Omihachiman Community Medical Center

Shiga, Japan

Omihachiman Community Medical Center

Shiga, Japan
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Iida O.,Kansai Rosai Hospital | Yokoi H.,Kokura Memorial Hospital | Soga Y.,Kokura Memorial Hospital | Inoue N.,Sendai Kousei Hospital | And 15 more authors.
Circulation | Year: 2013

Background: It remains unclear whether cilostazol, which has been shown to improve the clinical outcomes of endovascular therapy for femoropopliteal lesions, also reduces angiographic restenosis. Methods and Results: The Sufficient Treatment of Peripheral Intervention by Cilostazol (STOP-IC) study investigated whether cilostazol reduces the 12-month angiographic restenosis rate after percutaneous transluminal angioplasty with provisional nitinol stenting for femoropopliteal lesions. Two hundred patients with femoropopliteal lesions treated from March 2009 to April 2011 at 13 cardiovascular centers were randomly assigned 1:1 to receive oral aspirin with or without cilostazol. The primary end point was 12-month angiographic restenosis rate. Secondary end points were the restenosis rate on duplex ultrasound, the rate of major adverse cardiac events, and target lesion event-free survival. Researchers evaluated all follow-up data and assessed the end points in a blinded fashion. The mean lesion length and reference vessel diameter at the treated segment were 128±86 mm and 5.4±1.4 mm, respectively. The frequency of stent used was similar between groups (88% versus 90% in the cilostazol and noncilostazol group, respectively, P=0.82). During the 12-month follow-up period, 11 patients died and 152 patients (80%) had evaluable angiographic data at 12 months. The angiographic restenosis rate at 12 months was 20% (15/75) in the cilostazol group versus 49% (38/77) in the noncilostazol group (P=0.0001) by intention-to-treat analysis. The cilostazol group also had a significantly higher event-free survival at 12 months (83% versus 71%, P=0.02), although cardiovascular event rates were similar in both groups. Conclusions: Cilostazol reduced angiographic restenosis after percutaneous transluminal angioplasty with provisional nitinol stenting for femoropopliteal lesions. © 2013 American Heart Association, Inc.


Iida O.,Kansai Rosai Hospital | Takahara M.,Osaka University | Soga Y.,Kokura Memorial Hospital | Hirano K.,Saiseikai Yokohama City Eastern Hospital | And 6 more authors.
JACC: Cardiovascular Interventions | Year: 2016

Objectives This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR. Background The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined. Methods This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (≤50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE). Results Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p = 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p = 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p = 0.025 and 0.022, respectively) 1 year after re-EVT. Conclusions We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis of re-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT. © 2016 American College of Cardiology Foundation.


Iida O.,Kansai Rosai Hospital | Takahara M.,Osaka University | Soga Y.,Kokura Memorial Hospital | Nakano M.,Saiseikai Yokohama City Eastern Hospital | And 6 more authors.
JACC: Cardiovascular Interventions | Year: 2015

Objectives This study sought to assess the rate and predictors of 1-year restenosis after drug-eluting stent implantation for femoropopliteal (FP) lesions in patients with peripheral arterial disease. Background Zilver PTX, a paclitaxel-eluting stent for FP lesions, provides superior outcomes to angioplasty and bare-metal stents in clinical trials. However, its real-world outcomes and the associated features remain unclear. Methods This was a prospective multicenter study enrolling 831 FP lesions (797 limbs, 690 patients) treated by Zilver PTX implantation. The primary endpoint was 1-year restenosis. Secondary endpoints included major adverse limb event and stent thrombosis. Results Mean lesion length was 17 ± 10 cm. One-year restenosis, major adverse limb event, and stent thrombosis rates were 37%, 22%, and 2%, respectively. The generalized linear mixed model showed that lesion length ≥16 cm assessed by angiography and distal external elastic membrane area &27 mm and minimum stent area;12 mm2 assessed by intravascular ultrasound were independent risk factors for restenosis. One-year restenosis rates were 15% in cases with none of these risk factors and 50% in those with ≥2 risk factors. Conclusions The current study demonstrated 1-year real-world outcomes after drug-eluting stent treatment for FP lesions, including challenging ones in clinical practice. Lesion length, external elastic membrane area, and minimum stent area were independent predictors for restenosis. (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery - Prospective Multicenter Registry [ZEPHYR]; UMIN000008433) © 2015 American College of Cardiology Foundation.


