Hokusetsu General Hospital

Ōsaka, Japan

Hokusetsu General Hospital

Ōsaka, Japan
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Hayashi T.,Hokusetsu General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2017

A 64-year-old man was found to have serum carcinoembryonic antigen(CEA) elevation while undergoing an examination for recurrent gastroenteritis. His past medical history included gastroenteritis, rheumatoid arthritis, and diabetes. Blood testing revealed an increased CEA level of 153.00 ng/ml( normal ≤ 5.00 ng/ml). Chest computed tomography scan revealed an abnormal soft tissue shadow measuring 5.7 × 1.2 × 7 cm in the anterior mediastinum. The soft tissue shadow in the anterior mediastinum was the only abnormality found by whole-body examination. The possibility of a malignant tumor could not be ruled out, and the surgery was performed. Histopathological examination of the specimen confirmed thymic hyperplasia, and immunohistochemical staining detected CEA-positive cells. Serum CEA level normalized at three months after surgery and also 2 years postoperatively.


Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Minami T.,Osaka Medical College
Journal of Clinical Anesthesia | Year: 2017

Study objective This study aimed to compare the impact of stylet application for tracheal intubation for postoperative pharyngeal pain or hoarseness in patients undergoing elective surgery. Design Randomized clinical trial. Setting Operating room. Patients Forty adult patients scheduled for elective surgery under tracheal intubation with an ASA physical status of 1–3. Interventions Tracheal intubation was performed by anesthesiologists with stylet group (Stylet group; 20 patients) or without stylet group (Control group; 20 patients). Measurements Incidence of postoperative pharyngeal pain or hoarseness was assessed. Main results The incidence of postoperative pharyngeal pain was significantly higher in the Stylet group (10/20 patients) than in the Control group (2/20 patients) (P = 0.013). The incidence of hoarseness did not significantly differ between the Stylet group (6/20 patients) and the Control group (3/20 patients) (P = 0.45). Conclusions Stylet use increases the incidence of postoperative pharyngeal pain. © 2017 Elsevier Inc.


Kitano M.,Kinki University | Yamashita Y.,Red Cross | Tanaka K.,Red Cross | Konishi H.,Kyoto Prefectural University of Medicine | And 18 more authors.
American Journal of Gastroenterology | Year: 2013

OBJECTIVES:The requirements of biliary stents used in the palliation of malignant biliary obstruction are a long duration of patency and minimal adverse effects. Covered self-expandable metal stents (SEMSs) have been shown to prevent tumor ingrowth, which is the most frequent complication of uncovered SEMSs. However, because they are prone to migration, the superiority of covered SEMS has yet to be convincingly demonstrated. The aim of this study was to evaluate the superiority of covered over uncovered SEMSs in the palliation of distal biliary obstruction due to unresectable pancreatic carcinoma, using both stent types with relatively low axial force and uncovered flared ends to prevent their migration.METHODS:From April 2009 to December 2010, 120 patients who were admitted to 22 tertiary-care centers because of distal biliary obstruction from unresectable pancreatic carcinomas were enrolled in this prospective randomized multicenter study. Patients were randomly assigned to receive a covered or uncovered SEMS deployed at the site of the biliary stricture during endoscopic retrograde cholangiopancreatography. Stent patency time, patient survival time, patient survival time without stent dysfunction (time to stent dysfunction or patient death), cause of stent dysfunction (ingrowth, overgrowth, migration, or sludge formation), and serious adverse events were compared between covered and uncovered SEMS groups.RESULTS:Patient survival time in the two groups did not significantly differ (median: 285 and 223 days, respectively; P=0.68). Patient survival time without stent dysfunction was significantly longer in the covered than in the uncovered SEMS group (median: 187 vs. 132 days; P=0.043). Stent patency was also significantly longer in the covered than in the uncovered SEMS group (mean±s.d.: 219.3±159.1 vs. 166.9±124.9 days; P=0.047). Reintervention for stent dysfunction was performed in 14 of 60 patients with covered SEMSs (23%) and in 22 of 60 patients with uncovered SEMSs (37%; P=0.08). Stent dysfunction was caused by tumor ingrowth, tumor overgrowth, and sludge formation in 0 (0%), 3 (5%), and 11 (18%) patients in the covered SEMSs group, and in 15 (25%), 2 (3%), and 6 (10%) patients in the uncovered SEMSs group, respectively. Stent migration was not observed in either group. Rates of tumor overgrowth and sludge formation did not significantly differ between the two groups, whereas the rate of tumor ingrowth was significantly lower in the covered than in the uncovered SEMS group (P<0.01). Acute pancreatitis occurred in only one patient in the covered SEMS group. Acute cholecystitis occurred in one patient in the covered SEMS group and in two patients in the uncovered SEMS group. There was no significant difference between the two groups in the incidence of serious adverse events.CONCLUSIONS:By preventing tumor ingrowth and migration, covered SEMSs with an anti-migration system had a longer duration of patency than uncovered SEMSs, which recommends their use in the palliative treatment of patients with biliary obstruction due to pancreatic carcinomas.


