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Ogino H, Isogai N, Kume N, Shibutani S, Yashiro H, Takahara M, Fujimura N. Evaluating the Effectiveness and Clinical Outcomes of Endovascular Aneurysm Repair-First Approach for Ruptured Abdominal Aortic Aneurysm in Japan. J Endovasc Ther 2024:15266028241248337. [PMID: 38659330 DOI: 10.1177/15266028241248337] [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] [Indexed: 04/26/2024]
Abstract
PURPOSE To verify the validity of an endovascular aneurysm repair (EVAR)-first strategy for treating patients with ruptured abdominal aortic aneurysm (rAAA) in Japan. MATERIALS AND METHODS This study was conducted on 2 groups of patients with rAAA who underwent surgical treatment at 3 hospitals in the Kanagawa Prefecture, Japan, between January 2007 and September 2016. The open surgical treatment group comprised patients with rAAA who underwent open surgical treatment before January 2012; their data were retrospectively collected from their medical records. The EVAR-first strategy group comprised patients with rAAA who underwent treatment based on the Shonan rAAA protocol (SRAP; the standard protocol-based EVAR-first strategy) in or after February 2012; their data were collected prospectively. The short- and long-term treatment outcomes of both groups were compared. In addition, a risk score-based sensitivity analysis (one-to-one matching) was conducted on both groups using a caliper with 0.2 standard deviations of the score. RESULTS Of the 163 patients with rAAA, the open surgical and EVAR-first strategy groups comprised 53 and 110 patients, respectively (EVAR: 91.8%, open repair: 8.2%). The 30-day postoperative mortality rate differed significantly, being 42% for the open surgery group and 25% for the EVAR-first strategy group (odds ratio: 0.44, 95% confidence interval: 0.20-0.97). The postoperative survival rates at 6 months, 1 year, and 3 years were 66%, 48%, and 58% for the EVAR-first group, respectively, and 51%, 66%, and 48% for the open surgery group, respectively (p=0.072). In a matched cohort analysis (n=50), the 30-day postoperative mortality rate was 22% for the EVAR-first group and 44% for the open surgery group (odds ratio: 0.35, 95% confidence interval: 0.14-0.90). The postoperative survival rates at 6 months, 1 year, and 3 years were 76%, 76%, and 63% for the EVAR-first group, respectively, and 48%, 45%, and 45% for the open surgery group, respectively (p=0.003). CONCLUSION The SRAP-based EVAR-first strategy for rAAA yielded significantly better treatment outcomes than the open surgical strategy. These findings suggest that EVAR should be considered the primary treatment option for rAAA, given its potential to reduce early mortality rates. CLINICAL IMPACT Multicenter retrospective analysis of prospectively collected registry data was done to compare treatment outcomes of two groups of ruptured abdominal aortic aneurysm patients open surgery and endovascular-aneurysm-repair (EVAR)-first strategy (Shonan ruptured abdominal aortic aneurysm protocol). EVAR-first group showed better outcomes: lower 30-day mortality (25% vs. 42%), higher survival rates at 6 months, 1 year, and 3 years. Take home Message: The study supports the use of the EVAR-first strategy with the Shonan Protocol for treating ruptured abdominal aortic aneurysms in Japan, showing improved outcomes, reduced 30-day postoperative mortality, and better long-term survival rates compared to the conventional approach.
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Affiliation(s)
- Hidemitsu Ogino
- Department of Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, Japan
| | - Naoko Isogai
- Department of Vascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Nao Kume
- Department of Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, Japan
| | - Shintaro Shibutani
- Department of Vascular Surgery, Kawasaki Tsurumi Vascular Surgery Clinic, Kawasaki, Japan
| | - Hideki Yashiro
- Department of Radiology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Fujimura N, Obara H, Matsubara K, Toya N, Isogai N, Ogino H, Fujii T, Kudo T, Kanaoka Y, Harada H, Uchiyama H, Guntani A, Shimogawara T, Watada S, Shibutani S, Ohki T. Long-Term Outcomes of a Japanese Prospective Multicenter Registry Using a Heparin-Bonded Expanded Polytetrafluoroethylene Graft for Above-the-Knee Femoropopliteal Bypasses. Circ J 2024:CJ-24-0135. [PMID: 38616124 DOI: 10.1253/circj.cj-24-0135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Despite the widespread use of PROPATEN®, a bioactive heparin-bonded expanded polytetrafluoroethylene graft, in bypass surgery, there are only a few reports of long-term results. We evaluated the long-term results of PROPATEN®use for above-knee femoropopliteal bypass (AKFPB).Methods and Results: After PROPATEN®-based AKFPB, patients were prospectively registered at 20 Japanese institutions between July 2014 and October 2017 to evaluate long-term results. During the median follow-up of 76 months (interquartile range 36-88 months) for 120 limbs (in 113 patients; mean [±SD] age 72.7±8.1 years; 66.7% male; ankle-brachial index [ABI] 0.45±0.27; lesion length 26.2±5.7 cm; chronic limb-threatening ischemia in 45 limbs), there were 8 major amputations; however, clinical improvement was sustained (mean [±SD] ABI 0.87±0.23) and the Rutherford classification grade improved in 105 (87.5%) limbs at the latest follow-up. At 8 years, the primary patency, freedom from target-lesion revascularization, secondary patency, survival, and amputation-free survival, as estimated by the Kaplan-Meier method, were 66.3±4.8%, 71.5±4.4%, 86.5±3.4%, 53.1±5.0%, and 47.4±5.3%, respectively. CONCLUSIONS This multicenter prospective registry-based analysis showed sustained excellent clinical improvement and secondary patency for up to 8 years following PROPATEN®-based AKFPB. PROPATEN®constitutes a durable and good revascularization option for complex superficial femoral artery lesions, especially when endovascular treatment is inappropriate or an adequate venous conduit is unavailable.
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Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | | | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital
| | | | - Taku Fujii
- Department of Surgery, Saitama Municipal Hospital
| | - Toshifumi Kudo
- Department of Surgery, Tokyo Medical and Dental University
| | - Yuji Kanaoka
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | | | | | - Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital
| | | | | | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
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Yamamoto H, Kume N, Hashimoto K, Isogai J, Kuwabara T, Noguchi M, Murayama H, Hashimoto T, Ogino H. Subacute hemorrhagic pericardial tamponade after COVID-19 infection mimicking carcinomatous pericarditis: a case report. Front Cardiovasc Med 2024; 10:1329952. [PMID: 38264260 PMCID: PMC10803410 DOI: 10.3389/fcvm.2023.1329952] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Background Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT), showing unfavorable prognosis. However, early diagnosis and treatment remain challenging in cases of non-specific signs and symptoms. Case presentation A 64-year-old man was admitted to our hospital for acute osteomyelitis of the toes and was properly treated with antimicrobial agents. Three days after admission, the patient developed mild COVID-19 without pneumonia, for which early anti-COVID-19 agents were initiated. Nevertheless, the patient developed hemorrhagic PT due to acute pericarditis 2 weeks later, which was confirmed by cardiac magnetic resonance, requiring an urgent pericardiocentesis. Although cytological analysis of the hemorrhagic pericardial fluid strongly suggested adenocarcinoma, the atypical cells were eventually proven to be mesothelial cells with reactive atypia. Furthermore, lymph nodes swelling with abnormal 2-[18F]-fluoro-2-deoxy-D-glucose accumulation on imaging were suggestive of malignancy. However, biopsy examination revealed multiple non-caseating granulomas in the lymph node, unlikely due to malignancy. Eventually, the temporal association of the preceding COVID-19 with the occurrence of subacute PT without other identifiable cause led to a final diagnosis of COVID-19-associated acute pericarditis. With anti-inflammatory and corticosteroids treatment, the patient's symptoms involving the pericardial structure and function were completely resolved along with improvements in size of the affected lymphadenopathies. Conclusions We encountered a unique case of COVID-19-associated acute pericarditis exhibiting hemorrhagic PT. This case underscores the residual risk of delayed pericardial involvement even in patients with mild COVID-19 who receive early treatment, and the recognition that COVID-19 may cause various cytomorphological and histological features. Additionally, the importance of considering this rare entity as a cause of hemorrhagic pericardial effusions should be highlighted.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nao Kume
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Katsuya Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Division of Radiology, Asahi General Hospital, Asahi, Japan
| | - Takuya Kuwabara
- Department of Pathology, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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Murata T, Yamaguchi N, Shimomoto Y, Mikajiri Y, Sasaki Y, Konagaya K, Igarashi Y, Sawamura N, Yamamoto K, Kume N, Suno Y, Kurata S, Kasetani T, Kato I, Nishida T, Hirata H, Miyake K, Oonishi T, Isogai N, Fukai R, Kanomata H, Shimoyama R, Kashiwagi H, Takenoue T, Terashima T, Murayama H, Kohriki S, Morita T, Takaki M, Ogino H, Kanemaru T, Sano K, Kurogi N, Watanabe K, Hirata M, Kawachi J. Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study. Int J Surg 2023; 109:4119-4125. [PMID: 37720948 PMCID: PMC10720829 DOI: 10.1097/js9.0000000000000733] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis. MATERIALS AND METHODS In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors. RESULTS Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10. CONCLUSION This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.
