58 results on '"Yuichiro Hirata"'
Search Results
2. Impact of the COVID‐19 pandemic on pathological autopsy practices in Japan
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Yuichiro Hirata, Shun Iida, Takeshi Arashiro, Sayaka Nagasawa, Hisako Saitoh, Hiroyuki Abe, Masako Ikemura, Yohsuke Makino, Rintaro Sawa, Hirotaro Iwase, Tetsuo Ushiku, Tadaki Suzuki, and Shinji Akitomi
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General Medicine ,Pathology and Forensic Medicine - Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, autopsies have provided valuable insights into the pathogenesis of COVID-19. The precise effect of this pandemic on autopsy procedures in Japan, especially in instances unrelated to COVID-19, has not yet been established. Therefore, we conducted a questionnaire survey from December 2020 to January 2021 regarding the status of pathological autopsy practices in Japan during the first year of the COVID-19 pandemic. The questionnaire was sent to 678 medical facilities with pathologists, of which 227 responded. In cases where a confirmed diagnosis of COVID-19 was not made at the time of autopsy, many facilities counted them as suspected COVID-19 cases if pneumonia was suspected clinically. At around half of the sites, autopsies were prohibited for suspected COVID-19 cases. In addition, the number of autopsies of non-COVID-19 cases during the pandemic period was also investigated, and a significant decrease was observed compared with the incidence in the pre-pandemic period. The COVID-19 pandemic has affected not only the autopsies of COVID-19 cases but also the entire practice of pathological autopsies. It is necessary to establish a system that supports the implementation of pathological autopsy practices during the pandemic of an emerging infectious disease.
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- 2023
3. Clinical outcomes of pulmonary agenesis: A systematic review of the literature
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Shoji Fukuoka, Kenichiro Yamamura, Hazumu Nagata, Daisuke Toyomura, Yusaku Nagatomo, Yoshimi Eguchi, Kiyoshi Uike, Yuichiro Hirata, Hirosuke Inoue, Masayuki Ochiai, and Shouichi Ohga
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Lung Diseases ,Pulmonary and Respiratory Medicine ,Pediatrics, Perinatology and Child Health ,Humans ,Abnormalities, Multiple ,Tracheal Stenosis ,Lung - Abstract
Pulmonary agenesis is a complete absence of the pulmonary parenchyma, airways, and vasculature unilaterally or bilaterally. Although bilateral cases are lethal, the outcome of unilateral cases remains not well described. We performed a comprehensive literature review to assess the clinical features of pulmonary agenesis.Four database sources were searched on October 10, 2021 and two cases were included from our institution. Studies related to the clinical impact of comorbidity and intervention on the survival outcome in pulmonary agenesis were included for full-text review.We identified 259 patients-with right-sided (59%), left-sided (34%), and bilateral agenesis (7%)-among 195 articles and our two cases. Additional anomalies included cardiovascular (40%), skeletal (30%), gastrointestinal (20%), tracheal (20%: all stenoses), and genitourinary (14%) anomalies. Fifty-seven (24%) individuals in unilateral pulmonary agenesis had isolated disease. Outcomes related to survival were not uniformly reported, but the 2-year overall survival rate of unilateral agenesis was 62% and no subsequent death was reported until 13 years of age. The right-sided agenesis was more frequently associated with tracheal stenosis (27% vs. 11%, p = 0.003) than the left-sided disease. A multivariable analysis indicated that tracheal stenosis (hazard ratio [HR]: 2.2, 95% confidence interval [CI]: 1.3-4.1, p = 0.003) and gastrointestinal anomalies (HR: 2.0, 95% CI: 1.1-3.3, p = 0.010) were prognostic factors for mortality.The poor prognostic factors were tracheal stenosis, right agenesis, and gastrointestinal anomalies. Treatment for these comorbidities is a key point for improving the survival of unilateral pulmonary agenesis.
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- 2022
4. A case of fatal fulminant fat embolism syndrome following multiple fractures resulting from a fall
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Yuichiro Hirata, Go Inokuchi, Shigeki Tsuneya, Yumi Hoshioka, Fumiko Chiba, Maiko Yoshida, Yohsuke Makino, and Hirotaro Iwase
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Genetics ,Pathology and Forensic Medicine - Published
- 2022
5. SARS-CoV-2 Transmission from Virus-Infected Dead Hamsters
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Kiyoko Iwatsuki-Horimoto, Hiroshi Ueki, Mutsumi Ito, Sayaka Nagasawa, Yuichiro Hirata, Kenichiro Hashizume, Kazuho Ushiwata, Hirotaro Iwase, Yohsuke Makino, Tetsuo Ushiku, Shinji Akitomi, Masaki Imai, Hisako Saitoh, and Yoshihiro Kawaoka
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Molecular Biology ,Microbiology - Abstract
We found that SARS-CoV-2 could be transmitted from a dead body, presumably via postmortem gases. However, we also found that postmortem care, such as plugging the pharynx, nostrils, and rectum or embalming the corpse, could prevent transmission from the dead body. These results indicate that protection from infection is essential when handling infected corpses and that appropriate care of SARS-CoV-2-infected corpses is important.
- Published
- 2023
6. Extracorporeal membrane oxygenation for the control of pulmonary artery hemorrhage
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Yuichiro Hirata, Eiki Tayama, Ryuya Nomura, Tomofumi Fukuda, Tatshushi Onzuka, and Kojiro Furukawa
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Lung Diseases ,Pulmonary and Respiratory Medicine ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,Humans ,Hemorrhage ,Surgery ,General Medicine ,Pulmonary Artery ,Cardiology and Cardiovascular Medicine - Abstract
We report a case of catheter-induced pulmonary hemorrhage, which had a favorable outcome on using extracorporeal membrane oxygenation. This procedure helped shunt pulmonary blood flow and significantly reduced bleeding from the pulmonary artery. Massive hemoptysis was observed while weaning the patient off cardiopulmonary bypass. Thus, catheter-induced pulmonary hemorrhage was suspected. After the bronchial blocker was inserted, extracorporeal membrane oxygenation was initiated to reduce pulmonary blood flow. The bronchial blocker was removed the day after the surgery, and the extracorporeal membrane oxygenation was withdrawn on the fourth day after the surgery. Tracheal bleeding did not recur during the postoperative period.
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- 2022
7. TRALI as a Cause of Massive Tracheal Secretions during Cardiac Surgery
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Yuichiro Hirata, Kenichi Imasaka, Ryuya Nomura, Tomofumi Fukuda, Yuma Motomatsu, and Shigeki Morita
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- 2022
8. A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection
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Ryuya Nomura, Kojiro Furukawa, Tomofumi Fukuda, Yuichiro Hirata, Tatsushi Onzuka, Eiki Tayama, and Shigeki Morita
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- 2022
9. Valvular and aortic surgery in an adult patient late after repaired tetralogy of Fallot
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Ryuya Nomura, Kojiro Furukawa, Tomofumi Fukuda, Yuichiro Hirata, Tatsushi Onzuka, Kisho Ohtani, Ken-ichi Imasaka, Shigeki Morita, and Akira Shiose
- Abstract
Background The most common complication after tetralogy of Fallot repair is pulmonary valve regurgitation. However, concomitant surgery for tricuspid valve regurgitation and/or aortic dilatation is occasionally required. Case presentation A 56-year-old woman who underwent surgery for tetralogy of Fallot at age 29 years was diagnosed with progressive tricuspid valve regurgitation, hepatosplenomegaly, and thrombocytopenia. Moreover, computed tomography and transesophageal echocardiography revealed regurgitation in pulmonary and mitral valves and dilatation of the ascending aorta. One month after splenectomy for increasing platelet count, she underwent pulmonary valve replacement, tricuspid and mitral valve annuloplasty, and ascending aortic replacement. Postoperatively, the intensive care stay was complicated because of ventricular dysfunction and long-term ventilation. After 1 week, the patient was disconnected from the respirator, and she was transferred on the 55th postoperative day to another hospital for rehabilitation, without permanent disabilities. Conclusion We herein reported a patient with repaired TOF who successfully underwent PVR, tricuspid and mitral valve annuloplasty, and ascending aortic replacement.
