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PubMed | Ageo Central General Hospital, Nippon Telegraph and Telephone, Omuta City Hospital, Toho University and 5 more.
Type: Journal Article | Journal: The British journal of surgery | Year: 2017

Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy.An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of -lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection.A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (88 per cent) in the 24-h prophylaxis group and 26 (110 per cent) in the 72-h group (absolute difference -22 (90 per cent c.i. -68 to 24) per cent; P < 0001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group.Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).


PubMed | Kochi Health science Center, Red Cross, Gunma Prefectural Cancer Center, Sanjo General Hospital and 7 more.
Type: | Journal: Japanese journal of clinical oncology | Year: 2017

We conducted a multicenter prospective study to clarify the efficacy and safety of surgery and imatinib for liver oligometastasis of gastrointestinal stromal tumors. Eligible gastrointestinal stromal tumor patients were enrolled in the surgery trial or the imatinib trial. Primary endpoints were recurrence-free survival and progression-free survival, respectively. The trials were prematurely terminated due to amendment of guidelines for adjuvant imatinib therapy and low patient accrual. In the surgery trial, all the six patients showed hepatic recurrence: median recurrence-free survival was 145 days (range: 62-1366 days). Of the five patients receiving salvage imatinib therapy, two showed progressive disease although no death was observed. Of the five patients enrolled in the imatinib trial, one died of pneumonia after progressive disease, and four had not shown progressive disease as of last visit. The results suggest that liver oligometastasis of gastrointestinal stromal tumor may not be controllable by surgery alone and require concomitant imatinib therapy.


Nakajima K.,Kanazawa University | Nakata T.,Sapporo Medical University | Nakata T.,Hakodate Goryoukaku Hospital | Yamada T.,Osaka Prefectural General Medical Center | And 7 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2014

Purpose: Prediction of mortality risk is important in the management of chronic heart failure (CHF). The aim of this study was to create a prediction model for 5-year cardiac death including assessment of cardiac sympathetic innervation using data from a multicenter cohort study in Japan. Methods: The original pooled database consisted of cohort studies from six sites in Japan. A total of 933 CHF patients who underwent 123I-metaiodobenzylguanidine (MIBG) imaging and whose 5-year outcomes were known were selected from this database. The late MIBG heart-to-mediastinum ratio (HMR) was used for quantification of cardiac uptake. Cox proportional hazard and logistic regression analyses were used to select appropriate variables for predicting 5-year cardiac mortality. The formula for predicting 5-year mortality was created using a logistic regression model. Results: During the 5-year follow-up, 205 patients (22 %) died of a cardiac event including heart failure death, sudden cardiac death and fatal acute myocardial infarction (64 %, 30 % and 6 %, respectively). Multivariate logistic analysis selected four parameters, including New York Heart Association (NYHA) functional class, age, gender and left ventricular ejection fraction, without HMR (model 1) and five parameters with the addition of HMR (model 2). The net reclassification improvement analysis for all subjects was 13.8 % (p<0.0001) by including HMR and its inclusion was most effective in the downward reclassification of low-risk patients. Nomograms for predicting 5-year cardiac mortality were created from the five-parameter regression model. Conclusion: Cardiac MIBG imaging had a significant additive value for predicting cardiac mortality. The prediction formula and nomograms can be used for risk stratifying in patients with CHF. © 2014 The Author(s).


Mikuni I.,Asahikawa Medical College | Hirai H.,Hakodate Goryoukaku Hospital | Toyama Y.,Asahikawa Medical College | Takahata O.,Asahikawa Medical College | Iwasaki H.,Asahikawa Medical College
Journal of Clinical Anesthesia | Year: 2010

Study Objective: To evaluate the analgesia following cesarean delivery and the frequency of side effects of intrathecal morphine when combined with a continuous epidural infusion. Design: Randomized, double-blinded study. Setting: University hospital. Patients: 76 ASA physical status I and II term parturients undergoing cesarean delivery with combined spinal-epidural anesthesia. Interventions: Patients were randomized to one of three groups to receive 0, 50, or 100 μg (Group 0, Group 50, and Group 100, respectively) intrathecal morphine in addition to 8 mg of hyperbaric bupivacaine. Each patient received a continuous epidural infusion of 0.2% ropivacaine at the rate of 6 mL/hr. Measurements: 24-hour visual analog pain scores (VAPS), number of patients who requested rescue analgesics, frequency of requests for rescue analgesics per patient, and time interval before the first request for rescue analgesics were recorded. Frequency of pruritus and postoperative nausea and vomiting (PONV) were also recorded. Main Results: Group 50 and Group 100 patients exhibited lower VAPS and longer time intervals before the first request for rescue analgesics, and they requested rescue analgesics less frequently than Group 0 patients. The frequency of pruritus was significantly higher in Group 100 than Group 0. The groups did not differ with regard to PONV. Conclusions: 50 μg and 100 μg of intrathecal morphine improve analgesia when combined with a continuous epidural infusion of 0.2% ropivacaine (6 mL/hr) after cesarean delivery. 50 μg of intrathecal morphine is associated with a low frequency of side effects such as pruritus and PONV. © 2010 Elsevier Inc. All rights reserved.


