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Nagao Y.,Yao Tokushukai General Hospital | Tawatsin A.,National Institute of Health | Thammapalo S.,Ministry of Public Health | Thavara U.,National Institute of Health
Epidemiology and Infection | Year: 2012

Dengue haemorrhagic fever (DHF) is caused by dengue virus transmitted by Aedes mosquitoes; mean age of patients varies temporally and geographically. Variability in age of patients may be due to differences in transmission intensity or demographic structure. To compare these two hypotheses, the mean age of DHF patients from 90 districts in northern Thailand (1994-1996, 2002-2004) was regressed against (i) Aedes abundance or (ii) demographic variables (birthrate, average age) of the district. We also developed software to quantify direction and strength of geographical gradients of these variables. We found that, after adjusting for socioeconomics, climate, spatial autocorrelation, the mean age of patients was correlated only with Aedes abundance. The geographical gradient of mean age of patients originated from entomological, climate, and socioeconomic gradients. Vector abundance was a stronger determinant of mean age of patients than demographic variables, in northern Thailand. © 2011 Cambridge University Press.


Hatano T.,Osaka City University | Motomura H.,Osaka City University | Ayabe S.,Yao Tokushukai General Hospital
Journal of Neurological Surgery, Part B: Skull Base | Year: 2015

We present a modified locoregional flap for the reconstruction of large anterior skull base defects that should be reconstructed with a free flap according to Yano's algorithm. No classification of skull base defects had been proposed for a long time. Yano et al suggested a new classification in 2012. The lb defect of Yano's classification extends horizontally from the cribriform plate to the orbital roof. According to Yano's algorithm for subsequent skull base reconstructive procedures, a lb defect should be reconstructed with a free flap such as an anterolateral thigh free flap or rectus abdominis myocutaneous free flap. However, our modified locoregional flap has also enabled reconstruction of lb defects. In this case series, we used a locoregional flap for lb defects. No major postoperative complications occurred. We present our modified locoregional flap that enables reconstruction of lb defects. ©2015 Georg Thieme Verlag KG Stuttgart New York.


PubMed | Osaka City General Hospital, Yao Tokushukai General Hospital and Osaka City University
Type: Journal Article | Journal: Neurosurgical review | Year: 2016

Although titanium stand-alone cages are commonly used in anterior cervical discectomy and fusion (ACDF), there are several concerns such as cage subsidence after surgery. The efficacy of -tricalcium phosphate (-TCP) granules as a packing material in 1- or 2-level ACDF using a rectangular titanium stand-alone cage is not fully understood. The purpose of this study is to investigate the validity of rectangular titanium stand-alone cages in 1- and 2-level ACDF with -TCP. This retrospective study included 55 consecutive patients who underwent ACDF with autologous iliac cancellous bone grafting and 45 consecutive patients with -TCP grafting. All patients completed at least 2-year postoperative follow-up. Univariate and multivariate analyses were performed to examine the associations between study variables and nonunion after surgery. Significant neurological recovery after surgery was obtained in both groups. Cage subsidence was noted in 14 of 72 cages (19.4%) in the autograft group and 12 of 64 cages (18.8%) in the -TCP group. A total of 66 cages (91.7%) in the autograft group showed osseous or partial union, and 58 cages (90.6%) in the -TCP group showed osseous or partial union by 2years after surgery. There were no significant differences in cage subsidence and the bony fusion rate between the two groups. Multivariate analysis using a logistic regression model showed that fusion level at C6/7, 2-level fusion, and cage subsidence of grades 2-3 were significantly associated with nonunion at 2years after surgery. Although an acceptable surgical outcome with negligible complication appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF with -TCP, cage subsidence after surgery needs to be avoided to achieve acceptable bony fusion at the fused segments. Fusion level at C6/7 or 2-level fusion may be another risk factor of nonunion.


