PubMed | National Hospital Organization Osaka National Hospital, Critical Care and Trauma Center, Saiseikai Senri Hospital, Kansai Medical University and 9 more.
Type: | Journal: Journal of intensive care | Year: 2016
We established a multi-center, prospective cohort that could provide appropriate therapeutic strategies such as criteria for the introduction and the effectiveness of in-hospital advanced treatments, including percutaneous coronary intervention (PCI), target temperature management, and extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients.In Osaka Prefecture, Japan, we registered all consecutive patients who were suffering from an OHCA for whom resuscitation was attempted and who were then transported to institutions participating in this registry since July 1, 2012. A total of 11 critical care medical centers and one hospital with an emergency care department participated in this registry. The primary outcome was neurological status after OHCA, defined as cerebral performance category (CPC) scale.A total of 688 OHCA patients were documented between July 2012 and December 2012. Of them, 657 were eligible for our analysis. Patients average age was 66.2years old, and male patients accounted for 66.2%. The proportion of OHCAs having a cardiac origin was 50.4%. The proportion as first documented rhythm of ventricular fibrillation/pulseless ventricular tachycardia was 11.6%, pulseless electrical activity 23.4%, and asystole 54.5%. After hospital arrival, 10.5% received defibrillation, 90.8% tracheal intubation, 3.0% ECPR, 3.5% PCI, and 83.1% adrenaline administration. The proportions of 90-day survival and CPC 1/2 at 90days after OHCAs were 5.9 and 3.0%, respectively.The Comprehensive Registry of In-hospital Intensive Care for OHCA Survival (CRITICAL) study will enroll over 2000 OHCA patients every year. It is still ongoing without a set termination date in order to provide valuable information regarding appropriate therapeutic strategies for OHCA patients (UMIN000007528).
Three-dimensional conformal radiotherapy for locally advanced hepatocellular carcinoma with portal vein tumour thrombosis: evaluating effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification
PubMed | Tane General Hospital, Osaka City University and Osaka Saiseikai Nakatsu Hospital
Type: Journal Article | Journal: The British journal of radiology | Year: 2016
The purpose of this study was to retrospectively evaluate the effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification in patients who received three-dimensional conformal radiotherapy (3D CRT) for hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) by analyzing toxicity and prognostic factors.56 consecutive patients who had locally advanced HCC with PVTT treated by 3D CRT between September 2007 and April 2013 were retrospectively reviewed.The median survival time of all patients was 6.4 months. Receiver-operating characteristic (ROC) analysis identified MELD score=7.5 [area under the curve (AUC) 0.81] and Child-Pugh score=6.5 (AUC 0.86) as the best cut-off values for predicting the incidence of complications over Common Terminology Criteria for Adverse Events grade 2. There was no significant difference in the discrimination power between the MELD score and the Child-Pugh score on comparison of the two ROC curves (p=0.17). On multivariate analysis, age, MELD score and radiotherapy dose were significant prognostic factors for overall survival (p=0.021, 0.038 and 0.006, respectively). In contrast, the Child-Pugh classification, tumour response, PVTT response and the number of prior interventional radiologic treatments were not significant on multivariate analysis.This study showed that the best MELD score cut-off value is 7.5 and that the MELD score is a better prognostic factor than the Child-Pugh classification in 3D CRT for HCC with PVTT.The MELD score is useful for predicting the risk of severe toxicities and the prognosis of patients treated with 3D CRT for PVTT.
PubMed | Hirao Hospital, Nara Prefecture General Medical Center, Saiseikai Chuwa Hospital, Nara Medical University and 2 more.
