Akō, Japan
Akō, Japan

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Niitsu H.,Hiroshima University | Hinoi T.,Hiroshima University | Kawaguchi Y.,Hiroshima University | Ohdan H.,Hiroshima University | And 16 more authors.
Journal of Gastroenterology | Year: 2016

Background: It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. Methods: In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case–control study entitled “Retrospective study of laparoscopic colorectal surgery for elderly patients” that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. Results: Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P < 0.001), and less blood loss occurred with laparoscopic surgery (median open surgery, 109 g; median laparoscopic surgery, 30 g; P < 0.001). An operation duration of 180 min or more (odds ratio, 1.97; 95 % confidence interval, 1.17–3.37; P = 0.011) and selection of laparoscopic surgery (odds ratio, 0.41; 95 % confidence interval, 0.22–0.75; P = 0.003) were statistically significant in the multivariate analysis for postoperative morbidity. Moreover, laparoscopic surgery did not result in an inferior overall survival rate compared with open surgery (log-rank test P = 0.289, 0.278, 0.346, 0.199, for all-stage, stage 0–I, stage II, and stage III disease, respectively). Conclusions: Laparoscopic surgery in elderly colorectal cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival. © 2015, Springer Japan.


Nishie N.,Ako Central Hospital | Suzuka I.,Ako Central Hospital
Japanese Journal of Lung Cancer | Year: 2016

Background: Although intrapulmonary lymph nodes may masquerade as metastatic pulmonary nodules, metastasis from lung cancer is rare. Case: An 81-year-old woman presented with primary left upper lobe non small cell carcinoma associated with undiagnosed subpleural nodules in the ipsilateral upper and lower lobes. Because she wanted radical left upper lobectomy, she received thoracoscopic thoracotomy to confirm that these nodules were located in the lower lobe. A frozen section in situ analysis revealed intrapulmonary lymph nodes metastases from the primary lung cancer, and therefore further resection was not possible. To the best of our knowledge, the present case is the first report of lung cancer involving ipsilateral intrapulmonary lymph nodes within another lobe. The potential mechanisms of the rare lymphatic metastases are discussed. Conclusion: Although one of the most likely diagnoses of subpleural nodules is intrapulmonary lymph nodes, the nodes may be involved by other malignancies in the lung. General thoracic surgeons should not hesitate in diagnosing the nodules to evaluate the accurate extent of the pulmonary malignancy as their locations are easy to access. © 2016 The Japan Lung Cancer Society.


Kai S.,Hyogo College of Medicine | Wake A.,Toranomon Hospital | Okada M.,Hyogo College of Medicine | Kurata M.,Nagoya University | And 8 more authors.
Biology of Blood and Marrow Transplantation | Year: 2013

We analyzed the outcomes of 61 patients with hematologic malignancies who underwent double-unit cord blood transplantation (dCBT) after myeloablative conditioning performed as part of a prospective multicenter phase II study. The conditioning regimen for dCBT included total body irradiation, cyclophosphamide, and granulocyte colony-stimulating factor combined with cytosine arabinoside for myeloid malignancies and with total body irradiation and cyclophosphamide for lymphoid malignancies. The cumulative incidence of neutrophil engraftment after dCBT was 85% (95% confidence interval [CI], 73%-92%). All 51 of the patients who engrafted had complete chimerism derived from a single donor by day +60. Only the degree of HLA disparity in the host-versus-graft direction had an impact on unit dominance. The cumulative incidence of grade II-IV acute graft-versus-host disease was 25% (95% CI, 15%-37%), and that of chronic graft-versus-host disease was 32% (95% CI, 20%-44%). The 1-year cumulative incidence of relapse was 23% (95% CI, 13%-34%), and that of transplantation-related mortality was 28% (95% CI, 17%-39%). With a median follow-up of 41 months, event-free survival was 48% (90% CI, 37%-58%) at 1 year and 46% (90% CI, 35%-56%) at 3 years. Event-free survival at 3 years was 67% (95% CI, 46%-81%) for patients with standard risk and 29% (95% CI, 15%-45%) for those with advanced risk. This study suggests that dCBT after myeloablative conditioning is a promising alternative for adults and large children with hematologic malignancies who need stem cell transplantation but lack a suitable adult donor or an adequate single-unit cord blood graft. © 2013 American Society for Blood and Marrow Transplantation.