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Affiliation(s)
| | | | - Yutaro Shimomoto
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Yumi Mikajiri
- Department of General Surgery, Shonan Atsugi Hospital
| | - Yuki Sasaki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kensuke Konagaya
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Naoki Sawamura
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kota Yamamoto
- Department of General Surgery, Shonan Atsugi Hospital
| | - Nao Kume
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Shuji Kurata
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Tetsuya Kasetani
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Ichiro Kato
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Hirohisa Hirata
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | | | - Takahisa Oonishi
- Department of General Surgery, Yamato Tokushukai Hospital, Kanagawa
| | | | | | | | | | | | | | | | - Hiroyuki Murayama
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | - Shunsaku Kohriki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Takeshi Morita
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Mutsuo Takaki
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Ken Sano
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Kazunao Watanabe
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
| | - Masahiro Hirata
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Katoh N, Okimoto T, Sakurai H. The Japanese Nationwide Cohort Data of Particle Beam Therapy for Liver Oligometastasis in Esophagogastric Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e351-e352. [PMID: 37785217 DOI: 10.1016/j.ijrobp.2023.06.2427] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology (JASTRO) in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis of esophagogastric cancers. MATERIALS/METHODS Cases in which PBT was performed at all PBT facilities in Japan between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: controlled primary cancer; liver recurrence without extrahepatic tumors; and no more than three liver lesions. The dose and fraction of PBT were determined using unified treatment policy established by JASTRO. We used the following protocol, 64 gray (relative biological effect) (Gy (RBE))/8 fractions (fr) for the peripheral region, and 72.6 GyE/22fr for the central region. For safety aspect, the hepatocellular carcinoma irradiation protocols of 66 Gy (RBE)/10fr, 72.6-76 Gy (RBE)/20-22fr, and 74-76 Gy (RBE)/37-38fr could be allowed. The overall survival (OS), local control (LC), and adverse events (AEs) were examined. The OS and LC rates were calculated using the Kaplan-Meier method. Factors possibly related to OS, such as tumor size (for multiple lesions, the largest size), number of liver tumors, as well as the presence or absence of prior, concurrent, and post-PBT chemotherapy, were investigated. The cut-off values were estimated using the receiver operating characteristic curve and area under the curve. Univariate analysis was performed using the log-rank test. Statistical significance was P-values < 0.05. RESULTS Twenty-three males and two females with a median age of 69 (range, 52-80) years and 36 lesions were included. This study included six patients with esophageal and 19 patients with gastric cancer. The median lesion size, fraction size, and biological effective dose (BED)10 were 31 (7-104) mm, 3.8 gray (relative biological effect)/fractions (Gy (RBE)/fr) (2-8 Gy (RBE)/fr), and 96.9 (88.8-115.2) Gy, respectively. The median follow-up period was 18 (4-47) months. The 1-, 2-, and 3-year OS rates were 76.0, 49.5, and 43.3%, respectively, and the median OS was 19 months. The 1-, 2-, and 3-year OS rates of esophageal cancer were 83.3% for all. The 1-, 2-, and 3-year OS rates of gastric cancer were 73.7, 40.2, and 32.2%, respectively, and the median OS was 18 months. The 1-, 2-, and 3-year LC rates were 96.3, 91.5, and 91.5%, respectively. The 1-, 2-, and 3-year LC rates of esophageal cancer were 100% for all. The 1-, 2-, and 3-year LC rates of gastric cancers were 94.7, 88.0, and 88.0%, respectively. Tumor size was the only significant OS-related factor (P < 0.01). No grade 3 or higher adverse events were observed. CONCLUSION Owing to the low incidence of adverse events and the high LC rate, PBT is a feasible option for liver oligometastasis of esophagogastric cancers.
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Affiliation(s)
- H Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | | | - H Numajiri
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - N Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - T Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - H Sakurai
- Departement of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Okimoto T, Ogino T, Nishimura T. The Japanese Nationwide Cohort Data of Proton Beam Therapy for Liver Oligometastasis in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e352. [PMID: 37785219 DOI: 10.1016/j.ijrobp.2023.06.2428] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology (JASTRO) in Japan. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis in breast cancers. MATERIALS/METHODS Cases in which PBT was performed at all Japanese proton therapy facilities between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: the primary cancer was controlled, liver recurrence without extrahepatic tumors, and no more than three liver lesions. The treatment indication and strategy were discussed at cancer boards in each institution. The dose and fraction of PBT were determined by referring to the unified treatment policy established by JASTRO. We used the following protocol: 64 gray (Gy) (relative biological effectiveness [RBE])/8 fraction (fr) for the hepatic periphery area away from the GI tract, and 72.6 GyE/22 fr for the adjacent hilar region type. Regarding safety, the HCC irradiation protocols of 66 GyE/10 fr, 72.6-76 GyE/20-22 fr, and 74-76 GyE/37-38 fr could be used. The local control (LC), overall survival (OS), and progression free survival (PFS) rates were calculated using the Kaplan-Meier method. Factors possibly related to OS, such as tumor size, number of liver tumors, intervention of chemotherapy, and/or hormone therapy, were investigated. The cut-off values were estimated using the receiver operating characteristic curve and area under the curve. Univariate analysis was performed using the log-rank test. RESULTS Fourteen females, with a median age of 57 (range, 44-73) years and twenty-two lesions were included. Nine patients had one lesion, two patients had two lesions, and three patients had three lesions. PBT was selected because nine patients had underlying disease and five patients had general conditions (age, etc.). The median lesion size, fraction size, and biological effective dose using the linear-quadratic model with α/β = 10 Gy ((BED)10) were 44 (20-130) mm, 6.6 (2-8) (relative biological effectiveness [RBE])/fraction (fr), and 109.6 (52.7-115.2) Gy, respectively. The median follow-up period of breast cancers was 22.8 (4-54) months. The 1-, 2-, and 3-year LC rates of liver metastasis from breast cancers were 100% for all. The 1-, 2-, and 3-year OS rates were 85.7%, 62.5%, and 62.5%, respectively. The 1-, 2-, and 3-year PFS rates were 50.0%, 33.3%, and 16.7%, respectively, and median PFS time was 16 months. Tumor size, the number of liver tumors, and the intervention of chemotherapy and/or hormone therapy at any time were not significantly related to the OS. Only one patient did not complete PBT due to current disease progression. The other patients completed PBT without interruption. One patient had grade 3 radiation-induced dermatitis. CONCLUSION Based on the low incidence of adverse events and the high LC rate, PBT appears to be a feasible option for liver oligometastasis in breast cancer patients.
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Affiliation(s)
- H Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | | | - H Numajiri
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - T Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - T Ogino
- Medipolis Proton Therapy and Research Center, Ibusuki, Japan
| | - T Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
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Iwata H, Oguri M, Hattori Y, Nakajima K, Tsuzuki Y, Hayashi K, Toshito T, Umemoto Y, Ogino H, Hiwatashi A. Phase II Clinical Trial of Hypofractionated Image-Guided Proton Therapy with 12 Fractions for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e395-e396. [PMID: 37785323 DOI: 10.1016/j.ijrobp.2023.06.1522] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Towards hypofractionated proton therapy for prostate cancer for improving convenience for patients to receive treatment and improving therapeutic efficacy, image-guided technique with hydrogel spacer solved the late gastrointestinal toxicity, but it is unclear whether acute genitourinary (GU) toxicity is acceptable. The aim of this phase II study was to evaluate the safety and efficacy of hypofractionated image-guided proton therapy (IGPT) with 12 fractions for prostate cancer. MATERIALS/METHODS Eligibility criteria were as follows: (1) histologically confirmed primary prostate cancer; (2) T1-T3bN0M0 staged by (UICC TNM8th); (3) ECOG-PS ≤ 2; (4) age ≥ 20 years; (5) no serious underlying disease or other cancers; (6) technically capable of proton therapy, and (7) written informed consent. Primary endpoint was the ratio of grade 2 or more acute genitourinary toxicity. We used the modified CTCAE grading of grade 2 GU toxicities, in which prescribing two and more types of drugs for dysuria within 3 months of the start of radiation was considered to indicate grade 2 GU toxicity. A phase II trial was planned based on the minimax Simon's two-stage design with a significance level of 0.05 and a power of 90%. The acceptable incidence is considered to be less than 5%, and the unacceptable incidence is considered to be more than 15%. A total of 83 patients is required for completion of the trial (7 patients or fewer). After evaluating the primary endpoint in 83 patients, 217 additional patients were registered and a total of 300 patients were registered in order to further examine the safety and efficacy. The prescribed dose to the isocenter was 51.6 GyRBE in 12 fractions (4 days a week). RESULTS From January 2020 to March 2021, 30, 53, and 217 patients (total 300) were enrolled. The patient characteristics were as follows: median age, 70 (48-83) years; low/intermediate/high risk, 44/132/124. Forty-nine and 38 patients had benign prostatic hyperplasia and diabetes mellitus, respectively. Grade 2 acute GU toxicities were observed in 1, 5 and 13 patients, respectively (total 6.3%). No grade 3 or higher acute GU toxicities were observed. However, urinary retention during IGPT, which was not previously observed, was observed in 3 cases, and temporary urethral catheterization was performed (Grade 2). Most of the acute GU toxicity tended to improve at 1 month after IGPT, and almost improved at 3 months. Mean score deteriorations beyond the minimum clinically important difference threshold (1/2 SD) were observed only at 1 month in the following scales: summary (-6.0), bother (-7.0), and irritative/obstructive (-6.3). CONCLUSION Hypofractionated IGPT with 12 fractions for prostate cancer is well tolerated in acute GU toxicities. Longer follow-up is necessary to evaluate the efficacy and late toxicities. Further investigation of hypofractionated IGPT with 12 fractions for prostate cancer is warranted. Since April 2021, an additional 1000 cases of prospective registration study have been conducted.
