusion: The pepsinogen I/II ratio was related to glucose, triacylglycerol, and uric acid levels. Such an association fosters the idea that a decreased pepsinogen I/II ratio seems favorable for the prevention of overnutrition. © 2012 Elsevier Inc.. Source

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. Source

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