Matsuoka H.,Tokushima Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011
A lobectomy with systemic lymphadenectomy is a standard surgical procedure for a resectable lung cancer. However there is not a consensus on the limited surgery. A 60-year-old man underwent left upper lobe partial resection for small size lung adenocarcinoma under video assisted thoracic surgery (VATS). Fifty-six months after the operation, a computed tomography (CT) scan showed a local recurrence on the staple-line. A positron emission tomography (PET) scan showed an additional port site recurrence, which wasn't showed by a CT scan. He underwent left upper lobectomy and port site resection.
Hino N.,Tokushima Municipal Hospital |
Nakagawa Y.,Tokushima Municipal Hospital |
Ikushima Y.,Tokushima Municipal Hospital |
Yoshida M.,Tokushima Municipal Hospital |
Tsuyuguchi M.,Tokushima Municipal Hospital
Breast Cancer | Year: 2010
We report the case of a patient who presented with hypoglycemia associated with a giant breast mass and presence of serum high-molecular-weight insulin-like growth factor II (big IGF-II). In July 2005, a 49-year-old woman was admitted because of delirium, transient loss of consciousness, and a giant mass of about 28 cm in diameter on the right breast. She had noticed the mass for more than 2 years, but had refused medical attention at that time. A blood examination indicated hypoglycemia (21 mg/dl) and decreased levels of endogenous insulin. Furthermore, a western blot analysis revealed that big IGF-II (20 kDa) was the predominant serum IGF-II peptide (mature IGF-II is 7.5 kDa). Because we suspected that the big IGF-II was produced by the breast tumor and was likely the cause of the hypoglycemia, a mastectomy was performed. A histological examination determined that the mass was a benign phyllodes tumor. After surgery, the hypoglycemia resolved, and endogenous insulin levels improved. We suspected that the patient had non-islet cell tumor hypoglycemia (NICTH), but the behavioral symptoms of the hypoglycemia caused by NICTH were similar to some mental diseases, which made diagnosis based on the behavior alone difficult. We suggest that co-occurrence of symptoms such as recent appearance of mental disease-like behavior, hypoglycemia, and giant breast tumor may help diagnose NICTH caused by big IGF-II. © The Japanese Breast Cancer Society 2009.
Nakano S.,Tokushima Municipal Hospital |
Yoshioka S.,Tokushima Municipal Hospital |
Tezuka F.,Tokushima Municipal Hospital |
Nakamura M.,Tokushima Municipal Hospital |
And 2 more authors.
Journal of Arthroplasty | Year: 2013
We report 2 cases of patients (75 and 81 years old) who had a femoral shaft fracture around the femoral prosthesis after total hip arthroplasty. Using information on the implanted stem and the preoperative radiographs, we cut and trimmed an ordinary supracondylar type intramedullary nail, after which we have termed a "docking nail." We then performed osteosynthesis using the docking nail, which is connected to the tip of the implanted stem to ensure proper alignment. Within 3 months, bony union with good alignment was observed in both patients without malunion or infection. Clinical and radiographic examination during the follow-up period showed good results. The advantages of this method are that it is less invasive and simpler compared with the conventional methods. © 2013 Elsevier Inc.
Sone S.,Tokushima Municipal Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2015
In Japan, investigator-initiated clinical phase IV trials must follow the Ethical Guidelines for Medical and Health Research Involving Human Subjects, issued in December 2014. In addition, researchers must follow the Helsinki Declaration. In these clinical trials, academia-industry collaborations involving funding and technical support are required to develop better evidence-based medicine. Nevertheless, instances of publications reporting biases or misconduct in the research process occur frequently, which may lead to other problems due to lack of transparency. To address this issue, an institutional framework must be developed and maintained in which investigators maintain a high level of ethical adherence to protect the welfare of research subjects while carrying out research scientifically and appropriately under a conflict of interest (COI) disclosure. All authors must be seriously committed to greater responsibility, accountability, and transparency in collaborating with the industry.
