Yamada E.,Yokohama City University |
Inamori M.,Yokohama City University |
Uchida E.,Machida Municipal Hospital |
Tanida E.,Machida Municipal Hospital |
And 9 more authors.
American Journal of Gastroenterology | Year: 2014
OBJECTIVES:No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).METHODS:We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.RESULTS:Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.CONCLUSIONS:Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739). © 2014 by the American College of Gastroenterology.
Randomized Placebo-Controlled and Controlled Non-Inferiority Phase III Trials Comparing Trafermin, a Recombinant Human Fibroblast Growth Factor 2, and Enamel Matrix Derivative in Periodontal Regeneration in Intrabony Defects
PubMed | Nakayamadera Imai Clinic, Showa University, Tohoku University, Kaken Co. and 20 more.
Type: Journal Article | Journal: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research | Year: 2016
We investigated the efficacy, safety, and clinical significance of trafermin, a recombinant human fibroblast growth factor (rhFGF)-2, for periodontal regeneration in intrabony defects in Phase III trials. Study A, a multicenter, randomized, double-blind, placebo-controlled study, was conducted at 24 centers. Patients with periodontitis with 4-mm and 3-mm or deeper probing pocket depth and intrabony defects, respectively, were included. A total of 328 patients were randomly assigned (2:1) to receive 0.3% rhFGF-2 or placebo, and 323 patients received the assigned investigational drug during flap surgery. One of the co-primary endpoints, the percentage of bone fill at 36 weeks after drug administration, was significantly greater in the rhFGF-2 group at 37.131% (95% confidence interval [CI], 32.7502 to 41.5123; n = 208) than it was in the placebo group at 21.579% (95% CI, 16.3571 to 26.8011; n = 100; p < 0.001). The other endpoint, the clinical attachment level regained at 36 weeks, was not significantly different between groups. Study B, a multicenter, randomized, blinded (patients and evaluators of radiographs), and active-controlled study was conducted at 15 centers to clarify the clinical significance of rhFGF-2. Patients with 6-mm and 4-mm or deeper probing pocket depth and intrabony defects, respectively, were included. A total of 274 patients were randomly assigned (5:5:2) to receive rhFGF-2, enamel matrix derivative (EMD), or flap surgery alone. A total of 267 patients received the assigned treatment during flap surgery. The primary endpoint, the linear alveolar bone growth at 36 weeks, was 1.927 mm (95% CI, 1.6615 to 2.1920; n = 108) in the rhFGF-2 group and 1.359 mm (95% CI, 1.0683 to 1.6495; n = 109) in the EMD group, showing non-inferiority (a prespecified margin of 0.3 mm) and superiority of rhFGF-2 to EMD. Safety problems were not identified in either study. Therefore, trafermin is an effective and safe treatment for periodontal regeneration in intrabony defect, and its efficacy was superior in rhFGF-2 compared to EMD treatments.
PubMed | Red Cross, Tokyo Medical and Dental University, Yokosuka Kyosai Hospital, Tokyo Yamate Medical Center and Machida Municipal Hospital
Type: | Journal: Artificial organs | Year: 2016
Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mmHg and a pulmonary arterial systolic pressure of <30 mmHg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion. From September 2006 to March 2012, MICAB was performed in 37 patients. Either emergent or urgent MICAB was performed in 27 patients following AMI because of hemodynamic instability during reconstruction. Elective MICAB was performed in the remaining 10 patients because of dilated left ventricle (LV) or small target coronary arteries. The details of bypass grafts, perioperative renal function, and early and mid-term morbidity and mortality were compared between the patients who received MICAB and the 37 consecutive patients who underwent OPCAB during the study period at our hospital. The assist flow indices (actual support flow/body surface area) during anastomosis to the left anterior descending artery, left circumflex artery, and right coronary artery were 0.950.48 L/min/m
Shinohara T.,Machida Municipal Hospital |
Shinohara T.,Jikei University School of Medicine |
Hanyu N.,Machida Municipal Hospital |
Tanaka Y.,Machida Municipal Hospital |
And 3 more authors.
Langenbeck's Archives of Surgery | Year: 2013
Background: In patients having carcinoma in the remnant stomach, total resection of the remnant stomach with lymph node dissection is a prerequisite. Materials and methods: We present the first series of successful totally laparoscopic complete gastrectomy (TLCG) for gastric remnant cancer. Results: TLCG was successfully performed without adverse events during surgery in five patients with gastric remnant cancer. The median age of the patients was 72 years (range, 56-84 years), and there were three men and two women. Three of them had a Billroth I reconstruction and two had a Billroth II reconstruction, and in four cases following partial gastrectomy for gastric cancer and one for gastroduodenal ulcer. The median operative time was 360 min; blood loss was 20 ml. The median number of retrieved lymph nodes was 19. No complications occurred postoperatively, and all of the patients were discharged within the ninth postoperative day. Conclusions: Although TLCG for gastric remnant cancer is a technically difficult and challenging operation that requires careful lysis of adhesion and dissection along the major vessels, as well as intracorporeal anastomosis, this procedure is technically feasible. Long-term follow-up is mandatory to validate oncological outcome. © 2012 Springer-Verlag.
