Komaki City Hospital

Komaki, Japan

Komaki City Hospital

Komaki, Japan

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Sugimoto T.,Komaki City Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2016

The microenvironment of follicular lymphoma (FL) is composed of tumor-infiltrating CD8(+) T cells, follicular regulatory T cells, lymphoma-associated macrophages and mast cells, follicular helper T cells, follicular dendritic cells, and follicular reticular cells, all of which have been reported to have relevance in the prognosis of FL patients. In addition, some of these cells play a role in the histologic transformation of FL. Macrophages contribute to a poor prognosis in FL patients treated in the pre-rituximab era, but are associated with good prognosis in those treated in the rituximab era. T-cell immunoglobulin and mucin domain protein (TIM) 3 are markers of T-cell exhaustion, and T cells co-expressing programed death 1 (PD1) in peripheral blood and lymph nodes secrete interleukin (IL)-12 in the serum. Serum CXCL9, IL-2 receptor, and IL-1 receptor agonist are associated with shorter survival of FL patients. Agents for manipulation of the microenvironment surrounding FL cells include the immunomodulatory drug lenalidomide, immune check-point inhibitors, and cyclophosphamide prior to rituximab. To battle FL and to improve the outcomes of FL patients, understanding the relationship between neoplastic cells and the various microenvironmental cellular components is crucial for developing therapeutics against the microenvironment.


Hirakawa T.,Nagoya University | Suzuki S.,Nagoya University | Kato K.,Red Cross | Gotoh M.,Nagoya University | Yoshikawa Y.,Komaki City Hospital
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2013

Introduction and hypothesis To compare the effects of pelvic floor muscle training (PFMT), with or without biofeedback (BF), for stress urinary incontinence (SUI), focusing on condition-specific quality of life (QOL) outcomes. Methods Women with SUI were randomized to PFMT with BF (BF group, n023) or without BF (PFMT group, n023) for 12 weeks. As primary outcome measures, subjective symptoms and QOL were assessed by the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). A voiding diary, 1-h pad test, and measurement of PFM strength were secondary outcome measures. Changes in the primary and secondary outcomes were assessed before and after 12 weeks' exercise training. Results Of the 9 domains of the KHQ, the scores of 5 significantly decreased in the PFMT group, and the scores of 7 significantly decreased in the BF group. All ICIQ-SF items and the total score significantly decreased in both groups after therapy. The number of incontinence episodes significantly decreased in the PFMT group, and tended to decrease in the BF group, but this was not significant (P00.054). The leakage volume in the 1-h pad test tended to decrease in both groups, but was not significant. Maximum vaginal squeeze pressure significantly increased in both groups. There were no significant inter-group differences in the changes in any of the parameters assessed. Conclusions The results indicate that PFMT is effective for treating SUI. There is no apparent add-on effect of BF training in short-term follow-up. © The International Urogynecological Association 2013.


Hasegawa T.,Komaki City Hospital | Kobayashi T.,Nagoya Kyoritsu Hospital | Kida Y.,Komaki City Hospital
Neurosurgery | Year: 2010

OBJECTIVE: To determine the limiting dose to the optic apparatus in single-fraction irradiation in patients with craniopharyngioma treated with gamma knife radiosurgery (GKRS). METHODS: One hundred patients with 109 craniopharyngiomas treated with GKRS were evaluated with a median follow-up period of 68 months. Tumor volume varied from 0.1 to 36.0 (median, 3.3) cm. Marginal doses varied from 10 to 18 (median, 11.4) Gy. Maximum dose to any part of the optic apparatus varied from 2 to 18 (median, 10) Gy. RESULTS: The actuarial 5- and 10-year overall rates of survival of tumor progression after GKRS were 93% and 88%, respectively. Similarly, the actuarial 5- and 10-year progression-free survival rates were 62% and 52%, respectively. Among 94 patients in whom visual function was evaluable after GKRS, only 3 patients developed radiation-induced optic neuropathy, indicating an overall Kaplan-Meier radiation-induced optic neuropathy rate of 5%. Of these patients, 2 received 15 Gy or greater to the optic apparatus. Another patient who received 8 Gy or less had undergone previous fractionated radiation therapy with a biologically effective dose of 60 Gy. CONCLUSION: The optic apparatus seems to be more tolerant of irradiation than previously thought. Careful dose planning is essential, particularly in patients who underwent prior external beam radiation therapy. Copyright © 2010 by the Congress of Neurological Surgeons.


