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Takeyasu Y.,Osaka University | Oka K.,Osaka University | Oka K.,Bell Land General Hospital | Miyake J.,Osaka University | And 3 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: Cubitus varus deformity after a supracondylar fracture classically includes varus, extension, and internal rotation components. However, to our knowledge, no reliable surgical method for three-dimensional corrective osteotomy has been established. We developed an intraoperative guide system involving a custom-made surgical template designed on the basis of a three-dimensional computer simulation incorporating computed tomography (CT) data. We aimed to investigate the feasibility of this novel technique for correcting cubitus varus deformity. Methods: Thirty consecutive patients (twenty-three males and seven females) with a cubitus varus deformity resulting from the malunion of a distal humeral supracondylar fracture were included in this study. Between October 2003 and May 2011, the patients underwent a three-dimensional corrective osteotomy with use of a custom-made surgical template. The patients were then followed for a minimum of twelve months. We evaluated radiographic parameters, including the humerus-elbow-wrist angle and tilting angle, as well as the ranges of motion of the elbow and shoulder at the time of the most recent follow-up. An overall clinical evaluation was performed. Results: Bone union was achieved at a mean of four months after surgery. The mean humerus-elbow-wrist angle and tilting angle on the affected side improved significantly from 18.2° (varus) and 25.0°, respectively, before surgery, to 5.8° (valgus) and 38.0°, respectively, after surgery. Hyperextension of the elbow and internal rotation of the shoulder were normalized in all patients. Early plate breakage was observed in one patient. One patient had mild recurrence of varus deformity. Twenty-seven patients had an excellent result, three had a good result, and none had a poor result. Conclusions: Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Noura S.,Japan National Cardiovascular Center Research Institute | Ohue M.,Japan National Cardiovascular Center Research Institute | Shingai T.,Japan National Cardiovascular Center Research Institute | Kano S.,Japan National Cardiovascular Center Research Institute | And 6 more authors.
Annals of Surgical Oncology | Year: 2011

Background: The detection of intraperitoneal free cancer cells in colorectal cancer (CRC) patients is associated with a poorer prognosis. The aim of this study was to investigate the effects of intraperitoneal chemotherapy (IPC) with mitomycin C (MMC) on preventing peritoneal recurrence in CRC patients with positive peritoneal lavage cytology findings. Methods: A total of 52 CRC patients who had no clinically confirmed peritoneal dissemination and whose status of peritoneal lavage cytology was positive were investigated. Conventional peritoneal lavage cytology was performed. Overall, 31 of the 52 patients (59.6%) were administered IPC with MMC. Before closure of the abdomen, 4 silicon catheters were inserted into peritoneal cavity. After closure, the perfusate (diluting 20 mg MMC with 500 ml saline) was instilled from the catheter, and all catheters were clumped. All catheters were opened 1 h later. Results: The mean follow-up period was 83.1 months. According to univariate analyses of all 52 patients and the subgroup of 36 patients with stage II or III tumors, patients with IPC had a significantly better peritoneal recurrence-free survival and cancer-specific survival than patients who did not receive IPC (P < 0.005). In multivariate analysis, IPC remained an independent prognostic factor for peritoneal recurrence-free survival in all patients. Conclusions: It appears that IPC with MMC is an effective treatment to prevent peritoneal recurrence and prolong the cancer-specific survival in CRC patients without peritoneal dissemination, but who have positive peritoneal lavage cytology. It is necessary to verify the effectiveness of IPC with MMC in a prospective trial. © 2010 Society of Surgical Oncology.


Okura H.,Bell Land General Hospital | Kataoka T.,Bell Land General Hospital | Yoshiyama M.,Osaka City University | Yoshikawa J.,Nishinomiya Watanabe Cardiovascular Center | Yoshida K.,Kawasaki Medical School
Circulation Journal | Year: 2013

