PubMed | Nagoya Ekisaikai Hospital, Handa City Hospital, Kasugai Municipal Hospital, Nagoya University and 2 more.
Type: | Journal: The British journal of surgery | Year: 2017
Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS).Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis.In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (548 per cent). The estimated cumulative probability of recurrence was 543 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (141 per cent) and initial distant recurrence in 168 (432 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (116 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0001 and P = 0009 respectively), pancreatic invasion (both P <0001) and lymph node metastasis (both P <0001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 706 per cent for patients without any risk factors, 503 per cent for patients with one factor, 318 per cent for those with two factors, and 134 per cent when three factors were present.More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.
Shindo Y.,Nagoya University |
Ito R.,Nagoya University |
Ito R.,Red Cross |
Kobayashi D.,Nagoya University |
And 23 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2013
Rationale: Identification of patients with drug-resistant pathogens at initial diagnosis is essential for treatment of pneumonia. Objectives: Toelucidateclinicalfeaturesofcommunity-acquiredpneumonia (CAP) and healthcare-associated pneumonia (HCAP), and to clarify risk factors fordrug-resistantpathogens inpatientswithCAPandHCAP. Methods: A prospective observational study was conducted in hospitalizedpatientswithpneumoniaat10institutions inJapan.Pathogens identified as not susceptible to ceftriaxone, ampicillin-sulbactam,macrolides, and respiratory fluoroquinolones were defined as CAP drugresistant pathogens (CAP-DRPs). Measurements and Main Results: In total, 1,413 patients (887 CAP and 526 HCAP) were analyzed. CAP-DRPs were more frequently found in patients with HCAP (26.6%) than in patients with CAP (8.6%). Independent risk factors for CAP-DRPs were almost identical in patients with CAP and HCAP. These included prior hospitalization (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.23-3.43), immunosuppression (AOR, 2.31; 95% CI, 1.05-5.11), previous antibioticuse( AOR,2.45;95%CI,1.51-3.98),useofgastricacid-suppressive agents (AOR, 2.22; 95%CI, 1.39-3.57), tube feeding (AOR, 2.43; 95% CI, 1.18-5.00), and nonambulatory status (AOR, 2.45; 95% CI, 1.40-4.30) in the combined patients with CAP and HCAP. The area under the receiveroperating characteristic curve for counting the numberof risk factors was 0.79 (95%CI, 0.74-0.84). Conclusions: The clinical profile of HCAP was different from that of CAP. However, physicians can predict drug resistance in patients with eitherCAPorHCAPbytaking account of the cumulativenumber of the risk factors. Copyright © 2013 by the American Thoracic Society.
Iwata M.,Aichi University |
Yamanaka K.,Aichi University |
Kitagawa Y.,Nagoya Ekisaikai Hospital
International Journal of Emergency Medicine | Year: 2013
Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7% of the patients (1,215/3,503), and 88% of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95% of the time (1,153/1,215), with κ = 0.76 (95% CI 0.70-0.82). Opinions about disposition were discordant in 5% of the patients consulted upon. In 63% of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes. © 2013 Iwata et al.; licensee Springer.
Uchida W.,Nagoya Ekisaikai Hospital |
Hirate Y.,Nagoya Ekisaikai Hospital |
Ito H.,Nagoya Ekisaikai Hospital |
Kawaguchi O.,Toyota Kosei Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2013
We report a case of isolated pulmonary infectious endocarditis (IE) with Candida parapsilosis. A 66-year-old man presented with fever and cough. Echocardiography showed severe pulmonary regurgitation and vegetations on the pulmonary valves. Initially, antibiotics were prescribed against bacterial IE, and the vegetations disappeared; however, the pulmonary vegetations relapsed, and C. parapsilosis was grown from blood cultures. We performed a debridement without a pulmonary valve replacement. There was no recurrence of IE for 3 years, and then the patient developed right ventricular enlargement and severe tricuspid regurgitation due to severe pulmonary regurgitation. Pulmonary valve replacement was performed. Now the patient is free from infection. © 2013 The Author.
