Kawanishi, Japan
Kawanishi, Japan

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Ueda H.,Takai Hospital | Kido A.,Komatsu Hospital | Matsuhisa S.,Takai Hospital | Asawa K.,Takai Hospital | And 8 more authors.
American Heart Journal | Year: 2016

Background Patients with established coronary artery disease are at increased risk for future ischemic events and require secondary prevention for systemic vascular disease. We performed a randomized clinical trial to evaluate the impact of cilostazol on cardiovascular and cerebrovascular disease in patients undergoing percutaneous coronary intervention. Methods A total of 514 patients who had undergone coronary stent implantation >6 months previously and were thought to no longer need dual antiplatelet therapy with aspirin and a thienopyridine were randomly assigned to receive aspirin plus cilostazol therapy or aspirin therapy alone after discontinuation of thienopyridine therapy. The primary efficacy end point was a composite of all-cause death, myocardial infarction, stroke, or cardiovascular or cerebrovascular revascularization at 2 years after randomization. The main safety end point was major or minor bleeding, according to the Thrombolysis in Myocardial Infarction bleeding definition. Results At 2 years, follow-up clinical data were available for 98.1% of patients. The primary efficacy end point occurred in 13.9% of the aspirin plus cilostazol group versus 22.1% of the aspirin-only group (hazard ratio 0.61, 95% CI 0.40-0.93, P =.021). The rate of major or minor bleeding was not significantly different between the aspirin plus cilostazol and aspirin-only groups (1.6% and 4.0%, respectively, hazard ratio 0.40, 95% CI 0.13-1.28, P =.12). Conclusions In patients who underwent coronary stent implantation, the addition of cilostazol to aspirin therapy was associated with lower rates of cardiovascular and cerebrovascular events at 2 years compared with aspirin monotherapy. © 2015 Elsevier Inc. All rights reserved.


Sugita K.,Veritas Hospital | Kataoka S.,Veritas Hospital | Nishioka N.,Veritas Hospital | Tate H.,Veritas Hospital | And 3 more authors.
Gastroenterological Endoscopy | Year: 2012

Intestinal spirochetosis is a zoonotic infection caused by gram-negative, spiral-shaped bacilli. Because intestinal spirochetosis rarely causes severe sickness, we clinicians usually pay little attention to this bacillus. We report herein on our experience with the case of a 58 years old male who suffered from diarrhea and melena for 3 months and whose colonoscopy findings showed edema, reddening and an ulcer located at the ascending and transvers colon. The biopsy specimen showed gram-negative, spiral-shaped bacilli. The symptoms remarkably improved with 10 days of metronidazole per os and follow up colonoscopy revealed healing and scarring of the lesion. Serum antibodies to amoebae and light microscopic finding of biopsy specimens for amoebae and other bacterial culture study were negative.


Ichiba A.,Red Cross | Kido H.,Red Cross | Tokuyama F.,Red Cross | Makuya K.,Veritas Hospital | Oda K.,Red Cross
Journal of Orthopaedic Science | Year: 2014

Background: It is necessary to create bone tunnels within the native footprint during anatomic anterior cruciate ligament (ACL) reconstruction. Predicting the size of the ACL preoperatively may be useful in order to determine the diameter of the bone tunnels preoperatively or during surgery. The tibial insertion site of the ACL includes a depressed area, the ACL fovea, which is generally observed in the sagittal view on magnetic resonance imaging (MRI). The purposes of this study were to measure the anteroposterior diameter of the ACL fovea in the sagittal view on MRI and to investigate its associations with the physical characteristics of patients. Methods: One hundred patients (100 knees; 50 males and 50 females; mean age, 33 years) were included in this study. The anteroposterior diameter of the ACL fovea was measured in the sagittal view on MRI. The relationships between the diameter of the ACL fovea and physical characteristics including height, weight, and body mass index (BMI) were analyzed. Results: The mean diameter of the ACL fovea was 16.1 mm in male patients and 14.3 mm in female patients, which were comparable to the previously reported values. There were significant positive correlations between the diameter of the ACL fovea and height and weight, but not BMI. The number of knees in which the diameter of the ACL fovea was <13 mm was 14 (14%), and females were more likely to have ACL fovea diameter <13 mm. Conclusions: The study indicated that it is possible to predict the size of the ACL before surgery by measuring the diameter of the ACL fovea on MRI. Physical characteristics of patients correlated with the diameter of the ACL fovea. Especially in female patients, it is important to consider the size of the ACL preoperatively. © The Japanese Orthopaedic Association 2013.


