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Watanabe T.,Ome Municipal General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

A 70-year-old female with severe tricuspid regurgitation and stenosis was admitted to our institution because of watery diarrhea and peripheral edema. The urinary 5-hydroxyindoleacetic acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. The liver biopsy revealed metastatic carcinoid disease, which was thought as an etiology in severe tricuspid regurgitation and stenosis. We administered long acting somatostatin analog, octreotide to control carcinoid symptoms. After improvement of general condition, she successfully underwent bioprosthetic valve replacement with concomitant octreotide administration. Postoperative course was uneventful. She had been followed up with administration of octreotide at outpatient clinic. Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications. Octreotide is an effective tool to manage manifestation of carcinoid activity. We could performed surgical treatment of carcinoid heart disease safely in the perioperative presence of octreotide.

Watanabe T.,Ome Municipal General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

We report a 64-year-old male patient with papillary fibroelastoma of the tricuspid valve associated with moderate mitral regurgitation. Echocardiography had revealed a 10 x 10 mm tumor attaching to the anterior tricuspid leaflet 3 years before. Because the tumor was enlarged to 19 x 15 mm, we excised it with a part of the anterior tricuspid leaflet, and performed tricuspid and mitral valvoplasty. The histological findings suggested papillary fibroelastoma. The postoperative course was uneventful.

Ota M.,Ome Municipal General Hospital
Nihon Rinshō Men'eki Gakkai kaishi = Japanese journal of clinical immunology | Year: 2012

We describe 3 siblings who suffered from marked eosinophilia with organ involvement. One sibling, who experienced cervical lymphadenopathy and peripheral neuropathy with eosinophilia (5,834 cells/μL) following bronchial asthma, was diagnosed with Churg-Strauss syndrome (CSS) according to the criteria of the American College of Rheumatology. Another sibling, who suffered from severe asthma with persistent polyarthritis and eosinophilia (2,496 cells/μL), was also diagnosed with CSS according to the criteria of the Japanese Ministry of Health, Labour and Welfare. The remaining sibling, who had eosinophilic pleuritis with peripheral blood eosinophilia (699 cells/μL), did not fulfill the widely used criteria for CSS or hypereosinophilic syndrome (HES) ; however, he fit the newly proposed criteria for HES. Glucocorticoid treatment relieved their symptoms. Although the diagnoses and the criteria used for diagnosis differed between the siblings, all 3 patients showed common features such as eosinophilia with organ involvement that required treatment, indicating the possibility of familial eosinophilia (FE). Furthermore, the clinical features observed differed substantially from those of previously reported FE patients, therefore, these 3 siblings may be affected by a type of FE distinguishable from those previously described.

Akiyama H.,Ome Municipal General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2013

A 44-year-old man with advanced follicular lymphoma received 8 cycles of chemotherapy, which resulted in the complete disappearance of the original disease. However, a new abdominal mass with positive (18)F-FDG PET/CT uptake appeared after 5 cycles and this was maintained until 3 weeks after the completion of 8 cycles. Open biopsy showed a benign mass with fat necrosis. Although PET/CT is useful in evaluating residual lymphoma after chemotherapy, various benign conditions such as a result of post-chemotherapy inflammation, even in new locations without prior disease, should be noted as causes of false positive uptake.

Hara Y.,Ome Municipal General Hospital
Nihon Geka Gakkai zasshi | Year: 2013

A model project to determine the cause of deaths related to medical practice began in 2005. Since 2010, it has been managed by the Japan Medical Safety Research Organization (JMSRO), which is supported financially by the government and a majority of medical societies and organizations. There is a central office in Tokyo and nine local offices nationwide. When the JMSRO accepts a case, it makes a report on the cause of death and measures to prevent recurrence after detailed autopsy and clinical evaluation. So far, 180 cases have been accepted, of which 156 have been completed. A system to achieve the goals of the project has been established. About 80% of families of the deceased and medical organizations stated that they were satisfied with the results. Four families have initiated civil actions, and another four could potentially do so. No criminal charges have been filed. A new concept to establish an official third-party organization to analyze causes of medical practice-related deaths has been proposed by a committee under the JMSRO, and efforts should be made to put that proposal into practice.

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