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Affiliation(s)
- H Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - M Oguri
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Y Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - K Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Y Tsuzuki
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - K Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - T Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Y Umemoto
- Department of Nephro-Urology, Nagoya City University West Medical Center, Nagoya, Japan
| | - H Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - A Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Kume N, Konagaya K, Okamoto T, Ogino H. A Case of Profunda Femoris Artery Pseudoaneurysm Treated With Catheterization and Surgical Hematoma Removal. Cureus 2023; 15:e42708. [PMID: 37654926 PMCID: PMC10465818 DOI: 10.7759/cureus.42708] [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] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
A pseudoaneurysm of the profunda femoris artery (PFA) is a rare disease induced by femoral trauma, proximal femoral fracture, or iatrogenic causes associated with orthopaedic surgery. Recently, transcatheter arterial embolism was reported as an effective treatment for profunda femoris artery pseudoaneurysm. This report presents the case of an 85-year-old male who underwent artificial head replacement for a left femoral neck fracture and was hospitalized with a peri-stem fracture four years later. Conservative treatment was conducted with a brace, though the swelling and pain in his left thigh increased one week after his hospital admission. Contrast-enhanced computed tomography (CT) led to a diagnosis of a left profunda femoris artery pseudoaneurysm, and the patient underwent emergency transcatheter arterial embolism and surgical hematoma removal. Since the emergency surgery, the patient's course has been good, and he has been undergoing rehabilitation.
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Affiliation(s)
- Nao Kume
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
| | | | - Takashi Okamoto
- Cardiovascular Surgery, Narita Tomisato Tokusyukai Hospital, Chiba, JPN
| | - Hidemitsu Ogino
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
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9
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Ogino H. The 2021 Bo Lindell Lecture: Inclusive, accountable, transparent: the direction we should take for the benefit of present and future generations. Ann ICRP 2023; 52:9-15. [PMID: 38143300 DOI: 10.1177/01466453231211068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
The International Commission on Radiological Protection (ICRP) is recognised as the de-facto world authority in the field of radiological protection. The ICRP Recommendations have been used as a basis for regulations and policy in almost every country, and with the current review and revision of the System of Radiological Protection, it will continue to make significant contributions in radiation safety for patients, workers, the public, and the environment. In a society undergoing significant change, it is necessary to give careful thought to which groups will be perceived as authoritative organisations by the constituents of the future. The ideal form of an authoritative organisation in the new society of the future is to continue to show how it came to make such recommendations, how it reflected the opinions of interested parties in the process, and how it discloses its records with as much transparency as possible. The question now is what we must do to ensure that decision-making advances in a way that not only makes sense to the present generation, but will be easily consumed by future generations. The path that ICRP is taking to formulate the next set of General Recommendations is doing just that, in line with the key procedural values of INCLUSIVE, ACCOUNTABLE, AND TRANSPARENT.
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Affiliation(s)
- H Ogino
- Nuclear Regulation Authority, 1-9-9 Roppongi, Minato-ku, Tokyo 106-8450, Japan; e-mail:
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10
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Iwata H, Ogino H, Hattori Y, Nakajima K, Nomura K, Oguri M, Hayashi K, Toshito T, Sasaki S, Hashimoto S, Hiwatashi A. Clinical Outcomes of Image-Guided Proton Therapy for Recurrent Hepatocellular Carcinoma after TACE and/or RFA Treatment. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1063] [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: 12/01/2022]
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11
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Yamamoto H, Fukushima Y, Ikeda Y, Suda T, Goto M, Isogai J, Hashimoto T, Takahashi T, Ogino H. Decisive diagnostic clue for infectious abdominal aortic aneurysm caused by Arthrobacter russicus in a diabetic elderly woman with renal dysfunction: A case report and literature review. Front Cardiovasc Med 2022; 9:1007213. [PMID: 36386385 PMCID: PMC9650533 DOI: 10.3389/fcvm.2022.1007213] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
Infectious aortic aneurysm (IAA) can be a rare but potentially fatal sequela of infectious inflammatory disease of the aortic wall with a high incidence of rupture. The definitive diagnosis is based on vascular imaging of the aneurysm using contrast-enhanced computed tomography (CE-CT) and identification of the causative microorganism from positive blood cultures (BCs). However, IAA remains extremely difficult to diagnose and treat in patients with prior antimicrobial treatment or with renal dysfunction. Here we describe a case of an 85-year-old woman with IAA caused by Arthrobacter russicus presenting with abdominal pain and fever that was initially diagnosed as a presumptive urinary tract infection and treated with empiric antimicrobial therapy. However, persistent abdominal pain with increased serological inflammation necessitated further evaluation. Unenhanced multimodality imaging considering the renal dysfunction revealed infectious aortitis of the infrarenal abdominal aorta, together with the initial culture results, leading to the tentative diagnosis of Klebsiella pneumoniae aortitis. Thereafter, serial monitoring with unenhanced magnetic resonance angiography (MRA) using thin-slab maximum intensity projection (TS-MIP) revealed acute aortic expansion strongly suggestive of a pseudoaneurysm that was successfully treated with early surgical repair under adequate infection control. Despite negative Gram staining and tissue culture results for the excised aortic wall, a definitive diagnosis of IAA secondary to A. russicus rather than K. pneumoniae was finally made by confirming the histologic findings consistent with IAA and the identification of A. russicus 16S rRNA on the resected aortic wall. The patient also developed a vascular graft infection during the postoperative course that required long-term systemic antimicrobial therapy. This case highlights the value of unenhanced MRA in the early detection of IAA in patients with renal dysfunction and the importance of a molecular diagnosis for identifying the causative microorganism in cases of culture- or tissue-negative IAA.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- *Correspondence: Hiroyuki Yamamoto,
| | - Yasuto Fukushima
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mieko Goto
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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12
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Konagaya K, Yamamoto H, Nishida T, Morita T, Suda T, Isogai J, Murayama H, Ogino H. Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report. Front Med (Lausanne) 2022; 9:970239. [PMID: 36035387 PMCID: PMC9402970 DOI: 10.3389/fmed.2022.970239] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
The novel coronavirus disease (COVID-19) has resulted in a global pandemic. Recently, COVID-19-related pneumothorax has gained attention because of the associated prolonged hospital stay and high mortality. While most cases of pneumothorax respond well to conservative and supportive care, some cases of refractory pneumothorax with persistent air leaks (PALs) do not respond to conventional therapies. There is a lack of evidence-based management strategies to this regard. We describe the case of a 73-year-old man with COVID-19-related acute respiratory distress syndrome (ARDS) who developed delayed tension pneumothorax with PALs caused by alveolopleural fistulas. Despite chest tube drainage, autologous blood pleurodesis, and endoscopic procedures, the PALs could not be closed, and were complicated by thoracic empyema. Subsequent minimally invasive open-window thoracostomy (OWT) with vacuum-assisted closure (VAC) therapy helped successfully control the refractory PALs. Serial chest computed tomography monitoring was useful for the early detection of the pneumothorax and understanding of its temporal relationship with air-filled lung cysts. Our case provides a new perspective to the underlying cause of refractory pneumothorax with PALs, secondary to COVID-19-related ARDS, and underscores the potential of OWT with VAC therapy as a therapeutic alternative in such cases.
