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1.
Ann Surg Oncol ; 28(6): 3135-3144, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33128119

ABSTRACT

BACKGROUND: The clinical implications of pre- and postoperative KRAS-mutated circulating tumor DNA (ctDNA) present in patients with pancreatic ductal adenocarcinoma (PDAC) have remained an unresolved issue. This study sought to investigate the clinical significance of pre- and postoperative ctDNA analyses and their impact on the prognosis of PDAC patients. METHODS: Digital droplet polymerase chain reaction detected ctDNA in pre- and postoperative plasma samples prospectively obtained from patients with resectable and borderline-resectable PDAC. Its associations with recurrence-free survival (RFS) and overall survival (OS) were analyzed. The patients were sorted according to the presence of pre- and postoperative ctDNA, and its ability to stratify prognosis was evaluated. RESULTS: The study analyzed 97 patients. Both pre- and postoperative ctDNA were detected in 9 patients, and neither was detected in 55 patients. Whereas 15 patients harbored only preoperative ctDNA, 18 patients had only postoperative ctDNA. The multivariate analysis showed that the presence of preoperative ctDNA was associated with poorer OS (P = 0.008) and that postoperative ctDNA was not associated with either RFS or OS. Survival did not differ significantly between the patients with a positive shift in ctDNA status and those without detectable pre- or postoperative ctDNA. CONCLUSIONS: For the patients with PDAC, the presence of preoperative ctDNA was significantly associated poor OS, whereas postoperative ctDNA was not associated with poor survival. A positive change in ctDNA did not affect patients' survival.


Subject(s)
Adenocarcinoma , Carcinoma, Pancreatic Ductal , Circulating Tumor DNA , Pancreatic Neoplasms , Biomarkers, Tumor/genetics , Carcinoma, Pancreatic Ductal/genetics , Carcinoma, Pancreatic Ductal/surgery , Circulating Tumor DNA/genetics , Humans , Mutation , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms/surgery , Prognosis
2.
Int Heart J ; 61(6): 1188-1195, 2020 Nov 28.
Article in English | MEDLINE | ID: mdl-33191358

ABSTRACT

The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) on changes in cardiac sympathetic nervous (CSN) function remains unclear. Using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, we investigated the impact of PPM after TAVR on CSN activity.We enrolled 44 of 117 patients with severe aortic stenosis who underwent TAVR for analysis in the present study. We conducted 123I-MIBG scintigraphy at baseline and at about 9 months after TAVR. Differences between baseline and post-TAVR 123I-MIBG parameters were compared between cases with and without PPM.There were 17 and 27 patients with and without PPM, respectively. Those without PPM exhibited significantly decreased left ventricular mass index (122 ± 36 g/m2 versus 108 ± 30 g/m2, P < 0.001) following TAVR, whereas those with PPM did not (117 ± 21 g/m2 versus 110 ± 17 g/m2, P = 0.09). Significant improvements in delayed heart-to-mediastinum (H/M) ratio (2.8 ± 0.4 versus 3.0 ± 0.4, P = 0.004) and washout rate (WR) (33% ± 10% versus 24% ± 12%, P < 0.001) were observed after TAVR in patients without PPM but not in those with PPM. Multivariable linear regression analysis revealed PPM to be a negative predictor of improvements in delayed H/M ratio and WR.Delayed H/M ratio and WR improve significantly after TAVR in the absence of PPM, whereas these improvements are not observed in patients with PPM. Hence, the presence of PPM is a negative predictor of improvements in delayed H/M ratio and WR in patients undergoing TAVR.