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- 2022
10. High titers of infectious SARS-CoV-2 in COVID-19 corpses
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Hisako Saitoh, Yuko Sakai-Tagawa, Sayaka Nagasawa, Suguru Torimitsu, Kazumi Kubota, Yuichiro Hirata, Kiyoko Iwatsuki-Horimoto, Ayumi Motomura, Namiko Ishii, Keisuke Okaba, Kie Horioka, Hiroyuki Abe, Masako Ikemura, Hirofumi Rokutan, Munetoshi Hinata, Akiko Iwasaki, Yoichi Yasunaga, Makoto Nakajima, Rutsuko Yamaguchi, Shigeki Tsuneya, Kei Kira, Susumu Kobayashi, Go Inokuchi, Fumiko Chiba, Yumi Hoshioka, Aika Mori, Isao Yamamoto, Kimiko Nakagawa, Harutaka Katano, Shun Iida, Tadaki Suzuki, Shinji Akitomi, Iwao Hasegawa, Tetsuo Ushiku, Daisuke Yajima, Hirotaro Iwase, Yohsuke Makino, and Yoshihiro Kawaoka
- Abstract
BackgroundThe prolonged presence of infectious severe acute respiratory syndrome coronavirus (SARS-CoV-2) in deceased coronavirus disease 2019 (COVID-19) patients has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses.AimThe aim of this study was to assess the level of SARS-CoV-2 infectivity in COVID-19 corpses.MethodsWe collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation.ResultsInfectious virus was present in 6 of 11 (55%) cases, 4 of 11 (36%) nasopharyngeal swabs, and 9 of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units (PFU)/mL to 2.09E + 06 PFU/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days.ConclusionCOVID-19 corpses may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.
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- 2022
11. Can SARS-CoV-2 transmit from a dead body?
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Kiyoko Iwatsuki-Horimoto, Hiroshi Ueki, Mutsumi Ito, Sayaka Nagasawa, Yuichiro Hirata, Kenichiro Hashizume, Kazuho Ushiwata, Hirotaro Iwase, Yohsuke Makino, Tetsuo Ushiku, Shinji Akitomi, Masaki Imai, Hisako Saitoh, and Yoshihiro Kawaoka
- Abstract
Although it has been 2.5 years since the COVID-19 pandemic began, the transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a dead infected body remains unclear, and often, in Japan bereaved family members are not allowed to view in-person a loved one who has died from COVID-19. In this study, we analyzed the possibility of SARS-CoV-2 transmission from a dead body by using the hamster model. We also analyzed the effect of Angel-care––in which the pharynx, nostril, and rectum are plugged––and embalming on reducing transmissibility from dead bodies. We found that SARS-CoV-2 could be transmitted from the body of animals that died within a few days of infection; however, Angel-care and embalming were effective in preventing transmission from the dead body. These results suggest that protection from infection is essential when in contact with a SARS-CoV-2-infected dead body, and that sealing the cavities of a dead body is an important infection control step if embalming is not done.ImportanceWe found that SARS-CoV-2 could be transmitted from a dead body presumably via postmortem gases. However, we also found that postmortem care, such as plugging the pharynx, nostrils, and rectum, or embalming could prevent transmission from the dead body. These results indicate that protection from infection is essential when handling infected corpses, and that appropriate care of SARS-CoV-2-infected corpses is important.
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- 2022
12. Characterization of SARS-CoV-2 Omicron BA.2.75 clinical isolates
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Ryuta Uraki, Shun Iida, Peter J. Halfmann, Seiya Yamayoshi, Yuichiro Hirata, Kiyoko Iwatsuki-Horimoto, Maki Kiso, Mutsumi Ito, Yuri Furusawa, Hiroshi Ueki, Yuko Sakai-Tagawa, Makoto Kuroda, Tadashi Maemura, Taksoo Kim, Sohtaro Mine, Noriko Iwamoto, Rong Li, Yanan Liu, Deanna Larson, Shuetsu Fukushi, Shinji Watanabe, Ken Maeda, Zhongde Wang, Norio Ohmagari, James Theiler, Will Fischer, Bette Korber, Masaki Imai, Tadaki Suzuki, and Yoshihiro Kawaoka
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Multidisciplinary ,General Physics and Astronomy ,General Chemistry ,General Biochemistry, Genetics and Molecular Biology - Abstract
The prevalence of the Omicron subvariant BA.2.75 is rapidly increasing in India and Nepal. In addition, BA.2.75 has been detected in at least 34 other countries and is spreading globally. However, the virological features of BA.2.75 are largely unknown. Here, we evaluated the replicative ability and pathogenicity of BA.2.75 clinical isolates in Syrian hamsters. Although we found no substantial differences in weight change among hamsters infected with BA.2, BA.5, or BA.2.75, the replicative ability of BA.2.75 in the lungs was higher than that of BA.2 and BA.5. Of note, BA.2.75 caused focal viral pneumonia in hamsters, characterized by patchy inflammation interspersed in alveolar regions, which was not observed in BA.5-infected hamsters. Moreover, in competition assays, BA.2.75 replicated better than BA.5 in the lungs of hamsters. These results suggest that BA.2.75 can cause more severe respiratory disease than BA.5 and BA.2 and should be closely monitored.
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- 2022
13. In SARS-CoV-2 delta variants, Spike-P681R and D950N promote membrane fusion, Spike-P681R enhances spike cleavage, but neither substitution affects pathogenicity in hamsters
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Yuri Furusawa, Maki Kiso, Shun Iida, Ryuta Uraki, Yuichiro Hirata, Masaki Imai, Tadaki Suzuki, Seiya Yamayoshi, and Yoshihiro Kawaoka
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General Medicine ,General Biochemistry, Genetics and Molecular Biology - Published
- 2023
14. A Case of Anomalous Aortic Origin of the Right Coronary Artery Treated by Direct Coronary Reimplantation
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Yuichiro Hirata, Eiki Tayama, Hikaru Uchiyama, Shigeki Morita, Kojiro Furukawa, Tatsushi Onzuka, and Tomofumi Fukuda
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medicine.medical_specialty ,business.industry ,Right coronary artery ,medicine.artery ,Internal medicine ,medicine ,Cardiology ,General Medicine ,business - Published
- 2021
15. Viral load and timing of infection define neutralization diversity to SARS-CoV-2 infection
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Sho Miyamoto, Takeshi Arashiro, Akira Ueno, Takayuki Kanno, Shinji Saito, Harutaka Katano, Shun Iida, Akira Ainai, Seiya Ozono, Takuya Hemmi, Yuichiro Hirata, Saya Moriyama, Ryutaro Kotaki, Hitomi Kinoshita, Souichi Yamada, Masaharu Shinkai, Shuetsu Fukushi, Yoshimasa Takahashi, and Tadaki Suzuki
- Abstract
Immunity to SARS-CoV-2 in COVID-19 cases has diversified due to complex combinations of exposure to vaccination and infection. Elucidating the drivers for upgrading neutralizing activity to SARS-CoV-2 in COVID-19 cases with pre-existing immunity will aid in understanding immunity to SARS-CoV-2 and improving COVID-19 booster vaccines with enhanced cross-protection against antigenically distinct variants. This study revealed that the magnitude and breadth of neutralization responses to SARS-CoV-2 infection in breakthrough infections are determined by upper respiratory viral load and vaccination-infection time interval, but not by the lineage of infecting viruses. Notably, the time interval, but not the viral load, may play a critical role in expanding the breadth of neutralization to SARS-CoV-2. This illustrates the importance of dosing interval optimization in addition to antigen design in the development of variant-proof booster vaccines.One-Sentence SummaryViral load and infection timing define the magnitude and breadth of SARS-CoV-2 neutralization after breakthrough infection.
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- 2022
16. The earliest enzyme replacement for infantile-onset Pompe disease in Japan
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Vlad Tocan, Yuichi Mushimoto, Kanako Kojima‐Ishii, Akane Matsuda, Naoko Toda, Daisuke Toyomura, Yuichiro Hirata, Masafumi Sanefuji, Takaaki Sawada, Yasunari Sakai, Kimitoshi Nakamura, and Shouichi Ohga
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Male ,Japan ,Glycogen Storage Disease Type II ,Pediatrics, Perinatology and Child Health ,Humans ,Cardiomegaly ,Enzyme Replacement Therapy ,Female ,alpha-Glucosidases - Abstract
Infantile-onset Pompe disease (IOPD) is the most severe phenotype of a lysosomal storage disorder caused by acid alpha-glucosidase (GAA) deficiency. An enzymatic newborn screening (NBS) program started regionally in Japan in 2013 for early enzyme replacement therapy (ERT). We report the ERT responses of the first NBS-identified Japanese IOPD case and of another case diagnosed prior to NBS, to discuss the problems of promptly starting ERT in Japan.Acid alpha-glucosidase activity was measured by fluorometric assay in both patients. The diagnosis of IOPD was confirmed by next-generation followed by Sanger-method sequencing (patient 1) or direct sequencing of polymerase chain reaction (PCR)-amplified products (patient 2) of the GAA gene.A female infant identified by NBS had a novel out-of-frame (p.F181Dfs*6) variant and a reported pathogenic (p.R600C) variant, along with two pseudodeficiency variants. Enzyme replacement therapy was started at age 58 days when the infant had increased serum levels of creatine kinase and slight myocardial hypertrophy. Clinical and biochemical markers improved promptly. She has been alive and well without delayed development at age 14 months. Patient 2, a Japanese male, received a diagnosis of IOPD at age 5 months before the NBS era. He had a homozygotic variant of GAA (p.R608X), later registered as a cross-reactive immunological material (CRIM)-negative genotype, and developed a high titer of anti-rhGAA antibodies. The patient has survived myocardial hypertrophy with continuous respiratory support for 12 years of ERT.Enzyme replacement therapy should not be delayed over the age of 2 months for reversible cardiac function, although CRIM-negative cases may hamper turnaround time reduction.
