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Hirata K, Arakaki T, Tamashiro M, Kakazu M. Absent pansystolic murmur in Eisenmenger ventricular septal defect. Eur Heart J Case Rep 2023; 7:ytad031. [PMID: 36742019 PMCID: PMC9887720 DOI: 10.1093/ehjcr/ytad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Kazuhito Hirata
- Corresponding author. Tel: +81 98 850 3811, Fax: +81 98 850 3810,
| | - Tomohiro Arakaki
- Division of Cardiology, Yuuai Medical Center, 50-5 Yone, Tomigusuku city, Okinawa 901-0224, Japan
| | - Masahiro Tamashiro
- Division of Cardiology, Yuuai Medical Center, 50-5 Yone, Tomigusuku city, Okinawa 901-0224, Japan
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Yamazato M, Sakima A, Ishida A, Kohagura K, Matayoshi T, Tana T, Tamashiro M, Hata Y, Naka T, Nakamura Y, Ohya Y. Salt and potassium intake evaluated with spot urine and brief questionnaires in combination with blood pressure control status in hypertensive outpatients in a real-world setting. Hypertens Res 2021; 44:1316-1325. [PMID: 34345011 DOI: 10.1038/s41440-021-00707-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/09/2022]
Abstract
Reducing salt and increasing potassium intake are recommended lifestyle modifications for patients with hypertension. The estimated 24-h urinary salt excretion value from spot urine using Tanaka's formula and the salt check-sheet scores, questionnaire-based scores of salt intake, are practical indices of daily salt intake. However, few studies have evaluated salt intake with these methods in hypertensive outpatients. We examined salt and potassium intake with the spot urine method and the salt check-sheet scores of hypertensive outpatients in a multi-facility, real-world setting and examined whether the salt or potassium intake evaluated with these methods related to inadequate blood pressure control. Hypertensive outpatients from 12 medical facilities in the Okinawa prefecture were enrolled from November 2011 to April 2014 (n = 1559, mean age 63.9 years, 46% women). The mean blood pressure, urinary salt excretion value, urinary potassium excretion value, and total score on the salt check-sheet were 129/75 mmHg, 8.7 g/day, 1.6 g/day, and 10.4 points, respectively. The urinary salt excretion value and total score on the salt check-sheet but not urinary potassium excretion value were associated with inadequate blood pressure control (≥140/90 mmHg). Higher body mass index, estimated glomerular filtration rate, urinary potassium excretion value, total score on the salt check-sheet, and presence of inadequate blood pressure control were associated with high urinary salt excretion (≥10.2 g/day). In conclusion, hypertensive outpatients with high urinary salt excretion values estimated using Tanaka's formula or with high scores on the salt check sheet may be candidates for more intensive salt reduction guidance.
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Affiliation(s)
- Masanobu Yamazato
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan
| | - Akio Ishida
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Tetsutaro Matayoshi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | | | | | | | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Inoue T, Shinjo T, Matsuoka M, Tamashiro M, Oba K, Arasaki O, Moromizato T, Arima H. The association between frailty and chronic kidney disease; cross-sectional analysis of the Nambu Cohort Study. Clin Exp Nephrol 2021; 25:1311-1318. [PMID: 34244892 DOI: 10.1007/s10157-021-02110-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both frailty and chronic kidney disease (CKD) increase with age and share many similarities. Many studies have demonstrated an association between frailty and chronic kidney disease (CKD), but an association with dipstick proteinuria is limited. METHODS This is the cross-sectional analysis of the Nambu Cohort Study at the beginning of observation. Frailty was diagnosed using Kihon Checklist. Logistic analysis was used to evaluate the association between frailty and CKD or dipstick proteinuria. RESULTS Among a total of 630 outpatients [age, 78 (70-84) years, men, 50%], the prevalence of patients with pre-frailty and frailty was 32% and 40%, respectively. The proportion of patients with pre-frailty and frailty increased with decreasing estimated glomerular filtration rate (eGFR) and increasing dipstick proteinuria levels. The odds ratios (95% confidence intervals) for CKD stage of 60 < eGFR ≤ 45 ml/min/1.73 m2, and 45 ml/min/1.73 m2 < eGFR for frailty was 0.87 (0.56-1.35) and 2.54 (1.46-4.53), respectively, compared with non-CKD as a reference. Furthermore, the odds ratios for the frailty of dipstick proteinuria with ± and + or over were 1.36 (0.88-2.09) and 1.78 (1.00-3.17), respectively, when dipstick proteinuria-was used as a reference. Moreover, the combination of eGFR and dipstick proteinuria levels increased the odds ratio for pre-frailty and frailty. CONCLUSION Elderly patients with CKD had a higher prevalence of pre-frailty and frailty. By adding urinary protein information to eGFR, the link between CKD and frailty becomes even more robust.