Subject(s)
Aortic Valve Stenosis/surgery , Heart/innervation , Prosthesis Fitting , Sympathetic Nervous System/physiopathology , Transcatheter Aortic Valve Replacement , 3-Iodobenzylguanidine , Aged , Aged, 80 and over , Aortic Valve Stenosis/physiopathology , Body Surface Area , Echocardiography , Female , Heart/diagnostic imaging , Heart Valve Prosthesis , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Male , Organ Size , Postoperative Period , Radionuclide Imaging , Radiopharmaceuticals , Retrospective Studies , Stroke Volume , Sympathetic Nervous System/diagnostic imaging , Treatment Outcome , Ventricular Septum/diagnostic imaging , Ventricular Septum/pathology
3.
Ann Gastroenterol Surg ; 4(5): 597-601, 2020 Sep.
Article in English | MEDLINE | ID: mdl-33005855

ABSTRACT

AIM: To validate a Japanese version of the Gastrointestinal Quality of Life Index (GIQLI) in patients with symptomatic gallstone disease. METHODS: We investigated responsiveness, reliability, and convergent validity of the translated GIQLI in patients who underwent elective laparoscopic cholecystectomy. Questionnaire scores were compared with the Gastrointestinal Symptom Rating Scale (GSRS) to verify convergent validity. RESULTS: There were 120 patients originally enrolled in the study; three were excluded after their surgery as they no longer met the inclusion criteria. Questionnaires were collected from the remaining 117 patients (100% response rate). At 2 weeks post-surgery, total GIQLI score increased significantly from pre-surgery levels, suggesting high responsiveness. Cronbach's alpha ranged from 0.901 to 0.934 for the total score, while a comparison of scores at 2 vs 6 weeks post-surgery yielded an intraclass correlation coefficient of 0.843; thus, the Japanese version of the questionnaire was reliable. Correlations with GSRS ranged between -0.459 and -0.679, indicating fair to good convergent validity. CONCLUSION: The Japanese GIQLI had high responsiveness and reliability to assess how surgery for symptomatic gallstone disease influenced patient quality of life.

4.
Ann Thorac Cardiovasc Surg ; 26(2): 100-103, 2020 Apr 20.
Article in English | MEDLINE | ID: mdl-29695652

ABSTRACT

We present the case of an 86-year-old male with an aortic arch saccular aneurysm who underwent zone 1 thoracic endovascular aortic repair (TEVAR) with debranching from the right subclavian artery to the left carotid and left subclavian arteries. The patient developed a type Ia endoleak 1 month later. Postoperative contrast computed tomography (CT) showed a hematoma around the aneurysm, concerning for impending rupture. He thus underwent emergency endograft removal and replacement with a one-branched graft using selective cerebral perfusion via the left subclavian artery perfusion. The left subclavian artery was used for systemic and cerebral perfusion without need for cannulation of the cervical arteries. The patient was successfully discharged 6 months after surgery.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Device Removal , Endoleak/surgery , Endovascular Procedures/instrumentation , Perfusion/methods , Subclavian Artery/surgery , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Aortic Rupture/diagnostic imaging , Aortic Rupture/etiology , Aortic Rupture/physiopathology , Blood Vessel Prosthesis Implantation/adverse effects , Cerebrovascular Circulation , Endoleak/diagnostic imaging , Endoleak/etiology , Endoleak/physiopathology , Endovascular Procedures/adverse effects , Hemodynamics , Humans , Male , Subclavian Artery/diagnostic imaging , Subclavian Artery/physiopathology , Treatment Outcome
5.
J Cardiovasc Surg (Torino) ; 61(2): 226-233, 2020 Apr.
Article in English | MEDLINE | ID: mdl-30465415

ABSTRACT

BACKGROUND: Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS: The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS: The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS: In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Cause of Death , Spinal Cord Ischemia/epidemiology , Vascular Malformations/complications , Adult , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/mortality , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Blood Vessel Prosthesis Implantation/methods , Computed Tomography Angiography/methods , Confidence Intervals , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Paraplegia/diagnostic imaging , Paraplegia/epidemiology , Paraplegia/etiology , Preoperative Care/methods , Prognosis , Retrospective Studies , Risk Assessment , Sampling Studies , Spinal Cord Ischemia/diagnostic imaging , Spinal Cord Ischemia/etiology , Survival Analysis , Thoracic Vertebrae/blood supply , Treatment Outcome , Vascular Malformations/diagnostic imaging
6.
J Infect Chemother ; 26(2): 316-320, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31570322

