1.A Practical Grading Scale for Predicting Outcomes of Radiosurgery for Dural Arteriovenous Fistulas: JLGK 1802 Study
Hirotaka HASEGAWA ; Masahiro SHIN ; Jun KAWAGISHI ; Hidefumi JOKURA ; Toshinori HASEGAWA ; Takenori KATO ; Mariko KAWASHIMA ; Yuki SHINYA ; Hiroyuki KENAI ; Takuya KAWABE ; Manabu SATO ; Toru SERIZAWA ; Osamu NAGANO ; Kyoko AOYAGI ; Takeshi KONDOH ; Masaaki YAMAMOTO ; Shinji ONOUE ; Kiyoshi NAKAZAKI ; Yoshiyasu IWAI ; Kazuhiro YAMANAKA ; Seiko HASEGAWA ; Kosuke KASHIWABARA ; Nobuhito SAITO ;
Journal of Stroke 2022;24(2):278-287
Background:
and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration.
Methods:
This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching.
Results:
The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01).
Conclusions
SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.
2.Endoscopic Findings and Treatment of Gastric Neoplasms in Familial Adenomatous Polyposis
Chihiro SATO ; Kazuya TAKAHASHI ; Hiroki SATO ; Takumi NARUSE ; Nao NAKAJIMA ; Masafumi TAKATSUNA ; Ken-ichi MIZUNO ; Satoru HASHIMOTO ; Manabu TAKEUCHI ; Junji YOKOYAMA ; Masaaki KOBAYASHI ; Shuji TERAI
Journal of Gastric Cancer 2022;22(4):381-394
Purpose:
Gastric neoplasia is a common manifestation of familial adenomatous polyposis (FAP). This study aimed to elucidate the clinical characteristics, endoscopic features including fundic gland polyposis (FGPsis), and treatment outcomes of gastric neoplasms (GNs) in patients with FAP.
Materials and Methods:
A total of 35 patients diagnosed with FAP, including nine patients from four pedigrees who underwent esophagogastroduodenoscopy (EGD), were investigated regarding patient characteristics, GN morphology, and treatment outcomes.
Results:
Twenty-one patients (60.0%) had 38 GNs; 33 (86.8%) and 5 (13.2%) were histologically diagnosed with adenocarcinoma and adenoma, respectively. There were no specific patient characteristics related to GNs.Nodule-type GNs were more prevalent in patients with FGP than without (52.2% vs. 0.0%, P=0.002) in the upper body of the stomach. Conversely, depressed-type GNs were fewer in patients with FGPsis than in those without (13.0% vs. 73.3%, P<0.001). Slightly elevated-type GNs were observed in both groups (34.8% vs. 20.0%, P=0.538). Even within pedigrees, the background gastric mucosa and types of GNs varied. In total, 24 GNs were treated with endoscopic submucosal dissection (ESD) and eight with endoscopic mucosal resection (EMR). EMR was selected for GNs with FGPsis because of the technical difficulty of ESD, resulting in a lower en bloc resection rate (62.5% vs. 100%, P=0.014).
Conclusions
Our study indicates the necessity of routine EGD surveillance in patients diagnosed with FAP. Notably, the morphology and location of GNs differed between patients with and without FGPsis. Endoscopic treatment and outcomes require more attention in cases of FGPsis.
3.Features and Outcomes of Children with Ulcerative Colitis who Undergo a Diagnostic Change: A Single-Center Experience
Natsuki ITO ; Ichiro TAKEUCHI ; Reiko KYODO ; Yuri HIRANO ; Takuro SATO ; Masaaki USAMI ; Hirotaka SHIMIZU ; Toshiaki SHIMIZU ; Katsuhiro ARAI
Pediatric Gastroenterology, Hepatology & Nutrition 2021;24(4):357-365
Purpose:
A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change.
Methods:
The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC).
Results:
Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group (p<0.05).
Conclusion
Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.
