Shin Tokyo Hospital

Shin, Japan

Shin Tokyo Hospital

Shin, Japan
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Kimura T.,Kyoto University | Kozuma K.,Teikyo University | Tanabe K.,Mitsui Memorial Hospital | Nakamura S.,Shin Tokyo Hospital | And 16 more authors.
European Heart Journal | Year: 2015

Aims Theoretically, bioresorbable vascular scaffolds (BVSs) may provide superior long-Term results compared with permanent metallic drug-eluting stents (DESs). However, whether BVSs are as safe and effective as metallic DESs prior to complete bioresorption is unknown. Methods and results ABSORB Japan was a single-blind, multicentre, active-controlled, randomized trial designed to support regulatory approval of the Absorb BVS in Japan. Eligible patients with one or two de novo lesions in different epicardial vessels were randomized at 38 Japanese sites in a 2:1 ratio to Absorb BVS vs. cobalt-chromium everolimus-eluting stents (CoCr-EESs). The primary endpoint was target lesion failure [TLF: A composite of cardiac death, myocardial infarction attributable to target vessel, or ischaemia-driven target lesion revascularization (ID-TLR)] at 12 months, powered for non-inferiority. The major secondary endpoint was angiographic in-segment late lumen loss (LLL) at 13 months. A total of 400 patients were randomized to BVSs (266 patients and 275 lesions) or CoCr-EESs (134 patients and 137 lesions). TLF through 12 months was 4.2% with BVSs and 3.8% with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.39% (3.95%); Pnon-inferiority < 0.0001]. Definite/probable stent/scaffold thrombosis at 12 months occurred in 1.5% of the patients with both devices (P = 1.0), and ID-TLR for restenosis was infrequent (1.1% with BVSs and 1.5% with CoCr-EESs, P = 1.0). With 96.0% angiographic follow-up, in-segment LLL at 13 months was 0.13 ± 0.30 mm with BVSs and 0.12 ± 0.32 mm with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.01 (0.07); Pnon-inferiority < 0.0001). Conclusion In the ABSORB Japan randomized trial, 12-month clinical and 13-month angiographic outcomes of BVSs were comparable to CoCr-EESs. Clinical registration ClinicalTrials.gov, number NCT01844284. © 2015 Published on behalf of the European Society of Cardiology. All rights reserved.


PubMed | Tokyo Women's Medical University, Columbia University Medical Center, Imperial College London, Kurashiki Central Hospital and 11 more.
Type: Comparative Study | Journal: European heart journal | Year: 2015

Theoretically, bioresorbable vascular scaffolds (BVSs) may provide superior long-term results compared with permanent metallic drug-eluting stents (DESs). However, whether BVSs are as safe and effective as metallic DESs prior to complete bioresorption is unknown.ABSORB Japan was a single-blind, multicentre, active-controlled, randomized trial designed to support regulatory approval of the Absorb BVS in Japan. Eligible patients with one or two de novo lesions in different epicardial vessels were randomized at 38 Japanese sites in a 2:1 ratio to Absorb BVS vs. cobalt-chromium everolimus-eluting stents (CoCr-EESs). The primary endpoint was target lesion failure [TLF: a composite of cardiac death, myocardial infarction attributable to target vessel, or ischaemia-driven target lesion revascularization (ID-TLR)] at 12 months, powered for non-inferiority. The major secondary endpoint was angiographic in-segment late lumen loss (LLL) at 13 months. A total of 400 patients were randomized to BVSs (266 patients and 275 lesions) or CoCr-EESs (134 patients and 137 lesions). TLF through 12 months was 4.2% with BVSs and 3.8% with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.39% (3.95%); Pnon-inferiority < 0.0001]. Definite/probable stent/scaffold thrombosis at 12 months occurred in 1.5% of the patients with both devices (P = 1.0), and ID-TLR for restenosis was infrequent (1.1% with BVSs and 1.5% with CoCr-EESs, P = 1.0). With 96.0% angiographic follow-up, in-segment LLL at 13 months was 0.13 0.30 mm with BVSs and 0.12 0.32 mm with CoCr-EESs [difference (upper one-sided 95% confidence limit) = 0.01 (0.07); Pnon-inferiority < 0.0001).In the ABSORB Japan randomized trial, 12-month clinical and 13-month angiographic outcomes of BVSs were comparable to CoCr-EESs.ClinicalTrials.gov, number NCT01844284.