Saito T.,Ako Central Hospital | Nishida K.,Okayama University of Science | Hashizume K.,Okayama University of Science | Nakahara R.,Okayama University of Science | And 4 more authors.
Modern Rheumatology | Year: 2016

Objectives. To retrospectively investigate the clinical and radiographic results of partial arthrodesis for the wrists with rheumatoid arthritis (RA).Methods. Forty-one wrists with RA were treated by radiolunate (RL) or radiolunotriquetral (RLT) arthrodesis with ulnar head resection. The average follow-up period after surgery was 7.1 years. Preoperative radiographs of all wrists were classified according to Schulthess classification. We performed RL arthrodesis for all Type II (n = 26) and Type III wrists (n = 7), and RLT arthrodesis for Type III wrists (n = 8). Pre- and postoperative pain score (visual analog scale), grip strength, range of motion, and radiographic parameters were statistically compared.Results. Pain scores in all groups were significantly improved at final follow-up (P < 0.05). Grip strength increased from 5.9 to 12.4 (kg) significantly in Type II wrists (P < 0.01), from 7.2 to 9.1 in Type III wrists after RLT arthrodesis, but decreased from 6.9 to 6.0 in Type III wrists after RL arthrodesis. In all groups, the arc of pronation and supination improved significantly (P < 0.05), and all radiographic parameters improved.Conclusions. RL arthrodesis for Type II wrists showed satisfactory clinical results. RLT arthrodesis would be a reliable method in case of unstable wrist joint. © 2015 Japan College of Rheumatology.


Kitamura S.,Okayama University of Science | Misawa M.,Ako Central Hospital | Namba S.,Okayama University of Science | Tsuji K.,Okayama University of Science | And 3 more authors.
BMC Research Notes | Year: 2013

Background: Membranous nephropathy is one of the most common causes of nephrotic syndrome in adults. In contrast, acquired factor V inhibitor is a rare bleeding disorder. Case presentation. A 62-year-old Asian man with a history of cerebral hemorrhage, purpura, eosinophilia and hyper immunoglobulin E syndrome developed proteinuria. The bleeding disorder was diagnosed with acquired factor V inhibitors. A renal biopsy revealed that he suffered from membranous nephropathy with glomerular endothelial damage which is reported to be involved in another factor disorder. After the steroid administration, the coagulation test and proteinuria were improved. Conclusions: The presence of factor V inhibitors may have been involved in the development of membranous nephropathy. © 2013 KITAMURA et al.; licensee BioMed Central Ltd.


Nakashima K.,Kawasaki Medical School | Nakashima K.,Ako Central Hospital | Shimoda M.,Kawasaki Medical School | Hamamoto S.,Kawasaki Medical School | And 5 more authors.
Molecular and Cellular Endocrinology | Year: 2012

Based on the hypothesis that MIN6 cells could produce glucagon-like peptide-1 (GLP-1) to maintain cell survival, we analyzed the effects of GLP-1 receptor agonist, exendin-4 (Ex4), and antagonist, exendin-(9-39) (Ex9) on cell function and cell differentiation.MIN6 cells expressed proglucagon mRNAs and produced GLP-1, which was accelerated by Ex4 and suppressed by Ex9. Moreover, Ex4 further enhanced glucose-stimulated GLP-1 secretion, suggesting autocrine loop-contributed amplification of the GLP-1 signal. Ex4 up-regulated cell differentiation- and cell function-related CREBBP, Pdx-1, Pax6, proglucagon, and PC1/3 gene expressions. The confocal laser scanning images revealed that GLP-1 positive cells were dominant in the early stage of cells, but positive for insulin were more prominent in the mature stage of cells. Ex4 accelerated cell viability, while Ex9 and anti-GLP-1 receptor antibody enhanced cell apoptosis.MIN6 cells possess a mechanism of GLP-1 signal amplification in an autocrine fashion, by which the cells maintained insulin production and cell survival. © 2011 Elsevier Ireland Ltd.