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- 2022
17. Non-Omicron breakthrough infection with higher viral load and longer vaccination-infection interval improves SARS-CoV-2 BA.4/5 neutralization
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Sho Miyamoto, Takeshi Arashiro, Akira Ueno, Takayuki Kanno, Shinji Saito, Harutaka Katano, Shun Iida, Akira Ainai, Seiya Ozono, Takuya Hemmi, Yuichiro Hirata, Saya Moriyama, Ryutaro Kotaki, Hitomi Kinoshita, Souichi Yamada, Masaharu Shinkai, Shuetsu Fukushi, Yoshimasa Takahashi, and Tadaki Suzuki
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Multidisciplinary - Published
- 2023
18. A Surgical Case of Midventricular Hypertrophic Obstructive Cardiomyopathy with Apical Aneurysm
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Tatsushi Onzuka, Kojiro Furukawa, Yuichiro Hirata, Eiki Tayama, Shigeki Morita, and Takuya Nishijima
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Apical aneurysm ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Obstructive cardiomyopathy - Published
- 2020
19. Comparison of intra-wound drainage tubes after cardiac surgery: Blake drains versus Multichannel drains
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Hikaru Uchiyama, Tatsushi Onzuka, Yuichiro Hirata, Shigeki Morita, Eiki Tayama, Tomohiro Ueda, and Kojiro Furukawa
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medicine.medical_specialty ,business.industry ,Silicones ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,General Medicine ,medicine.disease ,Cardiac surgery ,Surgery ,Biomaterials ,chemistry.chemical_compound ,Silicone ,chemistry ,Cardiac tamponade ,Occlusion ,Drainage ,Medicine ,Cardiac Surgical Procedures ,Thrombus ,business ,Wound drainage - Abstract
Background: Blake and Multichannel drains have been used in our department. Although both are made up of silicone, they differ in structure. We investigated the drainage effects of these two types of drains and the factors related to their occlusion. Methods: We enrolled 100 consecutive cases (50 using Blake drains and 50 using Multichannel drains) of cardiovascular surgery performed in our department from July 2017 to April 2018. The formation of thrombi in the groove and tube of the drains was evaluated in each case. The tube portion was checked for the presence of occlusion, and the groove portion was examined for the number and ratio of thrombi formed in the grooves. Results: The clot formation rate in the groove part was slightly higher in the Multichannel cases than in the Blake cases. In addition, analysis within the Multichannel cases revealed that the thrombus formation rate between the catheter lumen and the three grooves (without the catheter lumen) was significantly different, with the highest groove clot formation rate occurring in the catheter lumen. Out of 34 cases of occlusions, there were 26 cases (52%) of Multichannel drains, and only 8 cases (16%) of Blake drains ( p Conclusions: The catheter lumen of the Multichannel drain was more susceptible to thrombus formation than the groove. The tube part of the Multichannel drain was more prone to occlusion than that of the Blake drain.
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- 2020
20. Critical vitamin deficiencies in autism spectrum disorder: Reversible and irreversible outcomes
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Pin Fee Chong, Michiko Torio, Fumihiko Fujii, Yuichiro Hirata, Wakato Matsuoka, Yuri Sonoda, Yuko Ichimiya, Yutaro Yada, Noriyuki Kaku, Masataka Ishimura, Momoko Sasazuki, Yuhki Koga, Masafumi Sanefuji, Yasunari Sakai, and Shouichi Ohga
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Heart Failure ,Nutrition and Dietetics ,Autism Spectrum Disorder ,Medicine (miscellaneous) ,Humans ,Thiamine Deficiency ,Avitaminosis ,Child ,Beriberi ,Heart Arrest - Abstract
Vitamin deficiencies are an emerging concern in the management of children with autism spectrum disorder (ASD). Particular attention is required for recognizing the variable signs caused by unbalanced food intakes. We herein report two patients with multiple vitamin deficiencies who needed critical care showing different prognoses. Patient 1 with 'Shoshin' beriberi presenting with cardiac arrest had thiamine deficiency developed severe neurological sequelae despite rapid vitamin supplementation. Patient 2, who had leg pain and a limping gait, showed a rapid recovery with intravenous infusion and tube feeding after being diagnosed with scurvy. A literature search revealed several children with ASD with critically ill thiamine deficiency, but few reports documented a life-threatening condition in the form of cardiac arrest at the onset. Considering the high observation rate of food selectivity in children with ASD, early intervention is required to prevent the exacerbation of vitamin deficiencies to severe neurological disabilities.
- Published
- 2022
21. Usefulness of a Radiofrequency Transseptal Needle in the Second Puncture of Fontan Extracardiac Conduit
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Shouichi Ohga, Kenichiro Yamamura, Yuichiro Hirata, Yusaku Nagatomo, Shoji Fukuoka, and Hazumu Nagata
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medicine.medical_specialty ,Transseptal needle ,medicine.medical_treatment ,Extracardiac conduit ,Punctures ,Fontan Procedure ,Electrical conduit ,medicine ,Humans ,Heart Atria ,cardiovascular diseases ,Child ,business.industry ,Stent ,General Medicine ,Atrial tissue ,Surgery ,surgical procedures, operative ,Needles ,Pulmonary Veins ,Pediatrics, Perinatology and Child Health ,Catheter Ablation ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Left Pulmonary Vein - Abstract
We performed a second puncture of the extracardiac conduit in an 11-year-old Fontan patient to assess the patency of the stent previously deployed in the left pulmonary vein. For the first puncture, a mechanical Brockenbrough needle was selected to puncture the Gore-Tex conduit, an electrical insulator. For the second puncture, the location of that previous hole was detected as an indentation covered with atrial tissue, which is an electrical conductor. The second puncture was performed safely using a radiofrequency transseptal needle.
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- 2021
22. Surgical Strategy for Mitral Valve Infective Endocarditis with Concomitant Cerebral Hemorrhage and Disseminated Intravascular Coagulation Syndrome : Decompressive Craniotomy before Open-Heart Surgery
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Kojiro Furukawa, Takuya Nishijima, Eiki Tayama, Hikaru Uchiyama, Shigeki Morita, Tatsushi Onzuka, and Yuichiro Hirata
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Disseminated intravascular coagulation ,medicine.medical_specialty ,Surgical strategy ,medicine.anatomical_structure ,business.industry ,Concomitant ,Infective endocarditis ,Mitral valve ,medicine ,medicine.disease ,business ,Decompressive Craniotomy ,Surgery - Published
- 2020
23. A case of inhaled nitric oxide (NO) effect on the hemodynamics and oxygenation decrease in endotracheal hemorrhage during extracorporeal circulatory surgery
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Yuichiro Hirata, Eiki Tayama, Shigeki Morita, Kojiro Furukawa, Tatsushi Onzuka, Tomohiro Ueda, and Hikaru Uchiyama
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business.industry ,Medicine ,business - Published
- 2020
24. Coronary artery bypass grafting via manubrium-sparing sternotomy in a patient with total laryngectomy and a permanent tracheostoma
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Ken-ichi Imasaka, Tatsushi Onzuka, Ryuya Nomura, Tomofumi Fukuda, Yuichiro Hirata, Shigeki Morita, and Akira Shiose
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Pulmonary and Respiratory Medicine ,Surgery ,Case Report ,Cardiology and Cardiovascular Medicine - Abstract
For patients who have previously undergone total laryngectomy and a permanent tracheostomy, median full sternotomy is not the ideal surgical approach because of the substantially increased risk of sternal wound complications and tracheal injuries. We present a case in which conventional coronary artery bypass grafting using bilateral internal thoracic arteries was performed safely via a manubrium-sparing sternotomy in a patient who had undergone total laryngectomy and a permanent tracheostoma. We also discuss the appropriate surgical approach for patients with total laryngectomy and a permanent tracheostoma. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-021-01309-8.