Yasui K.,Osaka Medical College | Mihata T.,Osaka Medical College | Takeda A.,Veritas Hospital | Watanabe C.,Osaka Medical College | Kinoshita M.,Osaka Medical College
Sports Medicine, Arthroscopy, Rehabilitation, Therapy and Technology | Year: 2012

Background: A screening of ulnar collateral ligament insufficiency is required for overhead throwers, since secondary pathologic changes result from an increased elbow valgus laxity. We developed a new manual method for assessing elbow valgus laxity and investigated the reliability of this method and its correlation with ultrasonographic assessment.Methods: We defined elbow valgus laxity as the difference between the shoulder external rotation angle (ER angle) measured with the elbow in 90 degrees flexion and that measured with the elbow in extension because ER angle measured with the elbow in 90 degrees flexion includes elbow valgus laxity and ER angle with the elbow in extension does not include it. ER angle measurement with the elbow in extension involved the use of a custom arm holder. Three examiners each measured elbow valgus laxity by the new method in 5 healthy volunteers. Intraobserver and interobserver reliability was evaluated by calculating the intraclass correlation coefficient. We then assessed 19 high-school baseball players with no complaints of shoulder or elbow pain. Elbow ultrasonography was performed with a 10-MHz linear transducer with the elbow in 90 degrees flexion, and the forearm in the neutral position, and the width of the medial joint space at the level of the anterior bundle was measured. Elbow valgus laxity assessed by ultrasonography was defined as the difference between the medial joint space width with gravity stress and that without gravity stress. Increased elbow valgus laxity assessed by both our method and ultrasonography was defined as the difference between the laxity of the elbow on the throwing side and that on the contralateral side. Pearson's correlation coefficient (r) was calculated to evaluate the relationship between increased elbow valgus laxity obtained by our manual method and that by ultrasonography.Results: Intraobserver reliability ranged from 0.92 to 0.98, and interobserver reliability was 0.70. The increased elbow valgus laxity assessed by our method was significantly correlated with that assessed by ultrasonographic assessment (P = 0.019, r = 0.53).Conclusions: Elbow valgus laxity can be assessed by our method. This method may be useful for screening for insufficiency of the ulnar collateral ligament. © 2012 Yasui et al; licensee BioMed Central Ltd.


Katsumoto Y.,Veritas Hospital | Aritake N.,Veritas Hospital | Endoh A.,Veritas Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2010

Cetuximab (Erbitux) is a targeted therapy that used to treat metastatic colorectal cancer. It is classified as a "monoclonal antibody" and "signal transduction inhibitor" by binding to epidermal growth factor receptors (EGFR). We report 6 patients who responded well to cetuximab out of 8 patients with recurrent/advanced colorectal cancer who have received the drug at our hospital since November 2008. Four patients were men and 2 were women, with their ages ranging from 48 to 77 years. The primary cancers were located in the rectum (n = 1), sigmoid colon (n = 4), and ascending colon (n = 1). Performance status (PS) was 0-1. These patients were treated with cetuximab as second-line (n = 1), third-line (n = 3), fifth-line (n = 1), or seventh-line (n = 1) therapy. Three patients received cetuximab monotherapy, while the other 3 were given CPT-11 (150 mg/m2, every 2 weeks) as concomitant therapy. Among the 3 patients receiving combination therapy, 2 patients had already received treatment with FOLFIRI. Even in the cetuximab monotherapy group, a partial response (PR) was observed in 2 patients, demonstrating a strong cytoreductive effect. Tumor markers also showed large decreases, with the percent decrease at 1 month being 31.7% and 60.8% in the monotherapy and combination therapy groups, respectively, while it was respectively 14.1% and 29.5% at 2 months. The mean progression-free survival (PFS) time and the time to treatment failure (TTF) were respectively 3.0 months and 4.5 months in the monotherapy group versus 7.3 months and 9.3 months in the combination therapy group. Acneiform rash and paronychia occurred in all 6 patients.


