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1. National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Author

Satoshi Suzuki, Kenji Yamamoto, Hiroaki Tanaka, Hiroshi Ozawa, Yuji Okamoto, Tatsuya Abe, Hidenori Suzuki, Akiko Kada, Shigeki Nishino, Nobuyuki Sakai, Kunihiro Nishimura, Tomoyoshi Oikawa, Takanari Kitazono, Hiroshi Tanaka, Daisuke Onozuka, Akihito Hagihara, Hiroshi Ooyama, Akira Watanabe, Shinichi Yoshimura, Toru Iwama, Hiroki Sato, Satoshi Ushikoshi, Kiyohiro Houkin, Nobuhiro Mikuni, Naoyuki Nakao, Michio Nakamura, Nanako Tamiya, Naofumi Isono, Koji Iihara, Yutaka Yamaguchi, Kuniaki Ogasawara, Osamu Onodera, Yusaku Nakamura, Naoki Hayashi, Akira Takada, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yuji Matsumaru, Ichiro Nakahara, Tomoaki Terada, Kazunari Yoshida, Ai Kurogi, Ataru Nishimura, Yoshiaki Shiokawa, Koichi Arimura, Kaoru Kurisu, Fusao Ikawa, Kenji Ohata, Kyoichi Nomura, Nobuhito Saito, Hiroaki Fujiwara, Susumu Suzuki, Masanori Isobe, Soshiro Ogata, Takeshi Matsuoka, Junichiro Satomi, Takashi Matsumoto, Hiroyuki Nakase, Yasunari Niimi, Manabu Kinoshita, Mamoru Murakami, Masaaki Uno, Junichi Iida, Takashi Matsuoka, Tatsuya Sasaki, Shinichi Wakabayashi, Hiroki Toda, Hideki Sakai, Hajime Ohta, Osamu Yamamura, Hideyuki Ohnishi, Hiroko Oyama, Junichi Ono, Izumi Nagata, Hiroharu Kataoka, Ryota Kurogi, Hajime Arai, Atsuo Yoshino, Tsuyoshi Ohta, Hiroshi Sugimori, Hidehiro Hirabayashi, Hiroyuki Masaoka, Satoshi Yamamoto, Hideki Murakami, Kazuhiko Nozaki, Hiroyuki Matsumoto, Yuichiro Tanaka, Takahisa Mori, Keizo Yasui, Akira Takahashi, Ichiro Suzuki, Sachio Suzuki, TAKASHI YOSHIDA, Masanori Morimoto, Tetsuya Ueba, Hiromu Hadeishi, Masaki Chin, Michihiro Kohno, Hitoshi Fukuda, Toru Nishi, Kazunari Koga, Toshihiko Wakabayashi, Hiroki Ohkuma, Kazuhiro Hongo, Hiroshi Nakane, Kazumi Nitta, Satoshi Utsuki, Toshihiko Iuchi, Nice Ren, Hidefuku Gi, Kensuke Kawai, Masayuki Ishihara, Eiji Kohmura, Yoshihiro Nishiura, Kazutaka Yatsushiro, Kensaku Yoshida, Atsushi Tominaga, Masayuki Sumida, Hidenori Yoshida, Atsushi Sato, Takashi Inoue, Hiroaki Shimizu, Eiichiro Kamatsuka, Makoto Ichinose, Naoya Takeda, Tsuyoshi Inoue, Hidekazu Takahashi, Satoshi Kuroda, Toshiaki Osato, Nobutaka Horie, Isao Date, Yoichiro Hashimoto, Haruhiko Hoshino, Takafumi Shimogawa, Koji Yoshimoto, Teiji Tominaga, Isao Sasaki, Kazuo Kitazawa, Minoru Saitoh, Hitoshi Saito, Minoru Asahi, Makoto Goda, Atsuhito Takemura, Masaaki Shibukawa, Isao Fuwa, Saburo Watanabe, Seiko Kataoka, Koji Takasaki, Kouji Shiga, Kensuke Hayashida, Ryunosuke Uranishi, Chiaki Ito, Kenji Wakui, Takashi Saegusa, Isao Kitahara, Yasushi Ejima, Satoru Hayashi, Kazuyoshi Hattori, Shinji Okita, Toshikazu Ichihashi, Tsugumichi Ichioka, Shinichi Shirakami, Teruo Kimura, Tomonori Kobayashi, Kanehisa Kohno, Kazunori Yamanaka, Akira Morooka, Nozomi Mori, Hideo Kunimine, Masahiro Satoh, Syougo Imae, Hirochiyo Wada, Masanori Kabuto, Katsuyuki Hirakawa, Isao Inoue, Kiyoshi Kazekawa, Masani Nonaka, Kouzou Fukuyama, Shigenari Kin, Kiyoshi Saito, Yoichi Watanabe, Tadashi Arisawa, Kou Takahashi, Tetsuya Tanigawara, Junki Ito, Kei Hisada, Makoto Takeda, Jun Niwa, Mikio Nishiya, Shuji Hayashi, Ichiro Fujishima, Teiji Nakayama, Yoshihiko Watanabe, Koichirou