Hayashi T.,Hokusetsu General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011

The patient was a 36-year-old woman. She had previously undergone surgery for hysteromyoma and endometriosis. At 8 week of pregnancy, the fetus's heart stopped beating, and the woman underwent abortion. On the same day, she began experiencing difficulty in breathing in the evening. After 4 days, she was referred to our hospital with dyspnea. Chest X-ray finding showed a right pneumothorax. Tube toracotomy was performed, and the right lung re-expanded immediately. Two months later, pneumothorax recurred without any association with the menstruation cycle. Thoracoscopic surgery was performed. No lesion was detected in the lung or visceral pleura, but a small hole and some thinned areas were noted in the diaphragm. Partial resection of the diaphragm was performed. Microscopic examination revealed endometriosis and localized lymphocyte infiltration in the resected diaphragm. It was suggested that the recurrence of pneumothorax without menstruation was caused by the thinning of the diaphragm due to endometriosis.


Saito N.,Hokusetsu General Hospital | Okuda K.,Hokusetsu General Hospital | Yuguchi H.,Hokusetsu General Hospital | Yamashita Y.,Osaka Medical College | And 2 more authors.
Journal of Minimally Invasive Gynecology | Year: 2014

Study Objective: To evaluate how endometriotic cystectomy and vaporization affect ovarian reserve after conservative surgery. Design: Prospective study (Canadian Task Force classification II-1). Setting: Hokusetsu General Hospital. Patients: Ninety-nine women who underwent conservative surgery to treat endometriotic cysts from June 2011 to July2013. Interventions: Vaporization with bipolar current was performed in nulligravid women, and cystectomy in those who had a child. In women with endometriotic cysts, bilateral cystectomy was performed in 28, bilateral vaporization in 15, unilateral cystectomy in 40, and unilateral vaporization in 16. In all patients, preoperative and postoperative serum anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH) concentrations at the early proliferative phase were assayed, and the change in concentrations was evaluated for each operation. Measurement and Main Results: In the bilateral cystectomy group, the mean (SD) postoperative FSH concentration (19.3 [21.8] IU/mL) was statistically higher than the preoperative concentration (9.0 [6.2] IU/mL) (p < .01). AMH significantly declined after all operations to treat endometriotic cysts, and the rate of decline in the AMH concentration was >50% compared with preoperative concentrations. Conclusion: Whether endometriotic cysts are unilateral or bilateral, both cystectomy and vaporization using bipolar current can lower ovarian reserve. Therefore, it is necessary to develop more effective surgical procedures to prevent ovarian damage. © 2014 AAGL.


Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Tatsumi S.,Osaka Medical College | Minami T.,Osaka Medical College
BMJ Open | Year: 2015

Objective: This study aimed to test the hypothesis that the i-gel supraglottic airway device would fit the larynx and provide better sealing pressure if prewarmed to 42°C relative to the device kept at room temperature in non-paralysed, sedated patients. Methods: A total of 74 adult patients were assigned to the warm (i-gel prewarmed to 42°C; W group; 37 patients) or the control (i-gel kept at room temperature; C group; 37 patients) groups. Anaesthesia was induced with propofol and fentanyl. The i-gel was prewarmed to 42°C for 30 min before insertion in the W group, but kept at room temperature (approximately 23°C) for the C group. The number of attempts made until successful insertion and sealing pressure were compared between the two groups. Results: Insertion was successful with one attempt in 35 cases each for the W and C groups. Two attempts were needed in two cases for the W group and one case for the C group. There was one failed attempt in the C group, but none in the W group. None of the differences between the two groups were significant (p=0.51). Sealing pressure was slightly, but not significantly, higher in the W group than in the C group (W group 22.6±6.1 cm H2O; C group 20.7 ±6.1 cm H2O; p=0.15). Conclusions: Prewarming of the i-gel to 42°C did not increase the success rate of insertion, nor did it significantly increase sealing pressure in anaesthetised, non-paralysed patients. Our data suggest that we can keep the i-gel at room temperature for emergency airway management for non-paralysed, sedated patients. Trial registration number: University Medical Information Network, Japan 000012287. © 2015, BMJ Publishing Group. All rights reserved.


Fujiwara A.,Osaka Medical College | Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Miyazaki S.,Osaka Medical College | And 3 more authors.
Journal of Anesthesia | Year: 2015

Background: Anesthesiologists often encounter LMA-ProSeal® (ProSeal) insertion difficulty due to its large cuff size. We performed a randomized clinical trial to examine how insertion efficacy and sealing pressure of ProSeal are affected by muscle relaxant administration in anesthetized patients. Methods: Our adult patients were either administered rocuronium (0.9 mg kg−1) as a muscle relaxant (R group; 40 patients) or not (C group; 40 patients). Anesthesia was induced with propofol and fentanyl. We compared the two groups with regard to the number of attempts required for successful insertion, sealing pressure, and subjective difficulty for insertion. Results: Total insertion attempts required for successful ventilation in the two groups were one (R group, 38 patients; C group, 28 patients), two (R group, one patient; C group, seven patients), and three (R group, one patient; C group, five patients), revealing a significant difference between groups (p < 0.001). Sealing pressure was significantly higher in the R group than in the C group (R group, 27.4 ± 5.4 cmH2O; C group, 21.2 ± 5.2 cmH2O; p < 0.001). Leakage volume by mechanical ventilation was significantly smaller in the R group than in the C group (R group, 17.4 ± 29.1 ml; C group, 46.8 ± 45.5 ml; p < 0.001). Subjective difficulty of insertion was significantly lower in the R group than in the C group (R group, 12.3 ± 23.1 mm; C group, 39.4 ± 31.9 mm; p < 0.001). Conclusions: Muscle relaxation appears to facilitate ProSeal insertion efficacy by enabling higher successful insertion rates, higher sealing pressure, lower leakage volume, and lower subjective difficulty of insertion in anesthetized patients. © 2015, Japanese Society of Anesthesiologists.


Komasawa N.,Osaka Medical College | Nishihara I.,Hokusetsu General Hospital | Tatsumi S.,Osaka Medical College | Minami T.,Osaka Medical College
Journal of Clinical Anesthesia | Year: 2014