ABSTRACT

Aeromonas dhakensis, a newly recognized species, is often misidentified as A. hydrophila, A. veronii, or A. caviae by commercial phenotypic tests. Limited data about A. dhakensis are available in Japan. We retrospectively analyzed the patients with monomicrobial Aeromonas bacteremia at Hiroshima University Hospital from January 2011 to December 2017, and species re-identification was conducted using rpoD and gyrB gene sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Of the 19 strains from blood isolates, A. caviae (n = 9, 47.4%), A. dhakensis (n = 4, 21.1%), A. hydrophila (n = 3, 15.8%), and A. veronii (n = 3, 15.8%) were re-identified. A. dhakensis was phenotypically misidentified as A. hydrophila (n = 3, 75%) or A. sobria (n = 1, 25%). A. dhakensis was also misidentified as A. caviae (n = 2, 50%), A. hydrophila (n = 1, 25%), and A. jandaei (n = 1, 25%) in MALDI-TOF MS system. Malignancies (n = 12, 63.2%) and liver cirrhosis (n = 7, 36.8%) were common comorbidities. Biliary tract infection was the most frequent source of Aeromonas bacteremia (n = 11, 57.9%). The major source of A. dhakensis bacteremia was also biliary tract infection (n = 3, 75%), and the 14-day infection-related mortality of A. dhakensis was 25%. A. dhakensis isolates showed similar clinical characteristics, antimicrobial susceptibility, and mortality with those of other Aeromonas species isolates. This study demonstrated that A. dhakensis is not a rare cause of Aeromonas bacteremia, but is often misidentified as A. hydrophila in Hiroshima, Japan. Further studies should be conducted to identify the geographical distribution and clinical impact of A. dhakensis in Japan.


Subject(s)
Aeromonas/pathogenicity , Bacteremia/microbiology , Gram-Negative Bacterial Infections/microbiology , Adult , Aeromonas/genetics , Aeromonas/isolation & purification , Aged , Aged, 80 and over , Bacteremia/epidemiology , Biliary Tract Diseases/epidemiology , Comorbidity , Female , Gram-Negative Bacterial Infections/epidemiology , Humans , Japan/epidemiology , Liver Cirrhosis/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Neoplasms/epidemiology , Retrospective Studies , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
7.
J Cardiol Cases ; 20(6): 197-199, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31762832

ABSTRACT

A 79-year-old man with a history of partial resection of the lung and the bladder due to cancer, hypertension, dyslipidemia, and heart failure, underwent transcatheter aortic valve replacement with a SAPIEN 3 (S3) valve (Edwards Lifesciences, Irvine, CA, USA). Preprocedural examination showed a bicuspid aortic valve and severe calcification of the leaflets. Computed tomography showed great tortuosity of the descending aorta. A 29-mm S3 valve prosthesis was advanced into the aorta, but a high degree of resistance was encountered in the middle of the descending aorta. The prosthesis was advanced to the level of aortic valve and an attempt was made to deploy the valve. However, the valve balloon did not expand. A balloon rupture was suspected. The balloon catheter was pulled back into the eSheath (Edwards Lifesciences), and the catheter and eSheath were removed together. Rupture of the balloon was confirmed. A new eSheath and prosthesis were prepared, with delivery supported with a Lunderquist guidewire (Cook Medical, Bloomington, IN, USA). The valve alignment procedure was performed in a straighter portion of the descending aorta. The new 29-mm S3 valve was then successfully implanted. .

