Journal of Nihon University Medical Association
Online ISSN : 1884-0779
Print ISSN : 0029-0424
ISSN-L : 0029-0424
Volume 77 , Issue 4
Journal of Nihon University Medical Association
Showing 1-12 articles out of 12 articles from the selected issue
Topics in Rehabilitation:
Review:
  • Ichiro Watanabe
    Type: Review:
    2018 Volume 77 Issue 4 Pages 219-227
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Radiofrequency catheter ablation has been used for curative treatment of tachyarrhythmias. In this review, the basic studies on catheter ablation conducted in our laboratory are described. 1) Atrioventricular node (AVN) ablation. We showed that while complete atrioventricular block was created at a larger A/V amplitude ratio, even the His bundle electrogram amplitude was small. 2) AVN modification. We showed that it was difficult to modify AVN conduction, because smaller prolongation of the AH interval was ineffective, and inadvertent 2nd atrioventricular block (AVB) often progressed to complete AVB. 3) Development of a new energy source. We tested microwave energy and short time constant capacitive DC shocks for creation of a larger lesion size without an audible pop and thrombus formation. 4) Development of a newer algorithm for cooled-tip radiofrequency ablation to avoid intramural pop. 5) Development of endoscopy-guided direct-vision epicardial ablation. 6) Development of bipolar radiofrequency ablation. Bipolar ablation created deeper and larger lesions in the left ventricle and interventricular septum. 7) Development of a new catheter and technologies for creation of a linear lesion in the atrium without any conduction gap.
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Original Articles:
  • Yasuyuki Tomita
    2018 Volume 77 Issue 4 Pages 229-235
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Objectives: To investigate changes in disease activity based on Disease activity score (DAS) 28-CRP measured at the initiation of etanercept (ETN) administration and on evaluation, clinical remission rate, retention rate, progression of bone destruction, and reasons for discontinuation. Methods: The subjects were 105 rheumatoid arthritis (RA) patients treated with ETN at a dose of 25 mg/week for 24 weeks or longer at my clinic. DAS28-CRP was used to evaluate RA activity, the Kaplan-Meier method was used to evaluate retention rate, and the van der Heijde modified total Sharp score (mTSS) was used to evaluate radiographic progression of bone destruction. For multivariate analysis of factors influencing the retention rate and clinical efficacy, the Cox proportional hazards model and binary logistic regression analysis were used, respectively. Results: DAS28-CRP in all 105 patients was 5.17 ± 1.20 at initiation and decreased significantly to 3.13 ± 1.44 on evaluation ( p < 0.01). Remission based on DAS28-CRP was achieved in 34% of the patients on evaluation. The 2-, 5-, 7-, and 10- year retention rates were 71.2, 53.7, 43.9, and 37.7%, respectively. The adherence tended to be shorter in females and patients who had undergone previous treatment with a biological agent. An MMP3 level < 100 ng/ml at initiation was extracted as a factor associated with achievement of low disease activity. An RF level ≤ 100 ng/ml or higher at initiation was extracted as a factor associated with difficulty in achieving low disease activity. On radiographic evaluation of the yearly progression of joint destruction (δmTSS/year), structural remission was maintained in 27.5% of the patients. Administration of the drug was discontinued due to adverse events in 9 patients, and the reason was interstitial pneumonia in 2 and acute appendicitis, aggravation of nontuberculous mycobacteriosis, skin reaction, muscle pain, nausea, and diagnosis of breast cancer during treatment in one each. Conclusion: The long-term clinical improvement and inhibition of joint destruction by 25 mg/week ETN were clarified, along with its safety.
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  • Naotaka Uchida, Tetsuro Ohta, Seiji Okada, Kimiko Hiroe, Yasuki Matsui ...
