1
|
Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Endoscopic retrograde cholangiopancreatography for bile duct stones in patients with a performance status score of 3 or 4. World J Gastrointest Endosc 2022; 14:215-225. [PMID: 35634487 PMCID: PMC9048491 DOI: 10.4253/wjge.v14.i4.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/22/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As the aging population grows worldwide, the rates of endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones (CBDS) in older patients with a poor performance status (PS) have been increasing. However, the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking, with only a few studies having investigated this issue among patients with poor PS.
AIM To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4.
METHODS This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic ERCP. As a result, 1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were included. One-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS 3-4.
RESULTS The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0% (100/1113) and 7.0% (16/230; P = 0.37), and 4.6% (9/196) and 6.6% (13/196; P = 0.51), respectively. In the propensity score-matched patients, complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group (P = 0.042). Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate analysis. Therapeutic success rates, including complete CBDS removal and permanent biliary stent placement, in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4% (191/196) and 97.4% (191/196), respectively (P = 1.0).
CONCLUSION ERCP for CBDS can be effectively performed in patients with a PS 3 or 4. Nevertheless, the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Tsuruta Hospital, Kumamoto City 862-0925, Japan
| | - Takashi Shono
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics, Kurume University, Kurume City 8300011, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
| |
Collapse
|
2
|
Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Increased post-endoscopic retrograde cholangiopancreatography pancreatitis for choledocholithiasis without acute cholangitis. J Gastroenterol Hepatol 2022; 37:327-334. [PMID: 34626433 DOI: 10.1111/jgh.15704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/14/2021] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Choledocholithiasis is the most common indication for endoscopic retrograde cholangiopancreatography (ERCP). Identifying risk factors for post-ERCP pancreatitis (PEP) is important for reducing the risk of developing PEP after common bile duct (CBD) stone removal. However, studies examining the risk factors for PEP for CBD stones are scarce. The aim of this study was to examine whether the presence or absence of acute cholangitis is a clinical risk factor for PEP in patients with CBD stones. METHODS In this multicenter retrospective study, 1539 patients with naïve papillae were divided into patients without and with acute cholangitis. We compared the incidence of PEP between the two groups using one-to-one propensity score matching to adjust for the potential confounding factors of PEP. RESULTS In the entire cohort, the rates of PEP in patients without and with acute cholangitis were 9.6% (52/542) and 1.8% (18/997), respectively (P < 0.001, odds ratio = 5.8). In the propensity-matched cohort, the rates of PEP in patients without and with acute cholangitis were 8.3% (27/326) and 2.5% (8/326), respectively (P = 0.002, odds ratio = 3.6). The rate of PEP was significantly higher in patients without acute cholangitis than in those with acute cholangitis after adjusting for the confounding factors of PEP. CONCLUSIONS The absence of acute cholangitis may be an important clinical risk factor for PEP due to CBD stone removal. In patients without acute cholangitis, endoscopists should explain the specific risk of PEP carefully and actively implement prophylaxis against PEP.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Tsuruta Hospital, Kumamoto, Japan
| | - Takashi Shono
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, School of Medicine, Kurume University, Fukuoka, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
| |
Collapse
|
3
|
Saito H, Sakaguchi M, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Disease-Based Risk Stratification of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis for Common Bile Duct Stones. Dig Dis Sci 2022; 67:305-314. [PMID: 33471253 DOI: 10.1007/s10620-021-06825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Risk stratification of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) for common bile duct (CBD) stones is needed for clinicians to adequately explain to patients regarding the risk of PEP in advance of ERCP and to proactively take preventive measures in high-risk patients. AIMS To stratify the risk of PEP for CBD stones based on CBD-related diseases. METHODS A total of 1551 patients with naïve papilla who underwent ERCP for CBD stones were divided into three groups: Group A: asymptomatic CBD stones, Group B: obstructive jaundice and elevated liver test values without cholangitis, and Group C: mild, moderate, and severe cholangitis. We stratified the risk of PEP by comparing its incidence among the three groups using the Holm's method. Furthermore, we performed one-to-one propensity score matching between Group A and the other groups to examine the risk of PEP in Group A. RESULTS The incidence rates in Groups A, B, and C were 13.7%, 7.3%, and 1.8%, respectively. The Holm-adjusted p values between Groups A and B, Groups A and C, and Groups B and C were 0.023, < 0.001, and < 0.001, respectively. Propensity score matching revealed that the incidence of PEP was significantly more in Group A than in the other groups (13.3% vs. 1.5%; p < 0.001). CONCLUSIONS The risk of PEP for CBD stones was stratified into low risk (Group C), intermediate risk (Group B), and high risk (Group A). This simple disease-based risk stratification may be useful to predict the risk of PEP in advance of ERCP.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City, Kumamoto, 862-8505, Japan.
| | - Masafumi Sakaguchi
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto City, Kumamoto, 861-4193, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Tsuruta Hospital, 10-112, Hotakubohonmachi, Higashi-ku, Kumamoto City, Kumamoto, 862-0925, Japan
| | - Takashi Shono
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-ku, Kumamoto City, Kumamoto, 862-0965, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto City, Kumamoto, 861-4193, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto City, Kumamoto, 861-4193, Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-ku, Kumamoto City, Kumamoto, 862-0965, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto City, Kumamoto, 861-4193, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-ku, Kumamoto City, Kumamoto, 862-0965, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, 67, Asahimachi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City, Kumamoto, 862-8505, Japan
| |
Collapse
|
4
|
Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Endoscopic retrograde cholangiopancreatography-related complications for bile duct stones in asymptomatic and symptomatic patients. JGH Open 2021; 5:1382-1390. [PMID: 34950782 PMCID: PMC8674545 DOI: 10.1002/jgh3.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
Background and Aim Current guidelines recommend the removal of common bile duct (CBD) stones by endoscopic retrograde cholangiopancreatography (ERCP) for both asymptomatic and symptomatic patients. We conducted this study because of the limited research comparing the risks of ERCP-related complications between these two groups. Methods This retrospective study involved 1491 patients with native major duodenal papilla diagnosed with choledocholithiasis at three institutions in Japan. The rates of ERCP-related complications, including post-ERCP pancreatitis (PEP), cholangitis, bleeding, and perforation, were compared using one-to-one propensity score matching between the asymptomatic and symptomatic patients. Results Complications were observed in 112 (7.5%) of the 1491 patients (asymptomatic group: 31/172 [18.0%] vs symptomatic group: 81/1319 [6.1%], P < 0.001). The rate of severe complications was higher in the asymptomatic group than that in the symptomatic group (asymptomatic group: 5/31 [16.1%] vs symptomatic group: 3/81 [3.7%], P = 0.036). In the propensity-matched asymptomatic and symptomatic patients, the incidences of PEP, cholangitis, bleeding, and perforation were 18/143 (12.6%) vs 4/143 (2.8%) (P = 0.003); 4/107 (3.7%) vs 6/107 (5.6%) (P = 0.75); 1/140 (0.7%) vs 3/140 (2.1%) (P = 0.62); and 2/140 (1.4%) vs 2/140 (1.4%) (P = 1.0). Conclusions ERCP for asymptomatic patients with CBD stones is associated with a higher risk of overall and severe complications than that for symptomatic patients with CBD stones; the overall rate is influenced by the high incidence of PEP in the asymptomatic group. Endoscopists should explain the risk of ERCP-related complications for asymptomatic patients before performing the procedure.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology Kumamoto City Hospital Kumamoto City Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology Tsuruta Hospital Kumamoto City Japan
| | - Takashi Shono
- Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto City Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Japan
| | - Atsushi Urata
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery Kumamoto Chuo Hospital Kumamoto City Japan
| | - Haruo Imamura
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Japan
| | - Ikuo Matsushita
- Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto City Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School Kurume University Kurume Japan
| | - Shuji Tada
- Department of Gastroenterology Kumamoto City Hospital Kumamoto City Japan
| |
Collapse
|
5
|
Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones. Clin Endosc 2021; 55:263-269. [PMID: 34763384 PMCID: PMC8995991 DOI: 10.5946/ce.2021.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background/Aims Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.
Methods This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.
Results Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.
Conclusions Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Tsuruta Hospital, Kumamoto, Japan
| | - Takashi Shono
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Fukuoka, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto, Japan
| |
Collapse
|
6
|
Yamada T, Kurokawa Y, Mizusawa J, Takeno A, Hihara J, Imamura H, Takagane A, Nunobe S, Fukuda H, Takiguchi S, Doki Y, Boku N, Yoshikawa T, Terashima M, Sano T, Sasako M. 1399P Risk factors for body weight loss after gastrectomy for gastric cancer analysed from the JCOG1001 phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Saito H, Imamura H, Matsushita I, Kakuma T, Tada S. Immediate or Interval Endoscopic Papillary Large-balloon Dilation after Limited Endoscopic Sphincterotomy for Bile Duct Stone Removal. Intern Med 2021; 60:2713-2718. [PMID: 33716286 PMCID: PMC8479206 DOI: 10.2169/internalmedicine.6708-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Objective Endoscopic papillary large-balloon dilation (EPLBD) with limited endoscopic sphincterotomy (EST) is widely used for removing multiple large common bile duct (CBD) stones. However, the safety and effectiveness of immediate EPLBD after limited EST and EPLBD at an interval after limited EST is unclear. Thus, this multicenter retrospective study was conducted to examine this matter. Methods Propensity score-matching was performed to adjust the baseline characteristics between the immediate and interval EPLBD groups. We compared the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications and the early outcomes of ERCP between the 2 matched groups, which comprised 66 patients each. Results The complete stone clearance rate in each study group was 100%. The overall incidence of post-ERCP complications in the propensity score-matched interval and immediate EPLBD groups was 3/33 (9.1%) and 1/33 (3.0%), respectively (p=0.61). The immediate EPLBD group had significantly fewer mean ERCP sessions for complete stone removal and a significantly lower rate of endoscopic mechanical lithotripsy (EML) usage than the interval EPLBD group [1.6 vs. 2.4 sessions, p<0.001; and 4/33 (12.1%) vs. 12/33 (36.4%), p=0.042, respectively]. Conclusion The incidence of post-ERCP complications in the immediate EPLBD group was not significantly different from that in the interval EPLBD group. Compared with interval EPLBD, immediate EPLBD may result in a reduced number of ERCP sessions for complete stone clearance and reduce the rate of EML usage.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Japan
| |
Collapse
|
8
|
Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Tada S. Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones. World J Gastroenterol 2021; 27:2131-2140. [PMID: 34025069 PMCID: PMC8117734 DOI: 10.3748/wjg.v27.i18.2131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Current guidelines for treating asymptomatic common bile duct stones (CBDS) recommend stone removal, with endoscopic retrograde cholangiopancreatography (ERCP) being the first treatment choice. When deciding on ERCP treatment for asymptomatic CBDS, the risk of ERCP-related complications and outcome of natural history of asymptomatic CBDS should be compared. The incidence rate of ERCP-related complications, particularly of post-ERCP pancreatitis for asymptomatic CBDS, was reportedly higher than that of symptomatic CBDS, increasing the risk of ERCP-related complications for asymptomatic CBDS compared with that previously reported for biliopancreatic diseases. Although studies have reported short- to middle-term outcomes of natural history of asymptomatic CBDS, its long-term natural history is not well known. Till date, there are no prospective studies that determined whether ERCP has a better outcome than no treatment in patients with asymptomatic CBDS or not. No randomized controlled trial has evaluated the risk of early and late ERCP-related complications vs the risk of biliary complications in the wait-and-see approach, suggesting that a change is needed in our perspective on endoscopic treatment for asymptomatic CBDS. Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to discuss whether routine endoscopic treatment for asymptomatic CBDS is justified or not.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Tsuruta Hospital, Kumamoto City 862-0925, Japan
| | - Takashi Shono
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Jiro Nasu
- Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
| |
Collapse
|
9
|
Yamasaki M, Takiguchi S, Omori T, Hirao M, Imamura H, Fujitani K, Tamura S, Akamaru Y, Kishi K, Fujita J, Hirao T, Demura K, Matsuyama J, Takeno A, Ebisui C, Takachi K, Takayama O, Fukunaga H, Okada K, Adachi S, Fukuda S, Matsuura N, Saito T, Takahashi T, Kurokawa Y, Yano M, Eguchi H, Doki Y. Multicenter prospective trial of total gastrectomy versus proximal gastrectomy for upper third cT1 gastric cancer. Gastric Cancer 2021; 24:535-543. [PMID: 33118118 DOI: 10.1007/s10120-020-01129-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. METHODS A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. RESULTS Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (- 12.8% versus - 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p < 0.0001), but there were no group-dependent differences in blood loss and postoperative complications. For long-term outcomes, incidence of reflux esophagitis in the PG group was significantly higher than that of the TG group (14.5% versus 5.4%; p = 0.02), while there were no differences in the incidence of anastomotic stenosis between the two (5.7% versus 5.4%; p = 0.92). Overall patient survival rates were similar between the two groups (3-year survival rates: 96% versus 92% in the PG and TG groups, respectively; p = 0.49). CONCLUSIONS Patients who underwent PG were better able to control weight loss without worsening the prognosis, relative to those in the TG group. Optimization of a reconstruction method to reduce reflux in PG patients will be important.
