A comparison of outcomes of Endoscopic Submucosal Dissection (ESD) for early gastric neoplasms between high-volume and low-volume centers: Multi-center retrospective questionnaire study conducted by the Nagano ESD Study Group
Hotta K.,Saku Central Hospital |
Oyama T.,Saku Central Hospital |
Akamatsu T.,Shinshu University |
Tomori A.,Saku Central Hospital |
And 6 more authors.
Internal Medicine | Year: 2010
Objective: Outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasms at low-volume centers have been unknown, because all previous reports have studied in advanced single centers. The aim of this study was to compare ESD outcomes between high- and low-volume centers. Methods: A retrospective questionnaire survey was conducted and 30 centers (96.8%) responded. The complete en-bloc resection rate (CERR) and the incidence of complications were analyzed. Early gastric cancer (EGC) was divided into three categories on the basis of pathological diagnosis-standard indication (SI), expanded indication (EI) and out-of-indication (OI). Results: A total of 703 early gastric neoplasms (586 EGCs, 117 gastric adenomas) were treated with ESD from January to December 2005. The institutions that treated more than 30 cases a year were classified as high-volume centers, and those with less than 30 cases, low-volume centers. In SI, the CERRs at high- and low-volume centers were 92.1% and 91.1%, in EI, CERRs were 86.2% and 82.6% and in OI, CERRs were 80.3% and 88.0%. The perforation rates at high- and low-volume centers were 3.6% and 4.7%. The intraoperative bleeding rates at high- and low-volume centers were 0.26% and 0%, while the delayed bleeding rates were 0% and 0.63%. Conclusion: There were no significant difference in the outcomes of ESD for early gastric neoplasms between high- and low volume centers. © 2010 The Japanese Society of Internal Medicine.
Ikegami S.,Shinshu University |
Uchiyama S.,Shinshu University |
Nakamura Y.,Shinshu University |
Mukaiyama K.,Shinshu University |
And 4 more authors.
Journal of Bone and Mineral Metabolism | Year: 2015
The exponential increase in the incidence of fragility fractures in older people is attributed to attenuation of both bone strength and neuromuscular function. Decrease in bone mineral density (BMD) does not entirely explain this increase. The objective of this study is to investigate the effect of age on various parameters related to bone health with aging, and to identify combinations of factors that collectively express the bone metabolic state in healthy postmenopausal women. Height, weight, and grip strength were measured in 135 healthy postmenopausal volunteer women. Hip BMD, biomechanical indices derived from quantitative computed tomography (QCT), cross-sectional areas of muscle and fat of the proximal thigh, and various biochemical markers of bone metabolism were measured. A smaller group of factors explanatory for bone health was identified using factor analysis and each was newly named. As a result, the factors bone mass, bone turnover, bone structure, and muscle strength had the greatest explanatory power for assessing the bone health of healthy postmenopausal women. Whereas dual X-ray absorptiometry parameters only loaded on the factor bone mass, QCT parameters loaded on both the factors bone mass and bone structure. Most bone turnover markers loaded on the factor bone turnover, but deoxypyridinoline loaded on both bone turnover and muscle strength. Age was negatively correlated with bone mass (r = −0.49, p < 0.001) and muscle strength (r = −0.67, p < 0.001). We conclude that aging is associated as much with muscle weakening as with low BMD. More attention should be paid to the effects of muscle weakening during aging in assessments of bone health. © 2014, The Japanese Society for Bone and Mineral Research and Springer Japan.
Bae J.Y.,Medical Simulation |
Han D.-W.,Pusan National University |
Wakitani S.,Osaka City University |
Nawata M.,Marunouchi Hospital |
Hyon S.H.,Medical Simulation
Cell Transplantation | Year: 2010
The beneficial effects of (-)-epigallocatechin-3-O-gallate (EGCG) on the nonfrozen preservation of mammalian cells and tissues are generally not well understood. A storage solution containing EGCG was employed to test the hypothesis that EGCG is capable of extending the storage duration for the cold preservation of articular cartilages. Human articular cartilages were preserved in a storage solution composed of serum-free RPMI-1640 medium with 1% antibiotic-antimycotic solution and 1 mM EGCG at 4°C for 1, 2, and 4 weeks. The chondrocyte viability (CCK-8 assay), biochemical and immunohistochemical composition [glycosaminoglycans (GAG) and (type II) collagen], and biomechanical property (compressive elastic modulus) were assessed. The chondrocyte viability of the cartilages preserved with EGCG was significantly well maintained for at least 2 weeks with high content of GAG and total collagen. These beneficial effects of EGCG were confirmed by the immunohistochemical observations of well-preserved cartilaginous structures and delayed denaturation of the extracellular matrix in preserved cartilages. There was no significant difference in the compressive elastic modulus (MPa) between the cartilages preserved with and without EGCG. These results suggest that EGCG may play an effective role in preserving osteochondral allografts, which can be exploited in devising strategies for the long-term preservation of other tissues under cold storage conditions. Copyright © 2010 Cognizant Comm. Corp.