Nakata T.,Hakodate Goryoukaku Hospital | Hashimoto A.,Sapporo Medical University | Sugawara H.,Hakodate Goryoukaku Hospital
Current Heart Failure Reports | Year: 2013

The autonomic nervous system has pivotal roles in pathophysiology and prognosis in patients with heart failure. Cardiac 123I-labeled metaiodobenzylguanidine (MIBG) imaging enables noninvasive and quantitative assessment of cardiac sympathetic innervation in cardiology practice. Several investigations have demonstrated independent and incremental prognostic values of this imaging technique in combination with clinical information in patients with heart failure. Cardiac MIBG imaging may help cardiologists evaluate cardiac sympathetic nerve function and predict lethal event risk in heart failure. It can contribute not only to the identification of low-risk or high-risk probability for lethal events but also to the selection of the appropriate therapeutic strategy, such as medical and device therapy in patients at greater risk for lethal outcomes due to pump failure or sudden arrhythmic events. Thus, precise risk stratification through cardiac MIBG imaging may contribute to more effective use of medical resources and more appropriate selection of therapeutic strategy in heart failure patients. © 2013 Springer Science+Business Media New York.


Nakata T.,Hakodate Goryoukaku Hospital | Nakata T.,Sapporo Medical University
Journal of Nuclear Cardiology | Year: 2016

A high-speed, multi-slice coronary computed tomography (CT) imaging has emerged as a promising or clinically available multifunctional technique for the assessment of myocardial ischemia, viability, ischemia-induced cardiac dysfunction, and coronary atherosclerotic alterations in patients with suspected or known coronary artery disease. Despite several technical issues remain to be resolved, cardiac CT imaging will have a reality as a multifunctional modality for guiding physicians in better decision-making for favorable clinical outcomes in patients with suspected coronary artery disease, provided that this imaging technology can contribute to characterization and localization of high-risk coronary atherosclerosis in combination with the quantitative evaluation of functional myocardial ischemia. © 2016 American Society of Nuclear Cardiology


Takayanagi A.,Sapporo Medical University | Masumori N.,Sapporo Medical University | Takahashi A.,Hakodate Goryoukaku Hospital | Takagi Y.,Hakodate Goryoukaku Hospital | Tsukamoto T.,Sapporo Medical University
International Journal of Urology | Year: 2012

Objectives: To examine the incidence of and the risk factors for upper urinary tract recurrence in patients undergoing a radical cystectomy for bladder cancer, and to examine the clinical course of patients harboring upper urinary tract recurrence. Methods: This retrospective study included 362 patients who underwent radical cystectomy for bladder cancer. Patients with a history of upper urinary tract recurrence and concomitant upper urinary tract recurrence at cystectomy were excluded. Results: After a median follow up of 48months (range 0-214) after radical cystectomy, 11 patients (3.0%) developed upper urinary tract recurrence. The median time to upper urinary tract recurrence was 48.4months (range 11.6-78.6). The overall probability of upper urinary tract recurrence was 3.3% at 5years. The median overall survival period after upper urinary tract recurrence was 23.5months (range 4.3-53.9), with a better overall survival for patients who received a radical operation than for those who did not (38.6months vs 11.9months, respectively; P=0.03). At multivariable analysis, the presence of carcinoma insitu (P<0.01) and invasion of the urethra (P=0.02) were independent risk factors for upper urinary tract recurrence. The 5-year upper urinary tract recurrence was significantly higher for patients positive for either of these risk factors than for those without risk factors (12.0% vs 0.9%, respectively; P<0.001). Conclusions: This study shows that the presence of carcinoma insitu and cancer invading the urethra are risk factors for upper urinary tract recurrence. Close follow up is needed for early detection of upper urinary tract recurrence in patients at higher risk. © 2011 The Japanese Urological Association.


Nakajima K.,Kanazawa University | Nakata T.,Hakodate Goryoukaku Hospital
Journal of nuclear medicine : official publication, Society of Nuclear Medicine | Year: 2015

Cardiac neuroimaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac (123)I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of (123)I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac (123)I-MIBG parameter, the heart-to-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6-1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on (123)I-MIBG studies had a good long-term prognosis. Future investigations of cardiac (123)I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of cost-effective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.


Matsuo S.,Kanazawa University | Nakajima K.,Kanazawa University | Nakata T.,Hakodate Goryoukaku Hospital
Circulation Journal | Year: 2016

Background: Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac123I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies. Methods and Results: All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome. Conclusions: Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death. © 2016, Japanese Circulation Society. All rights reserved.


Sato S.,Hakodate Goryoukaku Hospital
Japanese Journal of Clinical Urology | Year: 2014

We investigated the need of a 24-hour creatinine clearance (24-hour Ccr) when we performed chemotherapy for urothelial carcinoma. From January 2006 to April 2009, 24 chemotherapy patients received total of 70 courses. We used a 24-hour Ccr, Cockcroft-Gault (C-G) equation and estimated GFR (eGFR) as evaluation methods of renal function. Our results demonstrated that A 24-hour Ccr was higher than C-G equation and eGFR in 70% and 90%, respectively. If both C-G equation and eGFR were more than 60 ml/min, a 24-hour Ccr was more than 60 ml/min in 95%. Therefore if both C-G equation and eGFR are more than 60 ml/min, we might omit a 24-hour Ccr.

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