Collapse
Affiliation(s)
- Makoto Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan.
| | - S Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Omori
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - M Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - H Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - K Fujitani
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - S Tamura
- Department of Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Y Akamaru
- Department of Surgery, Ikeda Municipal Hospital, Osaka, Japan
| | - K Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - J Fujita
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - T Hirao
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - K Demura
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - J Matsuyama
- Department of Surgery, Higashiosaka City Medical Center, Osaka, Japan
| | - A Takeno
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - C Ebisui
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - K Takachi
- Department of Surgery, Kinki Central Hospital, Hyogo, Japan
| | - O Takayama
- Department of Surgery, Saiseikai Senri Hospital, Osaka, Japan
| | - H Fukunaga
- Department of Surgery, Itami Municipal Hospital, Osaka, Japan
| | - K Okada
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
| | - S Adachi
- Department of Surgery, Nishinomiya Municipal Central Hospital, Hyogo, Japan
| | - S Fukuda
- Department of Surgery, Kindai University Nara Hospital, Osaka, Japan
| | - N Matsuura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| | - T Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| | - Y Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| | - M Yano
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - H Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan
| |
Collapse
|
10
|
Sunohara T, Imamura H, Goto M, Fukumitsu R, Matsumoto S, Fukui N, Oomura Y, Akiyama T, Fukuda T, Go K, Kajiura S, Shigeyasu M, Asakura K, Horii R, Sakai C, Sakai N. Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes. AJNR Am J Neuroradiol 2021; 42:119-125. [PMID: 33184073 DOI: 10.3174/ajnr.a6859] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE With the increasing use of the Pipeline Embolization Device for the treatment of aneurysms, predictors of clinical and angiographic outcomes are needed. This study aimed to identify predictors of incomplete occlusion at last angiographic follow-up. MATERIALS AND METHODS In our retrospective, single-center cohort study, 105 ICA aneurysms in 89 subjects were treated with Pipeline Embolization Devices. Patients were followed per standardized protocol. Clinical and angiographic outcomes were analyzed. We introduced a new morphologic classification based on the included angle of the parent artery against the neck location: outer convexity type (included angle, <160°), inner convexity type (included angle, >200°), and lateral wall type (160° ≤ included angle ≤200°). This classification reflects the metal coverage rate and flow dynamics. RESULTS Imaging data were acquired in 95.3% of aneurysms persistent at 6 months. Complete occlusion was achieved in 70.5%, and incomplete occlusion, in 29.5% at last follow-up. Multivariable regression analysis revealed that 60 years of age or older (OR, 5.70; P = .001), aneurysms with the branching artery from the dome (OR, 10.56; P = .002), fusiform aneurysms (OR, 10.2; P = .009), and outer convexity-type saccular aneurysms (versus inner convexity type: OR, 30.3; P < .001; versus lateral wall type: OR, 9.71; P = .001) were independently associated with a higher rate of incomplete occlusion at the last follow-up. No permanent neurologic deficits or rupture were observed in the follow-up period. CONCLUSIONS The aneurysm neck located on the outer convexity is a new, incomplete occlusion predictor, joining older age, fusiform aneurysms, and aneurysms with the branching artery from the dome. No permanent neurologic deficits or rupture was observed in the follow-up, even with incomplete occlusion.
Collapse
Affiliation(s)
- T Sunohara
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - H Imamura
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Goto
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - R Fukumitsu
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Matsumoto
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Fukui
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Y Oomura
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Akiyama
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Fukuda
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Go
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Kajiura
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Shigeyasu
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Asakura
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - R Horii
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - C Sakai
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Sakai
- From the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
11
|
Funakoshi Y, Imamura H, Tani S, Adachi H, Fukumitsu R, Sunohara T, Omura Y, Matsui Y, Sasaki N, Fukuda T, Akiyama R, Horiuchi K, Kajiura S, Shigeyasu M, Iihara K, Sakai N. Predictors of Cerebral Aneurysm Rupture after Coil Embolization: Single-Center Experience with Recanalized Aneurysms. AJNR Am J Neuroradiol 2020; 41:828-835. [PMID: 32381548 PMCID: PMC7228172 DOI: 10.3174/ajnr.a6558] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/22/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recanalization after coil embolization is widely studied. However, there are limited data on how recanalized aneurysms rupture. Herein, we describe our experience with the rupture of recanalized aneurysms and discuss the type of recanalized aneurysms at greatest rupture risk. MATERIALS AND METHODS A total of 426 unruptured aneurysms and 169 ruptured aneurysms underwent coil embolization in our institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms (unruptured group) and 37 (21.9%) of 169 ruptured aneurysms (ruptured group). The Modified Raymond-Roy classification on DSA was used to categorize the recanalization type. Follow-up DSA was scheduled until 6 months after treatment, and follow-up MRA was scheduled yearly. If recanalization was suspected on MRA, DSA was performed. RESULTS In the unruptured group, the median follow-up term was 74.0 months. Retreatment for recanalization was performed in 18 aneurysms. Four of 20 untreated recanalized aneurysms (0.94% of total coiled aneurysms) ruptured. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .025). In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .02). CONCLUSIONS The types of recanalization after coil embolization may be predictors of rupture. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.
Collapse
Affiliation(s)
- Y Funakoshi
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - H Imamura
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Tani
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - H Adachi
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - R Fukumitsu
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Sunohara
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - Y Omura
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - Y Matsui
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Sasaki
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Fukuda
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - R Akiyama
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Horiuchi
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Kajiura
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Shigeyasu
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Iihara
- Department of Neurosurgery (K.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - N Sakai
- From the Department of Neurosurgery (Y.F., H.I., S.T., H.A., R.F., T.S., Y.O., Y.M., N.Sasaki, T.F., R.A., K.H., S.K., M.S., N.Sakai), Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
12
|
Arakawa M, Saiki T, Wada K, Ogawa K, Kadono T, Shirai K, Sawada H, Ishibashi K, Honda R, Sakatani N, Iijima Y, Okamoto C, Yano H, Takagi Y, Hayakawa M, Michel P, Jutzi M, Shimaki Y, Kimura S, Mimasu Y, Toda T, Imamura H, Nakazawa S, Hayakawa H, Sugita S, Morota T, Kameda S, Tatsumi E, Cho Y, Yoshioka K, Yokota Y, Matsuoka M, Yamada M, Kouyama T, Honda C, Tsuda Y, Watanabe S, Yoshikawa M, Tanaka S, Terui F, Kikuchi S, Yamaguchi T, Ogawa N, Ono G, Yoshikawa K, Takahashi T, Takei Y, Fujii A, Takeuchi H, Yamamoto Y, Okada T, Hirose C, Hosoda S, Mori O, Shimada T, Soldini S, Tsukizaki R, Iwata T, Ozaki M, Abe M, Namiki N, Kitazato K, Tachibana S, Ikeda H, Hirata N, Hirata N, Noguchi R, Miura A. An artificial impact on the asteroid (162173) Ryugu formed a crater in the gravity-dominated regime. Science 2020; 368:67-71. [PMID: 32193363 DOI: 10.1126/science.aaz1701] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/04/2020] [Indexed: 11/02/2022]
Abstract
The Hayabusa2 spacecraft investigated the small asteroid Ryugu, which has a rubble-pile structure. We describe an impact experiment on Ryugu using Hayabusa2's Small Carry-on Impactor. The impact produced an artificial crater with a diameter >10 meters, which has a semicircular shape, an elevated rim, and a central pit. Images of the impact and resulting ejecta were recorded by the Deployable CAMera 3 for >8 minutes, showing the growth of an ejecta curtain (the outer edge of the ejecta) and deposition of ejecta onto the surface. The ejecta curtain was asymmetric and heterogeneous and it never fully detached from the surface. The crater formed in the gravity-dominated regime; in other words, crater growth was limited by gravity not surface strength. We discuss implications for Ryugu's surface age.
