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Tsubame, Japan

Sawatsubashi T.,Tsubame Rosai Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We evaluated the effects of stenting for malignant bowel obstruction in terminally ill cancer patients. Six terminally ill cancer patients with malignant bowel obstruction underwent gastrointestinal stenting at our department from November 2010 to October 2012. Stent insertion was successful and abdominal symptoms improved in all cases. Oral intake improved in 4 cases. Descending colon perforation occurred in 1 case. The survival time ranged between 10 and 184 days( median, 71.5 days). The palliative performance status (PPS) improved in 4 cases, and the survival time was extended as assessed by the palliative prognostic index (PPI). In cases with a PPI of were more than 6.0, namely cases for which the estimated survival time was less than 3 weeks, survival time and oral intake did not change. These findings suggest that gastrointestinal stenting is clinically useful for malignant obstruction and improving the PPS and prognosis in terminally ill patients with malignant bowel obstruction.

Nakatsuka H.,Tsubame Rosai Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

Rupture of a pseudoaneurysm after pancreaticoduodenectomy is a fatal complication. To prevent this, we used the round ligament of the liver to separate the hepatic artery from pancreatic anastomosis, obtaining good results. The procedure involved detaching the round ligament of the liver from the abdominal wall during laparotomy and winding it from the proper and common hepatic artery mainly on a gastroduodenal artery stump after reconstruction. Postoperative computed tomography (CT) scan revealed that a thick layer of fat separated the hepatic artery from the abdominal abscess. We retrospectively analyzed 56 patients who had undergone pancreaticoduodenectomy at Tsubame Rosai Hospital from 2003 until 2012. The round ligament was used for 22 patients( ligament group) and was not used for 34 patients( non-ligament group). There was no difference in morbidity from intra-abdominal abscess and pancreatic fistula between the ligament and non-ligament group. Intra-abdominal hemorrhage occurred in 2 patients( 5.9%) in the non-ligament group but did not occur in the ligament group. We believe that this procedure is easy and useful for the prevention of post-pancreatectomy hemorrhage.

Sawatsubashi T.,Tsubame Rosai Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

We report a case of a 41-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer(T3N3cM0) in 2004. She was treated with chemotherapy for multiple bone metastases and recurrence in the iliopsoas from January 2008. Right chest wall recurrence was observed in May 2010 and it progressed to ulcer. She was admitted to our hospital complaining of dyspnea on December 2, 2011. We diagnosed open pneumothorax and inserted a chest tube, and then packed the ulcer. No recurrence was observed in the liver and lungs. After stabilization of her general condition, we performed chest wall resection and reconstruction with a latissimus dorsi flap. She was discharged 2 weeks after surgery without severe complications. Although there were distant metastases, this surgical procedure may be effective for patients with open pneumothorax from recurrent breast cancer in order to maintain quality of life.

Matsuzaki H.,Tsubame Rosai Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2012

We evaluated the injuries, survival rats, and secondary surgeries of patients who had undergone finger replantation or revascularization between October 2005 and July 2010. The 70 digits came from 43 patients (average age, 46 years; range, 19 to 78 years; 37 men). Overall replantation survival rate was 94%; 93% (27/29) for complete amputations and 95% (39/41) for near-amputations. In all, 39 digits from 21 patients required 48 secondary surgeries; skin grafts, tenolysis, joint fusion, bone graft, osteotomy, and web plasty. The more proximal or more severe the injuries, the higher the need of secondary surgeries. The most common surgery soon after replantation was skin coverage; the most common after two months was tendon surgery. Primary repair must be adequate to restore the function and appearance of amputated digits; however, the possible need for secondary surgeries must be kept in mind to avoid restricting the options for secondary procedures.

Kanda T.,Tsubame Rosai Hospital | Ishikawa T.,Niigata University | Takahashi T.,Osaka University | Nishida T.,Osaka Police Hospital
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Imatinib, a selective tyrosine kinase inhibitor (TKI), is currently the standard treatment for unresectable and metastatic gastrointestinal stromal tumors (GISTs). However, the disease control time by imatinib is limited due to intolerance or resistance. Nilotinib, a second-generation TKI, is expected to show enhanced clinical efficacy against advanced GIST. Areas covered: PubMed and ClincalTrial.gov were searched to identify clinical trials of nilotinib for GIST. The key words used were GIST and nilotinib and/or AMN107. This review summarizes the clinical trials of nilotinib for advanced GIST and outlines current understanding of the clinical usefulness of nilotinib in GIST therapy. Expert opinion: Clinical trials of nilotinib for advanced GIST were readily advanced from a Phase I study to Phase III studies. Unfortunately, the clinical utility of nilotinib was not demonstrated by the randomized control trials either in patients with imatinib-resistant GIST or in patients who used nilotinib as the first-line treatment. On the basis of the trial results, nilotinib is not recommended for GIST therapy generally. Nevertheless, a comparable number of patients showed significant response with different side-effect profiles from imatinib. Thus, this new TKI may still merit attention as an important alternative to imatinib in advanced GIST patients who are intolerant to imatinib. © 2013 Informa UK, Ltd.

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