Matsukado, Takamichi Yuguchi, Tadahisa Shono, Hiroyuki Nishimura, Jyunya Hayashi, Keisuke Migita, Kazuhiro Yokoyama, Hirotoshi Ohtaka, Takata Hisashi, Takamitsu Uchizawa, Naoki Shinohara, Mitsunobu Kaijima, Junkoh Yamamoto, Yoshio Sakagami, Hideo Aihara, Takayuki Sakaki, Keishi Fujita, Sumio Kobayashi, Nobuaki Momozaki, Masahito Hara, Akazi Kazunori, Fumitaka Miya, Hisato Minamide, Shinichiro Kurokawa, Syuichi Ishikawa, Naohisa Miura, Shinya Noda, Shoji Mashiyama, Shinji Amano, Takayuki Sugawara, Yukihiko Shimizu, Keiichi Saito, Kazuyuki Miura, Akinori Yabuta, Tatumi Yamanome, Hiroshi Seto, Makoto Hasebe, Hikaru Mizobuchi, Junkoh Sasaki, Shin Tsuruoka, Keiichi Nishimaki, Katsumi Takizawa, Hitoshi Tsugu, Nozomi Suzuki, Takeshi Kohno, Shu Hasegawa, Ken Asakura, Masaki Miyatake, Hiromu Konno, Katsunobu Takenaka, Akira Ikeda, Keizou Yamamoto, Keigo Matsumoto, Satoshi Inoha, Masaki Morisige, Kunihiko Harada, Hirofumi Hiyama, Yasuaki Takeda, Taturou Mori, Takekazu Akiyama, Osamu Okuda, Kazuaki Awamori, Naoki Shirasaki, Kimihiro Yoshino, Atsushi Shindo, Kazuho Hirahara, Shunichi Tanaka, Teruaki Kawano, Kazunori Arita, Hiroaki Sawaura, Yoichi Uozumi, Masahiko Tanaka, Shunsuke Shiraga, Shuji Sato, Mitsutoshi Nakada, Kimihisa Kinoshita, Nakazawa Kazutomo, Yasuhiro Fujimoto, Kunikazu Yoshimura, Masaaki Iwase, Shinichi Yagi, Atsushi Tsuchiya, Junichi Harashina, Sadao Kaneko, Naoto Kuwayama, Junya Hayashi, Masayuki Sasou, Sotaro Higashi, Masakazu Kitahara, Sumio Suda, Amami Kato, Satoshi Magarisawa, Kenji Hashimoto, Hirotoshi Hamaguchi, Tomohiko Satou, Masaru Idei, Haruhisa Tsukamoto, Toshihiro Kumabe, Naoaki Sato, Yasuyuki Toba, Takashi Tominaga, Haruo Yamashita, Toyoaki Shinohara, Kazuyoshi Watanabe, Hidenori Endo, Kenjirou Hujiwara, Toshinori Hasegawa, Hisashi Nitta, Kuroyanagi Takayuki, Nobuhiko Mizutani, Akira Tsunoda, Fumio Suzuki, Tetsuya Morimoto, Takuya Kawai, Mitsuyuki Fujitsuka, Hiromasa Tsuiki, Junichi Kuratsu, Hidemichi Sasayama, Shigehiro Ohmori, Seiko Hasegawa, Kazuhiro Kikuchi, Motohiro Morioka, Masayuki Yokota, Nozomu Murai, Yasumasa Yamamoto, Nobuhito Mori, Minoru Kidooka, Hiroshi Tenjin, Yoshihiro Iwamoto, Hitonori Takaba, Sei Haga, Yoshinori Arai, Toshiyuki Tsukada, Hirohide Karasudani, Masakazu Suga, Kawamoto Yukihiko, Naoto Izumi, Youtarou Takeuchi, Motohiro Arai, Shinji Okumura, Hisashi Tanaka, Yasushi Shibata, Tetsuya Masaoka, Masahiko Kasai, Hitoshi Miyake, Osamu Hamasaki, Misao Nishikawa, Naohiko Kubo, Yosimasa Kinosita, Hiroyuki Kaidu, Tarou Komuro, Hiroaki Shigeta, Yoshikazu Kusano, Shigekazu Takeuchi, Takayuki Matsuo, Yoshiharu Tokunaga, Norimoto Nakahara, Nobukazu Hashimoto, Mitsuhito Mase, Junpei Yoshimoto, Jin Momoji, Kenji Kamiyama, Koji Oka, Hiromichi Koga, Kazuya Morimoto, Tsutomu Kadekaru, Naoki Tokumitsu, Yasuyuki Nagai, Hirokazu Tanno, Takato Kagawa, Masaaki Saiki, Kotaro Ogihara, Junichi Imamura, Katsuhiro Yamashita, Akira Nakamizo, Yoshinari Nakamura, Ei-Ichirou Urasaki, Noriyuki Suzaki, Chiaki Takahashi, Youichirou Namba, Kazuo Hashikawa, Tomonori Yamada, Kazuyuki Kuwayama, Keiichi Sakai, Katsuhiro Kuroda, Hideyuki Kurihara, Masayuki Miyazono, Kosuke Miyahara, Hideaki Takahashi, Akihiko Saito, Igarashi Michitoku, Mitsuo Kouno, Shiro Kobayashi, Shunichi Yoneda, Hiroshi