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Hayakawa M.,Higashiosaka City General Hospital | Oda K.,Higashiosaka City General Hospital | Uda H.,Higashiosaka City General Hospital
Japanese Journal of Chest Diseases | Year: 2016

A 61-year-old man was referred to our hospital because of an abnormal shadow on his chest radiograph. A bronchofiberscopy was performed, and the patient was diagnosed with pulmonary small cell carcinoma Therefore, left lower lobectomy and mediastinal lymph node resection were performed. The tumor was pathologically classified as pulmonary small cell carcinoma pT2aN0M0, stage I B. Solitary metastatic liver cancer was diagnosed 6 months after pulmonary resection. Hepatic left lateral segmentectomy was performed, and subsequently adjuvant chemotherapy with cisplatin and etoposide was administered. Seven years and 7 months after pulmonary resection, no sign of recurrence is evident We suggest that resection and systemic chemotherapy are possible treatments for solitary metastatic liver cancer at an early stage after pulmonary resection.


Endo S.,Higashiosaka City General Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

A 50's underwent gastrectomy for gastric cancer 4 years before. He had received chemotherapy for para-aortic lymph node metastases. A central venous catheter with a subcutaneous port was implanted via the right subclavian vein, under ultrasonographic guidance, 1 year 3 months earlier. The patient complained of swelling in his right chest during intravenous injection of ramucirumab and paclitaxel via the port. A chest radiograph revealed that a catheter fracture. A CT scan showed that the fractured catheter had lacerated the pectoralis minor muscle and the tip was in the right inferior pulmonary artery. The catheter fragment was removed using a pigtail catheter and a snare catheter via a percutaneous transfemoral approach, without any complication. The catheter was cut at 15.5 cm from the tip. This fracture was thought to be caused by a kink in the pectoralis muscle.


Tsujinaka T.,Kaizuka City Hospital | Yamamoto K.,National Hospital Organisation Osaka National Hospital | Fujita J.,Nippon Telegraph and Telephone | Endo S.,Higashiosaka City General Hospital | And 7 more authors.
The Lancet | Year: 2013

Background Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery.


Yokota H.,Higashiosaka City General Hospital | Yokoyama K.,Higashiosaka City General Hospital | Noguchi H.,Higashiosaka City General Hospital | Uchiyama Y.,Higashiosaka City General Hospital
British Journal of Neurosurgery | Year: 2012

We describe a two-stage operation, rarely reported since being introduced in 1911, for treatment of an intramedullary ependymoma extending to the upper cervical cord in a young adult. This classic two-stage strategy combined with modern techniques remains a useful option for selected patients to safely remove intramedullary ependymomas. © 2012 The Neurosurgical Foundation.


Endo S.,Higashiosaka City General Hospital | Endo S.,National Hospital Organization | Dousei T.,Higashiosaka City General Hospital | Yoshikawa Y.,National Hospital Organization | And 3 more authors.
International Journal of Clinical Oncology | Year: 2013

Background: There is controversy regarding strategies for treating very elderly patients with gastric carcinoma. We aimed to assess survival after surgery in very elderly patients according to their clinical characteristics. Methods: Gastric cancer patients aged ≥85 years were retrospectively reviewed. There were no significant differences in clinical characteristics between 58 patients with curative resection (OP group) and 32 patients with best supportive care alone (BSC group) in cancer stage IA-IIIC and with a performance status of 0-3. Results: Overall survival (OS) was significantly better in the OP group than in the BSC group in females [hazard ratio (HR) 0.27, 95 % confidence interval (CI) 0.12-0.57, P < 0.001] but not in males (HR 0.71, 95 % CI 0.35-1.49, P = 0.35). OS was significantly better in the OP group in patients aged 85-89 years (HR 0.44, 95 % CI 0.25-0.78, P = 0.006) but not in patients aged ≥90 years (HR 0.47, 95 % CI 0.12-1.66, P = 0.24). OS was significantly better in the OP group in patients with stage IB-IIIC cancer (HR 0.29, 95 % CI 0.14-0.58, P < 0.001) but not in patients with stage IA cancer (HR 0.52, 95 % CI 0.21-1.27, P = 0.15). Conclusions: Females, patients aged 85-89 years, and patients with stage IB-IIIC cancer had significantly better OS with surgery than without. For males, patients aged ≥90 years, or stage IA patients, the decision to perform surgery should be carefully made, and BSC might be an optimal strategy. © 2012 Japan Society of Clinical Oncology.


Sugimoto T.,Higashiosaka City General Hospital | Park Y.-S.,Nara Medical University | Nakagawa I.,Nara Medical University | Nishimura F.,Nara Medical University | And 2 more authors.
Journal of Neurosurgery: Pediatrics | Year: 2015

Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. The authors report a rare case of pediatric pial AVF treated by direct disconnection with the aid of indocyanine green (ICG) videoangiography. A 3-year-old girl presented with developmental problems. Magnetic resonance imaging revealed brain atrophy and an anomalous left temporal vascular mass. Angiography showed a high-flow pial AVF in the early arterial phase fed by the M1 portion of the left middle cerebral artery and draining into the superficial sylvian vein and the vein of Trolard with a large varix. Given that her fistula was located in a superficial region that was easily accessible by craniotomy, the authors successfully disconnected her pial AVF by direct surgery aided by ICG videoangiography, which clearly confirmed the shunting point. In this report, the authors discuss the existing literature and compare the relative merits of endovascular versus surgical options for the treatment of pial AVF. © AANS, 2015.


