Publications by authors named "Harunobu Matsumoto"

62 Publications

Pathological processes and pretreatment cytologic diagnosis of neuroendocrine carcinoma of the endometrium: addendum report of the Kansai Clinical Oncology Group/Intergroup study in Japan.

Med Mol Morphol 2021 Sep 2;54(3):237-244. Epub 2021 May 2.

Division of Pathology, Shikoku Cancer Center, Matsuyama-shi, Ehime, Japan.

A previous retrospective study of a neuroendocrine carcinoma of the endometrium including 42 cases employed a central pathologic review to ensure the reliability of the findings. However, the pathological processes were not described in detail. In this study, we further analyzed these processes and the results of pretreatment endometrial cytology of neuroendocrine carcinoma. Of the 65 patients from 18 institutions registered in the study, 42 (64.6%) were diagnosed with neuroendocrine carcinoma of the endometrium based on the central pathological review. Thirteen of the 23 excluded cases conflicted from their original diagnoses: 5 (38.5%) were diagnosed with endometrioid adenocarcinoma, 5 (38.5%) with undifferentiated carcinoma, and 3 (23.1%) with carcinosarcoma. Immunohistochemical staining led to a change in diagnosis for 8 (61.5%) of the 13 cases. Pretreatment endometrial cytology was examined in 38 (90.5%) cases; 34 (89.5%) of these 38 cases were found, or suspected, to be positive. To ensure the selection of appropriate therapy and keeping patients correctly informed, it is important to distinguish neuroendocrine carcinoma from other similar histologic types. Endometrial cytology may help in the early detection of this disease.
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http://dx.doi.org/10.1007/s00795-021-00288-4DOI Listing
September 2021

Successful Embolectomy of the Plantar Artery Occlusion Due to Thromboembolism.

Ann Vasc Dis 2020 Dec;13(4):465-468

Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan.

A 76-year-old man was admitted to our hospital because of sudden pain in the left leg. Computed tomography and ultrasonography findings revealed occlusion of the plantar and sural arteries and atherothrombosis in the abdominal aorta, and thromboembolism was suspected. The foot was treated for ischemia and embolic sources in two stages. First, we performed embolectomy using a balloon catheter exposed to the common plantar artery through arteriotomy. This surgical revascularization is an effective treatment method for thromboembolism. Four weeks later, we performed graft replacement of the abdominal aorta to prevent thromboembolism.
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http://dx.doi.org/10.3400/avd.cr.20-00125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758579PMC
December 2020

Pembrolizumab and Radiotherapy for Platinum-refractory Recurrent Uterine Carcinosarcoma With an Abscopal Effect: A Case Report.

Anticancer Res 2020 Jul;40(7):4131-4135

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.

Background: Immune responses due to radiotherapy and immune checkpoint inhibitors potentially have synergistic effects.

Case Report: Here, we report a 65-year-old Japanese woman presenting with high-grade endometrial cancer. She was diagnosed with carcinosarcoma, stage IB. A month post-surgery, lung, and mediastinal lymph node metastasis/recurrence was detected. Progressive disease (with high microsatellite instability) with local recurrence and bone metastasis was detected after six chemotherapy cycles with paclitaxel and carboplatin. After combination therapy with pembrolizumab (2 mg/kg, tri-weekly, 10 cycles) and pelvic radiotherapy (30 Gy/10 fractions), enhanced computed tomography revealed a complete response. The patient survived for 14 months with the residual tumour post-relapse. This is the first case of a complete response of recurrent endometrial carcinosarcoma upon combinatorial pembrolizumab and radiotherapy.

Conclusion: Combinatorial immune checkpoint inhibitors and local radiotherapy cause the abscopal effect and may be a promising treatment strategy for advanced or recurrent carcinosarcomas refractory to traditional chemotherapy.
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http://dx.doi.org/10.21873/anticanres.14412DOI Listing
July 2020

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping.

Ann Vasc Dis 2020 Mar;13(1):45-51

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping. : The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group. : For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P<0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78). : Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.
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http://dx.doi.org/10.3400/avd.oa.19-00095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140154PMC
March 2020

Etiology and impact on outcomes of polycystic kidney disease in abdominal aortic aneurysm.

Surg Today 2020 Oct 6;50(10):1213-1222. Epub 2020 Apr 6.

