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Morikane K.,Yamagata University | Honda H.,Tokyo Metropolitan Tama Medical Center | Yamagishi T.,Japan National Institute of Infectious Diseases | Suzuki S.,Japan National Institute of Infectious Diseases
Infection Control and Hospital Epidemiology | Year: 2014

objective. Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). This study aims to assess factors associated with SSI after colorectal surgery in Japan, using a Japanese national database for HAIs. design. A retrospective nationwide surveillance-based study. setting. Japanese healthcare facilities. methods. Data on colon and rectal surgeries performed from 2008 through 2010 were extracted from a national monitoring system for healthcare-associated infections, the Japan Nosocomial Infections Surveillance (JANIS). Factors associated with SSI after colon and rectal surgery were assessed using multivariate logistic regression. results. The cumulative incidence of SSI for colon and rectal surgery was 15.0% (6,691 of 44,751) and 17.8% (3,230 of 18,187), respectively. Traditional risk factors included in the National Nosocomial Infections Surveillance (NNIS) modified risk index were significant in predicting SSI in the final model for both colon and rectal surgery. Among the additional variables routinely collected in JANIS were factors independently associated with the development of SSI, such as male sex (adjusted odds ratio [aOR], 1.20 [95% confidence interval (CI), 1.14-1.27]), ileostomy or colostomy placement (aOR, 1.13 [95% CI, 1.04-1.21]), emergency operation (aOR, 1.40 [95% CI, 1.29- 1.52]), and multiple procedures (aOR, 1.22 [95% CI, 1.13-1.33]) for colon surgery as well as male sex (aOR, 1.43 [95% CI, 1.31-1.55]), ileostomy or colostomy placement (aOR, 1,63 [95% CI, 1.51-1.79]), and emergency operation (aOR, 1.43 [95% CI, 1.20-1.72]) for rectal surgery. conclusions. For colorectal operations, inclusion of additional variables routinely collected in JANIS can more accurately predict SSI risk than can the NNIS risk index alone. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.


Machida H.,Tokyo Women's Medical University | Takeuchi H.,Tokyo Metropolitan Tama Medical Center | Tanaka I.,Tokyo Women's Medical University | Fukui R.,Tokyo Women's Medical University | And 4 more authors.
American Journal of Neuroradiology | Year: 2013

BACKGROUND AND PURPOSE: Improved CTA delineation of arteries and unruptured aneurysms is clinically desired in the posterior fossa. We present a novel model-based iterative reconstruction that models system statistics and optics to improve CT image quality. We investigated the utility of MBIR for improving delineation of arteries in the posterior fossa on 3D brain CTA. MATERIALS AND METHODS: Using filtered back-projection with a standard kernel and MBIR, we reconstructed axial images of 0.625-mm thickness of 28 consecutive patients (14 men; mean age, 58.6 ± 14.6 years) who underwent 64-detector brain CTA. We placed regions of interest on the axial images, measured the mean CT value in the basilar artery and the value and SD in the pons and bilateral cerebellar hemispheres, and calculated the contrast-to-noise ratio of the brain arteries in the posterior fossa. Using volume-rendered CTA and a 4-point scale, 2 radiologists independently graded delineation of the BA, bilateral vertebral artery, superior cerebellar artery, and anterior and posterior inferior cerebellar arteries. We compared the results between FBP and MBIR by using paired t and Wilcoxon signed-rank tests. RESULTS: Compared with FBP, MBIR significantly improved the contrast-to-noise ratio (P < .0001) and subjective delineation of all arteries in the posterior fossa except the BA (VA, SCA, AICA, and PICA; P < .05 for all). The mean visual score by MBIR was 3.0 or higher for all those arteries except the AICA assessed by reader 1 (2.6 ± 0.7). CONCLUSIONS: With 3D brain CTA, contrast-to-noise ratio and arterial delineation of the VA, SCA, AICA, and PICA in the posterior fossa are better with MBIR than FBP.


