34 results on '"Yuichiro, Hirata"'
Search Results
2. 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
3. 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
4. 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
5. 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
6. 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.
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- 2021
7. 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.
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- 2021
8. Procalcitonin levels predicting the infliximab response of immunoglobulin resistant Kawasaki disease
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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
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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.
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- 2019
9. Unique Regional System of Heart Disease Screening in Schools
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Yuichiro Hirata
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medicine.medical_specialty ,business.industry ,Medicine ,Heart disease screening ,business ,Intensive care medicine - Published
- 2021
10. Portosystemic venous shunt in the patients with Fontan circulation
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Hazumu Nagata, Ayako Ishikita, Shouichi Ohga, Kiyoshi Uike, Yusaku Nagatomo, Shouji Fukuoka, Ichiro Sakamoto, Yuichiro Hirata, and Kenichiro Yamamura
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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.
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- 2020
11. Molecular mechanisms of Wischnewski spot development on gastric mucosa in fatal hypothermia: an experimental study in rats
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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
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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.
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- 2020
12. Two Cases of Staged Repair of Anomalous Origin of Right Pulmonary Artery from the Ascending Aorta
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Hazumu Nagata, Yusaku Nagatomo, Kensaku Matsuda, Akira Shiose, Kazuhiro Hinokiyama, Shouichi Ohga, Hideki Tatewaki, and Yuichiro Hirata
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Cardiology ,Staged repair ,business ,Right pulmonary artery - Published
- 2018
13. High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch
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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
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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.
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- 2017
14. Endovascular Stent-Graft Repair of a Persistent Sciatic Artery Aneurysm
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Hiroyuki Tanaka, Seiji Onitsuka, Shohei Yoshida, Yuichiro Hirata, Shinichi Hiromatsu, and Hayato Fukuda
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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.
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- 2017
15. Elevated non-invasive liver fibrosis markers and risk of liver carcinoma in adult patients after repair of tetralogy of Fallot
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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
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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
16. Emergent transcatheter arterial embolization for norovirus‐associated life‐threatening ulcer bleeding to achieve successful hemostasis in 2‐year‐old boy
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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
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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.
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- 2016
17. Simple Excision for Cardiac Fibroelastomas Arising from Three Leaflets of the Aortic Valve
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Yuichiro Hirata, Yusuke Shintani, Hidetsugu Hori, Kenichi Kosuga, Teiji Okazaki, Keiichiro Tayama, and Koichiro Shimoishi
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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
18. High incidence of ductal closure or narrowing at birth in patients with right ventricular outflow tract obstruction with normal orientation of the ductus arteriosus
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Hazumu Nagata, Eiko Terashi, Shouichi Ohga, Hideki Tatewaki, Kenichiro Yamamura, Mamoru Muraoka, Kiyoshi Uike, Yasuyuki Fujita, and Yuichiro Hirata
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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
19. Activation of the AKT Pathway in the Ascending Aorta With Bicuspid Aortic Valve
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Satoru Tobinaga, Hiroki Aoki, Yoshihiro Fukumoto, Hiroyuki Tanaka, Takahiro Shojima, Yuichiro Hirata, Kohji Akasu, Tohru Takaseya, and Kazuyoshi Takagi
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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
20. Pediatric Biventricular Assist Device for Myocarditis and Complicated Left Ventricular Thrombus
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Akira Shiose, Hideki Tatewaki, Yoshihisa Tanoue, and Yuichiro Hirata
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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
21. Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease
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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
22. 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
23. 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
24. 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
25. 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
26. 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
27. Evaluation of echogenicity of the heart in Kawasaki disease
- Author
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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
28. Development of a Pseudoaneurysm of the Thoracic Aorta at the Cannulation Site : Our Experience with Three Cases
- Author
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Yukio Hosokawa, Hidetoshi Akashi, Kumiko Wada, Shinichi Hiromatsu, Tomokazu Ohno, Satoru Tobinaga, Hiroyuki Saisho, Hiroyuki Tanaka, Yuichiro Hirata, and Eiji Nakamura
- Subjects
medicine.medical_specialty ,Pseudoaneurysm ,business.industry ,medicine.artery ,medicine ,Thoracic aorta ,medicine.disease ,business ,Surgery - Published
- 2013
29. Surgical Results of Valvular Disease in Hemodialysis Patients
- Author
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Tomokazu Kosuga, Hidetoshi Akashi, Takahiro Shojima, Koichi Arinaga, Hiroyuki Saisho, Hiroyuki Tanaka, Yuichiro Hirata, Hiroshi Tomoeda, Koji Akasu, and Takanori Kono
- Subjects
Surgical results ,medicine.medical_specialty ,Valvular disease ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiology ,Hemodialysis ,business - Published
- 2013
30. Medical equipment deployment in pediatric emergency prehospital medical units in Japan
- Author
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Yuichiro Hirata, Masahiko Nitta, Takashi Muguruma, Yuki Enomoto, Nobuyuki Nosaka, Emily Knaup, Kohei Tsukahara, and Noriyuki Kaku
- Subjects
Pediatric emergency ,medicine.medical_specialty ,Emergency Medical Services ,Quality Assurance, Health Care ,Ambulances ,Medical equipment ,Pediatrics ,Health Services Accessibility ,03 medical and health sciences ,Blood pressure cuffs ,0302 clinical medicine ,Japan ,030225 pediatrics ,Epidemiology ,medicine ,Emergency medical services ,Humans ,Child ,Response rate (survey) ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Software deployment ,Health Care Surveys ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Medical emergency ,business ,Prehospital Emergency Care - Abstract
The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web-based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag-valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed. In Japan, prehospital emergency medical equipment deployment does not meet the needs of pediatric patients. Minimum equipment standards need to be established for pediatric prehospital care.