Department of General Internal Medicine, School of Medicine, The Jikei University, Tokyo, 105-8461, Japan.

Purpose: We investigated the etiology and impact on outcomes of polycystic kidney disease in patients with abdominal aortic aneurysm.

Methods: Eight-hundred patients who underwent open (n = 603) or endovascular aortic repair (n = 197) were divided into three groups: no cyst (n = 204), non-polycystic kidney (n = 503), and polycystic kidney (≥ 5 cysts in the bilateral kidneys, n = 93). The characteristics and outcomes were compared among the groups.

Results: In the polycystic kidney group, the age was increased and the proportions of patients with male sex, hypertension, and estimated glomerular filtration rate < 30 mL/min/1.73 m were greater. The overall hospital mortality rates were similar. The incidence of acute kidney injury after elective open aortic repair was increased in the polycystic kidney group (12%, 17%, and 29%, P = 0.020). In the polycystic kidney group, 80 patients did not have renal enlargement or a family history of renal disease, while 13 (corresponding to 1.6% [13/800] of the overall patients), had renal enlargement, suggesting the possibility of hereditary polycystic kidney disease.

Conclusions: In our cohort, 1.6% of the patients with abdominal aortic aneurysm who underwent surgery were at risk of hereditary polycystic kidney disease. Polycystic kidney disease was associated with acute kidney injury after open aortic repair.
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http://dx.doi.org/10.1007/s00595-020-01997-6DOI Listing
October 2020

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) with sarcomatous features without recurrence after extended radical surgery: A case report.

Medicine (Baltimore) 2020 Mar;99(11):e19166

Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita.

Rationale: The malignant potential and the appropriate treatment of uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is controversial. Although these tumors generally have benign outcomes, several reports have described recurrences, metastases, and deaths associated with this disease.

Patient Concerns: A 57-year-old Japanese woman (gravida 2, para 2) was referred to our hospital for the evaluation and treatment of uterine fibroids. Magnetic resonance imaging revealed a right ovarian mass and multiple fibroids in the uterine myometrium.

Diagnoses: The patient was diagnosed with UTROSCT with sarcomatous features.

Interventions: She initially underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by second-stage surgery comprising pelvic and para-aortic lymphadenectomy and subtotal omentectomy.

Outcomes: No postoperative recurrence was observed in the patient in 36 months.

Lessons: In this case, extended radical surgery prevented the development of recurrent disease in a patient with UTROSCT with sarcomatous features. These clinicopathological findings suggest that UTROSCT is associated with several risk factors, including older age, presence of necrosis, lymphovascular invasion, significant nuclear atypia, and significant mitotic activity. This lesion type should be considered malignant and treated with curative intent.
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http://dx.doi.org/10.1097/MD.0000000000019166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220453PMC
March 2020

Correlation of World Health Organization 2010 Classification for Gastroenteropancreatic Neuroendocrine Neoplasms with the Prognosis of Ovarian Neuroendocrine Neoplasms: Kansai Clinical Oncology Group-Protocol Review Committee/Intergroup Study.

Neuroendocrinology 2021 25;111(4):320-329. Epub 2020 Feb 25.

Department of Pathology, Osaka Medical College, Takatsuki, Japan.

Background: In 2014, the World Health Organization (WHO) released a classification system introducing neuroendocrine neoplasms (NENs) of the female reproductive tract, excluding the ovaries. This study aimed to evaluate whether retrospective adaption of the gastroenteropancreatic (GEP)-NEN classification is feasible for ovarian NENs (O-NENs) and correlates with prognosis.

Methods: Sixty-eight patients diagnosed with carcinoid, small cell carcinoma (pulmonary type), paraganglioma, non-small/large cell neuroendocrine carcinoma (NEC), mixed NEC, or undifferentiated carcinomas at 20 institutions in Japan were included in this retrospective cross-sectional study. We identified O-NENs through central pathological review using a common slide set, followed by reclassification according to WHO 2010 guidelines for GEP-NENs. A proportional hazards model was used to assess the association of prognostic factors (age, stage, performance status, histology, and residual disease) with overall survival (OS) and progression-free survival (PFS).

