PubMed | Ageo Central General Hospital, Nippon Telegraph and Telephone, Omuta City Hospital, Toho University and 5 more.
Type: Journal Article | Journal: The British journal of surgery | Year: 2017
Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy.An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of -lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection.A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (88 per cent) in the 24-h prophylaxis group and 26 (110 per cent) in the 72-h group (absolute difference -22 (90 per cent c.i. -68 to 24) per cent; P < 0001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group.Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).
Phase II trial of an alternating regimen consisting of first-line mFOLFOX6 plus bevacizumab and FOLFIRI plus bevacizumab for patients with metastatic colorectal cancer: FIREFOX plus bevacizumab trial (KSCC0801)
PubMed | Red Cross, Sasebo City General Hospital, Nakagami Hospital, Omuta City Hospital and 6 more.
Type: Clinical Trial, Phase II | Journal: International journal of clinical oncology | Year: 2016
The purpose of this phase II study was to explore the efficacy and safety of an alternating regimen consisting of folinic acid, 5-fluorouracil (5-FU) and oxaliplatin (mFOLFOX6) plus bevacizumab, and folinic acid, 5-FU and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer.Fifty-two patients with metastatic colorectal cancer received an alternating regimen consisting of four cycles of mFOLFOX6 plus bevacizumab followed by four cycles of FOLFIRI plus bevacizumab until disease progression. The primary endpoint was progression-free survival.The median age was 60 years (range 37-75 years). Median progression-free survival was 14.2 months (95 % confidence interval [CI] 10.6-16.3) and median overall survival was 28.4 months (95 % CI 22.6-39.1). The overall response rate was 60.0 % (95 % CI 45.2-73.6). Regarding toxicity, the commonest grade 3-4 hematological adverse events were neutropenia (34.6 %) and leukopenia (7.7 %), and the commonest grade 3-4 non-hematological adverse events were anorexia (13.5 %), fatigue (9.6 %), nausea (9.6 %), and vomiting (9.6 %). Bevacizumab-related grade 3-4 adverse events included hypertension (1.9 %) and thrombosis (1.9 %).An alternating regimen consisting of mFOLFOX6 plus bevacizumab and FOLFIRI plus bevacizumab is an effective and well-tolerated first-line chemotherapy combination for patients with metastatic colorectal cancer.
PubMed | Asakura Medical Association Hospital, Nagata Hospital, University of Occupational and Environmental Health Japan, Omuta City Hospital and 9 more.
Type: Journal Article | Journal: PloS one | Year: 2016
The aim of this study was to evaluate the efficacy of daclatasvir plus asunaprevir therapy in patients infected with hepatitis C virus and determine its relevance to resistant variants.A total of 629 consecutive patients infected with hepatitis C virus genotype 1 were assessed. Daclatasvir (60 mg/day) plus asunaprevir (200 mg/day) was given for 24 weeks. The virological responses and resistance-associated substitutions of hepatitis C virus mutants were examined by the direct sequence and cycleave methods were evaluated.Overall, 89.4% (555/621) of patients exhibited a sustained virological response (SVR). The SVR rates in the patients with wild type, mixed, and mutant type Y93 by direct sequencing were 92.5% (520/562), 70.3% (26/37), and 42.9% (9/21), respectively. The SVR rates in the patients with 100%, 90%, 80%-30%, and 20%-0% Y93 wild by the cycleave method were 93.4% (456/488), 88.2%(30/34), 56.0%(14/25), and 36.8%(7/19), respectively. In contrast, the SVR rates for the wild type and mixed/mutant type L31 by direct sequencing were 90.2% (534/592) and 72.4% (21/29), respectively. In the multivariate analyses, the wild type Y93, no history of simeprevir therapy, the wild type L31, and low HCV RNA level were independent factors of SVR.NS5A resistance-associated substitutions, especially Y93H, were major factors predicting the SVR. Although direct sequencing can predict the SVR rate, the cycleave method is considered to be more useful for predicting the SVR when used in combination.