Honda H.,Tokyo Metropolitan Tama Medical Center | Honda H.,Teine Keijinkai Medical Center | Yamazaki A.,Teine Keijinkai Medical Center | Sato Y.,Teine Keijinkai Medical Center | Dubberke E.R.,University of Washington
Anaerobe | Year: 2014

Background: Although increases in Clostridium difficile infection (CDI) incidence and severity have been observed in numerous countries, the incidence of CDI in Japan remains unclear. The goal of this study was to determine the incidence and outcomes of CDI at a Japanese tertiary care center. Materials and methods: Retrospective cohort study in patients with CDI was conducted at a 550-bed, tertiary care, academic center in Sapporo, Japan from September 2010 through August 2012. CDI cases diagnosed by enzyme immunoassays were categorized per internationally recognized surveillance definitions. Data on demographic characteristics, medication exposures, CDI presentation, and CDI treatment were collected on all CDI cases. Factors associated with 30-day all-cause mortality after the completion of CDI treatment were also investigated. Results: There were 32,296 admissions and 350,074 patient-days from 22,863 patients during the study period; 126 patients were diagnosed with CDI. The median age of CDI case patients was 78 years. Healthcare facility-onset (HO) CDI accounted for 86.5% of CDI cases, with a HO-CDI incidence of 3.11 cases per 10,000 patient-days. Three patients underwent surgery for CDI (2.4%) and 19 patients (15%) died within a 30 days of completing CDI treatment. Factors independently associated with mortality were diabetes mellitus and shock at time of CDI diagnosis. Conclusions: The CDI incidence was lower than that typically reported from North American hospitals, but the proportion of patients requiring surgical therapy and dying within 30 days of CDI in non-outbreak settings was higher. More study is needed to determine why CDI incidence is low relative to CDI-associated outcomes in Japan. © 2013 Elsevier Ltd.


Isogai T.,University of Tokyo | Isogai T.,Tokyo Metropolitan Tama Medical Center | Matsui H.,University of Tokyo | Tanaka H.,Tokyo Metropolitan Tama Medical Center | And 2 more authors.
Heart | Year: 2016

Objective A catecholamine-mediated mechanism has been implicated in the pathogenesis of Takotsubo cardiomyopathy (TC). However, the impact of ß-blockers in acute-phase management of TC remains uncertain. This study aimed to examine whether early ß-blocker use in TC was associated with lower in-hospital mortality. Methods This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with TC aged =20 years who were admitted to acute-care hospitals between 2010 and 2014 were identified. Thirty-day inhospital mortality was compared between patients who started ß-blocker therapy on hospitalisation day 1 or 2 (early ß-blocker group) and those who did not receive a ß-blocker during hospitalisation (control group) using propensity score-matching and instrumental variable analyses. Results Of 2672 eligible patients (female, 81.5%; 423 early ß-blocker therapy, 2249 controls) from 615 hospitals, 1:4 propensity score-matching created a cohort of 2110 patients (422 early ß-blocker therapy, 1688 controls). There was no significant difference in 30-day in-hospital mortality between the early ß-blocker group and control group (2.4% vs 2.0%, p=0.703; risk difference, 0.4%; 95% CI, -1.2% to 2.0%). Logistic regression analysis did not show a significant association between early ß-blocker use and 30-day in-hospital mortality (OR, 1.17; 95% CI 0.58 to 2.37). Instrumental variable analysis also found that early ß-blocker use was not associated with lower 30-day in-hospital mortality (risk difference, 1.2%; 95% CI -3.1% to 5.5%). Conclusions This study found no significant association between early ß-blocker use and in-hospital mortality in patients with TC. © 2016 BMJ Publishing Group Ltd & British Cardiovascular Society.


Kida W.,Tokyo Metropolitan Tama Medical Center
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2011

Malignant myoepithelioma is a rare salivary gland tumor and represnts less than 1% of all salivary gland tumor. Very few cases have been reported. We reported a case of a malignat myoepithelioma of the soft palate minor salivary gland treated by performing a reconstruction using a radial forearm flap with satisfactory prognosis.