Background: Both left atrial spontaneous echo contrast (LASEC) and aortic atherosclerotic plaque (AoP) ≥4.0 mm in thickness are predictors of cardiovascular events after stroke. The aim of this study was to investigate impact of AoP ≥4.0 mm or LASEC on cardiovascular events in patients with atrial fibrillation (AF). Methods and Results: One hundred and eight consecutive patients with AF were enrolled and studied. Patients were grouped according to the presence or absence of AoP ≥4.0 mm in the proximal aortic arch on transesophageal echocardiography (TEE). Cardiovascular events included death, myocardial infarction, ischemic stroke, systemic embolism and congestive heart failure. During a follow-up period (median, 3.9 years), cardiovascular event-free survival rate was significantly lower in patients with AoP ≥4.0 mm than in patients without AoP ≥4.0 mm (log-rank, P=0.01). In contrast, patients with LASEC showed a trend toward lower cardiovascular event-free survival than those without LASEC (log-rank, P=0.10). Univariate TEE predictors of cardiovascular events were AoP ≥4.0 mm, LASEC and left atrial appendage flow velocity. On multivariate Cox regression analysis, AoP ≥4.0 mm was the only TEE predictor of cardiovascular events during follow-up (P=0.02, hazard ratio, 2.6; 95% confidence interval: 1.1-6.0). Conclusions: In the present unselected patients with AF, AoP predicted long-term cardiovascular events.


Fukunaga Y.,Bell land General Hospital | Higashino M.,Minamiosaka Hospital | Tanimura S.,Kariya Toyota General Hospital | Takemura M.,Osaka City General Hospital | Fujiwara Y.,Osaka City General Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: The usefulness of laparoscopic low anterior resection for middle and lower rectal cancer remains controversial. Methods: Retrospective assessment was performed on 98 patients (51 with middle and 47 with lower rectal cancer) who underwent laparoscopic rectal surgery since 1998. Total mesorectal excision was standard. Cancers were classified as middle or lower rectal based on distance from the distal tumor border to the anal verge (<8 cm or ≥8 cm). Laparoscopic rectal surgery was performed with five or six ports and carbon dioxide pneumoperitoneum. Rectal mobilization was usually done by electrocautery and vessels were sealed with a LigaSureV. Pelvic anatomy was accurately visualized by endoscopic magnification, so autonomic nerves could be preserved. The rectum was mobilized just above the levator muscles. Operative variables and the short- and long-term outcomes were investigated. Results: Five open conversions were required, including three early cases related to rectal transection problems. The other two were for a large tumor and adhesions. Mean operating time was 236 min and blood loss was 147 g. Postoperative complications were 13 cases of anastomotic leakage (13.1%), 6 wound infections (6.1%), 4 cases of anastomotic bleeding (4.0%), and 3 cases of urinary retention (3.0%). Total morbidity was 32.2%, but there were no fatal complications or operative deaths. Mean postoperative period until bowel movement, oral intake, and hospital discharge was 1.6, 1.3, and 19.7 days, respectively. Twelve patients had recurrence: local in 3, lymph node in 2, lung in 5, and liver in 2. The 5-year disease-free/overall survival rates were 82.3/95.7% in stage I, 55.1/72.0% in stage II, and 59.5/80.7% in stage III. Conclusion: Laparoscopic low anterior resection achieves acceptable short- and long-term outcomes. It is a useful option even for advanced lower rectal cancer. © 2009 Springer Science+Business Media, LLC.


Okura H.,Nara Medical University | Kataoka T.,Bell Land General Hospital | Yoshida K.,Sakakibara Heart Institute of Okayama
Heart | Year: 2016

Objectives: Secondary mitral regurgitation (MR) is negatively related to the prognosis of patients with myocardial infarction (MI). Renin-angiotensin system inhibitors (RASI) may favourably affect left ventricular remodelling and reduce afterload and thereby improve prognosis of secondary MR. The aim of this study was to investigate if use of RASI improves prognosis of patients with MI with secondary MR. Methods: A total of 953 patients with MI were enrolled in this study. Long-term prognosis was compared between patients with MI with no/mild MR (n=657), moderate MR (n=196) and severe MR (n=100). Patients with MI with significant (≥moderate) secondary MR were further divided into those treated with and without RASI. Survival and cardiac-event (all-cause death and congestive heart failure)-free survival were compared. Results: Long-term survival was significantly associated with severity of MR (log-rank, p<0.0001). In patients with significant MR (n=296), RASI was used in 130 patients (44%) and not used in 166 patients (56%). Ejection fraction (47.3±12.2 vs 46.6±13.4%, p=NS) and E/e′ (18.4±8.1 vs 16.5±7.0, p=NS) were similar between the two groups. Kaplan-Meier curves for cardiac-event-free survival demonstrated that use of RASI was associated with better survival ( p=0.006) as well as event-free survival ( p=0.02). By univariable and multivariable Cox proportional hazard analysis, age (HR 1.046, 95% CI 1.002 to 1.091, p=0.039) and RASI (HR 0.480, 95% CI 0.231 to 0.995), p=0.048) were independent predictors of cardiac events. Conclusions: Secondary MR affects prognosis in patients with MI. Use of RASI may be associated with better long-term prognosis in patients with MI with significant MR. © 2016, BMJ Publishing Group. All rights reserved.