Kusunoki, Hiroji Miyake, Toshio Yokoe, Tatsuya Nakamura, Takayuki Kubodera, Mitsuhiko Hokari, Yasunari Otawara, Cheho Park, Hidemitu Nakagawa, Souichi Obara, Haruki Takahashi, Masafumi Ohtaki, Atsuya Okubo, Katsuhiko Hayashi, Masahisa Kawakami, Yu Takeda, Akihiko Kaga, Ryoichi Hayashi, Koji Tokunaga, Hiroyuki Nakashima, Yasuyuki Miyoshi, Atusi Kimoto, Toshimitsu Uchihara, Tomoaki Nagamine, Masahiro Noha, Hiromichi Sadashima, Toshihiko Kinjo, Osamu Tao, Masayuki Nakajima, Akira Isoshima, Kouichi Kuramoto, Shigeru Daido, Yoshiyasu Iwai, Toshihiko Kuroiwa, Akatsuki Wakayama, Kohsuke Yamashita, Yasunobu Gotou, Kouich Iwatsuki, Yoshida Masahiro, Nobuaki Kobayasi, Yoshimasa Niiya, Syouji Mabuchi, Motohiro Takayama, Kazuo Yamamoto, Junta Moroi, Masato Sugitani, Akio Ookura, Naoko Fujimura, Osamu Nishizaki, Sumio Isimaru, Hiroshi Wanihuchi, Nobukuni Murakami, Hiroto Murata, Naoki Kitagawa, Katsuhiko Kono, Michiya Kubo, Masashi Nakatsukasa, Makoto Inaba, Hidetoshi Ooigawa, Atsuhiro Kojima, Takamitsu Fujimaki, Osamu Fukuda, Yoshikazu Nakajima, Kazuyuki Kouno, Takaaki Yoshida, Reizou Kanemaru, Yohei Kudoh, Toshitaka Nakamura, Masayoshi Takigami, Shogo Nishi, Rokuya Tanikawa, Seisaburo Sakamoto, Makio Kaminogo, Seiichiro Hoshi, Yoshinari Okumura, Shinichi Okabe, Haruhiko Sato, Shiro Miyata, Kotaro Tsumura, Hiroshi Karibe, Noriaki Watabe, Ryuji Nakamura, Norifumi Shimoeda, Tsutomu Hitotsumatsu, Tomoaki Kameda, Hiroshi Ishiguchi, Atsuo Shinoda, Masanobu Hokama, Akinori Yamamura, Takeshi Kondoh, Kenichi Murao, Takafumi Wataya, Seiji Fukazawa, Shinsuke Muraoka, Hirosuke Fujisawa, Tsuneo Shishido, Mayumi Mori, Arai Hiroaki, Shinjitsu Nishimura, Zenichiro Watanabe, Susumu Nakashima, Kazuhito Nakamura, Yukinari Kakizawa, Hiroki Takano, Norihito Shirakawa, Masahiro Kagawa, Eiichiro Mabuchi, Kazusige Maeno, Takayuki Koizumi, Warou Taki, Yusuke Nakagaki, Kazuyuki Tane, Hiromichi Ooishi, Katsuyuki Asaoka, Yoshinori Akiyama, Tadao Kawamura, Atumi Takenobu, Takehisa Tuji, Masami Shimoda, Mitsunori Matsumae, Shinji Noda, Koiti Moroki, Hirofumi Oka, Masahito Agawa, Hajimu Miyake, Masateru Katayama, Shinichi Numazawa, Taketoshi Maehara, Hiroyuki Jimbo, Satoshi Ihara, Koji Matuoka, Oikawa Akihiro, Takahiro Oota, Makoto Noguchi, Takakazu Kawamata, Youichi Hashimoto, Keiichirou Onitsuka, Masahiko Kitano, Jae-Hyun Son, Toru Masuoka, Naoki Koketsu, Keiichi Akatsuka, Masamichi Kurosaki, Miyamori Tadao, Hiroaki Hondo, Kazumasa Yamatani, Hirofumi Oyama, Junji Koyama, Ogura Koichiro, Shinji Yamamoto, Hitoshi Tabata, Kazuya Uemura, Kazuhiko Sato, Hideyuki Yoshida, Takafumi Nishizaki, Hiroshi Egami, Hideo Takeshima, Shogo Ishiuchi, Akira Matsumura, Hiroyuki Kinouchi, Susumu Mekaru, Mikihiko Takeshita, Hitoshi Ozawa, Kiichiro Zenke, Takeshi Matsuyama, Toshikazu Kuwata, Teruyuki Habu, Tomoyoshi Okumura, Seiya Takehara, Rei Kondo, Takashi Kumagai, Keiten So, Sunao Takemura, Sonoda Yukihiko, Manabu Urakawa, Yasuhiro Hamada, Michiyasu Suzuki, Mikito Uchida, Hidehito Koizumi, Masaru Yamada, Takashi Tsuruno, Gen Ishida, Ryouichi Masuda, Makoto Kimura, Shinichirou Ishihara, Masashi Morikawa, Hidetoshi Murata, Katsumi Sakata, Motohiro Nomura, Akihiro Nemoto, Sumio Endou, Nobuo Hirota, Kennji Itou, Hiroaki Minami, and Yoshihumi Teramoto

