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PubMed | Ageo Central General Hospital, Nippon Telegraph and Telephone, Omuta City Hospital, Toho University and 5 more.
Type: Journal Article | Journal: The British journal of surgery | Year: 2017

Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy.An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of -lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection.A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (88 per cent) in the 24-h prophylaxis group and 26 (110 per cent) in the 72-h group (absolute difference -22 (90 per cent c.i. -68 to 24) per cent; P < 0001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group.Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).


Ciria R.,Iwate Medical University | Ciria R.,University of Cordoba, Spain | Cherqui D.,University Paris - Sud | Geller D.A.,University of Pittsburgh | And 3 more authors.
Annals of Surgery | Year: 2016

Objective: To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses. Summary Background Data: There are no updated pooled data since 2009 about the current status and short-term outcomes of LLR worldwide. Patients and Methods: All English language publications on LLR were screened. Descriptive worldwide data and short-term outcomes were obtained. Separate analyses were performed for minor-only and major-only resection series, and series in which minor/major resections were not differentiated. Apparent case duplications were excluded. Results: A set of 463 published manuscripts were reviewed. One hundred seventy-nine single-center series were identified that accounted for 9527 LLR cases worldwide. Minor-only, major-only, and combined major-minor series were 61, 18, and 100, respectively, including 32, 8, and 43 comparative series, respectively. Of the total 9527 LLR cases reported, 6190 (65%) were for malignancy and 3337 (35%) were for benign indications. There were 37 deaths reported (mortality rate = 0.4%). From the meta-analysis comparing case-matched LLR to OLR (N = 2900 cases), there was no increased mortality and significantly less complications, transfusions, blood loss, and hospital stay observed in LLR vs OLR. Conclusions: This is the largest review of LLR available to date with over 9000 cases published. It confirms growing safety when performed in selected patients and by trained surgeons, and suggests that LLR may offer improved patient short-term outcomes compared with OLR. Improved levels of evidence, standardized reporting of outcomes, and assuring proper training are the next challenges of laparoscopic liver surgery. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Ageo Central General Hospital, Saiseikai Tondabayashi Hospital, Daiichi Sankyo, Waseda University and 6 more.
Type: | Journal: Cardiovascular intervention and therapeutics | Year: 2017

Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that prasugrel may be associated with a higher risk of de novo and recurrent bleeding events compared with clopidogrel in Japanese patients undergoing percutaneous coronary intervention (PCI). In this review, we evaluate the risk of bleeding in Japanese patients treated with prasugrel at the doses (loading/maintenance doses: 20/3.75mg) adjusted for Japanese patients, evaluate the risk factors for bleeding in Japanese patients, and examine whether patients with a bleeding event are at increased risk of recurrent bleeding. This review covers published data and new analyses of the PRASFIT (PRASugrel compared with clopidogrel For Japanese patIenTs) trials of patients undergoing PCI for acute coronary syndrome or elective reasons. The bleeding risk with prasugrel was similar to that observed with the standard dose of clopidogrel (300/75mg), including when bleeding events were re-classified using the Bleeding Academic Research Consortium criteria. The pharmacodynamics of prasugrel was not associated with the risk of bleeding events. The main risk factors for bleeding events were female sex, low body weight, advanced age, and presence of diabetes mellitus. Use of a radial puncture site was associated with a lower risk of bleeding during PCI than a femoral puncture site. Finally, the frequency and severity of recurrent bleeding events during continued treatment were similar between prasugrel and clopidogrel. In summary, this review provides important insights into the risk and types of bleeding events in prasugrel-treated patients.Trial registration numbers: JapicCTI-101339 and JapicCTI-111550.


Hashimoto J.,Tokai University | Hashimoto J.,Keio University | Ogawa K.,Hosei University | Bai J.,Keio University | And 3 more authors.
Journal of Nuclear Cardiology | Year: 2013

Background: We contrived a scatter correction method based on an artificial neural network (ANN) and applied it to the simultaneous evaluation of myocardial perfusion and fatty acid metabolism in single-photon emission computed tomography (SPECT). Methods: The count data of three energy windows were used as inputs of the ANN. The count ratios of the estimated primary-to-total photons for 99mTc and 123I, which were used to reconstruct 99mTc and 123I images, were calculated using the ANN. In a phantom study, single- and dual-isotope imaging with 99mTc/123I and 201Tl/123I was performed by means of a cardiac phantom simulating patients with and without obesity. In a human study, five normal volunteers and ten patients with myocardial infarction underwent myocardial perfusion and fatty acid metabolism imaging with single and dual SPECT with combinations of 99mTc- methoxyisobutylisonitrile/123I-beta-methyl(p-iodophenyl) pentadecanoic acid (BMIPP) and 201Tl/123I-BMIPP as tracers. Results: Technetium-99m yielded more homogeneous images than 201Tl because of the lower degree of photon attenuation, especially in the condition of obese patients, resulting in clearer visualization of the perfusion-metabolism mismatch. Dual 99mTc/123I SPECT offered comparable images with single SPECT in assessing myocardial damage. Conclusions: The method effectively separated 99mTc and 123I primary photons and proved applicable to 99mTc/ 123I dual-isotope myocardial SPECT. © 2013 American Society of Nuclear Cardiology.


Ueno S.,Ageo Central General Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report a case of primary advanced breast cancer that was locally controlled by treatment with Mohs paste. A 57- year-old woman presented with right locally advanced breast cancer with massive exudate and oozing blood. Histopathological examination indicated an invasive ductal carcinoma. Moreover, the patient had lung, liver, and bone metastases. She received chemotherapy, following which the breast tumor was treated using Mohs paste and dissected. The bleeding and exudate stopped almost completely, and the breast tumor became flat. Therefore, it is suggested that locally advanced breast cancer could be controlled by treatment with Mohs paste.


