Toyonaka Municipal Hospital

Ōsaka, Japan

Toyonaka Municipal Hospital

Ōsaka, Japan

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Fujitani K.,Osaka National Hospital | Tsujinaka T.,Osaka National Hospital | Fujita J.,Toyonaka Municipal Hospital | Miyashiro I.,Japan National Cardiovascular Center Research Institute | And 6 more authors.
British Journal of Surgery | Year: 2012

Background: Perioperative enteral immunonutrition is thought to reduce postoperative morbidity in patients undergoing major gastrointestinal surgery. This study assessed the clinical effects of preoperative enteral immunonutrition in well nourished patients with gastric cancer undergoing total gastrectomy. Methods: Well nourished patients with primary gastric cancer, fit for total gastrectomy, were randomized to either a control group with regular diet, or an immunonutrition group that received regular diet supplemented with 1000 ml/day of immunonutrients for 5 consecutive days before surgery. The primary endpoint was the incidence of surgical-site infection (SSI). Secondary endpoints were rates of infectious complications, overall postoperative morbidity and C-reactive protein (CRP) levels on 3-4 days after surgery. Results: Of 244 randomized patients, 117 were allocated to the control group and 127 received immunonutrition. SSIs occurred in 27 patients in the immunonutrition group and 23 patients in the control group (risk ratio (RR) 1.09, 95 per cent confidence interval 0.66 to 1.78). Infectious complications were observed in 30 patients in the immunonutrition group and 27 in the control group (RR 1.11, 0.59 to 2.08). The overall postoperative morbidity rate was 30.8 and 26.1 per cent respectively (RR 1.18, 0.78 to 1.78). The median CRP value was 11.8 mg/dl in the immunonutrition group and 9.2 mg/dl in the control group (P = 0.113). Conclusion: Five-day preoperative enteral immunonutrition failed to demonstrate any clear advantage in terms of early clinical outcomes or modification of the systemic acute-phase response in well nourished patients with gastric cancer undergoing elective total gastrectomy. Registration number: ID 000000648 (University Hospital Medical Information Network (UMIN) database). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


Shimizu J.,Toyonaka Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

A 60-year-old man with intrahepatic cholangiocarcinoma (ICC) underwent a left hepatectomy. Following the procedure, S-1 was administered during the period of five months. About two years after the hepatectomy, the patient underwent a hepatic resection again for remunant hepatic recurrences of ICC. Aggressive surgical resection may be the only method to assure a good outcome. An indication of resection for the hepatic recurrence of ICC will be examined in the future.


Watanabe N.,Toyonaka Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 73-year-old woman who had underwent right lower lobectomy for adenocarcinoma of the lung( S10,pT1aN0M0, stage I A) 5 years before, visited our hospital with back pain. Whole body computed tomography (CT) revealed the enlargement of the abodominal lymph nodes surrounding the celiac artery,which was positive for fluorodeoxyglucose-positron emission tomography( FDG-PET). Open biopsy of the lymph node was performed and histopathological diagnosis was metastases of adenocarcinoma.Additional immunohistological examination showed positive findings for cytokeratin( CK) 7 and thyroid transcription factor( TTF)-1, but negative for CK20, suggesting the lesion to be metastases of lung cancer. Abdominal lymph node should be kept in mind in patients with lower lobe lung cancer.


Kameyama A.,Toyonaka Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report a case of a patient in whom a giant mucinous cystadenocarcinoma was treated with distal pancreatectomy. A 37-year-old woman was admitted to the hospital complaining of intermittent epigastric pain. The laboratory data revealed a marked increase in serum levels of carcinoembryonic antigen( CEA 22 ng/mL), cancer antigen( CA) 19-9( 258,129 U/ mL), and CA125 (53 U/mL). A computed tomography (CT) scan revealed a cystic tumor, 15 cm in diameter, in the body of the pancreas. The tumor presented as a multilocular cyst with enhanced nodules. On positron emission tomography (PET)-CT,[ 18F] fluorodeoxyglucose uptake by the nodules of the cyst was noted. Under the diagnosis of malignant mucinous cystic neoplasm, we performed distal pancreatectomy, splenectomy, partial gastrectomy, and left adrenalectomy because the tumor was suspected to be invading the stomach and left adrenal gland. The tumor was histologically diagnosed as invasive mucinous cystadenocarcinoma with ovarian-like stroma. The patient survived for 14 months after surgery without tumor recurrence. Invasive mucinous cystadenocarcinoma of the pancreas has high rates of lymph node metastasis and early recurrence after surgery. We believe that we would have had to perform complete tumor resection equivalent to that of invasive ductal carcinoma of the pancreas if the mucinous cystic neoplasm was found to be malignant preoperatively.


