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ABSTRACT: Predictive variables of delayed cerebral ischemia (DCI) and pulmonary edema following subarachnoid hemorrhage (SAH) remain unknown. We aimed to determine associations between transpulmonary thermodilution-derived variables and DCI and pulmonary edema occurrence after SAH. We reviewed 34 consecutive SAH patients monitored by the PiCCO system. Six patients developed DCI at 7 days after SAH on average; 28 did not (non-DCI). We compared the variable measures for 1 day before DCI occurred (DCI day -1) in the DCI group and 6 days after SAH (non-DCI day -1) in the non-DCI group for control. The mean value of the global end-diastolic volume index (GEDI) for DCI day -1 was lower than that for non-DCI day -1 (676 ± 65 vs. 872 ± 85 mL/m, P = 0.04). Central venous pressure (CVP) was not significantly different (7.8 ± 3.1 vs. 9.4 ± 1.9 cm H2O, P = 0.45). At day -1 for both DCI and non-DCI, 11 patients (32%) had pulmonary edema. Global end-diastolic volume index was significantly higher in patients with pulmonary edema than in those without this condition (947 ± 126 vs. 766 ± 81 mL/m, P = 0.02); CVP was not significantly different (8.7 ± 2.8 vs. 9.2 ± 2.1 cm H2O, P = 0.78). Although significant correlation was found between extravascular lung water (EVLW) measures and GEDI (r = 0.58, P = 0.001), EVLW and CVP were not correlated (r = 0.03, P = 0.88). Thus, GEDI might be associated with DCI occurrence and EVLW accumulation after SAH. ABBREVIATIONS: 95% CI - 95% confidence intervalAUC - area under the receiver operating characteristic curveCO - cardiac outputCVP - central venous pressureDCI - delayed cerebral ischemiaEVLW - extravascular lung waterEVLWI - extravascular lung water indexGEF - global ejection fractionGEDV - global end-diastolic volumeGEDI - global end-diastolic volume indexITBV - intrathoracic blood volumeITTV - intrathoracic thermal volumePVPI - pulmonary vascular permeability indexSAH - subarachnoid hemorrhageSVRI - systemic vascular resistance index.
Shock (Augusta, Ga.) 07/2012; 38(5):480-5. · 2.87 Impact Factor
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The journal of trauma and acute care surgery. 03/2012; 72(3):E116.
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Shigetaka Sugihara,
Tsutomu Ogata,
Tomoyuki Kawamura,
Tatsuhiko Urakami,
Koji Takemoto,
Nobuyuki Kikuchi,
Noriyuki Takubo,
Kohji Tsubouchi,
Reiko Horikawa,
Kisho Kobayashi, [......],
Satoshi Matsuo,
Keiichi Hanaki, Yutaka Igarashi,
Goro Sasaki,
Shun Soneda,
Shinichi Teno,
Susumu Kanzaki,
Hiroh Saji,
Katsushi Tokunaga,
Shin Amemiya
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ABSTRACT: To determine the HLA-DRB1, DQB1, DPB1, A, C, and B genotypes among Japanese children with autoimmune type 1 diabetes.
Four hundred and thirty patients who were GADAb and/or IA-2Ab-positive (Type 1A) were recruited from 37 medical centers as part of a nationwide multicenter collaborative study. DNA samples from 83 siblings of the children with Type 1A diabetes and 149 parent-child trios were also analyzed. A case-control study and a transmission disequilibrium test (TDT) were then performed.
The susceptible and protective DRB1 and DQB1 alleles and haplotypes were confirmed. DPB1 alleles unique to the Japanese population and those common to multiple ethnic groups were also present. A linkage disequilibrium (LD) analysis showed both susceptible and protective haplotypes. The TDT did not reveal any alleles that were transmitted preferentially from the mother or father to children with Type 1A. Homozygosity for DRB1-09:01-DQB1-03:03 and heterozygosity for DRB1-04:05-DQB1-04:01 and DRB1-08:02-DQB1-03:02 were associated with an extremely high risk of Type 1A. A comparison of children with Type 1A and their parents and siblings suggested a dose effect of susceptible DRB1-DQB1 haplotypes and an effect of protective alleles on immunological pathogenesis. DRB1-09:01 appeared to be strongly associated with an early onset in preschool children with Type 1A diabetes.
This study demonstrated the characteristic association of HLA-class II and class I genes with Type 1A diabetes among Japanese children. A TDT did not reveal the genomic imprinting of HLA-class II and class I genes in Type 1A diabetes.
