1.Mitral Valve Replacement in a Patient with a Patent Internal Thoracic Artery Graft after Coronary Artery Bypass Grafting.
Masahiro Aiba ; Yoshiaki Matsuo ; Koji Moriyasu ; Atsubumi Murakami ; Makoto Yamada ; Kouichi Inoue ; Toshihiro Takaba
Japanese Journal of Cardiovascular Surgery 1997;26(2):124-127
A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.
2.Construction of Anti-Doping Database for Pharmacist
Kensuke Usui ; Harutaka Komuro ; Chihiro Ito ; Michiyo Ito ; Koji Masubuchi ; Soichi Shibata ; Jun Kainuma ; Gaku Inoue ; Hiroyuki Nojima ; Koichiro Atsuda
Japanese Journal of Drug Informatics 2012;13(4):189-193
Objective: The sports community has placed its great hope on pharmacist since the establishment of the Accredited Sports Pharmacist System. Thus, we constructed an anti-doping database for pharmacist so that pharmacist can support appropriate drug use and contribute to the sports community.
Methods: The database was constructed by using Microsoft®Access 2007, based on our previously prepared anti-doping list.
Results: 686 prescription drugs and 268 ingredients for non-prescription drug were registered in the data base. It was able to retrieve the advisability of use for athlete, blood half-life and the other notes of the drugs easily and promptly.
Conclusion: We confirm that pharmacist can provide drug information easily, promptly and from the viewpoint of pharmaceutics by utilizing the database including necessary information for anti-doping.
3.Primary Multiple Cardiac Myxomas in a Patient without the Carney Complex.
Shohei KATAOKA ; Masato OTSUKA ; Masayuki GOTO ; Mitsuru KAHATA ; Asako KUMAGAI ; Koji INOUE ; Hiroshi KOGANEI ; Kenji ENTA ; Yasuhiro ISHII
Journal of Cardiovascular Ultrasound 2016;24(1):71-74
Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.
Aged
;
Breast Neoplasms
;
Carney Complex*
;
Echocardiography
;
Embolism
;
Female
;
Heart Atria
;
Heart Neoplasms
;
Heart Ventricles
;
Humans
;
Myxoma*
;
Pigmentation
;
Skin
4.Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis.
Hideki KUMAGAI ; Koji YOKOYAMA ; Tomoyuki IMAGAWA ; Shun INOUE ; Janyerkye TULYEU ; Mamoru TANAKA ; Takanori YAMAGATA
Pediatric Gastroenterology, Hepatology & Nutrition 2016;19(3):214-220
Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.
Abdominal Pain
;
Child*
;
Colectomy
;
Colitis, Ulcerative*
;
Dysbiosis
;
Enema
;
Fecal Microbiota Transplantation*
;
Feces
;
Female
;
Fever
;
Gastrointestinal Microbiome
;
Healthy Volunteers
;
Humans
;
Inflammatory Bowel Diseases
;
Microbiota
;
Tissue Donors
;
Ulcer*
5.Hyperbaric Oxygen Treatment of Carbon Monoxide Poisoning in the Past 5 Years
Kenji NAKAMAE ; Yoshiyuki HYODO ; Yoshikazu NARA ; Hirotaka INOUE ; Masayuki OKIJIMA ; Masahiro OGAWA ; Koji KONDO ; Yuki FUJII ; Atsuya SAKAIDE ; Kazuyoshi NISHIYAMA ; Ryota TANI ; Izumi OTA ; Osamu KAWAGUCHI
Journal of the Japanese Association of Rural Medicine 2016;65(1):1-8
Hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning is performed after oxygen therapy and breathing therapy. The usefulness of HBO therapy in emergency treatment has been reported. In this study, we examined the effectiveness of HBO for CO poisoning that was performed at our hospital over the past 5 years. Subjects were 23 patients who had HBO therapy for CO poisoning in the period January 2008-November 2013. The male to female ratio of the cases was 14:9 and the mean age was 54.6±20.8 years. The cause was suicide in 39.1% of cases and accident in 60.9%. The mean number of treatments was 5.4±6.8. The atmosphere absolute was 2ATA:2.8ATA=12:11. The ratio of direct conveyance of the patient to our hospital to indirect conveyance of the patient from another hospital was 15:8. The effectiveness of HBO therapy at the time of discharge was 73.9%. However, delayed neuropsychiatric sequelae (DNS) was detected in 3 of the 23 cases of CO poisoning. No correlations were found between elapsed time after CO inhalation and various blood parameters. However, time to start of therapy is important for DNS, and our results suggest that early treatment at a hospital with a hyperbaric chamber is necessary.