Mihata T.,Osaka Medical College | Watanabe C.,Osaka Medical College | Fukunishi K.,Osaka Medical College | Ohue M.,Katsuragi Hospital | And 3 more authors.
American Journal of Sports Medicine | Year: 2011

Background: Although previous biomechanical research has demonstrated the superiority of the suture-bridge rotator cuff repair over double-row repair from a mechanical point of view, no articles have described the structural and functional outcomes of this type of procedure.Hypothesis: The structural and functional outcomes after arthroscopic rotator cuff repair may be different between the single-row, double-row, and combined double-row and suture-bridge (compression double-row) techniques.Study Design: Cohort study; Level of evidence, 3.Methods: There were 206 shoulders in 201 patients with full-thickness rotator cuff tears that underwent arthroscopic rotator cuff repair. Eleven patients were lost to follow-up. Sixty-five shoulders were repaired using the single-row, 23 shoulders using the double-row, and 107 shoulders using the compression double-row techniques. Clinical outcomes were evaluated at an average of 38.5 months (range, 24-74 months) after rotator cuff repair. Postoperative cuff integrity was determined using Sugaya's classification of magnetic resonance imaging (MRI).Results: The retear rates after arthroscopic rotator cuff repair were 10.8%, 26.1%, and 4.7%, respectively, for the single-row, double-row, and compression double-row techniques. In the subcategory of large and massive rotator cuff tears, the retear rate in the compression double-row group (3 of 40 shoulders, 7.5%) was significantly less than those in the single-row group (5 of 8 shoulders, 62.5%, P <.001) and the double-row group (5 of 12 shoulders, 41.7%, P <.01). Postoperative clinical outcomes in patients with a retear were significantly lower than those in patients without a retear for all 3 techniques.Conclusion: The additional suture bridges decreased the retear rate for large and massive tears. The combination of the double-row and suture-bridge techniques, which had the lowest rate of postoperative retear, is an effective option for arthroscopic repair of the rotator cuff tendons because the postoperative functional outcome in patients with a retear is inferior to that without retear. © 2011 American Orthopaedic Society for Sports Medicine.


We report three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer. CASE 1: An 86-year-old woman who received cetuximab after a colostomy for unresectable rectal cancer with synchronous liver and lung metastases. Serum levels of CEA and CA19-9 showed a significant decrease at 2 months, after which they showed a gradual increase. Computed tomography (CT) revealed a reduction in the rectal tumor. CASE 2: An 82-year-old woman who received cetuximab for peritoneal metastases after a transverse colectomy. Serum levels of CEA and CA19-9 decreased to normal levels at 2 months, and CT imaging revealed disappearance of the tumor in the peritoneal cavity. CASE 3: A 79-year-old man who received panitumumab for lung, liver and para-aortic lymph node metastases after a descending colectomy. Serum levels of CEA and CA19-9 showed a decrease at 1 month, after which they showed a gradual increase. No marked change in the tumor was observed by CT. No change was observed in performance status or Vulnerable Elders Survey( VES-13) score, and the effect on overall condition was minimal. Grade 1-2 acneiform skin rash, paronychia, and desquamation, and grade 2-3 dry skin and pruritis were observed. More precise instructions on measures for dealing with skin rash are necessary to obtain higher drug compliance.