Collapse
Affiliation(s)
- M Arakawa
- Department of Planetology, Kobe University, Kobe 657-8501, Japan.
| | - T Saiki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - K Wada
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - K Ogawa
- Department of Planetology, Kobe University, Kobe 657-8501, Japan.,JAXA Space Exploration Center, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Kadono
- Department of Basic Sciences, University of Occupational and Environmental Health, Kitakyusyu 807-8555, Japan
| | - K Shirai
- Department of Planetology, Kobe University, Kobe 657-8501, Japan.,Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - H Sawada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - K Ishibashi
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - R Honda
- Department of Information Science, Kochi University, Kochi 780-8520, Japan
| | - N Sakatani
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - Y Iijima
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - C Okamoto
- Department of Planetology, Kobe University, Kobe 657-8501, Japan
| | - H Yano
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - Y Takagi
- Department of Regional Business, Aichi Toho University, Nagoya 465-8515, Japan
| | - M Hayakawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - P Michel
- Observatoire de la Côte d'Azur, Université Côte d'Azur, CNRS, Laboratoire Lagrange, CS34229, 06304 Nice Cedex 4, France
| | - M Jutzi
- Physics Institute, University of Bern, National Centre of Competence in Research PlanetS, Gesellschaftsstrasse 6, 3012, Bern, Switzerland
| | - Y Shimaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Kimura
- Department of Electrical Engineering, Tokyo University of Science, Noda 278-8510, Japan
| | - Y Mimasu
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Toda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - H Imamura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Nakazawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - H Hayakawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Sugita
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan.,Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - T Morota
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - S Kameda
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - E Tatsumi
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan.,Instituto de Astrofísica de Canarias, University of La Laguna, 38205 San Cristóbal de La Laguna, Spain
| | - Y Cho
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - K Yoshioka
- Department of Complexity Science and Engineering, The University of Tokyo, Kashiwa 277-8561, Japan
| | - Y Yokota
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Information Science, Kochi University, Kochi 780-8520, Japan
| | - M Matsuoka
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - M Yamada
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - T Kouyama
- National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan
| | - C Honda
- School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - Y Tsuda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Watanabe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Earth and Environmental Sciences, Nagoya University, Nagoya 464-8601, Japan
| | - M Yoshikawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - S Tanaka
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - F Terui
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Kikuchi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Yamaguchi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - N Ogawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - G Ono
- Research and Development Directorate, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - K Yoshikawa
- Research and Development Directorate, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Takahashi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - Y Takei
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Research and Development Directorate, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - A Fujii
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - H Takeuchi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - Y Yamamoto
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - T Okada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Chemistry, The University of Tokyo, Tokyo 113-0033, Japan
| | - C Hirose
- Research and Development Directorate, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Hosoda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - O Mori
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Shimada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - S Soldini
- Department of Mechanical, Materials and Aerospace Engineering, University of Liverpool, Liverpool L3 5TQ, UK
| | - R Tsukizaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - T Iwata
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - M Ozaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - M Abe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - N Namiki
- National Astronomical Observatory of Japan, Mitaka 181-8588, Japan.,Department of Astronomical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| | - K Kitazato
- School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - S Tachibana
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - H Ikeda
- Research and Development Directorate, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - N Hirata
- School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - N Hirata
- Department of Planetology, Kobe University, Kobe 657-8501, Japan
| | - R Noguchi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan
| | - A Miura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies, SOKENDAI, Hayama 240-0193, Japan
| |
Collapse
|
13
|
Saito H, Koga T, Sakaguchi M, Kadono Y, Kamikawa K, Urata A, Imamura H, Tada S, Kakuma T, Matsushita I. Post-endoscopic retrograde cholangiopancreatography pancreatitis in single-stage endoscopic common bile duct stone removal. JGH Open 2019; 4:394-399. [PMID: 32514443 PMCID: PMC7273691 DOI: 10.1002/jgh3.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/05/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Background and Aims Papillary treatment, such as endoscopic sphincterotomy or endoscopic papillary balloon dilation, and subsequent single-stage endoscopic stone removal are often performed for choledocholithiasis; however, the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is unclear. This study aimed to compare the overall incidence of PEP between single- and two-stage stone removal groups and the incidence of PEP between these two groups based on cannulation time. Methods We included 897 patients with native papilla who underwent papillary treatment and stone removal for choledocholithiasis with no inflammation or mild-to-moderate acute cholangitis at three institutions between April 2012 and March 2018 in Japan. We performed a propensity-matched analysis and regression adjustment by propensity score to adjust for potential confounding factors. Results In the propensity-matched analysis with 234 pairs, there was no significant difference in the overall incidence of PEP between single- and two-stage stone removal procedures (15/234, 6.4% vs 6/234, 2.6%, P = 0.072, respectively). Although single-stage stone removal after a cannulation time of ≤15 min was not a significant risk factor of PEP, the procedure after a cannulation time of >15 min was a significant risk factor of PEP as estimated by regression adjustment by propensity score (P = 0.014, 95% CI = 1.4-19.4, odds ratio = 5.2). Conclusions Single-stage endoscopic stone removal after a long cannulation time of >15 min increased the incidence of PEP compared with the two-stage stone removal procedure. Thus, single-stage stone removal should be performed in patients with a cannulation time ≤ 15 min.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto City Kumamoto Japan
| | - Takehiko Koga
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Masafumi Sakaguchi
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Atsushi Urata
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Haruo Imamura
- Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto City Kumamoto Japan
| | - Shuji Tada
- Department of Gastroenterology Kumamoto City Hospital Kumamoto City Kumamoto Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School Kurume University Kurume City Fukuoka Japan
| | - Ikuo Matsushita
- Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto City Kumamoto Japan
| |
Collapse
|
14
|
Saito H, Koga T, Sakaguchi M, Kadono Y, Kamikawa K, Urata A, Imamura H, Tada S, Kakuma T, Matsushita I. Safety and Efficacy of Endoscopic Removal of Common Bile Duct Stones in Elderly Patients ≥90 Years of Age. Intern Med 2019; 58:2125-2132. [PMID: 30996182 PMCID: PMC6709330 DOI: 10.2169/internalmedicine.2546-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective We examined the safety and efficacy of endoscopic stone removal for choledocholithiasis in elderly patients ≥90 years of age with native papilla and compared the outcomes with those in patients 75-89 years of age. Methods This multicenter retrospective study included 569 patients 75-89 years of age and 126 patients ≥90 years of age who had native papilla and underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at 3 institutions in Japan between April 2012 and March 2018. The main outcomes assessed were the incidence of post-ERCP complications during hospitalization and outcomes of ERCP in patients ≥90 years of age. Results Biliary cannulation and subsequent endoscopic sphincterotomy, endoscopic balloon dilation, and endoscopic large balloon dilation were successful in 97.7% of patients 75-89 years of age and in 98.4% of patients ≥90 years of age. There was no significant difference in the incidence of post-ERCP complications between patients 75-89 years of age and those ≥90 years of age (7.7% vs. 9.5%, respectively; p=0.47). Although the rate of use of mechanical lithotripter was not significantly different, the rate of complete stone removal in patients ≥90 years of age was lower than that in patients 75-89 years of age (81.0% vs. 94.9%, respectively; p<0.001). In all cases with incomplete stone removal in both groups, permanent biliary stent placement was successful. Conclusion ERCP for choledocholithiasis in elderly patients ≥90 years of age is a safe and effective procedure; however, endoscopists should select appropriate strategies after considering each patient's medical condition and background.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Takehiko Koga
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | | | - Yoshihiro Kadono
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| |
Collapse
|
15
|
Saito H, Koga T, Sakaguchi M, Kadono Y, Kamikawa K, Urata A, Imamura H, Tada S, Kakuma T, Matsushita I. Post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones. J Gastroenterol Hepatol 2019; 34:1153-1159. [PMID: 30650203 DOI: 10.1111/jgh.14604] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM For asymptomatic common bile duct (CBD) stones, removal by endoscopic retrograde cholangiopancreatography (ERCP) is recommended in available guidelines. However, few studies have reported the risk of post-ERCP pancreatitis (PEP), which is the most common and serious ERCP-related complication for asymptomatic CBD stones. We performed a propensity score matching analysis to examine the risk of PEP in therapeutic ERCP for asymptomatic CBD stones. METHODS Information from medical databases of three institutions in Japan was collected over 6 years to identify 1113 patients with native papilla who underwent therapeutic ERCP for choledocholithiasis (excluding biliary pancreatitis). We compared the risk of PEP between asymptomatic and symptomatic groups by performing one-to-one propensity score matching. RESULTS PEP was present in 52 (4.7%) of the 1113 patients overall. Of the 949 symptomatic patients, 28 (3.0%) had PEP, and of the 164 asymptomatic patients, 24 (14.6%) had PEP. The incidence of PEP was significantly higher in the asymptomatic group than in the symptomatic group (3.0% vs 14.6%; P < 0.001, odds ratio = 5.6). Of the 158 propensity score-matched symptomatic patients, five (3.2%) had PEP. In contrast, of the 158 propensity score-matched asymptomatic patients, 24 (15.2%) had PEP. Propensity score matching analysis revealed that the risk of PEP increased significantly in the asymptomatic group compared with the symptomatic group (3.2% vs 15.2%; P < 0.001, odds ratio = 5.5). CONCLUSIONS ERCP for asymptomatic CBD stones had a high risk of PEP. Endoscopists should explain in detail the risk of PEP to patients, especially those with asymptomatic CBD stones.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City, Kumamoto, Japan
| | - Takehiko Koga
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Masafumi Sakaguchi
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Fukuoka, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City, Kumamoto, Japan
| |
Collapse
|
16
|
Okuno T, Yoshida Y, Takaki Y, Araki Y, Inoue H, Soejima K, Okado Y, Yoshida K, Imamura H, Hagiwara S, Matsumoto S, Kitano T. Observation of Granulocyte Adsorption in Adacolumn Cellulose Acetate Beads after Granulocytapheresis. Ther Apher Dial 2019; 23:210-216. [PMID: 31025504 DOI: 10.1111/1744-9987.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
Adacolumn is a therapeutic mode for ulcerative colitis that achieves therapeutic efficacy through the adhesion of leukocytes to cellulose acetate beads. We used scanning electron microscopy and observed leukocyte adsorption on Adacolumn beads after granulocytapheresis/granulocyte and monocyte adsorption apheresis. We then compared results between two patients with a low and high C-reactive protein (CRP) levels to determine whether adhesion is affected by a difference in leukocyte activity depending on the level of inflammation. We found that the surface layers of the beads from both patients were covered by a clay-like layer, and spherical granulocytes were adsorbed here and there on top of it. In cross-section the adsorbed granulocytes were visible in the clay-like layer and the surface layer alike. The clay-like layer had a maximum thickness of approximately 12 μm in the low CRP patient and approximately 50 μm in the high CRP patient, so in the high CRP patient the clay-like adsorption layer was thicker. Taken together, adsorption onto beads is considered to involve an immunological mechanism. Our findings suggest that granulocytes contact and adhere to each other at the surface layer after adsorption, and that granulocyte-granulocyte adhesion is enhanced by a higher inflammatory response.
