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Yamane M.,Sayama Hospital | Muto M.,Cardiovascular and Respiratory Center | Matsubara T.,Nagoya Heart Center | Nakamura S.,Kyoto Katsura Hospital | And 6 more authors.
EuroIntervention | Year: 2013

Aims: The retrograde approach to CTO is promising, but questions remain with regard to its wider application and the potential risks. This study evaluated the feasibility and efficacy of retrograde recanalisation of chronic total occlusion (CTO) of the coronary arteries. Methods and results: A total of 378 consecutive patients (previously failed PCI 32.0%) who enrolled in 27 institutions in Japan underwent retrograde recanalisation for CTO. We analysed the data on lesion characteristics, procedural materials, technique used, complications and clinical outcomes. Successful retrograde recanalisation was achieved in 70.4% and the overall procedural success was 83.6%. Collateral crossing was achieved via a septal route in 68.9%, epicardial in 27.2% and bypass grafts in 2.6%, respectively. The retrograde approach was completed with implementation of reverse CART in 42.5%, direct wire crossing in 23.1%, bilateral wiring in 22.7%, and CART in 11.7%. Major and minor collateral injuries and coronary perforations were noted in 1.3%, 10.3% and 2.9% of cases, respectively. Stroke occurred in 0.3%, QWMI and emergency PCI in 0.3% of patients with successful recanalisation. Conclusions: Wider application of retrograde CTO PCI achieved a high rate of success in recanalisation with an acceptable rate of complications in Japan. © Europa Digital & Publishing 2013. All rights reserved.


Nishimura M.,Hokkaido University | Makita H.,Hokkaido University | Nagai K.,Hokkaido University | Konno S.,Hokkaido University | And 9 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: Although the rate of annual decline in FEV 1 is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about intersubject variability based on clinical phenotypes. Objectives: To examine the intersubject variability in a 5-year observational cohort study, particularly focusing on emphysema severity. Methods: A total of 279 eligible patients with COPD (stages I-IV:26,45, 24, and 5%) participated. We conducted a detailed assessment of pulmonary function and computed tomography (CT) at baseline, and performed spirometry every 6 months before and after inhalation of bronchodilator. Smoking status, exacerbation, and pharmacotherapy were carefully monitored. Emphysema severity was evaluated by CT and annual measurements of carbon monoxide transfer coefficient. Measurements and Main Results: Using mixed effects model analysis, the annual decline in post-bronchodilator FEV 1 was -32 ± 24 (SD) ml/yr (n = 261). We classified the subjects of less than the 25th percentile as Rapid decliners, the 25th to 75th percentile as Slow decliners, and greater than the 75th percentile as Sustainers (-63 ± 2, -31 ± 1, and -2 ± 1 [SE] ml/yr). Emphysema severity, but not %FEV 1, showed significant differences among the three groups. Multiple logistic regression analysis demonstrated that the Rapid decliners were independently associated with emphysema severity assessed either by CT or carbon monoxide transfer coefficient. The Sustainers displayed less emphysema and higher levels of circulating eosinophils. Conclusions: Emphysema severity is independently associated with a rapid annual decline in FEV 1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice. Copyright © 2012 by the American Thoracic Society.


Natsuaki M.,Kyoto University | Kozuma K.,Teikyo University | Morimoto T.,Kinki University | Kadota K.,Kurashiki Central Hospital | And 18 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives NEXT (NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial) was designed for evaluating the noninferiority of a biolimus-eluting stent (BES) relative to an everolimus-eluting stent (EES) in terms of target lesion revascularization (TLR) at 1 year. Background Efficacy and safety data comparing biodegradable polymer BES with durable polymer cobalt-chromium EES are currently limited. Methods The NEXT trial is a prospective, multicenter, randomized, open-label, noninferiority trial comparing BES with EES. Between May and October 2011, 3,235 patients were randomly assigned to receive either BES (n = 1,617) or EES (n = 1,618). Results At 1 year, the primary efficacy endpoint of TLR occurred in 67 patients (4.2%) in the BES group, and in 66 patients (4.2%) in the EES group, demonstrating noninferiority of BES relative to EES (p for noninferiority <0.0001, and p for superiority = 0.93). Cumulative incidence of definite stent thrombosis was low and similar between the 2 groups (0.25% vs. 0.06%, p = 0.18). An angiographic substudy enrolling 528 patients (BES: n = 263, and EES: n = 265) demonstrated noninferiority of BES relative to EES regarding the primary angiographic endpoint of in-segment late loss (0.03 ± 0.39 mm vs. 0.06 ± 0.45 mm, p for noninferiority <0.0001, and p for superiority = 0.52) at 266 ± 43 days after stent implantation. Conclusions One-year clinical and angiographic outcome after BES implantation was noninferior to and not different from that after EES implantation in a mostly stable coronary artery disease population. One-year clinical outcome after both BES and EES use was excellent, with a low rate of TLR and extremely low rate of stent thrombosis. (NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial [NEXT]; NCT01303640). © 2013 by the American College of Cardiology Foundation.