8.
Stem Cell Res ; 41: 101601, 2019 12.
Article in English | MEDLINE | ID: mdl-31731179

ABSTRACT

Spinal cord ischemia is a potential complication of thoracoabdominal aortic surgery that may induce irreversible motor disability. We investigated the therapeutic efficacy of simulated microgravity-cultured mesenchymal stem cell (MSC) injection following spinal cord ischemia-reperfusion injury. Sprague-Dawley rats were divided into sham, phosphate-buffered saline (PBS), normal gravity-cultured MSC (MSC-1 G), and simulated microgravity-cultured MSC (MSC-MG) groups. Spinal cord ischemia was induced by transient balloon occlusion of the thoracic aorta, which was followed immediately by PBS or MSC injection into the left carotid artery. Hindlimb motor function was evaluated by the Basso-Beattie-Bresnahan (BBB) scale. Spinal cords were removed 1, 3, or 7 days post-injury for immunohistochemical staining and Western blot analysis. One day post-injury, a few infiltrating inflammatory cells and small vacuoles were observed without significant group differences, followed over several days by progressive spinal cord degeneration. Glial fibrillary acidic protein (GFAP)-positive (reactive) astrocyte numbers were increased in all three groups, and brain-derived neurotrophic factor (BDNF) was colocalized with GFAP-positive cells in spinal ventral horn. Animals in the MSC-MG group demonstrated greater BDNF-positive astrocyte numbers, reduced caspase-3-positive cell numbers, and superior motor recovery. Microgravity-cultured MSC-based therapy may improve functional recovery following spinal ischemia-reperfusion injury by promoting astrocytic BDNF release, thereby preventing apoptosis.


Subject(s)
Ischemia/therapy , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/metabolism , Recovery of Function , Spinal Cord Diseases/therapy , Spinal Cord/metabolism , Weightlessness , Allografts , Animals , Ischemia/metabolism , Ischemia/pathology , Male , Mesenchymal Stem Cells/pathology , Rats , Rats, Sprague-Dawley , Spinal Cord/blood supply , Spinal Cord/pathology , Spinal Cord Diseases/metabolism , Spinal Cord Diseases/pathology
9.
Ann Vasc Dis ; 12(3): 398-400, 2019 Sep 25.
Article in English | MEDLINE | ID: mdl-31636755

ABSTRACT

We present a case of aorto-esophageal fistula (AEF) caused by distal stent graft-induced new entry (dSINE) after the frozen elephant trunk (FET) technique for chronic aortic dissection. We propose that the combination of the spring-back force and the radial force of the FET may play a role in the occurrence of dSINE, leading to AEF. In this case, we successfully performed a three-stage surgery, including esophagectomy, descending aortic replacement, and esophageal reconstruction. To prevent this critical complication, additional endovascular aortic repair should be performed if the FET is not positioned at the straight portion of the descending aorta.

10.
Int Cancer Conf J ; 8(4): 149-152, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31559113

ABSTRACT

A 48-year-old man with unresectable gastric cancer and widespread peritoneal dissemination received concentrated ascites reinfusion therapy, followed by systemic chemotherapy. However, leptomeningeal carcinomatosis (LMC) was diagnosed 1 year later. Spinal drainage and ventriculoperitoneal shunting improved the patient's neurological functions for approximately 2 weeks. The patient died 2 months after LMC diagnosis, but these treatments temporarily improved the quality of life during end-of-life care.

11.
J Gastrointest Surg ; 23(10): 2100-2109, 2019 10.
Article in English | MEDLINE | ID: mdl-31410820

ABSTRACT

BACKGROUNDS AND OBJECTIVES: Although metastasis in lymph nodes along the left side of superior mesenteric artery (SMA-LNs-lt) is sometimes found, survival benefit of SMA-LN-lt dissection for pancreatic head cancer is still unclear. The purpose of this study is to evaluate the prognostic significance of SMA-LN-lt metastasis and micrometastasis. METHODS: A total of 166 patients with pancreatic head cancer who underwent pancreatectomy with lymphadenectomy including SMA-LNs-lt between 2002 and 2017 were reviewed retrospectively. Micrometastasis was evaluated by immunohistochemistry. RESULTS: Twenty patients (12%) had SMA-LN-lt metastasis detected by hematoxylin and eosin (HE) staining, and eight patients (5%) had micrometastasis. Patients with SMA-LN-lt HE-positive or micrometastasis group experienced significantly shorter overall survival (OS) than those without (p = .015). In multivariate analysis, SMA-LN-lt HE-positive or micrometastasis (p = .034), portal vein resection (p = .002), histologic grade 2/3 (p = .046), LN metastasis (p = .002), and lack of adjuvant chemotherapy (p < .001) were independent risk factors. Within a subset of SMA-LN-lt HE-positive or micrometastasis group, lack of adjuvant chemotherapy (p = .003) was the independent poor prognostic factor. CONCLUSIONS: In pancreatic head cancer, the rate of SMA-LN-lt HE-positive and micrometastasis was found in 12% and 5%, respectively. Adjuvant chemotherapy may contribute to improvement of prognosis in patients with LN metastasis including SMA-LN-lt metastasis and micrometastasis.


