Time filter

Source Type

PubMed | Red Cross, Mabuchi Clinic, Nishijin Hospital, Tojinkai Hospital and University of Ryukyus
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2015

The aim of the study is to elucidate whether parathyroid hormone (PTH) levels after parathyroidectomy affect the prognosis of patients with secondary hyperparathyroidism.Two hundred and ninety-five patients, who underwent PTx without autotransplantation from July 1998 to December 2011, were divided into the low (n=148) and high (n=147) PTH groups, using the median value of each mean value of intact PTH after surgery (16.6pg/mL). After observation for 5.00years, we evaluated demographic factors, influences of postoperative mineral metabolism, magnitude of uremia, and vitamin D receptor activators on their prognosis, with the multivariate Cox proportional hazard model.While overall survival rates in the high and low PTH groups were 54.9 and 74.2%, respectively (P=0.1500), cardiovascular survival rates were 71.6 and 94.4%, respectively (P=0.0256). The hazard ratio for cardiovascular mortality in the high PTH group (16.6pg/mL) was 3.132 (P=0.0470), and those in groups with the median age more than 59years and with cardiovascular disease were 2.654 (P=0.0589) and 3.377 (P=0.0317), respectively. The intact PTH level 6days after surgery and the mean postoperative intact PTH value showed a strong correlation (Spearman =0.9007, P<0.0001, y=0.4725x+30.395, R The present study suggests that maintaining low PTH levels after parathyroidectomy reduces cardiovascular mortality and improves the prognosis. Total parathyroidectomy (more than 4 glands) without autotransplantation seems to be one of the treatment options for managing severe secondary hyperparathyroidism.


A 75-year-old man, who was on maintenance hemodialysis, underwent a radiotherapy for locally recurrence of rectal cancer. A pain palliation was achieved and serum tumor markers were reduced. However, after six months, a tumor re- growth was detected and sacral pain was increased. Then, a radiofrequency ablation (RFA) was performed repeatedly as a palliative therapy and pain palliation was achieved. RFA is a safe and effective palliative therapy for patients of poor-risk, such as a terminal stage or hemodialysis patient. Furthermore, it is able to perform repeatedly when the response was not satisfactory. However, a Cool-tip electrode could not to be placed because tumors were hardened by radiotherapy and a repeat of RFA. Then a development of novel Cool-tip electrode may be needed.


Soga K.,Nishijin Hospital | Kassai K.,Nishijin Hospital | Itani K.,Nishijin Hospital
Journal of Gastrointestinal and Liver Diseases | Year: 2016

The patient was a 66-year-old woman who had undergone laparoscopic cholecystectomy (Lap-C) secondary to chronic cholecystitis status post endoscopic choledocholithotomy 13 months previously. During surgery, Hem-o-Lok clips were used to control the cystic duct and the cystic artery. Due to the presence of extensive adhesions of the cystic duct and surrounding tissue, the surgeons had difficulty in debriding the area. Thirteen months after Lap-C, the patient underwent a screening esophagogastroduodenoscopy (EGD), which demonstrated clip appearance at the inferior wall of the first part of the duodenum. In the EGD, duodenal erosions and edema were observed around the clip. We appreciated that endoscopic clip removal would be difficult because of the presence of severe adhesions and inflammation of the duodenal bulb. On clinical examination of the patient, no major abnormalities or physical findings were noted. Therefore, we decided not to attempt to remove the clip. The patient was treated with an oral proton pump inhibitor to prevent extensive duodenal mucosal injury. Two months later, we repeated the EGD, which revealed that the clip was no longer present, and the duodenum was covered with normal mucosa surrounding the scar. © 2016, Romanian Society of Gastroenterology. All rights reserved.


PubMed | Nishijin Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

We present a case of gastritis cystica polyposa (GCP) that developed early after laparoscopy-assisted distal gastrectomy with Billrothreconstruction. GCP is a chronic inflammatory gastric mucosal lesion that emerges at an anastomotic site usually after a long post-gastrectomy period, which is mainly caused by constant chemical stimulation by duodenal juice. In addition, chronic mechanical stimulation caused by reflux or stasis of gastrointestinal contents may also trigger GCP. Surgeons should ensure a functional and physiologically patent anastomosis during surgery. Hypergastrinemia, caused by persistent Helicobacter pylori infection or continuing administration of proton pump inhibitors, may also contribute to the development of GCP, as GCP is a type of hyperplastic polyp. Therefore, appropriate postoperative follow-up, including pylorus eradication and avoidance of unnecessary administration of proton pump inhibitors, seems to be needed in order to prevent the development of GCP. In our case, many factors exhibited the multiplier effect, resulting in early development of GCP. As GCP also attracts much attention as a precancerous lesion, appropriate prevention and prompt treatment are required.


PubMed | Nishijin Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

A 44-year-old man presented to our hospital with high fever and right side ache. Laboratory data revealed the presence of inflammation. Enhanced CT of the abdomen revealed a 15 cm mass of the ascending colon, and FDG-PET showed abnormal uptake in the same site. Colonofiberscopy demonstrated an elevated lesion in the ascending colon without malignant findings in biopsies. Enema examination revealed an extrinsic compression of the ascending colon. Although the patient received antibiotic therapy, there were no signs of improvement. Therefore, right hemicolectomy with resection of the invasive lesion of the right abdominal wall and the jejunum was performed. The resected specimen showed a solid tumor, 17118 cm in size, in the ascending colon. The tumor invaded the ileum. Immunohistochemical findings revealed positive staining for NSE, synaptophysin, and chromogranin A. Neuroendocrine carcinoma was thus diagnosed. CPT-11-containing chemotherapy was administered for 1 year after surgery. The patient has been free from recurrent disease for over 7 years after surgery.