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- 2022
25. Differential Presentation of Renal Disease in Adult Fontan Patients with or Without Liver Disease
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Mamoru Muraoka, Hazumu Nagata, Ichiro Sakamoto, Kenichiro Yamamura, Ayako Ishikita, Akiko Nishizaki, Yoshimi Eguchi, Shouji Fukuoka, Kiyoshi Uike, Yusaku Nagatomo, Yuichiro Hirata, Kei Nishiyama, Hiroyuki Tsutsui, and Shouichi Ohga
- Published
- 2022
26. Clinical Outcomes of Patients with Pulmonary Agenesis
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Shouji Fukuoka, Hazumu Nagata, Kenichiro Yamamura, Daisuke Toyomura, Yusaku Nagatomo, Yoshimi Eguchi, Kiyoshi Uike, Yuichiro Hirata, Hirosuke Inoue, Masayuki Ochiai, and Shouichi Ohga
- Abstract
Introduction: Pulmonary agenesis is a complete absence of the pulmonary parenchyma, bronchi beyond the bifurcation, and pulmonary vasculature unilaterally or bilaterally. Because of the rare occurrence, its pathophysiology and outcome remain elusive. We evaluate the clinical features and risk factors for mortality due to pulmonary agenesis. Methods: Two patients we experienced are presented as index cases. All reported cases of pulmonary agenesis were collected from online and publication databases between 1955 and 2020. We assessed the impact of comorbidity and intervention on the survival outcome. Results: We identified 230 patients—138 (60%) with right-sided, and 14 (6%) with bilateral agenesis—among 164 articles and our cases. There were 93 (40%) cardiovascular, 70 (30%) skeletal, and 48 (21%) gastrointestinal anomalies; 47 (20%) tracheal stenoses; and 33 (14%) genitourinary anomalies. Fifty-two (23%) patients had isolated pulmonary agenesis. The 2-year overall survival (OS) rate was 66% and there was no subsequent death until 13 years of age. The right agenesis was significantly associated with a lower 2-year OS rate (58% vs. 78%, p=0.019) or more frequent tracheal stenosis (28% vs. 12%, p=0.006) than left-sided disease. A multivariable analysis indicated that tracheal stenosis (hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.5-4.1, p=0.004) and gastrointestinal anomaly (HR 1.9, 95% CI 1.1-3.3, p=0.018) were prognostic factors for mortality. Conclusions: The poor prognostic factors were tracheal stenosis, right agenesis and gastrointestinal anomaly. Tracheal and gastrointestinal controls are targeted at birth and in infancy for the improved survival of unilateral pulmonary agenesis.
- Published
- 2021
27. Laparoscopic colectomy for persistent descending mesocolon in sigmoid colon cancer: A case report
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Kiyoharu Takashimizu, Yuichiro Hirata, Yuya Nakamura, Teppei Matsuo, Koki Otsuka, Mizunori Yaegashi, Akira Sasaki, and Toshimoto Kimura
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medicine.medical_specialty ,Colorectal cancer ,Case Report ,Inferior mesenteric artery ,Descending colon ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Mesentery ,Barium enema ,business.industry ,Sigmoid colon ,Sigmoid function ,Laparoscopic colectomy ,medicine.disease ,Persistent descending mesocolon ,digestive system diseases ,Colon cancer ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Inferior mesenteric vein ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,business - Abstract
A 55-year-old-man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Preoperative barium enema showed a slightly medial displacement of the descending colon, and the sigmoid colon was quite long. The operative findings showed that the descending colon was not fused with the retroperitoneum and shifted to the midline and the left colon adhered to the small mesentery and right pelvic wall. Thus, a diagnosis of persistent descending mesocolon (PDM) was made. The left colon, sigmoid colon, and superior rectal arteries often branch radially from the inferior mesenteric artery. The sigmoid mesentery shortens, and the inferior mesenteric vein is often close to the marginal vessels. By understanding the anatomical feature of PDM and devising surgical techniques, laparoscopic sigmoidectomy for sigmoid colon cancer with PDM could be performed without compromising its curative effect and safety.
- Published
- 2021
28. Extracorporeal membrane oxygenation for the control of a pulmonary artery hemorrhage
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Tatshushi Onzuka, Ryuya Nomura, Tomofumi Fukuda, Shigeki Morita, Eiki Tayama, Kojiro Furukawa, and Yuichiro Hirata
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hemodynamics ,medicine.disease ,Bronchial blocker ,law.invention ,Cardiac surgery ,surgical procedures, operative ,law ,Internal medicine ,medicine.artery ,Pulmonary artery ,Cardiopulmonary bypass ,Cardiology ,Extracorporeal membrane oxygenation ,Medicine ,Pulmonary blood flow ,Pulmonary hemorrhage ,business - Abstract
No standard treatments have been established for airway hemorrhage during cardiopulmonary bypass (CPB). Herein, we describe two cases of catheter-induced pulmonary hemorrhage during cardiac surgery. In each case, massive hemoptysis was observed during cardiopulmonary bypass (CPB) weaning. A bronchial blocker was inserted into the right bronchus, and extracorporeal membrane oxygenation (ECMO) was initiated to reduce pulmonary blood flow, and stabilize the hemodynamics. ECMO significantly reduced bleeding from the pulmonary artery (PA). Both cases had favorable outcomes following the implementation of extracorporeal membrane oxygenation (ECMO). ECMO is effective at controlling PA bleeding during and after cardiac surgery.
- Published
- 2021
29. Procalcitonin levels predicting the infliximab response of immunoglobulin resistant Kawasaki disease
- Author
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Shouichi Ohga, Kiyoshi Uike, Hazumu Nagata, Hidetoshi Takada, Eiko Terashi, Eiji Morihana, Etsuro Nanishi, Kenichiro Yamamura, Yasutaka Nakashima, Satoshi Honjo, Tamami Tanaka, and Yuichiro Hirata
- Subjects
Male ,musculoskeletal diseases ,0301 basic medicine ,medicine.medical_specialty ,Immunology ,Mucocutaneous Lymph Node Syndrome ,Biochemistry ,Gastroenterology ,Procalcitonin ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,skin and connective tissue diseases ,Molecular Biology ,Receiver operating characteristic ,business.industry ,Sodium ,Area under the curve ,Immunoglobulins, Intravenous ,Infant ,Hematology ,Odds ratio ,medicine.disease ,Infliximab ,Confidence interval ,Logistic Models ,030104 developmental biology ,Child, Preschool ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Cytokines ,Biomarker (medicine) ,Female ,Kawasaki disease ,Inflammation Mediators ,business ,medicine.drug - Abstract
Objective To search the predictive factors of infliximab resistance in intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients. Study design. Twenty-seven patients with KD who received infliximab after 4–5 g/kg of IVIG therapy from 2013 to 2015 were consecutively recruited in this study. They were divided into two groups: patients who responded to infliximab (infliximab-responsive group, n = 15) and patients who required additional therapy for the disease control (infliximab-resistant group, n = 12). We analyzed the clinical and laboratory parameters just before the infliximab treatment including serum levels of procalcitonin and cytokines with respect to the infliximab response. Results Serum procalcitonin concentration (P = 0.017), neutrophils to lymphocytes ratio (P = 0.013), and % neutrophils (P = 0.004) were higher, and serum sodium concentration (P = 0.017) was lower in infliximab-resistant group than those of infliximab-responsive group, respectively. Multivariate logistic regression analyses indicated that higher procalcitonin concentration (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.00–5.00, P = 0.046) and lower sodium levels (OR 0.64, 95% CI 0.32–1.00, P = 0.047), but not other variables, were associated with infliximab-resistance. Serum procalcitonin concentrations positively correlated with the serum levels of interleukin-6, soluble tumor necrosis factor receptor type 1 and type 2, respectively. Analyses of the receiver operating characteristic (ROC) curve showed that the cut-off value of procalcitonin 2.0 ng/ml had 58.3% of sensitivity and 93.3% of specificity. ROC analysis yielded an area under the curve (AUC) of 0.739 to predict infliximab-resistance. Conclusion Serum procalcitonin might be an effective biomarker to predict infliximab resistance in severe KD patients who are refractory to IVIG treatment.
- Published
- 2019
30. Unique Regional System of Heart Disease Screening in Schools
- Author
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Yuichiro Hirata
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Heart disease screening ,business ,Intensive care medicine - Published
- 2021
31. SmartAmp method can rapidly detect SARS-CoV-2 in dead bodies
- Author
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Sayaka, Nagasawa, Aika, Mori, Yuichiro, Hirata, Ayumi, Motomura, Namiko, Ishii, Keisuke, Okaba, Kie, Horioka, Yohsuke, Makino, Makoto, Nakajima, Suguru, Torimitsu, Rutsuko, Yamaguchi, Go, Inokuchi, Fumiko, Chiba, Yumi, Hoshioka, Naoki, Saito, Maiko, Yoshida, Daisuke, Yajima, Shinji, Akitomi, Hirotaro, Iwase, and Hisako, Saitoh
- Subjects
Rapid test ,SmartAmp method ,SARS-CoV-2 ,Anal Canal ,COVID-19 ,Oropharynx ,Article ,Pathology and Forensic Medicine ,COVID-19 Nucleic Acid Testing ,Nasopharynx ,Cadaver ,Humans ,RNA, Viral ,Autopsy ,Swab test ,Law - Abstract
Rapid and accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dead bodies is essential to prevent infection among those working with dead bodies. This study focused on the Smart Amplification (SmartAmp) method, which has a short examination time (approximately an hour), is simple to perform, and demonstrates high specificity and sensitivity. This method has already been used for clinical specimens; however, its effectiveness in dead bodies has not been reported. This study examined the SmartAmp method using 11 autopsies or postmortem needle biopsies performed from January to May, 2021 (of these, five cases tested positive for SARS-CoV-2 by quantitative real-time polymerase chain reaction (qRT-PCR) and six cases tested negative). Swab samples were collected from the nasopharynx, oropharynx, or anus and the SmartAmp and qRT-PCR results were compared. For the nasopharynx and oropharynx samples, the same results were obtained for both methods in all cases; however, for the anal swabs, there was one case that was positive according to qRT-PCR but negative according to the SmartAmp method. The SmartAmp method may therefore be less sensitive than qRT-PCR and results may differ in specimens with a low viral load, such as anal swabs. However, in the nasopharynx and oropharynx specimens, which are normally used for testing, the results were the same using each method, suggesting that the SmartAmp method is useful in dead bodies. In the future, the SmartAmp method may be applied not only during autopsies, but also in various situations where dead bodies are handled.