- Published
- 2016
31. Reconstruction of the Left Ventricular Outflow Tract with a Rolled Equine Pericardium for Annular Abscess after Aortic Root Replacement
- Author
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Ryusuke Mori, Tomokazu Kosuga, Hidetoshi Akashi, Yuichiro Hirata, Hiroyuki Saisyo, Kumiko Wada, Shuji Fukunaga, and Shigeaki Aoyagi
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Aortic root ,medicine ,Ventricular outflow tract ,Pericardium ,Anatomy ,Abscess ,medicine.disease ,business ,Surgery - Published
- 2012
32. Diagnostic imaging of a child with congenital internal jugular vein phlebectasia
- Author
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Kenichiro Yamamura, Yuichiro Hirata, Toshiro Hara, Kiyoshi Uike, Hazumu Nagata, and Yasutaka Nakashima
- Subjects
Male ,medicine.medical_specialty ,Cardiac Catheterization ,business.industry ,Valsalva Maneuver ,Angiography ,Pediatrics ,Text mining ,Pediatrics, Perinatology and Child Health ,Medical imaging ,Medicine ,Humans ,Radiology ,Jugular Veins ,business ,Child ,Internal jugular vein ,Neck ,Dilatation, Pathologic - Published
- 2013
33. A unique association with persistent truncus arteriosus and partial midline chest wall defect
- Author
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Jun Muneuchi, Yuichiro Hirata, Kunitaka Joo, and Yoshie Ochiai
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Sternum ,Fatal outcome ,Fatal Outcome ,Scimitar syndrome ,Internal medicine ,Medicine ,Humans ,Thoracic Wall ,Persistent Truncus Arteriosus ,business.industry ,Scimitar Syndrome ,Infant, Newborn ,medicine.disease ,Infant newborn ,Truncus Arteriosus, Persistent ,Tomography x ray computed ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,business ,Tomography, X-Ray Computed ,Thoracic wall - Published
- 2012
34. The impact of pulmonary valve replacement on left ventricular mechanical efficiency in adult patients with tetralogy of fallot: a study with cardiac energetics
- Author
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Hazumu Nagata, Toshiro Hara, Kenji Sunagawa, Kiyoshi Uike, Yuichi Shiokawa, Ryuji Tominaga, Kenichiro Yamamura, Yuichiro Hirata, Ichiro Sakamoto, and Yoshihisa Tanoue
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,Pulmonary insufficiency ,Stroke volume ,medicine.disease ,eye diseases ,Afterload ,Anesthesia ,Internal medicine ,Cardiology ,Ventricular pressure ,End-diastolic volume ,Medicine ,cardiovascular diseases ,sense organs ,Systole ,Cardiology and Cardiovascular Medicine ,business ,Tetralogy of Fallot - Abstract
Purpose: Pulmonary valve replacement (PVR) improves right ventricular (RV) function in patients with tetralogy of Fallot (TOF). However, the impact of PVR on left ventricular (LV) function and the mechanism of improvement are still unclear. The purpose of this study is to clarify the impact of PVR on LV mechanical efficiency in adult patients with TOF. Methods: Fourteen patients with TOF (age 30.1±11.5 years) who underwent PVR for significant pulmonary insufficiency were enrolled in this study. We measured left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), contractility (end-systolic elastance; Ees), afterload (effective arterial elastance; Ea), and mechanical efficiency (ventriculoarterial coupling; Ea/Ees and the rate of stroke work and pressure-volume area; SW/PVA) on the basis of the echocardiographic data before, after and late after PVR. Ees, Ea and SW/PVA were approximated as follows: Ees=mean arterial pressure/minimal ventricular volume, Ea = maximal ventricular pressure / (maximal ventricular volume-minimal ventricular volume), and SW/PVA=1 / (1 + 0.5 Ea/Ees). Results: LVEDVI, stroke volume and ejection fraction increased significantly after PVR. Contractility (Ees) did not change but afterload (Ea) decreased, and LV mechanical efficiency (Ea/Ees and SW/PVA) improved significantly. These changes were observed just after PVR, and further improvement was not noted in the late period. ![Figure][1] Hemodynamic changes after PVR Conclusions: LV efficiency improves after PVR. Increased pulmonary forward flow and relief of the compression from the RV increase LVEDVI and stroke volume. LV afterload decreases to adapt the increase of stroke volume without the change of contractility. These changes result in the improvement of LV mechanical efficiency. [1]: pending:yes
- Published
- 2013
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