Collapse
Affiliation(s)
- Toshiyuki Okuno
- Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan.,Graduate School of Medicine, Oita University, Oita, Japan
| | - Yutaka Yoshida
- Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yuriko Takaki
- Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yasuyuki Araki
- Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hironobu Inoue
- Division of Nephrology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kazuaki Soejima
- Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan.,Division of Nephrology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yuki Okado
- Division of Gastroenterology & Hepatology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kenichi Yoshida
- Division of Gastroenterology & Hepatology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Haruo Imamura
- Division of Gastroenterology & Hepatology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Shigekiyo Matsumoto
- Department of Anesthesiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Takaaki Kitano
- Department of Anesthesiology, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
17
|
Uehara M, Takahashi J, Ikegami S, Kuraishi S, Fukui D, Imamura H, Okada K, Kato H. Thoracic aortic aneurysm is an independent factor associated with diffuse idiopathic skeletal hyperostosis. Bone Joint J 2018; 100-B:617-621. [PMID: 29701101 DOI: 10.1302/0301-620x.100b5.bjj-2017-1298.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aims Although we often encounter patients with an aortic aneurysm who also have diffuse idiopathic skeletal hyperostosis (DISH), there are no reports to date of an association between these two conditions and the pathogenesis of DISH remains unknown. This study therefore evaluated the prevalence of DISH in patients with a thoracic aortic aneurysm (AA). Patients and Methods The medical records of 298 patients who underwent CT scans for a diagnosis of an AA or following high-energy trauma were retrospectively examined. A total of 204 patients underwent surgery for an AA and 94 had a high-energy injury and formed the non-AA group. The prevalence of DISH was assessed on CT scans of the chest and abdomen and the relationship between DISH and AA by comparison between the AA and non-AA groups. Results The prevalence of DISH in the AA group (114/204; 55.9%) was higher than that in the non-AA group (31/94; 33.0%). On multivariate analysis, the factors of AA, male gender, and ageing were independent predictors of the existence of DISH, with odds ratios of 2.9, 1.9, and 1.03, respectively. Conclusion This study revealed that the prevalence of DISH is higher in patients with an AA than in those without an AA, and that the presence of an AA significantly influenced the prevalence of DISH. Cite this article: Bone Joint J 2018;100-B:617-21.
Collapse
Affiliation(s)
- M Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - J Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - S Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - S Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - D Fukui
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - H Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - K Okada
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - H Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| |
Collapse
|
18
|
Saito H, Kadono Y, Kamikawa K, Urata A, Imamura H, Matsushita I, Kakuma T, Tada S. The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis. Intern Med 2018; 57:469-477. [PMID: 29151506 PMCID: PMC5849540 DOI: 10.2169/internalmedicine.9123-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City Hospital, Japan
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Japan
| | - Ikuo Matsushita
- Department of Gastroenterology, Kumamoto Chuo Hospital, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City Hospital, Japan
| |
Collapse
|
19
|
Kuriyama T, Sakai N, Beppu M, Sakai C, Imamura H, Masago K, Katakami N, Isoda H. Quantitative Analysis of Conebeam CT for Delineating Stents in Stent-Assisted Coil Embolization. AJNR Am J Neuroradiol 2018; 39:488-493. [PMID: 29419404 DOI: 10.3174/ajnr.a5533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Innovative techniques and device-related advances have improved the outcomes of neuroendovascular treatment. 3D imaging has previously used 2 × 2 binning, but 1 × 1 binning has recently been made available. The aim of this study was to evaluate the quantitative ability of conebeam CT for stent delineation and to investigate its effectiveness in the clinical environment. MATERIALS AND METHODS Four acquisition groups of 3D MIP images acquired using conebeam CT with varying conditions (acquisition time, 10 or 20 seconds and binning, 1 × 1 or 2 × 2) were compared. Two methods of analysis were performed, a phantom study and an analysis of 28 randomly selected patients. The phantom study assessed the contrast-to-noise ratio and full width at half maximum values in conebeam CT images of intracranial stent struts. In the clinical subjects, we assessed contrast-to-noise ratio, full width at half maximum, and dose-area product. RESULTS In the phantom study, the contrast-to-noise ratio was not considerably different between 10- and 20-second acquisition times at equivalent binning settings. Additionally, the contrast-to-noise ratio at equivalent acquisition times did not differ considerably by binning setting. For the full width at half maximum results, equivalent acquisition times differed significantly by binning setting. In the clinical analyses, the 10-second/1 × 1 group (versus 20 second/2 × 2) showed a higher contrast-to-noise ratio (P < .05) and a dose-area product reduced by approximately 70% (P < .05), but the difference in full width at half maximum was not significant (P = .20). CONCLUSIONS For stent-assisted coil embolization, quantitative assessment of conebeam CT showed that 10 second/1 × 1 was equivalent to 20 second/2 × 2 for imaging deployed intracranial stents. Furthermore, the 10-second/1 × 1 settings resulted in a much smaller DAP.
Collapse
Affiliation(s)
- T Kuriyama
- From the Department of Radiological and Medical Laboratory Sciences (T.K., H. Isoda), Nagoya University Graduate School of Medicine, Nagoya, Japan .,Divisions of Radiological Technology (T.K.)
| | - N Sakai
- Neuroendovascular Therapy (N.S., C.S.).,Division of Neurosurgery (N.S., M.B., H. Imamura), Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Beppu
- Division of Neurosurgery (N.S., M.B., H. Imamura), Kobe City Medical Center General Hospital, Kobe, Japan
| | - C Sakai
- Neuroendovascular Therapy (N.S., C.S.)
| | - H Imamura
- Division of Neurosurgery (N.S., M.B., H. Imamura), Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Masago
- Department of Pathology and Molecular Diagnostics (K.M.), Aichi Cancer Center, Nagoya, Japan
| | - N Katakami
- Integrated Oncology (N.K.), Institute of Biomedical Research and Innovation, Kobe, Japan
| | - H Isoda
- From the Department of Radiological and Medical Laboratory Sciences (T.K., H. Isoda), Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain & Mind Research Center (H. Isoda), Nagoya University, Nagoya, Japan
| |
Collapse
|
20
|
Saito H, Kakuma T, Kadono Y, Urata A, Kamikawa K, Imamura H, Tada S. Increased risk and severity of ERCP-related complications associated with asymptomatic common bile duct stones. Endosc Int Open 2017; 5:E809-E817. [PMID: 28879226 PMCID: PMC5585073 DOI: 10.1055/s-0043-107615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic removal of asymptomatic common bile duct stones (CBDS) is generally recommended. Although many reports have described the risk of complications in endoscopic retrograde cholangiopancreatography (ERCP), no studies have addressed this problem in the context of asymptomatic CBDS. This study examines the risk of complications arising in ERCP for asymptomatic CBDS. PATIENTS AND METHODS This retrospective study included 425 patients with naive papilla who underwent therapeutic ERCP for choledocholithiasis at 2 institutions in Japan for 2 years. The risk of complications was examined in patients who were divided into the asymptomatic and symptomatic CBDS groups. We used propensity score analysis to adjust for confounding effects. RESULTS Complications were observed in 32 (7.5 %) of the 425 patients. Of the 358 patients with symptomatic CBDS, 14 patients (3.9 %) had complications. In contrast, of the 67 patients with asymptomatic CBDS, 18 patients (26.9 %) had complications. Propensity score analysis revealed that asymptomatic CBDS was a significant risk factor, with a significantly higher incidence of complications compared with symptomatic CBDS (odds ratio, 5.3). Moderate to severe complications were observed in 15 of 18 patients (83.3 %) in the asymptomatic CBDS group, with significantly more moderate to severe complications than those in the symptomatic CBDS (odds ratio, 6.7). CONCLUSIONS Asymptomatic CBDS carried a high risk of ERCP-related complications, and these were often more severe. In asymptomatic CBDS, endoscopic treatment should be carefully performed after considering the patient's background, and detailed explanation of its possible complications should be given to patients in advance.
Collapse
Affiliation(s)
- Hirokazu Saito
- Department of Gastroenterology, Kumamoto City-Hospital, Kumamoto, Japan,Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan,Corresponding author Hirokazu Saito Department of GastroenterologyKumamoto Chuo Hospital1-5-1, TainoshimaMinami-ku, Kumamoto-CityKumamoto, 862-0965Japan+81-96-370-4017
| | - Tatsuyuki Kakuma
- Department of Biostatics Center, Medical School, Kurume University, Fukuoka, Japan
| | - Yoshihiro Kadono
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Atsushi Urata
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kentaro Kamikawa
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Haruo Imamura
- Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Shuji Tada
- Department of Gastroenterology, Kumamoto City-Hospital, Kumamoto, Japan
| |
Collapse
|
21
|
Dumetz F, Imamura H, Sanders M, Seblova V, Myskova J, Pescher P, Vanaerschot M, Meehan CJ, Cuypers B, De Muylder G, Späth GF, Bussotti G, Vermeesch JR, Berriman M, Cotton JA, Volf P, Dujardin JC, Domagalska MA. Modulation of Aneuploidy in Leishmania donovani during Adaptation to Different In Vitro and In Vivo Environments and Its Impact on Gene Expression. mBio 2017; 8:e00599-17. [PMID: 28536289 PMCID: PMC5442457 DOI: 10.1128/mbio.00599-17] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/01/2017] [Indexed: 12/23/2022] Open
Abstract
Aneuploidy is usually deleterious in multicellular organisms but appears to be tolerated and potentially beneficial in unicellular organisms, including pathogens. Leishmania, a major protozoan parasite, is emerging as a new model for aneuploidy, since in vitro-cultivated strains are highly aneuploid, with interstrain diversity and intrastrain mosaicism. The alternation of two life stages in different environments (extracellular promastigotes and intracellular amastigotes) offers a unique opportunity to study the impact of environment on aneuploidy and gene expression. We sequenced the whole genomes and transcriptomes of Leishmania donovani strains throughout their adaptation to in vivo conditions mimicking natural vertebrate and invertebrate host environments. The nucleotide sequences were almost unchanged within a strain, in contrast to highly variable aneuploidy. Although high in promastigotes in vitro, aneuploidy dropped significantly in hamster amastigotes, in a progressive and strain-specific manner, accompanied by the emergence of new polysomies. After a passage through a sand fly, smaller yet consistent karyotype changes were detected. Changes in chromosome copy numbers were correlated with the corresponding transcript levels, but additional aneuploidy-independent regulation of gene expression was observed. This affected stage-specific gene expression, downregulation of the entire chromosome 31, and upregulation of gene arrays on chromosomes 5 and 8. Aneuploidy changes in Leishmania are probably adaptive and exploited to modulate the dosage and expression of specific genes; they are well tolerated, but additional mechanisms may exist to regulate the transcript levels of other genes located on aneuploid chromosomes. Our model should allow studies of the impact of aneuploidy on molecular adaptations and cellular fitness.IMPORTANCE Aneuploidy is usually detrimental in multicellular organisms, but in several microorganisms, it can be tolerated and even beneficial. Leishmania-a protozoan parasite that kills more than 30,000 people each year-is emerging as a new model for aneuploidy studies, as unexpectedly high levels of aneuploidy are found in clinical isolates. Leishmania lacks classical regulation of transcription at initiation through promoters, so aneuploidy could represent a major adaptive strategy of this parasite to modulate gene dosage in response to stressful environments. For the first time, we document the dynamics of aneuploidy throughout the life cycle of the parasite, in vitro and in vivo We show its adaptive impact on transcription and its interaction with regulation. Besides offering a new model for aneuploidy studies, we show that further genomic studies should be done directly in clinical samples without parasite isolation and that adequate methods should be developed for this.
