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Kawarada O.,Japan National Cardiovascular Center Research Institute | Kawarada O.,Kumamoto University | Ayabe S.,Yao Tokushukai General Hospital | Yotsukura H.,Japan National Cardiovascular Center Research Institute | And 8 more authors.
Journal of Endovascular Therapy | Year: 2013

Purpose: To report successful subintimal angioplasty of a lengthy femorotibial occlusion in a patient with Buerger's disease, with wound healing and limb salvage. Case Report: A 38-year-old female heavy smoker was referred to our hospital for treatment of extensive infectious tissue loss, with severe foot pain 1 month after early failure of a distal bypass graft. Angiography revealed total occlusion in the femoropopliteal and infrapopliteal arteries. Endovascular recanalization was attempted in order to establish "straight-line flow" to the foot on the verge of limb loss. The subintimal angioplasty technique with a 0.014-inch hydrophilic guidewire facilitated successful crossing of the occlusive femoropopliteal and posterior tibial arteries. The lesions were serially dilated (standard and cutting balloons). Angiography demonstrated antegrade flow to the foot without flow-limiting dissection, and the serious pain dramatically disappeared. Complete wound healing was observed 5 months after initial revascularization with the assistance of repeat angioplasty for restenosis. Conclusion: Contemporary endovascular therapy using the subintimal angioplasty technique could represent a viable option for Buerger's disease. © 2013 by the International Society of Endovascular Specialists. Source


Uryu K.,Yao Tokushukai General Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

We report a case of pneumatosis cystoides intestinalis (PCI) in a patient with lung cancer. A 60-year-old woman was admitted with multiple lung tumors and multiple brain tumors. She was given steroid hormones to reduce her brain edema. Total resection of a brain tumor yielded a pathological diagnosis of metastatic squamous cell carcinoma. During treatment, X-ray and CT images revealed intestinal pneumatosis and free air in the abdominal cavity, but a physical examination revealed no abnormal findings. She was given a diagnosis of PCI, and received conservative treatment. Her intestinal gas cysts and intra-abdominal free air disappeared spontaneously. PCI is an uncommon but important condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall. It is important to consider PCI as a possible complication in lung cancer patients who are given steroid hormones and systemic chemotherapy in the long-term. Source


Hatano T.,Osaka City University | Motomura H.,Osaka City University | Ayabe S.,Yao Tokushukai General Hospital
Journal of Neurological Surgery, Part B: Skull Base | Year: 2015

We present a modified locoregional flap for the reconstruction of large anterior skull base defects that should be reconstructed with a free flap according to Yano's algorithm. No classification of skull base defects had been proposed for a long time. Yano et al suggested a new classification in 2012. The lb defect of Yano's classification extends horizontally from the cribriform plate to the orbital roof. According to Yano's algorithm for subsequent skull base reconstructive procedures, a lb defect should be reconstructed with a free flap such as an anterolateral thigh free flap or rectus abdominis myocutaneous free flap. However, our modified locoregional flap has also enabled reconstruction of lb defects. In this case series, we used a locoregional flap for lb defects. No major postoperative complications occurred. We present our modified locoregional flap that enables reconstruction of lb defects. ©2015 Georg Thieme Verlag KG Stuttgart New York. Source


Nagao Y.,Yao Tokushukai General Hospital | Tawatsin A.,National Institute of Health | Thammapalo S.,Bureau of Vector Borne Disease | Thavara U.,National Institute of Health
Epidemiology and Infection | Year: 2012

Dengue haemorrhagic fever (DHF) is caused by dengue virus transmitted by Aedes mosquitoes; mean age of patients varies temporally and geographically. Variability in age of patients may be due to differences in transmission intensity or demographic structure. To compare these two hypotheses, the mean age of DHF patients from 90 districts in northern Thailand (1994-1996, 2002-2004) was regressed against (i) Aedes abundance or (ii) demographic variables (birthrate, average age) of the district. We also developed software to quantify direction and strength of geographical gradients of these variables. We found that, after adjusting for socioeconomics, climate, spatial autocorrelation, the mean age of patients was correlated only with Aedes abundance. The geographical gradient of mean age of patients originated from entomological, climate, and socioeconomic gradients. Vector abundance was a stronger determinant of mean age of patients than demographic variables, in northern Thailand. © 2011 Cambridge University Press. Source


Hirakawa T.,Yao Tokushukai General Hospital | Katou Y.,Yao Tokushukai General Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2014

In January 2012, the WallFlex Colonic Stent (Boston Scientific) for treating patients with malignant colorectal obstruction was included in the National Health Insurance (NHI) price list in Japan, and since July 2012, our hospital has placed this stent in 22 patients (as bridge-to-surgery [BTS] in 14 patients and as palliative treatment in 8 patients). The subjects included 13 men and 9 women, aged 27-94 years. The placement sites were the ileocecal lesion in 1 patient, the ascending colon in 1 patient, the transverse colon in 3 patients, the descending colon in 6 patients, the sigmoid colon in 4 patients, and the rectum in 7 patients. Stent placement was successful in all 22 patients (100%). The primary endpoint was improvement in scores on the ColoRectal Obstruction Scoring System (CROSS). The mean CROSS score before stenting was 1.18. The mean CROSS score after stenting was 3.71. Only 1 patient showed no change in the CROSS score (before versus after stenting). The rate of clinical efficacy was 95.4%. One patient experienced restenosis, an accidental event, requiring re-stenting after 3 days. There was 1 case of stent migration, which occurred 32 days after stenting. Colonic stent placement, as BTS and palliative treatment, is effective in improving the quality of life (QOL) of patients. Source

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