Subjects
Medicine
Abstract

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

Published
2023
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3. The Influence of Age on the Outcomes of Traumatic Brain Injury: Findings from a Japanese Nationwide Survey (J-ASPECT Study-Traumatic Brain Injury)

Author

Keitaro Yamagami, Ryota Kurogi, Ai Kurogi, Kunihiro Nishimura, Daisuke Onozuka, Nice Ren, Akiko Kada, Ataru Nishimura, Koichi Arimura, Keisuke Ido, Masahiro Mizoguchi, Tetsuya Sakamoto, Takamasa Kayama, Michiyasu Suzuki, Hajime Arai, Akihito Hagihara, Koji Iihara, Masayoshi Takigami, Kenji Kamiyama, Kiyohiro Houkin, Shougo Nishi, Tetsuyuki Yoshimoto, Sadao Kaneko, Koji Oka, Hiroshi Ooyama, Kyousuke Kamada, Kenichi Makino, Naoki Tokumitsu, Kazuhiro Sako, Susumu Suzuki, Nozomi Suzuki, Naoto Izumi, Kazumi Nitta, Masahumi Ootaki, Masanori Isobe, Mikio Nishiya, Takaaki Yamazaki, Syouji Mabuchi, Kuniaki Ogasawara, Naohiko Kubo, Yukihiko Shimizu, Keiichi Saito, Tatumi Yamanome, Atsuo Yoshino, Mitsuyuki Fujitsuka, Masaaki Takami, Hirotoshi Ohtaka, Teruyuki Hirano, Yosiaki Shiokawa, Takaharu Okada, Ichiro Suzuki, Michihiro Kohno, Jou Haraoka, Yoshinori Arai, Noriyoshi Kawamura, Akira Isoshima, Masaharu Yasue, Mitsuhiko Hokari Takayoshi Kobayashi, Kensuke Kawai, Taketoshi Maehara, Makoto Noguchi, Haruhiko Hoshino, Hirofumi Hiyama, Kensaku Yoshida, Osamu Utsugi, Yasuaki Takeda, Kouichi Tamaki, Hirohide Karasudani, Takao Urabe, Shiro Kobayashi, Michio Nakamura, Yorio Koguchi, Junichi Ono, Sumio Suda, Hiromu Hadeishi, Toshio Fukutake, Kenji Wakui, Hirokazu Tanno, Naoki Ishige, Takashi Ohasi, Hideki Sakai, Yasuaki Nishimura, Takayuki Watanabe, Takashi Matsumoto, Naoki Koketsu, Yuichi Hirose, Manabu Doyu, Toshinori Hasegawa, Naoto Kuwayama, Shinichi Terao, Nobuhiko Mizutani, Noriyuki Suzaki, Satoshi Okuda, Keizo Yasui, Yukio Seki, Yasuhiro Hasegawa, Akira Ikeda, Youtarou Takeuchi, Sigeki Ohara, Yoshio Araki, Toshihiko Wakabayashi, Hisashi Tanaka, Junpei Yoshimoto, Makoto Sugiura, Ogura Koichiro, Nozomu Kobayashi, Tomonori Yamada, Amami Kato, Ohtsuki Toshiho, Akatsuki Wakayama, Jun Takahashi, Hiroharu Kataoka, Toshiki Yoshimine, Yoshikazu Nakajima, Hidehuku Gi, Ryunosuke Uranishi, Yusaku Nakamura, Kazunori Yamanaka, Kazumi Ohmori, Hiroyuki Matsumoto, Yoshitugu Oiwa, Yosihiko Uemura, Hiroaki Fujiwara, Yoshiyasu Iwai, Masashi Morikawa, Kazuyuki Tane, Kazuo Hashikawa, Toshiyuki Fujinaka, Shunichi Yoneda, Kohsuke