Mihata T.,Osaka Medical College | Mihata T.,University of California at Irvine | Lee T.Q.,University of California at Irvine | Watanabe C.,Osaka Medical College | And 4 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) for symptomatic irreparable rotator cuff tears. Methods: From 2007 to 2009, 24 shoulders in 23 consecutive patients (mean, 65.1 years) with irreparable rotator cuff tears (11 large, 13 massive) underwent ASCR using fascia lata. We used suture anchors to attach the graft medially to the glenoid superior tubercle and laterally to the greater tuberosity. We added side-to-side sutures between the graft and infraspinatus tendon and between the graft and residual anterior supraspinatus/subscapularis tendon to improve force coupling. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Average follow-up was 34.1 months (24 to 51 months) after surgery. Results: Mean active elevation increased significantly from 84° to 148° (P <.001) and external rotation increased from 26° to 40° (P <.01). Acromiohumeral distance (AHD) increased from 4.6 ± 2.2 mm preoperatively to 8.7 ± 2.6 mm postoperatively (P <.0001). There were no cases of progression of osteoarthritis or rotator cuff muscle atrophy. Twenty patients (83.3%) had no graft tear or tendon retear during follow-up (24 to 51 months). The American Shoulder and Elbow Surgeons (ASES) score improved from 23.5 to 92.9 points (P <.0001). Conclusions: ASCR restored superior glenohumeral stability and function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique is a reliable and useful alternative treatment for irreparable rotator cuff tears. Level of Evidence: Level IV, therapeutic case series. © 2013 by the Arthroscopy Association of North America.


PubMed | Veritas Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

We report three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer. CASE 1: An 86-year-old woman who received cetuximab after a colostomy for unresectable rectal cancer with synchronous liver and lung metastases. Serum levels of CEA and CA19-9 showed a significant decrease at 2 months, after which they showed a gradual increase. Computed tomography (CT) revealed a reduction in the rectal tumor. CASE 2: An 82-year-old woman who received cetuximab for peritoneal metastases after a transverse colectomy. Serum levels of CEA and CA19-9 decreased to normal levels at 2 months, and CT imaging revealed disappearance of the tumor in the peritoneal cavity. CASE 3: A 79-year-old man who received panitumumab for lung, liver and para-aortic lymph node metastases after a descending colectomy. Serum levels of CEA and CA19-9 showed a decrease at 1 month, after which they showed a gradual increase. No marked change in the tumor was observed by CT. No change was observed in performance status or Vulnerable Elders Survey( VES-13) score, and the effect on overall condition was minimal. Grade 1-2 acneiform skin rash, paronychia, and desquamation, and grade 2-3 dry skin and pruritis were observed. More precise instructions on measures for dealing with skin rash are necessary to obtain higher drug compliance.


PubMed | Veritas Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

Cetuximab (Erbitux) is a targeted therapy that used to treat metastatic colorectal cancer. It is classified as a monoclonal antibody and signal transduction inhibitor by binding to epidermal growth factor receptors (EGFR). We report 6 patients who responded well to cetuximab out of 8 patients with recurrent/advanced colorectal cancer who have received the drug at our hospital since November 2008. Four patients were men and 2 were women, with their ages ranging from 48 to 77 years. The primary cancers were located in the rectum (n=1), sigmoid colon (n=4), and ascending colon (n=1). Performance status (PS) was 0-1. These patients were treated with cetuximab as second-line (n=1), third-line (n=3), fifth-line (n=1), or seventh-line (n=1) therapy. Three patients received cetuximab monotherapy, while the other 3 were given CPT-11 (150 mg/m2, every 2 weeks) as concomitant therapy. Among the 3 patients receiving combination therapy, 2 patients had already received treatment with FOLFIRI. Even in the cetuximab monotherapy group, a partial response (PR) was observed in 2 patients, demonstrating a strong cytoreductive effect. Tumor markers also showed large decreases, with the percent decrease at 1 month being 31.7% and 60.8% in the monotherapy and combination therapy groups, respectively, while it was respectively 14.1% and 29.5% at 2 months. The mean progression-free survival (PFS) time and the time to treatment failure (TTF) were respectively 3.0 months and 4.5 months in the monotherapy group versus 7.3 months and 9.3 months in the combination therapy group. Acneiform rash and paronychia occurred in all 6 patients.

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