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Yokosuka, Japan

Makita S.,Yokosuka Kyosai Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2014

A 76-year-old woman with primary antiphospholipid syndrome (APS) was referred to our hospital due to severe aortic valve stenosis. We performed aortic valve replacement using a bioprosthetic valve. Her postoperative course was uneventful. She was discharged in good health on postoperative day 33. As for cardiovascular operations in APS patients, high rates have been reported of perioperative mortality and thromboembolic and bleeding events. Perioperative management of anticoagulation must be strict. Source

Nakamura M.,The University of Shimane | Yoshizako T.,The University of Shimane | Koyama S.,Yokosuka Kyosai Hospital | Kitagaki H.,The University of Shimane
Journal of Medical Imaging and Radiation Oncology | Year: 2011

Introduction: The purpose of this study was to evaluate the risk factors for developing a pneumothorax requiring chest tube placement in patients undergoing CT-guided needle biopsy of the lung. Materials and methods: In 150 patients, 156 CT-guided needle biopsies of the lung were performed. Patient age, position during biopsy, presence of emphysema, lesion size, depth and location, number of pleural punctures and pleural-puncture angle were analysed as independent risk factors for chest tube placement for pneumothorax. Results: Pneumothorax occurred in 93 of 156 procedures (59.6%), and chest tube placement was required in 12 cases (7.7% of all biopsies, 12.9% of all pneumothoraces). Among patients with a pneumothorax, the proportion of cases biopsied in the supine position was significantly greater in the chest tube placement group (58.3%; 7/12) than in the nonchest tube placement group (28.4%; 23/81) (P = 0.026). Patient age, presence of emphysema, lesion size, needle path length, location of pulmonary lesions, number of pleural punctures and the smallest angle between the pleura and the needle showed no significant differences between the two groups. Conclusion: Chest tube insertion was required more frequently in patients biopsied in the supine versus prone position. The prone position is considered preferable to reduce the risk of significant pneumothorax requiring chest tube insertion. © 2011 The Authors. Source

Takagawa R.,Yokosuka Kyosai Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report the cases of 2 patients with clinical T4( cT4) esophageal cancer who achieved pathological complete response on treatment with neoadjuvant chemoradiation therapy. Case 1 involved a 68-year-old woman who was diagnosed as having cT4 advanced esophageal cancer( with involvement of the aorta and left pulmonary vein). Neoadjuvant chemoradiation therapy with 5-fluorouraci(l 5-FU)( 800 mg/m2, days 1-5 and days 29-33), cisplatin( CDDP 80 mg/m2, days 1 and 29), and radiation (39.6 Gy/22 Fr) was administered, and the tumor showed a partial response (PR). Case 2 involved a 69-year-old man who was diagnosed as having cT4 advanced esophageal cancer( with involvement of the main bronchus). Neoadjuvant chemoradiation therapy with 5-FU( 800 mg/m2, days 1-5 and days 29-33), CDDP( 80 mg/m2, days 1 and 29), and radiation( 39.6 Gy/22 Fr) was administered, and the tumor showed a clinical PR. After tumor response was noted, curative esophagectomy was performed in both cases, without any complications, and a pathological complete response was achieved in both patients. Source

Titulaer M.J.,University of Barcelona | Titulaer M.J.,Erasmus Medical Center | Hoftberger R.,University of Barcelona | Hoftberger R.,Medical University of Vienna | And 23 more authors.
Annals of Neurology | Year: 2014

Objective To report the clinical, radiological, and immunological association of demyelinating disorders with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods Clinical and radiological analysis was done of a cohort of 691 patients with anti-NMDAR encephalitis. Determination of antibodies to NMDAR, aquaporin-4 (AQP4), and myelin oligodendrocyte glycoprotein (MOG) was performed using brain immunohistochemistry and cell-based assays. Results Twenty-three of 691 patients with anti-NMDAR encephalitis had prominent magnetic resonance imaging (MRI) and/or clinical features of demyelination. Group 1 included 12 patients in whom anti-NMDAR encephalitis was preceded or followed by independent episodes of neuromyelitis optica (NMO) spectrum disorder (5 cases, 4 anti-AQP4 positive) or brainstem or multifocal demyelinating syndromes (7 cases, all anti-MOG positive). Group 2 included 11 patients in whom anti-NMDAR encephalitis occurred simultaneously with MRI and symptoms compatible with demyelination (5 AQ4 positive, 2 MOG positive). Group 3 (136 controls) included 50 randomly selected patients with typical anti-NMDAR encephalitis, 56 with NMO, and 30 with multiple sclerosis; NMDAR antibodies were detected only in the 50 anti-NMDAR patients, MOG antibodies in 3 of 50 anti-NMDAR and 1 of 56 NMO patients, and AQP4 antibodies in 48 of 56 NMO and 1 of 50 anti-NMDAR patients (p? Source

We report a 49-year-old man with alcoholic severe acute pancreatitis (SAP) complicated by drug-induced acute tubulointerstitial nephritis (DI-AIN). Oliguria persisted and became anuric again on day 17 despite improvement of pancreatitis. He presented rash, fever and eosinophilia from day 20. Renal biopsy was performed for dialysis-dependent acute kidney injury (AKI), DI-AIN was revealed, and prompt use of corticosteroids fully restored his renal function. This diagnosis might be missed because it is difficult to perform renal biopsy in such a clinical situation. If the patient's general condition allows, renal biopsy should be performed and reversible AKI must be distinguished from many cases of irreversible AKI complicated by SAP. This is the first report of biopsy-proven DI-AIN associated with SAP, suggesting the importance of biopsy for distinguishing DI-AIN in persisting AKI of SAP. Source

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