Nishinomiya Municipal Central Hospital

Nishinomiya, Japan

Nishinomiya Municipal Central Hospital

Nishinomiya, Japan
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Iida O.,Kansai Rosai Hospital | Uematsu M.,Kansai Rosai Hospital | Takahara M.,Osaka University | Soga Y.,Kokura Memorial Hospital | And 2 more authors.
JACC: Cardiovascular Interventions | Year: 2017

Objectives The authors sought to investigate the prognostic impact of revascularization for poor-risk CLI patients in real-world settings. Background Critical limb ischemia (CLI) is often accompanied with various comorbidities, and frailty is not rare in the population. Although previous studies suggested favorable outcomes of revascularization for CLI patients, those studies commonly included the healthier, that is, less frail patients. Methods This was a multicenter prospective observational study, registering patients who presented with CLI and who required assistance for their daily lives because of their disability in activities of daily living (ADL) and/or impairment of cognitive function. Revascularization was either planned (revascularization group) or not planned (non-revascularization group). The primary endpoint was 1-year survival, and was compared between the revascularization and non-revascularization groups, using the propensity score-matching method. Results Between January 2014 and April 2015, a total of 662 patients were registered, of those 100 non-revascularization patients were included. A total of 625 patients (94.4%) completed the 1-year follow-up. Death was observed in 223 patients (33.7%). After propensity score matching, the 1-year survival rate was 55.9% in the revascularization group versus 51.0% in the non-revascularization group, with no significant difference (p = 0.120). In the subgroups alive at 1 year after revascularization, health-related quality of life was significantly improved compared with baseline, whereas ADL scores were unchanged from baseline and still remained significantly worse than before CLI onset. Conclusions The 1-year overall survival rate was not significantly different between the revascularization and non-revascularization groups in poor-risk CLI patients. (Poor-Risk Patients With and Without Revascularization Therapy for Critical Limb Ischemia; [PRIORITY Registry]; UMIN000012871) © 2017 American College of Cardiology Foundation

Egami N.,University of Tokyo | Kakigi A.,University of Tokyo | Takeda T.,Nishinomiya Municipal Central Hospital | Yamasoba T.,University of Tokyo
Hearing Research | Year: 2016

We investigated the influence of vasopressin type 2 receptor antagonist (OPC-41061; Tolvaptan) on experimentally induced endolymphatic hydrops (EH) in guinea pigs. In the first series, the endolymphatic sac (ES) of the left ear of all animals was electrocauterized. Four weeks after surgery, the animals were allocated to four groups: three systemic applications groups (saline, OPC 10 and 100 mg/kg) and a local round window (RW) OPC 1 mg/body application group. We examined the histopathology of the temporal bones and assessed volumetric changes of the endolymphatic space in the cochlea and saccule. In the second series, we investigated the effects of systemic and topical applications of OPC on plasma vasopressin (p-VP) concentrations and plasma osmolality (p-OSM). In the first series, we found that EH was reduced in the OPC 10 mg/kg systemic and OPC RW application groups. In contrast, EH increased in the OPC 100 mg/kg systemic application group. In the second series, neither p-VP levels nor p-OSM were significantly different among the non-OPC, OPC 10 mg/kg systemic, and OPC RW application groups. However, in the OPC 100 mg/kg systemic application group, the p-VP level was significantly higher than that in other groups, and p-OSM was higher than that in the non-OPC group. The systemic application of a low dose of OPC and topical application of OPC resulted in reduced EH in the face of minimal systemic effects (p-VP and p-OSM). These findings suggest that OPC-41061 may be one useful treatment option for EH. © 2015 Elsevier B.V..

Monden M.,Osaka University | Sakon M.,Nishinomiya Municipal Central Hospital | Sakata Y.,Misawa City Hospital | Ueda Y.,Otsuka Pharmaceutical Factory Inc. | Hashimura E.,Otsuka Pharmaceutical Factory Inc.
Hepatology Research | Year: 2012

Aim: The efficacy and safety of 5-fluorouracil arterial infusion+interferon therapy (FAIT) was evaluated in patients with hepatocellular carcinoma (HCC) with a high degree of vascular invasion associated with poor prognosis, using best salvage therapy (BST) as a reference group. Methods: Sixty-nine patients with advanced HCC with a high degree of vascular invasion (Vp3, Vp4, Vv3) were randomly assigned to a FAIT group or a BST group. The FAIT group received interferon-α and 5-fluorouracil combination therapy; the BST group received either combination therapy of cisplatin and 5-fluorouracil (low-dose FP therapy) or cisplatin for arterial infusion. Results: Thirty patients in the FAIT group and 31 patients in the BST group were included in the efficacy analysis. The response rate (primary endpoint) was 26.7% (eight out of 30 patients) for the FAIT group and 25.8% (eight out of 31) for the BST group. The number of occurrences of adverse events of grade 3 or higher was 115 in 30 patients in the FAIT group and 113 in 29 patients in the BST group. None of the deaths were related to the study therapy. Conclusions: FAIT exerts modest antitumor effects and poses no particular safety concerns. FAIT may be a strategy of choice worth trying for advanced HCC with high degree of vascular invasion, which is associated with poor prognosis. © 2011 The Japan Society of Hepatology.

