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Komaki, Japan

Yamamoto M.,Katsuta Hospital Mito GammaHouse | Kida Y.,Komaki City Hospital | Fukuoka S.,Nakamura Memorial Hospital | Iwai Y.,Osaka City General Hospital | And 3 more authors.
Journal of Neurosurgery | Year: 2010

Object. Gamma Knife radiosurgery (GKS) is currently used for primary or postoperative management of cavernous sinus (CS) hemangiomas. The authors describe their experience with 30 cases of CS hemangioma successfully managed with GKS. Methods. Thirty patients with CS hemangiomas, including 19 female and 11 male patients with a mean age of 53 years (range 19-78 years) underwent GKS at 7 facilities in Japan. Pathological entity was confirmed using surgical specimens in 17 patients, and neuroimaging diagnosis only in 13. Eight patients were asymptomatic before GKS, while 22 had ocular movement disturbances and/or optic nerve impairments. The mean tumor volume was 11.5 cm3 (range 1.5-51.4 cm3). The mean dose to the tumor periphery was 13.8 Gy (range 10.0-17.0 Gy). Results. The mean follow-up period was 53 months (range 12-138 months). Among the 22 patients with symptoms prior to GKS, complete remission was achieved in 2, improvement in 13, and no change in 7. Hemifacial sensory disturbance developed following GKS in 1 patient. The most recent MR images showed remarkable shrinkage in 18, shrinkage in 11, and no change in 1 patient. Conclusions. Gamma Knife radiosurgery proved to be an effective treatment strategy for managing CS hemangiomas. Given the diagnostic accuracy of recently developed neuroimaging techniques and the potentially serious bleeding associated with biopsy sampling or attempted surgical removal, the authors recommend that GKS be the primary treatment in most patients who have a clear neuroimaging diagnosis of this condition. Source

Sawazaki M.,Komaki City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

Conventional repair of posterior mitral valve prolapse involves quadrangular resection and sliding plasty. However, these 2 methods require annular plication and useful leaflet tissue is sacrificed. Our concept is to make an ideally shaped posterior leaflet without annular plication. When the leaflet is not high, we select triangular resection( TRR). For a high leaflet, we developed hourglass resection (HGR). The hourglass shape consists of 2 triangles:the upper inverted triangle is resected and the lower triangle is resected and sutured to the annulus. From 2007 to 2012, 65 patients with mitral regurgitation (MR) with leaflet prolapse were repaired. 49 patients who had posterior leaflet prolapse were analized in this study. The mean age was 61.7±11.5 years and 67.3% were men. All patients underwent successful repair. There were no hospital deaths, or no systolic anterior motion. In 1 patient, repair was repeated 1 month post-operatively. The mean follow-up period was 2.6±1.5 (0.1 ~ 4.9) years. There were no late deaths. The most recent echocardiogram revealed no MR in 36, mild MR in 12, and moderate MR in 1 cases. The short-term results of our strategy for posterior leaflet repair are good. Source

Yamada M.,Komaki City Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2012

A simple method for improving the quality of electronic portal imaging device (EPID) portal images was proposed for the reduction of the burden on the registration between digital reconstruction radiography (DRR) and EPID portal images in radiation therapy. Conventional image filtering techniques in the spatial-frequency domain are applied to the proposed method. While a band-pass filter (BPF) is employed to extract spatial-frequency components included in the bone edge, a high-pass filter (HPF) is employed to obtain the effect corresponding to the general dynamic range compression. The band-pass filtered image is weighted by a parameter for adjusting the bone edge enhancement, and is added to the high-pass filtered image. This method was applied to the portal images in the neck region. In the image obtained by the proposed filtering, the bone edge was clearly observed. In addition, soft tissue structures were identified in the same display settings (window level/width; WL/WW) as the bone edge observation; that is, the adjustment of the display settings was not required for the observation of each object. These results suggested that both bone edge enhancement and dynamic range compression would be achieved successfully. It was estimated that the images obtained by the proposed method were more appropriate for the registration than conventional portal images, in 47 times registrations of 50 times in total (the registrations by five radiological technologists in ten patients). The proposed method was concluded to be useful for improving the quality of portal images, enabling the efficient registration. Source

Kimura K.,National Hospital Organization Nagoya Medical Center | Tsuzuki T.,Red Cross | Kato M.,Nagoya University | Saito A.M.,Clinical Research Center | And 6 more authors.
Prostate | Year: 2014

BACKGROUND Intraductal carcinoma of the prostate (IDC-P) is an adverse prognostic factor for radical prostatectomy (RP). The endpoint in most IDC-P studies is increased prostate-specific antigen (PSA) levels. The aim of this study was to evaluate whether IDC-P in RP specimens is an adverse prognostic factor for progression-free survival (PFS) and cancer-specific survival (CSS). METHODS We retrospectively evaluated 206 high-risk prostate cancer patients treated with RP and analyzed data on age, serum PSA level at diagnosis, biopsy Gleason score (bGS), surgical margin (SM), clinical T stage (cT), extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node metastasis (LN), and neoadjuvant therapy. RESULTS An IDC-P component was found in 104 cases. Forty-four patients experienced clinical failure, and 20 patients died of the disease. Patients with IDC-P showed a higher bGS and stage (including cT, EPE, SVI, and LN) than those without IDC-P. In univariate analysis, IDC-P, PSA level, bGS, SM, cT, SVI, LN, and EPE (P < 0.0001) were significantly associated with PFS. IDC-P (P = 0.0004), PSA level (P < 0.0001), SM (P = 0.0013), cT (P = 0.0019), SVI (P = 0.0012), and LN (P = 0.0002) were significantly associated with CSS. In multivariate analysis, IDC-P (P = 0.0038), and cT (P = 0.0001) were significantly associated with PFS. IDC-P (P = 0.0238) and PSA level (P = 0.0112) were significantly associated with CSS. CONCLUSIONS IDC-P in RP specimens was an independent risk factor for PFS and CSS and could predict clinical outcomes.© 2014 Wiley Periodicals, Inc. Source

Sawazaki M.,Komaki City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

In this study, we assessed the repair techniques employed for mitral valve prolapse. Between 1992 and 2011, we repaired 173 consecutive patients with mitral valve prolapse. The mean age of the patients was 60.1 years and 68.6% were male. For anterior leaflet (AL) prolapse, 27 patients with fibroelastic deficiency (FED) were treated with chordal replacement (CR). In 21 patients with Barlow type, 2 were repaired with CR and the remaining 19 were repaired with resection. In 130 patients with a prolapse of the posterior leaflet (PL), we selected quadrangular resection( QR:44), sliding plasty( SP:12), folding plasty and CR. More recently, triangular resection (TrR:22) was selected for ≤18 mm height leaflets, and an hourglass resection( HgR:21) for high leaflets.Hourglass represents the shape of the resection. In 1 patient of the AL CR group, the expanded polytetrafluoroethylene (ePTFE) was broken. Other patients in this group showed no mitral regurgitation (MR) and no re-operation during 16 years. Two patients receiving CR for AL Barlow received re-repair, whilst the other 19 patients in this group displayed good results over the following 19 years. In the QR and SP groups, 1 patient was rerepaired,whilst 3 patients displayed complicated mitral stenosis. In the TrR and HgR groups, no MR,no re-operation and no late deaths occurred during the following 4.5 years. CR for AL FED, resection for AL Barlow and TrR or HgR for PL were durable techniques for the treatment of mitral valve prolapse. Source

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