Rinku General Medical Center


Rinku General Medical Center

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Tsukamoto Y.,Hyogo College of Medicine | Imakita M.,Rinku General Medical Center | Nishitani A.,Rinku General Medical Center | Ito T.,Rinku General Medical Center | And 2 more authors.
Pathology, research and practice | Year: 2016

We experienced a rare case of pancreatic desmoid-type fibromatosis (DTF) in a 75-year-old Japanese woman. She was asymptomatic but routine examination including ultrasonography revealed a mass in the abdomen. For precise examination, she was referred to the regional hospital. Computed tomography showed that the mass was protruding anteriorly from the left-sided pancreas. Because of the enlargement of the mass lesion, distal pancreatectomy with splenectomy was performed after about 3 months. Macroscopically, the mass was encapsulated and approximately 8cm in diameter. Histological examination revealed that spindle or blunt stellate cells were proliferating in parallel or storiform fashion with myxoid and fibrous background. The tumor cells did not show prominent atypia and mitoses were rarely seen, suggesting that the tumor was low grade or borderline. Immunohistochemistry showed obvious nuclear staining of beta-catenin. Furthermore, analysis of beta-catenin gene revealed that the tumor had a typical missense mutation of threonine to alanine at colon 41 (T41A) in exon 3. These findings confirmed the pathological diagnosis of DTF of the pancreas. To the best of our knowledge, 18 cases of pancreatic DTF have been reported in the English literature and beta-catenin gene mutation had been examined in only one case among them. Thus, our case is the 19th pancreatic DTF and the second case with confirmed beta-catenin gene mutation. Copyright © 2016 Elsevier GmbH. All rights reserved.

Masuda D.,Osaka University | Yamashita S.,Osaka University | Yamashita S.,Rinku General Medical Center
Journal of Atherosclerosis and Thrombosis | Year: 2017

Fasting hypertriglyceridemia is positively associated with the morbidity of coronary heart disease (CHD), and postprandial (non-fasting) hypertriglyceridemia is also correlated with the risk status for CHD, which is related to the increase in chylomicron (CM) remnant lipoproteins produced from the intestine. CM remnant particles, as well as oxidized low density lipoprotein (LDL) or very low density lipoprotein (VLDL) remnants, are highly atherogenic and act by enhancing systemic inflammation, platelet activation, coagulation, thrombus formation, and macrophage foam cell formation. The cholesterol levels of remnant lipoproteins significantly correlate with small, dense LDL; impaired glucose tolerance (IGT) and CHD prevalence. We have developed an assay of apolipoprotein (apo)B-48 levels to evaluate the accumulation of CM remnants. Fasting apoB-48 levels correlate with the morbidity of postprandial hypertriglyceridemia, obesity, type Ⅲ hyperlipoproteinemia, the metabolic syndrome, hypothyroidism, chronic kidney disease, and IGT. Fasting apoB-48 levels also correlate with carotid intima-media thickening and CHD prevalence, and a high apoB-48 level is a significant predictor of CHD risk, independent of the fasting TG level. Diet interventions, such as dietary fibers, polyphenols, medium-chain fatty acids, diacylglycerol, and long-chain n-3 polyunsaturated fatty acids (PUFA), ameliorate postprandial hypertriglyceridemia, moreover, drugs for dyslipidemia (n-3 PUFA, statins, fibrates or ezetimibe) and diabetes concerning incretins (dipeptidyl-peptidase Ⅳ inhibitor or glucagon like peptide-1 analogue) may improve postprandial hypertriglyceridemia. Since the accumulation of CM remnants correlates to impaired lipid and glucose metabolism and atherosclerotic cardiovascular events, further studies are required to investigate the characteristics, physiological activities, and functions of CM remnants for the development of new interventions to reduce atherogenicity. © 2017 Japan Atherosclerosis Society.

Takahashi N.,Akita University | Kyo T.,Red Cross | Maeda Y.,National Hospital Organization | Sugihara T.,Kawasaki Medical School | And 13 more authors.
Haematologica | Year: 2012

It was recently recognized that some chronic myeloid leukemia patients with a complete molecular response could sustain that response after discontinuation of imatinib. To characterize the clinical outcomes and profiles of chronic phase chronic myeloid leukemia patients who could discontinue imatinib, we conducted a nationwide survey in Japan. Among 3,242 imatinib-treated chronic myeloid leukemia patients, we identified 50 who had discontinued imatinib for at least six months; of these we analyzed 43. Molecular recurrence was detected in 19 patients, and a complete molecular response rate was estimated to be 47% following imatinib discontinuation. Based on multivariate regression analysis, imatinib dose intensity and prior interferon-α administration were independently predictive of molecular recurrence within 12 months. The depth of the molecular response should be a factor influencing long-term sustained complete molecular response after discontinuation of imatinib. Additionally, an immunological mechanism modified by interferon-α might control chronic myeloid leukemia stem cells. © 2012 Ferrata Storti Foundation.

