1.Retroperitoneal Hematoma as a Serious Complication of Endovascular Aneurysmal Coiling.
Yasuo MURAI ; Koji ADACHI ; Yoichi YOSHIDA ; Mao TAKEI ; Akira TERAMOTO
Journal of Korean Neurosurgical Society 2010;48(1):88-90
Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.
Aged, 80 and over
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Anesthesia, General
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Aneurysm
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Angiography
;
Arteries
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Consciousness
;
Headache
;
Hematocrit
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Hematoma
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Heparin
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Humans
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Intracranial Aneurysm
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Multiple Organ Failure
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Physical Examination
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Radiology, Interventional
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Subarachnoid Hemorrhage
2.Report of health survey conducted during 1982 by the mutual welfare association of the Fukushima Pref. Agricultural Co-operative.
Mieko Tanaka ; Mitsuko Shiraishi ; Yoichi Yoshida ; Masaki Namatame ; Iwao Komuro ; Sadao Haga ; Jiro Tachibana ; Ryoichi Endo ; Shigeharu Kikuta ; Katsuya Akanuma
Journal of the Japanese Association of Rural Medicine 1984;33(2):218-223
Our examination was performed on 1, 541 men and 3, 803 women. Reviewed were blood pressure, obesity, anemia, fatty tissue (lipide), liver function, urine-suger and protein, urobilinogen, and their abnormalities.
(1) High blood pressure was found in 53.7 % of the men and 68.3 % of the women, with higher rates found in the middle to older age groups of both men and women.
(2) Obesity, by the Minowa method, was found to be over 20 %, with the higher rate being in women. The tendency to obesity in men was found to decrease with age. In females, abnormalities of blood pressure, total cholesterol, triglyceride, thickness of subcutaneous fatty tissue (of the upper arm and shoulder blade areas) were discovered to be greater in proportion to obesity.
(3) Abnormalities in GPT were seen as 15.3 % in men and 7.3 % in women. According to age group in men: Those in their 30's, 21 %, in the 40's, 27.2 %, 50's, 12.7%, 60's, 9.1 %.
A study on the effects of alcholic beverage consumption will be included in the 1983 survey.
3.A Case of \it{Legionella} Pneumonia Complicated by ARDS, Acute Renal Failure and Shock
Kazuhisa ITOH ; Hideyuki KOBAYASHI ; Satoshi HASEGAWA ; Ken YOSHIDA ; Osamu NAKAGAWA ; Yoichi IWAFUCHI ; Minoru ABE ; Kaoru KUNISADA ; Akira KAMIMURA
Journal of the Japanese Association of Rural Medicine 2006;55(1):18-24
A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
Shock
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Respiratory Distress Syndrome, Adult
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Pneumonia
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Kidney Failure, Acute
;
Complicated
4.A Case of Legionella Pneumonia Complicated by ARDS, Acute Renal Failure and Shock
Kazuhisa ITOH ; Hideyuki KOBAYASHI ; Satoshi HASEGAWA ; Ken YOSHIDA ; Osamu NAKAGAWA ; Yoichi IWAFUCHI ; Minoru ABE ; Kaoru KUNISADA ; Akira KAMIMURA
Journal of the Japanese Association of Rural Medicine 2006;55(1):18-24
A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
5.Comparison of treatment outcomes of surgery and radiotherapy, including concurrent chemoradiotherapy for stage Ib2-IIb cervical adenocarcinoma patients: a retrospective study
Eiji KONDO ; Kenta YOSHIDA ; Tsutomu TABATA ; Yoichi KOBAYASHI ; Wataru YAMAGAMI ; Yasuhiko EBINA ; Masanori KANEUCHI ; Satoru NAGASE ; Hiroko MACHIDA ; Mikio MIKAMI
Journal of Gynecologic Oncology 2022;33(2):e14-
Objective:
The study compared the treatment outcomes of surgery versus radiotherapy, including concurrent chemoradiotherapy, in stage Ib2–IIb cervical adenocarcinoma patients in Japan.
Methods:
Of 57,470 patients diagnosed with stage I–IV cervical cancer from January 2001–December 2011, 1,932 patients with stage Ib2–IIb cervical adenocarcinoma were initially treated by surgery or radiotherapy. The primary endpoint was 5-year overall survival (OS) in all and 614 propensity score-matched (PSM) patients (307 per group). We compared OS and prognosis factors based on age, primary stage, and treatment arm.
Results:
In Japan, >80% (n=1,573) of stage Ib2–IIb cervical adenocarcinoma patients underwent surgery. The 5-year OS of surgery vs. radiotherapy groups were 82.1% (n=704) vs. 79.7% (n=59) (hazard ratio [HR]=1.494; 95% confidence interval [CI]=0.826–2.702; p=0.181) for stage Ib2, 76.6% (n=239) vs. 66.7% (n=54) (HR=1.679; 95% CI=0.986–2.858; p=0.053) for stage IIa, and 71.1% (n=630) vs. 58.9% (n=246) (HR=1.711; 95% CI=1.341–2.184; p<0.001) for stage IIb. In 614 PSM patients balanced for age and carcinoma stage Ib2–IIb, the 5-year OS of surgery vs. radiation groups was 73.0% (n=307) vs. 65.5% (n=307) (HR=1.394; 95% CI=1.044–1.860; p=0.023). In multivariable analysis, age (HR=1.293; 95% CI=1.045–1.601; p=0.018), treatment arm, radiotherapy (HR=1.556; 95% CI=1.253–1.933; p<0.001), and stage IIb (HR=1.783; 95% CI=1.443–2.203; p=0.018) were independent prognosis factors for 5-year OS in stage Ib2–IIb adenocarcinoma patients.
