Yamamoto M.,Katsuta Hospital Mito Gamma House |
Serizawa T.,Tokyo Gamma Unit Center |
Shuto T.,Yokohama Rosai Hospital |
Akabane A.,Nippon Telegraph and Telephone |
And 29 more authors.
The Lancet Oncology | Year: 2014
Background: We aimed to examine whether stereotactic radiosurgery without whole-brain radiotherapy (WBRT) as the initial treatment for patients with five to ten brain metastases is non-inferior to that for patients with two to four brain metastases in terms of overall survival. Methods: This prospective observational study enrolled patients with one to ten newly diagnosed brain metastases (largest tumour <10 mL in volume and <3 cm in longest diameter; total cumulative volume ≤15 mL) and a Karnofsky performance status score of 70 or higher from 23 facilities in Japan. Standard stereotactic radiosurgery procedures were used in all patients; tumour volumes smaller than 4 mL were irradiated with 22 Gy at the lesion periphery and those that were 4-10 mL with 20 Gy. The primary endpoint was overall survival, for which the non-inferiority margin for the comparison of outcomes in patients with two to four brain metastases with those of patients with five to ten brain metastases was set as the value of the upper 95% CI for a hazard ratio (HR) of 1·30, and all data were analysed by intention to treat. The study was finalised on Dec 31, 2012, for analysis of the primary endpoint however, monitoring of stereotactic radiosurgery-induced complications and neurocognitive function assessment will continue for the censored subset until the end of 2014. This study is registered with the University Medical Information Network Clinical Trial Registry, number 000001812. Findings: We enrolled 1194 eligible patients between March 1, 2009, and Feb 15, 2012. Median overall survival after stereotactic radiosurgery was 13·9 months [95% CI 12·0-15·6] in the 455 patients with one tumour, 10·8 months [9·4-12·4] in the 531 patients with two to four tumours, and 10·8 months [9·1-12·7] in the 208 patients with five to ten tumours. Overall survival did not differ between the patients with two to four tumours and those with five to ten (HR 0·97, 95% CI 0·81-1·18 [less than non-inferiority margin], p=0·78; pnon-inferiority<0·0001). Stereotactic radiosurgery-induced adverse events occurred in 101 (8%) patients; nine (2%) patients with one tumour had one or more grade 3-4 event compared with 13 (2%) patients with two to four tumours and six (3%) patients with five to ten tumours. The proportion of patients who had one or more treatment-related adverse event of any grade did not differ significantly between the two groups of patients with multiple tumours (50 [9%] patients with two to four tumours vs 18 [9%] with five to ten; p=0·89). Four patients died, mainly of complications relating to stereotactic radiosurgery (two with one tumour and one each in the other two groups). Interpretation: Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. Funding: Japan Brain Foundation. © 2014 Elsevier Ltd.
Murakami T.,Chiba Cardiovascular Center |
Niwa K.,Chiba Cardiovascular Center |
Yoshinaga M.,National Hospital Organization Kagoshima Medical Center |
Nakazawa M.,Southern Tohoku General Hospital
International Journal of Cardiology | Year: 2012
Background: Despite the recent progress of cardiac surgery, the indications for surgical intervention during the active phase of infective endocarditis have not yet been established in patients with congenital heart diseases due to the limited number of such patients. The present study aims to determine the surgical indications for active infective endocarditis in congenital heart diseases. Methods: A retrospective observational cohort multi-center study on infective endocarditis with congenital heart diseases was conducted from January 1997 to December 2001 in Japan and 239 patients were registered. Sixty-one (26%) of the 239 patients had undergone surgical therapy for active infective endocarditis, which was defined as cardiac surgery during administration of intravenous antibiotics. Results: There were 7 deaths (11%). A univariate regression analysis revealed that the factors significantly associated with the need for surgical intervention for active IE were the lack of diagnosis of cardiac disorders before the onset of infective endocarditis, aortic valve infective endocarditis, perivalvular abscess, presence of heart failure, and change of antibiotics. A stepwise logistic regression analysis revealed that the presence of a perivalvular abscess, heart failure and a change in the antibiotics were independent determinant factors for the need for surgical treatment of active infective endocarditis in patients with congenital heart diseases. Conclusions: Surgery should therefore be considered even during the active phase in patients with congenital heart diseases and infective endocarditis, when they develop associated with heart failure, a perivalvular abscess, or the need for a change in antibiotics. © 2010 Elsevier Ireland Ltd. All rights reserved.