PubMed | Tokushima Municipal Hospital and Gunma University
Type: | Journal: Neuropathology : official journal of the Japanese Society of Neuropathology | Year: 2016
Atypical teratoid/rhabdoid tumors (AT/RTs) are rare malignant neoplasms of the CNS that preferentially affect young children. We herein report an adult case of AT/RT surviving for more than 5years with the residual tumor. The patient, a 24-year-old man at onset, presented with a contrast-enhancing mass lesion in the left occipital lobe, and underwent partial tumor resection. Histologically, the tumor was predominantly composed of long spindle cells exhibiting nuclear palisading and perivascular pseudorosettes, which appeared to mimic mesenchymal, ependymal and Schwann cell tumors. A small number of isolated rhabdoid cells did not initially attract attention, and a tentative pathological diagnosis of a malignant mesenchymal tumor was made. In a later examination focusing on the small areas of rhabdoid cells, the extensive loss of the nuclear expression of INI1 was detected in all areas. Diffuse staining with vimentin and focal immunoreactivity for epithelial membrane antigen and alpha smooth muscle actin were observed not only in AT/RT foci, but also in spindle cell areas. Thus, polyphenotypic immunoreactivity was evident. Fluorescence in situ hybridization revealed a homozygous deletion of chromosome 22q covering the INI1 locus. Histopathological differences between infant and adult AT/RTs currently remain unclear. In the case of a malignant adult brain tumor showing a hardly classifiable morphology and immunophenotypic diversity, an analysis of the INI1 status may contribute to an accurate diagnosis.
PubMed | Tokushima Municipal Hospital, National Hospital Organization Tokushima Hospital and Tokushima University
Type: Journal Article | Journal: Journal of echocardiography | Year: 2016
In patients with Duchenne muscular dystrophy (DMD), cardiomyopathy initially occurs during adolescence. In routine echocardiographic examination, we often recognize increased rotational movement of the left ventricle in DMD patients even if their conventional echocardiographic finding is normal. Two-dimensional speckle tracking echocardiography can assess left ventricular (LV) rotation. The aim of this study was to analyze the mid-LV rotation and to investigate the clinical implication of this abnormal movement.Nineteen DMD patients (age 15.53.1years) and 22 age-matched healthy subjects were recruited. The two-dimensional speckle tracking method was used to determine the mid-LV rotation at the papillary muscle level. The mid-LV rotation and rotational velocity were calculated and were compared with other echocardiographic data and indices of autonomic function.Total rotation was greater in the DMD group than in the normal group (7.31.4 versus 5.21.3, p<0.05). Both peak diastolic clockwise and counterclockwise rotational velocity were greater in the DMD group (p<0.005 and p<0.05, respectively). Time from the second heart sound to peak diastolic clockwise rotation (% diastolic duration) was greater in the DMD group (p<0.005). Total rotation and percentage of adjacent normal R-R intervals more than 50ms different showed a negative correlation (r=-0.72) in the DMD group.In DMD patients, cases diagnosed with normal LV fractional shortening showed an increase in mid-LV rotation that might be due to relative increase of sympathetic nervous function before global cardiac function decreases.
PubMed | Tokushima Municipal Hospital, Tokushima University and Tokushima Prefectural Central Hospital
Type: Journal Article | Journal: Journal of echocardiography | Year: 2016
The diastolic wall strain (DWS) of the left ventricle has been proposed as an indicator of left ventricular (LV) wall stiffness. The DWS is calculated as follows using M-mode echocardiography:[Formula: see text]Although this index is simple and clinically useful, normal values for children, including neonates, have not been reported.The DWS was measured in 235 healthy people, ranging from neonates to adults. They were classified into 8 subgroups according to their age. The DWS was compared with conventional echocardiographic parameters for left ventricle function, including shortening fraction of the left ventricle, the Tei index, E/A of mitral flow, mitral annular tissue Doppler velocity during systole (s) and during early diastole (e), and the E/e ratio.The DWS in the just after birth group was 0.280.11, which was significantly lower than that of the remaining groups (p<0.05), except for the neonate group at 5-10days after birth. The DWS was highest in the 1-9years of age group, and then gradually decreased with age. Stepwise regression of various echocardiographic parameters showed that e was the most relevant parameter for the DWS (=0.64).Normal values for the DWS of the left ventricle change with age. The data reported in this study can be used as normal values for the DWS of the left ventricle determined by M-mode echocardiography.
