Handa City Hospital

Handa, Japan

Handa City Hospital

Handa, Japan
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PubMed | Daiyukai Daiichi Hospital, Minami Seikyo Hospital, Yokkaichi Municipal Hospital, Handa City Hospital and 11 more.
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2016

Early withdrawal within 3years after starting peritoneal dialysis (PD) and PD-related peritonitis have been major obstacles preventing increases in the population of PD patients. To address these problems, we implemented education programs for medical staff. This study analyzed the recent status and outcomes of PD therapy, focusing on findings such as the incidence and prognosis of peritonitis as of 5years after our last study.We investigated background, laboratory data and status of PD therapy, reasons for withdrawal from PD and incidental statements on peritonitis from 2010 to 2012 (R2), and compared findings with those from our last study of 2005-2007 (R1).Early PD therapy withdrawal in R2 clearly improved to 44.7%, compared with 50.9% in R1. Peritonitis incidence improved slightly from once per 42.8months/patient in R1 to once per 47.3months/patient in R2. Notably, PD-related peritonitis as a cause of mortality improved markedly in R2, but outcomes of PD-related peritonitis did not change significantly between R1 and R2. In contrast, social problems increased as a reason for withdrawal from PD therapy.Our efforts at education might have been useful for improving early withdrawal from PD and deaths attributable to PD-related peritonitis. However, since improvements to incidence of PD-related peritonitis were limited by education, further improvement in PD-related peritonitis incidence requires development of new sterilized connecting systems during PD-bag exchanges to decrease PD-related peritonitis opportunities. Construction of medical support systems to address social problems is required to maintain long-term PD therapy.

PubMed | Red Cross, Toyohashi Municipal Hospital, Handa City Hospital, Ogaki Municipal Hospital and 6 more.
Type: Journal Article | Journal: Journal of cancer research and clinical oncology | Year: 2016

Predicting the feasibility of platinum-based chemotherapy remains an important issue in elderly (over 70years) patients with non-small cell lung cancer (NSCLC). The aim of this study was to identify the risk factors for the early serious adverse events (SAEs) (during cycles 1-2) in elderly receiving platinum-based chemotherapy, and to explore the clinical characteristics of patients who require early treatment termination without progressive disease (PD).One hundred and ninety-eight consecutive elderly NSCLC patients receiving platinum-based chemotherapy were retrospectively reviewed.The median age was 73years (range 70-83). 161 (81%) were males, and 190 (95%) were PS 0-1. Fifty-one (29%) and 39 (19%) patients developed early non-hematological SAEs and hematological SAEs, respectively. Multivariate analysis identified low serum albumin (<3.0g/dl) as an independent risk factor for non-hematological SAEs, while low creatinine clearance (<45ml/min) for hematological SAEs. In all, 24 (12%) patients needed early treatment termination without PD. The major reason for this event was the development of non-hematological SAEs (4.5%), followed by grade 2 non-hematological adverse events (AEs) (3%). In multivariate analysis, age over 75years and low serum albumin were associated with this event. The median overall survival (OS) in patients with this event was only 6.0months, while the development of early SAE was not associated with poor OS.Baseline serum albumin might be useful for predicting the feasibility of platinum-based chemotherapy, and the risk estimation of early treatment termination without PD might be beneficial for the treatment selection in elderly NSCLC patients.

PubMed | Nagoya Ekisaikai Hospital, Handa City Hospital, Kasugai Municipal Hospital, Nagoya University and 2 more.
Type: | Journal: The British journal of surgery | Year: 2017

Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS).Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis.In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (548 per cent). The estimated cumulative probability of recurrence was 543 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (141 per cent) and initial distant recurrence in 168 (432 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (116 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0001 and P = 0009 respectively), pancreatic invasion (both P <0001) and lymph node metastasis (both P <0001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 706 per cent for patients without any risk factors, 503 per cent for patients with one factor, 318 per cent for those with two factors, and 134 per cent when three factors were present.More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.