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Affiliation(s)
- Taku Inoue
- Cardiovascular Medicine, Tomishiro Central Hospital, Taku Inoue: 25 Ueta, Tomigusuku City, Okinawa, 901-0243, Japan. .,Department of Preventive Medicine and Public Health, School of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Tetsuji Shinjo
- Cardiovascular Medicine, Tomishiro Central Hospital, Taku Inoue: 25 Ueta, Tomigusuku City, Okinawa, 901-0243, Japan
| | | | | | - Kageyuki Oba
- Cardiovascular Medicine, Yuai Medical Center, Tomigusuku, Japan
| | - Osamu Arasaki
- Cardiovascular Medicine, Yuai Medical Center, Tomigusuku, Japan
| | | | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, School of Medicine, Fukuoka University, Fukuoka, Japan
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Sento Y, Arai M, Yamamori Y, Fujiwara S, Tamashiro M, Kawamoto E, Naito T, Atagi K, Fujitani S, Osaga S, Sobue K. The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis. J Anesth 2021; 35:222-231. [PMID: 33523292 PMCID: PMC7969491 DOI: 10.1007/s00540-021-02900-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
Purpose Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management. Methods This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan. We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non-postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary. Results There were 609 (12.7%) postoperative patients among the total patients in the registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non-postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%. Conclusion Approximately, 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02900-4.
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Affiliation(s)
- Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Masayasu Arai
- Division of Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yuji Yamamori
- Department of Emergency and Critical Care Medicine, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Shinsuke Fujiwara
- Department of Emergency Medicine, NHO Ureshino Medical Center, 2436 Shimojuku, Ureshino, Saga, 843-0393, Japan
| | - Masahiro Tamashiro
- Department of Intensive Care Medicine, Tomishiro Central Hospital, 25 Ueta, Tomigusuku, Okinawa, 901-0243, Japan
| | - Eiji Kawamoto
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kazuaki Atagi
- Intensive Care Unit, Nara Prefecture General Medical Center, 2-897-5 Shichijonishi, Nara, Nara, 630-8581, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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5
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Oba K, Shinjo T, Tamashiro M, Matsuoka M, Arasaki O, Arima H, Inoue T. Cause of Death and Associated Factors in Elderly Patients With Atrial Fibrillation - Long-Term Retrospective Study. Circ Rep 2020; 2:490-498. [PMID: 33693274 PMCID: PMC7819663 DOI: 10.1253/circrep.cr-20-0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
Oral anticoagulant (OAC) therapy reduces the risk of stroke in patients with atrial fibrillation (AF). This study elucidated the causes of death and related factors in elderly Japanese AF patients. Methods and Results:
Over a median (interquartile range [IQR]) follow-up period of 46 (20–76) months, there were 171 all-cause deaths (28% cardiovascular, 46% non-cardiovascular, and 26% unknown causes) among 389 AF patients (median [IQR] age 80 [74–85] years; CHAD2DS2-VASc score 5 [4–6]). Cox regression analysis indicated that diabetes was associated with an increase in all-cause death (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02–2.13), whereas hypercholesterolemia (HR 0.53; 95% CI 0.35–0.79), pre-existing heart failure (HR 0.67; 95% CI 0.48–0.95), and OAC use (HR 0.62; 95% CI 0.44–0.88) were associated with reductions in all-cause death. Pre-existing heart failure was associated with both cardiovascular (HR 3.03; 95% CI 1.33–8.20) and non-cardiovascular (HR 0.44; 95% CI 0.30–0.65) deaths, in opposite directions. OAC use was associated with a reduction in cardiovascular death (HR 0.34, 95% CI 0.17–0.69). The predominance of non-cardiovascular death and death-related factors were equivalent regardless of when observations started (before 2009 or in 2009 and later). Conclusions:
The predominant cause of death in elderly Japanese AF patients was non-cardiovascular. Distinct clinical factors were associated with cardiovascular and non-cardiovascular death.