Tounou S.,Shin Tokyo Hospital | Morita Y.,Shin Tokyo Hospital
Gastroenterological Endoscopy | Year: 2011

Recently, a sizable number of patients are taking anticoagulants and/or antiplatelet drugs. The Japanese guidelines on the management of endoscopic procedures in patients on anticoagulant and antiplatelet therapy recommend temporally discontinuation of anticoagulant and/or antiplatelet drugs in patients undergoing high risk endoscopic procedures. The problem is that some patients may meet serious life-threatening complication if they are forced to stop taking anticoagulants and/or antiplatelet drugs. In the present study, we investigated the occurrence of complications associated with endoscopic submucosal dissection (ESD) in patients taking various combinations of anticoagulant and antiplatelet drugs. We performed 232 ESDs for 219 patients with early gastric cancers and early duodenal cancers. In 152 patients who did not take anticoagulant nor antiplatelet drugs, postoperative hemorrhage was seen in 10 patients (6.6%), and 1 patient (0.7%) required blood transfusion. In 33 patients who had taken a single anticoagulant or antiplatelet drug and had stopped taking the drug before ESD, postoperative hemorrhage was seen in 4 patients (12.1%), and 3 patients (9.1%) required blood transfusion. In 12 patients who had taken more than 2 drugs and stopped all drugs before ESD, postoperative hemorrhage was seen in 1 patient (8.3%), and no patients (0.0%) required blood transfusion. In 7 patients who had taken a single drug and continued it (aspirin in all the cases), no postoperative hemorrhage was seen (0.0%), and no patients required blood transfusion (0.0%). In the remaining 15 patients who had taken more than 2 drugs and continued aspirin only, postoperative hemorrhage was experienced in 7 patients (46.7%), and 4 patients required blood transfusion (26.7%). In patients taking plural anticoagulants or antiplatelet drugs, the risk of postoperative hemorrhage was very high after re-starting these drugs. In contrast, in patients on aspirin therapy only, the risk of postoperative hemorrhage was low even if they continued aspirin therapy. According to the findings of this study, we conclude that ESD in patients on low-dose aspirin therapy only is safe, but when re-starting plural drugs, there is an increased risk of hemorrhage.


Tounou S.,Shin Tokyo Hospital | Morita Y.,Shin Tokyo Hospital | Miura M.,Shin Tokyo Hospital | Furuta R.,Shin Tokyo Hospital
Gastroenterological Endoscopy | Year: 2012

Endoscopic procedures in patients on anticoagulation therapy or antiplatelet therapy pose an increased risk of hemorrhage. Discontinuation of anticoagulation or antiplatelet therapy, however, has the risk of life-threating complications in some patients. In such patients, anticoagulation therapy should be replaced with heparin therapy while the minimum antiplatelet therapy is continued. Although endoscopic biopsies and therapeutic approaches (i.e. ESD, EMR and EPBD) on aspirin therapy add increased risk of hemorrhage, these procedures are feasible when performed with care. Confirmation of complete hemostasis at the end of each procedure is the most crucial in avoiding undue post-procedural bleeding. For the endoscopic biopsies, it is important to use endoscopic forceps with a small cup and to collect as small a specimen as possible from the surface tissue of the lesion. If the hemostasis after biopsy is incomplete, add compression hemostasis with endoscopic forceps and/or spray hemostatic agents (e.g. thrombin, epinephrine and sodium alginate). In endoscopic therapeutic approaches, the ulcer floor should be thoroughly coagulated after ESD or EMR, and ulcers should be closed with endoclips wherever possible. For endoscopic cholangiolithotomy, EPBD is preferred, and a pancreatic stent should be placed before EPBD or EST to prevent post-ERCP pancreatitis.


Mita K.,Shin Tokyo Hospital | Ito H.,Shin Tokyo Hospital | Fukumoto M.,Shin Tokyo Hospital | Murabayashi R.,Shin Tokyo Hospital | And 3 more authors.
American Journal of Surgery | Year: 2012

Extended multiorgan resection (EMR) for locally advanced (T4) gastric cancer remains controversial. The aim of this study was to evaluate the effectiveness of this approach with regard to morbidity, mortality, and survival. Between 2005 and 2009, 41 patients underwent aggressive surgery for clinical T4 gastric cancer. Univariate and multivariate analyses were used to identify prognostic factors for surgical outcomes and survival in these patients. Curative resection was performed in 29 patients (70.7%); postoperative morbidity and mortality rates were 17.1% and 4.9%, respectively. The survival rate in R0 resection patients was significantly longer than that in patients undergoing R1 or R2 resection. Multivariate analysis identified resectability and tumor size (<10 cm) as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection. EMR should be performed for patients with T4 gastric cancer in whom curative resection can be used. © 2012 Elsevier Inc. All rights reserved.