Uehara K.,Nagoya University | Hiramatsu K.,Toyohashi Municipal Hospital | Maeda A.,Ogaki Municipal Hospital | Sakamoto E.,Red Cross | And 9 more authors.
Japanese Journal of Clinical Oncology | Year: 2013

Objective: This Phase II trial was designed to evaluate the safety and efficacy of neoadjuvant oxaliplatin and capecitabine and bevacizumab without radiotherapy in patients with poor-risk rectal cancer. Methods: Patients with magnetic resonance imaging-defined poor-risk rectal cancer received neoadjuvant oxaliplatin and capecitabine and bevacizumab followed by total mesorectal excision or more extensive surgery. Results: Between February 2010 and December 2011, 32 patients were enrolled in this study. The completion rate of the scheduled chemotherapy was 91%. Reasons for withdrawal were refusal to continue therapy in two patients and disease progression in one, with two of these three patients not undergoing surgery. Among the 29 patients who completed the scheduled chemotherapy, one refused surgery within 8 weeks after the completion of chemotherapy, which was the period stipulated by the protocol, and another had rectal perforation, requiring urgent laparotomy. As a result, the completion rate of this experimental treatment was 84%. Of the 30 patients who underwent surgery, the R0 resection rate was 90% and a postoperative complication occurred in 43%. A pathological complete response was observed in 13% and good tumor regression was exhibited in 37%. Conclusions: Neoadjuvant oxaliplatin and capecitabine plus bevacizumab for poor-risk rectal cancer caused a high rate of anastomotic leakage and experienced a case with perforation during chemotherapy, both of which were bevacizumab-related toxicity. Although the shortterm results with the completion rate of 84.4% and the pathological complete response rate of 13.3% were satisfactory, we have to reconsider the necessity of bevacizumab in neoadjuvant chemotherapy (UMIN number, 000003507). ©The Author 2013.

Itatsu K.,Nagoya University | Yokoyama Y.,Nagoya University | Sugawara G.,Nagoya University | Kubota H.,Handa City Hospital | And 6 more authors.
British Journal of Surgery | Year: 2014

Results: A total of 4305 consecutive patients were registered. Of these, 378 were excluded because of failure to complete follow-up and 3927 patients were analysed. IH was diagnosed in 318 patients. The estimated incidence rates for IH were 5.2 per cent at 12 months and 10.3 per cent at 24 months. In multivariable analysis, wound classification III and IV (hazard ratio (HR) 2.26, 95 per cent confidence interval 1.52 to 3.35), body mass index of 25 kg/m2or higher (HR 1.76, 1.35 to 2.30), midline incision (HR 1.74, 1.28 to 2.38), incisional surgical-site infection (I-SSI) (HR 1.68, 1.24 to 2.28), preoperative chemotherapy (HR 1.61, 1.08 to 2.37), blood transfusion (HR 1.46, 1.04 to 2.05), increasing age by 10-year interval (HR 1.30, 1.16 to 1.45), female sex (HR 1.26, 1.01 to 1.59) and thickness of subcutaneous tissue for every 1-cm increase (HR 1.18, 1.03 to 1.35) were identified as independent risk factors. Compared with superficial I-SSI, deep I-SSI was more strongly associated with the development of IH.Conclusion: Although there are several risk factors for IH, reducing I-SSI is an important step in the prevention of IH. Registration number: UMIN000004723 (University Hospital Medical Information Network, http://www.umin.ac.jp/ctr/index.htm).Background: Few larger studies have estimated the incidence of incisional hernia (IH) after abdominal surgery.Methods: Patients who had abdominal surgery between November 2009 and February 2011 were included in the study. The incidence rate and risk factors for IH were monitored for at least 180 days. © 2014 BJS Society Ltd.

Tanaka A.,Handa City Hospital | Sakakibara M.,Handa City Hospital | Okumura S.,Handa City Hospital | Okada K.,Handa City Hospital | And 2 more authors.
Journal of Cardiology | Year: 2012