Hasegawa T.,Komaki City Hospital | Kida Y.,Komaki City Hospital | Yoshimoto M.,Komaki City Hospital | Iizuka H.,Komaki City Hospital | And 2 more authors.
Journal of Neurosurgery | Year: 2011

Object. The aim of this study was to evaluate the outcomes in patients with convexity, parasagittal, or falcine meningiomas treated using Gamma Knife surgery (GKS) and to determine management strategy considering a risk of radiation-induced edema. Methods. One hundred twelve patients who harbored 125 convexity, parasagittal, or falcine meningiomas were assessed. Forty-six patients underwent GKS as the initial treatment. The median tumor diameter was 25 mm, and median tumor volume was 8 cm 3. The median maximum and margin doses were 30 and 16 Gy, respectively. Results. The median follow-up period was 72 months. The actuarial 5- and 10-year progression-free survival rates were 78% and 55%, respectively. The actuarial 5- and 10-year local tumor control rates were 87% and 71%, respectively. Of 29 tumors that developed postradiosurgical edema, 7 were symptomatic. The actuarial symptomatic radiation-induced edema rate was 7%. The incidence of this complication was significantly higher in patients who underwent GKS as the initial treatment. Six of 46 patients for whom GKS was the initial treatment had preradiosurgical edema. Of these 6 patients, 4 developed severe panhemispheric edema after GKS (2 patients with parasagittal tumors, 1 with a falx tumor, and 1 with a convexity tumor). Conclusions. Gamma Knife surgery is an effective treatment for convexity, parasagittal, and falcine meningiomas as the initial or adjuvant treatment. However, GKS should be restricted to small- to medium-sized tumors, particularly in patients with primary tumors, because radiation-induced edema is more common in convexity, parasagittal, and falcine meningiomas than skull base meningiomas. ©1944-2011 by the American Association of Neurosurgeons.


Hasegawa T.,Komaki City Hospital | Kida Y.,Komaki City Hospital | Kato T.,Komaki City Hospital | Iizuka H.,Komaki City Hospital | And 2 more authors.
Journal of Neurosurgery | Year: 2013

Object. Little is known about long-term outcomes, including tumor control and adverse radiation effects, in patients harboring vestibular schwannomas (VSs) treated with stereotactic radiosurgery < 10 years previously. The aim of this study was to confirm whether Gamma Knife surgery (GKS) for VSs continues to be safe and effective < 10 years after treatment. Methods. A total of 440 patients with VS (including neurofibromatosis Type 2) treated with GKS between May 1991 and December 2000 were evaluable. Of these, 347 patients (79%) underwent GKS as an initial treatment and 93 (21%) had undergone prior resection. Three hundred fifty-eight patients (81%) had a solid tumor and 82 (19%) had a cystic tumor. The median tumor volume was 2.8 cm3 and the median marginal dose was 12.8 Gy. Results. The median follow-up period was 12.5 years. The actuarial 5- and = 10-year progression-free survival was 93% and 92%, respectively. No patient developed treatment failure < 10 years after treatment. According to multivariate analysis, significant factors related to worse progression-free survival included brainstem compression with a deviation of the fourth ventricle (p < 0.0001), marginal dose = 13 Gy (p = 0.01), prior treatment (p = 0.02), and female sex (p = 0.02). Of 287 patients treated at a recent optimum dose of = 13 Gy, 3 (1%) developed facial palsy, including 2 with transient palsy and 1 with persistent palsy after a second GKS, and 3 (1%) developed facial numbness, including 2 with transient and 1 with persistent facial numbness. The actuarial 10-year facial nerve preservation rate was 97% in the high marginal dose group (> 13 Gy) and 100% in the low marginal dose group (= 13 Gy). Ten patients (2.3%) developed delayed cyst formation. One patient alone developed malignant transformation, indicating an incidence of 0.3%. Conclusions. In this study GKS was a safe and effective treatment for the majority of patients followed < 10 years after treatment. Special attention should be paid to cyst formation and malignant transformation as late adverse radiation effects, although they appeared to be rare. However, it is necessary to collect further long-term follow-up data before making conclusions about the long-term safety and efficacy of GKS, especially for young patients with VSs. © AANS, 2013.