Results: Of the 68 enrolled patients, 48 were eligible for analysis. All carcinoids (n = 32) were reclassified as NET G1/G2, whereas 14 of 16 carcinomas were reclassified as NEC/mixed adeno-NEC (MANEC) (Fisher's exact test; p < 0.01). The OS/PFS was 49.0/42.5 months and 6.5/3.9 months for NET G1/G2 and NEC/MANEC, respectively. Histology revealed that NEC/MANEC was associated with increased risk of death (HR = 48.0; 95% CI, 3.93-586; p < 0.01) and disease progression (HR = 51.6; 95% CI, 5.54-480; p < 0.01).

Conclusion: Retrospective adaption of GEP-NEN classification to O-NENs is feasible and correlates well with the prognosis of O-NENs. This classification could be introduced for ovarian tumors.
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http://dx.doi.org/10.1159/000506743DOI Listing
November 2021

Clinicopathologic features, treatment, prognosis and prognostic factors of neuroendocrine carcinoma of the endometrium: a retrospective analysis of 42 cases from the Kansai Clinical Oncology Group/Intergroup study in Japan.

J Gynecol Oncol 2019 Nov;30(6):e103

Division of Pathology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.

Objective: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease.

Methods: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease.

Results: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery.

Conclusion: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
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http://dx.doi.org/10.3802/jgo.2019.30.e103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779616PMC
November 2019

Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection.

Gen Thorac Cardiovasc Surg 2020 Apr 29;68(4):328-334. Epub 2019 Aug 29.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-Shi, 330-8503, Saitama, Japan.

Background: The purpose of this study was to evaluate the risk factors for spinal cord injury (SCI) in patients with acute aortic dissection undergoing surgery with frozen elephant trunk technique (FET).

Methods: From December 2014 to February 2018, 17 patients with acute aortic dissection underwent surgical treatment of the aortic arch with FET. SCI occurred in 3 patients. Risk factors for SCI were evaluated.

Results: Mean age of the patients was 56 years and 88.2% were male. The ratio of true lumen to total aortic diameter at the level of carina (before: 0.48 vs. after: 0.75, P < 0.001), aortic valve (before: 0.47 vs. after: 0.67, P = 0.001), and celiac artery (before: 0.48 vs. after: 0.68, P = 0.003) increased after surgery. There were no significant differences in perioperative minimum hemoglobin level and postoperative mean arterial pressure between patients with and without SCI. However, patients with SCI had higher creatinine level before surgery (SCI: 1.32 mg/dL vs. no SCI: 0.81 mg/dL, P = 0.023). Although there was no difference in number of patent intercostal arteries before surgery, those originating from the true lumen were fewer in patients with SCI (SCI: 2.7 vs. no SCI: 8.6, P = 0.021). Furthermore, with entry closure, significant decrease in patency was observed in intercostal arteries originating from the false lumen (before: 3.1 vs. after: 1.0, P < 0.001).

Conclusion: FET was useful in entry closure. However, FET in patients with higher creatinine level and those who may have significant spinal cord perfusion from the false lumen could be a risk factor for postoperative SCI.
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http://dx.doi.org/10.1007/s11748-019-01196-2DOI Listing
April 2020

Prosthesis selection for aortic valve replacement in patients on hemodialysis.

Gen Thorac Cardiovasc Surg 2020 Feb 6;68(2):122-128. Epub 2019 Jul 6.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.

Objective: The purpose of this study was to evaluate the outcomes of prosthesis selection in hemodialysis patients undergoing valve replacement for aortic valve stenosis.

Methods: From July 2008 to December 2016, 76 patients on hemodialysis underwent aortic valve replacement for aortic valve stenosis. Of these patients, 30 patients were treated by a mechanical valve and 46 patients were treated by a bioprosthesis. Early outcomes and long-term outcomes were compared.

Results: The mean age of the patients treated by a mechanical valve was younger than the patients treated by a bioprosthesis (p < 0.001). There were no significant differences in in-hospital mortality (p = 0.52). For the long-term outcomes, complications associated with bleeding were higher in patients who received a mechanical valve (p = 0.032). However, no significant difference was observed in mortality (p = 0.65) and major adverse cardiovascular cerebrovascular event (MACCE: p = 0.59). The actuarial survival rate with a mechanical valve was 56.7% (95% CI 36.4-72.8%) at 3 years and 48.6% (95% CI 28.9-65.8%) at 5 years. The actuarial survival rate with a bioprosthesis was 61.2% (95% CI 44.0-74.5%) at 3 years and 39.5% (95% CI 20.9-57.8%) at 5 years. No patients from both groups needed redo surgery for valvular deterioration. Further, there was no significant difference in long-term mortality (p = 0.91) and MACCE (p = 0.63) in a propensity score-matched patient comparison.