Pediatric Diabetes 11/2011; 13(1):33-44. · 2.16 Impact Factor
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ABSTRACT: This report describes our onsite medical rounds and fact-finding activities conducted in the acute phase and medical relief work conducted in the subacute phase in Miyagi prefecture following the Great East Japan Earthquake and subsequent tsunami that occurred off northeastern Honshu on March 11, 2011. As part of the All-Japan Hospital Association medical team deployed to the disaster area, a Nippon Medical School team conducted fact-finding and onsite medical rounds and evaluated basic life and medical needs in the affected areas of Shiogama and Tagajo. We performed triage for more than 2,000 casualties, but in our medical rounds of hospitals, clinics, and nursing homes, we found no severely injured person but did find 1 case of hyperglycemia. We conducted medical rounds at evacuation shelters in Kesennuma City during the subacute phase of the disaster, from March 17 through June 1, as part of the Tokyo Medical Association medical teams deployed. Sixty-seven staff members (17 teams), including 46 physicians, 11 nurses, 3 pharmacists, and 1 clinical psychotherapist, joined this mission. Most patients complained of a worsening of symptoms of preexisting conditions, such as hypertension, respiratory problems, and diabetes, rather than of medical problems specifically related to the tsunami. In the acute phase of the disaster, the information infrastructure was decimated and we could not obtain enough information about conditions in the affected areas, such as how many persons were severely injured, how severely lifeline services had been damaged, and what was lacking. To start obtaining this information, we conducted medical rounds. This proved to be a good decision, as we found many injured persons in evacuation shelters without medication, communication devices, or transportation. Also, basic necessities for life, such as water and food, were lacking. We were able to evaluate these basic needs and inform local disaster headquarters of them. In Kesennuma City, we found that some evacuation shelters could not contact others even after 1 week after the earthquake. We realized from our experiences that, unlike our activities following more localized earthquake disasters, the first task following such large-scale disasters is to acquire information on basic life needs, including medication needs, and the number of persons requiring assistance. We must provide medical relief according to the unique characteristics of the disaster-affected areas as well as the specific nature of the disaster, in this case, a tsunami.
Journal of Nippon Medical School 01/2011; 78(6):401-4.
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Internal Medicine 02/2006; 45(5):333-4. · 0.94 Impact Factor
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Takako Kawakami,
Tetsuo Mitsui,
Masayo Kanai,
Emi Shirahata,
Dai Sendo,
Miyako Kanno,
Mizuka Noro,
Mikiya Endoh,
Asahito Hama,
Chikako Tono,
Etsuro Ito,
Shigeru Tsuchiya, Yutaka Igarashi,
Daiki Abukawa,
Kiyoshi Hayasaka
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ABSTRACT: Shwachman-Diamond syndrome (SDS) is a rare hereditary disorder characterized by pancreatic exocrine insufficiency, bone marrow dysfunction and skeletal changes. Recently, the cause of SDS was identified as mutations of Shwachman-Bodian-Diamond syndrome gene (SBDS) and most mutations are caused by gene conversion between SBDS and its highly homologous pseudogene. Clinical variations especially in skeletal and bone marrow abnormalities are well known in this syndrome. To study the relationship between SBDS mutation and its clinical features, we analyzed 9 Japanese patients including one sibling and detected the three different SBDS mutations in 7 patients: a mutation that disrupts the donor splice site of intron 2, deletes 8 bp of the exon 2 and produces premature termination (258+2 T > C), a dinucleotide change that replaces a lysine at 62 nd amino acid to a termination codon (183-184 TA > CT), and a 4-bp deletion that causes premature termination by frameshift (292-295 delAAAG). The 5 patients represent compound heterozygotes of the 258+2 T > C and 183-184 TA > CT mutations. One patient is a compound heterozygote of the 258+2 T > C and 292-295 delAAAG mutations, and in the remaining one case only a 258+2 T > C mutation could be detected. Thus, the 258+2 T > C and 183-184 TA > CT mutations are prevalent among Japanese patients. No mutations were found in two cases, despite the clinical features. Of the 7 patients with SBDS mutations, persistent hematologic abnormalities and skeletal changes were not observed in 3 and 2 patients, respectively. Notably, clinical variations are present even among the patients with the identical genotype: compound heterozygotes of the 258+2 T > C and 183-184 TA > CT mutations. Further study will be required to explain the clinical heterogeneity.
