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Takeuchi N.,Saga Prefectural Hospital Koseikan
Fukuoka igaku zasshi = Hukuoka acta medica | Year: 2011

A 91-year-old female sustained injuries to her left forearm while walking across a crosswalk. X-rays showed left radial shaft and ulna shaft fractures, and the injury was a type IIIB open fracture. On the day of admission, irrigation and debridement of the open wound, and temporary fixation of the radius and ulna using an external fixator and a Kirschner wire were peformed. Six days after the surgery, we used negative pressure wound therapy (NPWT) using the V.A.C.ATS system for the open wound. Thirteen days after the first surgery, definitive fixation was performed by using locking compression plates, and full thickness skin grafting was undertaken for the open wound. NPWT is a treatment that accelerates the wound healing process through the delivery of continuous subatmospheric pressure within a closed environment. In our case, we could reduce the healing period of the soft tissue and could convert to the definitive fixation in a timely fashion. NPWT is thought to be a useful adjunct in the management of the soft tissues of open fractures. Source


Kajihara T.,Saga Prefectural Hospital Koseikan
Japanese Journal of Clinical Radiology | Year: 2013

We report a case of calcified gastric cancer in a 69-year-old woman. The current dynamic CT showed multiple punctate calcifications in the thickened gastric wall. The CT taken 16 months before had also shown slight calcifications in the thickened gastric wall. Histological examination of the gastric tumor showed gastric adeno carcinoma with calcified deposits in the mucin pool, which suggested ontogenic calcification. If we had paid more attention to the calcifications in the thickened gastric wall at the previous CT, we might have reached the diagnosis earlier. Source


Yakabe T.,Saga University | Nakafusa Y.,Red Cross | Sumi K.,Saga University | Miyoshi A.,Saga University | And 4 more authors.
Annals of Surgical Oncology | Year: 2010

Background: We evaluated the efficiency of CEA and CA19-9 as tools for diagnosing recurrence in the postoperative surveillance of colorectal cancer. Materials and Methods: A total of 227 patients who underwent curative resection for colorectal cancer between 1999 and 2003 at our hospital received complete follow-up according to the schedule determined prospectively. Using receiver operating characteristic (ROC) analysis, performance of postoperative values of CEA or CA19-9 for detecting recurrence was assessed. Results: The sensitivity (1.000) and specificity (0.978) of the postoperative values of CEA in the high preoperative CEA group were very high. Even in the normal preoperative CEA group, the area under the curve (AUC) of the ROC curve of CEA (0.740, 95% confidence interval [95% CI], 0.628-0.852) was significantly larger than 0.5 (P < 0.001). The postoperative values of CA19-9 showed high sensitivity (0.833) and specificity (0.900) in the high preoperative CA19-9 group, while the AUC of the ROC curve of the normal preoperative group was as small as 0.510 (95% CI, 0.376-0.644). In the high preoperative CA19-9 group, however, there was no significant difference between the AUC of CA19-9 (0.904, 95% CI, 0.786-1.000) and that of CEA (0.869, 95% CI, 0.744-0.994) (P = 0.334). Conclusions: The measurement of CEA is an efficient way to detect recurrence. The efficiency of measuring CA19-9 for the purpose of detecting recurrence is low, especially in patients with a normal level of preoperative CA19-9. Even in patients with a high preoperative level of CA19-9, CEA might be able to fill the role of CA19-9. © 2010 Society of Surgical Oncology. Source


Higuchi O.,University of Toyama | Adachi Y.,University of Toyama | Adachi Y.S.,University of Toyama | Taneichi H.,University of Toyama | And 2 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Objective: To evaluate parents' knowledge regarding foreign body aspiration (FBA) and determine the factors that are associated with lack of knowledge. Methods: An 8-item questionnaire regarding knowledge of FBA was developed and distributed at regular check-ups for children younger than 24 months old. Results: Out of the 1766 questionnaires distributed, 1603 were recovered and most of them (1539) were answered by mothers. After omitting 49 questionnaires with incomplete data, 1490 questionnaires answered by mothers were analyzed. Only 4.3% [95% CI 3.3-5.3] of mothers did not recognize a small toy as a cause of FBA, while 20.2% [95% CI 18.2-22.2] did not know that peanuts and other nuts can be causes of FBA, and 48.1% [95% CI 45.5-50.6] did not know that they should not give peanuts to a child younger than 3 years old. Regarding clinical signs, 27.7% [95% CI 25.4-30.0] and 41.8% [95% CI 39.3-44.3] of mothers did not know that sudden choking and sudden coughing were symptoms suggesting FBA, respectively. Being a mother with a child younger than 12 months old and being a mother with a first child were independent risk factors for lack of knowledge about FBA, regardless of the age of the mother. Conclusions: A substantial number of mothers lack knowledge regarding FBA. To prevent FBA and to make timely diagnoses, parents, especially mothers with children younger than 12 months old and mothers with a first child should be given adequate information. © 2012 Elsevier Ireland Ltd. Source


Yamaguchi T.,EP Expert Doctors Team Tsuchiya | Tsuchiya T.,EP Expert Doctors Team Tsuchiya | Nagamoto Y.,Saga Prefectural Hospital Koseikan | Miyamoto K.,National Cerebral and Cardiovascular Center | And 3 more authors.
Europace | Year: 2014

AimsTo examine the impact of left atrial (LA) low-voltage zones (LVZs) on atrial fibrillation (AF) recurrence after pulmonary vein antrum isolation (PVAI) without LA substrate modification.Methods and resultsSeventy-six patients with AF (paroxysmal/persistent 65/11) were prospectively enroled. Left atrial voltage maps were constructed during sinus rhythm using NavX to identify LVZs (<0.5 mV), and PVAI without any LA substrate modification was performed using an open-irrigation catheter. After PVAI, 20 mg of adenosine triphosphate (ATP) was injected. Adenosine triphosphate-induced PV reconnections were eliminated by touch-up ablation when unmasked. Voltage maps revealed LVZs in 24 patients (32%) and no LVZs in 52 (68%). During 24 ± 7 months of follow-up, 15 patients (63%) with LVZs and 10 (19%) without had AF recurrences off antiarrhythmic drugs (log-rank P < 0.001). A multivariate logistic regression analysis revealed that LVZ areas [odds ratio (OR): 1.12 per 1 cm2, 95% confidence interval (CI): 1.04-1.23, P = 0.001] and ATP-induced reconnection (OR: 2.08, 95% CI: 1.01-4.91, P = 0.046) were significant predictors of recurrence. In those with LVZs, the LVZ area was strongly correlated with the LA body volume (r = 0.81, P < 0.001) and a unique predictor of recurrence (OR: 1.17 per 1 cm 2, 95% CI: 1.01-1.55, P = 0.031), while in those without an LVZ, ATP-induced PV reconnection was a unique predictor (OR: 3.24, 95% CI: 1.15-15.39, P = 0.025).ConclusionThe LVZ area was an independent predictor of recurrence after PVAI without any LA substrate modification. Adenosine triphosphate-induced PV reconnection was also an independent predictor, especially in those without LVZs. © The Author 2013. Source

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