Okada K.,Nishinomiya Municipal Central Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

A 64-year-old man was diagnosed as having advanced gastric cancer with peritoneal and para-aortic lymph node metastases. He received 2 courses of chemotherapy with S-1 and cisplatin( CDDP) and 5 courses of combination chemotherapy with capecitabine, CDDP, and trastuzumab. The peritoneal and para-aortic lymph node metastases disappeared after chemotherapy, and subsequently, total gastrectomy was performed (pT2N3aM0, stage IIIA). Although the patient received combination chemotherapy with capecitabine and trastuzumab, para-aortic lymph node recurrence was noted 6 months after the operation. Radiation therapy at a total dose of 50 Gy targeted at the para-aortic lymph node metastasis along with S-1 and trastuzumab chemotherapy was administered. No serious adverse effects were observed during chemoradiotherapy. Following chemoradiation therapy, tumor recurrence was not observed. Therefore, chemoradiotherapy is considered an effective treatment for lymph node metastasis from gastric cancer.

Tanabe K.,Nishinomiya Municipal Central Hospital | Miyamoto N.,Nishinomiya Municipal Central Hospital
Skeletal Radiology | Year: 2016

Fracture of the humeral medial epicondyle is a relatively common injury in children. Surgery is a good option for treatment, but correct diagnosis is important. Most fractures occur after the ossification of the medial epicondylar apophysis. If a fracture occurs before the ossification of the medial epicondyle, it is undetectable by radiographs. Here we report a case of an unossified medial epicondyle fracture of the humerus. A 9-year-old boy had persistent pain in the medial side of the right elbow after a fall. Despite his pain, he could move his injured elbow with a range from 60 to 90°. Radiographs and computed tomography showed neither fracture nor dislocation in the injured elbow, and soft tissue swelling was the only finding. Neither the trochlea nor the medial epicondyle was ossified. Magnetic resonance imaging showed that the medial epicondyle was separated from the medial metaphysis and displaced. This clear finding led us to surgical fixation. Under general anesthesia, valgus stress showed gross instability of the injured elbow. Two years after the operation, he had no complaints and could play sports with the same range of motion as the left elbow. It is important to keep in mind that medial epicondylar fractures may be hidden in a normal radiograph before the ossification of the medial epicondylar apophysis. © 2016 ISS

Introduction: Darexaban (YM150) is an oral direct factor Xa inhibitor in clinical development for prophylaxis of venous thromboembolism (VTE) after major orthopaedic surgery. The objective of this study was to assess the efficacy and safety of darexaban 15 mg twice daily (bid) in Japanese patients undergoing major abdominal surgery. Materials and Methods: In a Phase III, multicentre, randomized, open-label, mechanical prophylaxis-controlled, parallel-group study, adult patients (aged ≤ 40 years) were randomized to darexaban 15 mg bid or mechanical prophylaxis, for 28 days. The primary efficacy outcome was incidence of total VTE at Day 12. Adverse events (AEs) and bleeding events were recorded throughout the study. Results: The total VTE incidence at Day 12 was 2.6% in the darexaban 15 mg bid group (95% confidence interval [CI]: 0.32, 9.07), compared with 15.0% (95% CI: 5.71, 29.84) in the mechanical prophylaxis group. During the investigational period, the incidence of all bleeding events was 9.5% in the darexaban 15 mg bid group and 3.9% in the mechanical prophylaxis group. In the darexaban 15 mg bid group, one patient experienced major bleeding and five patients experienced clinically relevant non-major (CRNM) bleeding. No patients in the mechanical prophylaxis group experienced major and/or CRNM bleeding. AEs were reported in 71.4% of patients in the darexaban 15 mg bid group and 76.5% of patients in the mechanical prophylaxis group; the most frequent AEs across both treatment groups were constipation and insomnia. No patients died during the study. Conclusions: Based on these findings, darexaban is expected to be effective for the prevention of VTE in patients undergoing major abdominal surgery. (Clinical trial registration number: NCT00942435) © 2012 Elsevier Ltd.