Subject(s)
Antineoplastic Agents/therapeutic use , Lymphatic Metastasis , Neoplasm Micrometastasis , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , Male , Mesenteric Artery, Superior , Middle Aged , Pancreatectomy , Pancreatic Neoplasms/drug therapy , Prognosis , Retrospective Studies , Survival Rate
12.
Int J Clin Oncol ; 24(12): 1565-1573, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31327070

ABSTRACT

BACKGROUND: Invasive micropapillary carcinoma (IMPC) is a relatively rare subtype of gastric adenocarcinoma and has aggressive histopathologic characteristics, including lymphatic and vascular invasion. However, the associated long-term survival outcomes remain unclear. This study aimed to compare the clinicopathological characteristics and prognosis of gastric adenocarcinoma with and without IMPC using propensity score-matched (PSM) analysis. METHODS: Patients with gastric adenocarcinoma who underwent gastrectomy between 2006 and 2015 were included in the analysis. PSM analysis was performed to compensate for the background heterogeneity between the groups. The primary endpoint was disease-free survival (DFS) after gastrectomy, and the secondary endpoints were disease-specific survival (DSS) and recurrence pattern. RESULTS: Of 882 patients who underwent gastrectomy for gastric adenocarcinoma, with a follow-up duration greater than 36 months, 35 were diagnosed as having gastric adenocarcinoma with IMPC. After PSM, 70 patients, including 35 with IMPC and 35 without IMPC, were selected. Gastric adenocarcinoma with IMPC is characterized by lymphatic invasion (94% versus 69%, p = 0.012). Patients with IMPC had significantly poorer DFS than those without IMPC, with 3-year DFS rates of 62.2% and 93.4% (p = 0.003), respectively. Furthermore, a significant difference was also observed in DSS (p = 0.016); patients with IMPC more frequently developed liver metastasis (20%) than those without IMPC (3%, p = 0.006). CONCLUSIONS: Resected gastric carcinoma with IMPC was associated with poorer DFS and DSS; furthermore, an increased rate of lymphatic invasion and liver metastasis was noted than in cases without IMPC.


Subject(s)
Adenocarcinoma, Papillary/mortality , Adenocarcinoma, Papillary/surgery , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Adenocarcinoma, Papillary/pathology , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Gastrectomy , Humans , Liver Neoplasms/secondary , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoplasm Recurrence, Local , Prognosis , Propensity Score , Retrospective Studies , Stomach Neoplasms/pathology
13.
PLoS One ; 14(7): e0219363, 2019.
Article in English | MEDLINE | ID: mdl-31323026

ABSTRACT

Although the biological systems in the human body are affected by the earth's gravity, information about the underlying molecular mechanisms is limited. For example, apoptotic signaling is enhanced in cancer cells subjected to microgravity. We reasoned that signaling regulated by p53 may be involved because of its role in apoptosis. Therefore, we aimed to clarify the molecular mechanisms of modified cis-diamminedichloroplatinum (CDDP)-sensitivity under simulated microgravity by focusing on p53-related cell death mechanisms. Immunoblotting analyses indicated that, under microgravity, CDDP-induced ATM/p53 signaling increased and caspase-3 was cleaved earlier. However, microgravity decreased the levels of expression of p53 targets BAX and CDKN1A. Interestingly, microgravity increased the PTEN, DRAM1, and PRKAA1 mRNA levels. However, microgravity decreased the levels of mTOR and increased the LC3-II/I ratio, suggesting the activation of autophagy. The CDDP-induced cleavage of caspase-3 was increased during the early phase in Group MG (+), and cleaved caspase-3 was detected even in Group MG (+) with constitutive expression of a mutant type of p53 (hereafter, "+" indicates CDDP treatment). These results interestingly indicate that microgravity altered CDDP sensitivity through activation of caspase-3 by p53-independent mechanism.