PubMed | Shinshu University, Marunouchi Hospital and Kitami Institute of Technology
Type: Journal Article | Journal: Journal of medical ultrasonics (2001) | Year: 2015
We have devised a method that can obtain continuous detailed distributions of the elastic modulus along the measurement line in a non-decalcified specimen of human bone tissue. The aim of this study was to determine whether local variations exist in the distribution of mechanical properties within the trochanteric region of the femur of elderly females using a newly developed form of scanning acoustic microscopy (SAM) technology.Human proximal femurs were harvested from seven female cadavers aged between 67 and 88 years at death. Using data collected with SAM, the elastic modulus of cortical and trabecular bone tissue of the lateral and medial trochanter was calculated and statistically analyzed.The longitudinal and transverse elastic moduli in cortical bone tissue of the lateral trochanter were found to be significantly lower than those of the medial trochanter in all specimens from individuals over age 70 (p < 0.05). Compared to that of the distal region, the longitudinal and transverse elastic moduli of trabecular bone tissue of the proximal region of the lateral trochanter were significantly lower in all specimens from individuals over age 80 (p < 0.05).Our new method allows obtaining detailed distributions of the elastic modulus of bone tissue.
Kimura T.,Shinshu University |
Shinji A.,Red Cross |
Horiuchi A.,Showa Inan General Hospital |
Tanaka N.,Shinshu University |
And 8 more authors.
Digestive Diseases and Sciences | Year: 2012
Background: Ischemic colitis (IC) typically develops in the elderly, where hypertension, cerebrocardiovascular disease, and past history of abdominal surgery are regarded as risk factors. Although there have been reports of younger patients with IC, its clinical features remain unclear. Aim: The aim of this study was to clarify the clinical characteristics of IC in young adults. Methods: Three hundred fifty-nine patients were diagnosed as having IC at five hospitals across Nagano prefecture, Japan. Clinical data were compared between the young patient group [20-45 years, n = 53 (15%)] and the elderly patient group [>45 years, n = 306 (85%)], as well as with age- and gender-matched healthy individuals (n = 156). Results: The presence of a smoking habit and hyperuricemia were significantly higher in the young patient group compared with the elderly patient group (42 vs. 19%, P = 0.001 and 8 vs. 1%, P = 0.019, respectively), which was confirmed by multiple logistic regression analysis (P = 0.001, odds ratio 3.239 and P = 0.028, odds ratio 16.907, respectively). Additionally, multiple logistic regression analysis of the young IC patient group and age- and gender-matched healthy individuals demonstrated that these two factors were strongly associated with IC development (P = 0.008, odds ratio 2.49 for smoking habit and P = 0.039, odds ratio 6.37 for hyperuricemia). Conclusions: High prevalences of a smoking habit and hyperuricemia are characteristic features of IC in the young adult population. © Springer Science+Business Media, LLC 2012.
PubMed | Shinshu University, Shinonoi General Hospital, Ina Central Hospital and Marunouchi Hospital
Type: Journal Article | Journal: Asian spine journal | Year: 2015
Retrospective chart review.A comparison of mini open foraminotomy (MOF) for cervical radiculopathy using either large tubular (LT) or TrimLine (TL) retractors.Posterior foraminotomy relieves compression of the cervical nerve root in radiculopathy patients. However, invasion of the paravertebral muscle may cause major problems in these patients. To address these problems, we performed MOF.Twenty cervical radiculopathy patients (16 male and 4 female) who underwent MOF between May 2004 and August 2011 were assigned to LT and TL groups. Each group contained 10 subjects. Surgical and clinical outcomes were compared.The average operating time in the TL group was significantly shorter than that in the LT group. The final follow-up mean neck disability indices significantly improved compared to the preoperative values (LT group, 12.07.8 vs. 28.09.4; TL group, 6.05.9 vs. 21.910). The final follow-up neck pain visual analog scale (VAS) scores also decreased significantly from the preoperative of 8.01.5 and 2.52.5 to the final follow-up values of 2.22.2 and 1.02.5 in the LT and TL groups, respectively. The recovery rate for the neck pain VAS score was 70.031.9 in the LT group and 87.032.0 in the TL group, thus suggesting no significant difference between the two groups.MOF with the TL retractor is an easy and safe procedure. Furthermore, the use of the TL retractor allows for a minimally invasive and effective surgical treatment of cervical radiculopathy patients.
Akahane T.,Shinshu Ueda Medical Center |
Mori N.,Shinshu Ueda Medical Center |
Nakatsuchi Y.,Marunouchi Hospital
Journal of Medical Case Reports | Year: 2015
Introduction: Myositis ossificans is a benign, self-limiting, tumor-like lesion that usually affects the elbow and thigh; occurrence in the hand is uncommon. We report a rare case of a patient with myositis ossificans in the thenar region. Case presentation: A 15-year-old Japanese girl presented to our hospital with a 2-month history of a painful mass in the right thenar region without previous trauma. The clinical and radiological examination findings suggested an osteoblastic malignancy. A diagnosis of myositis ossificans was made on the basis of an incisional biopsy. Despite the location of the lesion in the thenar region, a normal functional outcome was achieved after marginal resection of the mature lesion. Conclusions: Clinicians should consider myositis ossificans as a possible diagnosis for a soft tissue mass in the hand, thereby avoiding unnecessarily aggressive therapy. © 2015 Akahane et al.; licensee BioMed Central.