Yasumoto T.,Toyonaka Municipal Hospital | Yokoyama S.,Yao Municipal Hospital | Nagaike K.,Suita Municipal Hospital
Journal of Vascular and Interventional Radiology | Year: 2010

Purpose: To evaluate the technical success and clinical effectiveness of percutaneous transcholecystic placement of self-expanding metallic stents for the treatment of malignant obstructions of the common bile duct. Materials and Methods: Fifteen patients with malignant obstruction at the lower level of the common bile duct not amenable to surgery were retrospectively reviewed in this study. In all patients, conventional biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage (ERBD) were technically difficult or deemed so at imaging evaluation. The causes of obstruction were cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 6), and metastatic lymphadenopathy from gastric carcinoma in the hepatoduodenal ligament (n = 2). Following percutaneous cholecystostomy, a 5-F catheter was inserted into the common bile duct, duodenum, or the anastomosed jejunum through the cystic duct and the malignant obstruction and metallic stents were placed. The technical success was defined as the removal of the drainage tube after the stent placement for the obstruction. The mean follow-up period was 25.4 months. Results: Sixteen stents were placed in 15 patients. Technical success was achieved in all patients (100%) without major complications. Minor complications included controllable pain or self-limited hemobilia in six of the 15 patients (40%). Lower bilirubin levels compared with those before the procedure were achieved in 14 of the 15 patients (93%). Conclusions: Percutaneous transcholecystic placement of metallic stents is a feasible and effective method to manage malignant obstruction at the lower level of the common bile duct not amenable to surgery when conventional biliary drainage via transhepatic peripheral duct access or ERBD were technically difficult or deemed so at imaging evaluation. © 2010 SIR.


Mizuno N.,Toyonaka Municipal Hospital | Denard P.J.,Southern Oregon Orthopedics | Raiss P.,University of Heidelberg | Melis B.,Policlinico Citta di Quartu | Walch G.,Center Orthopedique Santy
Journal of Shoulder and Elbow Surgery | Year: 2014

Background: The Latarjet procedure is effective in managing anterior glenohumeral instability in the short term, but there is concern for postoperative arthritis. The purpose of this study was to evaluate the long-term functional outcome after the Latarjet procedure and to assess the prevalence of and risk factors for glenohumeral arthritis after this procedure. Materials and methods: A retrospective review was conducted of 68 Latarjet procedures at a mean of 20years postoperatively. The mean age at surgery was 29.4years. Functional outcome was determined by the Rowe score, subjective shoulder value, and recurrence of instability. Preoperative arthritis and postoperative radiographs were reviewed to evaluate the development or progression of arthritis. Results: The mean Rowe score increased from 37.9 preoperatively to 89.6 at final follow-up (P<.001). The mean subjective shoulder value was 90.9% at final follow-up. The postoperative rate of recurrence was 5.9%. Of the 60 shoulders without arthritis preoperatively, 12 (20%) had developed arthritis at final follow-up. Among the 8 shoulders with preoperative arthritis (all stage 1), 4 (50%) demonstrated progression of arthritis at final follow-up. Overall, postoperative arthritis was stage 1 in 14.7%, stage 2 in 5.9%, and stage 3 in 8.8% of cases; no stage 4 arthritis was observed. Risk factors for postoperative arthritis were older age, high-demand sports activity, and lateral overhang of coracoid bone graft. Conclusion: The Latarjet procedure provides excellent long-term outcomes in the treatment of recurrent anterior glenohumeral instability. Twenty years after the Latarjet procedure, arthritis may develop or progress in 23.5% of cases, but the majority of arthritis is mild. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.


Ozaki R.,Toyonaka Municipal Hospital | Nakagawa S.,Yukioka Hospital | Mizuno N.,Toyonaka Municipal Hospital | Mae T.,Osaka University | Yoneda M.,Nakanoshima Iwaki Hospital
American Journal of Sports Medicine | Year: 2014

Background: In patients with traumatic anterior shoulder instability, a large Hill-Sachs lesion is a risk factor for postoperativerecurrence. However, there is no consensus regarding the occurrence and enlargement of Hill-Sachs lesions.Purpose: To investigate the influence of the number of dislocations and subluxations on the prevalence and size of Hill-Sachslesions evaluatd by computed tomography (CT) with 3-dimensional reconstruction.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: The prevalence and size of Hill-Sachs lesions were evaluated preoperatively by CT in 142 shoulders (30 with primaryinstability and 112 with recurrent instability) before arthroscopic Bankart repair. First, the prevalence of Hill-Sachs lesions wascompared with the arthroscopic findings. Then, the size of Hill-Sachs lesions confirmed by arthroscopy was remeasured usingthe previous CT data. In addition, the relationship of Hill-Sachs lesions with the number of dislocations and subluxations wasinvestigated.Results: Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy.The Hill-Sachs lesions missed by initial CT were 15 chondral lesions and 13 osseous lesions. However, all 103 osseous Hill-Sachslesions were detected by reviewing the CT data. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was26.7%, and the mean length, width, and depth of the lesions (calculated as a percentage of the diameter of the humeralhead) were 9.0%, 5.3%, and 2.1%, respectively, while the corresponding numbers for primary dislocation were 73.3%,27.7%, 14.8%, and 7.0%, all showing statistically significant differences. Among all 142 shoulders, the corresponding numberswere, respectively, 56.3%, 20.7%, 11.2%, and 4.8% in patients who had subluxations but never a dislocation; 83.3%, 33.4%,19.1%, and 7.6% in patients with 1 episode of dislocation; and 87.5%, 46.8%, 22.2%, and 10.2% in patients with≥2 episodes,all showing statistically significant differences. There were no differences in lesion measurements in relation to the number ofsubluxations.Conclusion: Computed tomography is a useful imaging modality for evaluating Hill-Sachs lesions except for purely cartilaginouslesions. Hill-Sachs lesions were more frequent and larger when the primary episode was dislocation than when it was subluxation.Among patients with recurrent episodes of complete dislocation, the prevalence of Hill-Sachs lesions is increased, and the lesionsare larger. ©2013 The Author(s).