Yamashita, Masahiko Kitano, Shinsuke Tominaga, Kazuhito Nakamura, Katsuhiko Kono, Kenji Ohata, Hirokatsu Taniguchi, Takanori Hazama, Toshihiko Kuroiwa, Yoji Tamura, Kazusige Maeno, Motohiro Arai, Masaaki Iwase, Kenji Hashimoto, Keisuke Yamada, Takashi Turuno, Tsutomu Ichinose, Shinichiro Kurokawa, Takeshi Matsuyama, Toshiaki Fujita, Takamichi Yuguchi, Yoshihumi Teramoto, Hiroto Kakita, Takayuki Matsuo, Tsuyoshi Izumo, Nobutoshi Ryu, Wataru Haraguchi Naoki Kitagawa, Makio Kaminogo, Seisaburo Sakamoto, Yosiharu Tokunaga, Ei-Ichirou Urasaki, Junichi Kuratsu, Akira Takada, Tadashi Terasaki, Isao Fuwa Hisami Oosima, Shigeo Yamashiro, Makoto Yoshikawa Hiromasa Tsuiki, Kazunari Koga, Hiroshi Egami, Tadao Kawamura, Kunihiko Mitsuo, Takamitu Hikawa Masaki Morisige, Yuu Takeda, Yutaka Yamaguchi, Shiro Miyata Shunro Uchinokura, Tomokazu Goya, Hideo Takeshima, Kazutaka Yatsushiro, Hajime Ohta, Tatsui Nagadou, Kazuho Hirahara, Souichi Obara, Hiroshi Seto, Koiti Moroki, Kazunori Arita, Shogo Ishiuchi, Toshimitsu Uchihara, Susumu Mekaru, Tomoaki Nagamine, Naoki Tomiyama Jin Momoji, Kouzi Idomari Atusi Kimoto, Tsutomu Kadekaru, Hirosi Syamoto, Osamu Sasaki, Makoto Minagawa, Hideaki Takahashi, Kiyoshi Onda Hiroyuki Arai, Shigekazu Takeuchi, Hiroshi Abe, Osamu Fukuda, Mitsuo Kouno, Tetsuro Tamura, Yukio Horie Michiya Kubo, Hiroaki Hondo, Hisashi Takada, Toru Masuoka, Naoki Shirasaki, Hisashi Nitta, Makoto Kimura Yasuo Katsuki, Yutaka Hayashi Hisato Minamide, Shigeru Munemoto, Kiyonobu Ikeda, Mitsutoshi Nakada Yutaka Hayashi, Syuji Sato, Taketo Hatano, Osamu Yamamura, Masanori Kabuto, Takahiro Sakuma Jyunya Hayashi, Hiroyuki Kinouchi, Hidehito Koizumi, Syougo Imae, Manabu Fujita, Masakazu Suga, Shinji Iwata Kanehisa Kohno, Kiichiro Zenke, Mutsuo Fujisawa, Hikaru Mizobuchi, Satoru Hayashi, Masanori Morimoto, Tetsuya Ueba, Hiroyuki Nishimura, Naoki Ikawa, Yuzo Matsumoto, Seiji Kannuki, Masahiro Kagawa, Naoki Hayashi, Takashi Tamiya Atsushi Shindo, Kimihiro Yoshino, Tetsuya Masaoka, Ichiro Nakahara, Akira Nakamizo Satoshi Suzuki, Yuji Okamoto, Haruki Takahashi, Katsuyuki Hirakawa, Shinji Nagata, Akio Ookura, Hidenori Yoshida Yoshiro Kaneko, Hiroshi Nakane, Isao Inoue, Tsutomu Hitotsumatsu, Terukazu Kuramoto Kouichi Kuramoto, Yoshihisa Matumoto Hiromichi Ooishi, Tooru Inoue Masani Nonaka, Motohiro Morioka, Hiroshi Sugimori Shuji Sakata, Hiroshi Takashima, Shin-Ichiro Ishihara, Kenji Suzuyama, Masayuki Miyazono, Masafumi Morimoto