- Published
- 2022
32. Portosystemic venous shunt in the patients with Fontan circulation
- Author
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Hazumu Nagata, Ayako Ishikita, Shouichi Ohga, Kiyoshi Uike, Yusaku Nagatomo, Shouji Fukuoka, Ichiro Sakamoto, Yuichiro Hirata, and Kenichiro Yamamura
- Subjects
Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Adolescent ,Vascular Malformations ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Fontan Procedure ,Vascular anomaly ,Veins ,Fontan procedure ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,Abnormalities, Multiple ,030212 general & internal medicine ,Cardiac catheterization ,Retrospective Studies ,business.industry ,Central venous pressure ,Vascular surgery ,Middle Aged ,medicine.disease ,Cardiac surgery ,medicine.anatomical_structure ,Echocardiography ,Heart failure ,cardiovascular system ,Vascular resistance ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Portosystemic venous shunt (PSVS) is a vascular anomaly between the portal and systemic veins, resulting in several critical complications. Although PSVS is often associated with congenital heart diseases, the clinical association between Fontan circulation and PSVS has not been elucidated. This study aimed to investigate the clinical features of Fontan patients with PSVS. Two hundred thirteen patients who underwent Fontan procedure are being followed up at Adult Congenital Heart Disease clinic in Kyushu University Hospital. Among them, 139 adult patients underwent cardiac catheterization between January 1, 2011 and September 30, 2019. Medical records were reviewed to investigate the laboratory, echocardiography, and cardiac catheterization findings, as well as clinical manifestations and outcomes. Eleven Fontan patients received the diagnosis of PSVS. The median age at cardiac catheterization was 25 (range 18–45) years. Fontan operation was performed using extracardiac conduit or lateral tunnel 22 (16–35) years previously. Ten patients presented with chronic heart failure [New York Heart Association class 2 (n = 5) and 3 (n = 5)]. The median level of peripheral oxygen saturation was 87 (70–95)%. Cardiac catheterization showed increased cardiac index [5.3 (2.72–14.3) L/min/m2] with or without high central venous pressure [18 (9–25) mmHg]. Although the pulmonary vascular resistance was within the normal range, the systemic vascular resistance was decreased [7.08 (1.74–18.6) Wood units]. Fontan patients complicated with PSVS had increased cardiac output. The presence of PSVS in Fontan circulation might be associated with unfavorable long-term outcome.
- Published
- 2020
33. Molecular mechanisms of Wischnewski spot development on gastric mucosa in fatal hypothermia: an experimental study in rats
- Author
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Yuichiro Hirata, Yu Kamakura, Yoshihisa Koyama, Chihpin Yang, Kentaro Nakama, Yukie Murata, Hiroshi Matsumoto, Kazuo Harada, Yohei Miyashita, Kazuma Higashisaka, Ryuichi Katada, and Kana Sugimoto
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,lcsh:Medicine ,Hypothermia ,Article ,H(+)-K(+)-Exchanging ATPase ,03 medical and health sciences ,C protein ,0302 clinical medicine ,Parietal Cells, Gastric ,Pepsin ,Internal medicine ,Pepsinogen C ,Extracellular ,medicine ,Gastric mucosa ,Animals ,Humans ,Secretion ,030216 legal & forensic medicine ,lcsh:Science ,Purpura ,Gastrin ,Multidisciplinary ,biology ,Chemistry ,lcsh:R ,digestive, oral, and skin physiology ,Cell Membrane ,Pepsin A ,Rats ,Experimental models of disease ,Cold Temperature ,Disease Models, Animal ,Mechanisms of disease ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,Gastric Mucosa ,biology.protein ,Gastric acid ,lcsh:Q ,medicine.symptom - Abstract
Numerous dark-brown-coloured small spots called “Wischnewski spots” are often observed in the gastric mucosa in the patients dying of hypothermia, but the molecular mechanisms through which they develop remain unclear. We hypothesised that hypothermia may activate the secretion of gastric acid and pepsin, leading to the development of the spots. To investigate this, we performed experiments using organotypic rat gastric tissue slices cultured at 37 °C (control) or 32 °C (cold). Cold loading for 6 h lowered the extracellular pH in the culture medium. The mRNA expression of gastrin, which regulates gastric acid secretion, increased after cold loading for 3 h. Cold loading increased the expression of gastric H+,K+-ATPase pump protein in the apical canalicular membrane and resulted in dynamic morphological changes in parietal cells. Cold loading resulted in an increased abundance of pepsin C protein and an elevated mRNA expression of its precursor progastricsin. Collectively, our findings clarified that cold stress induces acidification by activating gastric H+,K+-ATPase pumps and promoting pepsin C release through inducing progastricsin expression on the gastric mucosa, leading to tiny haemorrhages or erosions of the gastric mucosa that manifest as Wischnewski spots in fatal hypothermia.
- Published
- 2020
34. Two Cases of Staged Repair of Anomalous Origin of Right Pulmonary Artery from the Ascending Aorta
- Author
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Hazumu Nagata, Yusaku Nagatomo, Kensaku Matsuda, Akira Shiose, Kazuhiro Hinokiyama, Shouichi Ohga, Hideki Tatewaki, and Yuichiro Hirata
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Cardiology ,Staged repair ,business ,Right pulmonary artery - Published
- 2018
35. High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch
- Author
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Shouichi Ohga, Eiko Terashi, Yasuyuki Fujita, Kiyoko Kato, Masayuki Ochiai, Kiyoshi Uike, Hazumu Nagata, Kenichiro Yamamura, Yuichiro Hirata, Eiji Morihana, and Mamoru Muraoka
- Subjects
Adult ,Male ,Aortic arch ,medicine.medical_specialty ,Vertebral artery ,medicine.medical_treatment ,Cardiovascular Abnormalities ,Subclavian Artery ,Aorta, Thoracic ,Arterial Occlusive Diseases ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Japan ,medicine.artery ,Angioplasty ,medicine ,Humans ,Abnormalities, Multiple ,Retrospective Studies ,Ultrasonography ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Incidence ,Angiography ,medicine.disease ,Aneurysm ,Dysphagia ,Cardiac surgery ,Surgery ,Stenosis ,Female ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Subclavian steal syndrome - Abstract
Right aortic arch with aberrant left subclavian artery (RAA/aLSCA) is a rare aortic arch anomaly. The clinical association of aLSCA stenosis with RAA/aLSCA has not yet been fully elucidated. The aim of this study was to investigate the diagnosis, incidence, management and outcome of aLSCA stenosis in infants with prenatally diagnosed RAA/aLSCA. Ten fetuses who were diagnosed as having RAA/aLSCA in Kyushu University Hospital between January 2011 and December 2014 were enrolled. The maternal and child medical records were reviewed to investigate sex, gestational age at the fetal diagnosis, gestational age and body weight at birth, the findings of computed tomography (CT), Doppler ultrasonography of the vertebral artery and angiography, and the complications and outcomes of aLSCA stenosis. In 8 of 10 patients, aLSCA stenosis was identified on the first CT examination after birth. No patients had dysphagia or respiratory distress. The stenosis spontaneously resolved in 3 patients. In 4 of the 5 remaining patients, aLSCA stenosis progressed, including one case in which complete occlusion occurred-the case was associated with retrograde flow from the left vertebral artery supplying the distal LSCA. Balloon angioplasty was successfully used to treat stenosis in two cases. The subclavian steal phenomenon and developmental problems were not observed in any patients. aLSCA stenosis was identified in 80% of patients with RAA/aLSCA after birth. The early detection and elective treatment of stenotic lesions may be required to prevent complete occlusion during the development of the cardiovascular and cerebrovascular systems.