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Affiliation(s)
- Kensuke Konagaya
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- *Correspondence: Hiroyuki Yamamoto,
| | - Tomoki Nishida
- Department of General Thoracic Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomotaka Morita
- Department of Anesthesiology, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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13
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Konagaya K, Yamamoto H, Suda T, Tsuda Y, Isogai J, Murayama H, Arakawa Y, Ogino H. Ruptured Emphysematous Prostatic Abscess Caused by K1-ST23 Hypervirulent Klebsiella pneumoniae Presenting as Brain Abscesses: A Case Report and Literature Review. Front Med (Lausanne) 2022; 8:768042. [PMID: 35047523 PMCID: PMC8761798 DOI: 10.3389/fmed.2021.768042] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Emphysematous prostatic abscess (EPA) is an extremely rare but potentially fatal urinary tract infection (UTI). Here, we describe a case (a 69-year-old male with prediabetes) of ruptured EPA caused by a hypervirulent Klebsiella pneumoniae (hvKp) K1-ST23 strain, presenting as motor aphasia. Our patient presented with ruptured EPA concurrent with various severe systemic pyogenic complications (e.g., urethro-prostatic fistula, ascending UTIs, epididymal and scrotal abscesses, and liver, lung, and brain abscesses). Whole-body computed tomography (CT) and next-generation sequencing (NGS) were useful for the detection of ruptured EPA and its systemic complications, and for identification of K1-ST23 hvKp strains, respectively. Subsequently, the infections were successfully treated with aggressive antimicrobial therapy and multiple surgical procedures. This case highlights the significance of awareness of this rare entity, the clinical importance of CT for the early diagnosis of EPA and the detection of its systemic complications in view of hvKp being an important causative organism of severe community-acquired UTI, and the usefulness of NGS to identify hvKp strains.
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Affiliation(s)
- Kensuke Konagaya
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yusuke Tsuda
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yoshichika Arakawa
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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14
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Iwata H, Akita K, Ogino H, Yamaba Y, Kunii E, Takakuwa O, Nakajima K, Nomura K, Hayashi K, Toshito T, Hara M, Shibamoto Y. Immune-Related Radiation Pneumonitis in Patients Undergoing Durvalumab Treatment After Concurrent Chemo-Proton Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1245] [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: 10/20/2022]
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15
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Yamaguchi T, Nakai M, Yano T, Matsuyama M, Miyamoto Y, Kodama T, Ogino H. Population-based incidence and outcomes of acute aortic dissection in Japan. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1982] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival at the hospital, and the accurate diagnosis of AAD is difficult due to the low autopsy rate for patients with cardiopulmonary arrest outside of the hospital. We performed a population-based review of all patients with AAD in a well-defined geographical area in the southern part of Japan between 2016 and 2018.
Methods
Data of all patients with AAD at our Hospital, which performs medical care for 120,000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100,000 population were calculated using the Japanese population distribution model in 2015.
Results
The total incidence of AAD was 79 (type A: 64.5%, n=51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates after the onset of AAD were 74.5% (38/51) in type A and 25.0% (7/28) in type B. Excluding the dead-on-arrival patients, the 30-day mortality rates were 35.0% (7/20) in type A and 4.5% (1/22) in type B. The age-adjusted incidence and mortality of AAD per 100,000 inhabitants were 17.3 (type A: 11.3, type B: 6.0) and 9.6 (type A: 8.4, type B: 1.2), respectively. Both values were significantly higher in men than in women.
Conclusions
The population-based survey of emergency medical care for AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates after AAD onset were markedly higher due to the high incidence of dead-on-arrival.
Funding Acknowledgement
Type of funding sources: None. Representative CT images of type A AAD
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Affiliation(s)
| | - M Nakai
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - T Yano
- Miyazaki Prefectural Nobeoka hospital, Miyazaki, Japan
| | - M Matsuyama
- Miyazaki Prefectural Nobeoka hospital, Miyazaki, Japan
| | - Y Miyamoto
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - T Kodama
- Toranomon Hospital, Tokyo, Japan
| | - H Ogino
- Tokyo Medical University Hospital, Tokyo, Japan
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16
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Yamaguchi T, Nakai M, Sumita Y, Kodama T, Ogino H. Impact of endovascular repair on the outcomes of octogenarians with ruptured abdominal aortic aneurysms: a nationwide Japanese study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2347] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
This study aimed to clarify the impact of endovascular aneurysm repair (EVAR) on clinical outcomes in Japanese patients of advanced age with ruptured abdominal aortic aneurysm (rAAA).
Methods
This was a national registry based retrospective comparative study, using data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC), a nationwide claim based database from more than 600 hospitals. Patients admitted with rAAA between April 1, 2012, and March 31, 2015 were included in the study. Patient characteristics, management, and outcomes were compared between the elderly (aged ≥80 y) and the less old. The primary endpoint was in hospital mortality; the secondary endpoint was the functional status at discharge.
Results
Of 3 969 eligible patients, 49.9% were categorised as elderly. Elderly patients had a higher prevalence of female gender (41.8% vs. 17.0%, p<0.001) and disturbance of consciousness on admission (28.6% vs. 20.7%, p<0.001). They were less likely to undergo open surgical repair (31.6% vs. 56.7%, p<0.001), although EVAR was performed similarly in both groups (13.7% vs. 14.8%, p<0.33). The unadjusted mortality rate (61.8% vs. 37.6%, p<0.001) and mean Barthel index at discharge (73.0 vs. 91.8, p<0.001) were statistically significantly worse in the elderly. Multilevel mixed effect logistic regression analyses showed that old age was detected as an independent predictor of in hospital death (odds ratio 2.75; 95% confidence interval, 2.39–3.17; p<0.001). However, for patients who received EVAR, old age was not statistically significant (odds ratio 1.13; 95% confidence interval, 0.77–1.66; p<0.53).
Conclusion
Elderly patients with rAAA were less likely to be offered open surgical repair, and the mortality among those who received surgery was high. However, for the small subgroup of elderly patients currently selected for EVAR there was a favourable outcome. The further implementation of EVAR for rAAA in Japan, especially for elderly patients with suitable anatomy, may be justified.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - M Nakai
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - Y Sumita
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - T Kodama
- Toranomon Hospital, Tokyo, Japan
| | - H Ogino
- Tokyo Medical University Hospital, Tokyo, Japan
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17
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Tokumaru S, Ohnishi K, Harada H, Wada H, Nakamura N, Arimura T, Iwata H, Sato Y, Tamamura H, Ogino H, Ogino T, Akimoto T, Okimoto T, Kikuchi Y, Murayama S, Sakurai H. Clinical Outcomes of Proton Beam Therapy for Stage I Lung Cancer in Patients with Interstitial Pneumonia: A Multi-Institutional Retrospective Study in Japan. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1196] [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: 11/28/2022]
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18
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Takahashi T, Yoshino H, Akutsu K, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawata M, Masuhara H, Yamasaki M, Hagiya K, Yamamoto T, Nagao K, Takayama M. Sex-related differences in clinical features and in-hospital outcomes of acute aortic dissection type b. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute aortic dissection (AAD) is a life-threatening medical condition with high morbidity and mortality. The association between female sex and poorer outcomes following surgery for AAD type A has been reported; however, the sex-related differences in clinical features and in-hospital outcomes of AAD type B remain to be elucidated.
Methods
We studied a total of 1877 patients with AAD type B who were enrolled in the Tokyo Acute Aortic Super-network from January 2013 to December 2016. Clinical features and in-hospital outcomes were compared between sexes. Independent predictors of in-hospital mortality were assessed using a multivariable analysis.
Results
The mean age of the patients was 69±13 years and 549 (29%) were females. Female patients were older than males (74±13 years vs 67±13 years; p<0.001). Females had lower systolic blood pressure on admission (158±37 mmHg vs 164±38 mmHg; p=0.007) and were more likely to have altered consciousness level at presentation (8.7% vs 3.9%; p<0.001), intramural hematoma (IMH)-type AAD (62.7% vs 53.6%; p<0.001), and DeBakey type IIIa (28.4% vs 21.8%; p=0.002) compared with males. Females were treated with medical therapy alone more frequently (90.3% vs 85.9%; p=0.009) and had a higher in-hospital mortality rate (5.3% vs 2.6%; p=0.036). A multivariable analysis revealed that age [per year, odds ratio (OR) 1.06; 95% CI 1.04–1.09; p<0.001], altered consciousness level (OR 3.28; 95% CI 1.54–6.98; p=0.002), shock/hypotension (OR 14.0; 95% CI 5.92–33.1; p<0.001), classic-type AAD (OR 2.54; 95% CI 1.36–4.73; p=0.003), and medical therapy alone (OR 0.28; 95% CI 0.15–0.54; p<0.001) were independent predictors of in-hospital mortality, whereas female sex was not predictive of in-hospital mortality (OR 1.64; 95% CI 0.91–2.96; p=0.10).
Conclusion
In AAD type B, females were older and had altered consciousness level, IMH-type, and a less widespread dissection more frequently than males. The overall in-hospital mortality was higher in females; however, female sex was not associated with in-hospital mortality after multivariable adjustment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | - H Ogino
- Tokyo CCU Network, Tokyo, Japan
| | | | - M Usui
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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19
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Watanabe K, Yoshino H, Takahashi T, Usui M, Akutsu K, Shimokawa T, Kunihara T, Kawata M, Masuhara H, Ogino H, Yamasaki M, Hagiya K, Yamamoto T, Nagao K, Takayama M. Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment.
The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database.
We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded.
We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively.