Collapse
Affiliation(s)
- F Dumetz
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - H Imamura
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - M Sanders
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - V Seblova
- Charles University, Prague, Czech Republic
| | - J Myskova
- Charles University, Prague, Czech Republic
| | - P Pescher
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - M Vanaerschot
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - C J Meehan
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Cuypers
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
- Advanced Database Research and Modelling (ADReM), Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - G De Muylder
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - G F Späth
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - G Bussotti
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - J R Vermeesch
- Molecular Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - M Berriman
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - J A Cotton
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - P Volf
- Charles University, Prague, Czech Republic
| | - J C Dujardin
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - M A Domagalska
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
22
|
Shaw CD, Lonchamp J, Downing T, Imamura H, Freeman TM, Cotton JA, Sanders M, Blackburn G, Dujardin JC, Rijal S, Khanal B, Illingworth CJR, Coombs GH, Carter KC. In vitro selection of miltefosine resistance in promastigotes of Leishmania donovani from Nepal: genomic and metabolomic characterization. Mol Microbiol 2016; 99:1134-48. [PMID: 26713880 PMCID: PMC4832254 DOI: 10.1111/mmi.13291] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/17/2022]
Abstract
In this study, we followed the genomic, lipidomic and metabolomic changes associated with the selection of miltefosine (MIL) resistance in two clinically derived Leishmania donovani strains with different inherent resistance to antimonial drugs (antimony sensitive strain Sb‐S; and antimony resistant Sb‐R). MIL‐R was easily induced in both strains using the promastigote‐stage, but a significant increase in MIL‐R in the intracellular amastigote compared to the corresponding wild‐type did not occur until promastigotes had adapted to 12.2 μM MIL. A variety of common and strain‐specific genetic changes were discovered in MIL‐adapted parasites, including deletions at the LdMT transporter gene, single‐base mutations and changes in somy. The most obvious lipid changes in MIL‐R promastigotes occurred to phosphatidylcholines and lysophosphatidylcholines and results indicate that the Kennedy pathway is involved in MIL resistance. The inherent Sb resistance of the parasite had an impact on the changes that occurred in MIL‐R parasites, with more genetic changes occurring in Sb‐R compared with Sb‐S parasites. Initial interpretation of the changes identified in this study does not support synergies with Sb‐R in the mechanisms of MIL resistance, though this requires an enhanced understanding of the parasite's biochemical pathways and how they are genetically regulated to be verified fully.
Collapse
Affiliation(s)
- C D Shaw
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - J Lonchamp
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - T Downing
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK.,College of Science, NUI Galway, Galway, Ireland
| | - H Imamura
- Department of Biomedical Sciences, Instituut voor Tropische Geneeskunde Nationalestraat, Antwerpen, Belgium
| | - T M Freeman
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - J A Cotton
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - M Sanders
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - G Blackburn
- Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium.,Glasgow Polyomics, University of Glasgow, Glasgow
| | - J C Dujardin
- Department of Biomedical Sciences, Instituut voor Tropische Geneeskunde Nationalestraat, Antwerpen, Belgium.,Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium
| | - S Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Khanal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - G H Coombs
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - K C Carter
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| |
Collapse
|
23
|
Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Sakai N. Endovascular Treatment of Unruptured Paraclinoid Aneurysms: Single-Center Experience with 400 Cases and Literature Review. AJNR Am J Neuroradiol 2015; 37:679-85. [PMID: 26514613 DOI: 10.3174/ajnr.a4577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Paraclinoid aneurysms have been increasingly treated endovascularly. The natural history of these aneurysms has gradually been elucidated. The purpose of this study was to assess the safety and efficacy of endovascular treatment for these aneurysms. MATERIALS AND METHODS We performed a retrospective review of 377 patients with 400 paraclinoid aneurysms treated between January 2006 and December 2012. Their clinical records, endovascular reports, and radiologic and clinical outcomes were analyzed. Because aneurysms ≥7 mm are at higher risk of rupture, we classified aneurysms as small (<7 mm) or large (≥7 mm). RESULTS Overall, 115 of the 400 aneurysms (28.8%) were large (≥7 mm). Thromboembolic complications were found significantly more often with large aneurysms than with small ones (7.4% vs 1.0%, P = .001). Hemorrhagic complications were found only with small aneurysms (0.7%). The 6-month morbidity rates were similar for small (1.0%) and large (0.8%) aneurysms. Immediate angiographic outcomes were similar (P = .37), whereas recurrences and retreatment occurred more frequently with large aneurysms (P = .001 and P = .007, respectively). Multivariate analysis showed that aneurysm size was the only independent predictor for recurrence (P = .005). Most recurrences (81%) were detected by scheduled angiography at 6 months. CONCLUSIONS Aneurysm size influenced the type of complication (thromboembolic or hemorrhagic) and the recurrence rate. Given the approximately 1% annual rupture rate for aneurysms ≥7 mm, analysis of our data supports the rationale of using prophylactic endovascular treatment for unruptured paraclinoid aneurysms ≥7 mm.
Collapse
Affiliation(s)
- K Shimizu
- From the Department of Neurosurgery (K.S., H.I., H.A., N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - H Imamura
- From the Department of Neurosurgery (K.S., H.I., H.A., N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - Y Mineharu
- Department of Neurosurgery (Y.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Adachi
- From the Department of Neurosurgery (K.S., H.I., H.A., N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - C Sakai
- Division of Neuroendovascular Therapy (C.S., N.S.), Institute of Biomedical Research and Innovation, Kobe, Japan
| | - N Sakai
- From the Department of Neurosurgery (K.S., H.I., H.A., N.S.), Kobe City Medical Center General Hospital, Kobe, Japan Division of Neuroendovascular Therapy (C.S., N.S.), Institute of Biomedical Research and Innovation, Kobe, Japan
| |
Collapse
|
24
|
Suko S, Eguchi H, Yoshida K, Uehara M, Itoshima H, Koga T, Muraoka M, Kudo K, Kamikawa K, Imamura H. [Clinical examination of cases of radiation proctitis after intensity-modulated radiation therapy for prostate cancer]. Nihon Shokakibyo Gakkai Zasshi 2015; 112:1299-308. [PMID: 26155862 DOI: 10.11405/nisshoshi.112.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In our series of 366 patients who received intensity-modulated radiation therapy (IMRT) for prostate cancer, radiation proctitis developed in 24 patients. We examined the endoscopic evidence and clinical characteristics of radiation proctitis in these patients. The onset time was 2-29 months after treatment, with bloody bowel discharge being the most common symptom (22 cases). Colonoscopy revealed that the lesions tended to be concentrated on the rectal right anterior wall. Severity, according to the Tada classification, was 0b or Ia in 70.8% of all cases. The incidence of radiation proctitis decreased, and the clinical and endoscopic findings showed only mild radiation proctitis after IMRT.
Collapse
|
25
|
Imamura H, Konomoto T, Tanaka E, Hisano S, Yoshida Y, Fujimura Y, Miyata T, Nunoi H. Familial C3 glomerulonephritis associated with mutations in the gene for complement factor B. Nephrol Dial Transplant 2015; 30:862-4. [DOI: 10.1093/ndt/gfv054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/04/2015] [Indexed: 11/14/2022] Open
|
26
|
Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, Tsuji A, Imamura H, Tsuda M, Yasui H, Fujii H, Yamaguchi K, Yasui H, Hironaka S, Shimada K, Miwa H, Hamada C, Hyodo I. Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol 2015; 26:141-148. [PMID: 25316259 DOI: 10.1093/annonc/mdu472] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND We evaluated the efficacy and safety of S-1 plus oxaliplatin (SOX) as an alternative to cisplatin plus S-1 (CS) in first-line chemotherapy for advanced gastric cancer (AGC). PATIENTS AND METHODS In this randomized, open-label, multicenter phase III study, patients were randomly assigned to receive SOX (80-120 mg/day S-1 for 2 weeks with 100 mg/m(2) oxaliplatin on day 1, every 3 weeks) or CS (S-1 for 3 weeks with 60 mg/m(2) cisplatin on day 8, every 5 weeks). The primary end points were noninferiority in progression-free survival (PFS) and relative efficacy in overall survival (OS) for SOX using adjusted hazard ratios (HRs) with stratification factors; performance status and unresectable or recurrent (+adjuvant chemotherapy) disease. RESULTS Overall, 685 patients were randomized from January 2010 to October 2011. In per-protocol population, SOX (n = 318) was noninferior to CS (n = 324) in PFS [median, 5.5 versus 5.4 months; HR 1.004, 95% confidence interval (CI) 0.840-1.199; predefined noninferiority margin 1.30]. The median OS for SOX and CS were 14.1 and 13.1 months, respectively (HR 0.958 with 95% CI 0.803-1.142). In the intention-to-treat population (SOX, n = 339; CS, n = 337), the HRs in PFS and OS were 0.979 (95% CI 0.821-1.167) and 0.934 (95% CI 0.786-1.108), respectively. The most common ≥grade 3 adverse events (SOX versus CS) were neutropenia (19.5% versus 41.8%), anemia (15.1% versus 32.5%), hyponatremia (4.4% versus 13.4%), febrile neutropenia (0.9% versus 6.9%), and sensory neuropathy (4.7% versus 0%). CONCLUSION SOX is as effective as CS for AGC with favorable safety profile, therefore SOX can replace CS. CLINICAL TRIAL NUMBER JapicCTI-101021.