Itaro Hattori, Satoshi Ozaki, Nobuo Hirota, Yasunori Takemoto Yasuhiko Mochimatsu, Makoto Takagi, Isao Yamamoto Kenji Nakayama, Yoshinori Uchida Hiroshi Tanaka, Katsumi Sakata, Kawahara Nobutaka, Motohiro Nomura, Hitoshi Ozawa, Kotaro Tsumura, Makoto Inaba Michiyuki Maruyama, Tatsuro Mori, Takahisa Mori, Masato Sugitani, Yuichiro Tanaka, Masaru Yamada, Mitsunori Matsumae, Keiichirou Onitsuka, Kosuke Miyahara Tatsuya Takahashi, Sumio Endou, Hidekazu Takahashi, Hiroyuki Kaidu, Akira Tsunoda Chikashi Maruki, Takamitsu Fujimaki, Hidetoshi Ooigawa, Masahiko Tanaka Masatsugu Uchida, Hiroshi Wanihuti Kouiti Katoh, Akio Hyodo, Ken Asakura, Shigeyoshi Nakajima, Takao Kanzawa, Hideyuki Kurihara, Sigehiro Ohmori, Mitsugi Yoshinao Hiroshi Kusunoki, Satoshi Magarisawa, Shinichi Okabe, Yuuji Kujiraoka, Shin Tsuruoka, Mikihiko Takeshita, Tetsuya Yamamoto Akira Matsumura, Kazuya Uemura, Hitoshi Tabata, Makoto Sonobe, Masashi Nakatsukasa Ryoji Yoshida, Norifumi Shimoeda, Hideo Kunimine, Masayuki Ishihara, Nozomu Murai, Nobukuni Murakami, Minoru Kidooka, Yoshihiro Iwamoto, Hiroshi Tenjin, Kouji Shiga Masahiko Takamasu, Nobuhito Mori, Shigeru Kose, Eiji Kohmura, Keigo Matsumoto, Takayuki Sakaki, Hiroji Miyake, Eiichiro Mabuchi, Masayuki Yokota, Hideyuki Ohnishi Yosihiro Kuga, Mitsuru Kimura, Osamu Narumi Masaaki Saiki, Norio Nakajima, Minoru Asahi, Junji Koyama, Shinya Noda, Junichi Iida, Toyohisa Fujita, Hiroyuki Nakase, Hidehiro Hirabayashi Toru Hoshida, Takayoshi Fujimoto, Naoyuki Nakao, Yoshiyuki Tanaka, Fuminori Ozaki, Yoshinari Nakamura, Kazuhito Miki, Takashi Watanabe, Seiko Hasegawa, Hiromu Konno, Atsuhito Takemura, Atsuya Okubo, Hitoshi Saito, Tatsuya Ishikawa Taizen Nakase, Hiroaki Shimizu Toshio Sasajima, Masayuki Sasou, Yoichi Watanabe, Taku Sato Kiyoshi Saito, Satoshi Taira Masahiro Satoh, Takayuki Koizumi, Yasuhiro Suzuki Shoji Mashiyama, Tomoyoshi Oikawa, Yukihiko Sonoda, Rei Kondo Shinjiro Saito, Atsuo Shinoda, Eiichiro Kamatsuka, Keiten So, Toshihiko Kinjo, Tooru Sasaki Kennji Itou, Hidenori Endo Hiroaki Shimizu, Hirosi Karibe, Kou Takahashi, Masayuki Nakajima, Kazuyoshi Watanabe, Motohiro Takayama, Taro Komuro, Hisao Hirai Fumio Suzuki, Hidenori Suzuki, Hiroto Murata, Fumitaka Miya, Kenji Kanamaru, Akira Tamura, Kiyoshi Harada, Seiji Fukazawa, Seiya Takehara, Yoshihiko Watanabe, Teiji Nakayama, Haruhiko Sato Hiroshi Nagura, Shinji Amano Chiharu Tanoi, Katsuhiro Kuroda, Satoru Morooka, Takafumi Wataya Masashi