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Izutani H.,Ehime University | Nakamura T.,National Hospital Organization Kure Medical Center | Kawachi K.,Ehime University
Heart International | Year: 2010

We review and compare our experience with tricuspid ring annuloplasty between usage of the Cosgrove-Edwards flexible band and the MC3 rigid ring for repair of functional tricuspid regurgitation to determine the efficacy and mid-term durability of tricuspid annuloplasty. 117 patients with functional tricuspid regurgitation undergoing open heart surgery and tricuspid valve repair from May 2005 to December 2007 were reviewed. The flexible bands were used in thirty five patients before October 2006. Since then, the rigid rings were used in the next consecutive eighty two cases. Echocardiographic evaluation of tricuspid regurgitation was performed preoperatively and postoperatively in followup schedule. The degree of tricuspid regurgitation was reduced from 2.80±0.67 to 0.71±1.0 (regurgitation severity grade: 0 to 4) in the patients with flexible bands at discharge It was from 2.68±0.70 to 0.22±0.60 in the patients with rigid rings. At thirty six months postoperative period, tricuspid regurgitation grades in patients with flexible bands and rigid rings were 0.80±0.95 and 0.36±0.77, respectively. Freedom from recurrent tricuspid regurgitation (grade 2 or 3) in patients with flexible bands and rigid rings were 68.6% and 87.8%, respectively. Recurrent tricuspid regurgitation was significantly lower in the patients with rigid rings. Although both flexible band and rigid ring annuloplasty provide low rate of recurrent tricuspid regurgitation, rigid ring annuloplasty might be more effective than flexible band annuloplasty for decreasing functional tricuspid regurgitation in immediate and mid-term postoperative periods. © H. Izutani et al., 2010.


Terada H.,National Hospital Organization Kure Medical Center
Japanese Journal of Clinical Radiology | Year: 2013

A male had complained right abdominal pain for a month. CT showed a irregular solid tumor with a size of 7×5 cm in the right lower abdomen. It involved the cecum, terminal ileum, and appendix. It was hard to distinguish from neoplasm on CT and surgery. Pathology revealed the tumor as an inflammatory mass due to cecal diverticulitis. We report a rare case of the inflammatory mass caused by diverticulitis.


Fujiwara Y.,Hiroshima City Asa Hospital | Manabe H.,Hiroshima City Asa Hospital | Sumida T.,National Hospital Organization Kure Medical Center | Tanaka N.,Hiroshima University | Hamasakiy T.,Saka Midorii Hospital
Journal of Spinal Disorders and Techniques | Year: 2015

Retro-odontoid pseudotumors are noninflammatory masses formed posterior to the odontoid process. Because of their anatomy, the optimal surgical approach for resecting pseudotumors is controversial. Conventionally, 3 approaches are used: the anterior transoral approach, the lateral approach, and the posterior extradural approach; however, each approach has its limitations. The posterior extradural approach is the most common; however, it remains challenging due to severe epidural veins. Although regression of pseudotumors after fusion surgery has been reported, direct decompression and a pathologic diagnosis are ideal when the pseudotumor is large. We therefore developed a new microscopic surgical technique; transdural resection. After C1 laminectomy, the dorsal and ventral dura was incised while preserving the arachnoid. Removal of the pseudotumor was performed and both of the dura were repaired. The patient's clinical symptoms subsequently improved and the pathologic findings showed degenerative fibrocartilaginous tissue. In addition, no neurological deterioration, central spinal fluid leakage, or arachnoiditis was observed. Currently, the usefulness of the transdural approach has been reported for cervical and thoracic disk herniation. According to our results, the transdural approach is recommended for resection of retro-odontoid pseudotumors because it enables direct decompression of the spinal cord and a pathologic diagnosis. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Okochi-Takada E.,National Cancer Center Research Institute | Hattori N.,National Cancer Center Research Institute | Tsukamoto T.,Aichi Cancer Center Research Institute | Miyamoto K.,National Hospital Organization Kure Medical Center | And 8 more authors.
Oncogene | Year: 2014

Tumor suppressors with extracellular function are likely to have advantages as targets for cancer therapy, but few are known. Here, we focused on angiopoietin-like 4 (ANGPTL4), which is a secreted glycoprotein involved in lipoprotein metabolism and angiogenesis, is methylation-silenced in human cancers, but has unclear roles in cancer development and progression. We found a deletion mutation in its coiled-coil domain at its N-terminal in human gastric cancers, in addition to hypermethylation of the ANGPTL4 promoter CpG islands. Forced expression of wild-type ANGPTL4, but not ANGPTL4 with the deletion, at physiological levels markedly suppressed in vivo tumorigenicity and tumor angiogenesis, indicating that the latter caused the former. Tumor-derived ANGPTL4 suppressed in vitro vascular tube formation and proliferation of human umbilical vascular endothelial cells, partly due to suppression of ERK signaling. These showed that ANGPTL4 is a genetically and epigenetically inactivated secreted tumor suppressor that inhibits tumor angiogenesis. © 2014 Macmillan Publishers Limited. All rights reserved.


Cheng H.,Thomas Jefferson University | Terai M.,Thomas Jefferson University | Kageyama K.,Thomas Jefferson University | Ozaki S.,Thomas Jefferson University | And 4 more authors.
Cancer Research | Year: 2015

Uveal melanoma patients with metastatic disease usually die within one year, emphasizing an urgent need to develop new treatment strategies for this cancer. MEK inhibitors improve survival in cutaneous melanoma patients but show only modest efficacy in metastatic uveal melanoma patients. In this study, we screened for growth factors that elicited resistance in newly characterized metastatic uveal melanoma cell lines to clinicalgrade MEK inhibitors, trametinib and selumetinib. We show that neuregulin 1 (NRG1) and hepatocyte growth factor (HGF) provide resistance to MEK inhibition. Mechanistically, trametinib enhances the responsiveness to NRG1 and sustained HGF-mediated activation of AKT. Individually targeting ERBB3 and cMET, the receptors for NRG1 and HGF, respectively, overcome resistance to trametinib provided by these growth factors and by conditioned medium from fibroblasts that produce NRG1 and HGF. Inhibition of AKT also effectively reverses the protective effect of NRG1 and HGF in trametinib-treated cells. Uveal melanoma xenografts growing in the liver in vivo and a subset of liver metastases of uveal melanoma patients express activated forms of ERBB2 (the coreceptor for ERBB3) and cMET. Together, these results provide preclinical evidence for the use of MEK inhibitors in combination with clinical-grade anti-ERBB3 or anti-cMET monoclonal antibodies in metastatic uveal melanoma. © 2015 American Association for Cancer Research.

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