PubMed | Yao Tokushukai General Hospital, Osaka Medical College and Ujigawa Hospital
Type: Journal Article | Journal: Surgical case reports | Year: 2016

Occurrence of bronchial artery aneurysm is rare, and it has been detected in less than 1 % of all selective bronchial arteriography cases. Here, we present a case of a bronchial artery aneurysm caused by a tracheal stent migration. A 59-year-old man was operated on for esophageal cancer, where an esophageal-tracheal fistula occurred 1week after operation. Surgical repair of the esophageal-tracheal fistula was performed using a muscle flap, but this not results in fistula closure. Consequently, a self-expanding covered metallic tracheal stent was implanted for rescue, and this resulted in fistula closure. After 1year, there was frequent hemoptysis caused by migration of the stent. He was referred to our hospital where removal of the stent was planned. A sudden occurrence of massive bleeding from trachea occurred, and extracorporeal membrane oxygenation (ECMO) was used. Although removal of tracheal stent was performed successfully, the patient subsequently died from multi-organ failure. Post-mortem autopsy revealed that the massive bleeding is originated from the rupture of a bronchial artery aneurysm.


Hanabusa K.,Yao Tokushukai General Hospital | Nonoyama Y.,Yao Tokushukai General Hospital | Taki W.,Mie University
Neurologia Medico-Chirurgica | Year: 2010

A 66-year-old man presented with a rare case of a giant aneurysm of the internal carotid artery manifesting as difficulty in swallowing, resulting in severe malnutrition. Initial examination found a pulsating mass protruding from the posterior wall of the pharynx in the oral cavity. The patient had left hemiple-gia caused by cerebral infarction one year previously. The patient underwent surgical therapy consisting of superficial temporal artery-middle cerebral artery bypass and trapping of the internal carotid artery. The pulsation of the oral mass vanished just after surgery and his difficulty in swallowing gradually improved. The patient was discharged with no new neurological deficits. The previous cerebral infarction was probably caused by an embolus from this giant aneurysm.


Hirakawa T.,Yao Tokushukai General Hospital | Katou Y.,Yao Tokushukai General Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2014

In January 2012, the WallFlex Colonic Stent (Boston Scientific) for treating patients with malignant colorectal obstruction was included in the National Health Insurance (NHI) price list in Japan, and since July 2012, our hospital has placed this stent in 22 patients (as bridge-to-surgery [BTS] in 14 patients and as palliative treatment in 8 patients). The subjects included 13 men and 9 women, aged 27-94 years. The placement sites were the ileocecal lesion in 1 patient, the ascending colon in 1 patient, the transverse colon in 3 patients, the descending colon in 6 patients, the sigmoid colon in 4 patients, and the rectum in 7 patients. Stent placement was successful in all 22 patients (100%). The primary endpoint was improvement in scores on the ColoRectal Obstruction Scoring System (CROSS). The mean CROSS score before stenting was 1.18. The mean CROSS score after stenting was 3.71. Only 1 patient showed no change in the CROSS score (before versus after stenting). The rate of clinical efficacy was 95.4%. One patient experienced restenosis, an accidental event, requiring re-stenting after 3 days. There was 1 case of stent migration, which occurred 32 days after stenting. Colonic stent placement, as BTS and palliative treatment, is effective in improving the quality of life (QOL) of patients.


Nagao Y.,Yao Tokushukai General Hospital | Yamanaka H.,Yao Tokushukai General Hospital | Harada H.,Yao Tokushukai General Hospital
Journal of Medical Case Reports | Year: 2012