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Affiliation(s)
- Kageyuki Oba
- Cardiovascular Medicine, Tomishiro Central Hospital Okinawa Japan
| | | | | | | | - Osamu Arasaki
- Cardiovascular Medicine, Tomishiro Central Hospital Okinawa Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Fukuoka Japan
| | - Taku Inoue
- Cardiovascular Medicine, Nambu Hospital Okinawa Japan.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Fukuoka Japan
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Tamashiro M, Iseki K, Takishita S. Electron Beam Computed Tomography Evaluation of the Rapid Progression of Coronary Artery Calcification in Chronic Hemodialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139880102401212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - K. Iseki
- Dialysis Unit, University of the Ryukyus, Okinawa - Japan
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Tanaka A, Komukai S, Shibata Y, Yokoi H, Iwasaki Y, Kawasaki T, Horiuchi K, Nakao K, Ueno T, Nakashima H, Tamashiro M, Hikichi Y, Shimomura M, Tago M, Toyoda S, Inoue T, Kawaguchi A, Node K. Effect of pioglitazone on cardiometabolic profiles and safety in patients with type 2 diabetes undergoing percutaneous coronary artery intervention: a prospective, multicenter, randomized trial. Heart Vessels 2018; 33:965-977. [PMID: 29487991 DOI: 10.1007/s00380-018-1143-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/23/2018] [Indexed: 12/18/2022]
Abstract
Pioglitazone has superior antiatherosclerotic effects compared with other classes of antidiabetic agents, and there is substantial evidence that pioglitazone improves cardiovascular (CV) outcomes. However, there is also a potential risk of worsening heart failure (HF). Therefore, it is clinically important to determine whether pioglitazone is safe in patients with type 2 diabetes mellitus (T2DM) who require treatment for secondary prevention of CV disease, since they have an intrinsically higher risk of HF. This prospective, multicenter, open-label, randomized study investigated the effects of pioglitazone on cardiometabolic profiles and CV safety in T2DM patients undergoing elective percutaneous coronary intervention (PCI) using bare-metal stents or first-generation drug-eluting stents. A total of 94 eligible patients were randomly assigned to either a pioglitazone or conventional (control) group, and pioglitazone was started the day before PCI. Cardiometabolic profiles were evaluated before PCI and at primary follow-up coronary angiography (5-8 months). Pioglitazone treatment reduced HbA1c levels to a similar degree as conventional treatment (pioglitazone group 6.5 to 6.0%, P < 0.01; control group 6.5 to 5.9%, P < 0.001), without body weight gain. Levels of high-molecular weight adiponectin increased more in the pioglitazone group than the control group (P < 0.001), and the changes were irrespective of baseline glycemic control. Furthermore, pioglitazone significantly reduced plasma levels of natriuretic peptides and preserved cardiac systolic and diastolic function (assessed by echocardiography) without incident hospitalization for worsening HF. The incidence of clinical adverse events was also comparable between the groups. These results indicate that pioglitazone treatment before and after elective PCI may be tolerable and clinically safe and may improve cardiometabolic profiles in T2DM patients.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, Japan.