In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Watanabe
- Nihon University, Tokyo CCU Network, Tokyo, Japan
| | | | | | - M Usui
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | - H Ogino
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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20
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Iwata H, Ogino H, Hattori Y, Nakajima K, Nomura K, Hayashi K, Toshito T, Sasaki S, Hashimoto S, Mizoe J, Shibamoto Y. Image-guided Proton Therapy for Elderly Patients with Hepatocellular Carcinoma: High Local Control and Quality of Life. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1855] [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: 10/23/2022]
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21
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Nakajima K, Iwata H, Hattori Y, Hashimoto S, Nomura K, Hayashi K, Toshito T, Baba F, Mizoe J, Ogino H, Shibamoto Y. The 3-Year Patient-Reported Outcomes of Moderate Hypofractionation (3 GyE Per Fraction) and Conventional Fractionation (2 GyE Per Fraction) Proton Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1461] [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: 10/23/2022]
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Hashimoto S, Ogino H, Iwata H, Hattori Y, Nakajima K, Yamamori E, Hara M, Nakamae K, Akita K, Mizoe J, Shibamoto Y. Outcomes of Proton Beam Therapy for Lung Cancer in Patients with Interstitial Pneumonia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1297] [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]
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23
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Kawachi J, Ogino H, Shimoyama R, Ichita C, Isogai N, Murata T, Miyake K, Nishida T, Fukai R, Kashiwagi H. Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding. Acute Med Surg 2020; 7:e549. [PMID: 32817800 PMCID: PMC7426192 DOI: 10.1002/ams2.549] [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: 04/11/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Aim Bleeding in the small bowel rarely occurs, and its treatment is challenging. Surgery is sometimes required in unstable patients; however, intraoperative identification of the bleeding site is extremely difficult. Many methods have been reported, but no standard strategy has been established yet. Here, we aimed to assess the safety and feasibility of intraoperative angiography with indocyanine green staining to accurately identify small bowel bleeding sites. Methods This retrospective study analyzed contrast‐enhanced computed tomography images of patients (n = 8) with small bowel extravasation who underwent surgery. If extravasation or other vessel abnormalities that were potential bleeding sites were detected on intraoperative angiography, a microcatheter was placed as close as possible to the extravasation site. Laparotomy was carried out, and 3–5 mL indocyanine green was injected through the microcatheter. The green‐stained segment of the small bowel was resected. Results Seven of the eight patients had positive angiographic findings and underwent bowel resection. The eighth patient had no abnormalities and hence did not undergo laparotomy. The rate of hemostatic success among the resected cases was 85.7% (six of seven cases). The resected specimens showed pathologic features in six of the seven patients (85.7%), all of whom achieved hemostasis. One patient had pneumonia and congestive heart failure that required longer hospital stay, but no mortality occurred. Conclusions Intraoperative angiography with indocyanine green injection, followed by resection for massive small bowel bleeding is effective. This can be a therapeutic option for hemodynamically unstable patients.
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Affiliation(s)
- Jun Kawachi
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Hidemitsu Ogino
- Department of Surgery Narita Tomisato Tokushukai Hospital Tomisato Japan
| | - Rai Shimoyama
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Chikamasa Ichita
- Gastroenterology Center Shonan Kamakura General Hospital Kamakura Japan
| | - Naoko Isogai
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Takaaki Murata
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Katsunori Miyake
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Tomoki Nishida
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
| | - Ryuta Fukai
- Department of Surgery Shonan Kamakura General Hospital Kamakura Japan
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Miyake K, Iwagami M, Ohtake T, Moriya H, Kume N, Murata T, Nishida T, Mochida Y, Isogai N, Ishioka K, Shimoyama R, Hidaka S, Kashiwagi H, Kawachi J, Ogino H, Kobayashi S. Association of pre-operative chronic kidney disease and acute kidney injury with in-hospital outcomes of emergency colorectal surgery: a cohort study. World J Emerg Surg 2020; 15:22. [PMID: 32216810 PMCID: PMC7098074 DOI: 10.1186/s13017-020-00303-6] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-operative kidney function is known to be associated with surgical outcomes. However, in emergency surgery, the pre-operative kidney function may reflect chronic kidney disease (CKD) or acute kidney injury (AKI). We examined the association of pre-operative CKD and/or AKI with in-hospital outcomes of emergency colorectal surgery. METHODS We conducted a retrospective cohort study including adult patients undergoing emergency colorectal surgery in 38 Japanese hospitals between 2010 and 2017. We classified patients into five groups according to the pre-operative status of CKD (defined as baseline estimated glomerular filtration rate < 60 mL/min/1.73 m2 or recorded diagnosis of CKD), AKI (defined as admission serum creatinine value/baseline serum creatinine value ≥ 1.5), and end-stage renal disease (ESRD): (i) CKD(-)AKI(-), (ii) CKD(-)AKI(+), (iii) CKD(+)AKI(-), (iv) CKD(+)AKI(+), and (v) ESRD groups. The primary outcome was in-hospital mortality, while secondary outcomes included use of vasoactive drugs, mechanical ventilation, blood transfusion, post-operative renal replacement therapy, and length of hospital stay. We compared these outcomes among the five groups, followed by a multivariable logistic regression analysis for in-hospital mortality. RESULTS We identified 3002 patients with emergency colorectal surgery (mean age 70.3 ± 15.4 years, male 54.5%). The in-hospital mortality was 8.6% (169/1963), 23.8% (129/541), 15.3% (52/340), 28.8% (17/59), and 32.3% (32/99) for CKD(-)AKI(-), CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD, respectively. Other outcomes such as blood transfusion and post-operative renal replacement therapy showed similar trends. Compared to the CKD(-)AKI(-) group, the adjusted odds ratio (95% confidence interval) for in-hospital mortality was 2.54 (1.90-3.40), 1.29 (0.90-1.85), 2.86 (1.54-5.32), and 2.76 (1.55-4.93) for CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD groups, respectively. Stratified by baseline eGFR (> 90, 60-89, 30-59, and < 30 mL/min/1.73 m2) and AKI status, the crude in-hospital mortality and adjusted odds ratio increased in patients with baseline eGFR < 30 mL/min/1.73 m2 among patients without AKI, while these were constantly high regardless of baseline eGFR among patients with AKI. Additional analysis restricting to 2162 patients receiving the surgery on the day of hospital admission showed similar results. CONCLUSIONS The differentiation of pre-operative CKD and AKI, especially the identification of AKI, is useful for risk stratification in patients undergoing emergency colorectal surgery.
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Affiliation(s)
- Katsunori Miyake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan.
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Nao Kume
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomoki Nishida
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Yamaguchi T, Nakai M, Sumita Y, Nishimura K, Nagai T, Anzai T, Sakata Y, Ogino H. Impact of Endovascular Repair on the Outcomes of Octogenarians with Ruptured Abdominal Aortic Aneurysms: A Nationwide Japanese Study. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.01.026] [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: 10/25/2022]
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Shibutani S, Obara H, Matsubara K, Toya N, Isogai N, Ogino H, Watada S, Asami A, Kudo T, Kanaoka Y, Fujimura N, Harada H, Uchiyama H, Sato Y, Ohki T. Midterm Results of a Japanese Prospective Multicenter Registry of Heparin-Bonded Expanded Polytetrafluoroethylene Grafts for Above-the-Knee Femoropopliteal Bypass. Circ J 2020; 84:501-508. [PMID: 32062636 DOI: 10.1253/circj.cj-19-0908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study prospectively analyzed the midterm results of above-the-knee femoropopliteal bypass (AKb) using bioactive heparin-bonded expanded polytetrafluoroethylene (HB-ePTFE) graft in patients with femoropopliteal occlusive disease.Methods and Results:This prospective, multicenter, non-randomized study reviewed limbs undergoing AKb with HB-ePTFE graft for femoropopliteal lesion in 20 Japanese institutions between July 2014 and October 2017. Primary efficacy endpoints were primary, primary assisted, and secondary graft patency. Safety endpoints included any major adverse limb event and perioperative mortality. During the study period, 120 limbs of 113 patients (mean age, 72.7 years) underwent AKb with HB-ePTFE grafts. A total of 45 patients (37.5%) had critical limb ischemia and 17 (15.0%) were on hemodialysis (HD). Median duration of follow-up was 16 months (range, 1-36 months). Estimated 1- and 2-year primary, primary assisted, and secondary graft patency rates were 89.4% and 82.7%, 89.4% and 87.2%, and 94.7% and 92.5%, respectively. On univariate analysis of 2-year primary graft patency, having 3 run-off vessels, cuffed distal anastomoses, no coronary artery disease, and no chronic kidney disease requiring HD were significantly associated with favorable patency. CONCLUSIONS AKb using HB-ePTFE grafts achieved favorable 2-year graft patency. AKb using HB-ePTFE grafts may therefore be an acceptable, highly effective treatment option for femoropopliteal artery lesions.
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Affiliation(s)
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | | | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital
| | | | | | | | - Toshifumi Kudo
- Department of Surgery, Tokyo Medical and Dental University
| | - Yuji Kanaoka
- Department of Surgery, The Jikei University School of Medicine
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital
| | | | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Takao Ohki
- Department of Surgery, The Jikei University School of Medicine
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Yamaguchi T, Nakai M, Sumita Y, Miyamoto Y, Matsuda H, Inoue Y, Yoshino H, Okita Y, Minatoya K, Ueda Y, Ogino H. P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0543] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high.