Sawazaki M.,Komaki City Hospital | Tomari S.,Komaki City Hospital | Izawa N.,Komaki City Hospital | Ueda Y.,Nagoya University
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Objective: We developed a repair technique for an excessively high posterior leaflet of the mitral valve. This is an improvement of the folding plasty. Methods: The resection shape is that of an hourglass rather than a quadrangle. The vertical sides of the quadrangle curve inward, which helps to prevent the curtain effect or restriction that is common in the large triangular resection or folding plasty. We used hourglass resection for 26 tall posterior leaflets (53.8% were Barlow disease) and triangular resection for 23 posterior leaflets of normal height (without Barlow disease). Results: All surgeries were performed successfully. There was no mortality, no mitral regurgitation greater than moderate, and no systolic anterior motion of the anterior leaflet in the early postoperative period. One patient required a second pump run, and another required a second repair procedure. The mean follow-up period was 2.3 years (0.3-4.9 years) for the hourglass resection and 2.8 years (0.1-4.9 years) for the triangular resection. One patient in the triangular resection group died of rectal cancer. One patient treated with the hourglass resection via minithoracotomy required re-repair 1 month postoperatively due to suture dehiscence. For the hourglass and triangular resection groups, the most recent postoperative echocardiogram revealed no mitral regurgitation in 18 and 20 cases, respectively; mild mitral regurgitation in 7 and 3 cases, respectively; and moderate mitral regurgitation in 1 and 0 cases, respectively. Conclusions: The short-term results of our strategy for posterior leaflet repair appear promising. © 2013 by The American Association for Thoracic Surgery.


Takada N.,Nagoya City University | Otsuka T.,Nagoya City University | Suzuki H.,Komaki City Hospital | Yamada K.,Komaki City Hospital
Journal of Orthopaedic Trauma | Year: 2013

Objectives: The purpose of this report is to present our surgical technique using forged composites of unsintered hydroxyapatite particles/poly-L-lactide (F-u-HA/PLLA) pins for pediatric displaced fractures of the lateral condyle of the humerus, to retrospectively evaluate clinical outcomes, and to verify the advantages of this device by using postoperative radiographs. DESIGN: Retrospective (level IV) case series. SETTING: Academic medical center. PATIENTS: From October 2004 to September 2006, 8 pediatric displaced closed fractures of the lateral condyle of the humerus (AO/OTA 13-B1) were treated. INTERVENTION: Lateral condyle fractures were fixed using 2 threaded pins. All the patients were placed in a long arm cast for 4 weeks after surgery. MAIN OUTCOME MEASUREMENTS: Radiographic and clinical outcomes and postoperative complications were evaluated. RESULTS: The average follow-up period was 52.5 months. All fractures were successfully united. All shadows of pins were observed, and there were no radiolucent zones around the pins at the final radiographic follow-up. No patients experienced pain or cosmetic deformity at the most recent follow-up. Loss of reduction, malunion, deep infection, implant failure, osteolysis, skin ulcer, and foreign body reaction were not observed postoperatively. No patient required secondary operation. CONCLUSIONS: Radioopacity of F-u-HA/PLLA devices is a major advantage of this device. No radiolucent zones were present around the pins, no osteolysis was observed on postoperative radiographs, and there were no postoperative complications. Reoperation for removal was unnecessary. Open reduction, internal fixation using F-u-HA/PLLA pins offers several advantages in treating pediatric displaced fractures of the lateral condyle of the humerus. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2013 by Lippincott Williams & Wilkins.