Postoperative antimicrobial therapy is generally administered as standard prophylaxis against postoperative infection, despite a lack of sufficient evidence for its usefulness. This study was a phase II study to evaluate the necessity of postoperative antibiotic prophylaxis in patients undergoing a colectomy. Patients received 1 g cefmetazole or flomoxef immediately after anesthetic induction, every 3 h during surgery, and then later once again on the next day. They were randomly assigned to receive either cefmetazole or flomoxef. Ninety-one patients were enrolled in the study. A surgical site infection (SSI) occurred in 7.7% (7/91) of patients. All cases were superficial incisional infections. When comparing the two drugs, SSI occurred in 8.3% (4/48) of patients treated with cefmetazole and in 7.0% (3/43) treated with flomoxef, showing no significant difference (P > 0.99). Antimicrobial prophylaxis was well tolerated when used on the day of a colectomy and once again on the next day.


Ozawa T.,Toyonaka Municipal Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2014

A 48-year-old woman was hospitalized because of severe thrombocytopenia, leg edema, and fever. Intravenous immunoglobulin therapy was administered, but no efficacy was obtained. Her bone marrow was dry-tap, and fibrosis was found in the biopsy specimens. A positron emission tomographic study showed FDG-avid lymphadenopathy and hepatomegaly. Biopsy specimens of axillary lymph nodes showed Castleman's disease-like findings. Since she then developed severe proteinuria and massive pleural effusion, steroid therapy was started, providing temporary relief of symptoms other than the thrombocytopenia. However, rapid worsening of her general condition prompted us to attempt rituximab as salvage therapy. The pleural effusion, edema, and proteinuria disappeared soon after starting rituximab administration. Platelet counts also normalized and fibrosis of the bone marrow showed amelioration. Recently, a variant of multicentric Castleman's disease, termed the TAFRO syndrome, has been proposed, and our patient's features fit the diagnosis of this syndrome. Rituximab might be considered as a therapeutic option in such cases.


Mizuno N.,Toyonaka Municipal Hospital | Denard P.J.,Southern Oregon Orthopedics | Raiss P.,Center Orthopedique Santy | Walch G.,Center Orthopedique Santy
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: The biconcave glenoid in patients with primary glenohumeral osteoarthritis represents a surgical challenge because of the associated static posterior instability of the humeral head and secondary posterior glenoid erosion. The purpose of the present study was to evaluate the clinical and radiographic results of reverse total shoulder arthroplasty for the treatment of primary osteoarthritis in patients with a biconcave glenoid without rotator cuff insufficiency. Methods: We performed a retrospective review of twenty-seven reverse shoulder arthroplasties that were performed from 1998 to 2009 for the treatment of primary glenohumeral osteoarthritis and biconcave glenoid. Eighty-one percent of the patients were female, and the mean age of the patients at the time of surgery was 74.1 years (range, sixty-six to eighty-two years). All patients had a preoperative computed tomography arthrogram to allow for the measurement of glenoid retroversion and humeral head subluxation. The mean preoperative retroversion was 32°, and the mean subluxation of the humeral head with respect to the scapular axis was 87%. Seventeen patients had a reverse shoulder arthroplasty without bone graft, whereas ten had an associated bone graft to compensate for posterior glenoid erosion. Clinical outcomes were evaluated with the Constant score and shoulder range of motion. Results: The mean duration of follow-up was fifty-four months (range, twenty-four to 139 months). The mean Constant score increased from 31 points preoperatively to 76 points at the time of the latest follow-up (p < 0.0001). Active forward flexion, external rotation, and internal rotation also significantly increased (p < 0.0001). Complications occurred in four patients (15%) and included early loosening of the glenoid component (one patient) and neurologic complications (three patients). No radiolucent lines were observed around the central peg or screws of the glenoid component. Grade-1 or 2 scapular notching was present in ten shoulders (37%). No recurrence of posterior instability was observed. Conclusions: Reverse shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis in patients with a biconcave glenoid without rotator cuff insufficiency can result in excellent clinical outcomes. Reverse shoulder arthroplasty is a viable surgical option to solve both the problem of severe static posterior glenohumeral instability and severe glenoid erosion. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2013 by The Journal of Bone and Joint Surgery, Incorporated.

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