PubMed | Kameda Medical Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Hakuaikai Hospital, Chiba Foundation for Health Promotion and Disease Prevention and 7 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

37 Background: The intrinsic subtypes are important in the management of patients with early breast carcinoma; however, there have been only a few reports about the accuracy of preoperative subtyping by the preoperative ultrasonography guided vacuum-assisted breast biopsy (U.S.-guided VABB). The aim of this study was to evaluate concordance of the status of ER, PgR, HER2, and Ki67 between U.S.-guided VABB and subsequent surgical specimen.We retrospectively assessed the concordance of ER, PgR, HER2 and Ki67 status between U.S.-guided VABB and surgical specimen. The patients (n=228) underwent surgical treatment without neoadjuvant chemotherapy at the institute of Japan Association of Breast and Thyroid Sonology (JABTS) Interventional study Group from 2009 to 2012. All the US-guided VABB were performed using 8 or 11-gauge Mammotome or 10-gauge VACORA. The ER and PgR status were determined by IHC and HER2 expression status was tested by both IHC and FISH. The agreement on ER, PgR, HER2 and Ki67 status were evaluated by the absolute concordance rate and the kappa statistic values.The concordance rate of ER, PgR, and HER2 status between U.S.-guided VABB and surgical specimens were 96.4% (134/139), 89.2% (124/139), and 96.3% (130/135), respectively (kappa statistic value of 0.90, 0.77, and 0.84), and the agreement of Ki67 level was 89.6% (112/125) with a Kappa statistic value of 0.79. The concordance rate of the intrinsic subtypes was 84.0% (105 of 125 cases).The judgment of ER status, and HER2 status by preoperative U.S.-guided VABB can be used with confidence to determine the treatment strategies based on molecular subtypes.

Miyamoto Y.,Jikei University School of Medicine | Ito T.,Rinku General Medical Center | Takada E.,Dokkyo Medical University | Omoto K.,Jichi Medical University | And 2 more authors.
American Journal of Roentgenology | Year: 2014

OBJECTIVE. The objective of our study was to compare the efficacy of contrast-enhanced ultrasound (CEUS) using the ultrasound contrast agent Sonazoid (perflubutane) with unenhanced ultrasound and supplementary contrast-enhanced MRI in the differential diagnosis (benign vs malignant) of focal breast lesions. The safety of Sonazoid was also assessed in this study. SUBJECTS AND METHODS. A total of 127 patients with focal breast lesions were enrolled in this study at five centers in Japan. Three reviewers who were blinded to the patient characteristics independently assessed the ultrasound images and MR images in a randomized sequence. The accuracy, sensitivity, and specificity of CEUS, unenhanced ultrasound, and supplementary contrast-enhanced MRI for the differential diagnosis were compared using generalized estimating equation analyses. Diagnostic confidence was also assessed. RESULTS. The accuracy of CEUS was significantly higher than that of unenhanced ultrasound (87.2% vs 65.5%, respectively; p < 0.001). In addition, CEUS showed significantly higher specificity, although the improvement in sensitivity was not statistically significant. The accuracy and specificity were significantly higher with CEUS than with contrast-enhanced MRI, but the improvement in sensitivity was not statistically significant. The area under the curve in a receiver operating characteristic analysis was significantly greater with CEUS than with unenhanced ultrasound. The incidence of adverse events was 11.4% and the incidence of adverse drug reactions was 3.3%. All adverse drug reactions were mild. CONCLUSION. CEUS using Sonazoid was confirmed to be superior to unenhanced ultrasound for the differential diagnosis (benign vs malignant) of focal breast lesions in terms of diagnostic accuracy with no serious adverse reactions. © American Roentgen Ray Society.

Tsuji S.,Hoshigaoka Koseinenkin Hospital | Tomita T.,Osaka University | Hashimoto H.,Rinku General Medical Center | Fujii M.,Garacia Hospital | And 2 more authors.
International Orthopaedics | Year: 2011

The Dual Bearing Knee (DBK) prosthesis is a new concept which has a mobile-bearing insert. In May 2001, the posterior femoral condyle design of the DBK was changed to become smaller and there was a posterior shift in the base of the insert dish (Hi-Flex). Between 1998 and 2004, 371 DBKs (112 Hi-Flex and 220 Standard) were performed by one surgical team. There was a significant difference in postoperative flexion angle between the Hi-Flex and Standard DBKs (117.0° and 111.3°; p=0.001). The delta flexion angle in the Hi-Flex (-2.4°) was significantly increased compared with that in the Standard DBK (-9.6°) (p=0.001). In the Hi-Flex DBK, the postoperative flexion angle (5.7°) and the delta flexion angle (7.2°) were significantly larger than for the Standard DBK (p<0.001). These results suggest that the flexion is greater for a design with smaller posterior condyle prosthesis and with a posterior shift in the base of the insert dish in CR mobile-bearing TKA. © 2010 Springer-Verlag.