Itatsu K.,Nagoya University |
Yokoyama Y.,Nagoya University |
Sugawara G.,Nagoya University |
Kubota H.,Handa City Hospital |
And 6 more authors.
British Journal of Surgery | Year: 2014
Results: A total of 4305 consecutive patients were registered. Of these, 378 were excluded because of failure to complete follow-up and 3927 patients were analysed. IH was diagnosed in 318 patients. The estimated incidence rates for IH were 5.2 per cent at 12 months and 10.3 per cent at 24 months. In multivariable analysis, wound classification III and IV (hazard ratio (HR) 2.26, 95 per cent confidence interval 1.52 to 3.35), body mass index of 25 kg/m2or higher (HR 1.76, 1.35 to 2.30), midline incision (HR 1.74, 1.28 to 2.38), incisional surgical-site infection (I-SSI) (HR 1.68, 1.24 to 2.28), preoperative chemotherapy (HR 1.61, 1.08 to 2.37), blood transfusion (HR 1.46, 1.04 to 2.05), increasing age by 10-year interval (HR 1.30, 1.16 to 1.45), female sex (HR 1.26, 1.01 to 1.59) and thickness of subcutaneous tissue for every 1-cm increase (HR 1.18, 1.03 to 1.35) were identified as independent risk factors. Compared with superficial I-SSI, deep I-SSI was more strongly associated with the development of IH.Conclusion: Although there are several risk factors for IH, reducing I-SSI is an important step in the prevention of IH. Registration number: UMIN000004723 (University Hospital Medical Information Network, http://www.umin.ac.jp/ctr/index.htm).Background: Few larger studies have estimated the incidence of incisional hernia (IH) after abdominal surgery.Methods: Patients who had abdominal surgery between November 2009 and February 2011 were included in the study. The incidence rate and risk factors for IH were monitored for at least 180 days. © 2014 BJS Society Ltd.
Hoshino Y.,Nagoya University |
Nishikawa K.,Nagoya Ekisaikai Hospital |
Ito Y.,Nagoya University |
Kuzushima K.,Aichi Cancer Center Research Institute |
Kimura H.,Nagoya University
Journal of Clinical Virology | Year: 2011
Background: During the convalescent phase of acute infectious mononucleosis (AIM), Epstein-Barr virus (EBV) load shrinks rapidly in association with a rapid decline in the number of EBV-specific CD8+ T cells. The actual contribution of EBV-specific CD8+ T cells in reducing EBV load, however, is not known. Objectives: To clarify the impact of EBV-specific CD8+ T cells on the contraction of EBV load in AIM, we estimated half-lives of both EBV load and EBV-specific CD8+ T cells. Study design: Blood was serially taken from five pediatric patients with AIM during the convalescent period, including the very early phase, and both EBV load and EBV-specific CD8+ T cell numbers were assayed. Results: EBV load declined rapidly (half-life 1.5 d) during the first 2 weeks after onset of symptoms. This half-life was seven-fold shorter than that reported for CD27+ memory B cells. Subsequently, the EBV load declined much more slowly, with a half-life of 38.7 d. EBV-specific CD8+ T cell numbers also declined concomitantly with the decrease in EBV load. The half-life of EBV-specific CD8+ T cells during first 2 weeks was 2.9 d. The number of EBV-specific CD8+ T cells and the rate of change of viral load correlated significantly (R2≥0.8; p≤0.02). Conclusions: The short half-life of EBV load, together with the strong correlation between the number of EBV-specific CD8+ T cells and the rate of change of viral load indicates an active role for EBV-specific CD8+ T cells in elimination of EBV in AIM. © 2010 Elsevier B.V.
Muro Y.,Nagoya University |
Sugiura K.,Nagoya University |
Hoshino K.,Nagoya University |
Hoshino K.,Nagoya Ekisaikai Hospital |
And 2 more authors.