PubMed | Tokushima Municipal Hospital and Tokushima University
Type: Journal Article | Journal: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association | Year: 2016
Adverse tissue reaction to metal debris (ARMD) as a secondary complication of Metal-on-metal total hip replacement (MoM THR) has been of concern. We have been performing cementless MoM THR using an Asian-type anatomic medullary locking (AML) stem. The purpose of this study is to examine the incident rate of ARMD, and the implant survival rate.The study included 187 patients (211 hip joints) who underwent MoM THR between February 2007 and November 2009 at our hospital and who were followed up for a minimum of 6 years. The cases included 174 female joints and 37 male joints. The average age at the time of surgery was 68.4 years. The average postoperative follow-up period was 87.5 months.ARMD was observed in 23 joints postoperatively, and the incidence rate was 10.9%. Most of the instances occurred within the first 30 months postoperatively. Revision surgery was performed for 14 joints after conservative treatment failed, and we changed the bearing surface. During the intraoperative observation, black-colored deposition of metal debris on the head-neck junction was observed in 13 cases. Kaplan-Meier analysis using the replacement surgery as the end point showed that this implant has a survival rate of 93.8% 7 years after the primary surgery.We conclude that the major cause of failure of Asian-type AML stemmed MoM THR is likely the breakage of the fixation between the taper neck and metal head at the head-neck junction.
PubMed | Red Cross, Tokushima Prefectural Central Hospital, Tokushima Municipal Hospital, National Hospital Organization Kochi National Hospital and 5 more.
Type: Journal Article | Journal: Journal of gastroenterology and hepatology | Year: 2016
Various randomized clinical studies have suggested that short- and long-term outcomes of laparoscopic surgery (LAP) for colorectal cancer are comparable with those of open surgery (OP). However, these studies were performed in high-volume hospitals. The aim of the present study was to compare the outcomes of LAP versus OP for colorectal cancer in rural hospitals.This was a multicenter retrospective propensity score-matched case-control study of patients who underwent colorectal surgery from January 2004 to April 2009 in 10 hospitals in Japan. All patients underwent curative surgery for pathologically diagnosed stage II or III colorectal cancer. The primary end point was 5-year overall survival (OS). The secondary end points were disease-free survival (DFS) and postoperative complications.In total, 319 patients who underwent LAP and 1020 patients who underwent OP were balanced to 261 pairs. There was no significant difference in the OS and DFS between two groups. The operation time was significantly shorter for OP than for LAP. Blood loss was significantly lower in LAP than in OP. There was no difference in intraoperative morbidity between the two groups. The postoperative morbidity was significantly lower in LAP than in OP. The hospital stay was significantly shorter in LAP than in OP. There was no significant difference in 90-day postoperative mortality.Laparoscopic surgery may be a feasible option for colorectal cancer in rural hospitals.
PubMed | Tokushima Municipal Hospital
Type: Journal Article | Journal: The journal of medical investigation : JMI | Year: 2016
The synchronous existence of lung cancer and gastrointestinal stromal tumors (GIST) is considered to be extremely rare. To the best of our knowledge, this is the first report about the treatment of lung cancer and GIST with two kinds of molecular targeting drugs. An 83-year-old woman with a rectal GIST, which carried a c-kit mutation, and pulmonary adenocarcinoma, which exhibited an epidermal growth factor receptor (EGFR) mutation, was treated alternately with imatinib and erlotinib. Good control over both diseases was achieved for two years. The present case is not only of interest due to the rare co-occurrence of GIST and lung cancer, but also because it involved two tumors carrying different gene mutations, and both tumors were brought under control using different molecular targeting drugs.