Mizuno T.,Machida Municipal Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2011
Left ventricular assist devices (LVADs) greatly support heart recovery, but recurrent heart failure after LVAD removal limits their use as 'a bridge to recovery'. The combination of LVADs and cell transplantation (CTx) is expected to be effective to improve the success rate of LVAD removal. We investigated the feasibility of combined CTx therapy and LVAD support with a new heterotopic rat heart-lung transplantation model that could simulate LVAD support and LVAD removal. The heart and both lungs of a rat were heterotopically transplanted, and the heart was kept unloaded for two weeks. The heart was then reloaded for two weeks (LVAD group). Syngenic smooth muscle cells were transplanted into the hearts that had been unloaded for a week, and the hearts were kept unloaded for another week and then reloaded (CT-LVAD group). In the unloaded state, CTx could reduce the left ventricle (LV) volume more effectively than LVAD therapy alone (P<0.01) and maintain the LV volume even after the hearts were reloaded (P≤0.01). The results suggest that CTx with LVAD support can prevent recurrent LV dilation after LVAD removal and improve the success rate of LVAD removal. © 2011 Published by European Association for Cardio-Thoracic Surgery.
Fujita S.,Tokyo Medical and Dental University |
Arai H.,Tokyo Medical and Dental University |
Tomita M.,Tokyo Medical and Dental University |
Mizuno T.,Tokyo Medical and Dental University |
And 4 more authors.
Circulation Journal | Year: 2013
Optimal ring size in tricuspid annuloplasty (TAP) surgery to treat functional tricuspid regurgitation (TR) was investigated because optimal ring size remains undefined. Methods and Results: Sixty seven patients who underwent TAP at our institution were retrospectively studied. Tricuspid Annuloplasty Ring size Index (TARI) was defined as implanted tricuspid annuloplasty ring size divided by body surface area (BSA). Different TARI cut-off values were tested to determine which value produced the greatest difference in TR improvement (TRI=preoperative minus postoperative TR grade) between patients with TARI smaller (group S) and larger (group L) than the cut-off. Group S was also subdivided by ring type: Cosgrove rings (SC) and MC3 rings (SM). TARI and TRI were negatively correlated (r=-0.307). A TARI threshold of 18.9 mm/m2 produced the greatest and most significant difference (P<0.0005) in TRI. Defining groups S and L using this threshold, TRI was significantly greater for group S (1.77±0.80) than for group L (0.97±0.83); P <0.0005. There was no difference in TRI between groups SC and SM. Conclusions: A novel index TARI that normalizes tricuspid annuloplasty ring size by BSA was developed. Choosing ring size to make TARI <18.9 mm/m2 is likely to be better than setting an upper limit of absolute ring size in the surgical treatment of TR.
Kurihara Y.Y.,Machida Municipal Hospital
Japanese Journal of Clinical Radiology | Year: 2014
The neoplasms of the ear are rare and may be similar to the inflammatory lesions and normal variants. To diagnose them precisely, we need to familiar with those findings. As each disease has characteristic shape, location and density/intensity, we can differentiate many of them radiologically. In some cases, differentiation is difficult, which have to rely on the pathological diagnosis. Furthermore, the decision of bounds of tumor extension may be a determining factor of the operation procedure, which demand the radiological diagnosis.
Mizuno T.,Machida Municipal Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2011
We present a rare case with pituitary apoplexy after three-vessel off-pump coronary artery bypass grafting (OPCAB). The patient exhibited right third cranial nerve palsy; ptosis of the right eye with completely dilated pupils and a loss of reflex to light after the effects of anesthesia completely subsided. The patient underwent endonasal transsphenoidal resection of the pituitary gland 14 days after the OPCAB, and the symptoms completely disappeared 40 days after the resection. OPCAB is recommended for patients with known pituitary tumor who require coronary artery bypass grafting, but OPCAB also has a risk of pituitary apoplexy. The present case report is the first to describe pituitary apoplexy after OPCAB. Pituitary apoplexy is a very rare complication after cardiac surgery, but cardiac surgeons should know the disease and quickly diagnose it to avoid severe brain injury. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
PubMed | Machida Municipal Hospital
Type: | Journal: Asian journal of endoscopic surgery | Year: 2016
Accidental gallbladder perforation frequently occurs during laparoscopic cholecystectomy and may increase the risk of infection. However, the necessity of antimicrobial prophylaxis for these patients is unclear. The aim of this study was to examine the clinical outcomes and necessity of antimicrobial prophylaxis after laparoscopic cholecystectomy with gallbladder perforation.One hundred patients who underwent laparoscopic cholecystectomy were divided into two groups: patients with gallbladder perforation (Group A, n=37) and patients without perforation (Group B, n=63). We compared the white blood cell count and C-reactive protein level the day after the operation, the complication rates of systemic inflammatory response syndrome and surgical-site infection, and postoperative hospital stay between the two groups. All patients received antimicrobial prophylaxis only once before the operation.There were significant differences in every variable with the exception of postoperative hospital stay. Group A had a higher risk of infection, but the postoperative clinical course of Group A was not inferior to that of Group B.The clinical outcomes of patients with accidental gallbladder perforation were acceptable, and the use of antimicrobial prophylaxis once before the operation was sufficient.
PubMed | Machida Municipal Hospital
Type: Journal Article | Journal: Surgical endoscopy | Year: 2016
This study aimed to compare the short-term surgical outcomes and cost-benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (p=0.024) and received Roux-en-Y reconstruction more frequently (p<0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8%) after TLDG and in two patients (4.7%) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (p<0.001), a shorter time to oral intake (p=0.012), and hospital stay (p=0.018). The median operation costs were greater in the TLDG group than in the LADG group (982,000 in TLDG vs. 879,830 in LADG; p<0.001), whereas the median total hospital costs were similar between the two groups (1302,665 in LADG vs. 1383,322 in TLDG: p=0.119).This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.