Introduction. Hypereosinophilic syndrome is defined as a prolonged state (more than six months) of eosinophilia (greater than 1500 cells/L), without an apparent etiology and with end-organ damage. Hypereosinophilic syndrome can cause coagulation abnormalities. Among hypereosinophilic syndrome types, the lymphocytic variant (lymphocytic hypereosinophilic syndrome) is derived from a monoclonal proliferation of T lymphocytes. Here, we describe the case of a patient with lymphocytic hypereosinophilic syndrome who presented with a coagulation abnormality. To the best of our knowledge, this is the first such report including a detailed clinical picture and temporal cytokine profile. Case presentation. A 77-year-old Japanese man presented to our facility with massive hematuria and hypereosinophilia (greater than 2600 cells/l). His eosinophilia first appeared five years earlier when he developed femoral artery occlusion. He manifested with multiple hematomas and prolonged activated partial thromboplastin time. His IgG4 level was remarkably elevated (greater than 2000 mg/dL). Polymerase chain reaction tests of peripheral blood and bone marrow identified lymphocytic hypereosinophilic syndrome. His prolonged activated partial thromboplastin time was found to be due to acquired hemophilia. Glucocorticoids suppressed both the hypereosinophilia and coagulation abnormality. However, tapering of glucocorticoids led to a relapse of the coagulation abnormality alone, without eosinophilia. Tumor necrosis factor , interleukin-5, and/or eotaxin-3 may have caused the hypereosinophilia, and interleukin-10 was correlated with the coagulation abnormality. Conclusions: To the best of our knowledge, this is the first case in which lymphocytic hypereosinophilic syndrome and IgG4-related disease have overlapped. In addition, our patient is only the second case of hypereosinophilic disease that manifested with acquired hemophilia. Our patient relapsed with the coagulation abnormality alone, without eosinophilia. This report shows that the link between eosinophilia, IgG4, and clinical manifestations is not simple and provides useful insight into the immunopathology of hypereosinophilic syndrome and IgG4-related disease. © 2012 Nagao et al; licensee BioMed Central Ltd.


Uryu K.,Yao Tokushukai General Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 57-year-old man was admitted with headache, vomiting, and bloody sputum. We diagnosed large cell lung cancer T4N2M1 (pituitary metastasis), Stage IV. When hospitalized, low values of cortisol and hyponatremia were found. A hormone stimulation test was performed, because we suspected hypopituitarism. The reaction of adrenocorticotropic hormone (ACTH) to the corticotropin-releasing hormone (CRH) loading test was good, but the reaction of serum cortisol was minimal. After corticosteroid administration, his serum sodium normalized. Limited ACTH reserve according to insufficient pituitary function was suggested as a cause of the hyponatremia. He received gamma-knife therapy, however his pituitary gland tumor did not decrease in size. Clinical symptoms such as visual field disturbance, oculomotor paresis, and visual impairment progressed, and he died about 5 months later. We report a case of hyponatremia in a patient with pituitary metastasis of lung cancer, as it is comparatively rare.


Akagi H.,Yao Tokushukai General Hospital | Irie H.,Yao Tokushukai General Hospital | Nakao Y.,Yao Tokushukai General Hospital | Sakai K.,Yao Tokushukai General Hospital
Journal of Cardiac Surgery | Year: 2013

Papillary fibroelastomas (PFEs) are rare benign tumors usually found on cardiac valves, and do not commonly originate from the left ventricle (LV). We report a 74-year-old female with a PFE in the LV apex. We performed complete resection of the tumor through a transmitral approach using video-assisted thoracoscopy. © 2013 Wiley Periodicals, Inc.


Uryu K.,Yao Tokushukai General Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

We report a case of pneumatosis cystoides intestinalis (PCI) in a patient with lung cancer. A 60-year-old woman was admitted with multiple lung tumors and multiple brain tumors. She was given steroid hormones to reduce her brain edema. Total resection of a brain tumor yielded a pathological diagnosis of metastatic squamous cell carcinoma. During treatment, X-ray and CT images revealed intestinal pneumatosis and free air in the abdominal cavity, but a physical examination revealed no abnormal findings. She was given a diagnosis of PCI, and received conservative treatment. Her intestinal gas cysts and intra-abdominal free air disappeared spontaneously. PCI is an uncommon but important condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall. It is important to consider PCI as a possible complication in lung cancer patients who are given steroid hormones and systemic chemotherapy in the long-term.

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