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Ōgaki, Japan

Asano F.,Gifu Prefectural General Medical Center | Shinagawa N.,Hokkaido University | Ishida T.,Fukushima Medical University | Shindoh J.,Ogaki Municipal Hospital | And 4 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2013

Rationale: In bronchoscopy, an ultrathin bronchoscope can be advanced to more peripheral bronchi. Because virtual bronchoscopic navigation (VBN) is a method to guide a bronchoscope under direct observation using VB images, VBN may be particularly useful when combined with ultrathin bronchoscopy. Objectives: This prospective multicenter study evaluated the value of VBN-assisted ultrathin bronchoscopy for diagnosing peripheral pulmonary lesions. Methods: We randomly assigned 350 patients with peripheral pulmonary lesions (diameter, <30 mm) to VBN-assisted or non-VBNassisted groups. An ultrathin bronchoscope (outer diameter, 2.8mm) was introducedtothetarget bronchus usingaVBNsystemin theVBNassisted group, whereas only computed tomography axial images were referred to in the non-VBN-assisted group. Specimen sampling sites were verified using X-ray fluoroscopy. Measurements and Main Results: Subjects for analysis included 334 patients. There was no significant difference in the diagnostic yield between the VBN-assisted group (67.1%) and the non-VBN-assisted group (59.9%; P = 0.173). The subgroup analysis showed that the diagnostic yield was significantly higher in the VBN-assisted group than in the non-VBN-assisted group for right upper lobe lesions (81.3% vs. 53.2%; P = 0.004); lesions invisible on posterior-anterior radiographs (63.2% vs. 40.5%; P = 0.043); and lesions in the peripheral third of the lung field (64.7% vs. 52.1%; P = 0.047). Conclusions: VBN-assisted ultrathin bronchoscopy does not improve the diagnostic yield for peripheral pulmonary lesions. However, the method improves the diagnostic yield for lesions in the subcategories (right upper lobe, invisible, peripheral third), warranting further study. Clinical trial registeredwithwww. umin.ac.jp/ctr/ (UMIN000001536). © 2013 by the American Thoracic Society. Source

Perihilar and distal cholangiocarcinoma remain difficult to treat, and long-term survival is poor. We conducted a retrospective study of patients with cholangiocarcinoma to examine whether hepatopancreatoduodenectomy, in comparison to standard surgeries, provides a survival benefit. Subjects were 75 patients with perihilar or distal cholangiocarcinoma who, between April 1997 and May 2007, underwent hepatectomy with bile duct resection (Hx, n = 29), pancreatoduodenectomy (PD, n = 32), or hepatopancreatoduodenectomy (HPD, n = 14) at our hospital. We compared surgical outcomes and survival between groups and identified factors negatively influencing survival. Morbidity and in-hospital mortality did not differ significantly between groups (Hx group, 34% and 10%, respectively; PD group, 44% and 3%; and HPD, 57% and 0%). The overall median survival time was 39 months, and overall 5-year survival (including in-hospital mortality) was 42%. Respective group values were as follows: Hx, 24 months and 31%; PD, 51 months and 49%, and HPD, 63 months and 50%. Although the number of patients was small, survival in the HPD was not influenced by the type of invasion whether widespread intramural invasion (n = 8), superficial spread (n = 4), or hepatoduodenal ligament invasion (n = 2). Multivariate analysis (Cox proportional hazards model) showed only perineural invasion (p = .007) and decreased curability (R1/2 resection) (p = .017) to be independent risk factors influencing survival. In cases of perihilar or distal cholangiocarcinoma, aggressive surgery must be aimed at overcoming perineural invasion. Our findings indicate that HPD improves survival of patients undergoing surgery for widespread cholangiocarcinoma in comparison to standard surgeries. Source

Kimura T.,Kyoto University | Morimoto T.,Kyoto University | Nakagawa Y.,Tenri Hospital | Kawai K.,Chikamori Hospital | And 11 more authors.
Circulation | Year: 2012

Background-There is a scarcity of long-term data from large-scale drug-eluting stent registries with a large enough sample to evaluate low-frequency events such as stent thrombosis (ST). Methods and Results-Five-year outcomes were evaluated in 12 812 consecutive patients undergoing sirolimus-eluting stent (SES) implantation in the j-Cypher registry. Cumulative incidence of definite ST was low (30 day, 0.3%; 1 year, 0.6%; and 5 years, 1.6%). However, late and very late ST continued to occur without attenuation up to 5 years after sirolimus-eluting stent implantation (0.26%/y). Cumulative incidence of target lesion revascularization within the first year was low (7.3%). However, late target lesion revascularization beyond 1 year also continued to occur without attenuation up to 5 years (2.2%/y). Independent risk factors of ST were completely different according to the timing of ST onset, suggesting the presence of different pathophysiological mechanisms of ST according to the timing of ST onset: acute coronary syndrome and target of proximal left anterior descending coronary artery for early ST; side-branch stenting, diabetes mellitus, and end-stage renal disease with or without hemodialysis for late ST; and current smoking and total stent length >28 mm for very late ST. Independent risk factors of late target lesion revascularization beyond 1 year were generally similar to those risk factors identified for early target lesion revascularization. Conclusion-Late adverse events such as very late ST and late target lesion revascularization are continuous hazards, lasting at least up to 5 years after implantation of the first-generation drug-eluting stents (sirolimus-eluting stents), which should be the targets for developing improved coronary stents. © 2011 American Heart Association, Inc. Source

Ando N.,Ogaki Municipal Hospital
Journal of Japanese Society of Gastroenterology | Year: 2011

We describe a 72-year-old man admitted to hospital as an emergency case of epigastric abdominal pain. CT scan visualized massive hemorrhage around the pancreatic head. Computed tomographic angiography showed stenosis at the origin of the celiac artery and a 10mm aneurysm of the posterior inferior pancreaticoduodenal artery (PIPDA). An emergency angiogram revealed a long aneurysm in the PIPDA. The aneurysm had irregular width and was 75mm in length. A gastroduodenal artery and the PIPDA were supplied from the superior mesenteric artery. A transcatheter arterial embolization (TAE) was performed. We reviewed 45 cases of pancreaticoduodenal aneurysms after 2000 and cases of the pancreaticoduodenal false aneurysms after 1972. As a result, we inferred that this case without pancreatitis or pancreas surgery was a true aneurysm made by the bloodstream changes caused by the celiac artery stenosis. Source

Toyoda H.,Ogaki Municipal Hospital | Kumada T.,Ogaki Municipal Hospital | Takaguchi K.,Kagawa Prefectural Central Hospital | Shimada N.,Shinmatsudo Central General Hospital | Tanaka J.,Hiroshima University
Epidemiology and Infection | Year: 2014

Genotypes are associated with the natural course of hepatitis C virus (HCV) infection and response to antiviral therapy for HCV. HCV genotype 1b has been the dominant genotype in Japan, where the prevention of HCV transmission through blood transfusion or nosocomial infection has been established since 1990. The distribution of HCV genotype was investigated based on patient's birth year in 5515 HCV-infected Japanese individuals at three institutions from different areas of Japan. At all three institutions, the proportion of HCV genotype 1b decreased and was <50% in individuals born after 1970. By contrast, the percentage of HCV genotype 2b increased in subsequent birth cohorts after 1920-1929. Significant changes in HCV genotype distribution were observed across Japan regardless of area. Copyright © 2014 Cambridge University Press. Source

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