Study Objective: To determine if prewarming of the i-gel (Intersurgical, Wokingham, United Kingdom) improves insertion and ventilation efficacy with muscle relaxation in patients undergoing elective surgery. Design: Clinical randomized study. Setting: Operating room. Patients: Sixty-eight adult patients scheduled for elective surgery under general anesthesia with American Society of Anesthesiologists physical status 1-3. Interventions: The i-gel was warmed to 42°C for 30 minutes before insertion (W group; 34 patients) or kept at room temperature (approximately 23°C) (C group; 34 patients). Measurements: The number of attempts for a successful insertion and the sealing pressure and leak volume 30 seconds and 30 minutes after initiating mechanical ventilation. Main Results: The total insertion attempts were 1 (W group, 31 cases; C group, 24 cases) and 2 (W group, 3 cases; C group, 10 cases), which was significant (P = .001). Sealing pressure was significantly higher in the W group than the C group (W group, 21.8 ± 3.7 cm H2O; C group, 18.5 ± 3.4 cm H2O; P = .001). Leak volume was significantly smaller after 30 seconds in the W group than the C group (P = .002), but not after 30 minutes (P = .69). Conclusions: Prewarming the i-gel to 42°C demonstrated a higher successful ventilation initiation. © 2014 Elsevier Inc. All rights reserved.


PubMed | Osaka Medical College and Hokusetsu General Hospital
Type: Journal Article | Journal: Journal of cardiology | Year: 2016

Endothelial dysfunction has previously been reported in children with a history of Kawasaki disease, but the determinants of endothelial function in Kawasaki disease patients are still unknown. In this study, we investigated endothelial function in Kawasaki disease patients and attempted to identify risk factors for persistent endothelial dysfunction.Using high-resolution ultrasound, we measured the percent flow-mediated dilatation, an arterial response to reactive hyperemia, to evaluate endothelial function in 67 patients with a history of Kawasaki disease and 28 age- and sex-matched control subjects. We divided the Kawasaki disease patients into a group with impaired endothelial function (the percent flow-mediated dilatation below -2 standard deviations of the control group) and a group with normal endothelial function (the percent flow-mediated dilatation more than -2 standard deviations of control). Logistic multiple regression analysis was performed to identify independent predictors of impaired endothelial function.In Kawasaki disease patients, the percent flow-mediated dilatation was significantly lower than in the control subjects (9.83.6%, compared with 13.13.4%, p<0.01). In 13 Kawasaki disease patients (3 patients with coronary artery lesions and 10 patients without coronary artery lesions), the percent flow-mediated dilatation was below -2 standard deviations of control. Logistic multiple regression analysis showed that a febrile period of longer than 10 days during the acute phase was the significant risk factor for endothelial dysfunction (odds ratio: 8.562; 95% confidence interval: 1.366-53.68). Presence of coronary artery lesions was not a determinant of endothelial dysfunction.Systemic endothelial dysfunction exists in children with a history of Kawasaki disease, and a febrile period of longer than 10 days during the acute phase is an independent predictor of endothelial dysfunction irrespective of coronary artery involvement.


We established a new colorectal T1 invasion depth sub-classification and evaluated it to determine whether total excisional biopsy can be performed on colorectal carcinoma (CRC) cases using narrow-band imaging (NBI) magnification.The cases included 73 T1 carcinomas selected from 173 early CRC cases. The T1 invasion depth sub-classification was defined as follows: T1a, invasion less than 1,000 m from the inferior border of the muscularis mucosae; T1b-1, between T1a and T1b-2; and T1b-2, T1b lesions with invasion from the deepest part of the carcinoma to within 1,000 m of the superior border of the muscularis propria. The T1b-2 lesions were not suitable for total excisional biopsy to be performed on them. We examined the maximum diameter of Type C2 (NBI Hiroshima classification) areas and invasion depth.Among 47 lesions classified as Type C2, 38 lesions showed a maximum diameter of 10 mm or less and were classified as Tis, T1a, or T1b-1. The remaining 9 lesions exceeded 10 mm, and among these, 3 cases were classified as T1b-2 (p = 0.0035).For using the new T1 invasion depth sub-classification to classify T1 CRCs in which total excisional biopsy is possible, it is useful to measure the maximum diameter of the Type C2 area.

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