Arthritis Research and Therapy | Year: 2011
Introduction: Several reports have found the onset or activity of inflammatory myopathies to show spatial clustering and seasonal association. We recently detected autoantibodies against melanoma differentiation-associated gene 5 (MDA-5) in more than 20% of patients with dermatomyositis. Anti-MDA-5 antibodies were associated with the presence of rapidly progressive interstitial lung disease in clinically amyopathic dermatomyositis (CADM). The present study aims to assess the growing prevalence of CADM and the geographical incidence of anti-MDA-5-positive patients.Methods: We reviewed medical charts and examined the presence of anti-MDA-5 antibodies in 95 patients, including 36 CADM patients. Sera were obtained from 1994 through 2011. Statistical analyses were performed to assess whether CADM development and the presence of anti-MDA-5 antibodies were associated with various parameters, including age at disease onset, season of onset, annual positivity, and population of resident city.Results: Tertiles based on the year when the sera were collected showed increasing tendencies of CADM and anti-MDA-5-positive patients among all of the dermatomyositis patients. From 1994 to 2010, the relative prevalence of CADM and anti-MDA-5 antibody-positive patients significantly increased. Interestingly, the presence of anti-MDA-5 antibodies in 26 patients was inversely associated with the population of their city of residence.Conclusions: This is the first study to examine the distribution of anti-MDA-5-positive dermatomyositis phenotypes in Japan. Regional differences in the incidences of these phenotypes would suggest that environmental factors contribute to the production of antibodies against MDA-5, which triggers innate antiviral responses. © 2012 Muro et al.; licensee BioMed Central Ltd.
Yoneda H.,Nagoya Ekisaikai Hospital |
Watanabe K.,Nagoya Ekisaikai Hospital
Journal of Hand Surgery: European Volume | Year: 2014
We performed primary excision of the ulnar head on 23 patients over 70 years of age with severe comminuted fractures of both the distal radius and ulna. The distal radius fracture was fixed rigidly with a volar locking plate, and the ulnar head was resected at the fracture site. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 122, the mean pronation/supination arc was 164, and grip strength was 69% of that on the contralateral side. All patients returned to their daily activities within a short time without any additional surgical treatment. For elderly patients, primary excision of the ulnar head is an effective treatment for comminuted distal radius and ulna fractures. © 2013 The Author(s).
Watanabe K.,Nagoya Ekisaikai Hospital |
Kino Y.,Nagoya Ekisaikai Hospital |
Yajima H.,Nagoya Ekisaikai Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2015
To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.
Watanabe K.,Nagoya Ekisaikai Hospital
Journal of Hand Surgery | Year: 2011
Purpose To clarify the correlation between a scaphoid deformity and carpal malalignment in patients with scaphoid waist nonunion and to investigate how accurately a corrective bone graft improves carpal malalignment according to the preoperative plan. Methods A total of 38 patients were analyzed retrospectively. Surgery was performed according to the anterior wedge bone graft method described by Fernandez. The scaphoid deformity and carpal malalignment were evaluated by the changes in the intrascaphoid angle (ISA) and axial length (AL) and by the changes in the radiolunate angle (RLA) and scapholunate angle (SLA), respectively, compared with the uninjured side by using standardized x-rays. Each variable was measured at 1 year after surgery. By performing multiple regression analysis, the correlation between the scaphoid deformity and carpal malalignment and between the correction of the scaphoid deformity and the change in carpal alignment were analyzed. Results Compared with the uninjured side, the mean respective changes in the ISA, AL, RLA, and SLA were 11°, 1.3 mm, 14°, and 11°, preoperatively. The changes in the RLA and SLA correlated with the change in the ISA, but not with the change in the AL. The mean postoperative corrections of the ISA and AL were 15° from full extension and 1.7 mm, and the changes in the RLA and SLA were 18° and 12° from full extension, respectively. The change in the RLA correlated with the corrections of the ISA and AL. Although the change in the SLA did not correlate with either of them, the mean postoperative SLA was not significantly different from the mean value of the uninjured side. Conclusions The degree of humpback deformity of the scaphoid correlated with the degree of carpal malalignment. The corrective bone graft resulted in the expected recovery of carpal alignment according to the preoperative plan. Type of study/level of evidence Prognostic IV. © 2011 American Society for Surgery of the Hand.