Subject(s)
Apoptosis/drug effects , Cisplatin/pharmacology , Tumor Suppressor Protein p53/metabolism , Weightlessness , AMP-Activated Protein Kinases/metabolism , Autophagy/drug effects , Caspase 3/metabolism , Cell Proliferation , Cyclin-Dependent Kinase Inhibitor p21/metabolism , Hep G2 Cells , Humans , Membrane Proteins/metabolism , Mutation , PTEN Phosphohydrolase/metabolism , Signal Transduction/drug effects , bcl-2-Associated X Protein/metabolism
14.
Sci Rep ; 9(1): 7711, 2019 05 22.
Article in English | MEDLINE | ID: mdl-31118440

ABSTRACT

Critical limb ischemia (CLI) is associated with a high risk of limb amputation. It has been shown that cell therapy is safe and has beneficial effects on ischemic clinical symptoms in patients with CLI. The aim of this study was to further investigate the outcomes of intramuscular injection of autologous bone-marrow mononuclear cells (BM-MNCs) in a long-term follow-up period in atherosclerotic peripheral arterial disease (PAD) patients who have no optional therapy. This study was a retrospective and observational study that was carried out to evaluate long-term clinical outcomes in 42 lower limbs of 30 patients with atherosclerotic PAD who underwent BM-MNC implantation. The median follow-up period was 9.25 (range, 6-16) years. The overall amputation-free rates were 73.0% at 5 years after BM-MNC implantation and 70.4% at 10 years in patients with atherosclerotic PAD. The overall amputation-free rates at 5 years and at 10 years after implantation of BM-MNCs were significantly higher in atherosclerotic PAD patients than in internal controls and historical controls. There were no significant differences in amputation rates between the internal control group and historical control group. The rate of overall survival was not significantly different between the BM-MNC implantation group and the historical control group. Implantation of autologous BM-MNCs is feasible for a long-term follow-up period in patients with CLI who have no optional therapy.


Subject(s)
Bone Marrow Transplantation , Ischemia/therapy , Leg/blood supply , Monocytes/transplantation , Aged , Aged, 80 and over , Amputation, Surgical , Comorbidity , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Ischemia/etiology , Ischemia/surgery , Kaplan-Meier Estimate , Male , Middle Aged , Peripheral Arterial Disease/complications , Progression-Free Survival , Retrospective Studies , Transplantation, Autologous , Treatment Outcome
15.
Interact Cardiovasc Thorac Surg ; 28(3): 489-490, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30204877

ABSTRACT

A 64-year-old woman who underwent thoraco-abdominal aortic replacement for a Crawford type II aneurysm 11 years ago was referred to our hospital because of a residual juxtarenal abdominal aortic aneurysm. The coeliac, superior mesenteric and inferior mesenteric arteries were occluded. Collateral vessels from the left internal iliac artery to these 3 mesenteric arteries had developed. We performed open aneurysm repair using an extracorporeal circuit to maintain collateral flow to these mesenteric arteries.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Iliac Artery/surgery , Mesenteric Vascular Occlusion/surgery , Vascular Surgical Procedures/methods , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Computed Tomography Angiography , Female , Humans , Imaging, Three-Dimensional , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/etiology , Middle Aged
16.
Intern Med ; 58(5): 743-747, 2019 Mar 01.
Article in English | MEDLINE | ID: mdl-30333402

ABSTRACT

The emergence of a Japan-intrinsic community associated methicillin-resistant Staphylococcus aureus strain (CA-MRSA/J) has been reported. A 70-year-old man with recurrent colon cancer and a history of mitral valve replacement was admitted to the hospital in a state of shock. He was diagnosed with prosthetic valve endocarditis (PVE) caused by MRSA and underwent cardiac surgery. The MRSA isolates belonged to multilocus sequence type 8 and carried staphylococcal cassette chromosome mec IVl and the genes of toxic shock syndrome toxin-1, enterotoxin C, and enterotoxin L. These characteristics indicated a CA-MRSA/J clone. This is the first reported case of PVE caused by CA-MRSA/J.