Conclusions: Although bleeding complications were higher in patients who received a mechanical valve, there were no significant differences in early- and long-term mortality, and MACCE between patients treated by a mechanical valve and a bioprosthesis.
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http://dx.doi.org/10.1007/s11748-019-01172-wDOI Listing
February 2020

How is preoperative sarcopenia assessed in patients undergoing heart valve surgery?

J Thorac Cardiovasc Surg 2019 04;157(4):e199-e200

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2018.10.126DOI Listing
April 2019

Sutureless repair for postinfarction left ventricular free wall rupture.

J Thorac Cardiovasc Surg 2019 09 14;158(3):771-777. Epub 2019 Feb 14.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Objective: Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction. Sutureless repair has been reported to be an effective surgical procedure for left ventricular free wall rupture. However, the outcomes of sutureless repair remain unclear.

Methods: Between January 2001 and December 2016, 42 patients were treated for left ventricular free wall rupture at Jichi Medical University. Of them, 35 consecutive patients undergoing sutureless repair using the TachoComb (CSL Behring, Tokyo, Japan) or TachoSil (Nycomed, Zurich, Switzerland) patches were included in this study. No patient required cardiopulmonary bypass. The oozing type of left ventricular free wall rupture was observed in 33 patients (94%), and the blow-out type was observed in 2 patients (6%). The rupture sites were the anterior wall in 16 patients (46%), the posterior-lateral wall in 11 patients (31%), and the inferior wall in 8 patients (23%).

Results: The in-hospital mortality rate was 17% (6 patients). Re-rupture after sutureless repair occurred in 17% (6 patients). Of them, 4 cases (67%) of re-rupture occurred within 24 hours after surgery. The 2 patients with blow-out type left ventricular free wall rupture experienced re-rupture. Three patients required mitral valve surgery after sutureless repair during the admission. The overall survivals at 1, 5, and 10 years were 71.4%, 68.6%, and 62.9%, respectively. Multivariable analysis revealed that re-rupture was an independent predictor for decreased survival (hazard ratio, 58.6; 95% confidence interval, 4.9-701.6; P = .001). Postoperative pseudoaneurysm formation was not detected during the follow-up.

Conclusions: Sutureless repair using TachoComb/TachoSil patches can be a viable treatment option for left ventricular free wall rupture. Care should be taken when applying this technique in cases of the blow-out type left ventricular free wall rupture.
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http://dx.doi.org/10.1016/j.jtcvs.2019.01.124DOI Listing
September 2019

Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm.

Ann Vasc Dis 2018 Sep;11(3):298-305

Department of Cardiovascular Surgery, Jichi Medical University, Saitama, Japan.

: To investigate the predictors of acute kidney injury (AKI) following surgery for abdominal aortic aneurysm. : Subjects were 642 non-hemodialysis patients (open aortic repair [OAR] group, n=453; endovascular aortic repair [EVAR] group, n=189) who underwent elective surgery between 2009 and 2015. AKI was assessed according to the Kidney Disease Improving Global Outcomes criteria. In-hospital mortality and incidence of AKI were compared between the OAR and EVAR groups. The effect of AKI on outcomes and predictors of AKI were examined in both groups. : In-hospital mortalities were 0.7% (3/453) in the OAR group and 0.5% (1/189) in the EVAR group. The incidence of AKI increased in the OAR group (14.1% vs. 3.7%, P<0.01). In the OAR group, in-hospital mortality (0% vs. 4.7%, P<0.01) increased in patients with AKI. In the OAR group, hemoglobin level <10 g/dL, estimated glomerular filtration rate <60 mL/min/1.73 m, operation time >300 min, history of ischemic heart disease, and amount of bleeding >1,000 mL were predictors of AKI. In the EVAR group, amount of transfusion>1,000 mL was a predictor of AKI, but AKI was not found to worsen outcomes. : AKI affected outcomes of OAR. Knowledge of predictors may optimize perioperative care.
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http://dx.doi.org/10.3400/avd.oa.18-00029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200611PMC
September 2018

Perioperative factors associated with aneurysm sac size changes after endovascular aneurysm repair.

