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Endo A.,Saiseikai Central Hospital | Endo A.,Keio University | Kawamura A.,Keio University | Miyata H.,University of Tokyo | And 45 more authors.
PLoS ONE | Year: 2015

Objective: We devised a percutaneous coronary intervention (PCI) scoring system based on angio-graphic lesion complexity and assessed its association with in-hospital complications. Background: Although PCI is finding increasing application in patients with coronary artery disease, lesion complexity can lead to in-hospital complications. Methods: Data from 3692 PCI patients were scored based on lesion complexity, defined by bifurcation, chronic total occlusion, type C, and left main lesion, along with acute thrombus in the presence of ST-segment elevation myocardial infarction (1 point assigned for each variable). Results: The patients' mean age was 67.5 +/- 10.8 years; 79.8% were male. About half of the patients (50.3%) presented with an acute coronary syndrome, and 2218 (60.1%) underwent PCI for at least one complex lesion. The patients in the higher-risk score groups were older (p < 0.001) and had present or previous heart failure (p = 0.02 and p = 0.01, respectively). Higher-risk score groups had significantly higher in-hospital event rates for death, heart failure, and cardiogenic shock (from 0 to 4 risk score; 1.7%, 4.5%, 6.3%, 7.1%, 40%, p < 0.001); bleeding with a hemoglobin decrease of >3.0 g/dL (3.1%, 11.0%, 13.1%, 10.3%, 28.6%, p < 0.001); and postoperative myocardial infarction (1.5%, 3.1%, 3.8%, 3.8%, 10%, p = 0.004), respectively. The association with adverse outcomes persisted after adjustment for known clinical predictors (odds ratio 1.72, p < 0.001). Conclusion: The complexity score was cumulatively associated with in-hospital mortality and complication rate and could be used for event prediction in PCI patients. © 2015 Endo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Sakamoto K.,Keio University | Sakamoto K.,Saiseikai Utsunomiya Hospital | Imanishi Y.,Keio University | Tomita T.,Keio University | And 10 more authors.
Japanese Journal of Head and Neck Cancer | Year: 2011

We reviewed 86 patients with oral tongue squamous cell carcinoma who were initially treated with curative intent in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1996 and 2007. Statistical analysis was performed to examine the prognostic value of the clinical features. Eighty patients underwent surgery and six underwent radiotherapy as the initial treatment. The five-year disease-free survival (DFS) rates determined by the Kaplan-Meier method were as follows: 75.8% in all stages, 88.7% in stage I (n = 30), 82.6% in stage II (n = 24), 77.1% in stage III (n = 14), and 39.7% in stage IV (n = 18). Univariate analysis demonstrated that stage III/IV, T 3/4, and N2 were significantly correlated with poor prognosis, whereas multivariate analysis showed that only N2 was independently correlated with poor prognosis. Neoadjuvant chemotherapy (NAC) was applied for 24 patients. Although the DFS of the responders (CR+PR) was higher than that of the non-responders (NC+PD), the difference was not significant. Among 80 patients who received surgical treatment initially, neck dissection (ND) was performed in 42 patients. Five-year DFS was significantly higher in the patients with no or single node metastasis than in the patients with multiple node metastases (93.8% vs. 32.7%). These outcomes suggest that more aggressive postoperative therapy should be recommended for patients found to have pathologically multiple positive nodes.

Matsuzaki S.,Keio University | Matsuzaki S.,Tachikawa Kyosai Hospital | Sato Y.,Tachikawa Kyosai Hospital | Habu N.,Tachikawa Kyosai Hospital | Senba K.,Tachikawa Kyosai Hospital
Journal of Otolaryngology of Japan | Year: 2016

HIV-associated salivary gland disease (HSD) is one of the initial symptoms of HIV infection. HSD occurs in about 5%∼10% HIV patients. Usually, HSD shows multilocular soft cystic lesions in parotid glands; however, it does not show bilateral parotid abscesses. We report the case of a 32-year-old man with HIV infection that initially presented as bilateral parotid abscesses. He came to our hospital with a 1-week history of bilateral parotid swelling. He did not have a history of HIV infection, diabetes mellitus, or tuberculosis infection. We performed incision and drainage, bacterial culture, and serological examination, which showed HIV infection. This is a rare case of HSD starting as bilateral parotid abscesses. Because cystic enlargement of the bilateral parotid glands is an unusual condition in the HIV-negative population, HIV testing should be recommended in such cases.

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