Kawano R.,19 1 Takarazaka machi |
Takemoto S.,19 1 Takarazaka machi |
Shimamatsu K.,Omuta City Hospital |
Hori D.,Kurume University |
Kamura T.,Kurume University
Journal of Obstetrics and Gynaecology Research | Year: 2013
A 37-year-old Asian woman, gravid 0 para 0, was admitted to our hospital at 34 weeks and 5 days of her pregnancy for management of preeclampsia. A few days after admission, she recognized diminished fetal movement, and a non-stress test revealed a non-reassuring fetal heart rate pattern with decreased variability. A female baby weighing 1840 g was delivered by emergency cesarean section with Apgar scores of 5 and 5 at 1 and 5 min, respectively. Significant neonatal anemia with a hemoglobin level of 4.3 g/dL was observed. The elevated level of hemoglobin F (HbF) in the maternal blood accounted for 4.6% (normal < 0.5%), and was indicative of the presence of fetomaternal hemorrhage (FMH). Microscopic examination of the placenta revealed chorioangioma. We report here a rare case of FMH with intraplacental chorioangioma, and discuss the relationship between these two pathologies. © 2012 Japan Society of Obstetrics and Gynecology.
Sueyoshi S.,Omuta City Hospital |
Shin B.,Omuta City Hospital |
Nakashima T.,Kurume University
Journal of Otolaryngology of Japan | Year: 2013
A 66-year-old man visited our hospital with a chief complaint of a sore throat. On examination, the pharyngeal and laryngeal mucosa was reddish and localized mucosal erosion was present on the left side. Based on an initial diagnosis of acute pharyngitis caused by bacteriological infection or mycotic infection, treatment with antibacterial and antimycotic agents was initiated. However, the patient's sore throat gradually worsened and he developed intractable hiccups. Intravenous steroids were given for the treatment of the severe sore throat, and this symptom was gradually alleviated. However, the intractable hiccups persisted. In addition, the patient began to have convulsive syncope episodes and was subsequently admitted to our hospital. Further examination revealed that the syncope episodes were linked to the hiccups. To treat the hiccups, baclofen and Chinese medicine were prescribed, and the convulsive syncope episodes disappeared immediately. The patient's hiccups also improved and disappeared six days thereafter. Based on this clinical evidence, we concluded that the hiccups were caused by pharyngitis, resulting in the stimulation of the glossopharyngeal nerve, while the convulsive syncope episodes were a type of situational syncope related to hiccups.
Takemoto S.,Omuta City Hospital |
Takemoto S.,Kurume University |
Kawano R.,Omuta City Hospital |
Honda K.,Omuta City Hospital |
And 2 more authors.
Journal of Medical Case Reports | Year: 2012
Introduction: Benign multicystic peritoneal mesothelioma is an extremely rare tumor that occurs mainly in women in their reproductive age. Its preoperative diagnosis and adequate treatment are quite difficult to attain. Case presentation: Our patient was a 23-year-old Japanese woman who had a history of right oophorectomy and left ovarian cystectomy for an ovarian tumor at 20 years of age. The left ovarian tumor had been diagnosed on histology as a mucinous borderline tumor. Two years and nine months after the initial operation, multiple cysts were found in our patient. A laparotomy was performed and her uterus, left ovary, omentum and pelvic lymph nodes were removed due to suspicion of recurrence of the borderline tumor. A histological examination, however, revealed that the cysts were not a recurrence of the borderline tumor but rather benign multicystic peritoneal mesothelioma. There were no residual lesions and our patient was followed up with ultrasonography. She remains free from recurrence nine months after treatment. Conclusion: We report a case of benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor. Benign multicystic peritoneal mesothelioma should be suspected when a multicystic lesion is present in the pelvis as in the case presented here, especially in patients with previous abdominal surgery. © 2012 Takemoto et al.; licensee BioMed Central Ltd.