Subject(s)
Endocarditis, Bacterial/microbiology , Heart Valve Prosthesis/adverse effects , Methicillin-Resistant Staphylococcus aureus/genetics , Prosthesis-Related Infections/microbiology , Staphylococcal Infections/microbiology , Aged , Community-Acquired Infections/microbiology , Humans , Male , Methicillin-Resistant Staphylococcus aureus/classification , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Mitral Valve Stenosis/surgery , Multilocus Sequence Typing/methods , Shock, Septic/microbiology
17.
J Gastrointest Surg ; 23(2): 312-319, 2019 02.
Article in English | MEDLINE | ID: mdl-30353491

ABSTRACT

BACKGROUND: Anastomotic surgical recurrence after bowel resection in Crohn's disease patients is problematic. This study was performed to evaluate the increased risk of anastomotic surgical recurrence. METHODS: From 2006 to 2016, we performed anastomoses in 215 consecutive Crohn's disease patients. The cohort was divided into two groups: Kono-S anastomosis (n = 117) and end-to-end anastomosis (n = 98). Multivariate analysis of predictors of anastomotic surgical recurrence and Kaplan-Meier analysis for the 5-year anastomotic surgical recurrence rate were evaluated. RESULTS: The two groups showed no statistically significant differences in patient backgrounds. During a median follow-up of 54 months, 28 patients required anastomotic surgical recurrence [4 (3.4%) in the Kono-S group and 24 (24.4%) in the end-to-end group]. Six leaks (5.1%) were detected in the Kono-S group and 17 leaks (17.3%) in the end-to-end group; all were successfully treated conservatively. End-to-end anastomosis, leakage, age < 45 years, and body mass index of ≥ 18 kg/m2 at the first surgery had a higher risk of anastomotic surgical recurrence. Kono-S anastomosis significantly reduced the risk of anastomotic surgical recurrence after 1 year (odds ratio, 0.14). Anastomotic leakage influenced anastomotic surgical recurrence within 1 year (odds ratio, 4.84). The 5-year surgery-free survival rate at the anastomosis site with Kono-S anastomosis (95.0%) was significantly higher than that with end-to-end anastomosis (81.3%; P < 0.001). CONCLUSIONS: Anastomotic leakage after bowel resection in Crohn's disease patients increased anastomotic surgical recurrence within 1 year, and Kono-S anastomosis is associated with a low risk of anastomotic surgical recurrence after > 1 year.


Subject(s)
Crohn Disease/surgery , Intestine, Large/surgery , Intestine, Small/surgery , Adult , Age Factors , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Anastomotic Leak/etiology , Body Mass Index , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Recurrence , Risk Factors , Survival Rate
18.
Circ J ; 82(10): 2518-2522, 2018 09 25.
Article in English | MEDLINE | ID: mdl-30068794

ABSTRACT

BACKGROUND: Recently, the carotid artery has been used as an alternative approach for transcatheter aortic valve implantation (TAVI). The aim of this study was to prove the safety and feasibility of transcarotid (TC) vs. transfemoral (TF) TAVI. Methods and Results: This retrospective study enrolled 726 consecutive patients with severe symptomatic aortic stenosis. All patients underwent TC-TAVI or TF-TAVI at Hôpital Haut-Lévèque, Bordeaux Heart University Hospital between September 2012 and October 2017. The TC-TAVI (n=83) and TF-TAVI (n=643) groups were compared statistically. The EuroSCORE II was significantly higher (8.2±6.7 vs. 6.4±5.5; P=0.007) and rates of current smoking, dyslipidemia and peripheral arterial disease were higher in the TC-TAVI than TF-TAVI group. All TC-TAVIs and 9.3% of TF-TAVIs were performed under general anesthesia. Radiation time was significantly shorter in the TC-TAVI than TF-TAVI group (14.5±6.0 vs. 23.0±10.8 min; P<0.001). Postimplant balloon valvuloplasty was performed more frequently in the TF-TAVI than TC-TAVI group (7.2% vs. 19.4%; P=0.006). Postoperative echocardiographic data were similar between the 2 groups, and there were no significant differences in 30-day mortality (8.4% vs. 5.0%; P=0.189) or stroke rate (1.2% vs. 2.6%; P=0.428) between the TF-TAVI and TC-TAVI groups. CONCLUSIONS: The feasibility and 30-day safety of TC-TAVI and TF-TAVI are similar. When TF-TAVI is not suitable anatomically for a particular patient, TC-TAVI is a preferable alternative.