PubMed | Kokura Memorial Hospital, Omihachiman Community Medical Center, Osaka University, Fukuoka Sanno Hospital and 4 more.
Type: Journal Article | Journal: JACC. Cardiovascular interventions | Year: 2016

This study sought to investigate the characteristics of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation for femoropopliteal (FP) lesions, and to examine 1-year prognosis after repeat endovascular therapy (re-EVT) for these DES-ISR.The morphology of DES-ISR and its association with clinical outcomes after re-EVT have not been well examined.This was a subanalysis of the ZEPHYR (Zilver PTX for the femoral artery and proximal popliteal artery) study. The current study included 210 cases with loss of patency confirmed 1 year after DES implantation. Morphology of DES-ISR was classified into the following subgroups: class I, focal lesions (50 mm in length), class II, diffuse lesions (>50 mm in length), and class III, totally occluded ISR. One-year prognosis after re-EVT for DES-ISR was assessed by restenosis and major adverse limb events (MALE).Classes I, II, and III accounted for 50%, 25%, and 25% of DES-ISR, respectively. Factors associated with the morphology of DES-ISR were the presence of chronic total occlusion and the size of the external elastic membrane area before DES implantation (p= 0.009 and 0.017). Compared with the class I restenotic lesion, the class II and III lesions had a significantly higher risk of restenosis (74% and 78% vs. 53%: p= 0.048 and 0.019, respectively) and MALE (56% and 56% versus 32%: p= 0.025 and 0.022, respectively) 1 year after re-EVT.We evaluated the characteristics of ISR after DES implantation for FP lesions and 1-year prognosis ofre-EVT for DES-ISR. The morphology of DES-ISR had a significant association with 1-year prognosis after re-EVT.


PubMed | Kansai Rosai Hospital, Kokura Memorial Hospital, Kishiwada Tokushukai Hospital, Shin Koga Hospital and Omihachiman Community Medical Center
Type: Journal Article | Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists | Year: 2016

To investigate the clinical outcomes of endovascular therapy (EVT) for upper extremity peripheral artery disease (PAD) with critical hand ischemia (CHI).A subanalysis was performed of multicenter registry data on 36 consecutive patients (mean age 65.710.3 years; 19 men) who underwent EVT from January 2003 to December 2013 for angiographically diagnosed de novo upper limb PAD with CHI in 40 limbs. Fifty percent of patients had diabetes, and two-thirds were on hemodialysis. Technical success of EVT was straight-line flow to the hand and final residual diameter stenosis 50% for balloon angioplasty alone and 30% without flow-limiting dissection for subclavian artery stenting. The primary outcome was 12-month amputation-free survival [AFS; freedom from a composite of major (above-the-wrist) amputation and death]. The 12-month secondary outcomes were overall survival, limb salvage, freedom from major adverse limb events (MALE; major amputation or any repeat revascularization of the limb), and wound healing (complete epithelialization without death or major amputation).Initial success was achieved in 87% (35 of 40 limbs); 1 patient experienced puncture site problems, and 3 (8%) of 36 patients (4 treated limbs) died within 30 days. Hand symptoms were alleviated in 37 (92%) limbs. The mean follow-up was 26.827.8 months. Seven fingers (5 limbs) underwent phalanx amputations and 2 limbs had an amputation above the wrist. Complete wound healing was achieved in only 5 (19%) of 26 surviving patients at 12 months. At 1 year, the Kaplan-Meier estimates for AFS, overall survival, limb salvage, and freedom from MALE were 56.4%, 59.4%, 93.1%, and 78.5%, respectively. Univariate analysis revealed that the predictors of AFS at 1 year were diabetes (p=0.03), hemodialysis (p<0.001), PAD (p=0.003), and the presence of a wound (p<0.001). During follow-up, 20 (56%) patients died; a cardiovascular cause accounted for 40% of deaths.Endovascular therapy for upper limb PAD with CHI was technically successful and alleviated symptoms in the majority of cases, but the prognosis of patients with CHI was extremely poor in real-world clinical practice.


PubMed | Japan National Cardiovascular Center Research Institute, Omihachiman Community Medical Center, Takatsu General Hospital, Kokura Memorial Hospital and 3 more.
Type: Journal Article | Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions | Year: 2016

This study aimed to compare the outcomes of revascularization strategies for patients with critical limb ischemia (CLI) whereby single vessel run off to the foot was established with or without flow into a patent pedal arch.We retrospectively analyzed data from 312 consecutive patients with CLI who underwent endovascular therapy (EVT) between December 2009 and February 2011. Below-the-knee angiography identified one vessel run off in 137 patients (44%), and we aimed to compare the outcomes between those patients where revascularization resulted in one-straight-line flow into a patent pedal arch (76 limbs, Group A) versus those who attained one straight-line flow to the distal end of a tibial vessel without flow into a patent pedal arch (61 limbs, Group B). The study endpoints were amputation free survival rate, limb salvage rate and wound healing rate at 12 months after EVT.Amputation free survival rate differed significantly between groups (88.2% in group A vs. 65.6% in group B, P=0.01). Limb salvage rate also differed between groups (98.4% vs.89.3%, P=0.03). Wound healing rate showed a trend towards difference between the two groups (89.4% vs. 80.6% P=0.11).Among patients with CLI where only one vessel runoff can be established to the foot, direct flow into a patent pedal arch is essential to improve their clinical outcomes. 2015 Wiley Periodicals, Inc.


