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Furukawa H, Taniguchi M, Fujiyoshi M, Oota M. Experience using extended criteria donors in first 100 cases of deceased donor liver transplantation in Japan. Transplant Proc 2012; 44:373-5. [PMID: 22410020 DOI: 10.1016/j.transproceed.2012.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Because of the serious organ shortage in Japan, the use of extended criteria (EC) donors is inevitable to increase the number of deceased donors. However, the influence of this practice on recipient outcomes has not been clarified yet. We analyzed donor and recipient factors to determine whether those factors, especially from EC donors impacted early recipient outcomes. From February 1999 to January 2011, 100 deceased liver transplantations were performed in Japan, including 85 consecutive adult cases (age≥18 years) who were studied to evaluate whether 6 recipient and 16 donor factors affected 3-month (90-day) recipient survival. Upon univariate analysis, Model for End-stage Liver Disease (MELD) score≥25 (P=.018), donor age≥55 years (P=.040), and cold ischemia time (CIT)≥10 hours (P=.00013) significantly reduced 3-month survival. Multivariate analysis confirmed the independent contributions of, three adverse factors including MELD score≥25 (P=.0133, odds ratio [OR]=12.3, 95% confidence interval [CI]=1.7-90.3), donor age≥55 years (P=.013, OR=14.0, 95% CI=1.6-119.5), and CIT≥10 hours (P=.0024, OR=67.6, 95% CI=4.5-1024.9). Three-month recipient survivals with 0, 1, 2, and 3 positive factors were 100% (n=34), 94.4% (n=36), 53.8% (n=13), and 0% (n=2), respectively (P<.0001). In conclusion, to improve recipient short-term survivals, minimizing CIT is the first priority. In the long-term, we must promote deceased donation to reduce recipient MELD scores by shortening the waiting time, and revise the allocation system to minimize CIT by giving priority to the local area.
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Affiliation(s)
- H Furukawa
- Department of Gastroentrologic and General Surgery, Asahikawa Medical University, Asahikawa, Japan.
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Mori M, Oota M, Taguchi H, Ohno T, Tanimoto M, Miyata A, Naoe T, Murai Y, Masuda M. Pirarubicin (THP) therapy for elderly aggressive non-Hodgkin’s lymphoma— T-COP vs reduced CHOP, and reduced T-COP in the patients with poor physical status. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17571] [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
17571 Background: We have previously reported that T-COP using pirarubicin (THP) is useful in treatment of NHL in elderly patients. In the present study on elderly aggressive NHL, the usefulness and safety were compared between THP and ADM using the optimum dose of THP (ML1). In patients with poor physical status, reduced dose T-COP was conducted (ML2). Methods: ML1 protocol: PS 0–3 and Alb ≥ 3.0 g/dl Patients in their 70s were assigned randomly to either T-COP (A group) or CHOP (B group) receiving THP (A) or ADM (B) 40 mg/m2,CPA 650 mg/m2, VCR 1 mg/m2dayl, P 40 mg/m2dayl -5. Patients in their 80s were assigned randomly to either T-COP (C) or CHOP (D) receiving THP (C) or ADM (D) 30, CPA 400, VCR 1, P 30. ML2 protocol: PS 4 or Alb < 3.0 g/dl. Patients in their 70s (E group) received THP 26, CPA 430, VCR 1, P 40. Patients in their 80s (F group) received THP 20, CPA 260, VCR 1, P 30. Each group underwent 3 courses every 3 weeks. CR (CR+CRu) patients underwent 6 courses or more. Results: Analyzed as competent cases were 173 out of 207 patients who were registered between Aug 99 and Dec 03. The CR rates were A: 83% (39/47), B: 74% (37/50), C: 67% (14/21), D: 74% (14/19), E: 58% (7/12), F: 33% 2/6, and 78% in T-COP (A + C) and 74% in CHOP (B + D). The 5-year survival rates were A: 50%, B: 35% (p < 0.05) and C: 26% D: 55% (p < 0.05.), demonstrating that T-COP in their 70s and CHOP in their 80s were significantly higher. The 5-year survival rate in ML1 was 41%. In multivariate analysis, factors influencing the survival (p < 0.01) in ML1 were age, the primary effect and treatment method. There were no significant differences in PS, CS, LDH and lesions outside nodes. Conclusions: Patients aged 70 years or older had the CR rate at 75.9% and a 5-year survival rate at 41%, demonstrating satisfactory outcomes. The results suggested that in 70s, THP 40 mg/m2 was more effective than ADM 40 mg/m2. In their 80s, ADM30 mg/m2 was more effective than THP30 mg/m2. ML2 was feasible in elderly patients with poor physical status. No significant financial relationships to disclose.