Surg Today 2019 Feb 12;49(2):130-136. Epub 2018 Sep 12.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan.

Purpose: To identify the perioperative factors associated with aneurysm size changes after endovascular aortic aneurysm repair (EVAR).

Methods: Between August, 2008 and December, 2014, 187 patients underwent EVAR treatment in our institution. The subjects of this study were 135 of these patients without peripheral artery disease, who were followed up with computed tomography (CT) for 3 years. Significant aneurysm size change was defined as sac size change of more than 5 mm from the baseline.

Results: Sac enlargement was identified in 25 patients (18.5%) and sac shrinkage was identified in 59 (43.7%) patients. The factors associated with sac enlargement were postoperative pulse wave velocity (OR: odds ratio 3.80, p = 0.047), prevalence of a type 2 endoleak 1 week after surgery (OR 4.26, p = 0.022), inner diameter (OR 1.10, p = 0.005), and distance from the lower renal artery to the terminal aorta (OR 1.05, p = 0.017). The factors associated with sac shrinkage were prevalence of a type 2 endoleak (OR 0.09, p < 0.001) and preoperative pulse wave velocity (OR 0.32, p = 0.022). The factors independently associated with type 2 endoleak were the use of an Excluder device (OR 3.99, p = 0.002) and the length of the aneurysm (OR 1.02, p = 0.027).

Conclusion: Inner diameter, treatment length, perioperative pulse wave velocity, and type 2 endoleak were associated with sac size changes after EVAR.
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http://dx.doi.org/10.1007/s00595-018-1714-zDOI Listing
February 2019

The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery.

J Thorac Cardiovasc Surg 2019 Mar 27;157(3):1071-1079.e3. Epub 2018 Jul 27.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

Objective: Sarcopenia, age-related loss of muscle mass, is an objective and comprehensive marker of frailty. We aimed to clarify the influence of sarcopenia on the outcomes after heart valve surgery.

Methods: We retrospectively reviewed 1119 patients who underwent valve surgery via median sternotomy at our institution from June 2009 to December 2013. Patients aged <70 years, urgent/emergent cases, and patients without preoperative computed tomography of the abdomen were excluded. The remaining 428 patients were included in this study. Psoas muscle area, a validated measure of sarcopenia, was measured on preoperative computed tomography. Sarcopenia was defined as the lowest sex-specific quartile in psoas muscle area. The mean follow-up period was 3.4 years.

Results: Overall in-hospital mortality did not differ between the sarcopenia and nonsarcopenia patient groups. However, the incidence of stroke and intra-aortic balloon pump/percutaneous cardiopulmonary support use was greater in the sarcopenia group than in the nonsarcopenia group. The patients with sarcopenia had significantly decreased long-term survival and decreased freedom from major adverse cardiac and cerebrovascular events. Multivariable analysis and inverse probability weighting revealed that sarcopenia was an independent predictor for decreased survival (hazard ratio, 2.22; 95% confidence interval, 1.26-3.92; P = .006).

Conclusions: Preoperative sarcopenia defined from the psoas muscle area was associated with long-term outcomes after valve surgery. Thus, the measurement of psoas muscle area can help facilitate more accurate risk scoring in elderly patients.
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http://dx.doi.org/10.1016/j.jtcvs.2018.06.098DOI Listing
March 2019

Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis.

Nefrologia (Engl Ed) 2019 Jan - Feb;39(1):90-92. Epub 2018 Feb 13.

Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

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http://dx.doi.org/10.1016/j.nefro.2017.11.023DOI Listing
January 2020

Pulmonary Stenosis Caused by Ductus Arteriosus Aneurysm: A Case Report.

Ann Vasc Dis 2017 Sep;10(3)

Department of Cardiovascular Surgery, Kasukabe Chuo General Hospital,Kasukabe, Saitama, Japan.