Collapse
Affiliation(s)
- Y Yamada
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo.
| | - K Higuchi
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara
| | - K Nishikawa
- Department of Surgery, Osaka General Medical Center, Osaka
| | - M Gotoh
- Cancer Chemotherapy Center, Osaka Medical College Hospital, Takatsuki
| | - N Fuse
- Division of Gastrointestinal Oncology and Digestive Endoscopy, National Cancer Center Hospital East, Kashiwa
| | - N Sugimoto
- Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - T Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama
| | - K Amagai
- Department of Gastroenterology, Ibaraki Prefectural Central Hospital, Kasama
| | - K Chin
- Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo
| | - Y Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya
| | - A Tsuji
- Department of Medical Oncology, Kochi Health Sciences Center, Kochi
| | - H Imamura
- Department of Surgery, Sakai City Hospital, Sakai
| | - M Tsuda
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi
| | - H Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun
| | - H Fujii
- Division of Clinical Oncology, Jichi Medical University, Shimotsuke
| | - K Yamaguchi
- Division of Gastroenterology, Saitama Cancer Center, Kita-adachi-gun
| | - H Yasui
- Department of Medical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto
| | - S Hironaka
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba
| | - K Shimada
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama
| | - H Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya
| | - C Hamada
- Faculty of Engineering, Tokyo University of Science, Tokyo
| | - I Hyodo
- Division of Gastroenterology, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
27
|
Matsuyama J, Imamura H, Gotoh M, Kimura Y, Ueda S, Nishikawa K, Sugimoto N, Fujita J, Tamura T, Fukushima N, Sakai D, Shimokawa T, Kurokawa Y, Satoh T, Tsujinaka T, Furukawa H. Randomized Phase Ii Study of Cpt-11 Vs Ptx Vs Each Combination Chemotherapy with S-1 in Patients with Advanced Gastric Cancer Refractory to S-1 or S-1 Plus Cddp (Ogsg0701). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Kishi K, Nishikawa K, Inoue K, Matsuyama J, Akamaru Y, Kimura Y, Tamura S, Kawabata R, Kawata J, Shimokawa T, Imamura H. PP074-MON: Evaluation of Oral, Nutritional Support by Using an Elemental Diet on Postoperative Body Weight in Gastric Cancer Patients: A Randomized Clinical Trial. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Kawabata R, Nishikawa K, Kishi K, Inoue K, Matsuyama J, Akamaru Y, Kimura Y, Tamura S, Kawada J, Fujiwara Y, Kawase T, Fukui J, Takagi M, Takeno A, Shimokawa T, Imamura H. Evaluation of Oral, Nutritional Support on Postoperative Body Weight in Gastric Cancer Patients Receiving Elemental Diet: a Randomized Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
30
|
Nishikawa K, Yamada Y, Higuchi K, Gotoh M, Fuse N, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, Tsuji A, Imamura H, Tsuda M, Yasui H, Fujii H, Yamaguchi K, Yasui H, Hironaka S, Hamada C, Hyodo I. Impacts of Progression Type on Overall Survival in Advanced Gastric Cancer: Randomized Piii Study of S-1 + Oxaliplatin Vs. S-1 + Cisplatin. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
31
|
Yamamoto K, Fujitani K, Tamura S, Fujita J, Matsuyama J, Kimura Y, Imamura H, Makari Y, Kurokawa Y, Satoh T, Tsujinaka T, Furukawa H. Multicenter Phase Ii Trial of Adjuvant S-1 Plus Docetaxel for 6 Months in Patients with Pathological Stage III Gastric Cancer (Ogsg-1002). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Iwazawa T, Imamura H, Dono K. PP115-SUN: S-1 Adjuvant Chemotherapy Induces Sarcopenic Change After Gastrectomy in Gastric Cancer Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Wakhloo AK, Lylyk P, de Vries J, Taschner C, Lundquist J, Biondi A, Hartmann M, Szikora I, Pierot L, Sakai N, Imamura H, Sourour N, Rennie I, Skalej M, Beuing O, Bonafé A, Mery F, Turjman F, Brouwer P, Boccardi E, Valvassori L, Derakhshani S, Litzenberg MW, Gounis MJ. Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study. AJNR Am J Neuroradiol 2014; 36:98-107. [PMID: 25125666 DOI: 10.3174/ajnr.a4078] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Incomplete occlusion and recanalization of large and wide-neck brain aneurysms treated by endovascular therapy remains a challenge. We present preliminary clinical and angiographic results of an experimentally optimized Surpass flow diverter for treatment of intracranial aneurysms in a prospective, multicenter, nonrandomized, single-arm study. MATERIALS AND METHODS At 24 centers, 165 patients with 190 intracranial aneurysms of the anterior and posterior circulations were enrolled. The primary efficacy end point was the percentage of intracranial aneurysms with 100% occlusion on 6-month DSA. The primary safety end point was neurologic death and any stroke through a minimum follow-up of 6 months. RESULTS Successful flow-diverter delivery was achieved in 161 patients with 186 aneurysms (98%); the mean number of devices used per aneurysm was 1.05. Clinical follow-up (median, 6 months) of 150 patients (93.2%), showed that the primary safety end point occurred in 18 subjects. Permanent neurologic morbidity and mortality were 6% and 2.7%, respectively. Morbidity occurred in 4% and 7.4% of patients treated for aneurysms of the anterior and posterior circulation, respectively. Neurologic death during follow-up was observed in 1.6% and 7.4% of patients with treated intracranial aneurysms of the anterior and posterior circulation, respectively. Ischemic stroke at ≤30 days, SAH at ≤7 days, and intraparenchymal hemorrhage at ≤7 days were encountered in 3.7%, 2.5%, and 2.5% of subjects, respectively. No disabling ischemic strokes at >30 days or SAH at >7 days occurred. New or worsening cranial nerve deficit was observed in 2.7%. Follow-up angiography available in 158 (86.8%) intracranial aneurysms showed 100% occlusion in 75%. CONCLUSIONS Clinical outcomes of the Surpass flow diverter in the treatment of intracranial aneurysms show a safety profile that is comparable with that of stent-assisted coil embolization. Angiographic results showed a high rate of intracranial aneurysm occlusion.
Collapse
Affiliation(s)
- A K Wakhloo
- From the Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery
| | - P Lylyk
- Department of Neurosurgery (P.L., J.L.), ENERI, Buenos Aires, Argentina
| | - J de Vries
- Department of Neurosurgery (J.d.V.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - C Taschner
- Department of Neuroradiology (C.T.), University of Freiburg, Freiburg, Germany
| | - J Lundquist
- Department of Neurosurgery (P.L., J.L.), ENERI, Buenos Aires, Argentina
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A. Biondi), University of Besançon, Besançon, France
| | - M Hartmann
- Department of Neuroradiology (M.H.), Helios Hospital, Berlin, Germany
| | - I Szikora
- National Institute of Neurosciences (I.S.), Budapest, Hungary
| | - L Pierot
- Department of Neuroradiology (L.P.), Hôpital Maison Blanche, University Hospital of Reims, Reims, France
| | - N Sakai
- Department of Neurosurgery (N. Sakai, H.I.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - H Imamura
- Department of Neurosurgery (N. Sakai, H.I.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Sourour
- Department of Neuroradiology (N. Sourour), Hôpital Pitié-Salpetrière, Paris, France
| | - I Rennie
- Department of Neuroradiology (I.R.), The Royal Hospitals, Belfast, Ireland
| | - M Skalej
- Department of Neuroradiology (M.S., O.B.), Universitātsklinikum Magdeburg, Magdeburg, Germany
| | - O Beuing
- Department of Neuroradiology (M.S., O.B.), Universitātsklinikum Magdeburg, Magdeburg, Germany
| | - A Bonafé
- Department of Neuroradiology (A. Bonafé), Hôpital Guy de Chauillac, Montpellier, France
| | - F Mery
- Department of Neurosurgery (F.M.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Turjman
- Department of Neuroradiology (F.T.), Hôpital Neurologique, Lyon, France
| | - P Brouwer
- Department of Neuroradiology (P.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Boccardi
- Department of Neuroradiology (E.B., L.V.), Niguarda Ca' Granda Hospital, Milan, Italy
| | - L Valvassori
- Department of Neuroradiology (E.B., L.V.), Niguarda Ca' Granda Hospital, Milan, Italy
| | - S Derakhshani
- Department of Neuroradiology (S.D.), Essex Center for Neurological Sciences, Queen's University Hospital, London, United Kingdom
| | | | - M J Gounis
- New England Center for Stroke Research (M.J.G.), University of Massachusetts Medical School, Worcester, Massachusetts
| | | |
Collapse
|
34
|
Imamura H, Kimura M, Kamimura T, Momohara S. An arthroscopic check valve release improves knee intrameniscal cyst symptoms in adolescent: a case report. Orthop Traumatol Surg Res 2014; 100:239-41. [PMID: 24332721 DOI: 10.1016/j.otsr.2013.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/25/2013] [Indexed: 02/02/2023]
Abstract
Intrameniscal cysts begin with the flow of synovial fluid from a meniscal tear in one direction, enlarging probably as a result of an on-and-off valve mechanism of the tear flap. The current available literature focuses primarily on the necessity for surgery, however a large meniscus resection to remove cysts may place an additional burden on menisci, leading ultimately to knee joint degenerative changes. In this article, we present a rare case of intrameniscal cysts with an isolated horizontal meniscal tear in an adolescent, and describe a new arthroscopic procedure for treating this type of intrameniscal cyst. We performed arthroscopic partial release of the meniscal tear check-valve mechanism, preventing further intrameniscal cyst expansion. The patient's clinical symptoms improved, and this procedure may also be useful in treating intrameniscal cysts with an isolated horizontal meniscal tear and can be considered as an option to preserve meniscal function and minimize degenerative arthritis in young athletes.
Collapse
Affiliation(s)
- H Imamura
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan; Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan.
| | - M Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
| | - T Kamimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
| | - S Momohara
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
35
|
Miwa S, Ishibashi S, Tomita H, Nozaki T, Tamura E, Ando K, Mizuochi N, Saruya T, Kubota H, Yakushiji K, Taniguchi T, Imamura H, Fukushima A, Yuasa S, Suzuki Y. Highly sensitive nanoscale spin-torque diode. Nat Mater 2014; 13:50-56. [PMID: 24141450 DOI: 10.1038/nmat3778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/14/2013] [Indexed: 06/02/2023]
Abstract
Highly sensitive microwave devices that are operational at room temperature are important for high-speed multiplex telecommunications. Quantum devices such as superconducting bolometers possess high performance but work only at low temperature. On the other hand, semiconductor devices, although enabling high-speed operation at room temperature, have poor signal-to-noise ratios. In this regard, the demonstration of a diode based on spin-torque-induced ferromagnetic resonance between nanomagnets represented a promising development, even though the rectification output was too small for applications (1.4 mV mW(-1)). Here we show that by applying d.c. bias currents to nanomagnets while precisely controlling their magnetization-potential profiles, a much greater radiofrequency detection sensitivity of 12,000 mV mW(-1) is achievable at room temperature, exceeding that of semiconductor diode detectors (3,800 mV mW(-1)). Theoretical analysis reveals essential roles for nonlinear ferromagnetic resonance, which enhances the signal-to-noise ratio even at room temperature as the size of the magnets decreases.