Purpose
This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database.
Methods
A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses.
Results
A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality.
QIs and in-hospital mortality
Conclusions
Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.
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Affiliation(s)
- T Yamaguchi
- Toranomon Hospital, Cardiovascular center, Tokyo, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - H Matsuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Inoue
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - H Yoshino
- Kyorin University School of Medicine, Tokyo, Japan
| | - Y Okita
- Kobe University, Kobe, Japan
| | | | - Y Ueda
- Nara Prefecture General Medical Center, Nara, Japan
| | - H Ogino
- Tokyo Medical University Hospital, Tokyo, Japan
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Yoshino H, Akutsu K, Takahashi T, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawada M, Niino T, Masuhara H, Yamamoto T, Nagao K, Takayama M. P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD.
Methods
Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS.
Results
After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively).
Conclusion
Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type.
Acknowledgement/Funding
Tokyo Metropolitan government
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Affiliation(s)
| | | | | | | | - H Ogino
- Tokyo CCU Network, Tokyo, Japan
| | | | - M Usui
- Tokyo CCU Network, Tokyo, Japan
| | | | | | - T Niino
- Tokyo CCU Network, Tokyo, Japan
| | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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Yamaguchi T, Nakai M, Sumita Y, Nishimura K, Sakata Y, Ogino H. P5605The impact of institutional case volume on the Ppognosis of ruptured aortic aneurysms: a Japanese nationwide study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To improve outcome for ruptured aortic aneurysms (rAA), centralization of treatment is potentially effective. However, there is no nationwide survey for the current managements and outcomes of rAA in Japan.
Purpose
The aim of this study was to assess the volume-outcome relationship for rAA treatment using the nationwide claim-based database.
Methods
Using the Japanese Registry Of All cardiac and vascular Diseases- Diagnostic Procedure Combination database, we identified patients admitted to 564 certified teaching-hospitals with rAA between April 1, 2012 and March 31, 2015. Institutional case volume (cardiovascular surgeries per year) was categorized into quartiles (Lowest, Low, High, and Highest) and the odds ratios (ORs) for in-hospital mortality and neurological status at discharge were analyzed for each quartile.
Results
Of 7086 eligible patients, 3925 (55.4%) died in hospital. Mortality rates decreased from 69.4% in the lowest-volume to 43.8% in the highest-volume category (P<0.001). The favourable impact of institutional case volume was sustained even after adjustment for covariates (Low-volume: OR, 0.83; 95% confidence interval [CI], 0.65–1.07; P=0.147; High-volume: OR, 0.69; 95% CI, 0.54–0.89; P=0.005; and Highest-volume: OR, 0.55; 95% CI, 0.42–0.72; P<0.001 vs. Lowest-volume). Additionally, other three institutional parameters (increased aortic surgery volume, cardiovascular surgeons' volume, and certified cardiologists' volume) were consistently associated with reduced in-hospital mortality. The rate of coma at discharge was the lowest in the Highest-volume group (P<0.001).
Institutional volume and mortality
Conclusions
Increased institutional volume was associated with lower in-hospital mortality. Establishing regionally tailored systems to transfer patients to high-volume centers is needed to improve outcomes.
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Affiliation(s)
- T Yamaguchi
- Toranomon Hospital, Cardiovascular Center, Tokyo, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Cardiology, Osaka, Japan
| | - H Ogino
- Tokyo Medical University Hospital, Tokyo, Japan
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Nakajima K, Iwata H, Hattori Y, Hashimoto S, Hayashi K, Toshito T, Baba F, Sasaki S, Mizoe J, Ogino H, Shibamoto Y. Image-guided Proton Therapy (IGPT) for Oligometastatic Liver Tumors from Gastric/Colorectal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1982] [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: 10/26/2022]
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Iwata H, Nakajima K, Omachi C, Toshito T, Nomura K, Nagayoshi J, Ogino H, Shibamoto Y. Gene Expression Profiling in HeLa Cells After Proton and X-Ray Irradiation with Cisplatin. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1110] [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: 10/26/2022]
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Nomura K, Iwata H, Toshito T, Omachi C, Nagayoshi J, Hashimoto S, Nakajima K, Ogino H, Shibamoto Y. Biological Effects of Spot Scanning and Passive Scattering Proton Beams at the Distal End of the Spread-Out Bragg Peak (SOBP) in Single Cells and Multicell Spheroids. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yamaguchi T, Nakai M, Sumita Y, Nishimura K, Tazaki J, Kyuragi R, Kinoshita Y, Miyamoto T, Sakata Y, Nozato T, Ogino H. Endovascular Repair Versus Surgical Repair for Japanese Patients With Ruptured Thoracic and Abdominal Aortic Aneurysms: A Nationwide Study. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.053] [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: 10/26/2022]
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Shishido K, Yamanaka F, Ochiai T, Yamabe T, Noguchi K, Ota T, Koide Y, Ogino H, Tanaka Y, Saito S. Hemodynamic comparison of CoreValve and SAPIEN-XT TAVI valves in Japanese patients. Heart Vessels 2019; 34:1674-1683. [PMID: 30993441 DOI: 10.1007/s00380-019-01414-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/19/2018] [Accepted: 04/12/2019] [Indexed: 12/18/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is a viable treatment option for high-risk patients with severe aortic stenosis. In Japan, TAVI can be performed using first-generation self-expandable Medtronic CoreValve or balloon-expandable Edwards SAPIEN-XT from 2012. Since the durability and hemodynamic outcomes after transcatheter heart valve (THV) implantation in Japanese patients have not been clearly elucidated, we assessed serial changes in post-TAVI THV performances over a-3-year period by transthoracic echocardiography (TTE). From January 2012 to September 2014, among 83 patients with severe aortic stenosis, 26 underwent TAVI with CoreValve and 57 underwent TAVI with SAPIEN-XT. We assessed the serial changes in first post-implant (FPI) and 3-year post procedure THV hemodynamics by TTE. Valve performance was evaluated by serial assessment of aortic valve mean pressure gradient (PG) and aortic valve area (AVA) assessments. Three-year clinical outcomes were compared between the patients with CoreValve and those with SAPIEN-XT. Seventeen patients with CoreValve and 34 patients with SAPIEN-XT had FPI and 3-year TTEs. The AVA decreased significantly from FPI to 3-year follow-up among patients with SAPIEN-XT, but not among patients with CoreValve. The mean aortic PG decreased significantly from FPI to the 3-year follow-up point among patients with CoreValve; however, it was not significantly different from those with SAPIEN-XT. The absolute change in mean PG from FPI to the 3-year follow-up point decreased significantly among those with CoreValve compared to those with SAPIEN-XT. Clinical outcomes after TAVI were similar for both devices at 3-years after TAVI. In this study, long-term clinical outcomes for CoreValve and SAPIEN XT were similar. The 3-year THV performance of both devices was maintained after TAVI. Serial change in mean aortic PGs for CoreValve decreases significantly from FPI to the 3-year follow-up point compared to that for SAPIEN-XT.
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Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan.
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan
| | - Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan
| | - Tsuyoshi Yamabe
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Ota
- Department of Anesthesiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Koide
- Department of Anesthesiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan
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Nakajima K, Iwata H, Naito M, Hirai S, Yakura T, Hatayama N, Kume K, Tomita J, Gao T, Hashimoto S, Omachi C, Nagayoshi J, Mizoe J, Ogino H, Shibamoto Y. Fruit Fly Helps Elucidate the Biological Effects of Proton Therapy: In Vivo Model of Normal Tissue Response. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.612] [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]
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Iwata H, Shuto T, Kamei S, Omachi K, Moriuchi M, Omachi C, Toshito T, Nagayoshi J, Nakajima K, Hashimoto S, Ogino H, Mizoe J, Kai H, Shibamoto Y. Effects of Proton Beams and X Rays on the Cell Cycle of Fluorescent Ubiquitination-Based Cell Cycle Indicator (Fucci)-Expressing Cells. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.602] [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]
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Hashimoto S, Katsurada M, Muramatsu R, Asai K, Shimomura A, Ueki K, Kino H, Yoshida A, Tanaka K, Hayashi K, Kimura M, Kibe Y, Omachi C, Toshito T, Nakajima K, Hattori Y, Iwata H, Mizoe J, Ogino H, Shibamoto Y. Effect of a Device-Free Compressed Shell Fixation Method on Hepatic Respiratory Movement. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1544] [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: 10/28/2022]
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Fujimura N, Takahara M, Isogai N, Yashiro H, Shibutani S, Inoue M, Obara H, Ogino H. Retroperitoneal hematoma volume is a good predictor of perioperative mortality after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. J Vasc Surg 2018; 68:998-1006.e2. [DOI: 10.1016/j.jvs.2018.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022]
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Hattori S, Noguchi K, Gunji Y, Nagatsuka M, Yamabe T, Ogino H, Katayama I. Descending aortic banding for re-rupture of retrograde aortic dissection after emergency thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2018; 68:70-73. [PMID: 30244366 DOI: 10.1007/s11748-018-1016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 05/25/2018] [Accepted: 09/15/2018] [Indexed: 11/30/2022]
Abstract
Conversion to open repair after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection is rare, but inevitable. We present a case of an 86-year-old man with ruptured type B aortic dissection after TEVAR. He received a successful stent-graft implantation of the descending aorta without any type of endoleak. After the patient was transferred to the intensive care unit, he went into a shock state. Contrast-enhanced CT revealed a re-rupture of acute retrograde type B aortic dissection. The false lumen was patent and perforated to the left thorax. Left thoracotomy and descending aortic banding was performed. Descending aorta was encircled with a woven Dacron graft at the distal part of the rupture site to compress the patent false lumen. The bleeding was stopped, and the follow-up CT showed false lumen thrombosis. Descending aortic banding is one of the quick and effective open conversion techniques.