Sughimoto K.,Tokyo Women's Medical University |
Matsuo K.,Chiba Cardiovascular Center |
Ohba M.,Chiba Cardiovascular Center
European Journal of Cardio-thoracic Surgery | Year: 2012
Although indications for a Fontan procedure have broadened, some patients, in the past, were ineligible for the Fontan completion after a Glenn procedure and thus suffered the limitations of the Glenn procedure-namely desaturation, arrhythmia and reduced quality of life. If examined more closely, however, completion may yet be feasible for such patients. We present here a complex case of asplenia, dextrocardia and total anomalous pulmonary venous return (1b) where the Fontan procedure was successfully completed 12 years after the Glenn procedure. A unique surgical strategy incorporating intra-atrial total cavopulmonary connection and atrioventricular valve repair contributed to our success. © The Author 2012.
Nakazaki K.,Ota Memorial Hospital |
Higuchi Y.,Chiba University |
Nagano O.,Chiba Cardiovascular Center |
Serizawa T.,Chiba Cardiovascular Center |
Serizawa T.,Tokyo Gamma Unit Center
Acta Neurochirurgica | Year: 2013
Background: The efficacy and limitations of salvage gamma knife surgery (GKS) have not been thoroughly described. This study evaluated the efficacy of GKS for treating brain metastases associated with small-cell lung cancer (SCLC) after whole-brain radiotherapy (WBRT) as the first-line radiation therapy. Methods: Forty-four patients with recurrent or new SCLC-associated brain metastases underwent GKS after receiving WBRT (median age, 62 years; median duration between WBRT and first GKS, 8.8 months). The median Karnofsky performance status (KPS) score was 100 (range, 40-100), and the median number of brain metastases at the first GKS was five. Ten patients who partially or completely responded to chemotherapy received prophylactic cranial irradiation (PCI) for limited disease. Results: The median prescribed dose and number of lesions treated with the initial GKS were 20.0 Gy and 3.5, respectively, and the tumor control rate was 95.8 % (median follow-up period, 4.0 months). The 6-month new lesion-free survival, functional preservation rates, and overall survival were 50.0 %, 94.7 %, and 5.8 months, respectively. Neurological death occurred in 17.9 % of cases. The poor prognostic factors for new lesion-free survival time and functional preservation were >5 brain metastases and carcinomatous meningitis, respectively. Poor prognostic factors for survival time were KPS <70, >10 brain metastases, diameter of the largest tumor >20 mm, and carcinomatous meningitis. Median overall survival time from brain metastasis diagnosis was 16.9 months. Conclusions: GKS may be an effective option for controlling SCLC-associated brain metastases after WBRT and for preventing neurological death in patients without carcinomatous meningitis. © 2012 Springer-Verlag Wien.
Yonezu T.,Chiba University |
Ito S.,Chiba University |
Mori M.,Chiba University |
Ogawa Y.,Chiba Cardiovascular Center |
And 3 more authors.
Multiple Sclerosis Journal | Year: 2014
Background: Spinal magnetic resonance imaging (MRI) finding of longitudinally extensive spinal cord lesions (LESCL) extending over three vertebral segments and involvements of spinal central gray matter have been reported in patients with neuromyelitis optica (NMO). Objectives: We aimed to review spinal MRI findings in NMO and multiple sclerosis (MS), and to determine whether the "bright spotty lesions" (BSLs) are a discriminative finding of NMO. Methods: For this study, 24 consecutive patients with NMO and 34 patients with MS were enrolled. BSLs were defined as very hyperintense spotty lesions on axial T2WI. We also studied the length, distribution, signal homogeneity, size, and presence of contrast-enhanced lesions. Results: BSLs were more frequently found in patients with NMO (54%) than in those with MS (3%; p < 0.01). LESCL were found in 67% of the NMO patients. BSLs were seen in 63% of the patients without LESCL. BSLs or LESCL were found in 88% of the NMO patients. Inhomogeneous lesions, transversally extensive lesions, and central lesions were more frequently seen in NMO than in MS. Conclusions: BSLs are a newly defined spinal MRI finding specifically seen in NMO. In combination with LESCL, BSLs can help differentiate patients with NMO from those with MS with higher sensitivity than LESCL alone. © 2014 The Author(s).