Sakon M.,Nishinomiya Municipal Central Hospital | Ogawa H.,Nishinomiya Municipal Central Hospital | Fujita M.,Nishinomiya Municipal Central Hospital | Nagano H.,Osaka University
Hepatology Research | Year: 2013

Survival or disease-free survival is not considered an appropriate surrogate outcome for the locoregional curability (i.e. surgical margin) of hepatectomy for hepatocellular carcinoma because these are greatly influenced by non-metastatic factors like multicentric carcinogenesis (MC) or liver function. Hepatocellular carcinoma metastasizes by hematogenous seeding; therefore, the tumor blood flow (TBF) drainage area is a high-risk area for intrahepatic metastasis, and can be identified by computed tomography under hepatic arteriography and completely resected as part of the surgical margin. The TBF pattern is classified into marginal, portal vein or hypovascular types. Partial hepatectomies were mostly performed in patients with marginal or hypovascular type, whereas anatomical surgery was frequently performed in those with portal vein type. Pathologically, nodules inside the TBF drainage area were moderately or poorly differentiated carcinomas, suggesting intrahepatic metastasis. In contrast, those outside the drainage area were frequently solitary and contained well-differentiated carcinoma, which is consistent with MC. The pattern of tumor recurrences after TBF-based hepatectomy is divided into two distinct groups - "a few nodules" and "many nodules in multiple segments or extrahepatic" - indicating that intrahepatic recurrences develop from MC and from circulating tumor cells in peripheral blood, respectively. Anatomical resection has not shown a survival benefit over that of TBF-based partial hepatectomy. TBF-based hepatectomy enables us to preserve liver function without compromising locoregional curability. © 2012 The Japan Society of Hepatology.

Takeda T.,Nishinomiya Municipal Central Hospital | Kakigi A.,University of Tokyo
ORL | Year: 2010

Objective: To evaluate the clinical conditions causing an elevation in the click-evoked summation potential (SP)/action potential (AP) amplitude ratio (SP/AP ratio), the cause of the SP enhancement in Ménière's disease (MD) and the diagnostic efficacy of electrocochleography (ECoG) were discussed. Study Design: Retrospective case review. Setting: An outpatient clinic of the Otolaryngology Department of Kochi Medical School. Patients: ECoG testing was performed in 632 patients (727 ears) with vertigo/dizziness and/or deafness over a 10-year period (1995-2005). Among them, 334 patients had diagnoses of definite MD, including 95 cases of bilateral involvement. Main Outcome Measures: Audiological thresholds and SP/AP ratio. Results: An enhanced SP was observed in 56.3% of patients with MD. The incidence of an enhanced SP was low in patients for whom the disease duration was 2 years or less and the frequency of attacks was once a year or less, but was significantly higher in cases where the disease duration was 2 years or longer and/or the frequency of attacks was several times a year (Games-Howell test, p < 0.05). The incidence of an enhanced SP was significantly elevated in cases with pure-tone average exceeding 31 dB (Kendall's rank correlation test, p < 0.001). However, the enhanced SP, once it appeared, did not always disappear in spite of hearing improvement. Hearing improvement induced by the glycerol test also produced no alteration in an SP/AP ratio, and there was no significant difference between the glycerol test results and the incidence of an enhanced SP (χ2 goodness-of-fit test). Conclusions: The longer the patients were symptomatic or the severer the ear symptoms, the more likely the ECoG was to be positive. The abnormally elevated SP, once it had appeared, persisted for long periods. Spontaneous and glycerol-induced hearing gains did not result in a decrease in SP/AP ratio. These clinical characteristics of ECoG seem to indicate that the enhanced SP in MD might be caused by the malfunction of hair cells, not by the displacement of the basilar membrane toward the scala tympani. © 2010 S. Karger AG, Basel.

Tanabe K.,Nishinomiya Municipal Central 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: 2011

Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers.

Sakon M.,Nishinomiya Municipal Central Hospital | Kobayashi T.,Hamamatsu Medical Center | Shimazui T.,Institute of Clinical Medicine
Thrombosis Research | Year: 2010

Background: Enoxaparin sodium (enoxaparin) is used worldwide for the prevention of venous thromboembolism (VTE). Registration trials of enoxaparin have been conducted primarily in Caucasian populations, and its preventive use in Japanese patients has yet to be established. To address this, we evaluated the efficacy and safety of postoperative enoxaparin in Japanese patients undergoing surgery for abdominal cancer. Methods: This multicenter, open-label study randomized 151 Japanese patients undergoing curative surgery for abdominal cancer to enoxaparin 20 mg twice daily for 14 days, started 24-36 hours after surgery (n = 113) or intermittent pneumatic compression (IPC) as a reference (n = 38). IPC was performed at least once in both groups between randomization and surgery. The primary efficacy endpoint was the incidence of VTE in the modified intention-to-treat (mITT) population. The primary safety outcome was the incidence of any bleeding during treatment and follow-up. Results: Incidence of VTE was 1.2% (95% CI, 0.03-6.53%) (1/83 patients) in the enoxaparin group and 19.4% (95% CI, 7.45-37.47%) (6/31 patients) in the IPC group. In the safety population, 10/109 patients in the enoxaparin group (9.2%; 95% CI, 4.49-16.23%) and 3/38 patients in the IPC group (7.9%; 95% CI, 1.66-21.38%) experienced a bleeding event. There were no cases of fatal bleeding or bleeding into any critical organ. Conclusions: These favorable efficacy and safety data support the use of enoxaparin (20 mg twice daily for 14 days started 24-36 hours after surgery) in Japanese patients undergoing abdominal or pelvic cancer surgery. © 2009 Elsevier Ltd. All rights reserved.

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