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Affiliation(s)
- Shigeru Hattori
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Yusuke Gunji
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Motoki Nagatsuka
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Tsuyoshi Yamabe
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ikuo Katayama
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Ono R, Kashiwagi H, Kawachi J, Isogai N, Miyake K, Murata T, Shimoyama R, Fukai R, Ogino H, Shinozaki N. Successful treatment of hepatic gas gangrene by open drainage: A case report and review of the Japanese literature. Int J Surg Case Rep 2018; 49:121-125. [PMID: 30005363 PMCID: PMC6037661 DOI: 10.1016/j.ijscr.2018.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/01/2018] [Revised: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Liver gas gangrene is rare and has a low prognosis. This case, reports a successful treatment of hepatic gas gangrene using an open drainage technique, followed by antibiotics and hyperbaric oxygen therapy (HBO). PRESENTATION OF THE CASE An 82-year-old male with a history of left hepatectomy and bile duct resection for hilar cholangiocarcinoma presented with chilling, lethargy and dyspnea. He had a history of diabetes mellitus, hypertension, atrial fibrillation, and angina pectoris. Physical examination revealed scleric icterus, right hypochondrium tenderness and percussion tenderness of the liver, with warm extremities. Laboratory findings revealed leukocytosis and increased levels of hepatobiliary enzymes. A computed tomography (CT) scan showed gas accumulation in an S8 lesion with portal vein gas. Percutaneous drainage was performed immediately, and broad-spectrum antibiotics were started, but the drainage was insufficient. Consequently, laparotomy drainage was carried out, followed by HBO. No abscess was detected at one-year of follow-up. DISCUSSION Hepatic gas gangrene progresses rapidly and has a high mortality rate. Malignant disease and diabetes mellitus may be predisposing factors. While half of non-clostridial cases survive, most cases of hepatic gas gangrene are associated with clostridial infection and have a fatal outcome. CONCLUSION All survival cases of hepatic gas gangrene were treated by laparotomy drainage, thus immediate laparotomy seems essential to prevent a fatal outcome.
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Affiliation(s)
- Ryohei Ono
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | | | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | | | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Japan
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Ono R, Ogino H, Kawachi J, Shimoyama R, Kashiwagi H, Isogai N, Miyake K, Fukai R, Murata T, Igarashi Y, Shinozaki N. Small intestinal metastases from esophageal carcinoma presenting as a perforation: A case report and review of the literature. Int J Surg Case Rep 2018; 48:104-108. [PMID: 29885913 PMCID: PMC6041422 DOI: 10.1016/j.ijscr.2018.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/11/2018] [Revised: 05/17/2018] [Accepted: 05/26/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Small intestinal metastasis from oesophageal carcinoma is rare. We report a case of small intestinal metastases from oesophageal carcinoma presenting as a perforation and discuss the aetiology with other cases of small intestinal metastasis from oesophageal carcinoma reported in previous literature. PRESENTATION An 86-year-old man presented with fever and coughing. He had choked while eating and had history of weight loss. He was diagnosed with aspiration pneumonia. Two days after the admission, he complained of abdominal pain. Physical examination revealed guarding and rebound tenderness in the upper abdomen. A contrast computed tomography of the abdomen showed ascites, free air, and irregular thickness of the small intestinal walls. Small intestinal perforation was noted, and surgical resection of the small intestine was performed. The pathological findings of the resected small intestine revealed ulcers with squamous cell carcinoma, and upper gastrointestinal endoscopy demonstrated oesophageal tumour, whose biopsy revealed squamous cell carcinoma. A diagnosis of small intestinal metastases from oesophageal carcinoma was made, but the patient died one month after the diagnosis. DISCUSSION Most cases found in the literature of oesophageal tumour involve squamous cell carcinoma with male patients, and specific symptoms are divided into obstruction and perforation. All patients with small intestinal metastasis from oesophageal carcinoma who survived were treated by a combination of resection and radiation and/or chemotherapy; thus, immediate treatments seem essential to improve the prognosis. CONCLUSION Physicians should keep in mind the possibility of small intestinal metastasis when patients with a history of oesophageal cancer have abdominal symptoms.
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Affiliation(s)
- Ryohei Ono
- Department of Surgery, Shonan Kamakura General Hospital, Japan.
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | | | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | | | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Yuto Igarashi
- Department of Surgery, Shonan Kamakura General Hospital, Japan
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Yamamoto K, Gondo G, Ogino H, Watanabe T, Tanaka M, Tanaka S, Kawasaki T. Sciatic Neuralgia Caused by May-Thurner Syndrome. World Neurosurg 2018; 116:40-43. [PMID: 29772369 DOI: 10.1016/j.wneu.2018.05.035] [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] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sciatic neuralgia (SN) is a type of pain commonly associated with lumbosacral radiculopathy. May-Thurner syndrome (MTS) is a disease characterized by venous congestion in the left common iliac vein (LCIV) due to right common iliac artery compression. A case of MTS with SN as the first presenting symptom is described. CASE DESCRIPTION A 53-year-old man gradually developed left SN; however, radiologic examination showed no causal findings. Conservative medical treatment did not result in satisfactory pain relief. During the follow-up period, edema and brownish skin pigmentation were noted on the left crural region. Follow-up magnetic resonance imaging of lumbar spine revealed vascular enlargement around the spine and compression of the LCIV by the right common iliac artery. Furthermore, the left S1 nerve root was compressed by enlarged veins, which was thought to be the cause of the left S1 radiculopathy and SN. After the stenosed part of the LCIV was expanded, the pain and edema in the left leg disappeared. CONCLUSIONS This is the first report of SN associated with MTS. MTS should be considered as one of the differential diagnoses of SN. Thus, symptoms such as pain, edema, and skin hyperpigmentation on the left leg should be closely noted.
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Affiliation(s)
- Kazuaki Yamamoto
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Gakuji Gondo
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Division of Vascular Surgery, Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tsuyoshi Watanabe
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masahiko Tanaka
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Satoshi Tanaka
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Taisuke Kawasaki
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
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Kawachi J, Isogai N, Shimoyama R, Miyake K, Fukai R, Kashiwagi H, Murata T, Nishida T, Nakano H, Ogino H. Lumbar Arterial Bleeding Treated with Endovascular Aneurysm Repair: A Report of 4 Patients. Ann Vasc Surg 2018; 49:316.e11-316.e15. [PMID: 29501896 DOI: 10.1016/j.avsg.2017.12.018] [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] [Received: 09/17/2017] [Accepted: 12/21/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Lumbar arterial bleeding is a severe condition. Surgical exploration is not indicated because of its rich collateral flow. Transarterial embolization (TAE) is reportedly effective, but there have been cases of failure. It may be a time-consuming procedure for patients with multiple bleeding sources or those with poor vital signs. In this case series, we used endovascular aneurysm repair (EVAR) instead of TAE. METHOD In this case series, we described 4 male patients (2 with traumatic injury, 1 with iatrogenic injury, and 1 with drug-induced hypocoagulability) with lumbar arterial bleeding. The reasons we chose EVAR are because 2 patients had poor vital signs, one patient was a technically difficult case for selective cannulation, and one patient had accompanying aortic dissection. RESULT In all patients, EVAR was performed successfully, and hemostasis was obtained although one patient died of pneumonia on postoperative day 23. CONCLUSIONS EVAR is an effective alternative for lumbar arterial bleeding although TAE is a first choice of treatment.
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Affiliation(s)
- Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Tomoki Nishida
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hidehiko Nakano
- Department of Emergency, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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Kawachi J, Kashiwagi H, Ogino H, Isogai N, Shimoyama R, Fukai R, Miyake K, Sasaki A, Terashima T, Teshima S, Watanabe K. Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer. J Minim Access Surg 2017; 14:236-240. [PMID: 29067944 PMCID: PMC6001300 DOI: 10.4103/jmas.jmas_61_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG. Patients and Methods: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures. Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13–60) mm. Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.