The Tohoku Journal of Experimental Medicine 08/2005; 206(3):253-9. · 1.24 Impact Factor
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Satoru Komura,
Masaomi Chinushi,
Michiko Kudo,
Takashi Saikawa,
Yasutaka Tanabe,
Hiroshi Furushima,
Takashi Washizuka,
Makoto Kodama,
Hirotaka Oda,
Seiichi Miyajima,
Fumiaki Masani, Yutaka Igarashi,
Minoru Murata,
Yoshifusa Aizawa
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ABSTRACT: The purpose of this study was to assess the candidates suitable for cardiac resynchronization therapy (CRT) and to examine the significance of the QRS duration in Japanese patients with idiopathic dilated cardiomyopathy (DCM).
The study population consisted of 357 patients. The selection criteria for candidates suitable for CRT were QRS duration =130 ms, left ventricular ejection fraction (LVEF) =35% and New York Heart Association (NYHA) functional class III or IV by ACC/AHA/NASPE 2002 guidelines. We divided the study population into 2 groups: group A with a QRS duration <130 ms, and group B with a QRS duration =130 ms. In 25 of the 375 patients (7.0%), all the criteria were fulfilled. Group B had a significantly larger left ventricular diameter end-diastole and end-systole than group A (P<0.0001). Group B had a lower LVEF (P<0.0001). There was a fair inverse correlation (r=-0.58, P<0.0001) between the length of the QRS duration and LVEF.
Approximately 7% of the Japanese patients with DCM are CRT candidates. In the present study, we found that prolonged QRS duration was associated with poor systolic function.
Circulation Journal 12/2004; 68(12):1104-9. · 3.77 Impact Factor
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ABSTRACT: The predictive values for long-term outcome in 127 consecutive patients with acute myocardial infarction (AMI) after successful primary percutaneous transluminal coronary angioplasty (PTCA) were prospectively investigated in the present study. The primary endpoint was a composite of cardiac death, nonfatal AMI, and recurrent angina. Follow-up angiography was performed in 120 patients to assess restenosis. The primary endpoint occurred in 21 patients during a follow-up period of 35+/-24 months. These patients had a higher lipoprotein(a) [Lp(a)] concentration (p=0.0105) and more prevalence of multivessel disease (p=0.0028) than the other patients. The subjects were divided into 2 groups at the 75th percentile Lp(a) value: group A had an Lp(a) concentration >or=47 mg/dl and group B <47 mg/dl. Kaplan-Meier analysis showed a lower cardiac event-free survival rate in group A (p=0.0007) and in patients with multivessel disease (p=0.001). In Cox proportional hazards regression analysis, an Lp(a) level >or=47 mg/dl (relative risk[RR] 5.5, 95% confidence interval [CI] 2.0-15.0, p=0.0007) and multivessel disease (RR 5.3, 95% CI 2.0-13.7, p=0.0006) were independent predictors of the primary endpoint. An elevated Lp(a) concentration on admission and multivessel disease are significant predictors for long-term adverse outcome in AMI patients treated by primary PTCA.
Circulation Journal 08/2003; 67(7):605-11. · 3.77 Impact Factor
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Nobuo Matsuura,
Yukifumi Yokota,
Kouji Kazahari,
Nozomu Sasaki,
Shin Amemiya,
Yoshiya Ito,
Naoki Fukushima,
Akemi Koike, Yutaka Igarashi,
Takeki Hirano, [......],
Masakuni Tokuda,
Toshikazu Takahashi,
Susumu Kanzaki,
Ichiro Yokota,
Kaichi Kida,
Taisuke Okada,
Soroku Nishiyama,
Hidenari Masuda,
Akihiko Kinugasa,
Osamu Nukada
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ABSTRACT: The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) was established in July 1994 with the chief aim to improve the quality of therapy for type 1 diabetes in children, an entity far less common in Japan than in Europe. We proposed four initial research topics: (i) to determine the current status of medical care and glycemic control in Japanese children with type 1 diabetes mellitus; (ii) to standardize the measurement of hemoglobin A1c; (iii) to establish a registry of a large cohort of patients in order to enable prospective studies to improve the quality of therapy for children with type 1 diabetes in Japan; and (iv) to enable participants of the JSGIT to hold a workshop twice annually.We registered a total of 736 patients from 45 hospitals throughout Japan. Intervention via insulin treatment was instituted after 2 yr for those patients whose hemoglobin A1c level was more than 8.1%. The proportion of patients receiving multiple insulin injections increased after intervention; however, average hemoglobin A1c in females remained significantly higher than in males. We identified two forms of diabetes in Japanese children: a rapidly progressive form and a more slowly progressive form. There was a significantly higher prevalence of a family history of diabetes in first-degree relatives in the slowly progressive form. These preliminary findings are the result of the first collaborative study of childhood diabetes in Japan.
Pediatric Diabetes 01/2002; 2(4):160 - 169. · 2.16 Impact Factor
