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Akita H.,JA Aichi Anjo Kosei Hospital | Okamura T.,JA Aichi Anjo Kosei Hospital | Ando R.,JA Aichi Anjo Kosei Hospital | Nagata D.,East Medical Center Higashi Municipal Hospital City of Nagoya | And 9 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2011

Purpose: There is ongoing discussion as to the necessity for certain surgical procedures being limited to high through-put institutions. To cast light on this question regarding use of open as compared to laparoscopic radical prostatectomy (LRP) the present study was conducted focusing on biochemical (PSA) recurrence-free survival of Japanese patients with clinically localized prostate carcinomas. Materials and Methods: From April 2004 to December 2010 we identified 579 patients undergoing LRP (n=245) and retropubic radical prostatectomy (RRP) (n=334) who did not undergo immediate adjuvant therapy (radiation and/or hormonal) and whose PSA levels were lower than 25 ng/ml. Preoperative prostate specific antigen (PSA) level, clinical stage, biopsy Gleason score and pathological features were assessed and Kaplan-Meier estimates of biochemical recurrence (BCR)-free survival were compared. A Cox regression model analysis was performed to determine predictors of biochemical recurrence. Results: Median follow up was 35 months(2- 115). On univariate analysis the LRP group had a slightly lower pathological T stage (p<0.001), higher biopsy Gleason score (p<0.001), but much more organ confined disease (p=0.001) than the RRP group. BCR-free survival did not significantly differ between LRP and RRP groups with preoperative PSA <6, clinical stage T1c,T2a, pathological stage T3 or more, biopsy Gleason score of 8 or more, pathological Gleason score of 6 or less and 8 or more, extra-capsular extension and negative surgical margin. The 3-year BCR-free survival rates were 91.0%(RRP) and 82.2%(LRP) (p<0.001). Conclusion: We conclude that in general LRP may be associated with a less positive outcome than BCR for resection of low risk prostate cancers. Therefore indications for LRP should be very carefully monitored.

Yoshida T.,East Medical Center Higashi Municipal Hospital City of Nagoya | Ito S.,East Medical Center Higashi Municipal Hospital City of Nagoya
Journal of Cardiology Cases | Year: 2011

Subacute coronary occlusion due to dissection of the right coronary sinus of Valsalva after coronary stenting at the proximal portion of the right coronary artery is described. A bail-out procedure was successfully performed by stent deployment at the ostium of the right coronary artery with its proximal edge protruding into the ascending aorta. However, the patient died of multiple organ failure due to worsened renal failure and cardiogenic shock. An autopsy was performed. © 2010 Japanese College of Cardiology.

Katayama M.,Senri Chuou Hospital | Katayama M.,Kobe University | Naritomi H.,Director of Senri Chuou Hospital | Oomura M.,East Medical Center Higashi Municipal Hospital City of Nagoya | And 14 more authors.
Kobe Journal of Medical Sciences | Year: 2010

Suicide after stroke is a grievous occurrence. Since the majority of cases under study had shown signs of recovery from stroke, persons surrounding these patients were severely shocked by these suicides. Six patients who attempted suicide within six months after stroke were investigated to determine factors following stroke that relate to suicide in order to prevent future post-stroke suicides. Clinical findings in these six cases were retrospectively analyzed in collaboration with stroke neurologists and coworkers caring for these patients. Four of six patients had sustained a recent infarction extending from the temporal cortex to the parietal cortex. Four of six patients showed depression, and five of six patients showed moderate disability after stroke. Physicians should carefully observe patients with infarction extending from the temporal cortex to the parietal cortex, depression and moderate disability, in order to prevent suicidal behavior.

Naiki T.,East Medical Center Higashi Municipal Hospital City of Nagoya | Naiki T.,Nagoya City University | Okamura T.,Anjo Kosei Hospital | Nagata D.,East Medical Center Higashi Municipal Hospital City of Nagoya | And 8 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2011

Because recovery of erectile function and avoidance of positive surgical margins are important but competing outcomes with prostate cancer therapy, the decision to preserve or resect a neurovascular bundle (NVB) during laparoscopic radical prostatectomy (LRP) should be firmly based on information concerning the presence and location of extracapsular extension. In the current retrospective study, the propriety of actual decisions was assessed using preoperative magnetic resonance imaging (MRI), combining T2-weighted imaging (T2WI) with diffusion-weighted imaging (DWI), the apparent diffusion coefficient (ADC), numbers of positive biopsy cores, tumor volume and the Gleason score. MRI before prostate biopsy was performed in 35 patients who underwent LRP for clinically localized prostate cancer. A single radiologist retrospectively assessed whether the tumor localization, capsular penetration, seminal vesicle invasion, NVB involvement, and MRI findings correlated with the postoperative histological results. With the postoperative specimens, 83 lesions demonstrated a Gleason score of 6 or more. Using T2WI with and without DWI and ADC, 39 and 27 of 54 lesions were correctly identified, respectively, the difference being significant. For cancers in the transitional zone, using a threshold Gleason score of 3 or greater, sensitivity was also significantly higher for T2+DWI+ADC than for T2WI alone. Of 35 patients, using all available clinical information (biopsy results including Gleason score, tumor location, percentage of positive biopsy cores, and the percentage of tumor-involved core tissue), we found that the preoperative and postoperative staging were concordant in 25 cases. There is no universal consensus for nerve-sparing LRP; therefore, we performed an additional analysis using simplified clinically defined selection criteria (PSA level >15ng/mL, cT2, less than two positive biopsy scores in the unilateral lobe and less than 30% tumor volume, and a Gleason score of 6). Using this criteria, we selected 12 of 35 patients, and the detection rate of NVB involvement by MRI combined T2WI + DWI + ADC maps was 100% in their 30 lesions, and therefore we consider it safe to perform nerve-sparing LRP using our criteria. Our findings suggest that NVB can be safely preserved in patients with low-grade tumors using simplified clinically defined selection criteria to determine margin involvement.

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