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Ōsaka, Japan

Sasaki M.,Iseikai Hospital | Aoki M.,Yukioka Hospital | Yoshimine T.,Osaka University
Neurologia Medico-Chirurgica | Year: 2011

A 56-year-old man presented with a very rare case of mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma, manifesting as attack of severe back pain and bilateral sciatica which developed just after a fall. Magnetic resonance imaging demonstrated a large intradural tumor at the L4-5 level with redundant nerve roots below that. Two days before the surgery, his pain unexpectedly lessened without additional treatment. Computed tomography showed that the tumor had migrated cranially and was now located at the L3-4 level. These findings suggest that the severe symptoms were caused by incarceration of a mobile tumor at the L4-5 level following the trauma. The tumor was successfully removed using minimally invasive procedures with guidance provided by the intraoperative myelography. The patient was relieved from pain postoperatively. The histological diagnosis was schwannoma. This case suggests that intraoperative myelography is a useful method for guiding the removal of mobile tumors.

Makino T.,Osaka University | Miyata H.,Osaka University | Yamasaki M.,Osaka University | Fujiwara Y.,Osaka University | And 6 more authors.
Surgery | Year: 2010

Background: Neoadjuvant chemotherapy (NACT) has been frequently used for locally advanced esophageal squamous cell cancer (ESCC). It is therefore important to establish criteria for evaluating the response to NACT based on survival analysis. Methods: This study analyzed 100 patients with ESCC (cT1, 2/3/4:25/57/18, cN0/1/M1lym: 5/59/36) who received NACT (5-fluorouracil, adriamycin, and cisplatin) followed by surgical resection. NACT response was monitored using 18F-fluorodeoxyglucose-positron emission tomography (PET) and computed tomography by measuring pre- and post-NACT maximal standardized uptake value (SUVmax) and area of primary tumor, respectively. The associations between NACT and clinicopathological factors including prognosis were analyzed. Results: The mean ± SEM values of pre- and post-NACT SUVmax were 12.23 ± 4.62 and 6.31 ± 5.41, respectively, and the mean/median SUVmax reduction was 59.50%/73.45%. The most significant difference in survival between responders and non-responders was at 70% of cutoff value based on every 10% stepwise cutoff analysis (2-year progression-free survival [PFS]: 57.7% vs 25.1%; hazard ratio [HR] = 2.864; P = .0004). Univariate analysis indicated a correlation between PFS and number of cN before NACT, SUVmax reduction, decrease in tumor area, pT, and number of pN, while cT before NACT and pathological response to NACT showed no association. Multivariate analysis identified number of cN before NACT (HR = 2.537; P = .0092), SUVmax reduction (HR = 3.202; P = .0072), and number of pN (HR = 2.226; P = .0146) as independent prognostic predictors. Conclusion: By determining the optimal cutoff value based on survival analysis, we evaluated patient responses to NACT using PET. Such evaluation could be valuable in formulating treatment strategies for ESCC. © 2010 Mosby, Inc. All rights reserved.

Mega S.,Iseikai Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2015

We experienced a rare case of anterior mediastinal bronchogenic cyst. A 55-year-old female was admitted to our hospital because of paroxysmal supraventricular tachycardia (PSVT) and an abnormal shadow on the chest computed tomography. She had a 5.5 cm tumor at anterior mediastinum. The tumor was surgically removed completely by video assisted thoracoscopic surgery, and the diagnosis of bronchogenic cyst was established pathologically. After surgery, PSVT has disappeared.

Tsuda A.,Akita | Kanaoka Y.,Iseikai Hospital
International Journal of Hyperthermia | Year: 2015

Purpose: The aim of this paper was to evaluate the effectiveness in day clinics of microwave endometrial ablation (MEA) on transcervical microwave myolysis for patients with menorrhagia caused by submucosal myomas. Materials and methods: Thirty-five outpatients (average age 44.8 ± 5.2 years (mean ± SD), range 34-58) with a single submucosal myoma that was 4-7 cm (5.5 ± 2.1 cm) in size underwent MEA with transcervical microwave myolysis using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture. Primary outcomes were the changes in the blood haemoglobin level and the volume of myoma before and after the treatment. Secondary outcomes were the improvement in menorrhagia and satisfaction after the operation, assessed by visual analogue scale (VAS). Results: The mean operation time was 27.9 ± 13.6 min. The myomas had shrunk by 56.2% at 3 months and 73.8% at ≥6 months after the operation. Blood haemoglobin levels had increased significantly at 3 months (10.2 ± 2.0 vs. 12.7 ± 1.2, p < 0.001). The average VAS assessment of menstrual bleeding had decreased to 1.7 ± 1.7 at 3 months after the operation (preoperative VAS = 10). The average VAS score for feelings of satisfaction 3 months after the operation was 9.8 ± 0.5 (full score = 10). Conclusions: MEA with transcervical microwave myolysis is a feasible and effective procedure in a day surgery clinic for menorrhagia caused by submucosal myomas. The procedure may be an alternative to hysterectomy for menorrhagia caused by submucosal myomas in women during the perimenopausal period. © 2015 © 2015 Taylor & Francis.

Oshino S.,Osaka University | Nishino A.,Hanwa Memorial Hospital | Suzuki T.,Japan National Cardiovascular Center Research Institute | Arita H.,Osaka University | And 6 more authors.
Pituitary | Year: 2013

The prevalence of cerebral aneurysm was retrospectively investigated in 208 patients with acromegaly relative to the rate of cerebral aneurysm in a group of control subjects. Neuroradiological examinations of the cerebral vascular system were conducted in 208 acromegaly patients (101 men; mean age, 48.8 years). The prevalence of cerebral aneurysm in the acromegaly patients was compared to that in a control group consisting of 7,390 subjects who underwent "brain checkup" between 2006 and 2008 (mean age, 51.6 years). In the acromegaly group, cerebral aneurysm was detected in 4.3 % of patients. By sex, the prevalence was 6.9 % in males, a significantly proportion than that in the control group with an odds ratio of 4.40. The prevalence in females did not differ between the two groups. In the acromegaly group, the rate of hypertension was significantly higher in the patients with aneurysm compared to those without aneurysm. Multiple logistic regression identified acromegaly as a significant factor related to the prevalence of cerebral aneurysm in all male subjects; other factors, such as age, hypertension and smoking, were not found to be significant. A significantly higher prevalence of cerebral aneurysm was detected in male patients with acromegaly. This finding indicates that excess growth hormone or insulin-like growth factor 1 affects the cerebral vascular wall, resulting in aneurysm formation. In addition to known systematic complications in the cardiovascular, respiratory, metabolic, and other systems, the risk of cerebral aneurysm should be considered in the management of acromegaly. © 2012 Springer Science+Business Media, LLC.

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