Kitagawa, Kazuo Koide, Tetsuya Tanigawara, Toru Iwama, Junki Ito, Shinji Noda, Kazuyuki Kouno, Kazuo Kitazawa, Yoshikazu Kusano Toshiki Takemae, Masanobu Hokama, Hiroki Sato Yoshihisa Nishiyama, Tatsuya Seguchi, Sumio Kobayashi Yoshihiko Inui, Youji Oohigashi, Shinsuke Muraoka, Masaki Miyatake, Kensuke Hayashida Nakagawa Shinichi, Atsushi Inoue, Keiichi Sakai, Shuhei Yamaguchi, Tatsuya Mizoue Fusao Ikawa, Gen Ishida Hideki Irie, Takato Kagawa, Yoichiro Namba, Hiroyuki Nakashima, Isao Date Koji Abe, Masaaki Uno, Masaki Chin Sen Yamagata, Hidemiti Sasayama Soitiro Takao, Hideyuki Yoshida Kouji Muneda, Akira Watanebe, Syouichi Katou, Yasuhiro Hamada, Takafumi Nishizaki, Katsuhiro Yamashita, Takaharu Nakamura Ryuji Nakamura, Shinichi Wakabayashi, Takahito Okazaki, Kaoru Kurisu, Masayasu Matsumoto, Atsushi Tominaga Katsuzo Kiya, Masaaki Shibukawa Syuichi Oki, Toshinori Nakahara, Shinji Okita, Tuyosi Torii, Minoru Nakagawa Kenjirou Fujiwara, Takashi Matsuoka Syuuhei Nishimura, Osamu Hamasaki Naoyuki Isobe, Junichiro Satomi Shinji Nagahiro, Masahito Agawa, Hirofumi Oka, Kunikazu Yoshimura, Tsutomu Kato, Nobuaki Kobayasi Satoshi Minoshima, Nobuhiro Mikuni, Rokuya Tanikawa, Jyunkou Sasaki, Yasunari Otawara, Teiji Tominaga, Tatsuya Sasaki, Sunao Takemura, Masahisa Kawakami, Satoshi Ihara, Yasushi Shibata, Takashi Saegusa, Toshihiko Iuchi, Chiaki Ito, Osamu Okuda, Kazunari Yoshida, Sadao Suga Masateru Katayama, Oikawa Akihiro, Naohisa Miura, Takahiro Ota, Toshihiro Kumabe, Sachio Suzuki, Takashi Kumagai, Keiichi Nishimaki, Kazuhiro Hongo, Hiroaki Shigeta, Kazuyoshi Hattori, Yoichi Uozumi, Norimoto Nakahara, Nobukazu Hashimoto, Shinichi Shirakami Shu Imai, Yoshinari Okumura, Ryo Tamaki Kazuhiro Yokoyama, Susumu Miyamoto, Kazuo Yamamoto, Tsugumichi Ichioka, Tsuyoshi Inoue, Manabu Kinoshita, Minoru Saitoh, Hideo Aihara, Hajimu Miyake, Kotaro Ogihara Tukasa Nishiura, Shigeki Nishino, Yasuyuki Miyoshi, Tadashi Arisawa, Shigeru Daido Shoji Tsuchimoto, Kimihisa Kinoshita, Kiyoshi Yuki Keisuke Migita, Keiichi Akatsuka, Hirosuke Fujisawa, Tadahisa Shono, Hitoshi Tsugu, Shuji Hayashi, Tatsuya Abe Toshio Matsushima, Susumu Nakashima, Takehisa Tuji, Akihiko Kaga, Reizou Kanemaru, Koji Takasaki, Junichi Imamura, Masahiro Noha, Saburo Watanabe, Nobuyuki Sakai, Yasuhisa Yoshida Hiroaki Minami, Tomoyoshi Okumura, Shinjitsu Nishimura, Shinichi Numazawa, Kiyoshi Kazekawa Masanori Tsutsumi, Kouzou Fukuyama, and Yasuhiro Fujimoto