Tsukioka T.,Bell land General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 76-year-old man with dyspnea and left side chest pain was admitted to our hospital. Chest roentgenogram showed a left side pneumothorax. Chest computed tomography( CT) showed a mass shadow in S3 and a nodular shadow in S10 of left lung. Drainage of the pleural cavity and a trans-bronchial biopsy was performed, and primary lung adenocarcinoma was diagnosed. Abdominal CT showed a left enlarged adrenal gland. Because pneumothorax was resistant to the treatment by closed drainage, a surgical treatment was performed. Since the main tumor of left upper lobe was adjacent to emphysematous bullae, simple bullectomy was not possible. Accordingly, left upper lobectomy, partial resection of left lower lobe and lymph node dissection were performed. Positron emission tomography( PET)-CT after surgery strongly suggested adrenal gland metastasis and the pathological stage was established in combination with the histopathological examination. Appropriate surgical approach must be considered even for case with the advanced lung cancer, like present case.


Tange M.,Mukogawa Women's University | Yoshida M.,Mukogawa Women's University | Nakai Y.,Bell Land General Hospital | Uchida T.,Mukogawa Women's University
Chemical and Pharmaceutical Bulletin | Year: 2012

The purpose of this study was to compare the compatibility of ROCEPHINE® Intravenous, the original manufacturer's ceftriaxone sodium preparation for injection, and seven generic versions thereof, with various calcium chloride injection 2%. The influence of calcium ion concentration, storage time and shaking strength on the appearance and quantity of insoluble microparticles in mixed solutions was examined using a light obscuration particle counter. In all products, the observed number of insoluble microparticles was proportional to the calcium ion concentration, storage time and shaking strength after the addition of calcium chloride solution. In several of the generic products, the number of insoluble microparticles was significantly higher than those of the original product, while in others it was lower. We evaluated the quality of the original and 7 generic preparations, measured the content of impurity and pH of the various ceftriaxone solutions, as impurity content and pH of solution are possible factor affecting compatibility. Three impurities were found in all products. The impurity content of several generic products, as estimated from their peak area on high performance liquid chromatography (HPLC), was significantly lower than that of the original product. pH of solution was difference between products. Although it was difficult that impurity and pH of solution verify critical factor affecting compatibility. The results show that there are differences in the appearance of insoluble microparticles between the original product and seven generic products, when calcium chloride injection 2% solution is added to the product. © 2012 The Pharmaceutical Society of Japan.


Miyake J.,Osaka University | Murase T.,Osaka University | Oka K.,Bell Land General Hospital | Moritomo H.,Osaka University | And 2 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2012

