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Tsuchikane E.,Toyohashi Heart Center | Yamane M.,Sayama Hospital | Mutoh M.,Saitama Prefecture Cardiovascular and Respiratory Center | Matsubara T.,Toyohashi Heart Center | And 5 more authors.
Catheterization and Cardiovascular Interventions

Objectives This registry evaluated the current trends and outcomes associated with retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Background Since its introduction, several techniques and technologies have been introduced for retrograde PCI for CTO. Methods Eight hundred and one patients who underwent retrograde PCI for CTO in 28 Japanese centers between January 2009 and December 2010 were enrolled in this registry. Results Overall procedural and clinical success rates were 84.8 and 83.8%, respectively, of which, retrograde procedures accounted for 71.2 and 70.3%, respectively. The use of channel dilators increased in 2010 compared to that in 2009 (36 vs. 95.3%, P < 0.0001), attributed improving collateral channel crossing using a wire and catheter (70.6% vs. 81.1%, P = 0.0005) and increased availability of epicardial channels (27.6% vs. 36.9%). The use of the reverse controlled antegrade and retrograde tracking technique also increased (41.9 vs. 66.5%). Although these changes decreased procedure time (203.3 min vs. 187.9 min, P = 0.024), they did not significantly improve overall procedural success rate (84.1% vs. 85.3%, P = 0.63). Multivariate analysis identified age 65 years or more and lesion calcification as unfavorable factors and the use of a channel dilator as a favorable factor for retrograde procedural success. Conclusions Increased availability of channel dilators has altered strategies for retrograde PCI for CTO. However, retrograde PCI for CTO could be improved by overcoming its main obstacle of severe calcification. © 2013 Wiley Periodicals, Inc. Source

Yamane M.,Sayama Hospital | Muto M.,Cardiovascular and Respiratory Center | Matsubara T.,Nagoya Heart Center | Nakamura S.,Kyoto Katsura Hospital | And 6 more authors.

Aims: The retrograde approach to CTO is promising, but questions remain with regard to its wider application and the potential risks. This study evaluated the feasibility and efficacy of retrograde recanalisation of chronic total occlusion (CTO) of the coronary arteries. Methods and results: A total of 378 consecutive patients (previously failed PCI 32.0%) who enrolled in 27 institutions in Japan underwent retrograde recanalisation for CTO. We analysed the data on lesion characteristics, procedural materials, technique used, complications and clinical outcomes. Successful retrograde recanalisation was achieved in 70.4% and the overall procedural success was 83.6%. Collateral crossing was achieved via a septal route in 68.9%, epicardial in 27.2% and bypass grafts in 2.6%, respectively. The retrograde approach was completed with implementation of reverse CART in 42.5%, direct wire crossing in 23.1%, bilateral wiring in 22.7%, and CART in 11.7%. Major and minor collateral injuries and coronary perforations were noted in 1.3%, 10.3% and 2.9% of cases, respectively. Stroke occurred in 0.3%, QWMI and emergency PCI in 0.3% of patients with successful recanalisation. Conclusions: Wider application of retrograde CTO PCI achieved a high rate of success in recanalisation with an acceptable rate of complications in Japan. © Europa Digital & Publishing 2013. All rights reserved. Source

Takamatsu K.,Saiseikai Yokohamashi Tobu Hospital
Japanese Journal of Clinical Urology

Because of the increase of fluoroquinorone resistant bacteria after transrectal ultrasound-guided prostate biopsy, we used a single 800 mg/160 mg oral dose of sulfamethoxazole-trimethoprim which has good penetration to the prostate gland. In this study, we investigate the effectiveness of the sulfamethoxazole-trimethoprim as prophylaxis after transrectal ultrasound-guided prostate biopsy. Nine of the 380patients (2.6%) experienced the acute prostatitis. The rate of prostatitis after transrectal ultrasound- guided prostate biopsy in our study is as approximately same as previous reports. Source

Egawa T.,Saiseikai Yokohamashi Tobu Hospital
Gan to kagaku ryoho. Cancer & chemotherapy

A 70-year-old woman was diagnosed as having advanced lower thoracic esophageal cancer with abdominal lymph node metastases(T3N1M0, Stage III). After administering 2 courses of neoadjuvant chemotherapy with 5-fluorouracil(5- FU)( 800 mg/m2)and cisplatin(80 mg/m2), we performed curative surgery with D2 lymph node dissection. The patient could not receive adjuvant chemotherapy because of her poor performance status. After curative surgery, liver metastasis appeared in segment 8. The liver metastasis(S8)was treated with stereotactic body radiation therapy(SBRT)( 60 Gy/3 Fr). After SBRT, we administered systemic chemotherapy with docetaxel and nedaplatin as second-line chemotherapy. The patient had no recurrence for 12 months after SBRT. SBRT exhibited an excellent local therapeutic effect without any serious complications, suggesting that it is an effective treatment for liver metastasis from esophageal cancer. Source

Eto E.,Saiseikai Yokohamashi Tobu Hospital
Gan to kagaku ryoho. Cancer & chemotherapy

The patient was a 51-year-old woman who presented with nausea, vomiting, and abdominal pain. Detailed examination revealed a carcinoma of the descending colon with simultaneous hepatic metastasis. Because the carcinoma comprised a circumferential stenotic lesion and resection of the hepatic metastasis was feasible, combined left hemicolectomy and hepatectomy were initially performed. During postoperative adjuvant chemotherapy, the hepatic metastasis was observed to increase in size, and therefore, a second hepatectomy was performed approximately 2 years and 6 months after the initial surgery. Adjuvant chemotherapy was subsequently continued for approximately 1 year. A metastatic ovarian tumor was identified on abdominal computed tomography (CT) approximately 1 year after chemotherapy was discontinued. Bilateral salpingo-oophorectomy was performed approximately 3 years and 6 months after the initial surgery. Histopathological examination revealed the lesion to be a colon carcinoma metastasis. Source

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