Ohhashi G.,Shin Tokyo Hospital | Inoya H.,Shin Tokyo Hospital
Neurological Surgery | Year: 2013

Cerebrovascular disorders complicated by persistent primitive arteries are commonly reported, but, we herein present a 78-year-old man with cerebral infarction due to stenosis of a persistent primitive artery by itself Cerebral angiography revealed bilateral vertebral artery aplasia to be complicated by a persistent primitive proatlantal artery which had become an important collateral circulation pathway. While the patient was hospitalized because of mild sensory impairment, he also developed visual field constriction and cerebellar symptoms due to recurrent stroke despite anticoagulation treatment Based on the results of various examinations, cerebral embolism, probably caused by stenosis at the origin of the persistent proatlantal artery, was diagnosed. Carotid artery stenting for the stenosis was planned. A filter protection device was found to be very useful for stenting with maintenance of blood flow in the persistent primitive proatlantal artery There have been no reports of stenting in persistent primitive proatlantal arteries, such as that our present case is considers It provides valuable information on the management of this rare disorder.


Mita K.,Shin Tokyo Hospital | Ito H.,Shin Tokyo Hospital | Fukumoto M.,Shin Tokyo Hospital | Murabayashi R.,Shin Tokyo Hospital | And 4 more authors.
Hepato-Gastroenterology | Year: 2011

Background/Aims: Pancreatic fistula is the most common complication following distal pancreatectomy. We have developed a fibrin adhesive sealing method which covers the cut surface and parenchyma of the pancreas, to prevent pancreatic fistula. Methodology: We performed 25 distal pancreatectomies. Fibrin adhesive (TachoComb®) was applied to the staple line of the pancreas before stapling. Pancreatic fistula was defined and graded according to the International Study Group of Postoperative Pancreatic Fistula (ISGPF) definition. Results: The overall incidence of pancreatic fistula was five cases (20%). Four cases (16%) were classified as Grade A. Only one case (4%) was classified as Grade B. In patients with or without pancreatic fistula, the mean length of postoperative hospital stay was not significant. Conclusions: The fibrin adhesive sealing method is a simple and effective method of preventing postoperative pancreatic fistula formation after distal pancreatectomy. © H.G.E. Update Medical Publishing S.A.


Mita K.,Shin Tokyo Hospital | Ito H.,Shin Tokyo Hospital | Fukumoto M.,Shin Tokyo Hospital | Murabayashi R.,Shin Tokyo Hospital | And 3 more authors.
Hepato-Gastroenterology | Year: 2011

Background/Aims: Pancreatic fistula is a common complication following pancreaticoduodenectomy. A number of technical modifications aimed to improve the pancreato-enteric anastomosis technique have been reported. The aim of this study was to evaluate the safety of TachoComb® fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Methodology: Between 2005 to 2009, 40 patients (28 men and 12 women) underwent ductto-mucosa pancreaticojejunostomy using a fibrin adhesive (TachoComb*) sealing method after pancreaticoduodenectomy (either pylorus-preserving or modified Child's methods). The mean age was 67.9 years (range of 49 to 80 years). Results: The overall postoperative rates of mortality and morbidity were 0.0% and 35.0%, respectively. Following the classification system described by the International Study Group on Pancreatic Fistula, 5 patients (12.5%) had Grade A pancreatic fistulas and 3 patients (7.5%) had Grade B pancreatic fistulas. There were no patients with Grade C pancreatic fistulas, and no cases of postoperative hemorrhage. No significant difference in the length of postoperative hospital stay was observed in patients with or without pancreatic fistulas. Conclusions: The use of TachoComb® fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy is safe, reliable for the prevention of pancreatic fistula, and shows promise for all types of reconstruction following pancreaticoduodenectomy. © H.G.E. Update Medical Publishing S.A.


PubMed | Shin Tokyo Hospital
Type: Case Reports | Journal: General thoracic and cardiovascular surgery | Year: 2012

Pulmonary artery aneurysms are rare and often arise in the left main trunk. Because they are uncommon, standardized treatment and clinical management are not clearly established. We present the case of a pulmonary artery aneurysm arising intraparenchymally and its surgical reconstruction using autologous pericardium. In terms of preserving pulmonary function, this procedure is effective compared with surgical procedures such as removal of part of the lungs.


PubMed | Shin Tokyo Hospital
Type: Case Reports | Journal: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia | Year: 2011

The aortic root of a 30-year-old man was replaced with a Freestyle stentless aortic bioprosthesis for aortic regurgitation associated with annuloaortic ectasia. His clinical course was uneventful, and he was discharged without complications. Three years and six months after surgery, he presented with a high fever. Four years after surgery, transthoracic echocardiography revealed severe aortic regurgitation. We performed exploratory surgery and discovered a torn left coronary cusp of the Freestyle bioprosthesis. Organized vegetation was adherent to the left coronary cusp leaflet. The non-coronary cusp and the right coronary cusp were normal. The diagnosis was aortic regurgitation due to valve failure related to infective endocarditis. Consequently, we reconstructed the aortic root with a composite graft (26-mm Valsalva graft and a 21-mm ON-X mechanical valve).

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