Collapse
Affiliation(s)
- S Miwa
- 1] Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan [2]
| | - S Ishibashi
- 1] Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan [2] National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan [3]
| | - H Tomita
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
| | - T Nozaki
- 1] Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan [2] National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - E Tamura
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
| | - K Ando
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
| | - N Mizuochi
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
| | - T Saruya
- 1] National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan [2]
| | - H Kubota
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - K Yakushiji
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - T Taniguchi
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - H Imamura
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - A Fukushima
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - S Yuasa
- National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| | - Y Suzuki
- 1] Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan [2] National Institute of Advanced Industrial Science and Technology (AIST), Spintronics Research Center, Tsukuba, Ibaraki 305-8568, Japan
| |
Collapse
|
36
|
Imamura H, Nagata A, Oshikata R, Yoshimura Y, Miyamoto N, Miyahara K, Oda K, Iide K. High-density lipoprotein cholesterol subfractions and lecithin: cholesterol acyltransferase activity in collegiate soccer players. Int J Sports Med 2012; 34:398-401. [PMID: 23152129 DOI: 10.1055/s-0032-1327651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many of the published data on the lipid profile of athletes is based on studies of endurance athletes. The data on soccer players are rare. The purpose of this study was to examine serum high-density lipoprotein cholesterol subfractions and lecithin:cholesterol acyltransferase activity in collegiate soccer players. 31 well-trained male collegiate soccer players were divided into 2 groups: 16 defenders and 15 offenders. They were compared with 16 sedentary controls. Dietary information was obtained with a food frequency questionnaire. The subjects were all non-smokers and were not taking any drug known to affect the lipid and lipoprotein metabolism. The offenders had significantly higher high-density lipoprotein cholesterol, high-density lipoprotein2 cholesterol, and apolipoprotein A-I than the defenders and controls, whereas the defenders had the significantly higher high-density lipoprotein2 cholesterol than the controls. Both groups of athletes had significantly higher lecithin:cholesterol acyltransferase activity than the controls. The results indicate that favorable lipid and lipoprotein profile could be obtained by vigorous soccer training.
Collapse
Affiliation(s)
- H Imamura
- Department of Health and Nutrition, Nagasaki International University, Sasebo-shi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Kusunoki H, Haruma K, Manabe N, Imamura H, Kamada T, Shiotani A, Hata J, Sugioka H, Saito Y, Kato H, Tack J. Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography. Neurogastroenterol Motil 2012; 24:540-5, e250-1. [PMID: 22385472 DOI: 10.1111/j.1365-2982.2012.01897.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvement in subjective symptoms has been reported in functional dyspepsia (FD) patients administered with acotiamide. Improvement was confirmed in meal-related symptoms, such as postprandial fullness, upper abdominal bloating, and early satiety. We examined the mechanism underlying the effects of acotiamide on gastric accommodation reflex (GAR) and gastroduodenal motility in FD patients. METHODS Thirty-four FD patients (mean age, 40.4 years) were examined ultrasonographically before and after 14-18 days of acotiamide (100 mg t.i.d.) or placebo administration. To assess GAR, expansion rate in cross-sectional area of the proximal stomach was measured after every 100-mL ingestion, using a straw, of up to 400 mL of a liquid meal (consommé soup, 13.1 kcal; 400 mL) in a supine position. Next, we measured gastric emptying rate (GER), motility index (MI, antral contractions), and reflux index (RI, duodenogastric reflux) to assess gastroduodenal motility. Patients also completed a survey based on the seven-point Likert scale both before and after drug administration. KEY RESULTS Of the 37 cases, 19 and 18 were administered with acotiamide and placebo A respectively, significant difference was observed in GAR between the acotiamide and placebo groups (21.7%vs 4.4%) after 400 mL ingestion. GER significantly accelerated after treatment in the acotiamide group (P = 0.012), no significant differences were observed in MI and RI between the two groups. Improvement rates were 35.3 and 11.8% for the acotiamide and placebo groups. CONCLUSIONS & INFERENCES Acotiamide significantly enhances GAR and GER in FD patients. Acotiamide may have therapeutic potential for FD patients.
Collapse
Affiliation(s)
- H Kusunoki
- Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Furuta Y, Kudoh K, Tada S, Sugihara K, Izumi K, Kadono Y, Kamikawa K, Chikazawa H, Imamura H. [A case of pulmonary embolism due to heparin-induced thrombocytopenia after the placement of hepatic arterial infusion catheter]. Nihon Shokakibyo Gakkai Zasshi 2012; 109:944-951. [PMID: 22688171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 68-year-old woman developed acute pulmonary embolism after hepatic arterial infusion therapy for advanced hepatocellular carcinoma. Because the platelet count was significantly reduced, heparin-induced thrombocytopenia (HIT) due to heparin usage in hepatic arterial infusion therapy was clinically suspected. Subsequently, the patient tested positively for HIT antibodies, and a definitive diagnosis was obtained. Antithrombotic therapy with heparin was discontinued and treatment with argatroban was started. After the heparinized hydrophilic catheter was removed, the platelet count improved immediately. HIT should be considered when a decrease in platelet count and thrombosis are involved with the usage of heparin.
Collapse
Affiliation(s)
- Yoki Furuta
- Department of Gastroenterology, Saiseikai Kumamoto Hospital.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kanazawa K, Matsumoto R, Imamura H, Matsuhashi M, Kunieda T, Mikuni N, Miyamoto S, Takahashi R, Ikeda A. Are Ictal DC Shifts and High Frequency Oscillation Complementary? A Study by Subdural Electrodes in Partial Epilepsy (P04.012). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
40
|
Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, Kobayashi K, Kurokawa Y, Shimokawa T, Furukawa H. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg 2012; 99:621-9. [PMID: 22367794 DOI: 10.1002/bjs.8706] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 12/13/2022]
Abstract
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).
Collapse
Affiliation(s)
- K Fujitani
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Inoue K, Nakane Y, Kogire M, Fujitani K, Kimura Y, Imamura H, Tamura S, Okano S, Kwon AH, Kurokawa Y, Shimokawa T, Takiuchi H, Tsujinaka T, Furukawa H. Phase II trial of preoperative S-1 plus cisplatin followed by surgery for initially unresectable locally advanced gastric cancer. Eur J Surg Oncol 2011; 38:143-9. [PMID: 22154885 DOI: 10.1016/j.ejso.2011.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/17/2011] [Accepted: 11/21/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and feasibility of preoperative chemotherapy with S-1 plus cisplatin in patients with initially unresectable locally advanced gastric cancer. METHODS We enrolled patients with initially unresectable locally advanced gastric cancer because of severe lymph node metastases or invasion of adjacent structures. Preoperative chemotherapy consisted of S-1 at 80 mg/m(2) divided in two daily doses for 21 days and cisplatin at 60 mg/m(2) intravenously on day 8, repeated every 35 days. If a tumor decreased in size, patients received 1 or 2 more courses. Surgery involved radical resection with D2 lymphadenectomy. RESULTS Between December 2000 and December 2007, 27 patients were enrolled on the study. No CR was obtained, but PR was seen in 17 cases, and the response rate was 63.0%. Thirteen patients (48.1%) had R0 resections. There were no treatment related deaths. The median overall survival time (MST) and the 3-year overall survival (OS) of all patients were 31.4 months and 31.0%, respectively. Among the 13 patients who underwent curative resection, the median disease-free survival (DFS) and the 3-year DFS were 17.4 months and 23.1%, respectively. The MST and the 3-year OS were 50.1 months and 53.8%, respectively. The most common site of initial recurrence after the R0 resection was the para-aortic lymph nodes. CONCLUSIONS Preoperative S-1 plus cisplatin can be safely delivered to patients undergoing radical gastrectomy. This regimen is promising as neoadjuvant chemotherapy for resectable gastric cancer. For initially unresectable locally advanced gastric cancer, new trials using more effective regimens along with extended lymph node dissection are necessary.
Collapse
Affiliation(s)
- K Inoue
- Department of Surgery, Kansai Medical University, Shinmachi 2-3-1, Hirakata city, Osaka 573-1191, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Terashima M, Ochiai A, Kitada K, Ichikawa W, Kurahashi I, Sakuramoto S, Fukagawa T, Sano T, Imamura H, Sasako M. Impact of human epidermal growth factor receptor (EGFR) and ERBB2 (HER2) expressions on survival in patients with stage II/III gastric cancer, enrolled in the ACTS-GC study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
43
|
Kawabata R, Imamura H, Kishimoto T, Kimura Y, Goto M, Iijima S, Fujitani K, Oshita M, Ueda S, Shimokawa T, Takiuchi H, Tsujinaka T, Furukawa H. Multicenter phase II study of combination therapy with paclitaxel, cisplatin, and S-1 for adavanced gastric cancer (OGSG0703). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
44
|
Manabe N, Nakamura K, Hara M, Imamura H, Kusunoki H, Tanaka S, Chayama K, Hata J, Haruma K. Impaired gastric response to modified sham feeding in patients with postprandial distress syndrome. Neurogastroenterol Motil 2011; 23:215-9, e112. [PMID: 21059155 DOI: 10.1111/j.1365-2982.2010.01622.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Impaired vagal function has been reported to be important in some patients with functional dyspepsia (FD). However, the pathophysiologic mechanisms influencing the cephalic phase of vagal activity in FD are incompletely understood. The aim of this study was to investigate the gastric response to modified sham feeding (MSF) on ultrasound and cardiovascular autonomic function in FD patients. METHODS Nineteen patients with postprandial distress syndrome (PDS, 11 men and eight women; mean age: 48.2 years) and 26 healthy subjects (HS, 13 men and 13 women; mean age: 45.0 years) were studied prospectively. Firstly, cardiovascular autonomic function was assessed by spectral analysis of RR interval variability. Antral contraction was then evaluated by ultrasonography after MSF was performed to stimulate the cephalic phase of vagal activity. KEY RESULTS Spectral analysis of RR interval variability showed that the high-frequency component was significantly smaller in the patients than in the HS (P<0.01). The frequency of antral contraction in response to MSF over 15 min was also significantly lower in the PDS patients than in the HS. The 15-min integrated antral contractile response (area under the contraction vs time curve) was significantly smaller in the PDS patients than in the HS (P<0.01). Univariate analysis revealed a modest correlation between the high-frequency component of RR interval variability and the area under the contraction vs time curve (n=46, r=0.49, P<0.01). CONCLUSIONS & INFERENCES Autonomic abnormalities affecting the cephalic phase of vagal activity may be important in the pathogenesis of FD.