6.A Proposal on the Curriculum of Behavioral Science
Marie Amitani ; Yoshiki Ishikawa ; Akio Inui ; Shigeru Inoue ; Akihito Shimazu ; Shigeki Suwa ; Akira Tsuda ; Akizumi Tsutsumi ; Koji Tsuboi ; Mutsuhiro Nakao ; Takeo Nakayama ; Masahiro Hashizume ; Kazuhiro Yoshiuchi
Medical Education 2015;46(1):37-40
Introduction: No formal curriculum has been formulated for teaching behavioral science to undergraduate medical students in Japan.
Method: We conducted a survey using the Delphi method to investigate the required competency in behavioral science for graduates in medicine. Then, we developed an outcome-oriented curriculum for teaching behavioral science.
Results: We propose an educational module of behavioral science consisting of 15 sessions of 90-minute lectures, small group discussions, and practice.
Discussion: We recommend including not only lectures but also practices according to problem-based learning as well as team-based learning in the curriculum to achieve the target outcome.
7.PHYSICAL ACTIVITY PATTERNS AND PHYSICAL FITNESS LEVELS OF HOMEBOUND ELDERLY PEOPLE LIVING IN THE COMMUNITY
AKIYO TSUNEYOSHI ; HIROSHI NAGAYAMA ; SAWAKO WAKUI ; TAKAFUMI HAMAOKA ; KAZUTO SAITOU ; AKIRA MAEDA ; KOJI ZUSHI ; NAOTAKE INOUE ; TOMOHITO WADA ; MISAKI SUMINO ; FUTOSHI OGITA ; YUTAKA YOSHITAKE
Japanese Journal of Physical Fitness and Sports Medicine 2008;57(4):433-442
There have so far been no studies examining the physical fitness and physical activity (PA), measured using objective measures, in homebound elderly people. The purpose of this study was to examine physical fitness levels and PA patterns and evaluate their relationships in homebound elderly people. In 2004, a total of 3964 community-dwelling elderly aged 65 years and over participated in a base line survey. The subject data were directly collected by in-home interviewer. Subjects were defined as being homebound if they went outdoors less than once a week. However, the subjects who could not go out without assistance due to sickness and/or disability were excluded from the analysis. In 2005, 38 homebound (22 men, 16 women) and 70 non-homebound (33 men, 37 women) older adults who participated in the base line survey were selected. Measurements of physical fitness levels and PA patterns measured using an accelerometer, were taken in 2005. The total steps per day did not significantly differ between homebound and non-homebound men and women. The time spent in 1.8 METs activity (corresponding to activity level 1 of the accelerometer) was significantly higher in women than in men for non-homebound and homebound, respectively. The time spent in lower-, moderate-, and high-intensity PA did not significantly differ between homebound and non-homebound men and women, respectively. Handgrip strength, knee extensor strength, leg extensor power, stepping and maximum walking speed were significantly higher in non-homebound than in homebound men and women. These results suggest that the physical fitness levels of homebound were lower than those of non-homebound, but no difference was observed in the PA levels between homebound and non-homebound.
8.Clinical Usefulness of Corticotropin Releasing Hormone Testing in Subclinical Cushing's Syndrome for Predicting Cortisol Replacement after Adrenalectomy.
Masahiro INOUE ; Hisamitsu IDE ; Koji KURIHARA ; Tatsuro KOSEKI ; Jingsong YU ; Toshiyuki CHINA ; Keisuke SAITO ; Shuji ISOTANI ; Satoru MUTO ; Shigeo HORIE
Korean Journal of Urology 2012;53(6):414-418
PURPOSE: The purpose of this study was to investigate the clinical and hormonal features of patients with incidentally discovered adrenal adenomas in relation to corticotropin releasing hormone (CRH) testing and the clinical outcome of adrenalectomy. MATERIALS AND METHODS: Twenty-three consecutive patients with incidentally detected adrenal adenomas were included in this retrospective study. All the patients underwent abdominal computed tomography scans and hormonal assays, including assessment of circadian rhythms of plasma cortisol and corticotropin (adrenocorticotropic hormone, ACTH), a corticotropin stimulation test, and low-dose and high-dose dexamethasone tests. The patients were reevaluated at regular intervals (6, 12, and 24 months) for a median period of 24 months. Subclinical Cushing's syndrome (SCS) was diagnosed in patients with subtle hypercortisolism who did not present clinical signs of Cushing's syndrome. RESULTS: We calculated the responsive index (peak value of ACTH in CRH test/baseline value of ACTH in CRH test). Of 23 patients, 6 had Cushing's syndrome, 8 had SCS, and 9 had a non-functioning tumor. All patients underwent laparoscopic adrenalectomy. Several patients (5 of 6 with Cushing's syndrome and 2 of 8 with SCS) required cortisol replacement therapy after surgery. The remaining patients required no hormonal replacement after surgery. Those who required hormone replacement had a responsive index of less than 1.2. Those who did not need hormone replacement therapy had a responsive index of more than 2.0. CONCLUSIONS: In our limited experience, the responsive index of the CRH test might be a valuable tool for predicting the need for cortisol replacement after surgery in patients with SCS.