Type: | Journal: Neurourology and urodynamics | Year: 2016
We aimed to compare the efficacy and safety of mirabegron, a 3-adrenoceptor agonist, and imidafenacin, an anticholinergic agent, in overactive bladder patients.We conducted a multicenter, prospective randomized cross-over study at 5 hospitals in Japan from December 2012 to June 2015. We enrolled female patients with overactive bladder aged 50 years, who had never received treatment for the condition. The patients were assigned to Group A or B. Group A patients were administered mirabegron (50mg per day) for 8 weeks, followed by a 2-week washout period, and then imidafenacin (0.2mg per day) for 8 weeks. This order of drug administration was reversed in Group B.A total of 33 and 18 patients in Group A and 37 and 26 patients in Group B continued to receive treatment at weeks 8 and 18, respectively. Mirabegron administration significantly improved overactive bladder symptom score (OABSS), the urinary frequency per 24hr, voided volume per micturition, and number of nocturia episodes per night at week 8. Moreover, imidafenacin administration improved all these variables, except for the number of nocturia episodes per night at week 8. No significant difference was observed in the drug effects between mirabegron and imidafenacin. Although imidafenacin administration significantly increased the scores for dry mouth, blurred vision, and constipation, mirabegron administration did not.Mirabegron and imidafenacin have the same efficacy. Imidafenacin administration is associated with a higher rate of dry mouth, blurred vision, and constipation as compared to mirabegron administration. Neurourol. Urodynam. 2016 Wiley Periodicals, Inc.
PubMed | Izumi Municipal Hospital, Yodogawa Christian Hospital and Tane General Hospital
Type: Journal Article | Journal: Journal of radiation research | Year: 2016
The purpose of this study was to determine appropriate beam arrangement for volumetric-modulated arc therapy (VMAT)-based stereotactic body radiation therapy (SBRT) in the treatment of patients with centrally located lung tumors. Fifteen consecutive patients with centrally located lung tumors treated at our institution were enrolled. For each patient, three VMAT plans were generated using two coplanar partial arcs (CP VMAT), two non-coplanar partial arcs (NCP VMAT), and one coplanar full arc (Full VMAT). All plans were designed to deliver 70 Gy in 10 fractions. Target coverage and sparing of organs at risk (OARs) were compared across techniques. PTV coverage was almost identical for all approaches. The whole lung V10Gy was significantly lower with CP VMAT plans than with NCP VMAT plans, whereas no significant differences in the mean lung dose, V5Gy, V20Gy or V40Gy were observed. Full VMAT increased mean contralateral lung V5Gy by 12.57% and 9.15% when compared with NCP VMAT and CP VMAT, respectively. Although NCP VMAT plans best achieved the dose-volume constraints for mediastinal OARs, the absolute differences in dose were small when compared with CP VMAT. These results suggest that partial-arc VMAT may be preferable to minimize unnecessary exposure to the contralateral lung, and use of NCP VMAT should be considered when the dose-volume constraints are not achieved by CP VMAT.
The best objective response of target lesions and the incidence of treatment-related hypertension are associated with the survival of patients with metastatic renal cell carcinoma treated with sunitinib: a Japanese retrospective study
PubMed | Yamato Takada Municipal Hospital, Matsuzaka Chuo General Hospital, Nara Medical University, Tane General Hospital and Nara Prefecture General Medical Center
Type: | Journal: BMC research notes | Year: 2016
The aim of this study is to investigate the prognostic relevance of the best objective response of metastatic target lesions during sunitinib treatment in patients with metastatic renal cell carcinoma.Radiographic analysis of the best objective response according to the Response Evaluation Criteria in Solid Tumors was assessed in 50 patients. Clinicopathological characteristics including the Heng risk classification and sunitinib-related adverse reactions were compared among four patient subgroups [complete response or partial response (CR/PR), stable disease (SD), progressive disease (PD), and those without treatment evaluation (NE)]. Kaplan-Meier and Cox proportional regression analyses of progression-free survival and overall survival were performed to identify prognostic variables.The best objective response was CR/PR in 12 (24%) patients, SD in 22 (44%), PD in 6 (12%), and NE in 10(20%). The incidence of hypertension and hypothyroidism was associated with a better objective response. Progression-free survival was 15.0, 9.2, 6.8, and 2.2months in the CR/PR, SD, PD, and NE groups, respectively (P=0.0004, log-rank test), while the corresponding median overall survival was 59.7, 24.2, 17.1, and 18.1months, respectively (P=0.007). Multivariate analysis revealed that hazard ratios for risk of death of the SD, PD, and NE groups were 4.51 (P=0.06), 7.93 (P=0.02), and 4.88 (P=0.04), respectively, as compared to the CR/PR group.Our findings suggested that the best objective response of target lesions was a prognostic marker for both progression-free survival and overall survival in sunitinib treatment. Furthermore, the incidence of sunitinib-induced hypertension was associated with a longer progression-free survival.
