論文 - 小松　克也

NIH Stroke Scaleを用いるAdvanced OSCEの実施と工夫 8年間807名の受験を振り返る

齊藤 正樹, 山本 和利, 米増 保之, 小松 克也, 三上 毅, 外山 祐一郎, 鈴木 秀一郎, 松村 晃寛, 寺本 篤史, 射場 浩介, 三國 信啓, 寳金 清博, 有山 静香, 橋本 諭, 下濱 俊, 札幌医科大学医学部OSCE実施委員会

医学教育 ( (一社)日本医学教育学会 )  46 ( Suppl. ) 177 - 177  2015年07月

Rigid endoscopic resection of deep-seated or intraventricular brain tumors.

Yukinori Akiyama, Masahiko Wanibuchi, Takeshi Mikami, Yoshifumi Horita, Katsuya Komatsu, Kengo Suzuki, Shunya Otaki, Nobuhiro Mikuni

Neurological research ( MANEY PUBLISHING )  37 ( 3 ) 278 - 82  2015年03月  [査読有り]  [国際誌]

　概要を見る

Rigid endoscopic resection using a thick sheath (ViewSite) may be a viable method for the resection or biopsy of selected deep-seated brain tumors, such as thalamic gliomas and malignant lymphomas. Neuroendoscopic biopsy is one technique used for the histological verification of suspected brain tumors. There are a number of advantages to using this technique. For example, under direct vision, it is possible to carefully observe the tumor surface and avoid vessels during tumor resections. It is also possible to collect enough specimens for a pathological diagnosis. Eighteen consecutive patients safely underwent rigid endoscopic resection or biopsy using a thick sheath (ViewSite). The two-handed endoscopic technique that utilized a mounted rigid endoscope proved very useful and safe, since it enabled easy stanching of hemorrhages. The aim of this study was to demonstrate how to use a thick sheath for deep-seated or intraventricular tumors. The rigid endoscopic approach with a thick sheath provides an alternative medial approach with improved visualization and a wider working space.

DOI PubMed

Nascent lobar microbleeds and stroke recurrences.

Toshio Imaizumi, Shigeru Inamura, Ikuhide Kohama, Kazuhisa Yoshifuji, Tatsufumi Nomura, Katsuya Komatsu

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( ELSEVIER SCIENCE BV )  23 ( 4 ) 610 - 7  2014年04月  [査読有り]  [国際誌]

　概要を見る

BACKGROUND: Lobar microbleeds (MBs) are occasionally visible on gradient-echo T2*-weighted (T2*-w) magnetic resonance imagings (MRIs) in patients with deep intracerebral hemorrhages (ICHs). This study investigated the contribution of nascent lobar MBs to occurrences of deep ICHs. METHODS: We prospectively analyzed nascent lobar MBs in patients admitted to our hospital who were treated with index strokes between April 2004 and November 2009. Numbers of nascent lobar MBs were counted on T2*-w MRI scans around 1 year after index strokes and compared with previous MRIs on admission. Deep ICH occurrence-free rate curves were generated by the Kaplan-Meier method using the log-rank test. The odds ratio (OR) for deep ICH occurrence was derived from a multivariate logistic regression model using nascent lobar MBs and risk factors. RESULTS: We investigated MRIs (interscan interval: 14.6 ± 5.9 months) of 508 patients (207 women, 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-w MRIs demonstrated 157 nascent lobar MBs in 62 of 508 patients. The occurrence rate of deep ICHs (1.9% per year) was significantly higher in patients with nascent lobar MBs than in those without (.5% per year, P = .012). Multivariate analyses revealed that the rate of nascent lobar MBs was significantly elevated in patients with deep ICH-type stroke recurrences (OR: 3.85, P = .020), adjusted by the presence of hypertension, diabetes mellitus, use of antithrombotic drugs, severity of white matter lesions, age, and gender. CONCLUSIONS: Though a cohort study limited the power of analyses, our findings suggested that lobar MBs might be associated with deep ICH.

DOI PubMed

Nascent deep microbleeds and stroke recurrences.

Toshio Imaizumi, Shigeru Inamura, Ikuhide Kohama, Kazuhisa Yoshifuji, Tatsufumi Nomura, Katsuya Komatsu

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( ELSEVIER SCIENCE BV )  23 ( 3 ) 520 - 8  2014年03月  [査読有り]  [国際誌]