Background: Recent studies have reported that concomitant use of clopidogrel with proton-pump inhibitors (PPIs) might decrease antiplatelet effects and increase the risk of adverse outcomes after coronary stenting. However, little is known about the difference between clopidogrel and ticlopidine in concomitant use with PPIs, especially within the Asian population. Methods: We retrospectively analyzed 302 consecutive patients (248 males, mean age 66. ± 12 years) undergoing primary stenting for acute myocardial infarction from July 2006 to June 2010. PPIs were administered to 92% (278/302) of the patients. The patients were divided into two groups on the basis of clopidogrel (clopidogrel group, n= 187) or ticlopidine (ticlopidine group, n= 91) with PPI. Their characteristics, medications, and 30-day clinical outcomes were examined. Results: There were no significant differences in 30-day major adverse cardiac events (cardiac death, non-fatal myocardial infarction, and definite stent thrombosis), bleeding events, and stroke between the two groups. The discontinuation of clopidogrel due to side effects was significantly less frequent than that of ticlopidine (1.1% vs 7.7%, p= 0.003, respectively). Conclusion: Our findings suggest that concomitant use of clopidogrel with PPIs might be safer than ticlopidine with PPIs in patients undergoing primary stenting for acute myocardial infarction. © 2012 Japanese College of Cardiology.

Tanaka A.,Nagoya University | Sakakibara M.,Handa City Hospital | Ishii H.,Nagoya University | Hayashida R.,Nagoya University | And 4 more authors.
Journal of Vascular Surgery | Year: 2014

Objective Clinical outcomes in acute type B aortic dissection patients with partial thrombosis of the false lumen have not been clearly elucidated. The purpose of this study was to investigate long-term mortality and incidence of surgical treatment by focusing on the status of the false lumen including partial thrombosis. Methods One hundred three patients (69 males, mean age 67 ± 13 years) with acute type B aortic dissection were enrolled. Patients were divided into three groups according to the status of the false lumen on enhanced computed tomography image (complete thrombosis, n = 55; partial thrombosis, n = 25; patent, n = 23). Results Requirement of surgical (open or endovascular) treatment during initial hospitalization was significantly less frequent in patients with complete thrombosis (0% in complete thrombosis, 16% in partial thrombosis, and 26% in patent). The long-term mortality (mean follow-up term, 1143 ± 933 days) did not differ among the three groups. Long-term surgical treatment-free rate was significantly lower in patients with patent false lumen. Cox regression analysis revealed that age (P <.01) and male sex (P =.013) were significant predictive factors of long-term mortality. Conclusions In acute type B aortic dissection, the incidence of surgical treatment was higher in patients with patent false lumen during long-term follow-up, whereas status of the false lumen did not influence long-term mortality. © 2014 by the Society for Vascular Surgery.

Tanaka A.,Nagoya University | Tanaka A.,Handa City Hospital | Tanaka A.,Okazaki City Hospital | Sakakibara M.,Handa City Hospital | And 4 more authors.
Therapeutic Apheresis and Dialysis | Year: 2014

The high prevalence of significant asymptomatic coronary artery disease (CAD) has been reported in patients with end-stage renal disease (ESRD) at the initiation of dialysis. However, the approach to evaluate asymptomatic CAD for these patients has not been established. The aim of this study is to assess the applicability of our practical approach at the initiation of dialysis. We prospectively enrolled 182 consecutive ESRD patients who initiated dialysis. After echocardiography as primary screening, pharmacologic stress thallium-201 scintigraphy and/or coronary angiography (CAG) were performed to diagnose CAD. The patients were classified into two groups: those with coronary artery stenosis by CAG (CAD+ group), those without coronary artery stenosis by CAG or with negative scintigraphy examination (CAD- group). Of the eligible 93 patients without the history of CAD, 22 patients were allocated to the CAD+ group (18 of 26 patients with abnormal echocardiography and 4 of 13 patients with positive scintigraphy examination) and 71 patients to the CAD- group. Patients were followed up for an average of 520±304 days. The event-free survival rate of major adverse cardiac events was significantly lower in the CAD+ group than in the CAD- group (P<0.001). There was no cardiovascular event including major adverse cardiac events, unstable angina, coronary revascularization or stroke in the CAD- group during the first year of dialysis. Patients without CAD diagnosed by our approach had favorable clinical outcomes. Our approach may be useful for screening of occult CAD in ESRD patients at the initiation of dialysis. © 2014 International Society for Apheresis.

Tanaka A.,Handa City Hospital | Sakakibara M.,Handa City Hospital | Okada K.,Handa City Hospital | Jinno Y.,Handa City Hospital | And 2 more authors.
Internal Medicine | Year: 2013

Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft. © 2013 The Japanese Society of Internal Medicine.

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