- Published
- 2017
36. Endovascular Stent-Graft Repair of a Persistent Sciatic Artery Aneurysm
- Author
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Hiroyuki Tanaka, Seiji Onitsuka, Shohei Yoshida, Yuichiro Hirata, Shinichi Hiromatsu, and Hayato Fukuda
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Internal medicine ,medicine ,persistent sciatic artery aneurysm ,cardiovascular diseases ,Thrombus ,Sciatica ,endovascular therapy ,business.industry ,Stent ,General Medicine ,Sciatic nerve injury ,medicine.disease ,Limb ischemia ,Surgery ,Embolism ,acute limb ischemia ,Cardiology ,medicine.symptom ,business ,Sciatic artery ,030217 neurology & neurosurgery - Abstract
Persistent sciatic artery (PSA) is a rare anomaly that may cause various symptoms, such as aneurysm, rupture, thromboembolism, and sciatica. Direct surgery can be performed to treat PSA aneurysm (PSAA), but is associated with complications; e.g., anatomical problems such as sciatic nerve injury. Herein we report a case of a 74-year-old woman with acute limb ischemia that developed from a distal embolism caused by a thrombus in the left PSAA; favorable results were obtained for her by treatment with a stent-graft after rapid anticoagulation therapy for limb salvage.
- Published
- 2017
37. Elevated non-invasive liver fibrosis markers and risk of liver carcinoma in adult patients after repair of tetralogy of Fallot
- Author
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Shouichi Ohga, Hiroyuki Tsutsui, Hazumu Nagata, Yukihiko Okumura, Eiji Morihana, Kazuhiro Koto, Yuzo Yamasaki, Kenichiro Yamamura, Kenichi Kohashi, Ichiro Sakamoto, and Yuichiro Hirata
- Subjects
Adult ,Collagen Type IV ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Heart disease ,medicine.medical_treatment ,Biopsy ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Fontan procedure ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Japan ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Hyaluronic Acid ,Tetralogy of Fallot ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Incidence ,Liver Neoplasms ,Alanine Transaminase ,medicine.disease ,Congestive hepatopathy ,Liver ,Hepatocellular carcinoma ,Cardiology ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,Liver cancer ,business ,Complication ,Biomarkers ,Follow-Up Studies - Abstract
Congestive hepatopathy and hepatocellular carcinoma is a serious complication after Fontan procedure. Liver fibrosis due to hepatic congestion could occur also in adult patients after repair of tetralogy of Fallot (rTOF). However, the incidence and severity remain unclear.A total of 111 patients with adult congenital heart disease between 2009 and 2016 were enrolled. Liver fibrosis markers and hemodynamic parameters assessed by cardiac magnetic resonance imaging and catheterization were analyzed in 50 rTOF patients having significant pulmonary regurgitation and/or stenosis, 50 Fontan patients and 11 controls.Liver fibrosis markers in patients with rTOF were significantly higher than controls, and tended to be lower than Fontan patients (median, hyaluronic acid: 25.8 vs. 15.9 vs. 40.8, type IV collagen: 129 vs. 113 vs. 166, ng/mL, p 0.05, respectively). Patients with rTOF showed abnormal hyaluronic acid levels more frequently than controls, and less frequently than Fontan patients (22% vs. 0% vs. 38%, respectively, p 0.05). Multivariate analyses indicated a positive association of right atrial pressure with type IV-collagen or hyaluronic acid levels (each, p 0.001, p = 0.003). Abdominal ultrasonography revealed hepatic congestion in 50% of rTOF patients tested. Liver biopsy of the two rTOF patients with highest hyaluronic acid levels showed pathological evidence of moderate and severe (F2 and F3) liver fibrosis and one had combined hepatocellular and cholangiocarcinoma.We first demonstrated elevated liver fibrosis markers in adult patients with rTOF. These levels may help to predict the progressive liver disease as well as consider the timing of pulmonary valve replacement.
- Published
- 2018
38. Emergent transcatheter arterial embolization for norovirus‐associated life‐threatening ulcer bleeding to achieve successful hemostasis in 2‐year‐old boy
- Author
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Tomohiko Akahoshi, Ryota Souzaki, Sooyoung Lee, Makoto Hayashida, Yoshihiko Maehara, Tomoaki Taguchi, Wakato Matsuoka, Norihiro Fujita, Yuichiro Hirata, Hiroshi Sugimori, Noriyuki Kaku, Hidetoshi Takada, and Yoshiki Asayama
- Subjects
medicine.medical_specialty ,Gastrointestinal bleeding ,pediatrics ,transcatheter arterial embolization ,Case Reports ,medicine.disease_cause ,pediatric duodenal ulcer ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Melena ,Internal medicine ,Medicine ,Ulcer bleeding ,business.industry ,RC86-88.9 ,Arterial Embolization ,General Engineering ,Norovirus infection ,Medical emergencies. Critical care. Intensive care. First aid ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Hemostasis ,Shock (circulatory) ,Norovirus ,Vomiting ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Case We report a 2-year-old boy with duodenal ulcer with active bleeding that occurred as a result of norovirus gastroenteritis. On admission, the patient presented with shock accompanied with vomiting and melena. Abdominal contrast enhanced computed tomography scan showed signs of duodenal bleeding. Outcome He was successfully treated with emergent transcatheter arterial embolization. After the treatment, endoscopic examination revealed duodenal ulcer and the stool norovirus antigen test was found to be positive. The patient recovered completely without any sequelae. Conclusion Life-threatening duodenal ulcer bleeding in children can be caused by viral gastroenteritis. When endoscopic therapy is unsuccessful or difficult, in cases of small children, angiographic intervention can be a safe alternative treatment option of gastrointestinal bleeding.
- Published
- 2016
39. Regional Variation of CH4 and N2 Production Processes in the Deep Aquifers of an Accretionary Prism
- Author
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Makoto Matsushita, Shugo Ishikawa, Satoshi Mitsunobu, Hiroyuki Kimura, Kunio Ozawa, Kazushige Nagai, and Yuichiro Hirata
- Subjects
0301 basic medicine ,chemistry.chemical_classification ,geography ,Accretionary wedge ,geography.geographical_feature_category ,Ecology ,Geochemistry ,Soil Science ,Sediment ,Aquifer ,Plant Science ,General Medicine ,Methane ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,chemistry ,Oceanic crust ,Convergent boundary ,Organic matter ,Ecology, Evolution, Behavior and Systematics ,Groundwater ,Geology - Abstract
Accretionary prisms are mainly composed of ancient marine sediment scraped from the subducting oceanic plate at a convergent plate boundary. Large amounts of anaerobic groundwater and natural gas, mainly methane (CH4) and nitrogen gas (N2), are present in the deep aquifers associated with an accretionary prism; however, the origins of these gases are poorly understood. We herein revealed regional variations in CH4 and N2 production processes in deep aquifers in the accretionary prism in Southwest Japan, known as the Shimanto Belt. Stable carbon isotopic and microbiological analyses suggested that CH4 is produced through the non-biological thermal decomposition of organic matter in the deep aquifers in the coastal area near the convergent plate boundary, whereas a syntrophic consortium of hydrogen (H2)-producing fermentative bacteria and H2-utilizing methanogens contributes to the significant production of CH4 observed in deep aquifers in midland and mountainous areas associated with the accretionary prism. Our results also demonstrated that N2 production through the anaerobic oxidation of organic matter by denitrifying bacteria is particularly prevalent in deep aquifers in mountainous areas in which groundwater is affected by rainfall.
- Published
- 2016
40. Simple Excision for Cardiac Fibroelastomas Arising from Three Leaflets of the Aortic Valve
- Author
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Yuichiro Hirata, Yusuke Shintani, Hidetsugu Hori, Kenichi Kosuga, Teiji Okazaki, Keiichiro Tayama, and Koichiro Shimoishi
- Subjects
Aortic valve ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,medicine.anatomical_structure ,business.industry ,Simple (abstract algebra) ,030220 oncology & carcinogenesis ,Internal medicine ,Cardiology ,Medicine ,030204 cardiovascular system & hematology ,business - Published
- 2016
41. High incidence of ductal closure or narrowing at birth in patients with right ventricular outflow tract obstruction with normal orientation of the ductus arteriosus
- Author
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Hazumu Nagata, Eiko Terashi, Shouichi Ohga, Hideki Tatewaki, Kenichiro Yamamura, Mamoru Muraoka, Kiyoshi Uike, Yasuyuki Fujita, and Yuichiro Hirata
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Hemodynamics ,Prenatal diagnosis ,030204 cardiovascular system & hematology ,Right ventricular outflow tract obstruction ,Shunt operation ,Ventricular Outflow Obstruction ,03 medical and health sciences ,0302 clinical medicine ,Orientation (mental) ,Pregnancy ,Ductus arteriosus ,Internal medicine ,Prenatal Diagnosis ,medicine ,Humans ,In patient ,cardiovascular diseases ,Ductus Arteriosus, Patent ,Retrospective Studies ,Cyanosis ,business.industry ,Incidence ,Infant, Newborn ,General Medicine ,Ductus Arteriosus ,medicine.anatomical_structure ,030228 respiratory system ,Echocardiography ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Female ,High incidence ,Cardiology and Cardiovascular Medicine ,business - Abstract
BackgroundDuctal patency is mandatory to manage patients with ductal-dependent pulmonary circulation. The aim of this study is to elucidate the morphological and haemodynamic features of ductus arteriosus with right ventricular outflow tract obstruction, and investigate the appropriate perinatal management.Patients and methodsPatients with prenatal diagnosis of right ventricular outflow tract obstruction at our institution between 2010 and 2015 were included in the study. Reverse orientation of the ductus arteriosus is defined as an inferior angle of 90°. We retrospectively reviewed the shape and flow pattern of ductus arteriosus and the clinical characteristics of the cases.ResultsA total of 39 patients were enrolled. The shape was divided into normal orientation (n=15) and reverse orientation (n=24) of the ductus arteriosus. There was no significant difference in the type of oxygen saturation at birth and age at shunt operation between both the groups. However, the median narrowest diameter of ductus arteriosus in the normal orientation group was significantly smaller than that in the reverse orientation group (2.0 [1.0–5.4] versus 3.0 [1.3–4.4] mm, pConclusionsNormal orientation pattern might have high incidence of an early narrowing or closure of ductus arteriosus at birth. The critical patients need careful evaluation by repeated foetal echocardiography and further maternal interventions.