Adenoma
;
Adrenalectomy
;
Adrenocorticotropic Hormone
;
Circadian Rhythm
;
Corticotropin-Releasing Hormone
;
Cushing Syndrome
;
Dexamethasone
;
Hormone Replacement Therapy
;
Humans
;
Hydrocortisone
;
Plasma
;
Retrospective Studies
9.Relationship between dietary habits and urinary concentrations of 3-phenoxybonzoic acid in a middle-aged and elderly general population in Japan.
Akiko KIMATA ; Takaaki KONDO ; Jun UEYAMA ; Kanami YAMAMOTO ; Michihiro KAMIJIMA ; Koji SUZUKI ; Takashi INOUE ; Yoshinori ITO ; Nobuyuki HAMAJIMA
Environmental Health and Preventive Medicine 2009;14(3):173-179
OBJECTIVESThe ingestion of pesticides in the daily diet is assumed to be the main modality of pesticide exposure for most people. A widely used class of pesticides in agricultural or residential settings is pyrethroid. We have examined the relationship between the intake frequency of selected items of vegetables and fruits and urinary metabolites of pyrethroid pesticides in a healthy general population.
METHODSA total of 535 residents (184 men and 351 women) who attended a healthcare checkup program conducted in a rural area of Hokkaido, Japan, in August 2005 provided informed consent for their spot urine samples to be used for the determination of 3-phenoxybenzoic acid (3-PBA) levels. They also completed a self-administered questionnaire regarding the intake frequency of 12 food items. The concentrations of creatinine-corrected 3-PBA were predicted by the intake frequency of each item, using analysis-of-covariance models to adjust for age, sex, body mass index, and drinking and smoking status.
RESULTSBoth a significant association between the 3-PBA concentration and the frequency of tomato consumption and a significant positive linear trend was found in female subjects. In contrast, no such association was found in the male subjects.
CONCLUSIONSThe frequency of tomato consumption was confirmed to strongly predict the urinary pyrethroid metabolite levels in the general population-presumably because tomatoes are most often consumed raw and unpeeled (more so than all other vegetables and fruits analyzed in the current study). However, it should be noted that the 3-PBA levels, even among those subjects with the highest consumption of tomatoes, were far below the levels of toxicological significance, although the health consequences from long-term low-level exposure to pyrethroid requires further exploration.
10.A Novel, Fully Covered Laser-Cut Nitinol Stent with Antimigration Properties for Nonresectable Distal Malignant Biliary Obstruction: A Multicenter Feasibility Study.
Hiroyuki ISAYAMA ; Kazumichi KAWAKUBO ; Yousuke NAKAI ; Kouta INOUE ; Chimyon GON ; Saburo MATSUBARA ; Hirofumi KOGURE ; Yukiko ITO ; Takeshi TSUJINO ; Suguru MIZUNO ; Tsuyoshi HAMADA ; Rie UCHINO ; Koji MIYABAYASHI ; Keisuke YAMAMOTO ; Takashi SASAKI ; Natsuyo YAMAMOTO ; Kenji HIRANO ; Naoki SASAHIRA ; Minoru TADA ; Kazuhiko KOIKE
Gut and Liver 2013;7(6):725-730
BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged
;
Aged, 80 and over
;
Alloys
;
Carcinoma/*complications
;
Cholestasis/etiology/*therapy
;
Digestive System Neoplasms/*complications
;
Drainage
;
Equipment Design
;
Feasibility Studies
;
Female
;
Humans
;
Kaplan-Meier Estimate
;
Lymphatic Metastasis
;
Male
;
Middle Aged
;
*Prosthesis Failure
;
Recurrence
;
Reoperation
;
*Stents/adverse effects
;
Time Factors