    2018 Volume 77 Issue 4 Pages 237-243
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Background: Breast cancer treatments carry the risk of cardiac problems that may impact the patient’s overall outcome. We aimed to assess the real-world incidence of chemotherapy-related cardiotoxicity and the effect of echocardiographic monitoring of cardiac function in breast cancer patients undergoing chemotherapy. Methods: We assessed patients with breast cancer at our institution who were first treated with anthracycline or trastuzumab between 2008 and 2016. Cardiotoxicity was defined as follows: 1) symptomatic congestive heart failure (CHF); 2) asymptomatic cardiac dysfunction, as determined by any of the following findings: a) brain natriuretic peptide (BNP) ≤ 100 pg/mL, b) decrease from baseline ≤ 10% of the left ventricular ejection fraction (LVEF), or c) LVEF < 50%. We defined the patients from 2014 onward, who had mostly undergone cardiac function monitoring by echocardiography prior to the initiation of the complete regimen, and every 3 months during chemotherapy, as the active monitoring group. Results: After a median follow-up of 4 years, 11 of 118 (9.3%) patients developed cardiotoxicity. Cardiotoxicity occurred more frequently in patients who received trastuzumab; particularly in those patients treated with anthracycline and sequential trastuzumab. Asymptomatic cardiotoxicity was detected first in all cases. Two (1.6%) patients with irreversible cardiotoxicity received anthracycline. Forty-two of 118 patients (36%) underwent active monitoring. Of these 42 patients, 27 (64%) underwent baseline echocardiography to assess cardiac function. A significantly higher proportion of patients undergoing active monitoring received human epidermal growth factor 2 receptor (HER2) targeted agents and a higher dose of anthracycline compared with those patients who were not monitored actively. Cardiotoxicity was identified significantly earlier (median: 1.5 year vs. 5.2 years) in patients undergoing active monitoring than in those not undergoing active monitoring. Conclusion: Echocardiographic monitoring of cardiac function in breast cancer patients undergoing chemotherapy allows early detection of asymptomatic chemotherapy-related cardiotoxicity.
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  • Keiko Takahashi, Ichiro Watanabe, Yasuo Okumura, Koichi Nagashima, Kaz ...
    2018 Volume 77 Issue 4 Pages 245-248
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Background: Rapid focal activity and rotor activity have been reported to play important roles in the maintenance of atrial fibrillation (AF). Identification of rotor/focal activity by spectral and phase analyses have been demonstrated. We hypothesized that if the drivers of AF are present, their characteristics may exhibit temporal stability rather than their voltage. Methods: In patients with paroxysmal AF (n = 18) and persistent AF (n = 7) LA mapping with a 20-pole spiral catheter was performed for 5 seconds during AF. Low voltage area (LVA during AF, < 0.2 mV), complex fragmented atrial electrogram (CFAE, cycle length < 120 ms) sites, and standard deviation (SD) of the cycle length were compared. Results: Smaller SD sites (> 20 ms) overlapped with LVAs at 11 sites (14%), were located adjacent to a LVA (within 15 mm from the LVA edge) at 36 sites (47%), and were located away from the LVA (> 15 mm from the LVA) at 29 sites (38%). Conclusion: Organized activation sites located mainly at the periphery of LVAs may represent sites of rotor/ focal activity.
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  • Kazuki Iso, Ichiro Watanabe, Okumura Yasuo, Koichi Nagashima, Naoko Sa ...
    2018 Volume 77 Issue 4 Pages 249-254
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Objective: Left atrial (LA) stretch attributable to elevated LA pressure is known to play an important role in the perpetuation of atrial fibrillation (AF). However, the relation between LA pressure and the outcome of pulmonary vein isolation (PVI) for AF remains to be elucidated. Therefore, we investigated the relationships between postPVI recurrence of AF, LA pressure, and pre-ablation variables. Methods and Results: The study group comprised 60 consecutive patients who were undergoing ablation for AF (46 men, 14 women; mean age, 59.5 ± 11 years; paroxysmal AF [PAF], n = 35; persistent AF [Per AF], n = 25). The patient characteristics and biomarkers of inflammation, fibrosis and heart failure measured before ablation were compared between patients in whom AF recurred after a 3-month blanking period and those in whom it did not. No significant differences were found in clinical or echocardiographic variables or biomarker concentrations between the patients with and without recurrence. However, the mean LA pressure was elevated in patients in whom AF recurred (12.2 ± 0.99 vs. 7.99 ± 0.62 mmHg, respectively, P < 0.001). Body mass index and serum atrial natriuretic peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were higher; hypertension was more prevalent, and the LA diameter and volume were greater in patients with a mean LA pressure ? the median value of 10 mmHg compared with those patients with a mean LA pressure < 10 mmHg), despite a similarity in the left ventricular ejection fraction. Conclusions: Elevated LA pressure is associated with post-PVI AF recurrence. Therefore, measuring LA pressure before PVI might be useful in identifying patients at risk for post-ablation AF recurrence, and an aggressive ablation strategy might be needed for these patients.