- Published
- 2018
42. Activation of the AKT Pathway in the Ascending Aorta With Bicuspid Aortic Valve
- Author
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Satoru Tobinaga, Hiroki Aoki, Yoshihiro Fukumoto, Hiroyuki Tanaka, Takahiro Shojima, Yuichiro Hirata, Kohji Akasu, Tohru Takaseya, and Kazuyoshi Takagi
- Subjects
0301 basic medicine ,Aortic valve ,Male ,medicine.medical_specialty ,Vascular smooth muscle ,Aortic Valve Insufficiency ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Protein kinase B ,PI3K/AKT/mTOR pathway ,Aorta ,Aged ,Aged, 80 and over ,business.industry ,Gene Expression Profiling ,General Medicine ,medicine.disease ,Immunohistochemistry ,030104 developmental biology ,medicine.anatomical_structure ,Aortic valve stenosis ,Aortic Valve ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Proto-Oncogene Proteins c-akt ,Dilatation, Pathologic ,Signal Transduction - Abstract
Background Dilatation of the ascending aorta affects those patients with bicuspid aortic valve (BAV), even after valvular surgery, possibly due to tissue fragility. The goal of the study was the molecular characterization of aorta with BAV compared to that with normal tricuspid aortic valve (TAV). Methods and Results: The subjects were patients who underwent surgery for aortic valve stenosis in 2013 and 2014. Nine patients with BAV and 13 with TAV were examined. There was no difference in the clinical characteristics or grade of aortic valve stenosis, but the diameters of the ascending aorta were significantly higher in the BAV group. The ascending aortic specimens were subjected to transcriptome analyses, which revealed the changes in receptor tyrosine kinase (RTK) pathway-related genes between TAV and BAV samples. Immunohistochemical study revealed higher staining of phosphorylated AKT (pAKT) in the media of the ascending aorta in the BAV group, regardless of the size of ascending aorta, whereas total AKT did not show such a difference. Immunofluorescence staining revealed the AKT activation was mainly in the medial vascular smooth muscle cells. Conclusions The results showed that the RTK-AKT pathway in the medial layer of the ascending aorta is activated in aortae with BAV. Activation of this pathway may be associated with fragility and dilatation of the ascending aorta with BAV.
- Published
- 2018
43. Pediatric Biventricular Assist Device for Myocarditis and Complicated Left Ventricular Thrombus
- Author
-
Akira Shiose, Hideki Tatewaki, Yoshihisa Tanoue, and Yuichiro Hirata
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocarditis ,Fulminant ,medicine.medical_treatment ,Shock, Cardiogenic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,cardiovascular diseases ,Thrombus ,Child ,business.industry ,Coronary Thrombosis ,Cardiogenic shock ,Left ventricular thrombus ,medicine.disease ,030228 respiratory system ,Shock (circulatory) ,Circulatory system ,cardiovascular system ,Cardiology ,Female ,Surgery ,Heart-Assist Devices ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
An 8-year-old girl presenting with fulminant myocarditis and cardiogenic shock underwent peripheral extracorporeal membrane oxygenation. She was switched to central extracorporeal membrane oxygenation because of inadequate venous drainage, and an echocardiogram showed left ventricular (LV) thrombus. She underwent removal of the LV thrombus with LV venting. An echocardiogram showed LV thrombus again 2 days later. The LV thrombus was again removed, and a biventricular assist device support was initiated to avoid further thrombus formation. The patient was completely weaned from mechanical circulatory support after 7 days. She recovered fully without any neurologic deficit.
- Published
- 2019
44. Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease
- Author
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Yusaku Nagatomo, Jun Muneuchi, Yasutaka Nakashima, Etsuro Nanishi, Hiromitsu Shirozu, Mamie Watanabe, Kiyoshi Uike, Hazumu Nagata, Yuichiro Hirata, Kenichiro Yamamura, Yasuhiko Takahashi, Seigo Okada, Yasuo Suzuki, Shunji Hasegawa, and Shouichi Ohga
- Subjects
Infliximab therapy ,Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Mucocutaneous Lymph Node Syndrome ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,Coronary artery aneurysm ,business.industry ,Remission Induction ,Coronary Aneurysm ,Immunoglobulins, Intravenous ,Infant ,medicine.disease ,Infliximab ,Antirheumatic Agents ,Child, Preschool ,Cardiology ,Kawasaki disease ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression.Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5%) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups.Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24%, 24% and 24% in IFX-group, whereas 67%, 52% and 33% in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33%, 33% and 33% in IFX group, whereas 77%, 51% and 48% in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression.IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.
- Published
- 2017
45. Diagnostic potential of stored dried blood spots for inborn errors of metabolism: a metabolic autopsy of medium-chain acyl-CoA dehydrogenase deficiency
- Author
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Kenji Ihara, Kenji Yamada, Yoshihiko Maehara, Haruhisa Baba, Noriyuki Kaku, Shouichi Ohga, Yoshitomo Motomura, Hikaru Kanemasa, Yasunari Sakai, Sooyoung Lee, Yuichiro Hirata, and Tamami Tanaka
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Autopsy ,Acyl-CoA Dehydrogenase ,Lipid Metabolism, Inborn Errors ,Pathology and Forensic Medicine ,Specimen Handling ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Dried blood ,Cause of death ,Postmortem Diagnosis ,Newborn screening ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Metabolism ,Medium-Chain Acyl-CoA Dehydrogenase Deficiency ,Sudden infant death syndrome ,Female ,Dried Blood Spot Testing ,business ,030217 neurology & neurosurgery ,Sudden Infant Death - Abstract
AimIt is estimated that 1–5% of sudden infant death syndrome (SIDS) cases might be caused by undiagnosed inborn errors of metabolism (IEMs); however, the postmortem identification of IEMs remains difficult. This study aimed to evaluate the usefulness of dried blood spots (DBSs) stored after newborn screening tests as a metabolic autopsy to determine the causes of death in infants and children who died suddenly and unexpectedly.MethodsInfants or toddlers who had suddenly died without a definite diagnosis between July 2008 and December 2012 at Kyushu University Hospital in Japan were enrolled in this study. Their Guthrie cards, which had been stored for several years at 4–8°C, were used for an acylcarnitine analysis by tandem mass spectrometry to identify inborn errors of metabolism.ResultsFifteen infants and children who died at less than 2 years of age and for whom the cause of death was unknown were enrolled for the study. After correcting the C0 and C8 values assuming the hydrolysation of acylcarnitine in the stored DBSs, the corrected C8 value of one case just exceeded the cut-off level for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency screening. Genetic and biochemical analyses confirmed this patient to have MCAD deficiency.ConclusionDBSs stored after newborn screening tests are a promising tool for metabolic autopsy. The appropriate compensation of acylcarnitine data and subsequent genetic and biochemical analyses are essential for the postmortem diagnosis of inborn errors of metabolism.