Funakubo Asanuma Y.,Saitama University |
Funakubo Asanuma Y.,Marunouchi Hospital
Japanese Journal of Clinical Immunology | Year: 2015
Rheumatoid arthritis (RA) affects mainly women during their childbearing years. As aging of childbirth advances in Japan, women who plan pregnancy would increase after they developed RA. Recent findings showed that high disease activity of RA might impair fertility. Planning pregnancy is preferable after female patients achive and maintain low disease activity or remission of RA. Women on methotrexate, which is the anchor drug for RA, need to discontinue the medication with a high risk of causing birth defects during conception and pregnancy. Data of RA patients exposed TNF inhibitors during pregnancy has been accumulating in recent years. These data suggest that increased risk of spontaneous abortion and congenital abnomalies has not been observed. Although there is insufficient data about safety of breastfeeding while using TNF inhibitors, the secretion of the drugs in breast milk is very little and fetal toxicity has not been observed. Since long term safety of children exposed TNF inhibitors in uterus has not been established, we should discontinue the drugs as soon as pregnancy is recognized. TNF inhibitors may be an useful tools for management of active RA resistant to conventional DMARDs in women who desire to bear children. © 2015 The Japan Society for Clinical Immunology.
Takanashi T.,Marunouchi Hospital |
Matsuda M.,Shinshu University |
Yazaki M.,Shinshu University |
Yamazaki H.,Marunouchi Hospital |
And 3 more authors.
Amyloid | Year: 2013
Objective: To investigate histological features of deposited amyloid in the synovial tissue and its clinical significance in knee joint osteoarthritis (OA) patients. Methods: We prospectively enrolled 232 consecutive patients who underwent arthroplasty or total replacement of the knee joint for treatment of OA. Congo red staining and immunohistochemistry were performed in the synovial tissue obtained at surgery. When transthyretin (TTR)-derived amyloid was positive, we analyzed all 4 exons of the TTR gene using the direct DNA sequencing method in order to detect mutations. Results: We analyzed 322 specimens in this study. Twenty-six specimens (8.1%) obtained from 21 patients (5 men and 16 women; mean, 79.0±4.6 years) showed deposition of amyloid, which was positively stained with the anti-TTR antibody. Eighteen patients showed inhomogeneous accumulations of amyloid in the loose connective tissue under the synovial epithelia sometimes with nodule formation, while in the remaining three, small vessels in the adipose tissue were involved. Medical records of these patients revealed nothing remarkable in the clinical course, laboratory data or macroscopic intraarticular findings at surgery. No mutations were detectable in the TTR gene analysis. Conclusion: Wild-type TTR-derived amyloid may affect the synovial tissue as a result of long-term mechanical stress or as a part of senile systemic amyloidosis in approximately 8% of knee joint OA patients. No obvious clinical significance was found in synovial deposition of amyloid. © 2013 Informa UK Ltd. All rights reserved.
PubMed | Shinshu University, Azumi Hospital, Aizawa Hospital and Marunouchi Hospital
Type: Journal Article | Journal: The American journal of sports medicine | Year: 2016
Bone peg grafting (BPG) has been advocated for early-stage humeral capitellar osteochondritis dissecans (COCD). However, the clinical and radiological results of BPG, along with its indications, have not been described in detail.COCD classified as International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) I or II in adolescent baseball players can be treated successfully by BPG.Case series; Level of evidence, 4 METHODS: Eleven male baseball players (age range at surgery, 13-16 years) who underwent BPG for COCD were enrolled in this study. No improvement had been seen in any patient after 6 months of preoperative nonthrowing observation. During surgery, 2 to 5 bone pegs were inserted into the COCD lesion after confirmation of lesion stability to the bony floor. All patients were directly evaluated at 12 and 24 months after surgery by physical findings, radiological prognosis, and magnetic resonance imaging (MRI).Of the 11 patients, 10 could return to comparable baseball ability levels within 12 months. The Timmerman-Andrews score improved significantly from a mean SD of 171.8 12.1 preoperatively to 192.3 6.5 at the final observation. Radiological healing of the lesions was determined as complete in 8 patients and partial in 3. Patients possessing a centrally positioned lesion or a lesion <75% of the size of the capitellum tended most strongly to achieve complete radiological healing, while growth plate status appeared unrelated to outcome. The mean Henderson MRI score improved from 6.3 1.5 to 4.8 1.6 at 12 and 24 months after BPG, respectively. MRI findings also suggested that remodeling of COCD lesions had continued to up to 24 months postoperatively.BPG enabled 91% of COCD patients with ICRS OCD I or II to return to preoperative baseball abilities within 12 months. Integration of the grafted site may continue until at least 24 months postoperatively. An ICRS OCD I or II lesion with central positioning and/or occupying <75% of the size of the capitellum in the coronal plane is a good indication for BPG.