Traditional anvil graspers cannot delicately handle the anvil head as a result of their unique jaw shape that enhances grip force, and they are not suitable for confined pelvic space. With a manufacturing company, we developed a novel anvil grasper, the evolutional anvil grasper for laparoendoscopic surgery (EAGLE), to ensure more precise and safer anastomosis procedures. The EAGLE has curved blades that create a 6-mm grasping surface that is the same diameter as the anvil stem and is covered with tungsten carbide tips. When using the EAGLE, a surgeon grasps the anvil stem slightly and easily, handles the anvil head and proximal colon, and smoothly sets the anvil to the center rod of the circular stapler. A surgeon can also securely grasp the stem of the anvil, push it into the center rod of the circular stapler and then perform a sequence of actions in anastomosis procedures smoothly and safely. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.


PubMed | Nishijin Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

A 76-year-old man underwent radical surgery for Stage IV a hilar cholangiocarcinoma in July 2009, and had been followed at an outpatient clinic. Although no apparent recurrent lesion was detected by PET/CT examination, an elevated CA19-9 level was found in January 2014. He was then started on the oral anticancer drug S-1. However, his CA19-9 level increased gradually. The patient presented to a urological department with a complaint of macrohematuria in May 2015. Detailed examination revealed a mass lesion at the top of the urinary bladder, which was suspected to be peritoneal dissemination of the known hilar cholangiocarcinoma invading the urinary bladder wall. Thus, he underwent partial resection of the urinary bladder in July 2015. A histopathological examination of the resected specimen confirmed the diagnosis of recurrence. The patient is nowreceiving chemotherapy with gemcitabine and cisplatin. Detection of recurrences of cholangiocarcinoma is often difficult since the recurrence pattern of cholangiocarcinoma varies widely. However, early detection might enable longterm survival by adequate treatment including chemotherapy. Therefore, thorough multidisciplinary examinations are required when recurrence of cholangiocarcinoma is suspected. In addition, long-term follow-up after radical surgery is required since cholangiocarcinoma sometimes shows slow progression.


PubMed | Nishijin Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

A-77-year-old man presented to our hospital with high fever and lower abdominal pain. Enhanced CT of the abdomen revealed swelling of the appendix with wall thickening and fluid collection. We diagnosed appendicitis with abscess formation and performed transumbilical laparoscopic-assisted appendectomy after the inflammation improved in response to antibiotics. Operative findings revealed a cystic lesion ofthe appendix and strong adhesion ofthe appendix to the terminal ileum. Based on these operative findings, we changed the operative procedure to a single-incision laparoscopic assisted ileocecal resection because ofthe possibility ofhydrops processus vermiformis. Histopathological findings revealed hyperplasia ofthe glandular epithelium with nuclear enlargement. Mucinous cystadenocarcinoma ofthe appendix was diagnosed. Additional surgery was not performed due to the patients request. The patient has been free from recurrent disease for approximately 6 months after the surgery. Transumbilical laparoscopic-assisted appendectomy is useful for preventing pseudomyxoma peritonei and easing changes in extended operations for suspected cases of hydrops processus vermiformis.


PubMed | Nishijin Hospital
Type: Comparative Study | Journal: Surgery today | Year: 2015

To compare the surgical outcomes after transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) at a single institution.We compared the surgical outcomes for 94 consecutive patients who underwent TULAA between April 2010 and March 2014 to those for 91 consecutive patients who underwent OA between April 2006 and March 2010.There were no significant differences in the clinicopathological backgrounds between the two groups. Although the lengths of the operations were similar in both groups, the postoperative hospital stay was significantly shorter in the TULAA group (4.7 days vs. 5.4 days, P = 0.02). The need for abdominal drain insertion was significantly reduced in the TULAA group owing to sufficient intraperitoneal exploration (P = 0.03). The incidence of postoperative complications was also lower in the TULAA group, but the difference was not significant (8.6 % vs. 12.1 %, P = 0.31). In complicated cases, a lower incidence of surgical site infection was confirmed in the TULAA group (6.7 % vs. 20.7 %, P = 0.12).Our results demonstrated that TULAA provided better surgical outcomes, especially a faster recovery. TULAA could be an effective procedure incorporating both open and laparoscopic techniques, and can be implemented as a standard procedure for the treatment of appendicitis, regardless of disease severity.


PubMed | Nishijin Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

The purpose of this study was to evaluate the outcome of treating obstructive left-sided colon cancer with a combination of self-expandable metallic stent (SEMS) insertion and laparoscopic surgery. Ten patients were included in this study. Two patients had obstructive transverse colon cancer, and eight had obstructive sigmoid colon cancer. The patients had a SEMS inserted preoperatively as a bridge to surgery. Efficient decompression was achieved in all the patients, without any complications. Normal oral intake was possible until the laparoscopic, or laparoscope-assisted, one-stage radical operation. The SEMS insertion did not affect the surgical maneuver or laparoscopic operation at all. None of the patients developed any postoperative complications. After surgery, five patients were diagnosed with Stage II disease and three patients were diagnosed with Stage IIIA disease. The remaining two patients had distant metastasis (para-aortic lymph node and liver) and were diagnosed with Stage IV disease. Chemotherapy was administered to the two patients with Stage IV disease after a comparatively early recovery from a less invasive surgical procedure. SEMS insertion appears to be an effective, less invasive decompression method. When used in combination with laparoscopic surgery, SEMS insertion appears to be a safe and less invasive method of treating obstructive left-sided colon cancer.

Loading Nishijin Hospital collaborators
Loading Nishijin Hospital collaborators