　概要を見る

BACKGROUND: Cerebral microbleeds (MBs) on gradient echo T2*-weighted magnetic resonance imaging (MRI) scans are associated with the severity of cerebral microangiopathies. This study investigated the contributions of nascent deep MBs to stroke recurrence. METHODS: We prospectively analyzed nascent deep MBs in patients admitted to our hospital who were treated for index strokes between April 2004 and November 2009. The number of nascent deep MBs was counted on T2*-weighted MRI scans around 1 year after the index strokes, and compared to previous MRIs on admission. Stroke recurrence-free rate curves were generated using the Kaplan-Meier method using the log-rank test. The odds ratio for nascent deep MBs was derived using a multivariate logistic regression model that was based on recurrent strokes and other risk factors. RESULTS: We evaluated the MRIs (interval between MRIs 14.6 ± 5.9 months) of 508 patients (207 women; 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-weighted MRI scans revealed 256 nascent deep MBs in 116 of 508 patients. The incidence of deep intracerebral hemorrhage was significantly greater in patients with nascent deep MBs than those without (2.0% vs 0.4% per year, respectively; P < .0001). Multivariate analyses revealed that the rate of nascent deep MBs was significantly elevated in patients whose stroke recurrences took the form of deep intracerebral hemorrhages (odds ratio 5.41; P = .007), when adjusted for hypertension, preexisting MBs, and other risk factors. CONCLUSIONS: Our findings suggested that nascent deep MBs might be associated with stroke recurrence, in particular with deep intracerebral hemorrhage.

DOI PubMed

Antithrombotic drug uses and deep intracerebral hemorrhages in stroke patients with deep cerebral microbleeds.

Toshio Imaizumi, Shigeru Inamura, Ikuhide Kohama, Kazuhisa Yoshifuji, Tatsufumi Nomura, Katsuya Komatsu

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( 6 )  22 ( 6 ) 869 - 75  2013年08月  [査読有り]  [国際誌]

　概要を見る

BACKGROUND: It has been suggested that antiplatelet or anticoagulant drugs elevate the rate of intracerebral hemorrhage (ICH) in patients with cerebral microbleeds (MBs). To investigate the mechanism by which antiplatelet drugs or warfarin may contribute to deep ICH occurrences in patients with deep MBs, we prospectively analyzed deep ICH occurrences in 807 consecutive patients (351 females and 456 males; mean age ± standard deviation 69.8 ± 12.0 years) who were admitted to our hospital with strokes. METHODS: Occurrence-free rate curves were generated using the Kaplan-Meier method; deep ICH occurrence-free rates were compared using the log-rank test. The follow-up period was 0.5 to 71 months (mean ± standard deviation 31.6 ± 22.2 months). RESULTS: In patients with deep MBs, the rates (1.0%/year; 6 ICHs in 180 patients) of deep ICH occurrence associated with antiplatelet drugs were not significantly greater than that without the drugs (1.0%/year; 6 ICHs in 167 patients; P = .977). The incidence of deep ICHs associated with warfarin use was not significantly greater than that without warfarin use. CONCLUSIONS: Multivariate analysis revealed that the use of antiplatelet drugs or warfarin did not significantly influence the occurrence of deep ICH in patients with deep MBs. Antiplatelet drugs or warfarin did not significantly elevate the rate of deep ICHs in stroke patients with pre-existing deep MBs.

DOI PubMed

脳卒中教育としてのNIH stroke scaleの卒前医学教育とOSCE導入、卒業試験実施報告

齊藤 正樹, 山本 和利, 寳金 清博, 米増 保之, 高橋 明, 小松 克也, 三上 毅, 今井 富裕, 矢坂 正弘, 岡田 靖, 佐藤 利夫, 下濱 俊

臨床神経学 ( (一社)日本神経学会 )  50 ( 12 ) 1238 - 1238  2010年12月

Therapeutic time window of mesenchymal stem cells derived from bone marrow after cerebral ischemia.

Katsuya Komatsu, Osamu Honmou, Junpei Suzuki, Kiyohiro Houkin, Hirofumi Hamada, Jeffery D Kocsis

Brain research ( ELSEVIER SCIENCE BV )  1334   84 - 92  2010年06月  [査読有り]  [国際誌]

　概要を見る

Intravenous transplantation of mesenchymal stem cells (MSCs) prepared from bone marrow ameliorates functional deficits in rat cerebral infarction models. Although several hypotheses to account for these therapeutic effects have been suggested, angiogenesis is thought to be largely responsible. MSCs were intravenously infused into rats in the relatively later time points after permanent middle cerebral artery occlusion (MCAO) to determine if they could contribute to neovascularization and functional recovery. Although MRI analysis revealed that only rats receiving MSCs 7days after MCAO exhibited decreased ischemic lesion volume than the control group, all MSCs treated rats receiving MSCs up to 1month after MCAO had greater angiogenesis near the border of the ischemic lesions and showed greater functional recovery in the treadmill stress test than did control rats. Thus, these results suggest that the time window of MSC therapy is at least over 1 month after cerebral infarction in the rat permanent MCAO model, and systemic delivery of MSCs in the later phase after cerebral ischemia may have beneficial effect through an angiogenic mechanism.

DOI PubMed

尾骨部滑液包炎の1例

吉藤 和久, 小柳 泉, 馬場 雄大, 原口 浩一, 秋山 幸功, 山下 太郎, 小松 克也, 杉野 寿哉, 池田 英之, 宝金 清博

小児の脳神経 ( (一社)日本小児神経外科学会 )  31 ( 2 ) 150 - 150  2006年04月