Kasai, Japan
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Nishida T.,Kasai City Hospital | Ikuta H.,Kasai City Hospital | Yoshida S.,Kasai City Hospital | Yokoyama K.,Kasai City Hospital
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2015

Background: While using an irrigation-suction instrument for laparoscopic surgery, irregular adsorption of fatty tissue may damage the tissue or obstruct continuous sucking. A new device made up of a divided silicone drain tip to prevent irregular adsorption was reported. Materials and Methods: A cigarette-type silicone drain was cut 4 cm in length. It was slipped over the instrument to cover the side holes, leaving 1.0 to 1.5 cm free from the end of the instrument. It was fixed by means of 1-0 silk above the side holes. Finally, the free tip was divided vertically into 4 even pieces like octopus arms. Results: This device could prevent the irregular adsorption of fatty tissue (greater and lesser omentum, or epiploic appendices) and could suck saline, fresh, and coagulated blood almost continuously. Conclusions: This simple and easy device facilitated the prevention of irregular adsorption of fatty tissue while using an irrigation-suction instrument for laparoscopic surgery. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Terashima K.,Hyogo Ion Beam Medical Center | Demizu Y.,Hyogo Ion Beam Medical Center | Hashimoto N.,Hyogo Ion Beam Medical Center | Jin D.,Hyogo Ion Beam Medical Center | And 12 more authors.
Radiotherapy and Oncology | Year: 2012

Purpose: We conducted the study to assess the feasibility and efficacy of gemcitabine-concurrent proton radiotherapy (GPT) for locally advanced pancreatic cancer (LAPC). Materials and methods: Of all 50 patients who participated in the study, 5 patients with gastrointestinal (GI)-adjacent LAPC were enrolled in P-1 (50 Gy equivalent [GyE] in 25 fractions) and 5 patients with non-GI-adjacent LAPC in P-2 (70.2 GyE in 26 fractions), and 40 patients with LAPC regardless of GI-adjacency in P-3 (67.5 GyE in 25 fractions using the field-within-a-field technique). In every protocol, gemcitabine (800 mg/m 2/week for 3 weeks) was administered concurrently. Every patient received adjuvant chemotherapy including gemcitabine after GPT within the tolerable limit. Results: The median follow-up period was 12.5 months. The scheduled GPT was feasible for all except 6 patients (12%) due to acute hematologic or GI toxicities. Grade 3 or greater late gastric ulcer and hemorrhage were seen in 5 patients (10%) in P-2 and P-3. The one-year freedom from local-progression, progression-free, and overall survival rates were 81.7%, 64.3%, and 76.8%, respectively. Conclusion: GPT was feasible and showed high efficacy. Although the number of patients and the follow-up periods are insufficient, the clinical results seem very encouraging. © 2012 Elsevier Ireland Ltd. All rights reserved.


Sakai J.,Kasai City Hospital | Inoue Y.,Inoue Eye Clin | Kashiwagi H.,Div of Ophthalmol | Sasaki T.,Sasaki Eye Clin
Japanese Journal of Clinical Ophthalmology | Year: 2012

Purpose : To report the outcome of questionnaire regarding the lacrimal side effects of TS-1 ®. Cases and Method : This study was made on the side effects of peroral TS-1 ®, an anticancer medication. Results : Reports were obtained from 32 institutions on 107 patients. The series included 71 males, 35 females, and one ambiguous sex. Ninety-two cases were bilaterally and 15 cases were unilaterally affected. Corneal lesion was present in 34 cases (32%). After 2007, the interval between start of medication and complication and between medication and treatment became shorter. Lacrimal puncti and lacrimal canaliculi were frequently involved. Conjunctivodacryostomy showed poor outcome. Intubation was performed in 131 cases and resulted in recurrence of obstruction in 16 sites (13%). Prophylactic intubation was performed in 5 cases with favorable outcome. Conclusion I Peroral TS-1 ® may result in obstruction lacrimal passage.


Takatori K.,Kasai City Hospital | Terashima K.,Hyogo Ion Beam Medical Center | Yoshida R.,Kasai City Hospital | Horai A.,Kasai City Hospital | And 6 more authors.
Journal of Gastroenterology | Year: 2014

Background: Little is known about acute upper gastrointestinal (GI) complications associated with gemcitabine-concurrent proton radiotherapy (GPT) for inoperable pancreatic cancer. We investigated acute GI complications following GPT in patients with inoperable pancreatic cancer using small-bowel endoscopy. Methods: This prospective single center observational study was conducted at the Hyogo Ion Beam Medical Center from January 2010 to January 2012. Ninety-one patients who had clinically and medically inoperable pancreatic cancer treated by GPT were analyzed. Endoscopic examinations were performed before and after GPT to clarify the incidence rates of radiation-induced ulcers, GI hemorrhage, and GI perforation associated with GPT. Results: Post-treatment endoscopic examinations revealed that 45 (49.4 %) patients had radiation-induced ulcers in the stomach and duodenum. Of those, many ulcerative lesions were found in the lower stomach (51 %) and horizontal part of the duodenum (39 %), regardless of the primary tumor site in the pancreas. Neither GI hemorrhage, nor perforation, was found in post-treatment endoscopy examinations. Conclusion: Approximately half of the patients treated with GPT for inoperable pancreatic cancer exhibited radiation-induced ulcers in the stomach and duodenum. © 2013 Springer.