| | - Sho Komukai
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Yoshisato Shibata
- Miyazaki Medical Association Hospital, Cardiovascular Center, Miyazaki, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshihiro Iwasaki
- Department of Cardiology, Nagasaki Kouseikai Hospital, Nagasaki, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Kenji Horiuchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Takafumi Ueno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hitoshi Nakashima
- Department of Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | | | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, Japan
| | - Mitsuhiro Shimomura
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, Japan
| | - Motoko Tago
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, Japan.
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8
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Takahashi Y, Yamauchi A, Tabuchi M, Toritsuka D, Arasaki O, Tamashiro M, Kakazu M, Iju K, Kume M, Sakihama S, Matayoshi Y. [Cardiac Rehabilitation in Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting]. Kyobu Geka 2017; 70:483-487. [PMID: 28698412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES A purpose is to compare the in-hospital rehabilitation progress after minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) with that after off pump coronary artery bypass grafting( OPCAB). METHODS We analyzed 60 patients who underwent coronary artery bypass grafting surgery from January 2015 to December 2016. Fourteen patients underwent MICS CABG (MICS CABG group) and 46 patients underwent OPCAB (OPCAB group). The post-operative days to start standing position and independent walking, and hospitalization duration were analyzed between the 2 groups. RESULTS There were no significant differences between the groups:standing position(1.2 vs 1.2 days) and independent walking(4.8 vs 4.9 days). Hospitalization duration was shorter in MICS CABG group(14.3 vs 17.5 days). CONCLUSION MICS CABG may shorten hospitalization length compared with OPCAB, however, further research will be needed.
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Affiliation(s)
- Yo Takahashi
- Department of Rehabilitation, Tomishiro Central Hospital, Tomishiro, Japan
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Negri Aranguren M, Shanley C, Cranco S, Otero V, Fiad L, Fernandez I, Miodosky M, Kusminsky G, Corso A, Bistmans A, Huber M, Marull M, Jarchum S, Guanchiale L, Marquez M, Beligoy L, Cerutti I, Navieckas A, Tamashiro M, Pujol M, Taus R, Canosa V, Lopez Galletti L, Prates M, Riddick M, Pavlovsky A. Brentuximab vedotin: A retrospective multicenter analysis of its indication, safety and efficacy in Argentina. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - C. Shanley
- Hematology; Htal. Britanico Buenos Aires; Caba Argentina
| | - S. Cranco
- Hematology; Instituto Alexander Fleming; Caba Argentina
| | - V. Otero
- Hematology; Htal. Italiano Buenos Aires; Caba Argentina
| | - L. Fiad
- Hematology; Htal. Italiano De La Plata; La Plata Argentina
| | | | | | | | - A. Corso
- Hematology, Htal. De Clinicas; Caba Argentina
| | - A. Bistmans
- Hematology, Htal. Ramos Mejia; Caba Argentina
| | - M. Huber
- Hematology, Cemic; Caba Argentina
| | - M. Marull
- Hematology, Centro Posadas; Posadas Argentina
| | - S. Jarchum
- Hematology, Sanatorio Allende; Cordoba Argentina
| | | | | | - L. Beligoy
- Hematology; Hospital Perrando; Chaco Argentina
| | | | - A. Navieckas
- Hematology, Htal. Del Cruce; Florencio Varela Argentina
| | - M. Tamashiro
- Hematology; Sanatorio Sagrado Corazon; Caba Argentina
| | - M. Pujol
- Hematology, Htal Angela I. De Llano; Corrientes Argentina
| | - R. Taus
- Hematology, Htal. Rossi; La Plata Argentina
| | - V. Canosa
- Hematology, Htal. Lagomaggiore; Mendoza Argentina
| | | | - M.V. Prates
- Hematology; Htal. Italiano De La Plata; La Plata Argentina
| | - M. Riddick
- Ciencias Exactas, Unlp; La Plata Argentina
| | - A. Pavlovsky
- Hematology; Centro Hematologia Pavlovsky; Caba Argentina