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Affiliation(s)
- Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Sasaki
- Gastroenterology Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazunao Watanabe
- Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
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Yoshida M, Ogino H, Iwata H, Hattori Y, Hashimoto S, Nakajima K, Senoo K, Kuwabara Y, Sasaki S, Hara M, Sekido Y, Mizoe J, Shibamoto Y. Transient Increases of Serum AFP and PIVKA-II Levels After Proton Therapy Do Not Necessarily Indicate Progression of Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1086] [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: 10/18/2022]
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Hashimoto S, Ogino H, Iwata H, Hattori Y, Nakajima K, Nakanishi M, Baba F, Sasaki S, Shimamura Y, Kuwabara Y, Senoo K, Shibamoto Y, Mizoe J. Efficacy of Proton Beam Therapy for Hepatocellular Carcinoma With Portal Vein or Inferior Vena Cava Tumor Thrombosis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kashiwagi H, Kawachi J, Isogai N, Ishii M, Miyake K, Shimoyama R, Fukai R, Ogino H. Scarless surgery for a huge liver cyst: A case report. Int J Surg Case Rep 2017; 39:328-331. [PMID: 28898797 PMCID: PMC5597879 DOI: 10.1016/j.ijscr.2017.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/15/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022] Open
Abstract
Fenestration is the definitive treatment for symptomatic/complicated liver cysts. NOTES, which has been reported recently, enables surgery without scars. Multiple clinical and technological barriers impede further progress with NOTES. Our safe and unique method enables minimally invasive surgery with small incisions. This “scarless surgery” is expected to yield some clinical benefits.
Introduction Symptomatic or complicated liver cysts sometimes require surgical intervention and laparoscopic fenestration is the definitive treatment for these cysts. We performed minimally invasive surgery, hybrid natural orifice transluminal endoscopic surgery (NOTES) without scarring, for a huge liver cyst. Presentation of case An 82-year-old female presented with a month-long history of right upper abdominal pain. We diagnosed her condition as a huge liver cyst by morphological studies. She denied any history of abdominal trauma. Her serum CEA and CA19-9 were normal and a serum echinococcus serologic test was negative. Laparoscopic fenestration, using a hybrid NOTES procedure via a transvaginal approach, was performed for a huge liver cyst because we anticipated difficulty with an umbilical approach, such as single incision laparoscopic surgery (SILS). Her post-operative course was uneventful and she was discharged from our hospital three days after surgery. Pain killers were not required during and after hospitalization. No recurrence of the liver cyst or bulging was detected by clinical examination two years later. Discussion A recent trend of laparoscopic procedure has been towards minimizing the number of incisions to achieve less invasiveness. This hybrid NOTES, with a small incision for abdominal access, along with vaginal access, enabled painless operation for a huge liver cyst. Conclusion We report a huge liver cyst treated by hybrid NOTES. This approach is safe, less invasive, and may be the first choice for a huge liver cyst.
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Affiliation(s)
- Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan.
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Masanori Ishii
- Department of Surgery, Fuefuki Chuoh Hospital, Yamanashi 406-0032, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Ryota Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
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Kawachi J, Kashiwagi H, Shimoyama R, Isogai N, Fukai R, Miyake K, Egashira H, Sugitani A, Ogino H. Comparison of efficacies of the self-expandable metallic stent versus transanal drainage tube and emergency surgery for malignant left-sided colon obstruction. Asian J Surg 2017; 41:498-505. [PMID: 28844781 DOI: 10.1016/j.asjsur.2017.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/06/2017] [Revised: 06/15/2017] [Accepted: 06/23/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/OBJECTIVE Patients with left-sided malignant colorectal obstruction require emergency treatment. Emergency stoma surgery has traditionally been recommended, however many stomas became permanent, decreasing patient quality of life. Recently, self-expandable metallic stents (SEMS) and transanal decompression tubes (TDT) have become widely used decompression methods to avoid stoma surgery. In this study, we evaluated: 1) the efficacy of SEMS compared with TDT and emergency surgery (ES) to avoid permanent stomas; and 2) the safety and success rate of each treatment. METHODS We retrospectively reviewed data from 56 patients who underwent SEMS, TDT, or emergency surgery for malignant left-sided colon obstruction. We compared the permanent stoma rate of each group, and assessed whether or not each treatment was an independent risk factor for permanent stomas. We compared morbidity and mortality for each treatment group (SEMS, TDT, ES), and the success rate of the decompression procedures (SEMS and TDT). RESULTS The permanent stoma rates in the SEMS, TDT, and ES groups were 5.3%, 50.0%, and 56.0%, respectively. Emergency surgery (vs. SEMS) and TDT (vs. SEMS) were independent risk factors for permanent stomas, as was age ≥ 75 years. Operative morbidity, mortality, and hospital stay were not different between groups. The success rate of SEMS was significantly higher than TDT; however, two deaths, including one perforation, occurred in the former group. CONCLUSION SEMS seems to be effective in avoiding permanent stomas, but caution should be taken to avoid complications.
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Affiliation(s)
- Jun Kawachi
- Shonan Kamakura General Hospital, Department of Surgery, Japan.
| | | | - Rai Shimoyama
- Shonan Kamakura General Hospital, Department of Surgery, Japan
| | - Naoko Isogai
- Shonan Kamakura General Hospital, Department of Surgery, Japan
| | - Ryuta Fukai
- Shonan Kamakura General Hospital, Department of Surgery, Japan
| | | | - Hideto Egashira
- Shonan Kamakura General Hospital, Gastroenterology Center, Japan
| | - Ayumu Sugitani
- Sapporo Higashi Tokushukai Hospital, Center for Clinical and Biomedical Research, Japan
| | - Hidemitsu Ogino
- Shonan Kamakura General Hospital, Department of Surgery, Japan
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Miyata Y, Kashiwagi H, Koizumi K, Kawachi J, Kudo M, Teshima S, Isogai N, Miyake K, Shimoyama R, Fukai R, Ogino H. Fatal liver gas gangrene after biliary surgery. Int J Surg Case Rep 2017; 39:5-8. [PMID: 28783522 PMCID: PMC5545817 DOI: 10.1016/j.ijscr.2017.07.049] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/07/2017] [Accepted: 07/23/2017] [Indexed: 02/06/2023] Open
Abstract
Liver gas gangrene is a rare condition with a highly mortality rate. Development of liver gas gangrene is associated with host conditions such as malignancy and immunosuppression. We report a case of liver gas gangrene after biliary surgery which is one of the risks of the liver parenchymal infection.
Introduction Liver gas gangrene is a rare condition with a highly mortality rate. It is mostly associated with host factors, such as malignancy and immunosuppression. Presentation of case A 57-year-old female was admitted to our hospital with abnormalities of her serum hepato-biliary enzymes. She had a history of hypertension, diabetes mellitus, cerebral infarction, and chronic renal failure. She was diagnosed with bile duct cancer of the liver hilum and a left hepatectomy was carried out, with extrahepatic bile duct resection. Initially her post-operative state was uneventful. However, she suddenly developed melena with anemia on post-operative day (POD) 18. A Computed tomography (CT) examination on POD 19 revealed a massive build up of gas and portal gas formation in the anterior segment of the liver. Although we immediately provided the drainage and a probe laparotomy, she died on POD 20 due to shock with disseminated intravascular coagulation. Discussion Liver gas gangrene is rare and has a high mortality rate. This case seems to have arisen from an immunosuppressive state after major surgery with biliary reconstruction for bile duct cancer and subsequent gastrointestinal bleeding, leading to gas gangrene of the liver.
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Affiliation(s)
- Yui Miyata
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Madoka Kudo
- Department of Pathology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Ryota Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
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Miyake K, Sawamura N, Ikegaya Y, Isogai N, Kawachi J, Shimoyama R, Fukai R, Kashiwagi H, Ogino H. Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report. Int J Surg Case Rep 2017; 38:154-157. [PMID: 28759829 PMCID: PMC5537433 DOI: 10.1016/j.ijscr.2017.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/04/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 11/27/2022] Open
Abstract
CT or MRI scan is crucial in the diagnosis of adventitial cystic disease (ACD). Surgery is the first line in the treatment of ACD at the popliteal artery. The short saphenous vein was successfully employed in bypass graft surgery.
Introduction Adventitial cystic disease is relatively rare vascular disease, frequently occurred in the popliteal artery. No definitive treatment has been established yet. Prentation of case A 53-year-old woman presenting intermittent claudication of the right leg was diagnosed as adventitial cystic disease of popliteal artery. Percutaneous balloon dilation yielded an immediate recurrence. The disease was successfully treated by bypass grafting utilizing the short saphenous vein to replace the part of the popliteal artery containing the adventitial cyst. No postoperative complication was found six months after surgery. Discussion Comparing to a great saphenous vein, a short saphenous vein as a material of bypass graft has a significant advantage, as only a single surgical field is necessary. Conclusion We propose that bypass graft surgery employing a short saphenous vein is worth considering as a treatment of adventitial cystic disease at the popliteal artery.
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Affiliation(s)
- Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan.
| | - Naoki Sawamura
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Yuki Ikegaya
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
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