Takeura H.,Tane General Hospital
Rinsho byori. The Japanese journal of clinical pathology | Year: 2011
Medical institutes need to prepare for earthquake or severe disasters which may happen at some future date and need to take countermeasures for those situations. Also our laboratory must do the same things. New medical center will be open in March, 2011. At the same time, this hospital will be registered as the one of the centers which contend with disasters to follow the infrastructure outline of disaster caring hospitals of Osaka prefecture.
Ishii K.,Tane General Hospital |
Ogino R.,Tane General Hospital |
Okada W.,Tane General Hospital |
Nakahara R.,Tane General Hospital |
And 2 more authors.
British Journal of Radiology | Year: 2013
To compare the dosimetric results and treatment delivery efficiency among RapidArc® (Varian Medical Systems, Palo Alto, CA), 7-field intensity-modulated radiotherapy (7-f IMRT) and 9-field IMRT (9-f IMRT) with hypofractionated simultaneous integrated boost to the prostate. Methods: RapidArc, 7-f IMRT and 9-f IMRT plans were created for 21 consecutive patients treated for high-risk prostate cancer using the Eclipse™ treatment planning system (Varian Medical Systems). All plans were designed to deliver 70.0Gy in 28 fractions to the prostate planning target volume (PTV) while simultaneously delivering 50.4Gy in 28 fractions to the pelvic nodal PTV. Target coverage and sparing of organs at risk (OARs) were compared across techniques. The total number of monitor units (MUs) and the treatment time were used to assess treatment delivery efficiency. Results: RapidArc resulted in slightly superior conformity and homogeneity of prostate PTV, whereas all plans were comparable with respect to dose to the nodal PTV. Although OARs sparing for RapidArc and 7-f IMRT plans were almost equivalent, 9-f IMRT achieved better sparing of the rectum and bladder than RapidArc and 7-f IMRT. RapidArc provided the highest treatment delivery efficiency with the lowest MUs and shortest treatment time. Conclusion: RapidArc resulted in similar OAR sparing to 7-f IMRT, whereas 9-f IMRT provided the best OAR sparing. Treatment delivery efficiency is significantly higher for RapidArc. Advances in knowledge: This study validated the feasibility and limitations of RapidArc in the treatment of high-risk prostate cancer with complex pelvic target volumes. © 2013 The Authors. Published by the British Institute of Radiology.
PubMed | Nara Medical University and Tane General Hospital
Type: Case Reports | Journal: Hinyokika kiyo. Acta urologica Japonica | Year: 2016
A 68-year-old man presented with the chief complaint of swelling of the penis. A pencil had been inserted into his urethra by a commercial sex worker for sexual stimulation. On a computed tomography (CT) scan, a foreign object was visible throughout the urethra and in the urinary bladder. Cystoscopy performed under spinal anesthesia showed a pencil in the urethra. We attempted removing the object endoscopically by using a Holmium laser. However, the endoscopic procedure failed and finally, we removed the object by transvesical open surgery. At the same time, suprapubic cystostomy was performed for the disorder of the urethra. An anterior urethrocutaneous fistula was formed 5 days after the operation. After removal of the urethral catheter, he was managed with only suprapubic cystostomy. Conservative management of the urethrocutaneous fistula was effective. The fistula was completely closed 26 days after the operation. He was discharged 33 days after the operation.