Maemondo M.,Miyagi Cancer Center | Inoue A.,Tohoku University | Kobayashi K.,International University of Japan | Sugawara S.,Sendai Kousei Hospital | And 19 more authors.
New England Journal of Medicine | Year: 2010

BACKGROUND: Non-small-cell lung cancer with sensitive mutations of the epidermal growth factor receptor (EGFR) is highly responsive to EGFR tyrosine kinase inhibitors such as gefitinib, but little is known about how its efficacy and safety profile compares with that of standard chemotherapy. METHODS: We randomly assigned 230 patients with metastatic, non-small-cell lung cancer and EGFR mutations who had not previously received chemotherapy to receive gefitinib or carboplatin-paclitaxel. The primary end point was progression-free survival; secondary end points included overall survival, response rate, and toxic effects. RESULTS: In the planned interim analysis of data for the first 200 patients, progression-free survival was significantly longer in the gefitinib group than in the standard-chemotherapy group (hazard ratio for death or disease progression with gefitinib, 0.36; P<0.001), resulting in early termination of the study. The gefitinib group had a significantly longer median progression-free survival (10.8 months, vs. 5.4 months in the chemotherapy group; hazard ratio, 0.30; 95% confidence interval, 0.22 to 0.41; P<0.001), as well as a higher response rate (73.7% vs. 30.7%, P<0.001). The median overall survival was 30.5 months in the gefitinib group and 23.6 months in the chemotherapy group (P = 0.31). The most common adverse events in the gefitinib group were rash (71.1%) and elevated amino transferase levels (55.3%), and in the chemotherapy group, neutropenia (77.0%), anemia (64.6%), appetite loss (56.6%), and sensory neuropathy (54.9%). One patient receiving gefitinib died from interstitial lung disease. CONCLUSIONS: First-line gefitinib for patients with advanced non-small-cell lung cancer who were selected on the basis of EGFR mutations improved progression-free survival, with acceptable toxicity, as compared with standard chemotherapy. (UMIN-CTR number, C000000376.) Copyright © 2010 Massachusetts Medical Society.


Sudo H.,Hokkaido University | Ito M.,Hokkaido University | Kaneda K.,Hokushin Memorial Hospital | Shono Y.,Hokkaido Social Insurance Hospital | Abumi K.,Hokkaido University
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: Anterior spinal fusion with instrumentation is used for the treatment of thoracolumbar/lumbar scoliosis. The aim of this long-term, retrospective, hospital-based cohort study was to determine the outcomes of anterior dual-rod instrumentation in a consecutive series of patients with thoracolumbar/lumbar adolescent idiopathic scoliosis managed by a single surgeon at a single institution. Methods: A consecutive series of thirty-two patients with Lenke type-5C thoracolumbar/lumbar adolescent idiopathic scoliosis were included. Outcome measures included patient demographics, radiographic measurements, adjacentsegment degeneration, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores. Perioperative and postoperative complications were recorded. Results: Thirty patients were followed for a mean of 17.2 years (range, twelve to twenty-three years). The mean thoracolumbar/ lumbar Cobb angle correction rate and correction loss at the time of the latest follow-up were 79.8% and 3.4°, respectively. The average percent-predicted forced vital capacity and forced expiratory volume in one second were 91.8% and 81.8%, respectively. The average total SRS-30 score was 4.2. Mild degeneration below the fusion mass was observed in 23% of the patients. No instrumentation failure, pseudarthrosis, surgical site infection, or clinically relevant neurovascular complications were observed. Two patients required surgical revision with posterior spinal instrumentation, one because of subjacent disc wedging and the other because of progression of the thoracic curve deformity. Conclusions: Radiographic findings, pulmonary function, and clinical measures were satisfactory at the time of followup, at a minimum of twelve years. Anterior dual-rod instrumentation remains a useful surgical treatment for Lenke type-5C thoracolumbar/lumbar adolescent idiopathic scoliosis. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by the journal of bone and joint surgery, incorporated.