4.Features and Outcomes of Children with Ulcerative Colitis who Undergo a Diagnostic Change: A Single-Center Experience
Natsuki ITO ; Ichiro TAKEUCHI ; Reiko KYODO ; Yuri HIRANO ; Takuro SATO ; Masaaki USAMI ; Hirotaka SHIMIZU ; Toshiaki SHIMIZU ; Katsuhiro ARAI
Pediatric Gastroenterology, Hepatology & Nutrition 2021;24(4):357-365
Purpose:
A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change.
Methods:
The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC).
Results:
Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group (p<0.05).
Conclusion
Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.
5.9-4 Education Given at Jichi Medical University's Dormitory during the COVID-19 Pandemic: Strategies and Challenges in a Boarding Medical College
Yosikazu NAKAMURA ; Yoshihiro ITAI ; Nobuko MAKINO ; Masaaki SATO ; Shigeo NAGASHIMA ; Yukiko ISHIKAWA ; Kenji KUROIWA ; Teppei SASAHARA ; Yasuko NODA ; Masami MATSUMURA ; Shizukiyo ISHIKAWA ; Masanori OGAWA ; Akinori YAMABE ; Yoshikazu ASADA
Medical Education 2020;51(3):306-307
6.Endolymphatic Hydrops as a Clinical Condition in Traditional Oriental Medicine —Is an Endolymphatic Hydrops Condition the Same as Suidoku? Analysis of Endolymphatic Hydrops by Traditional C
Michitaka HOSHINO ; Xiaochen HU ; Juichi SATO ; Masaaki TERANISHI ; Tsutomu NAKASHIMA
Kampo Medicine 2016;67(3):251-256
Endolymphatic hydrops, regarded as a marker of Ménière's disease, can now be diagnosed using MRI. Since endolymphatic hydrops is considered a condition of fluid disturbance known as suidoku in Kampo medicine, Kampo preparations with a water flow smoothing ability are often used to treat endolymphatic hydrops. However, the hypothesis that endolymphatic hydrops is suidoku indication has not been fully tested. We used traditional Chinese medicine to diagnose patterns in 11 patients who had been diagnosed with endolymphatic hydrops using MRI. Additionally, we researched the literature regarding the condition of fluid disturbance and resulting vertigo. Of the 11 patients, seven showed disorder of fluid, eight showed kidney (traditional medicine, TM) disorder, and five showed liver (TM) disorder. According to the literature, the vertigo condition caused by fluid disturbance was described in the chapters “tanyinkesoubing and shuiqibing” in the “Jinguiyaolue”. Since no auditory symptom is mentioned in these chapters on vertigo, vertigo caused by fluid disturbance might differ from typical Ménière's disease with auditory symptoms. It is suggested that the patients with endolymphatic hydrops do not necessarily indicate suidoku and we should consider the states of kidney (TM) and liver (TM) disorders.
7.A study of the triage function of referrals in an urban clinic
Kazuhiro Waza ; Shinsuke Fujita ; Takashi Yamada ; Maiko Ono ; Masaaki Yamaoka ; Junichi Mise ; Hirotaka Onishi ; Mikiya Sato ; Hirofumi Takayanagi ; Kenichi Sato
An Official Journal of the Japan Primary Care Association 2015;38(2):111-115
Introduction : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.
Methods : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.
Results : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).
Conclusion : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”
8.Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy.
Yoshihisa ARAO ; Yuichi SATO ; Satoru HASHIMOTO ; Hiroki HONDA ; Kazumi YOKO ; Masaaki TAKAMURA ; Ken ichi MIZUNO ; Masaaki KOBAYASHI
Clinical Endoscopy 2015;48(6):563-565
A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.