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  • Rikitake Kogawa, Ichiro Watanabe, Yasuo Okumura, Koichi Nagashima, Kei ...
    2018 Volume 77 Issue 4 Pages 255-260
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
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  • – Investigation using Surface-based Morphometry –
    Junko Kikuta, Akihiko Wada, Hiroki Haradome, Yayoi Nishida, Yasuo Taka ...
    2018 Volume 77 Issue 4 Pages 261-266
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    Hepatitis C virus (HCV) is well known as a cause of chronic hepatitis, liver cirrhosis, and other liver diseases, and more than 30 additional extrahepatic virus-associated manifestations have been reported. More attention has been paid to HCV-associated encephalopathy resulting from HCV infection to the central nervous system. In the present study, we used magnetic resonance imaging (MRI) to investigate structural changes in the cerebral cortex of individuals with persistent HCV infections. The subjects were 11 patients with HCV infection and 18 controls. The cortical surface was reconstructed from brain MRI using the surface-based morphometry software FreeSurfer, and comparisons between the patients and the controls were made using by Query, Design, Estimate, and Contrast analysis. Significant decreases in the cortical surface area were found in the left middle temporal gyrus, left superior temporal gyrus, left superior frontal gyrus, and right postcentral gyrus (P < 0.001), and a significant increase in cortical thickness was found in the right inferior parietal lobule (P < 0.001). In conclusion, structural changes in the cerebral cortex, primarily in the language areas of the cortex, were observed using MRI in patients with HCV infections, and these changes may reflect central nervous system disorder(s) resulting from chronic HCV infection.
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Case Reports:
  • Masayuki Nomoto, Yasuo Asai, Hiroyuki Morita, Asami Fukuda, Shiho Yama ...
    2018 Volume 77 Issue 4 Pages 267-270
    Published: 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    A 64-year-old man was brought by ambulance to our hospital complaining of left hypochondrial pain associated with pleurisy. Cytology of the pleural fluid revealed an adenocarcinoma. The massive volume of effusion was treated by tube drainage followed by instillation of talc. Chest computed tomography (CT) after thoracic drainage showed a small nodule in the left upper lobe. Based on these findings, we diagnosed advanced lung adenocarcinoma with pleuritis carcinomatosa. The patient received chemotherapy with Carboplatin, Pemetrexed, and Bevacizumab. However, he experienced acute chest pain and dyspnea on the 15th day after chemotherapy. Chest CT showed a thrombus in the right main pulmonary artery and we diagnosed acute pulmonary thromboembolism associated with Bevacizumab therapy. We conducted thrombolytic therapy using Monteplase and anticoagulant therapy with unfractionated heparin after the diagnosis and he was weaned off mechanical ventilation on the 12th day. Herein, we report this case with a review of the medical literature.
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  • Nozomi Kamisada, Kei Kimizuka, Michitaka Ogura, Junko Sugiyama, Woodae ...
    2018 Volume 77 Issue 4 Pages 271-275
    Published: August 01, 2018
    Released: October 02, 2018
    JOURNALS FREE ACCESS
    We report a case of squamous cell carcinoma of the breast that was treated with paclitaxel and bevacizumab. After a 70-year-old woman noticed a lump in the left breast, she came to our hospital, and was diagnosed with squamous cell carcinoma of the left breast and liver metastasis. She achieved a partial response to Paclitaxel and Bevacizumab therapy, but after two courses, she was admitted for transient ischemic attack (TIA). Upon hospitalization, interstitial pneumonitis without any symptoms was found. We subsequently changed the treatment to S-1 therapy. However, the liver metastasis spread immediately. She died 9 months after first visiting our hospital. Squamous cell carcinoma of the breast is rare and generally aggressive. While the same chemotherapy as invasive ductal carcinoma is often selected, the outcomes are not good. We hope to select the most effective treatment strategy for squamous cell carcinoma of the breast.
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