Subject(s)
Carotid Arteries/surgery , Femoral Artery/surgery , Transcatheter Aortic Valve Replacement/methods , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Balloon Valvuloplasty/statistics & numerical data , Echocardiography , Female , Humans , Male , Mortality , Peripheral Arterial Disease , Postoperative Complications , Retrospective Studies , Stroke , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/mortality , Treatment Outcome
19.
Surg Today ; 48(12): 1035-1039, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29934686

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the long-term results of partial arch repair using the frozen elephant trunk (FET) technique for distal arch aortic aneurysm and to examine the late complications. METHODS: Thirty-eight patients with true distal arch aortic aneurysms were repaired with FET introduced through an incision in the proximal arch aorta. Follow-up computed tomography was performed every 6 or 12 months in 36 surviving patients. The maximum dimension of the excluded aneurysmal space was measured to determine whether the aneurysmal space had decreased or disappeared. Late complications were also evaluated during the long-term follow-up. RESULTS: There was 1 hospital death (2.6%) and 1 (2.6%) case of paraplegia. There were 2 late sudden deaths (5.2%) thought to be due to aneurysm rupture and arrhythmia. Postoperative serial-computed tomography showed shrinkage of the excluded aneurysmal space in 33 of 36 patients. Late aneurysmal formation occurred in the anastomotic site in three patients. One patient underwent thoracic endovascular stent grafting 10 years after surgery, 1 patient had total arch replacement 9 years after surgery, and 1 died due to rupture. CONCLUSION: Frozen elephant trunk was found to be a useful alternative for treating true distal arch aortic aneurysm. However, we must be alert for late aneurysmal formation at the incision site.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Endovascular Procedures/methods , Aged , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
20.
J Surg Oncol ; 118(7): 1105-1114, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29878355

ABSTRACT

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the prognostic impact of postoperative complications after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) stratified by resectability status. METHODS: Medical records of 226 patients with pancreatic head carcinoma who underwent PD, including 115 with resectable (R) and 111 with borderline resectable/unresectable (BR/UR) PDAC, were reviewed retrospectively. Major complications were defined as grade III or IV based on the Clavien-Dindo classification system. The prognostic impact of major complications on overall survival (OS) was analyzed using univariate and multivariate analyses with stratification by resectability status. RESULTS: A multivariate analysis in the BR/UR group identified R1 resection (P = 0.03), T 3/4 stage (P = 0.03), and incidence of major complications (P = 0.03) as independent risk factors for poor survival, whereas major complications did not affect survival in the R group. Initiation of adjuvant gemcitabine plus S-1 chemotherapy occurred significantly less frequently for patients with major complications than for those without major complications in the BR/UR group (P = 0.02). CONCLUSION: A negative prognostic impact of postoperative major complications after PD was observed in patients with BR/UR PDAC, whereas the prognostic impact was unclear in patients with R PDAC.


Subject(s)
Carcinoma, Pancreatic Ductal/mortality , Carcinoma, Pancreatic Ductal/surgery , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/adverse effects , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Pancreatic Ductal/drug therapy , Carcinoma, Pancreatic Ductal/pathology , Chemotherapy, Adjuvant/statistics & numerical data , Cohort Studies , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/pathology , Postoperative Complications/classification , Prognosis , Retrospective Studies
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