Shinmura K.,Kimitsu Chuo Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013
A 67-year-old woman was referred to our hospital because of a gallbladder mass. Abdominal computed tomography revealed a protruding mass 34 mm in diameter in the body of the gallbladder with wall thickening and enhancement. Advanced gallbladder carcinoma was diagnosed by image analysis, with liver metastasis in segment 5 and lymph node metastasis in the hepatoduodenal ligament. Subsequently, S4a+S5 hepatic segmentectomy was performed with extrahepatic bile duct resection and regional lymphadenectomy. The final pathological diagnosis was pT2 pN1 pM1, Stage IV,according to the International Union against Cancer classification system. Curative resection was then performed. In addition, we performed adjuvant chemotherapy with 15 courses of 1,000 mg/m2 gemcitabine on days 1, 8, and 15 at every 28 days. At 5 years after the operation, the patient was alive and free of disease. Therefore, in cases of limited liver metastasis (within segments 4a and 5), aggressive surgery should be considered even for Stage IV gallbladder carcinoma. In such cases, long-term patient survival may be expected only when curative resection is achieved.
Kobe Y.,Kimitsu Chuo Hospital |
Setoguchi D.,Kimitsu Chuo Hospital |
Kitamura N.,Kimitsu Chuo Hospital
Journal of Medical Case Reports | Year: 2011
Introduction. Dapsone (diaminodiphenylsulfone) is used for the treatment of intractable skin diseases such as pemphigus and leprosy. The side effects of Dapsone are anemia, leukopenia, and liver dysfunction. Here, we present a case of agranulocytosis-induced septic shock, which was a side effect of Dapsone. Case presentation. An 82-year-old Japanese woman was transferred to our hospital with fever, leucopenia, and respiratory arrest. At the previous hospital, she had been administered Dapsone for linear IgA bullous dermatosis. At the time of admission, she presented with methemoglobinemia and septic shock, which was due to immunosuppression caused by the normal dose of Dapsone. Although her overall health initially improved, her condition deteriorated because of septic shock caused by an anal fistula. She died of sepsis on hospital day 80. Conclusion: One of the side effects of Dapsone is agranulocytosis. Patients with agranulocytosis may be in danger of developing anal fistula. Therefore, care must be taken if a patient with agranulocytosis develops a decubitus ulcer in the sacral region, since it could develop into a fistula-in-ano. © 2011 Kobe et al; licensee BioMed Central Ltd.
Arikawa S.,Kimitsu Chuo Hospital |
Shigehara T.,Kimitsu Chuo Hospital
Japanese Journal of Plastic Surgery | Year: 2015
Polydactyly of the foot is a common anomaly, but preaxial Polydactyly of the foot is rare. We present a rare case of preaxial Polydactyly of the right foot in a 7-month-old male infant. The patient had duplicated great toes that bifurcated completely at the tarsometatarsal joint. The tibial side extra toe was excised at the tarsometatarsal joint, and the abductor halluces muscle tendon was reconstructed. According to Blauth and Olason's classification, this was a metatarsal type case. Only a few other case reports describe cases similar to the case presented here. The decision of which side toe should be excised is often a problem in surgical treatment. This should be determined individually, with the consideration of various factors. In this case, the tibial side extra toe was excised because it was paralytic, and the varus deformity was severe. The cosmetic result was good, and the patient's functional development has been normal.
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.
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.
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.
Wada M.,Chiba Rehabilitation Center |
Yamakami I.,Chiba Central Medical Center |
Higuchi Y.,Chiba University |
Tanaka M.,Sanmu Medical Center |
And 3 more authors.
Clinical Neurology and Neurosurgery | Year: 2014
Objective The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. Method We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. Results Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value < 0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. Conclusion Antiplatelet therapy significantly influences the recurrence of CSDH. © 2014 Elsevier B.V.
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.
PubMed | Tokushima Prefectural Central Hospital, Kumamoto University, Chugoku Central Hospital, NHO Nishigunma Hospital and 10 more.
Type: Journal Article | Journal: Annals of hematology | Year: 2016
Bortezomib is one of the most widely used novel drugs for the treatment of multiple myeloma (MM). However, twice-weekly intravenous administration is associated with innegligible adverse events and treatment discontinuation. We therefore evaluated the long-term efficacy and feasibility of reduced frequency treatment with intravenous bortezomib in elderly patients with relapsed and/or refractory MM. A total of 47 bortezomib-nave patients (median age 75years) received bortezomib (1.3mg/m(2), intravenously) and dexamethasone (20mg) on days 1, 8, and 15 of every 4-week cycle. Twenty-six patients completed the planned 8cycles. Best responses were stringent complete response (sCR) in 5 patients, very good partial response (VGPR) in 3, PR in 15, stable disease (SD) in 18, and disease progression (PD) in 6, respectively. Median progression-free and overall survivals were 9.6 and 35.1months, respectively. After progression, 11 patients were retreated with bortezomib-based regimens and another 24 patients with immunomodulatory drugs. Multivariate analysis revealed that ISS 3, t(4;14), and <4 therapy cycles were significantly poor prognostic factors and that subsequent therapy with bortezomib-based regimens was a favorable factor for extended OS. The common adverse events were diarrhea, constipation, and peripheral neuropathy with no grade 4 toxicity. In conclusion, reduced frequency treatment with intravenous bortezomib+dexamethasone is an effective option for elderly patients with MM.
PubMed | Kagoshima City Hospital, Kimitsu Chuo Hospital, Hokkaido University, Funabashi Central Hospital and Gifu Prefectural General Medical Center
Type: Journal Article | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2016
Infant flow biphasic nasal continuous positive airway pressure (Bi-NCPAP) and regular NCPAP (Re-NCPAP) are equally useful with respect to the rate of successful weaning from mechanical ventilation. It remains unclear, however, whether Bi-NCPAP or Re-NCPAP is more effective for reducing apnea of prematurity (AOP).A multicenter randomized controlled study was conducted of 66 infants assigned to receive Bi-NCPAP and 66 assigned to receive Re-NCPAP for respiratory support after extubation. Primary outcome was the number of AOP events during the 48h observation period after successful extubation, defined as no reintubation and no adverse events associated with the use of NCPAP during the observation period. The secondary outcome was successful extubation. Reintubation was at the discretion of the attending physician.Baseline characteristics were similar between the two groups. The number of AOP events during the 48h observation period was significantly lower in infants with Bi-NCPAP than in those with Re-NCPAP (5.26.5 vs 10.310.9 per infant, respectively; P=0.002). The rate of successful extubation tended to be greater in those with Bi-NCPAP than in those with Re-NCPAP (92.4%, 61/66 vs 80.3%, 53/66, respectively; P=0.074). Adverse events occurred in only one of 132 infants: erosive dermatitis developed on the nose after application of Re-NCPAP. The risk of reintubation did not differ significantly between the two groups (7.6%, 5/66 for Bi-NCPAP vs 18.2%, 12/66 for Re-NCPAP; P=0.117).Bi-NCPAP was superior to Re-NCPAP for reduction of AOP following extubation.