Iwanaga Y.,Rinku General Medical Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

A 64-year-old man had a sudden onset of gastrointestinal bleeding. He had been diagnosed as systemic mantle cell lymphoma (MCL) 27 months ago, and the first-line chemotherapy was undergone. After maintaining CR state during 12 months, he showed PD. Upper gastrointestinal endoscopy revealed multiple lymphomatous polyps, and active bleeding was noticed from the ulceration of the top of these polyps. After hemostasis was gained, biopsies were done twice and a local recurrence of MCL was diagnosed finally by immunohistological examination. In consequence of the second-line chemotherapy including bendamustine, he was introduced into CR again. We present this rare case of long-term follow up of MCL with a series of upper gastrointestinal endoscopy.

Moriuchi S.,Rinku General Medical Center | Yamada K.,Rinku General Medical Center | Dehara M.,Rinku General Medical Center | Teramoto Y.,Rinku General Medical Center | And 3 more authors.
Journal of Neurosurgery | Year: 2011

5-Aminolevulinic acid (ALA) has been successfully used to confirm the target tumor tissues obtained during stereotactic biopsy. The authors report their experience with 2 patients who underwent stereotactic biopsies of thalamic malignant lymphoma and pontine glioma utilizing 5-ALA. Intraoperatively, the tumor specimens fluoresced, allowing for confirmation that the obtained target specimen contained tumor tissues. No serious side effects or complications occurred.

Doi H.,Rinku General Medical Center | Arai F.,Rinku General Medical Center | Kobayashi S.,Rinku General Medical Center
Japanese Journal of Anesthesiology | Year: 2013

The transversus abdominis plane (TAP) block is a newly described technique introducing a local anesthetic agent between the internal oblique and the transversus abdominis muscles of the abdominal wall, which is safer and more reliable analgesia in recent years by ultrasound technique. We report the perioperative management of transversus abdominis plane block with catheterization for a patient with severe cardiac dysfunction and chronic kidney failure, who underwent bilateral inguinal hernioplasty. A bilateral TAP block was first performed with 0.5% ropivacaine 20 ml under ultrasonographic visualization on right side, and after sixty-minutes the other side injection was performed through the indwelling catheter. During the operation, the patient received a target-controlled infusion of 0.4-0.6 μg·ml-1 propofol. The perioperative courses were uneventful and there was no adverse effect including central nervous system (CNS) symptoms.

PubMed | Osaka Medical Center and Research Institute for Maternal and Child Health, Mukogawa Women's University and Rinku General Medical Center
Type: | Journal: Journal of mass spectrometry : JMS | Year: 2017

Trans fatty acid may impair fetal growth and infant neurodevelopment, but the quantity in a placenta and human tissues remains unknown. To address the issue, a simple and reliable method of quantification is needed. We established a method of quantifying trans-octadecenoic acids (trans-6,8,9,11 18:1 fatty acids, TOAs), a major component of TFA, in human tissue samples, and then determined the TOAs level in the placenta. Oleic acid (OA) (C18:1(9c)) was measured by isotope dilution gas-chromatography mass-spectrometry, and the TOAs level was subsequently calculated based on the ratio of the peak areas for TOAs and OA (TOAs/OA) in the mass chromatogram. Lipids were extracted from 28 human placentas at different gestational ages from 28 to 41weeks, and the TOAs and OA levels were measured. In method validation, the limit of detection for elaidic acid (EA: trans-9,18:1 fatty acid), a major component of TOAs, was 0.57ng, and linearity of calibration ranging from 7.7 to 68.0g/g placenta for TOAs. In human placenta analysis, the TOAs level was significantly higher in term (n=15, 40.29.7g/g placenta) than in preterm placentas (n=13, 18.97.4g/g placenta) (p<0.001), while OA levels were similar in term (n=15, 863132g/g placenta) and preterm (n=13, 743283g/g placenta) placentas (p=0.15). TOAs accumulate in the placenta as pregnancy progresses, and have a fate different from that of OA in vivo. To our knowledge, this is the first report of TOA quantification in human tissue samples.

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