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Ohkubo H.,Yokohama City University | Kessoku T.,Hiratsuka City Hospital | Fuyuki A.,Chigasaki Municipal Hospital | Iida H.,Yokohama City University | And 11 more authors.
American Journal of Gastroenterology | Year: 2013

OBJECTIVES:Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays i. The diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluat. The motility o. The entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluate. The usefulness of cine-MRI as a novel diagnostic method for CIPO.METHODS:Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared betwee. The groups.RESULTS:Cine-MRI provided sufficient dynamic images to asses. The motility o. The entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed i. The contraction cycle.CONCLUSIONS:This study i. The first to asses. The clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluat. The entire small bowel peristalsis, and can detec. The affected loops at a glance; therefore, it might be extremely useful fo. The diagnosis and follow-up of CIPO patients in clinical practice. Source


Yamauchi Y.,Keio University | Izumi Y.,Keio University | Yashiro H.,Hiratsuka City Hospital | Inoue M.,Keio University | And 3 more authors.
Chest | Year: 2011

Lung cancers in the residual lungs of patients who have undergone pneumonectomies are often unresectable, primarily because of the risks of overt pulmonary function losses. Percutaneous cryoablation of lung tumors is a potentially minimally invasive technique that has recently been used in the treatment of lung cancers and metastatic lung tumors. Here, we present two patients who had previously undergone pneumonectomies, in whom lung cancers in the residual lungs were treated by cryoablation. In both patients, the procedures were performed safely without any complications, such as airway bleeding, hemothoraces, or pneumothoraces. The changes in pulmonary functions after the procedures were minimal: % vital capacity (2 1% and 2 4%), and %FEV 1( - 1% and + 10%) in the first and second patients, respectively. The performance statuses were maintained at zero in both patients after cryoablation. In the first patient, local control has been maintained for 4 years. In the second patient, local control was maintained for 2 years until the patient died of distant metas tases. This is, to our knowledge, the first reported case of lung cryoablation in residual lungs of patients who have previously undergone pneumonectomiespneumonectomies. Application of percutaneous cryoablation may represent a new treatment option for lung tumors in patients who have previously undergone pneumonectomies. © 2011 American College of Chest Physicians. Source


Inoue Y.,Hiratsuka City Hospital | Takahashi R.,Saiseikai Utsunomiya Hospital | Ueda T.,Tokai University | Yozu R.,Keio University
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objectives: Preference for arterial inflow during surgery for type A acute aortic dissection remains controversial. Antegrade central perfusion prevents malperfusion and retrograde embolism, and the ascending aorta provides arterial access for rapid establishment of systemic perfusion, especially if there is hemodynamic instability. It has not been used routinely, however, because of the disruption caused to the aorta. We evaluated the safety and efficacy of routine cannulation of the dissected aorta for the repair of type A dissection. Methods: Surgical results were analyzed for 83 consecutive patients with type A acute aortic dissection between 2002 and 2009. They were treated surgically by prosthetic graft replacement under hypothermic circulatory arrest. The ascending aorta was routinely cannulated using the Seldinger technique with epiaortic echocardiographic guidance; antegrade systemic perfusion was evaluated by color Doppler ultrasound. Results: Systemic antegrade perfusion via the dissected ascending aorta was performed safely in all cases. There was no malperfusion or thromboembolism as a result of ascending aortic cannulation. Epiaortic 2-dimensional and color Doppler imaging provided real-time monitoring adequate for the placement and for proper systemic perfusion. There were 5 in-hospital deaths (5/83 = 6.0%) and 8 strokes (preoperative 6/83 = 7.2%, postoperative 2/83 = 2.4%). A total of 78 patients (78/83 = 94%) were discharged and have been followed up without major adverse cardiac events for a mean duration of 31.8 months. Conclusions: Ascending aortic cannulation is a simple and safe technique that provides a rapid and reliable route of antegrade central systemic perfusion in type A aortic dissection. Copyright © 2011 by The American Association for Thoracic Surgery. Source


Suganuma J.,Hiratsuka City Hospital | Ohkoshi T.,Red Cross
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2011

Purpose: To compare the arc of rotation of the knee joint at 90° of flexion in control knee joints and those affected by recurrent subluxation of the lateral meniscus (RSLM), in determining whether rotatory instability of the knee joint is a risk factor for RSLM. Methods: Knee joints were diagnosed with RSLM when there was a history of mechanical locking episodes and when subluxation of the lateral meniscus with the peripheral margin of the posterior segment moving anteriorly beyond the lateral femoral condyle was recognized on arthroscopy. In this study 288 knee joints in 270 subjects were evaluated. The joints were classified into a control group (252 joints), an RSLM group (24 joints), and a contralateral RSLM group (12 joints). The arcs of external and internal rotation at 90° of flexion of the knee joint induced by 7 Nm of torque under non-weight-bearing conditions were measured with a Biodex System 3 (Biodex Medical Systems, Shirley, NY). Results: There were no significant differences in mean values of external rotation among the 3 groups. The mean values of internal rotation of both the RSLM and contralateral RSLM groups were significantly larger than that of the control group, by about 15° (P < .0001). The mean value of internal rotation was slightly higher than that of external rotation in the RSLM and contralateral RSLM groups, although the mean value of internal rotation was smaller than that of external rotation by 10.1° in the control group. Conclusions: RSLM was found to be strongly related to bilateral increase in the arc of internal rotation at 90° of flexion of the knee joint, suggesting that internal rotatory instability of the flexed knee joint can be considered one of the risk factors for and diagnostic parameters of RSLM. Level of Evidence: Level III, diagnostic study of nonconsecutive patients. © 2011 Arthroscopy Association of North America. Source


Hinoi T.,Hiroshima University | Kawaguchi Y.,Tsuchiya General Hospital | Hattori M.,Hiroshima University | Okajima M.,Hiroshima City Hiroshima Citizens Hospital | And 8 more authors.
Annals of Surgical Oncology | Year: 2015

Methods: We conducted a propensity scoring matched case–control study of colon and rectal cancer patients aged ≥80 years using data from 41 hospitals between 2003 and 2007. A total of 1,526 colon cancer patients and 282 rectal cancer patients underwent surgery and were included in the analysis. The primary end point was 3-year overall survival (OS). Secondary end points included disease-free survival (DFS), cancer-specific survival (CSS), and postoperative complications.Results: LAP and OP were compared in 804 colon cancer patients (402 pairs) and 114 rectal cancer patients (57 pairs) after all covariates were balanced, and no significant differences were observed, except for tumor size in colon cancer. OS, DFS, and CSS did not differ between the groups for either colon cancer (P = 0.916, 0.968, and 0.799, respectively) or rectal cancer (P = 0.765, 0.519, and 0.950, respectively). In colon cancer cases, LAP was associated with fewer morbidities than was OP (24.9 vs. 36.3 %, P < 0.001); no such difference was observed for rectal cancer patients (47.4 vs. 40.4 %, P = 0.450).Conclusions: LAP is an acceptable alternative to OP in elderly patients with colorectal cancer.Background: The safety of laparoscopic surgery (LAP) in elderly patients with colorectal cancer has not been demonstrated. The aim of this study was to compare the outcomes of LAP and open surgery (OP) and estimate the feasibility of LAP in colorectal cancer patients aged ≥80 years. © 2014, Society of Surgical Oncology. Source

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