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Affiliation(s)
- M. Mori
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - M. Oota
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - H. Taguchi
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - T. Ohno
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - M. Tanimoto
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - A. Miyata
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - T. Naoe
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - Y. Murai
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
| | - M. Masuda
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Kochi Medical School, Kochi, Japan; Ohtu Red-Cross Hospital, Ohtu, Japan; Okayama University Graduate School of Medicine, Okayama, Japan; Chugoku Central Hospital, Fukuyama, Japan; Nagoya University, Nagoya, Kenya; Tama Hokubu Medical Center, Tokyo, Japan; Tokyo Women’s Medical University, Tokyo, Japan
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Onodera Y, Oota M, Sasaki H, Yogi S, Ikeuchi T, Matsumoto K, Kai Y. Clinical evaluation of the results of open or transurethral surgery for prostate hypertrophy. Int J Urol 1996; 3:S60-2. [PMID: 24304027 DOI: 10.1111/j.1442-2042.1996.tb00089.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We evaluated the outcome of surgery for prostate hypertrophy through measurement of the urine flow rate and the Boyarsky symptom score. The study covered 108 patients admitted to Showa University School of Medicine, Fujigaoka Hospital. Thirty-eight had been admitted for retropubic prostatectomy and the remaining 70 patients for transurethral resection of the prostate. Their ages ranged from 48 to 84 years, with an average age of 64.4 years. The urine flow rate was measured before and after prostatic operation using Dantec Urodyn 1000. The symptom scores were calculated according to the Boyarsky symptom score. The Student's t test was used for statistical analysis. Frequency (daytime, nighttime) was the most common preoperative symptom (97.2%, 96.3%), followed by impairment of stream (88.0%), and intermittency (78.7%). Frequently observed symptoms tended to raise the symptom scores. The period of admission, age and prostatic size did not correlate with the preoperative urine flow rate and symptom score. Significant improvements in the urine flow rate occurred after the operation. Frequency (daytime, nighttime) was the most common postoperative symptom (82.7%, 81.1%), followed by urgency (37.0%), then terminal dribbling (32.2%). Of 39 patients who were evaluated by symptom score and urine flow simultaneously, 6 patients (15.1%) failed to show improvement in 1 of the 2 evaluations, while 9 (23.1%) patients failed to show improvement in either. The irritative symptoms (frequency, urgency) tended not to show significant postoperative improvement.
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Affiliation(s)
- Y Onodera
- Department of Urology, Showa University Fujigaoka Hospital, Yokohama, Japan
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Utsunomiya J, Oota M, Matsumoto M, Natori H. [Surgery of ulcerative colitis using ileoanal anastomosis]. Nihon Geka Gakkai Zasshi 1985; 86:1304-7. [PMID: 4088260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ideal surgical treatment for ulcerative colitis is the ileoanal anastomosis (IAA), which, however, is not yet generally accepted as a practical procedure because of a suboptimal fecal function, frequent postoperative complications and technical difficulties. Based on one (U.) of the authors experiences on 36(34) polyposis and 19(12) colitis (paracentesis indicate the number of cases in (U.)'s previous appointment, Tokyo Medical and Dental University, 1977-1983). The practical procedure of IAA can be achieved by combining the following basic principles; a direct anastomosis of J-shape ileal pouch to the anal sphincteric mechanism, temporarily exclusion of the anastomosis by a loop-ileostomy, mucosectomy confined to the lower rectum leaving the short muscular cuff, and meticulous dissection of inflamed mucosa of the anal canal minimizing the damage to the internal sphincter which is achieved by the prone ano-abdominal approach. At elective operation, the procedure can be performed either as primary surgery or as the secondary following rectum preserving operation, in which, coeco-rectal anastomosis is advisable for preserving the ileocolic vessels that is helpful for J-pouch construction. In emergency surgical program, IAA is still be preserved as a final restructive surgery following colectomy with an open rectal exclusion or Turnbull' s total colonic exclusion. In this occasion, an ascendicostomy is advisable for preserving the ileocolic vessels.
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