Background: Corrective osteotomy for malunited diaphyseal forearm fractures remains a challenging procedure. We developed a computer-assisted system for corrective surgery, including a three-dimensional simulation program and a custom-made osteotomy template, and investigated the results of corrective surgery for malunited diaphyseal forearm fractures with use of this technology. Methods: Twenty patients (fifteen male patients and five female patients) with malunited diaphyseal forearm fractures were managed with three-dimensional corrective osteotomy with a custom-made osteotomy template based on computer simulation. We performed osteotomy of both radius and ulna in fourteen patients and osteotomy of the radius alone in six patients. The median age at the time of surgery was eighteen years (range, eleven to forty-three years). The median duration between the time of injury and the time of surgery was thirty-three months (range, five to 384 months). The minimum duration of follow-up was twenty-four months (median, twenty-nine months; range, twenty-four to forty-eight months). To evaluate the results, we compared preoperative and postoperative data from radiographs, forearm motion, grip strength, and pain. Results: The average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with the normal arm; the radiographic deformity angle was improved to 1° (range, 0° to 4°) postoperatively. The distal radioulnar joints of both sides were symmetric on postoperative radiographs regarding the relative lengths of the radius and ulna. In eighteen patients who had a restricted range of forearm motion preoperatively, the mean arc of forearm motion improved from 76° (range, 25° to 160°) preoperatively to 152° (range, 80° to 180°) postoperatively (p < 0.01). However, forearm supination was still restricted by ≥70° in three patients who had been younger than ten years old at the time of the initial injury and who had long-standing malunion for ninety-six months or longer. Painful recurrent dislocation of the distal ulna or radial head resolved or decreased in five patients. Average grip strength improved from 82% to 94% compared with that of the contralateral, normal side. Conclusions: Computer-assisted osteotomy can provide excellent radiographic and clinical outcome for the treatment of malunited diaphyseal forearm fractures. Satisfactory restoration of forearm motion can be achieved even in relatively longstanding cases in adults. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.


Okura H.,Bell Land General Hospital
European heart journal cardiovascular Imaging | Year: 2013

Positive arterial remodelling is recognized as one of the morphological characteristics of the vulnerable plaque. Limited data are available on a long-term outcome of acute coronary syndrome (ACS) patients with culprit lesion positive arterial remodelling (PR). The aim of this study was to investigate the long-term impact of culprit lesion PR in patients with ACS. In 134 patients with ACS, intravascular ultrasound (IVUS) was performed to assess target lesion remodelling before percutaneous coronary intervention. PR was defined as the ratio of the external elastic membrane cross-sectional area at the target lesion to that of at the proximal reference of >1.05, and intermediate or negative remodelling (IR/NR) was defined as that of ≤1.05. Major adverse cardiac event (MACE) was defined as a composite of death, ACS, and target lesion revascularization. During the follow-up (median 5.8 years), MACE-free survival was significantly lower in the PR group than that in the IR/NR group (log-rank, P = 0.005). Survival and ACS-free survival were also significantly lower in the PR group than that in the IR/NR group (log-rank, both P = 0.04). By multivariable Cox regression analysis, PR (hazard ratio = 2.4, P = 0.02) and diabetes (hazard ratio = 1.9, P = 0.03) were independent predictors of MACE. Culprit lesion PR was associated with a poor long-term prognosis in patients with ACS. PR may be a marker of vulnerable patients.


Takeyasu Y.,Osaka University | Murase T.,Osaka University | Miyake J.,Osaka University | Oka K.,Bell Land General Hospital | And 4 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2011

Background: What is thought of as a classic "cubitus varus" deformity usually consists of varus, extension, and internal rotation. However, its 3-dimensional (3D) pattern with 3D imaging has not been reported. This study aimed to obtain such 3D patterns using 3D bone models created from computed tomography data and evaluate the accuracy of conventional radiographic and clinical methods of assessing the deformity. Methods: Imaging of 25 humeri of 25 patients with cubitus varus deformity caused by previous humeral supracondylar fractures was performed. The deformity was assessed by superimposing the 3D bone model onto a mirror-image model of the contralateral normal humerus. The 3D deformity pattern of cubitus varus was evaluated based on the 3 deformity components. Values obtained from conventional radiographic and physical measurements-that is, humerus-elbow-wrist angle (HEW-A), tilting angle (TA), maximal elbow flexion angle (MEF), and internal rotation angle (IRA)-were compared with those from the 3D technique. Results: Of the patients, 44% had varus, extension, and rotation deformities of 10° or greater; 20% had varus and extension deformities of 10° or greater; 16% had varus and internal rotation deformities of 10° or greater; and 20% had varus deformity only. When the 3D measurements were considered accurate, an error of 10° or greater was found in 8%, 24%, 8%, and 44% of cases in terms of HEW-A, TA, MEF, and IRA values, respectively. Conclusion: Of the humeri, 80% had other bony deformities in addition to varus and 20% had isolated varus deformities. HEW-A and MEF showed reasonable accuracy as measures for the degree of deformity, whereas TA and IRA were found to be relatively inaccurate. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

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