Enomoto J.,Toyo University |
Nakazawa J.,Chiba University |
Mizuno Y.,Chiba Cardiovascular Center |
Shirai T.,St Lukes International Hospital |
And 2 more authors.
Circulation Journal | Year: 2013
Background: Although adult congenital heart disease (ACHD) patients encounter unique challenges related to social adaptation and mental health, only minimal research has been conducted on this functioning in Japanese ACHD patients. The aims of this study were to describe aspects of the psychosocial functioning of ACHD patients and to determine the psychosocial factors influencing their mental health. Methods and Results: Seventy-two ACHD patients (aged 18-39 years) and 86 control participants (aged 18-39 years) completed the 36-item Short Form Health Survey, a measure of mental health, and 4 self-report questionnaires measuring aspects of psychosocial functioning: Independent-Consciousness, Problem-solving, Locus of Control, and Self-esteem. Compared to the control group, ACHD patients had significantly lower scores for Independence, Problem-solving, and Self-esteem; whereas they had higher scores for Dependence on Parents. To examine the psychosocial factors influencing mental health, a structural equation model was used. The psychosocial factor Problem-solving was found to have the most direct influence on mental health. This factor was associated with Independence and Self-esteem. Conclusions: ACHD patients in Japan have psychosocial difficulties, and the psychosocial factors influencing patients' mental health are social problem-solving, independence, and self-esteem. The patients have poorer abilities than the control group in all of these areas and hence, they run the risk of developing poor mental health.
Murakami T.,Chiba Childrens Hospital |
Tateno S.,Chiba Cardiovascular Center |
Kawasoe Y.,Chiba Cardiovascular Center |
Niwa K.,St Lukes International Hospital
International Journal of Cardiology | Year: 2014
Background: Excessive aortic pressure wave reflection is one of the risk factors of cardiovascular diseases. In some clinical course of congenital heart diseases, the elevated pressure wave reflection has been reported. The purpose of this study is to elucidate the risk factors of the enhanced pressure wave reflection in adult patients with congenital heart disease. Methods: We enrolled 99 adult (≥ 20 years) patients with congenital heart disease. We measured their radial pressure augmentation index and examined the relationship between it and various clinical variables. Results: The radial pressure augmentation index was 77.1 ± 19.1% and it had a significant correlation with the history of aorto-pulmonary shunt (t = 4.194; p < 0.0001), age (t = 4.091; p < 0.0001), height (t = - 3.580; p = 0.001) and the history of direct aortic surgery (t = 2.253; p = 0.027). Forty-four patients (44.4%) demonstrated high radial augmentation index (> 1 SD of age- and gender matched control) and the determinants of the elevated radial augmentation index were the history of aorto-pulmonary shunt (odds ratio, 21.32; 95% confidence interval, 5.47-83.14; p < 0.0001) and the direct aortic surgery (4.18; 1.38-12.72; p = 0.012). Conclusions: The history of aortic surgeries enhances aortic pressure wave reflection in adult patients with congenital heart disease. The enhanced aortic pressure wave reflection is one of the risk factors for cardiovascular diseases. Therefore, the adult patients with congenital heart disease after aortic surgeries should be carefully observed and tightly controlled concerning the risk factors for cardiovascular diseases. © 2014 Elsevier Ireland Ltd. All rights reserved.
