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Hamon M.,University of Caen Lower Normandy | Pristipino C.,San Filippo Neri Hospital | Di Mario C.,Royal Brompton Hospital | Nolan J.,Staffordshire University | And 20 more authors.
EuroIntervention | Year: 2013

Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.


PubMed | Saiseikai Yokohama City Eastern Hospital, Toyohashi Heart Center, Sendai Kousei Hospital, Keio University and 4 more.
Type: | Journal: The American journal of cardiology | Year: 2016

The aim of this study was to evaluate the incidence, predictors, and outcomes of percutaneous closure device (PCD) failure during transfemoral transcatheter aortic valve implantation (TAVI) with an Edwards Sapien-XT prosthesis using an expandable sheath (eSheath). From October 2013 to April 2016, 1,215 patients who underwent TAVI were prospectively enrolled in the Optimized Transcatheter Valvular Intervention (OCEAN-TAVI) registry. Of these, 478 patients underwent transfemoral TAVI with Sapien-XT prosthesis using an eSheath and percutaneous closure with a Perclose ProGlide system. We evaluated the predictors of PCD failure and whether it affected the clinical outcomes. Patients were aged 85years (interquartile range 82 to 88years). PCD failure occurred in 36 patients (8%). Sheath-to-femoral artery ratio (SFAR) (per 1 increase) (odds ratio 5.40, 95% confidence interval 1.28 to 22.92, p= 0.022) predicted PCD failure in a multivariate model. The sensitivity-specificity curves identified an SFAR threshold of 1.03; the area under the curve for SFAR as a predictor of PCD failure was 0.629. The PCD failure group did not have a higher rate of 30-day mortality (0% vs 1%, p= 0.52) or mid-term (365-day) mortality (log-rank test p= 0.85) compared with the PCD success group in the Kaplan-Meier analysis. In conclusion, PCD failures occurred in 8% of the patients and were not associated with 30-day or mid-term mortality rates after percutaneous transfemoral TAVI. The SFAR threshold of 1.03 was useful for predicting PCD failures.


Mukai Y.,Yokohama City University | Hata M.,Yokohama City University | Mitsudo K.,Yokohama City University | Koike I.,Yokohama City University | And 6 more authors.
Strahlentherapie und Onkologie | Year: 2014

Purpose: The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. Methods and materials: In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors. Results: Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment. Conclusion: Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma. © 2013 Springer Heidelberg Berlin.


Hata M.,Yokohama City University | Wada H.,Yokohama City University | Ogino I.,Yokohama City University | Omura M.,Yokohama City University | And 7 more authors.
Strahlentherapie und Onkologie | Year: 2014

Results: Fourteen of the 17 patients developed recurrences during the median follow-up period of 14 months after radiation therapy; 7 had recurrences in the scalp, including primary tumor progression in 2 patients and new disease in 5, and 12 patients developed distant metastases. The primary progression-free, scalp relapse-free, and distant metastasis-free rates were 86, 67, and 38 % at 1 year and 86, 38, and 16 % at 3 years, respectively. Thirteen patients died; the overall and cause-specific survival rates were both 73 % at 1 year and 23 and 44 % at 3 years, respectively. The median survival time was 16 months. There were no therapy-related toxicities ≥ grade 3.Patients and methods: Seventeen patients with angiosarcoma of the scalp underwent radiation therapy with total scalp irradiation. Four patients had cervical lymph node metastases, but none had distant metastases. A median initial dose of 50 Gy in 25 fractions was delivered to the entire scalp. Subsequently, local radiation boost to the tumor sites achieved a median total dose of 70 Gy in 35 fractions.Background and purpose: Wide surgical excision is the standard treatment for angiosarcoma of the scalp, but many patients are inoperable. Therefore, we investigated the outcome of radiation therapy for angiosarcoma of the scalp.Conclusion: Total scalp irradiation is safe and effective for local tumor control, but a dose of ≤ 50 Gy in conventional fractions may be insufficient to eradicate microscopic tumors. For gross tumors, a total dose of 70 Gy, and > 70 Gy for tumors with deep invasion, is recommended. © 2014, Springer-Verlag Berlin Heidelberg.


Noguchi K.,Shonankamakura General Hospital | Tanaka M.,Shonankamakura General Hospital | Katayama I.,Shonankamakura General Hospital | Yamabe T.,Shonankamakura General Hospital | And 3 more authors.
Heart Surgery Forum | Year: 2015

Background: The vasopressin type 2 receptor antagonist tolvaptan (TLV) has recently become available for treating congestion. However, there is no evidence confirming the efficacy of TLV for patients with volume overload after cardiac surgery. Here, we retrospectively studied the efficacy of TLV in patients with volume overload after cardiac surgery. Methods: We enrolled a total of 39 patients who had volume overload after cardiac surgery and who were treated with our protocol of body fluid management. The primary endpoint of this study was to evaluate the hospitalization period, while the secondary endpoints were to estimate adverse events such as hypotension, electrolyte abnormality, presence or absence of renal dysfunction and liver damage, and the incidence of atrial fibrillation (AF). Results: The hospitalization period of the T (TLV) and C (furosemide and spironolactone) groups was 12.3 ± 2.6 days and 14.7 ± 4.4 days, respectively (P = .044), the mean urine volume was 2761.5 ± 850.3 mL/day and 2205.2 ± 598.5 mL/ day, respectively (P = .024), and the incidence of postoperative AF after diuretics administration was 2/19 (11%) and 9/17 (52%), respectively. Conclusion: TLV successfully and rapidly improved organ congestion without causing hemodynamic abnormalities (hypotension, arrhythmia development), electrolyte abnormality, liver damage or renal dysfunction, thus significantly reducing the period of hospitalization. © 2015 Forum Multimedia Publishing, LLC.