Yokota H.,Higashiosaka City General Hospital | Yokoyama K.,Higashiosaka City General Hospital | Noguchi H.,Higashiosaka City General Hospital
World Neurosurgery | Year: 2016

Background: De novo aneurysm formation has been reported as a rare complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. Case Description: The first patient with intracerebral hemorrhage had a ruptured de novo aneurysm arising from the recipient MCA at 6 years after undergoing STA-MCA bypass for hemispheric hemodynamic insufficiency. In the second case, an enlarging unruptured STA aneurysm was detected by follow-up magnetic resonance angiography at 8 years after the patient underwent STA-MCA bypass for moyamoya disease. Both patients were successfully treated by surgical clipping. Conclusions: Persistent hemodynamic stress with hypertension in an artificial T-shaped vasculature and traumatic injury during surgical manipulation are the most important causes for de novo aneurysms after STA-MCA bypass. Follow-up magnetic resonance and computed tomography angiography examinations, along with appropriate blood pressure control, are recommended for patients who have undergone STA-MCA bypass surgery. © 2016 Elsevier Inc.


Yokota H.,Higashiosaka City General Hospital | Noguchi H.,Higashiosaka City General Hospital | Yokoyama K.,Higashiosaka City General Hospital
World Neurosurgery | Year: 2016

Background Rupture of a true anterior choroidal artery (AChA) aneurysm in the cisternal segment is extremely rare, whereas cases of a distal AChA aneurysm associated with moyamoya disease are increasingly reported. Case Description A 58-year-old woman presented with a severe headache and vomiting. Computed tomography demonstrated a subarachnoid hemorrhage without intraventricular or intracerebral hemorrhaging. Cerebral angiogram findings revealed a proximal AChA aneurysm mimicking an internal carotid artery aneurysm at the origin of the AChA. Intraoperative findings demonstrated a ruptured aneurysm located on a bend of the proximal AChA in the carotid cistern. Neck clipping of the aneurysm with preservation of the AChA led to a good outcome. Conclusions A rare case of ruptured true AChA aneurysm in the cisternal segment, unrelated to moyamoya disease, is presented as a cause of subarachnoid hemorrhage. © 2016 Elsevier Inc. All rights reserved.


Sugimoto T.,Higashiosaka City General Hospital | Uranishi R.,Bell Land General Hospital | Yamada T.,National Hospital Organization Osaka Minami Medical Center
World Neurosurgery | Year: 2016

Background: Arachnoid cysts in the fourth ventricle are extremely rare, with only 13 cases having been described in the literature. Especially, only 1 case of a patient older than 70 years has been reported. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus. Here, we report the case of a 72-year-old man who presented with an arachnoid cyst in the fourth ventricle that caused gradually progressive symptoms of normal pressure hydrocephalus. Methods: A 72-year-old man complaining of persistent dizziness and gait difficulty was admitted to our hospital due to a gradual worsening of his symptoms and apparent cognitive impairment. Computed tomography scan of the head showed symmetrically dilated third, fourth, and lateral ventricles. Result: Though we performed a ventriculoperitoneal shunt operation, his trunk ataxia persisted. We finally diagnosed an arachnoid cyst in the fourth ventricle by direct ventricular infusion of enhanced material. We performed direct surgical fenestration of the cyst and achieved a good outcome. Conclusion: Arachnoid cysts of the fourth ventricle are exceedingly rare, but it is important to recognize them because they cause normal pressure hydrocephalus symptoms and cerebellar or brainstem deficit. We propose detailed neurologic and radiologic examinations of patients with normal pressure hydrocephalus symptoms to avoid unnecessary shunt. © 2016, Elsevier Inc. All rights reserved.


Fukushima M.,Higashiosaka City General Hospital | Fukushima M.,Osaka Rosai Hospital | Miyaguchi M.,Higashiosaka City General Hospital | Kitahara T.,Osaka Rosai Hospital
Acta Oto-Laryngologica | Year: 2011

Conclusions: We performed extracapsular dissection (ECD) on 31 patients with pleomorphic adenoma, including 7 deep lobe cases. ECD is minimally invasive and has limited complications compared with other conventional parotidectomy procedures. This is the first report on performance of ECD in patients with deep lobe parotid pleomorphic adenomas. Surgeons who are capsule-conscious can perform ECD with good results. Objective: Pleomorphic adenoma, the most common benign neoplasm occurring in the parotid gland, has a constant frequency of recurrence and facial paralysis in patients after surgery. ECD is one of the surgical procedures performed on patients with these tumors, but its validity is still unclear because of its similarity to enucleation. Methods: We performed ECD in patients with untreated parotid neoplasms that were clinically diagnosed as benign before surgery. Of these, resected samples from 31 patients were histologically diagnosed as pleomorphic adenoma. Results: We achieved resection in patients with pleomorphic adenoma with no permanent facial paralysis or tumor recurrence, with a median follow-up time of 61 months (range 18-125 months). © 2011 Informa Healthcare.

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