Matsuda S.,Chiba Cardiovascular Center
Journal of neurosurgery | Year: 2010
Gamma Knife surgery (GKS) is an effective treatment option for intractable trigeminal neuralgia (TN). The incidence of trigeminal nerve dysfunction, such as facial numbness or dysesthesia, has been reported to be higher than previously published, and the degree and prognosis of trigeminal nerve dysfunction has not been well evaluated. The authors evaluated the incidence, timing, degree, and outcome of trigeminal nerve dysfunction after GKS for TN. One hundred four patients with medically refractory TN were treated by GKS. Thirty-nine patients were men and 65 were women; their median age at GKS was 74 years. Using a single isocenter and a 4-mm collimator, 80 or 90 Gy was directed to the trigeminal nerve root. Follow-up data were obtained at clinical examinations every 3-6 months after GKS. Each patient's pain-control status and degree of trigeminal nerve dysfunction were recorded. The incidence, timing, and degree of dysfunction (assessed using the Barrow Neurological Institute facial numbness scale [BNI-N]) and the prognosis and factors related to trigeminal nerve dysfunction were analyzed. The median duration of follow-up in these patients was 37 months (range 6-121 months). At the final clinical visit, a pain-free status was still observed in 71 patients (68.3%). In 51 patients (49.0%), new or increased trigeminal nerve dysfunction developed at a median of 10.5 months (range 4-68 months) after GKS. In 24 patients (23.1%), this dysfunction was categorized as BNI-N Score II, in 20 patients (19.2%) as BNI-N Score III, and in 7 patients (6.7%) as BNI-N Score IV. Among those patients, 18 patients, including 3 patients with BNI-N Score IV, experienced improvement in nerve dysfunction between 24 and 108 months after GKS (median 52.5 months). At the final clinical visit, 43 patients (41.3%) reported having some trigeminal nerve dysfunction: in 26 patients (25.0%) this was categorized as BNI-N Score II, in 13 patients (12.5%) as BNI-N Score III, and in 4 patients (3.8%) as BNI-N Score IV. The only independent factor that was correlated to all trigeminal nerve dysfunction and also specifically to bothersome trigeminal nerve dysfunction was pain-free status at the final clinic visit. The incidence of trigeminal nerve dysfunction after GKS for TN was 49%. The severity of the dysfunction improved in one-third of the afflicted patients, even in those with severe dysesthesia at long-term follow-up. A strong relationship between TN and good pain control was identified.
Nagano O.,Chiba Cardiovascular Center
Journal of neurosurgery | Year: 2010
The authors prospectively analyzed volume changes in vestibular schwannomas (VSs) after Gamma Knife surgery (GKS). Among 104 VSs treated by GKS at the Chiba Cardiovascular Center between 1998 and 2004, 87 consecutively treated unilateral VSs observed on follow-up MR imaging for at least 5 years were analyzed. These lesions were harbored by 31 men and 56 women, with a mean age of 58.6 years (range 29-80 years). The Gd-enhanced volume of each lesion was measured serially every 3 months during the 1st year and every 6 months thereafter using Gamma Plan or SurgiPlan. The frequency and degree of volume shrinkage were documented and possible prognostic factors were analyzed. The mean tumor volume at GKS was 2.5 cm3 (range 0.1-13.2 cm3). The lesions were irradiated by directing a mean dose of 12.0 Gy (range 10.5-13.0 Gy) to the tumor margin, which was located at the mean 52.2% isodose line (range 50%-67% isodose line). The mean follow-up period was 7.5 years (range 5.0-11.1 years). Peak tumor volume expansion was most frequently observed at 8.6 months after GKS and averaged 58% (range 0%-613%). Five years after GKS, the mean reduction in tumor volume was 31%, and 9 tumors still remained larger than their initial volumes. Tumors that homogeneously enhanced on MR images displayed less shrinkage than other tumors. Most VSs exhibit shrinkage 5 years after GKS. The mean volume reduction in this series was 31%. These results indicate that careful serial follow-up is necessary for patients who harbor tumors that display homogeneous enhancement on MR images and patients whose tumors continue to expand in size after GKS. (DOI: 10.3171/2010.8.GKS10960)
Horibata Y.,Chiba Cardiovascular Center |
Murakami T.,Chiba Cardiovascular Center |
Niwa K.,St Lukes International Hospital
Cardiology in the Young | Year: 2014
Tolvaptan, an oral vasopressin receptor antagonist, was administered to a 6-year-old boy with advanced congestive cardiac failure due to restrictive cardiomyopathy. Slow up-titration of the tolvaptan improved the loop diuretic-resistant congestive cardiac failure without hypernatraemia, deterioration of vital signs, and significant complications. Tolvaptan could be useful and safe for children with severe congestive cardiac failure. It is necessary to accumulate clinical data on tolvaptan administration in children in order to determine the optimal method of administration. © 2013 Cambridge University Press.