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Fujimoto N, Iseki K, Tokuyama K, Tamashiro M, Takishita S. Significance of coronary artery calcification score (CACS) for the detection of coronary artery disease (CAD) in chronic dialysis patients. Clin Chim Acta 2006; 367:98-102. [PMID: 16413522 DOI: 10.1016/j.cca.2005.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 11/26/2005] [Accepted: 11/26/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a principal cause of death in patients with end-stage renal disease (ESRD). The coronary artery calcification score (CACS), determined by electron-beam computed tomography (EBCT), is useful for the detection of CAD in non-ESRD patients. There are few reports on the usefulness of EBCT for the detection of CAD, however, in ESRD patients. We examined the relation between CACS and CAD in ESRD patients. METHODS Coronary angiography (CAG) was used to diagnose CAD in patients with significant coronary artery stenosis (>or=50%). We examined 76 ESRD patients on chronic dialysis therapy from 1997 to 2005, of which 51 are men, 25 are women, mean (S.D.) age of 57.9 (12.1) years and mean (S.D.) HD duration of 7.7 (6.6) years. There were 50 (35 men, 15 women) patients with CAD and 26 (16 men, 10 women) without CAD. RESULTS The median CACS was 1290 in all patients, 1689 in the CAD group and 527 in the non-CAD group; the mean (S.D.) CACS was 1833 (2003) in all patients, 2338 (2209) in the CAD group and 861 (991) in the non-CAD group. CACS was significantly higher in the CAD group than in the non-CAD group. The CACS cutoff values for predicting CAD were calculated at intervals of 100. At the cutoff values of >or=100, >or=500, >or=1000, >or=2000, and >or=3000, the sensitivity was 98%, 90%, 68%, 42%, and 32% and the specificity was 35%, 50%, 69%, 85%, and 96%, respectively. CONCLUSIONS EBCT is not adequate for screening asymptomatic ESRD patients. Because EBCT is less invasive than CAG, further study is necessary to determine whether CAG should be performed in all high-risk ESRD patients on chronic dialysis.
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Affiliation(s)
- Naoko Fujimoto
- Tokuyama Clinic, and Dialysis Unit, University Hospital of the Ryukyus, Japan.
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11
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Matsuoka M, Iseki K, Tamashiro M, Fujimoto N, Higa N, Touma T, Takishita S. Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 2004; 8:54-8. [PMID: 15067517 DOI: 10.1007/s10157-003-0260-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Accepted: 10/01/2003] [Indexed: 12/17/2022]
Abstract
BACKGROUND Electron-beam computed tomography (EBCT) is a noninvasive measure of coronary artery calcification and, therefore, could be a marker of developing cardiovascular disease. Whether the coronary artery calcification score (CACS) is a prognostic marker in chronic dialysis patients is not known. METHODS In the present study, the mortality rate was observed in relation to the baseline CACS. EBCT was performed in 104 chronic hemodialysis patients (62 men and 42 women) in one dialysis unit. The mean (SD) duration of hemodialysis was 48.7 (62.6) months at the time of EBCT. The mean (SD) age at EBCT was 55.9 (13.6) years, ranging from 23 to 88 years. The duration of follow-up was 43.8 (19.3) months after the EBCT. Cox proportional hazard analysis was performed to examine the impact of CACS on survival after adjusting for age, sex, duration of dialysis, diabetes mellitus, hypertension, serum albumin, and dyslipidemia. RESULTS The CACS was distributed from zero to 5896, with a median of 200. During the study period, 24 patients (15 men and 9 women) died, 7 in the low CACS group (<200) and 17 in the high CACS group (> or =200). The 5-year cumulative survival rate was 84.2% in the low CACS group and 67.9% in the high CACS group. The adjusted relative risk (95% confidence interval) of death was 1.001 (1.000-1.002); P = 0.0003, for the absolute value of CACS. CONCLUSIONS The present study suggested that CACS was an independent predictor of death in patients on chronic hemodialysis. Patients with a high CACS should be carefully monitored and evaluated for reversible prognostic factors such as dyslipidemia and, probably, hyperphosphatemia and a high value for the calcium x phosphate product.Electron-beam computed tomography (EBCT) is a noninvasive measure of coronary artery calcification and, therefore, could be a marker of developing cardiovascular disease. Whether the coronary artery calcification score (CACS) is a prognostic marker in chronic dialysis patients is not known.