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Databases, Factual, Traumatic brain injury, Nationwide survey, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Level of consciousness, Japan, Surveys and Questionnaires, Epidemiology, Brain Injuries, Traumatic, medicine, Humans, Hospital Mortality, Child, Aged, Retrospective Studies, Aged, 80 and over, Univariate analysis, business.industry, Neurological status, Glasgow Coma Scale, Age Factors, Infant, Newborn, Infant, Odds ratio, Middle Aged, medicine.disease, Patient Discharge, 030220 oncology & carcinogenesis, Child, Preschool, Emergency medicine, Surgery, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

The epidemiology of patients with traumatic brain injury (TBI) has changed dramatically over recent decades as a result of rapid advances in aging societies. We assessed the influence of age on outcomes of patients with TBI and sought to identify prognostic factors for in-hospital mortality of TBI among elderly patients.Using a nationwide database, we analyzed data from 5651 patients with TBI. Univariate analysis was conducted to compare patient demographics, neurologic status on admission, radiologic findings, systemic complication rates, length of hospital stay, in-hospital mortality, and home discharge rates between elderly and nonelderly groups. Multivariable analysis was conducted to determine prognostic factors for in-hospital mortality among elderly patients.Overall in-hospital mortality was significantly higher in elderly patients (12.8% vs. 19.3%; P0.001). In-hospital mortality of elderly patients with mild TBI increased significantly at7 days after admission, whereas that of elderly patients with moderate or severe TBI was significantly higher immediately after admission. Age (odds ratio [OR], 1.62; P = 0.024), male sex (OR, 1.30; P = 0.004), Japan Coma Scale score on admission (OR, 5.95, P0.001), and incidence of acute subdural hematoma (OR, 1.89; P0.001) were associated with in-hospital mortality in elderly patients with TBI.Elderly patients with TBI showed significantly higher in-hospital mortality. Delayed increases in in-hospital mortality were observed among elderly patients with mild TBI. Level of consciousness on admission was the strongest predictor of in-hospital mortality among elderly patients.

Published
2019

4. Evolution of the Management of Tentorial Dural Arteriovenous Malformations

Author

L. Nelson Hopkins, Bernard R. Bendok, Robert H. Rosenwasser, Jacques E. Dion, Cameron G. McDougall, Duke Samson, Evandro de Oliveira, Robert F. Spetzler, Thomas A. Kopitnik, Harry J. Cloft, Felipe C. Albuquerque, Akihiko Kaga, César de Paula Lucas, C. Michael Cawley, Patrick R. Tomak, Daniel L. Barrow, and H. Hunt Batjer

Subjects
Adult, Male, medicine.medical_specialty, Dura mater, Fistula, medicine.medical_treatment, Tentorium cerebelli, Radiosurgery, Veins, Postoperative Complications, medicine, Humans, Embolization, Aged, Retrospective Studies, Aged, 80 and over, Central Nervous System Vascular Malformations, Neurologic Examination, medicine.diagnostic_test, business.industry, Vascular disease, Arteriovenous malformation, Arteries, Middle Aged, medicine.disease, Embolization, Therapeutic, Cerebral Angiography, Surgery, Outcome and Process Assessment, Health Care, medicine.anatomical_structure, Angiography, Female, Dura Mater, Neurology (clinical), Radiology, Tomography, X-Ray Computed, business, Follow-Up Studies
Abstract

OBJECTIVE Tentorial dural arteriovenous malformations (DAVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present a single-institution series of tentorial DAVMs treated during a 12-year period, address the current controversies, and present the rationale for our current therapeutic strategy. METHODS Twenty-two patients with tentorial DAVMs were treated between 1988 and 2000. Treatment consisted of transarterial or transvenous embolization, surgical resection, disconnection of venous drainage, or a combination of these therapies. The clinical presentations, radiological features, treatment strategies, and results were studied. RESULTS Eighteen patients (82%) presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in 22 cases (100%), classifying the lesions as Borden Type III. Angiographic follow-up monitoring was performed for 0 to 120 months and clinical follow-up monitoring for 1 to 120 months. Posttreatment angiography demonstrated obliteration in 22 cases (100%). Two patients experienced neurological decline after endovascular treatment and died. All of the 20 surviving patients exhibited clinical improvement; there were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in 17 cases (77%), good in 2 cases (9%), and fair in 1 case (5%), and there were 2 deaths (9%). CONCLUSION Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

Published
2003

5. CT-guided stereotactic hematoma evacuation was performed on two cases of cerebral hemorrhage in hemodialysis patients

Author

Kohei Hara, Mitsunobu Akashi, Masashi Tomo, Yoshiyuki Oozono, Masaru Nasu, Tetsuo Shibata, Akihiko Kaga, Sumio Watanabe, Ryokichi Yasumori, and Takashi Harada

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Medicine, Hemodialysis, Radiology, business, Hematoma evacuation
Abstract

脳出血を合併した血液透析患者2例にCT定位血腫吸引除去術を施行した. 症例1は, 63歳男性, 意識レベル3, III-a型左被殼出血で発症2日目に手術を施行した. 症例2は, 59歳男性, 意識レベル3, III-b型左視床出血で発症7時間後に手術を施行した.2症例とも, 急性期には抗凝固剤としてNafamostat mesilateを使用し, 頻回短時間血液濾過透析を施行し, 脳圧亢進予防のためグリセオールを使用し, 特に重篤な合併症を起こさず経過を観察し得た.透析患者の脳外科手術に際しては, 持続的血液濾過透析や腹膜透析が推奨されているが, CT定位血腫吸引術に際しては, 手術侵襲が少ないことから, 術後も頻回短時間血液濾過透析にてコントロール可能と考えられた.血液透析患者の脳出血に対してCT定位血腫吸引除去術の有用性, および, 今後手術適応の拡大等が示唆された.

Published
1994

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