Fukui-shi, Japan
Fukui-shi, Japan

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No H.,Fukui Prefectural Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2016

A 15-year-old boy was referred to our emergency room due to a penetrating injury of the back. Computed tomography( CT) demonstrated a descending aortic injury at the Th9/10 level, bilateral hemothorax, and spinal cord injury. Although surgical treatment was indicated, multiple organ injury complicated open surgical repair, which required cardiopulmonary bypass with full heparinization. Therefore, the patient was scheduled to undergo thoracic endovascular aortic repair (TEVAR). A 23×33-mm Excluder aortic extension cuff was chosen for the small, 15-mm diameter aorta. The aortic extension was delivered and deployed in the descending aorta. Postoperative CT demonstrated neither endoleak nor collapse of the stent-graft. TEVAR for traumatic aortic aneurysm appears to be safe and effective, and an aortic extension for an abdominal aortic aneurysm may be utilized as an alternative device if the patient is young and the aorta is small.

Tanaka N.,Fukui Prefectural Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2016

A case was a 72-year-old female who was pointed out abnormal findings on her chest X-ray taken at the medical checkup. Chest computed tomography revealed a tumor with 3.1 cm in diameter at the right lower lobe and multiple small nodules in both lung lobes. We initially suspected lung cancer with intrapulmonary metastases. However, only tumor at the right lower lobe increased in size and the size of other small nodules was not changed. Therefore, we performed the right lower lobectomy with mediastinal nodal dissection and the partial resection of right middle lobe to establish the diagnosis. Pathological assessment revealed that the tumor at right lower lobe was adenocarcinoma with follicular bronchiolitis, and small nodules in the lower lobe were intrapulmonary lymph nodes, and the nodules in the middle lobe were lymph node infiltration with follicular bronchiolitis. The composite tumor of primary lung cancer and follicular bronchitis is very rare, and the cancer stage could be overdiagnosed.

Tamura M.,Fukui Prefectural Hospital
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2016

ABSTRACT: In this report, we describe the use of new small-diameter forceps (Endo Relief forceps) for port-reduced thoracoscopic surgery. Forceps were designed with end that were the same size and shape as conventional 5-mm forceps, except that the diameter of the shaft was decreased to 2.4 mm. Endo Relief forceps were used for thoracoscopic surgery in 18 patients. We retrospectively compared the frequency of grasping error between conventional small-diameter forceps and Endo Relief group. The mean surgical time was 57.5 minutes (range, 45–75 minutes). There were no complications, no recurrences of pneumothorax and lung cancer, and no deaths after surgery. There were no intraoperative complications and no need for a second surgery to open additional ports. The frequency of grasping error was significantly lower in the Endo Relief group compared to the conventional small-diameter forceps group (0.17 ± 0.23 vs 1.33 ± 0.22; P = 0.022). Our experience thus far indicates that this technique has cosmetic benefit and is as effective as the classic 3-port technique for experienced thoracoscopic surgeons. Endo Relief forceps has a safety comparing conventional small-diameter forceps. ©2016 by the International Society for Minimally Invasive Cardiothoracic Surgery

Hattori M.,Fukui Prefectural Hospital
[Nippon kōshū eisei zasshi] Japanese journal of public health | Year: 2010

PURPOSE: This study was conducted to clarify the efficacy of centralization of cancer treatment using population-based cancer registry data in Fukui prefecture, Japan. METHOD: Associations between hospital procedure volume and cancer survival were analyzed using the population-based cancer registry survival data for Fukui prefecture between 1994 and 1998. Firstly the cancer patients who received primary treatments for each target sites such as esophagus, stomach, colon, liver, gall bladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, and lymphoid tissue were totaled. Then, hospitals were divided into 4 categories according to the number of patients by each site; high, medium, low and very low volume. Stage-matched 5-year relative survival rates for each site were then calculated for each categorized hospital volume, and that most desirable for medical treatment for each target site was decided with reference to age-, sex-, and cancer stage-adjusted hazard ratios. Age-adjusted morality reduction was estimated by the expected survival rate after centralization when all cancer patients had received treatments. RESULTS: The 5-year relative survival rates were higher in hospitals with large numbers of patients. With some target sites, such as the stomach, colon, and breast, the mortality was similar between high and low volume hospitals, whereas the other target sites showed higher mortality in line with decrease in number of patients treated. It was estimated that a 2.06% reduction in the mortality rate might be achieved if each case were treated at the most desirable category of hospital in Fukui prefecture. CONCLUSION: Cancer treatment at hospitals have appropriate procedure volumes is an effective way to increase cancer survival and lower the mortality rate.

Sato Y.,Fukui Prefectural Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report our experience with a case of colorectal cancer treated with chemotherapy for a liver metastasis patient on hemodialysis. The patient was a 67-year-old man with a history of chronic renal failure, who was on hemodialysis since 2005. High anterior resection was performed for sigmoid colon and rectal cancer in January, 2010. After starting chemotherapy while planning to use FOLFOX6+bevacizumab(BV)as a postoperative standard chemotherapy, in combination with hemodialysis three times a week while performing dose escalation, administration postponement was continued for myelosuppression that was considered to be the effect of oxaliplatin. Oxaliplatin was administered for only 2 courses, and was then changed to BV+sLV5FU2 therapy. We continued treating the metastases approximately on schedule. Imaging revealed, the liver metastases were CR because they had disappeared. The BV use case of the dialysis case had few reports, but was thought to be able to use it by careful administration safely.

