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Chiba, Japan

Sudo Y.,Kimitsu Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

Metastatic cardiac tumors are commonly detected during autopsy. However, they are seldom diagnosed during life, and surgical resection is rarely indicated. Among the malignant tumors, colon cancer rarely metastasizes to the heart. We report a case of a 70-year-old woman with sigmoid colon cancer, which metastasized to her heart and caused obstruction of the right ventricular outflow tract. The tumor had already metastasized to the liver, lungs, periaortic lymph nodes, and peritoneum. Cardiopulmonary bypass surgery was performed to excise the right ventricular metastatic tumor and to reconstruct the tricuspid valve. Histological analysis of the specimen confirmed a metastatic adenocarcinoma. Although this surgery was performed as palliative cancer therapy, the patient's symptoms were satisfactorily improved. Follow-up echocardiography 2 months after her cardiac surgery showed no space-occupying mass in the right ventricle. Source

Shinmura K.,Kimitsu Chuo Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

A 59-year-old woman with upper abdominal pain was diagnosed as having an advanced-stage gallbladder carcinoma with significant metastases in the para-aortic lymph nodes to the more distant right external iliac nodes by imaging studies. These findings suggested that the tumor was unresectable, and therefore, palliative cholecystectomy with lymph node biopsy was performed. Furthermore, we initiated chemoradiotherapy with linac radiotherapy( 50 Gy) and weekly gemcitabine (GEM 300 mg/body) for 6 weeks. Partial response (PR) was achieved after chemoradiotherapy. Subsequently, we initiated chemotherapy with GEM alone (1,000 mg/m2) on days 1, 8, and 15, every 28 days for 15 courses. Following disease progression, we initiated chemotherapy with S-1 alone( 80 mg/m2/day) on days 1-14, every 21 days for 9 courses, as second-line treatment. Two years later, following re-progression of the disease, we performed best supportive care with retrograde ureteral stenting for hydronephrosis and retrograde biliary stenting for obstructive jaundice. The patient survived for 35 months after palliative surgery. Moreover, she remained well and performed normal activities for 34 months. This experience indicates that, in patients with unresectable gallbladder carcinoma, multidisciplinary treatment could extend survival and improve the quality of life. Source

Iida H.,Kimitsu Chuo Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

We developed novel methods to simplify valve repair techniques.Adequate exposure is crucial for mitral valve surgery. The right side of the pericardium is sutured to the chest wall, and both cava are mobilized and hitched up to the left. Then a longitudinal incision of the right side of the left atrium allows excellent exposure of the mitral valve.We have developed a new device for replace neochordae. This double-armed, double-hooked device is inserted through the loop formed by the neochordae, which is anchored on the papillary muscle and pass through the prolapsing segment. The device pulls up both leaflets and maintains the neochordae at the same length as that of the opposing normal chordae during tying slippery neochordae.A simple method to repair large prolapsing posterior leaflet was developed. The middle of the prolapsed portion is cut, and both sides are laid each other. The water test is made to confirm accurate closure,and 2 layers are sutured.A novel method for adjustable tricuspid annuloplasty was developed. A flexible annuroplasty band,through which an expanded polytetrafluoroethylene (ePTFE) thread was passed, was secured to the tricuspid annulus. The thread was snared from outside of the ejecting heart under observation by echocardiogram. Source

Shinozaki K.,Chiba University | Oda S.,Chiba University | Sadahiro T.,Chiba University | Nakamura M.,Chiba University | And 7 more authors.
Resuscitation | Year: 2011

Introduction: No reliable predictor for the prognosis of out-of-hospital cardiac arrest (OHCA) on arrival at hospital has been identified so far. We speculate that ammonia and lactate may predict patient outcome. Methods: This is a prospective observational study. Non-traumatic OHCA patients who gained sustained return of spontaneous circulation and were admitted to acute care unit were included. Blood ammonia and lactate levels were measured on arrival at hospital. The patients were classified into two groups: 'favourable outcome' group (Cerebral Performance Category CPC1-2 at 6-months' follow-up) and 'poor outcome' group (CPC3-5). Basal characteristics obtained from the Utstein template and biomarker levels were compared between these two outcome groups. Independent predictors were selected from all candidates using logistic regression analysis. Results: A total of 98 patients were included. Ammonia and lactate levels in the favourable outcome group (n=10) were significantly lower than those in poor outcome group (n=88) (p<0.05, respectively). On receiver operating characteristic analysis, the optimal cut-off value for predicting favourable outcome was determined as 170μgdl-1 of ammonia and 12.0mmoll-1 of lactate (area under the curve; 0.714 and 0.735, respectively). Logistic regression analysis identified ammonia (≤170μgdl-1), therapeutic hypothermia and witnessed by emergency medical service personnel as independent predictors of favourable outcome. When both these biomarker levels were over threshold, positive predictive value (PPV) for poor outcome was calculated as 100%. Conclusions: Blood ammonia and lactate levels on arrival are independent prognostic factors for OHCA. PPV with the combination of these biomarkers predicting poor outcome is high enough to be useful in clinical settings. © 2010 Elsevier Ireland Ltd. Source

Umemura H.,Chiba University | Togawa A.,Kimitsu Chuo Hospital | Sogawa K.,Chiba University | Satoh M.,Chiba University | And 7 more authors.
Journal of Gastroenterology | Year: 2011

Background: Serum biomarkers currently available for gastric cancers are not sufficiently sensitive and specific. Methods: We used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MS) to generate comparative peptide profiles of serum samples obtained from gastric cancer patients (n = 81) and age- and sex-matched healthy controls (n = 66). Results: Because of initial screening and further validation, we found that the intensities of a 2209 m/z MS peak were increased in the preoperative sera obtained from gastric cancer patients, and we identified this peak, a 2209 Da peptide, as a high molecular weight (HMW) kininogen fragment. Receiver operating characteristic analyses showed that the area under the curve (AUC) for the 2209 Da peptide (AUC = 0.715) was greater than those for conventional tumor markers (carcinoembryonic antigen AUC = 0.593, carbohydrate antigen 19-9 AUC = 0.527) used for the detection of stage I gastric cancers. Inverse correlations were observed between the levels of intact HMW kininogen and the 2209 Da peptide, suggesting that the upregulation of some protease activities is responsible for the overproduction of a kininogen fragment in gastric cancer patients. Conclusions: Serum levels of the 2209 Da peptide identified in this study have a greater diagnostic ability than those of conventional tumor markers used for the early detection of gastric cancer. © 2011 Springer. Source

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