Eating
;
Female
;
Fibrosis
;
Fistula*
;
Gastrostomy*
;
Humans
;
Inflammation
;
Lupus Erythematosus, Systemic
;
Middle Aged
;
Pharyngeal Neoplasms
;
Prednisolone
;
Steroids
;
Wound Healing
9.Comparative Clinical Evaluation of the Efficacy and Safety between the Original Drug and Generic Products (II)
Yukinaga Kishikawa ; Tomomi Iwasaki ; Megumi Ito ; Kazuki Ishikura ; Kaoko Ikeda ; Keigo Sato ; Yumiko Kon-no ; Tomomi Yagi ; Soh Katsuyama ; Masaaki Shindo ; Daichi Minakawa ; Tetsuo Togo ; Hitoshi Nakamura ; Michinao Mizugaki
Japanese Journal of Drug Informatics 2011;13(3):86-94
Objective: The purpose of this study is to compare the clinical efficacy between original drugs and generic products. Candidate drugs included two types of hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, simvastatin and pravastatin, because of their importance at reducing the health expenditure for hyperlipidemia.
Design: We retrospectively evaluated the efficacy (total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein levels), safety (biochemical parameters), and medication adherence based on patient data. We set the follow-up period at 6 months before and after substitution. Data were analyzed by paired-sample t-tests (statistical significance level of 0.05).
Methods: The subjects included in this study were ambulatory patients visiting Nakajima Hospital for dyslipidemia treatment. Selected patients included those taking both the original drug and the generic product; i.e., patients who had substituted the original drug Lipovas® for the generic product Simvastatin OHARA, or those who had substituted the original drug Mevalotin® for the generic drug Pravatin®.
Results: A total of 118 patients in the simvastatin study and 43 patients in the pravastatin study were candidates for the present study. We found that there were no significant differences before and after substitution. Even though there were differences in some of the biochemical parameters, the range remained within normal levels. With regard to medication adherence, we found no significant differences.
Conclusion: In this study, we found no significant differences before and after substituting medications with generic drugs. Additionally, we found no subjective symptom changes after substitution. To develop clinical information on generic products and to store such information, it is important that pharmaceutical products be used appropriately.
10.Mass screening of prostate cancer in a Chinese population: the relationship between pathological features of prostate cancer and serum prostate specific antigen.
Hong-Wen GAO ; Yu-Lin LI ; Shan WU ; Yi-Shu WANG ; Hai-Feng ZHANG ; Yu-Zhuo PAN ; Ling ZHANG ; Hiroo TATENO ; Ikuro SATO ; Masaaki KUWAHARA ; Xue-Jian ZHAO
Asian Journal of Andrology 2005;7(2):159-163
AIMTo investigate the pathological features of the prostate biopsy through mass screening for prostate cancer in a Chinese cohort and their association with serum prostate specific antigen (PSA).
METHODSA total of 12027 Chinese men in Changchun were screened for prostate cancer by means of the serum total prostate specific antigen tPSA test (by Elisa assay). Transrectal ultrasound-guided systematic six-sextant biopsies were performed on those whose serum tPSA value was > 4.0 ng/mL and those who had obstructive symptoms (despite their tPSA value) and were subject to subsequent pathological analysis with the aid of the statistic software SPSS 10.0 (SPSS. Inc., Chicago. USA).
RESULTSOf the 12027 cases, 158 (including 137 patients whose serum tPSA values were 4.0 ng/mL and 21 patients [serum tPSA < 4.0 ng/mL] who had obstructive symptoms) undertook prostate biopsy. Of the 158 biopsies, 41 cases of prostatic carcinoma were found (25.9 %, 41/158). The moderately differentiated carcinoma and poorly differentiated carcinoma accounted for 61% and 34%, respectively. A significant linear positive correlation between the serum tPSA and the Gleason scores in the 41 cases of prostatic carcinoma (r = 0.312, P < 0.01) was established. A significant linear positive correlation between the serum tPSA value of the 41 prostatic carcinoma and the positive counts of carcinoma in sextant biopsies was established (r = 0.406, P < 0.01), indicating a significant linear relationship between serum tPSA and the size of tumor.
CONCLUSIONThis study was the first to conduct mass screening for prostate cancer by testing for serum tPSA values and the first to investigate the pathological features of prostate cancer in a cohort of Chinese men. Our results reveal that the moderately differentiated carcinoma is the most common type of prostate cancer. This study also has shown that the serum tPSA value in prostate cancer is associated with the Gleason score and the size of tumor.
Biopsy ; methods ; China ; Humans ; Male ; Mass Screening ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography
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