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Affiliation(s)
- Mitsuteru Matsuoka
- Third Department of Internal Medicine, University Hospital of The Ryukyus, Okinawa, Japan
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Tamashiro M, Iseki K, Takishita S. Electron beam computed tomography evaluation of the rapid progression of coronary artery calcification in chronic hemodialysis patients. Int J Artif Organs 2001; 24:835-7. [PMID: 11831587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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13
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Inoue T, Tamashiro M, Matsuoka M, Miyara T, Okumura K, Touma T, Sunagawa O, Fukiyama K. Arrhythmogenic right ventricular dysplasia presenting as regression of left ventricular dysfunction: a case report. J Cardiol 2001; 38:93-7. [PMID: 11525115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Arrhythmogenic right ventricular dysplasia is considered to be a slowly progressive disease in which left ventricular dysfunction and congestive heart failure usually appear at the end stage. The initial clinical presentation of this 56-year-old Japanese woman was left-sided heart failure, and the diagnosis was dilated cardiomyopathy, but her left ventricular size and ejection fraction regressed during 10 years of treatment, whereas her right ventricular parameters showed no change.
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Affiliation(s)
- T Inoue
- Third Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara-cho, Nakagami-gun, Okinawa 903-0215
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Tamashiro M, Iseki K, Sunagawa O, Inoue T, Higa S, Afuso H, Fukiyama K. Significant association between the progression of coronary artery calcification and dyslipidemia in patients on chronic hemodialysis. Am J Kidney Dis 2001; 38:64-9. [PMID: 11431183 DOI: 10.1053/ajkd.2001.25195] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quantification of coronary artery calcification (CAC) determined by electron-beam computed tomography (EBCT), known as the CAC score (CACS), correlates with total plaque amount and coronary risk factors and strongly associates with maximal stenosis in the epicardial arteries. However, data are limited concerning the CACS in chronic dialysis patients, although atherosclerotic vascular disease is the most frequent complication. We examined the relation between coronary risk factors, metabolic factors of calcium and other minerals, and CACS progression in 24 dialysis patients. The mean patient age was 53 +/- 14 (SD) years, and mean duration of dialysis was 64 +/- 69 months. In each patient, the CACS was measured twice, with a mean interscan period of 17 +/- 3 months. The mean CACS progressed from 449 +/- 605 to 669 +/- 894 overall, and the mean change in CACS (DeltaCACS) was 220 +/- 78. Patients were divided into two groups: slow progressors, with DeltaCACS of 7.5 +/- 31 (n = 12), and rapid progressors, with DeltaCACS of 432 +/- 458 (n = 12). Triglyceride concentrations (198 +/- 65 versus 103 +/- 50 mg/dL; P < 0.001) were high, and high-density lipoprotein cholesterol (HDL-C) concentrations (46 +/- 11 versus 60 +/- 18 mg/dL; P < 0.05) were low in rapid progressors. Rapid progression of CAC was associated with high triglyceride and low HDL-C concentrations. The clinical significance of these observations remains to be determined.
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Affiliation(s)
- M Tamashiro
- Third Department of Internal Medicine and Dialysis Unit, School of Medicine, University of The Ryukyus, Japan.