Ohtsuka T.,Tokyo Metropolitan Tama Medical Center | Ninomiya M.,Tokyo Metropolitan Tama Medical Center | Nonaka T.,Tokyo Metropolitan Tama Medical Center | Hisagi M.,Tokyo Metropolitan Tama Medical Center | And 2 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives: This study sought to evaluate thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation (AF). Background: Closing the left atrial appendage (LAA) is an efficacious alternative to oral anticoagulation as prevention against AF-induced thromboembolism, provided that the procedure is safe and complete. Methods: Thirty patients (mean age, 74 ± 5.0 years) who had had thromboembolisms were selected. A subgroup of 21 patients (mean age, 75 years; mean CHA 2DS2 VASc score, 4.5) urgently needed an alternative treatment to anticoagulation: warfarin was contraindicated due to hemorrhagic side effects in 13, the international normalized ratio was uncontrollable in 7, and transient ischemic attacks had developed immediately after the warfarin dose was reduced for oncological treatment in 1. The LAA was thoracoscopically excised with an endoscopic cutter. Results: Thoracoscopic appendectomy (mean operating time, 32 min, switched to mini-thoracotomy in 2 cases) led to no mortality and no major complications. Three-month post-operative 3-dimensional enhanced computed tomography, performed with patients' consent, confirmed the completeness of the appendectomy. Patients have been followed for 1 to 38 months (mean, 16 ± 9.7 months [18 ± 9.4 months for the subgroup]). One patient died of breast cancer 28 months after surgery. Despite discontinued anticoagulation, no patients have experienced recurrence of thromboembolism. Conclusions: Thoracoscopic stand-alone appendectomy is potentially safe and may allow surgeons to achieve relatively simple, complete LAA closure. Further experience may demonstrate this technique to be a viable option for thromboembolism prevention in nonvalvular AF. © 2013 American College of Cardiology Foundation.


Fuchigami T.,Tokyo Metropolitan Tama Medical Center
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2013

A 21-year-old female presented with a mass of the upper right neck. It was suspected a neurinoma of the vagus nerve by MRI and CT scan. The tumor was located in the higher position of bifurcation of common carotid artery. Intracapsular microscopic enucleation was performed under general anesthesia. We removed the tumor with the vagus nerve preserving the nerve function. Pathological diagnosis was neurinoma. She had no palsy of the vagus nerve after the surgery.


Kimura Y.,Tokyo Metropolitan Tama Medical Center
Otolaryngology - Head and Neck Surgery (Japan) | Year: 2013

Desending necrotizing Mediastinitis (DMN) resulting from deep neck infections have a high mortality rate. It is necessary to diagnose DMN rapidly and accurately, as the delay of deagnosis and treatment could lead patients to unfortunate outcome. The dranage by thoracotectomy was the gold standard for DMN spread throughout the mediastinum. However, wereported two cases successfully drained by thoracoscopy, as similar reports have been increasing in recent years. The drainage by thoracoscopy for DMN couls be recommended for some case.


Sakashita K.,Tokyo Metropolitan Tama Medical Center
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 72-year-old man visited our hospital due to persistent cough, fever and weight loss. A chest X-ray film revealed a round tumor in the left lower lung field. A specimen obtained by transbronchial lung biopsy demonstrated histiocytic and lymphocytic infiltration in the alveolar space, with spindle myofibroblasts and plasmacytes in the interstitium, Those findings were consistent with inflammatory pseudotumor. Four weeks later, a chest X-ray film showed only scars of the primary lesion, and his symptoms resolved dramatically. He has had no recurrence of symptoms and pulmonary tumor since then. Although spontaneous remission is uncommon in inflammatory pseudotumor of the lung, there are several case reports about spontaneous remission of hepatic inflammatory pseudotumor and autoimmune pancreatitis, parts of IgG4-related sclerosing disease. Recently, inflammatory pseudotumor is thought to be IgG4-related sclerosing disease. We speculate that IgG4 may be associated with spontaneous remission of inflammatory pseudotumor of the lung, and we discuss this issue in relation to the pertinent literature.


Honda H.,Tokyo Metropolitan Tama Medical Center | Dubberke E.R.,University of Washington
Current Opinion in Gastroenterology | Year: 2014

PURPOSE OF REVIEW: Clostridium difficile infection (CDI) is a growing concern and has a substantial impact on morbidity and mortality. Epidemiology of CDI has dramatically changed over the last decade. Diagnostic and treatment strategies are even more complicated given the wide variety of available diagnostic methods and the emergence of refractory or recurrent CDI. This review is intended to provide information on current CDI epidemiology and guidance for evidence-based diagnosis and management strategies. RECENT FINDINGS: Various studies from the United States, Europe, and Canada revealed increased incidence of CDI since 2000. Although CDI has long been associated with healthcare settings, recent studies indicate it is more common in the community than previously recognized. For diagnostic strategies, newer testing methods, including nucleic acid amplification tests, have enhanced sensitivity compared with toxin testing, but at the expense of decreased specificity. New agents for treating CDI are being developed and higher quality data to support fecal microbiota transplantation for treating recurrent CDI are emerging. SUMMARY: CDI epidemiology continues to evolve. Prompt recognition and an evidence-based treatment approach is the key to successfully manage CDI. Further, studies on diagnostic and therapeutic strategies are needed to further improve patient outcomes. © Lippincott Williams & Wilkins.

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