PubMed | Shonankamakura General Hospital
Type: Case Reports | Journal: Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2013

We report two cases of ruptured pyogenic liver abscesses where one patient survived and the other died. We suspected that infection with gas-producing bacteria was the cause of the latter outcome, and we reviewed 47 case reports of ruptured pyogenic liver abscesses. Of the 47 cases, we determined that 77.6% included gas-producing pathogens. Moreover, the presence of gas-producing pathogens was associated with a mortality of 22.2%, whereas there were no deaths in cases with no gas-producing pathogens.


PubMed | Shonankamakura General Hospital
Type: Case Reports | Journal: Kyobu geka. The Japanese journal of thoracic surgery | Year: 2015

Empyema with fistula usually resists conservative treatment such as thoracic cavity drainage and administration of antibacterial agents, thus it often requires surgeries such as fenestration, omental/muscle filling, and thoracoplasty. However, due to advanced age and poor condition, conducting invasive surgeries is often difficult in elderly patients. We report a case with the improvement of empyema by bronchial filling with endobronchial Watanabe spigot (EWS) under thoracoscopic observation for an 89-year-old patient who had developed chronic empyema with a bronchial fistulas. After filling EWS, air-leakage from bronchial fistula disappeared and the patient could discharged from the hospital successfully.


PubMed | Shonankamakura General Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2014

A 63-year-old woman with colon cancer who was treated with capecitabine as adjuvant chemotherapy presented with vertigo on day 5, and dysarthria and dysphagia on day 7 of the treatment. Diffusion-weighted magnetic resonance imaging of the brain revealed high signal intensity in the corpus callosum and corona radiata. The patient was diagnosed with acute leukoencephalopathy, and the capecitabine treatment was discontinued. Her symptoms recovered immediately. On the basis of these findings, it can be concluded that diffusion-weighted imaging is useful for the early detection and diagnosis of acute leukoencephalopathy.


PubMed | Shonankamakura General Hospital
Type: Journal Article | Journal: The heart surgery forum | Year: 2016

The vasopressin type 2 receptor antagonist tolvaptan (TLV) has recently become available for treating congestion. However, there is no evidence confirming the efficacy of TLV for patients with volume overload after cardiac surgery. Here, we retrospectively studied the efficacy of TLV in patients with volume overload after cardiac surgery.We enrolled a total of 39 patients who had volume overload after cardiac surgery and who were treated with our protocol of body fluid management. The primary endpoint of this study was to evaluate the hospitalization period, while the secondary endpoints were to estimate adverse events such as hypotension, electrolyte abnormality, presence or absence of renal dysfunction and liver damage, and the incidence of atrial fibrillation (AF).The hospitalization period of the T (TLV) and C (furosemide and spironolactone) groups was 12.3 2.6 days and 14.7 4.4 days, respectively (P = .044), the mean urine volume was 2761.5 850.3 mL/day and 2205.2 598.5 mL/day, respectively (P = .024), and the incidence of postoperative AF after diuretics administration was 2/19 (11%) and 9/17 (52%), respectively.TLV successfully and rapidly improved organ congestion without causing hemodynamic abnormalities (hypotension, arrhythmia development), electrolyte abnormality, liver damage or renal dysfunction, thus significantly reducing the period of hospitalization.


PubMed | ShonanKamakura General Hospital
Type: Comparative Study | Journal: The Journal of invasive cardiology | Year: 2012

To address safety concerns with first-generation drug-eluting stents (DESs), the everolimus-eluting stent (EES) has been developed as a second-generation DES. The study aim was to: (1) demonstrate that use of the EES in Japanese patients is non-inferior to use of the paclitaxel-eluting stent (PES) in US patients; and (2) compare vessel response to the EES in Japanese vs US patients.The SPIRIT III Japan Registry, a prospective single-arm multicenter study was a part of the SPIRIT III global clinical program using harmonization by doing. The primary endpoint was in-segment late loss at 8 months, compared to US PES.A total of 88 subjects were enrolled in the Japan EES group. Angiographic in-segment late loss was significantly less in Japan EES vs US PES (0.15 0.34 mm vs 0.28 0.48 mm, respectively; P=.0185; Pnon-inferio r<.0001), while target vessel failure (TVF; 8.0% vs 9.9%) and major adverse cardiac events (MACE) at 9 months (5.7% vs 8.8%) were not significantly different between the 2 groups. No differences were observed between Japan and US EES populations in terms of late loss, TVF, or MACE. Neointimal volume and postprocedural incomplete stent apposition rate were lower in Japan EES vs US EES/PES.The SPIRIT III Japan Registry met the primary endpoint of lower late loss in the Japan EES group vs the US PES group, with comparable results for EES between the Japanese and US patients.

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