Mikami H.,The University of Shimane | Ishimura N.,The University of Shimane | Fukazawa K.,Kasai City Hospital | Okada M.,The University of Shimane | And 6 more authors.
Journal of Neurogastroenterology and Motility | Year: 2016

Background/Aims Prokinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance. Methods Nine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumenimaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject. Results Following administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm2/mmHg), suggesting no significant effect of metoclopramide on EGJ compliance. Conclusions Metoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults. © The Korean Society of Neurogastroenterology and Motility.


Watanabe M.,Kasai City Hospital | Sakai J.,Kasai City Hospital
Japanese Journal of Clinical Ophthalmology | Year: 2013

Purpose: To report a case who developed acute visual field defect during treatment for sarcoidosis. Case: A 30-year-old female presented with blurring in her right eye. She had had left facial palsy 2 months before and been treated with peroral prednisolone. Findings: Corrected visual acuity was 1.0 in either eye. The right eye showed intraocular pressure of 58 mmHg. Both eyes showed signs of anterior uveitis, retinal periphlebitis and swollen optic disc. X-ray findings and tracheal biopsy led to the diagnosis of sarcoidosis. She was also diagnosed with diabetes insipidus. The findings improved following peroral prednisolone. She showed visual field defect 5 months after initial visit. Diagnostic imaging showed a pituitary suprasellar granuloma of 20 mm across. Although steroides alone repeated recurrence of worse during decremented, steroid dosage in weight loss well in combination with methotrexate. Conclusion: The case illustrates that central nervous system may be involved during treatment for sarcoidosis.


Furuta K.,The University of Shimane | Kushiyama Y.,The University of Shimane | Kushiyama Y.,Red Cross | Kawashima K.,Matsue Coop Hospital | And 6 more authors.
Journal of Gastroenterology | Year: 2012

Background: The characteristics of symptoms reported by elderly patients with gastroesophageal reflux disease (GERD) have not been fully investigated. We performed this study to clarify these characteristics in elderly patients with GERD. Methods: The study subjects were 340 Japanese patients with symptoms of heartburn and/or acid regurgitation. All patients were investigated by upper gastrointestinal endoscopy, and were asked about the presence of atypical GERD symptoms, such as an epigastric burning sensation, epigastralgia, epigastric discomfort, and abdominal fullness, as well as the time of day when bothersome symptoms occurred. Results: Of the 340 patients, 161 were elderly (≥65 years old) and 179 were non-elderly (age<65 years). There were 158 patients without esophageal mucosal breaks, 147 with low-grade reflux esophagitis (RE; Los Angeles classification grade A or B), and 35 with high-grade reflux esoph-agitis (LA grade C or D). Elderly patients with RE reported typical reflux symptoms at the same frequency as the non-elderly patients, whereas elderly patients without mucosal breaks reported typical symptoms more frequently than the non-elderly patients without mucosal breaks. Both elderly and non-elderly patients with different types of GERD reported that their symptoms occurred most frequently during the postprandial period. Conclusion: Elderly patients with GERD tend to show typical GERD symptoms frequently at the typical postprandial time points in a day, irrespective of the presence of esophageal mucosal breaks. © Springer 2011.


PubMed | Kasai City Hospital and The University of Shimane
Type: Journal Article | Journal: Journal of neurogastroenterology and motility | Year: 2015

Prokinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance.Nine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumen-imaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject.Following administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 9.2 vs 26.7 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 0.5 vs 4.1 0.5 mm(2)/mmHg), suggesting no significant effect of metoclopramide on EGJ compliance.Metoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.


PubMed | Kasai City Hospital
Type: Journal Article | Journal: Journal of gastroenterology | Year: 2014

Little is known about acute upper gastrointestinal (GI) complications associated with gemcitabine-concurrent proton radiotherapy (GPT) for inoperable pancreatic cancer. We investigated acute GI complications following GPT in patients with inoperable pancreatic cancer using small-bowel endoscopy.This prospective single center observational study was conducted at the Hyogo Ion Beam Medical Center from January 2010 to January 2012. Ninety-one patients who had clinically and medically inoperable pancreatic cancer treated by GPT were analyzed. Endoscopic examinations were performed before and after GPT to clarify the incidence rates of radiation-induced ulcers, GI hemorrhage, and GI perforation associated with GPT.Post-treatment endoscopic examinations revealed that 45 (49.4 %) patients had radiation-induced ulcers in the stomach and duodenum. Of those, many ulcerative lesions were found in the lower stomach (51 %) and horizontal part of the duodenum (39 %), regardless of the primary tumor site in the pancreas. Neither GI hemorrhage, nor perforation, was found in post-treatment endoscopy examinations.Approximately half of the patients treated with GPT for inoperable pancreatic cancer exhibited radiation-induced ulcers in the stomach and duodenum.


PubMed | Kasai City Hospital
Type: Journal Article | Journal: Surgical laparoscopy, endoscopy & percutaneous techniques | Year: 2015

While using an irrigation-suction instrument for laparoscopic surgery, irregular adsorption of fatty tissue may damage the tissue or obstruct continuous sucking. A new device made up of a divided silicone drain tip to prevent irregular adsorption was reported.A cigarette-type silicone drain was cut 4 cm in length. It was slipped over the instrument to cover the side holes, leaving 1.0 to 1.5 cm free from the end of the instrument. It was fixed by means of 1-0 silk above the side holes. Finally, the free tip was divided vertically into 4 even pieces like octopus arms.This device could prevent the irregular adsorption of fatty tissue (greater and lesser omentum, or epiploic appendices) and could suck saline, fresh, and coagulated blood almost continuously.This simple and easy device facilitated the prevention of irregular adsorption of fatty tissue while using an irrigation-suction instrument for laparoscopic surgery.

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