Sangkyun K.,Ageo Central General Hospital | Kawano A.,Ageo Central General Hospital | Yamanoi T.,Ageo Central General Hospital | Tokunaga K.,Ageo Central General Hospital
Clinical Neurology | Year: 2014

A 39-year-old woman developed right hemiparesis in a few days. Magnetic resonance images revealed cerebral infarction in the territory of the left lenticulostriate artery, and MR angiography showed severe stenosis of the middle and anterior cerebral arteries and moderate one of the vertebral arteries. Bilateral and symmetric T1 hyperintensity in the pulvinar (T 1-weighted imaging-pulvinar sign; "T1 pulvinar sign") was detected, which is recognized as a key imaging of Fabry disease. The α-galactosidase A gene analysis, however, showed no mutation. Although specific physical symptoms were solely short stature and oligomenorrhea, the diagnosis of Turner syndrome was confirmed by the chromosome analysis which showed mosaicism of 45XO and 46X,r(X) (60%:40%). To our knowledge, this is the first report of Turner syndrome with "T1 pulvinar sign".


Yabe S.,Niigata University | Takano T.,Niigata University | Higuchi W.,Niigata University | Mimura S.,Ageo Central General Hospital | And 2 more authors.
Journal of Infection and Chemotherapy | Year: 2010

The USA300 clone is a highly-virulent community-acquired methicillin-resistant Staphylococcus aureus, which has been predominant in the United States. In a previous study, we isolated the USA300 clone from an 11-month-old Japanese girl, who lived in Saitama (Japan), and suffered from cellulitis and sepsis, and subsequently osteomyelitis, in 2008. In this study, we searched for the source of such USA300 infection in three related families (the patient's grandfather and grandmother, having a USA300-infected daughter [F2D], and a mother [F3M] who was a sister of F2D's mother). In January, 2008, F3M and her family members visited Hawaii and were treated in a hospital for gastroenteritis (with diarrhea) with an intravenous drip for F3M. After their return to Japan in January, F3M suffered from unusually frequent (more than 10 times) skin soft-tissue infections (SSTIs) until successful chemotherapy in July in Saitama. In the same summer season, SSTI was observed in 7 of 11 family members (63.6%). This dense spread of SSTI was followed by cellulitis and sepsis (USA300-isolated case) in October and subsequent osteomyelitis in December in F2D. After successful chemotherapy for the patient (F2D), no new SSTI cases were observed among the family members, and no USA300 colonization was observed when examined in December, 2009. The data suggest the first spread of the USA300 clone in Japan with related families at the core and that such USA300 spread in the community is likely to have occurred in the summer season in Japan. © 2010 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.


Yamasaki T.,Ageo Central General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011

In patients with previous infrarenal abdominal aortic aneurysm (AAA) repair, the risk of spinal cord ischemia increases after thoracic endovascular aortic repair (TEVAR) for a descending thoracic aortic aneurysm (DTAA). The case is a 67-year-old man with a 60 mm infrarenal AAA and a 73 mm DTAA. We performed the staged hybrid procedure for these aortic aneurysms. First of all we underwent a conventional AAA repair. The bilateral internal iliac arteries and a inferior mesenteric artery were preserved. In addition, the right leg of the tube graft was anastomosed to the right superficial femoral artery to facilitate access of TEVAR. Two months later we performed TEVAR for the DTAA. DTAA extended from the level of the 7th thoracic vertebra to that of the 11th thoracic vertebra. Although there was a certain risk of paraplegia, no complications occurred. The hybrid procedure for combined DTAA and AAA may be a valuable option.


Matsushita H.,Ageo Central General Hospital | Hanayama N.,Ageo Central General Hospital | Hobo K.,Ageo Central General Hospital | Kuba K.,Ageo Central General Hospital | Takazawa A.,Ageo Central General Hospital
Annals of Thoracic Surgery | Year: 2010

Rhodococcus equi is an unusual cause of infection. Furthermore, this infection also tends to be typically described in immunocompromised patients. This report describes a 25-year-old previously healthy man with infectious endocarditis that was found to have been caused by R equi complicated by a subarachnoid hemorrhage, subdural hematoma, and a superior mesenteric artery aneurysm. The patient was successfully treated with antibiotic therapy, followed by a resection of the superior mesenteric artery aneurysm and a repair of the mitral valve. © 2010 The Society of Thoracic Surgeons.


PubMed | Ageo Central General Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

Of the 210 patients who underwent breast-conserving surgery for breast cancer and received radiation therapy for 3 years from April 2012 to March 2015 at the Department of Therapeutic Radiology of our hospital, 6 were diagnosed with cryptogenic organizing pneumonia(COP)-like pneumonia and treated as reported. The mean age of the patients was 51years(40- 65 years), and the pathological subtypes were the luminal type(5 cases)and HER2 type(1case ), all of which were treated with radiation therapy for breast conservation. Postoperative systemic therapy included hormonal therapy with anastrozole in 2 cases, tamoxifen plus LH-RH agonist in 3 cases, and chemotherapy in 1case. The mean onset time of COP was 4.2 months after the completion of irradiation therapy, and all of the 5 patients who received endocrine therapy received it concurrently with radiation therapy. The major symptoms were fever(4 cases)and cough(6 cases). Chest radiography showed an infiltrative shadow consistent with pneumonia. Steroid therapy was effective in all cases while antibiotics were not. It was inferred that COP should be regarded as one of the complications of radiation therapy after breast-conserving surgery.

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