Tanizaki S.,Fukui Prefectural Hospital
Open Access Emergency Medicine | Year: 2015

Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality. © 2015 Tanizaki.

Tamura M.,Fukui Prefectural Hospital | Shimizu Y.,Fukui Prefectural Hospital | Hashizume Y.,Fukui Prefectural Hospital
Journal of Cardiothoracic Surgery | Year: 2014

We describe surgical resection of an extralobar pulmonary sequestration via single-incision thoracoscopic surgery (SITS), which we recommend as a suitable surgical option. A 45-year-old Japanese woman was admitted to our hospital for further examination of chest abnormal shadow. A rigid 5-mm 30° video-thoracoscope, an endograsper and an electric cautery were passed within the same single small incision. The tumor was suspended using articulating endograspers and resected after clipping and ligation of the anomalous vessel. The final pathology was determined an extrapulmonary sequestration. © 2014 Tamura et al.; licensee BioMed Central Ltd.

Tamura M.,Fukui Prefectural Hospital | Shimizu Y.,Fukui Prefectural Hospital | Hashizume Y.,Fukui Prefectural Hospital
Journal of Cardiothoracic Surgery | Year: 2013

Background: The current trend in thoracoscopic surgery is to use fewer ports to decrease postoperative pain, chest wall paresthesia, and duration of hospital stay. In this study we compared the results of our current experience with single-incision thoracoscopic surgery (SITS) and conventional three-port video-assisted thoracoscopic surgery (3P-VATS).Methods: From October 2011 to August 2012, 37 consecutive patients underwent thoracoscopic surgery. This is a non-randomized retrospective study. Among these patients, 19 (SITS group) were treated using single port method (SITS), whereas 18 (3P-VATS group) were treated using the conventional three-port methods (3P-VATS). The surgical duration, number of resected lesions, duration of chest drainage, duration of hospital stay, inpatient pain scores, and patient satisfaction scores were compared between both groups.Results: The mean age at surgery, indication, gender, body mass index, and the side involved were similar in both groups. The procedures performed in the SITS group were similar to those performed in the 3P-VATS group. The mean operative time was longer in the SITS group compared with the 3P-VATS group. Duration of postoperative drainage days and hospital stay was shorter in the SITS group compared with the 3P-VATS group, although these differences were not statistically significant. Pain scores on postoperative days 0,1, and 3 were significantly higher in patients who underwent 3P-VATS compared with those who underwent SITS (p = 0.012, 0.039, and 0.037, respectively). The SITS group reported higher patient satisfaction scores than the 3P-VATS group, patients in the 3P-VATS group tended to receive higher total doses of analgesics (NSAIDs) after surgery compared with those in the SITS group, although these differences were not statistically significant.Conclusions: Our experience demonstrated that SITS decreased postoperative pain and resulted in higher patient satisfaction compared with the conventional three-port VATS. However, a prospective, randomized study is needed to confirm our preliminary findings. To overcome the technological limitations of SITS, the development of new instruments is needed. © 2013 Tamura et al.; licensee BioMed Central Ltd.

Ueda Y.,Fukui Prefectural Hospital
Orthopedics | Year: 2012

Eosinophilic granuloma of the spine is a common benign disease in children and adolescents that rarely affects adults.This article describes the case of a 32-year-old woman with a solitary eosinophilic granuloma presenting as a local lytic lesion at the L4 vertebral body. She presented with a 2-month history of low back pain without neurological deficits. Plain radiographs showed a lytic lesion of the L4 vertebral body. Computed tomography scans showed an osteolytic lesion surrounded by partial sclerotic change of the L4 vertebral body. Magnetic resonance imaging revealed a low-intensity lesion on T1-weighted images and a high-intensity lesion on T2-weighted images. A computed tomography-guided transpedicular needle biopsy of the L4 vertebral body was performed. The histological specimen stained with hematoxylin-eosin revealed features of eosinophilic granuloma with aggregates of Langerhans cells. On immunological studies, the diagnosis of eosinophilic granuloma was facilitated by diffuse immunoreactivity of S-100 protein and CD1a. For the 3-month period after biopsy, the patient was fitted with a corset and allowed to walk. Four months after biopsy, computed tomography scans showed that remodeling of the destructive lesion of the L4 vertebral body was occurring. Two years after initial onset, the patient had complete relief of low back pain and no neurologic deficit. Computed tomography scans showed full reconstitution of the lesion. This was a rare case of successful conservative treatment of eosinophilic granuloma of the lumbar spine in an adult. Conservative treatment may be considered in a patient with an eosinophilic granuloma with no neurological deficit or spinal instability. Copyright 2012, SLACK Incorporated.

Hattori Y.,Fukui Prefectural Hospital
Japanese Journal of Clinical Radiology | Year: 2016

Acute abdominal pain due to adrenal ischemia as an initial symptom of myelodysplastic syndrome. Report of 3 cases. Radiologic findings of 3 cases who showed the acute adrenal lesion was the first to recognized abnormal finding of myelodysplastic syndrome were reported. CE-CT showed total or spotty absence of enhancement and swelling of uni- or bilateral adrenal gland. On follow up CT, these abnormalities were normalized. It is important that acute abdominal pain due to adrenal ischemia or infarction can be recognized as an initial symptom of myelodysplastic syndrome.

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