Sudo H.,Hokkaido University | Ito M.,Hokkaido University | Kaneda K.,Hokushin Memorial Hospital | Shono Y.,Hokkaido Social Insurance Hospital | And 2 more authors.
Spine | Year: 2013

STUDY DESIGN.: Retrospective review. OBJECTIVE.: To assess the long-term outcomes of anterior spinal fusion (ASF) for treating thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA.: Although ASF is reported to provide good coronal and sagittal correction of the main thoracic (MT) AIS curves, the long-term outcomes of ASF is unknown. METHODS.: A consecutive series of 25 patients with Lenke 1 MT AIS were included. Outcome measures comprised radiographical measurements, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores (preoperative SRS-30 scores were not documented). Postoperative surgical revisions and complications were recorded. RESULTS.: Twenty-five patients were followed-up for 12 to 18 years (average, 15.2 yr). The average MT Cobb angle correction rate and the correction loss at the final follow-up were 56.7% and 9.2 , respectively. The average preoperative instrumented level of kyphosis was 8.3 , which significantly improved to 18.6 (P = 0.0003) at the final follow-up. The average percent-predicted forced vital capacity and forced expiratory volume in 1 second were significantly decreased during long-term follow-up measurements (73% and 69%; P = 0.0004 and 0.0016, respectively). However, no patient had complaints related to pulmonary function. The average total SRS-30 score was 4.0. Implant breakage was not observed. All patients, except 1 who required revision surgery, demonstrated solid fusion. Late instrumentation-related bronchial problems were observed in 1 patient who required implant removal and bronchial tube repair, 13 years after the initial surgery. CONCLUSION.: Overall radiographical findings and patient outcome measures of ASF for Lenke 1 MT AIS were satisfactory at an average follow-up of 15 years. ASF provides significant sagittal correction of the main thoracic curve with long-term maintenance of sagittal profiles. Percent-predicted values of forced vital capacity and forced expiratory volume in 1 second were decreased in this cohort; however, no patient had complaints related to pulmonary function. Copyright © 2013 Lippincott Williams & Wilkins.


Ohe M.,Hokkaido Social Insurance Hospital | Hashino S.,Hokkaido University
Korean Journal of Hematology | Year: 2011

We report a case of follicular B-cell lymphoma (FL) treated successfully using clarithromycin (CAM). A 44-year-old man who presented with lymphadenopathy was diagnosed with FL after a histological examination of his biopsy specimens. He was administered chemotherapy with R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) following which stable disease was achieved. However, the subsequent clinical course showed partial remission of FL and stable disease with tumor regrowth, each of which was treated with chemotherapeutic regimens. Since the patient was diagnosed with leukocytopenia, he could not undergo chemotherapy for the third regrowth; hence, he was administered CAM. His lymphadenopathy regressed and the levels of soluble interleukin 2-receptor decreased. This case shows that treatment using CAM may be effective in some cases of FL. © 2011 Korean Society of Hematology.


Ohe M.,Hokkaido Social Insurance Hospital | Hashino S.,Hokkaido University
Korean Journal of Internal Medicine | Year: 2012

Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment. © 2012 The Korean Association of Internal Medicine.


Ohe M.,Hokkaido Social Insurance Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2010

A 79-year-old woman was admitted with submandibular lymphadenopathy and was diagnosed as having bacterial and fungal lymphadenitis by lymph nodal biopsy. Laboratory examination demonstrated leukopenia with 7% blasts. The bone marrow was infiltrated with about 90% blasts and surface antigen analysis of these blasts demonstrated expression of cyCD3, TdT and MPO. The diagnosis was Mixed phenotype acute leukemia, T/myeloid, NOS. The patient was treated with prednisone (10 mg/day) for fever and subsequently CAM (800 mg/day) for pneumonia. Three months later, leukemic cells had disappeared on both bone marrow aspiration and peripheral blood smear. This clinical course suggests CAM is effective for this leukemia.


Yamaguchi T.,Hokkaido Social Insurance Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2012

The purpose of this study is to clarify the effectiveness of the use of β-blocker in coronary computed tomography angiography (CCTA). In 1783 patients, heart rate was controlled by propranolol injection to patients with heart rates of 61 bpm or more. As a result, the scan heart rate (58.8±6.5 bpm) decreased significantly compared with the initial heart rate (72.7±9.4 bpm). Prospective gating method was used by 61.9% including 64.3% of the intravenous β-blocker injection group. Moreover, daily use of oral β-blocker had influence on reduction of the scan heart rate (daily use group: 60.1±6.5 bpm vs. unuse group: 58.5±6.3 bpm p<0.01). When we evaluated the image quality of CCTA by the score, the improvement of the score was obviously admitted by 65 bpm or less of the scan heart rate. The ratio of scan heart rate that was controlled by 65 bpm or less was decreased in the initial heart rate groups that were 81 bpm or more. The incidence of adverse reactions by the propranolol injection was few, and these instances only involved slight symptoms. Therefore, heart rate control with the use of β-blocker is useful for the image quality improvement of CCTA. This form of treatment can be safely enforced.

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