Conclusion
Age (>65 years), treatment arm (radiotherapy), and stage IIb significantly affect OS in cervical adenocarcinoma patients. Surgery may be considered for <65-year-old patients with stage IIb adenocarcinoma.
6.Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors
Tetsuya SUWA ; Kohei TAKIZAWA ; Noboru KAWATA ; Masao YOSHIDA ; Yohei YABUUCHI ; Yoichi YAMAMOTO ; Hiroyuki ONO
Clinical Endoscopy 2022;55(1):15-21
Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.
7.Long-term efficacy and tolerability of dose-adjusted thiopurine treatment in maintaining remission in inflammatory bowel disease patients with NUDT15 heterozygosity
Takato MAEDA ; Hirotake SAKURABA ; Hiroto HIRAGA ; Shukuko YOSHIDA ; Yoichi KAKUTA ; Hidezumi KIKUCHI ; Shogo KAWAGUCHI ; Keisuke HASUI ; Tetsuya TATSUTA ; Daisuke CHINDA ; Tatsuya MIKAMI ; Shinsaku FUKUDA
Intestinal Research 2022;20(1):90-100
Background/Aims:
Thiopurines are key drugs for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Recently, NUDT15 polymorphism (R139C, c.415C > T) has been shown to be associated with thiopurineinduced adverse events in Asian populations. In patients with the C/T genotype, low-dose thiopurine treatment is recommended, but its long-term efficacy and tolerability remain unclear. This study aimed to uncover the long-term efficacy and appropriate dosage of thiopurine for IBD patients with the C/T genotype.
Methods:
A total of 210 patients with IBD (103 UC and 107 CD) determined to have NUDT15 R139C variants were enrolled. Clinical data were retrospectively reviewed from medical records.
Results:
Of 46 patients (21.9%) with the C/T genotype, 30 patients (65.2%) were treated with thiopurines. Three of whom (10.0%) discontinued thiopurine treatment due to adverse events and 27 of whom continued. The median maintenance dosage of 6-mercaptopurine was 0.25 mg/kg/day (range, 0.19–0.36 mg/kg/day), and 6-thioguanine nucleotides level was 230 (104–298) pmol/8 × 108 red blood cells. Cumulative thiopurine continuation rates for 120 months for patients with the C/C and C/T genotypes were not significantly different (P= 0.895). Cumulative non-relapse rates in the patients with UC treated with thiopurine monotherapy and surgery-free rates in CD patients treated with combination therapy (thiopurines and anti-tumor necrosis factor-α agents) for maintenance remission were not significantly different at 60 months (C/C vs. C/T, P= 0.339 and P= 0.422, respectively).
Conclusions
Low-dose thiopurine treatment is an effective and acceptable treatment for patients with C/T genotype.
8.Multimorbidity of Allergic Diseases Is Associated With Functional Gastrointestinal Disorders in a Young Japanese Population
Yasunori YAMAMOTO ; Shinya FURUKAWA ; Teruki MIYAKE ; Junichi WATANABE ; Yukihiro NAKAMURA ; Yoshihiro TAGUCHI ; Tetsuya YAMAMOTO ; Aki KATO ; Katsunori KUSUMOTO ; Osamu YOSHIDA ; Eiji TAKESHITA ; Yoshio IKEDA ; Naofumi YAMAMOTO ; Yuka SAEKI ; Osamu YAMAGUCHI ; Yoichi HIASA
Journal of Neurogastroenterology and Motility 2024;30(2):229-235
Background/Aims:
Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS.The aim of this study is to determine this issue in young people.
Methods:
A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria.Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire.
Results:
The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018).
Conclusion
Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.
9.Factors affecting satisfaction following acupuncture therapy in office workers with a chief complaint of katakori (chronic neck pain)
Shogo MIYAZAKI ; Yoichi MINAKAWA ; Kenta SAWAZAKI ; Kaori IIMURA ; Hideaki WAKI ; Naruto YOSHIDA
Journal of the Japan Society of Acupuncture and Moxibustion 2022;72(1):47-67
10.Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease
Teruki MIYAKE ; Shinya FURUKAWA ; Bunzo MATSUURA ; Osamu YOSHIDA ; Masumi MIYAZAKI ; Akihito SHIOMI ; Ayumi KANAMOTO ; Hironobu NAKAGUCHI ; Yoshiko NAKAMURA ; Yusuke IMAI ; Mitsuhito KOIZUMI ; Takao WATANABE ; Yasunori YAMAMOTO ; Yohei KOIZUMI ; Yoshio TOKUMOTO ; Masashi HIROOKA ; Teru KUMAGI ; Eiji TAKESITA ; Yoshio IKEDA ; Masanori ABE ; Yoichi HIASA
Diabetes & Metabolism Journal 2024;48(3):440-448
Background:
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods:
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results:
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.