Takahashr K.,Ako Central Hospital | Hayashi M.,Okayama Saiseikai General Hospital | Fujii T.,Okayama Saiseikai General Hospital | Kawamura K.,Kibi International University | Ozaki T.,Okayama University
Acta Medica Okayama | Year: 2012

The objective of early rehabilitation after anterior cruciate ligament (ACL) reconstruction is to increase the muscle strength of the lower extremities. Closed kinetic chain (CKC) exercise induces co-contraction of the agonist and antagonist muscles. The purpose of this study was to compare the postoperative muscle strength/mass of subjects who performed our new CKC exercise (new rehabilitation group: group N) from week 4, and subjects who received traditional rehabilitation alone (traditional rehabilitation group: group T). The subjects stood on the device and maintained balance. Then, low-frequency stimulation waves were applied to 2 points each in the anterior and posterior region of the injured thigh 3 times a week for 3 months. Measurement of muscle strength was performed 4 times (before the start, and then once a month). Muscle mass was evaluated in CT images of the extensor and flexor muscles of 10 knees (10 subjects) in each group. The injured legs of group N showed significant improvement after one month compared to group T. The cross-sectional area of the extensor muscles of the injured legs tended to a show a greater increase at 3 months in group N. This rehabilitation method makes it possible to contract fast-twitch muscles, which may be a useful for improving extensor muscle strength after ACL reconstruction. © 2012 by Okayama University Medical School.


Souri M.,Yamagata University | Biswas A.,University of Bonn | Misawa M.,Ako Central Hospital | Omura H.,Tottori Prefectural Central Hospital | Ichinose A.,Yamagata University
Haemophilia | Year: 2014

Factor XIII (FXIII) consists of the A and B subunits (FXIII-A and FXIII-B) and stabilizes fibrin clots. Defects in either the FXIII-A or FXIII-B gene lead to congenital FXIII deficiency, which manifests a life-long haemorrhagic tendency. Thus, prophylactic FXIII replacement therapy is recommended. To establish a management plan for a 30-year-old male patient with 'indefinite' FXIII deficiency (<40% of the normal FXIII), he was characterized by state-of-the-art techniques as guided by the FXIII/Fibrinogen subcommittee of ISTH/SSC. FXIII activity turned out to be virtually undetectable by three functional assays. Four immunological assays detected essentially no FXIII protein, FXIII-A antigen, and A2B2 antigen, but normal FXIII-B antigen. Accordingly, he was diagnosed as a 'severe' FXIII-A deficiency case. He had no anti-FXIII antibodies, because a 1:1 cross-mixing test (ammonia release assay) and a five-step mixing test (amine incorporation assay) between his plasma and normal plasma demonstrated deficiency patterns. Furthermore, a dosing test using plasma-derived FXIII concentrates revealed its normal recovery. DNA sequencing analysis identified two novel mutations, W187X & G273V, in the F13A gene. Genetic analyses confirmed that he was a compound heterozygote and his mother and sister were heterozygotes of either one of these mutations, indicating the hereditary nature of this disorder. Molecular modelling predicted that the G273V mutation would cause clashes with the surrounding residues in the core domain of FXIII-A, and ultimately would result in the instability of the mutant molecule. Detailed characterization of 'indefinite' FXIII deficiency made it possible to make its definite diagnosis and best management plan. © 2013 John Wiley & Sons Ltd.


The objective of early rehabilitation after anterior cruciate ligament (ACL) reconstruction is to increase the muscle strength of the lower extremities. Closed kinetic chain (CKC) exercise induces co-contraction of the agonist and antagonist muscles. The purpose of this study was to compare the postoperative muscle strength/mass of subjects who performed our new CKC exercise (new rehabilitation group:group N) from week 4, and subjects who received traditional rehabilitation alone (traditional rehabilitation group:group T). The subjects stood on the device and maintained balance. Then, low-frequency stimulation waves were applied to 2 points each in the anterior and posterior region of the injured thigh 3 times a week for 3 months. Measurement of muscle strength was performed 4 times (before the start, and then once a month). Muscle mass was evaluated in CT images of the extensor and flexor muscles of 10 knees (10 subjects) in each group. The injured legs of group N showed significant improvement after one month compared to group T. The cross-sectional area of the extensor muscles of the injured legs tended to a show a greater increase at 3 months in group N. This rehabilitation method makes it possible to contract fast-twitch muscles, which may be a useful for improving extensor muscle strength after ACL reconstruction.


PubMed | Ako Central Hospital
Type: Journal Article | Journal: Annals of vascular diseases | Year: 2014

We report the anatomical similarity of abdominal aortic aneurysms (AAAs) regarding morphology and visceral vessel relations with three-dimensional computed tomography in monozygotic twins, both of whom had the left accessory renal artery, patent inferior mesenteric artery and bilateral common iliac artery aneurysms without aortic wall calcification and mural thrombus in the same fashion. Both twins underwent AAA open repair for enlargement of it at the same age. Genetic contributions might be strongly associated with morphology and visceral vessel relations of AAAs in monozygotic twins.

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