Hasegawa T.,Komaki City Hospital | Kato T.,Komaki City Hospital | Iizuka H.,Komaki City Hospital | Kida Y.,Komaki City Hospital
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose Surgical resection is considered the desirable curative treatment for trigeminal schwannomas. However, complete resection without any complications remains challenging. During the last several decades, stereotactic radiosurgery (SRS) has emerged as a minimally invasive treatment modality. Information regarding long-term outcomes of SRS for patients harboring trigeminal schwannomas is limited because of the rarity of this tumor. The aim of this study was to evaluate long-term tumor control and functional outcomes in patients harboring trigeminal schwannomas treated with SRS, specifically with gamma knife surgery (GKS). Methods and Materials Fifty-three patients harboring trigeminal schwannomas treated with GKS were evaluated. Of these, 2 patients (4%) had partial irradiation of the tumor, and 34 patients (64%) underwent GKS as the initial treatment. The median tumor volume was 6.0 cm3. The median maximum and marginal doses were 28 Gy and 14 Gy, respectively. Results The median follow-up period was 98 months. On the last follow-up image, 7 patients (13%) had tumor enlargement, including the 2 patients who had partial treatment. Excluding the 2 patients who had partial treatment, the actuarial 5- and 10-year progression-free survival (PFS) rates were 90% and 82%, respectively. Patients with tumors compressing the brainstem with deviation of the fourth ventricle had significantly lower PFS rates. If those patients with tumors compressing the brainstem with deviation of the fourth ventricle are excluded, the actuarial 5- and 10-year PFS rates increased to 95% and 90%, respectively. Ten percent of patients had worsened facial numbness or pain in spite of no tumor progression, indicating adverse radiation effect. Conclusions GKS can be an acceptable alternative to surgical resection in patients with trigeminal schwannomas. However, large tumors that compress the brainstem with deviation of the fourth ventricle should be surgically removed first and then treated with GKS when necessary. © 2013 The Authors. Published by Elsevier Inc. All rights reserved.


Hasegawa T.,Komaki City Hospital | Kida Y.,Komaki City Hospital | Kato T.,Komaki City Hospital | Iizuka H.,Komaki City Hospital | Yamamoto T.,Komaki City Hospital
Journal of Neurosurgery | Year: 2011

Object. Gamma Knife surgery (GKS) has been a safe and effective treatment for small- to medium-sized vestibular schwannomas (VSs) over relatively long-term outcomes. However, even with recent radiosurgical techniques, hearing results following GKS remain unsatisfactory. The purpose of this study was to evaluate the hearing preservation rate as well as factors related to hearing preservation in patients with VSs and serviceable hearing who were treated with GKS. Methods. Among patients with Gardner-Robertson (GR) Class I or II serviceable hearing and VSs treated with GKS between 1991 and 2009, 117 were evaluable via periodic MR imaging and audiometry. Results. The median age at the time of GKS was 52 years. Four patients (3%) had undergone prior surgery. Fifty-six patients (48%) had GR Class I hearing and 61 (52%) had GR Class II hearing at the time of GKS. The median tumor volume was 1.9 cm 3. The median maximum and tumor margin radiation doses were 24 and 12 Gy, respectively. The median follow-up periods for MR imaging and audiometry were 74 and 38 months, respectively. The overall tumor control rate was 97.5%. Actuarial 3-, 5-, and 8-year hearing preservation rates were 55%, 43%, and 34%, respectively. On multivariate analysis, GR hearing class at the time of GKS and the mean cochlear dose affected hearing preservation significantly. In a limited number of patients who were treated using the most recent dose planning techniques and who had GR Class I hearing before treatment, the 3- and 5-year hearing preservation rates increased to 80% and 70%, respectively. Conclusions. For the majority of patients with small- to medium-sized VSs, GKS was an effective and reasonable alternative to resection with satisfactory long-term tumor control. Factors related to hearing preservation included a GR Class I hearing pre-GKS and a lower mean cochlear radiation dose. To retain serviceable hearing, it is important to apply GKS treatment while patients retain GR Class I hearing.


Hasegawa T.,Komaki City Hospital
Neurosurgery Clinics of North America | Year: 2013

This article summarizes tumor control and functional outcomes of stereotactic radiosurgery (SRS) for patients with nonvestibular schwannomas, in comparison with those treated with microsurgical resection. To date, surgical resection has been a common treatment for nonvestibular schwannomas. Because these tumors are generally benign, complete tumor resection is a desirable curative treatment. However, it is almost infeasible to completely remove these tumors without any complications, even for experienced neurosurgeons, because of adherence to surrounding critical structures such as cranial nerves, brainstem, or vessels. SRS provides a good tumor control rate with much less morbidity than microsurgical resection. © 2013 Elsevier Inc.

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