Collapse
Affiliation(s)
- N Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Fujita J, Imamura H, Takiguchi S, Fujitani K, Miyashiro I, Kobayashi K, Kimura Y, Ebisui C, Matsuyama J, Doki Y. Randomized controlled trial comparing Billroth-I and Roux-en-Y reconstruction in distal gastrectomy for gastric cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
65 Background: In distal subtotal gastrectomy for gastric cancer, Billroth-I (B-I) reconstruction has been performed predominantly in Japan, while increasing number of surgeons chose Roux-en-Y (R-Y) reconstruction recently. To evaluate the safety and superiority of R-Y we conducted a multi-institutional prospective randomized controlled trial. Methods: Gastric cancer patients who underwent distal gastrectomy were randomized to B-I or R-Y intraoperatively. The primary endpoint was the ratio of body weight loss 1 year after surgery, the secondary endpoints were the incidence of delayed gastric emptying (DGE) and postoperative morbidity. Results: Between Aug 2005 and Dec 2008, a total of 332 patients were enrolled and 163 patients were assigned to B-I and 169 patients to R- Y. The patient's characteristics were well balanced between the two groups. The operation time was significantly longer in R-Y than B-I (median 180 min in B-I vs 214 min in R-Y, p < 0.0001). The postoperative morbidity was 14 patients (8.6%) in B-I and 23 (13.6%) in R-Y (p = 0.14), the incidence of DGE was 7 (4.3%) in B-I vs 16 (9.5%) in R-Y (p = 0.06), and the hospital stay after surgery was 14.1days in B-I vs 16.4 days in R-Y (p = 0.02). There was no hospital death in the two groups. The body weight loss at 1 year after surgery compared to preoperation was -5.4kg (-9.1%) in B-I vs -6.2kg (-9.8%) in R-Y (p = 0.11). Conclusions: The advantage of R- Y reconstruction compared to B-I was not proved in terms of postoperative morbidity either the body weight loss 1 year after surgery. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. Fujita
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - H. Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - S. Takiguchi
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - K. Fujitani
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - I. Miyashiro
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - K. Kobayashi
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - Y. Kimura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - C. Ebisui
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - J. Matsuyama
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| | - Y. Doki
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Hyogo
| |
Collapse
|
46
|
Tsuburaya A, Katayama H, Mizusawa J, Nakamura K, Katai H, Imamura H, Nashimoto A, Fukushima N, Sano T, Sasako M. An integrated analysis of two phase II trials (JCOG0001 and JCOG0405) of preoperative chemotherapy followed by D3 gastrectomy for gastric cancer (GC) with extensive lymph node metastasis (ELM). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: GC with ELM (bulky N2 metastasis and / or para-aortic lymph node metastases [PAN]) is commonly regarded unresectable, while in JCOG combined modality treatment has been tested since 2000 (JCOG0001 and JCOG0405). Both trials met their primary endpoints (i.e., 3 year-survival of 27.3% in JCOG0001 and R0 resection of 82.4% in JCOG0405). The survival and the toxicity profile were quite different between the trials despite the similar eligibility with an outstanding 3-year survival of 58.8% in JCOG0405. This study is conducted to explore if survival is still better in JCOG0405 after adjusting baseline factors and if there is a subset of patients (pts) who benefit more from either treatment. Methods: Eligibility criteria for both included histologically proven gastric adenocarcinoma; bulky nodal involvement around major branched arteries to the stomach and/or PAN; cM0 (except PAN); negative lavage cytology; not linitis plastica type; PS of 0 or 1. Pts received two or three cycles of induction chemotherapy of IP: irinotecan (70 mg/m2 on day 1 and day 15) and cisplatin (80 mg/m2 on day 1) in JCOG0001, or SP: S1 (80 mg/m2 from day 1 to 21) and cisplatin (60 mg/m2 on day 8) in JCOG0405, followed by D3 gastrectomy. Multivariate analysis for overall survival adjusting baseline factors and treatment (IP/SP) was performed with a Cox regression model. Interaction tests were also carried out between baseline factors and treatment. Results: After adjusting baseline factors, SP was superior than IP for overall survival (HR=0.335: 0.184 – 0.612). There was only interaction effect between treatment and the status of lymph node metastases (bulkyN+/PAN- vs bulkyN-/PAN+ vs bulkyN+/PAN+; p=0.1306). Conclusions: SP was shown to be the favorable treatment for GC with ELM by multivariate analysis, while poor prognosis in pts having both bulky N+ and PAN+ may necessitate further treatment improvement. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Tsuburaya
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - H. Katayama
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - J. Mizusawa
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - K. Nakamura
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - H. Katai
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - H. Imamura
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - A. Nashimoto
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - N. Fukushima
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - T. Sano
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - M. Sasako
- Kanagawa Cancer Center, Yokohama, Japan; National Cancer Center, Tokyo, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Niigata Cancer Center Hospital, Niigata, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Cancer Institute Hospital, Tokyo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | | |
Collapse
|
47
|
Kimura Y, Tsujinaka T, Fujitani K, Fujita J, Miyashiro I, Imamura H, Kobayashi K, Kurokawa Y, Shimokawa T, Furukawa H. A randomized controlled phase III trial to evaluate the effect of preoperative enteral immunonutrition on the surgical site infection after total gastrectomy (OGSG0507). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
74 Background: To investigate the effect of preoperative enteral immunonutrion on the incidence of surgical site infection (SSI) after total gastrectomy for gastric cancer, we conducted a prospective randomized controlled trial. Methods: Eligibility criteria included: (1) histologically proven adenocarcinoma of stomach, (2) scheduled total gastrectomy, (3) aged less than 80 years, (4) not malnourished, (5) possible to ingest liquid diet, (6) written informed consent. Eligible patients (pts) wereassigned to the immunonutrition (I) group or the control (C) group. In the C group pts freely accessed to regular diet until surgery. In the I group, pts were supplemented with 1,000 ml/day of immunonutrient enriched with arginine, omega-3 fatty acids and RNA (Impact) in addition to the regular diet for 5 days before surgery. The primary endpoint was the incidence of SSI and the secondary endpoints were other infectious complications and serum CRP level on POD 3 or 4. Results: From 02/2004 to 12/2009, 240 gastric cancer patients (pts) who underwent gastric surgery were enrolled. 125 pts assigned to the I group and 115 pts assigned to the C group. Age, sex, body weight, serum albumin and general nutritional status were well balanced between the two groups. 223 pts underwent total gastrectomy, 6 pts proximal gastrectomy, 4 pts distal gastrectomy, and 7 pts simple laparotomy. In terms of tumor status, there were no significant difference between the groups in histological type, T stage, and lymph node metastasis. 104 of 125 pts assigned to the I group tolerated a daily intake 1,000 ml of Impact for 5 days. The incidence of SSI was 26 (20.8%) in the I group and 24 (20.9%) in the C group (R.R: 1.00, 95% C.I: 0.61-1.63). Postoperative morbidity was 36 (28.8%) in the I group and 30 (26.1%) in the C group. There was no difference in days of hospital stay after surgery between the groups. Conclusions: The oral administration of immunonutrient for 5 days before surgery did not contributed to the reduction of infectious complications after total gastrectomy in gastric cancer pts. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- Y. Kimura
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - T. Tsujinaka
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - K. Fujitani
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - J. Fujita
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - I. Miyashiro
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - H. Imamura
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - K. Kobayashi
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - Y. Kurokawa
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - T. Shimokawa
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | - H. Furukawa
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan; Osaka National Hospital, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Kinki Central Hospital Itami, Itami, Japan; Department of Gastroenterological Surgery, Osaka University Graduate School
| | | |
Collapse
|
48
|
Kurokawa Y, Fujiwara Y, Takiguchi S, Fujita J, Imamura H, Tsujinaka T, Mori M, Doki Y. Randomized controlled trial of omental bursectomy for resectable cT2-3 gastric cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
72 Background: Omental bursectomy, a traditional surgical procedure to dissect the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has often been performed against resectable gastric cancer. We have conducted a multi- institutional randomized controlled trial to elucidate the safety and usefulness of this procedure. Methods: Patients with cT2 or cT3 gastric adenocarcinoma were intraoperatively randomized to radical gastrectomy plus D2 lymphadenectomy either with or without bursectomy. The primary endpoint was overall survival (OS). The planned sample size was 464, with an alpha error of 0.05 and statistical power of 80% to detect a 10% margin of non-inferiority for the non-bursectomy group. The first interim analysis was conducted on Sep 2008, and we decided the preliminary data release according to Korn's proposal (J Clin Oncol. 2005). Results: Between Jul 2002 and Jan 2007, a total of 210 patients were randomized to either the bursectomy group or the non-bursectomy group. Background characteristics were well balanced. Intraoperative blood loss was greater in the bursectomy group than in the non-bursectomy group (median, 475 mL vs. 350 mL, p=0.047), while other surgical factors did not vary significantly. The overall morbidity rate was 14%, the same between two groups. The hospital mortality rate was 0.95%; one patient per group. In the first interim analysis, the 3-year OS were 86% in bursectomy group and 79% in non-bursectomy group, and the hazard ratio was 1.55 (95% CI: 0.84-2.84). The non-bursectomy group had more patients with peritoneal recurrences than the bursectomy group (14% vs. 8%). Conclusions: Experienced surgeons could safely perform a D2 gastrectomy with an additional bursectomy. First interim analysis suggested the survival advantage of omental bursectomy for cT2-3 gastric cancer patients. Final analysis will be conducted in 2012. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- Y. Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Y. Fujiwara
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - S. Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - J. Fujita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - H. Imamura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - T. Tsujinaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - M. Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Y. Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan; Department of Surgery, Sakai Municipal Hospital, Osaka, Japan; Department of Surgery, Osaka National Hospital, Osaka, Japan
| |
Collapse
|
49
|
Imamura H, Matsumoto R, Nakagawa T, Inouchi M, Matsuhashi M, Mikuni N, Takahashi R, Ikeda A. P15-5 Ictal slow shift and high frequency oscillation as revealed by intracranial wideband recording in human neocortical epilepsy. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Sugiyama Y, Ishizaki Y, Imamura H, Sugo H, Yoshimoto J, Kawasaki S. Effects of intermittent Pringle's manoeuvre on cirrhotic compared with normal liver. Br J Surg 2010; 97:1062-9. [PMID: 20632273 DOI: 10.1002/bjs.7039] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although patients with liver cirrhosis are supposed to tolerate ischaemia-reperfusion poorly, the exact impact of intermittent inflow clamping during hepatic resection of cirrhotic compared with normal liver remains unclear. METHODS Intermittent Pringle's manoeuvre was applied during minor hepatectomy in 172 patients with a normal liver, 59 with chronic hepatitis and 97 with liver cirrhosis. To assess hepatic injury, delta (D)-aspartate aminotransferase (AST) and D-alanine aminotransferase (ALT) (maximum level minus preoperative level) were calculated. To evaluate postoperative liver function, postoperative levels of total bilirubin, albumin and cholinesterase (ChE), and prothrombin time were measured. RESULTS Significant correlations between D-AST or D-ALT and clamping time were found in each group. The regression coefficients of the regression lines for D-AST and D-ALT in patients with normal liver were significantly higher than those in patients with cirrhotic liver. Irrespective of whether clamping time was 45 min or less, or at least 60 min, D-AST and D-ALT were significantly lower in patients with cirrhosis than in those with a normal liver. Parameters of hepatic functional reserve, such as total bilirubin, prothrombin time, albumin and ChE, were impaired significantly after surgery in patients with a cirrhotic liver. CONCLUSION Patients with liver cirrhosis had a smaller increase in aminotransferase levels following portal triad clamping than those with a normal liver. However, hepatic functional reserve in those with a cirrhotic liver seemed to be affected more after intermittent inflow occlusion.
Collapse
Affiliation(s)
- Y Sugiyama
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | | | | | | | | | | |
Collapse
|