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15
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Uechi Y, Sunagawa O, Ishikawa N, Inoue T, Tamashiro M, Kamiyama T, Suzuki T, Touma T, Fukiyama K. Risk Factors for Stiffness of the Wall of the Thoracic Aorta in Patients With Mild Atherosis. ACTA ACUST UNITED AC 2001; 65:409-13. [PMID: 11348044 DOI: 10.1253/jcj.65.409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous studies have suggested that aging is associated with progressive arterial stiffness and widening of the pulse pressure, and pulse pressure has been found to be a risk factor of cardiovascular diseases. However, the effects of age, blood pressure (including pulse pressure) or atherogenic factors on thoracic aortic wall stiffness in patients with mild atherosis are unclear, so the present study used transesophageal echocardiography to examine 103 consecutive patients with various cardiovascular diseases. The extent of atherosis was evaluated in terms of intima-medial thickness (IMT), and 2 indices of wall stiffness in the aorta were calculated: elastic modulus and stiffness parameter (beta). In subjects with mild atherosis (IMT <1.0mm), age, body mass index, systolic blood pressure, pulse pressure, triglyceride level, and hypertension were factors significantly associated with high wall stiffness, and multiple logistic stepwise analysis revealed that age, pulse pressure, and triglyceride level were particularly significant.
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Affiliation(s)
- Y Uechi
- The Third Department of Internal Medicine, School of Medicine, University of the Ryukyus, Okinawa, Japan
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16
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Tamaki M, Tamashiro M, Kamada Y, Koja K, Kusaba A. Distribution and localization of cells and collagens in the proliferated intima of arterially implanted autovein grafts. Surg Today 1999; 29:614-25. [PMID: 10452239 DOI: 10.1007/bf02482987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined the microscopic features and distribution of collagens in the hyperplastic intima of arterially implanted autovein bypass grafts under conditions of a reduced blood flow with a poor distal outflow. Vascular anastomosis was made using 7-0 nonabsorbable polypropylene sutures (PP group), or absorbable polydioxanone sutures (PDS group). On the contralateral limb, an autovein bypass graft was performed under normal flow conditions (NF group). The thickness of the intima in the NF group was approximately 50 microm throughout the duration of the study, while in the PP and PDS groups, intimal hyperplasia progressed to 290+/-112 microm and 267+/-123 microm, respectively, at 13 months after grafting. Collagen accumulated significantly in both the PP and PDS groups; types IV and V collagen in particular increased considerably in the deep layer. Regardless of the suture materials, the progression of intimal hyperplasia was considered to be closely related to the poor distal outflow to be and caused by the proliferation of myofibroblasts and active production of collagen. The increase in types IV and V collagen, particularly in the deep layer of the hyperplastic intima, was due to development of numerous vasa vasora in this region.
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Affiliation(s)
- M Tamaki
- Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Kuda T, Nagamine N, Oshiro J, Matsubara S, Tamashiro M, Sakuda H, Kamada Y, Kuniyoshi Y, Koja K. [Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect]. Jpn J Thorac Cardiovasc Surg 1998; 46:344-6. [PMID: 9619033 DOI: 10.1007/bf03217753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.
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Affiliation(s)
- T Kuda
- Second Department of Surgery, Ryukyus University School of Medicine, Okinawa, Japan
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Takei G, Tamashiro M. Changes observed in hemolymph proteins of the lawn armyworm, Spodoptera mauritia acronyctoides, during growth, development, and exposures to a nuclear polyhedrosis virus. J Invertebr Pathol 1975. [DOI: 10.1016/0022-2011(75)90043-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Laigo F, Tamashiro M. Interactions between a microsporidian pathogen of the lawn-armyworm and the hymenopterous parasite Apanteles marginiventris. J Invertebr Pathol 1967. [DOI: 10.1016/0022-2011(67)90136-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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