PubMed | Omuta City Hospital, National Hospital Organization and Kurume University
Type: Comparative Study | Journal: General thoracic and cardiovascular surgery | Year: 2016
This study compared the prediction of postoperative exercise capacity by employing lung perfusion scintigraphy images obtained with single photon emission computed tomography together with computed tomography (SPECT/CT) versus the common method of counting subsegments (SC method).In 18 patients scheduled for lobectomy, predicted postoperative maximum oxygen uptake per kilogram body weight ([Formula: see text]) was calculated by the SPECT/CT and SC methods. Correlations were examined between the [Formula: see text] predicted by SPECT/CT or the SC method, and the actual [Formula: see text] measured at 2weeks (mean 15.41.5days) and 1month (mean 29.10.75days) after surgery to determine whether SPECT/CT was more accurate than SC for predicting postoperative exercise capacity.There was a significant positive correlation between the [Formula: see text] predicted by SPECT/CT and the actual value at 2weeks (r=0.802, p<0.0001) or 1month (r=0.770, p<0.0001). There was also a significant positive correlation between the [Formula: see text] predicted by SC and the actual value at 2weeks (r=0.785, p<0.0001) or 1month (r=0.784, p<0.0001).This study showed that both SPECT/CT and the SC method were useful for predicting postoperative [Formula: see text] in the clinical setting.
PubMed | Omuta City Hospital, National Hospital Organization Omuta National Hospital and Kurume University
Type: Journal Article | Journal: Surgery today | Year: 2015
This study investigates whether postoperative exercise capacity can be predicted from preoperative lung perfusion scintigraphy and the number of subsegments resected.We studied 315 patients, with 158 being assigned odd numbers and 157 being assigned even numbers. In the 158 patients assigned odd numbers, the predicted postoperative VO2 max/m2 (ppo VO2 max/m2) was obtained from the results of lung perfusion scintigraphy and the number of subsegments scheduled for resection. We then examined correlations with the actual values, 2 weeks and 1 month postoperatively, to obtain a regression equation (Series 1). In the 157 patients assigned even numbers, the ppo VO2 max/m2 corrected by the regression equation derived from Series 1 (corrected-ppo VO2 max/m2) was compared with the actual values, 2 weeks and 1 month postoperatively, to establish whether the postoperative VO2 max/m2 could be predicted.The regression equation between the ppo VO2 max/m2 and its actual value was y = 0.83x + 103, 2 weeks postoperatively, and y = 0.923x + 82, 1 month postoperatively. The difference between the corrected-ppo VO2 max/m2 and the actual postoperative value was small.Calculating the residual [Formula: see text]o2 max/m2 preoperatively from the results of lung perfusion scintigraphy and the number of segments scheduled for resection is useful for predicting postoperative exercise capacity.
Oda K.,Omuta Tenryo Hospital |
Kasada T.,Omuta City Hospital |
Yoshikawa M.,Omuta City Hospital |
Tanoue M.,Omuta City Hospital |
And 2 more authors.
Therapeutic Drug Monitoring | Year: 2014
BACKGROUND: The serum level of teicoplanin (TEIC) is immediately elevated following administration of the recommended dose. In this study, the predictability of the serum trough for TEIC was investigated at day 2 or 3 (C2-3), and the authors performed a simulation based on the Bayesian method using C2-3 in Japanese patients. METHODS: Patients whose the serum trough level was measured within 48 hours (C2-3) and at steady state (Css) were eligible for the study. C2-3 was compared with the predicted level based on the population mean method, and Css was compared with the predicted Css based on both the Bayesian method using C2-3 and the population mean method. Bias and prediction accuracy were evaluated by the mean prediction error and the mean absolute prediction error (MAE), respectively. RESULTS: The observed and predicted C2-3 values were 13.2 ± 4.2 μg/mL and 10.4 ± 2.1 μg/mL, respectively. The observed Css was 17.1 ± 3.7 μg/mL, and the predicted Css values based on the Bayesian method and the population mean method were 16.8 ± 2.4 μg/mL and 15.3 ± 2.1 μg/mL, respectively. The mean prediction error and MAE for Css based on the population mean method were -1.87 μg/mL (not significant) and 3.45 μg/mL, respectively, and those based on the Bayesian method were -0.35 μg/mL (not significant) and 2.27 μg/mL, respectively. The change in MAE was 1.18 μg/mL (P < 0.05). CONCLUSIONS: A simulation based on the Bayesian method using C2-3 of TEIC is acceptable in clinical settings. © 2014 by Lippincott Williams & Wilkins.