Dong M.,National Institute of Neuroscience | Dong M.,China Japan Friendship Hospital | Noguchi S.,National Institute of Neuroscience | Noguchi S.,Translational Medical Center | And 9 more authors.
Neurology | Year: 2015

Objectives: To identify gene mutations in patients with dystroglycanopathy and prove pathogenicity of those mutations using an in vitro cell assay. Methods: We performed whole-exome sequencing on 20 patients, who were previously diagnosed with dystroglycanopathy by immunohistochemistry and/or Western blot analysis. We also evaluated pathogenicity of identified mutations for phenotypic recovery in a DAG1-knockout haploid human cell line transfected with mutated DAG1 complementary DNA. Results: Using exome sequencing, we identified compound heterozygous missense mutations in DAG1 in a patient with asymptomatic hyperCKemia and pathologically mild muscular dystrophy. Both mutations were in the N-terminal region of a-dystroglycan and affected its glycosylation. Mutated DAG1 complementary DNAs failed to rescue the phenotype in DAG1-knockout cells, suggesting that these are pathogenic mutations. Conclusion: Novel mutations in DAG1 are associated with asymptomatic hyperCKemia with hypoglycosylation of α-dystroglycan. The combination of exome sequencing and a phenotyperescue experiment on a gene-knockout haploid cell line represents a powerful tool for evaluation of these pathogenic mutations. © 2014 American Academy of Neurology.


Yamaguchi S.,Omihachiman Community Medical Center | Zen K.,Omihachiman Community Medical Center | Kambayashi D.,Omihachiman Community Medical Center
Catheterization and Cardiovascular Interventions | Year: 2016

During revascularization for chronic total occlusion (CTO) of the proximal superficial femoral artery (SFA), the guiding sheath may prolapse out of the common femoral artery (CFA) or may not be fully inserted during treatment. Therefore, we have developed a treatment strategy using a novel side-grooved guiding sheath, whereby a 5.0-Fr guiding sheath (45 cm long) with a 1.0 mm × 5.0 mm rectangular side-groove is inserted into the deep femoral artery, the side-groove is aligned with the bifurcation, and the SFA lesion treatment is performed via the side-groove. This technique provides good stability and maintains the wire's torque performance, while avoiding sheath prolapse from its position in the CFA. We have successfully treated seven cases of SFA-CTO with this guiding sheath, and did not observe any increase in complications, procedure time, or amount of contrast media (vs. the conventional procedure). Therefore, our side-grooved guiding sheath appears to be safe and effective for treating SFA-CTO, and we hope to perform additional development of this technique. © 2015 Wiley Periodicals, Inc.


Tameno H.,Omihachiman Community Medical Center
Otolaryngology - Head and Neck Surgery (Tokyo) | Year: 2010

A low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor originally described by Evans in 1987. We reported a case of LGFMS of the clavicular region. A 22-year-old female presented with a painless mass in her left clavicular region which had gradually enlarged for the next five months. Initial diagnosis was a benign tumor by US, CT and fine needle aspiration (FNA) examinations. The tumor was surgically extirpated and it was histopathologically diagnosed as a low-grade fibromyxoid sarcoma. LGMFS shows a high rate of local recurrence and metastasis, so careful follow-up should be needed.


Iwai T.,Omihachiman community medical center
Japanese Journal of Clinical Radiology | Year: 2013

We reported a 56-year-old woman with retroperitoneal extraskeletal osteosarcoma. Abdominal Xp demonstrated a huge mass in the right abdomen with irregular mineralization. CT and MRI revealed a heterogenous mass with cystic change and irregular mineralization in the right retroperitoneum. The mass was completely removed, but the patient died of multiple metastases 10 months after surgery. Retroperitoneal extraskeletal osteosarcoma is a rare tumor and preoperative diagnosis is usually difficult But it would be helpful for preoperative diagnosis if we interpreted the mineralization on abdominal Xp as osteogenic mineralization.

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