- Published
- 2017
46. Long Term Results and Predictors of Left Ventricular Function Recovery after Aortic Valve Replacement for Chronic Aortic Regurgitation
- Author
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Hiroyuki Saisho, Kumiko Wada, Koichi Arinaga, Satoshi Kikusaki, Hiroyuki Tanaka, Tatsuyuki Kakuma, and Yuichiro Hirata
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Aortic Valve Insufficiency ,Cardiac index ,Sensitivity and Specificity ,Ventricular Function, Left ,Body Mass Index ,Transcatheter Aortic Valve Replacement ,Chronic aortic regurgitation ,Aortic valve replacement ,Afterload ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,business.industry ,Left ventricular function ,Gastroenterology ,Stroke Volume ,Retrospective cohort study ,General Medicine ,Stroke volume ,Middle Aged ,medicine.disease ,body surface area (BSA) ,Treatment Outcome ,Heart Valve Prosthesis ,Predictive value of tests ,Heart failure ,Chronic Disease ,cardiovascular system ,Cardiology ,Ventricular pressure ,Isolated aortic valve replacement ,Female ,Original Article ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) improves left ventricular (LV) function, but some patients will not have favorable remodeling. Our objectives were to review long term clinical results of AVR for AR and to examine what factors affect the normalization of LV function after AVR for chronic AR.Between 1989 and 2010, 177 patients underwent isolated AVR for chronic pure AR. The patients were divided into 2 groups based on indexed end-systolic LV diameter (iESD): Group L (iESD) ≥25 mm/m(2)) (130 patients) and Group S (iESD25 mm/m(2)) (47 patients).There was no significant difference between groups in late mortality, freedom from cardiac-related death and rehospitalization for heart failure at late follow up after operation. At postoperative follow-up, 16% of patients had not recovered normal LV systolic function. By means of multivariate analysis, iESD and cardiac index (CI) were independent predictors of recovery of LV function and iESD26.7 mm/m(2) and CI2.71 l/min/m(2) were the best cut-off values.Early and late surgical results of AVR for chronic AR were good, but for the preservation of postoperative normal LV function, AVR for AR patients should be performed before iESD reaches 26.7 mm/m(2).
- Published
- 2015
47. A Suspected Case of Heyde Syndrome with Bleeding of the Small Intestine before Aortic Valve Replacement for Severe Aortic Valve Stenosis
- Author
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Toru Takaseya, Takahiro Shojima, Yuichiro Hirata, Koichi Arinaga, Hidetoshi Akashi, Hiroyuki Tanaka, Takanori Kono, Koji Akasu, Kumiko Wada, and Kazuyoshi Takagi
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Aortic valve replacement ,business.industry ,Aortic valve stenosis ,Internal medicine ,medicine ,Cardiology ,medicine.disease ,business ,Small intestine - Published
- 2015
48. Effective shunt closure for pulmonary hypertension and liver dysfunction in congenital portosystemic venous shunt
- Author
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Yasunari Sakai, Shouichi Ohga, Kanako Ishii, Hazumu Nagata, Eiji Morihana, Kiyoshi Uike, Toshiharu Matsuura, Yuichiro Hirata, Tomoaki Taguchi, Eiko Terashi, Kenichiro Yamamura, and Kazuhiro Ohkubo
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Bilirubin ,Vascular Malformations ,Hypertension, Pulmonary ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine.artery ,Internal medicine ,polycyclic compounds ,medicine ,Risk of mortality ,Humans ,Child ,Newborn screening ,Bile acid ,business.industry ,Liver Diseases ,Vascular malformation ,Infant, Newborn ,Infant ,medicine.disease ,Pulmonary hypertension ,medicine.anatomical_structure ,Treatment Outcome ,chemistry ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Pulmonary artery ,Vascular resistance ,Cardiology ,030211 gastroenterology & hepatology ,Female ,business - Abstract
OBJECTIVE Congenital portosystemic venous shunt (CPSVS) is a rare vascular malformation with a high risk of mortality from pulmonary arterial hypertension (PAH), but the treatment outcome of CPSVS closure remains elusive. Our aim was to investigate the clinical features and establish the optimal management of CPSVS with or without PAH. METHODS Twenty-four patients with CPSVS treated in Kyushu University Hospital between 1990 and 2015 were enrolled in this study. The patients were divided into a PAH group (n = 9) and a non-PAH group (n = 15). Clinical characteristics and outcomes were evaluated. RESULTS The first manifestation of CPSVS at diagnosis (28.5 [1-216] months) was hypergalactosemia in 13 (54%) or PAH in six (25%) patients. PAH was the cause of all three deaths. The PAH group had higher levels of serum total bile acid, manganese, and total bilirubin, along with higher pulmonary vascular resistance index (PVRI) than the non-PAH group (7.2 [5.1-38.1] vs 1.2 [0.5-3.3] unit/m2 , P
- Published
- 2017
49. Early progression of atherosclerosis in children with chronic infantile neurological cutaneous and articular syndrome
- Author
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Toshiro Hara, Shouichi Ohga, Kenichiro Yamamura, Eiji Morihana, Yasutaka Nakashima, Tomohito Takimoto, Yuichiro Hirata, Masataka Ishimura, Hidetoshi Takada, Hazumu Nagata, and Kiyoshi Uike
- Subjects
Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Inflammation ,Gene mutation ,Carotid Intima-Media Thickness ,Gastroenterology ,Pathogenesis ,Rheumatology ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Child ,Pulse wave velocity ,business.industry ,Cryopyrin-associated periodic syndrome ,Atherosclerosis ,medicine.disease ,Rash ,Cryopyrin-Associated Periodic Syndromes ,Intima-media thickness ,Child, Preschool ,Disease Progression ,Female ,medicine.symptom ,business ,Uveitis - Abstract
OBJECTIVE Chronic inflammation plays a key role in the development of atherosclerosis. Early progression of atherosclerosis has been reported in patients with RA. Cryopyrin-associated periodic syndromes (CAPS) are autosomal dominant autoinflammatory disorders caused by heterozygous NLRP3 gene mutations. Chronic infantile neurological cutaneous and articular (CINCA) syndrome is the most severe form of CAPS and patients display early onset of rash, fever, uveitis and joint manifestations. However, there has been no previous report on atherosclerosis in patients with CAPS. The objective of this study is to assess the development of atherosclerosis in patients with CINCA syndrome. METHODS Intima-media thickness (IMT) of the carotid arteries, stiffness parameter β, ankle brachial index (ABI) and pressure wave velocity (PWV) were evaluated by ultrasonography in 3 patients with CINCA syndrome [mean age 9.0 years (S.D. 5.3)] and 19 age-matched healthy controls [9.3 years (S.D. 4.3)]. RESULTS The levels of carotid IMT, stiffness parameter β and PWV in CINCA syndrome patients were significantly higher than those in healthy controls [0.51 mm (S.D. 0.05) vs 0.44 (0.04), P = 0.0021; 6.1 (S.D. 1.7) vs 3.9 (1.0), P = 0.0018; 1203 cm/s (S.D. 328) vs 855 (114), P = 0.017, respectively]. CONCLUSION Patients with CINCA syndrome showed signs of atherosclerosis from their early childhood. The results of this study emphasize the importance of chronic inflammation in the development of atherosclerosis. Further analysis on atherosclerosis in young patients with CINCA syndrome may provide more insights into the pathogenesis of cardiovascular disease.
- Published
- 2014
50. Evaluation of echogenicity of the heart in Kawasaki disease
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Kiyoshi Uike, Hazumu Nagata, Eiji Morihana, Yasutaka Nakashima, Kenichiro Yamamura, Yumi Mizuno, Yuichiro Hirata, Toshiro Hara, and Shiro Ishikawa
- Subjects
Male ,medicine.medical_specialty ,Myocarditis ,Heart Diseases ,Mucocutaneous Lymph Node Syndrome ,Pericarditis ,Japan ,Internal medicine ,Mitral valve ,medicine ,Humans ,Prospective Studies ,Child ,Papillary muscle ,business.industry ,Immunoglobulins, Intravenous ,Infant ,Echogenicity ,Heart ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Kawasaki disease ,business ,Vasculitis ,Artery - Abstract
Pathologic studies of the heart in patients with Kawasaki disease (KD) revealed vasculitis, valvulitis, myocarditis, and pericarditis. However, there have been no studies on the quantitative determination of multi-site echogenicity of the heart in KD patients. It is also undetermined whether the degree of echogenicity of each site of the heart in patients with KD might be related to the response to intravenous immunoglobulin (IVIG) treatment. In 81 KD patients and 30 control subjects, we prospectively analyzed echogenicity of the heart. Echogenicity was measured in four sites: coronary artery wall (CAW), mitral valve (MV), papillary muscle (PM), and ascending aortic wall (AAo wall) by the calibrated integrated backscatters (cIBs). The cIB values of all measurement sites at acute phase in KD patients were significantly higher than those in control subjects (KD patients vs control subjects; CAW, 19.8 ± 6.2 dB vs 14.5 ± 2.0 dB, p < 0.05; MV, 23.3 ± 5.3 dB vs 16.0 ± 3.3 dB, p < 0.05; PM, 22.4 ± 5.1 dB vs 12.7 ± 1.9 dB, p < 0.05; AAo wall, 25.3 ± 5.6 dB vs 18.3 ± 3.4 dB, p < 0.05). The cIB values of CAW at the acute phase in IVIG nonresponders were significantly higher than those in responders. Conclusion: Echogenicity of the heart in KD patients at the acute phase increased not only in the coronary artery wall but also in other parts of the heart. Echogenicity of CAW might be helpful in determining the unresponsiveness of IVIG treatment.
- Published
- 2014
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