A 76-year-old woman with a 2-week history of dyspnea on exertion was admitted to our hospital. A computed tomography scan showed a 70-mm diameter aortic arch aneurysm containing a large thrombus that was compressing the pulmonary artery. Echocardiography showed severe pulmonary stenosis and no shunt flow. Operative findings revealed an aneurysmal thrombus protruding into the lumen of the pulmonary artery through a foramen. A ductus arteriosus aneurysm was diagnosed. After the thrombus removal, arch replacement and ductus closure with a prosthetic patch were performed. Histological examination showed that the thrombus had no vascular components. The patient's symptoms were relieved, and she was discharged.
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http://dx.doi.org/10.3400/avd.cr.16-00136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684151PMC
September 2017

Characteristics of Abdominal Aortic Aneurysm in Japanese Patients Aged 50 Years or Younger.

Ann Vasc Dis 2017 Jun;10(2):119-124

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan.

We investigated the characteristics and surgical outcomes of abdominal aortic aneurysm (AAA), which typically occurs in elderly persons, in Japanese patients aged 50 years or younger. Clinical records of 999 patients who underwent open or endovascular repair for AAA at our hospital between 2007 and 2015 were reviewed to identify the clinical characteristics and surgical outcomes of young patients with AAA. The cohort included 14 patients aged 50 years or younger (mean, 40.4 years; young group) and 985 patients aged older than 50 years (mean, 72.8 years; old group). Marfan syndrome, prior aortic dissection, and a history of aortic surgery were more prevalent in the young group, and 50% of the patients in the young group had dissecting aneurysms. All patients in the young group underwent open repair. Overall in-hospital mortality rates were 7.1% (1/14) and 1.9% (19/985) in the young and old groups, respectively (P=0.67). Seven-year survival and aortic event-free survival rates in the young group were 82.5%±11.5%, and 71.2±14.5%, respectively. AAA in patients aged 50 years or younger tended to be associated with Marfan syndrome, a history of aortic surgery, and prior aortic dissection. Early outcomes of AAA among young patients are acceptable, but close postoperative monitoring is important.
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http://dx.doi.org/10.3400/avd.oa.16-00083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579777PMC
June 2017

Ruptured external iliac artery pseudoaneurysm following surgery for ovarian cancer: A case report and literature review.

J Obstet Gynaecol Res 2018 Jan 13;44(1):184-186. Epub 2017 Oct 13.

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.

Ruptured pseudoaneurysm following pelvic surgery is a rare and fatal complication. Because of its rarity, existing evidence is limited to a small case series. A 60-year-old woman underwent staging laparotomy, including pelvic and para-aortic lymphadenectomy, for ovarian cancer. On the 11th day, the patient developed a sudden lumbar pain and loss of consciousness, which resulted in a state of shock. She was diagnosed as having a pelvic abscess and ruptured external iliac artery pseudoaneurysm. We performed ligation of the external iliac artery to restrain hemorrhage and femoro-femoral artery bypass to prevent infection, which saved the patient's life. Our study had two findings. First, this is the first reported case of ruptured external iliac artery pseudoaneurysm following surgery for ovarian cancer. Second, treatment of ruptured pseudoaneurysm requires rapid hemostasis, prevention of infection, and revascularization.
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http://dx.doi.org/10.1111/jog.13475DOI Listing
January 2018

A Case of Neuroendocrine Carcinoma Developing from the Broad Ligament of the Uterus.

Rare Tumors 2017 Jul 3;9(2):6958. Epub 2017 Jul 3.

Department of Obstetrics and Gynecology, Faculty of Medicine Oita University, Oita, Japan.

Neuroendocrine carcinoma (NEC), also called small cell carcinoma or large cell carcinoma, is a rare and aggressive tumor that develops mainly in the lung and intestine. More rarely, NEC develops in gynecologic organs, with poor prognoses. We experienced a case of NEC in the broad ligament of the uterus. The patient was a 74-year-old woman with symptoms of abdominal distension and constipation. Ultrasound sonography detected an abdominal tumor larger than 10 cm. She was then admitted to our hospital. She underwent surgery under the diagnosis of ovarian cancer, but the bilateral ovaries and uterus were normal in appearance, and a tumor was developing instead from the broad ligament of the uterus. The patient then received a hysterectomy, salpingo-oophorectomies, and lymphadenectomy, and the peritoneal membrane was stripped around the pelvic space. Despite our suggestion, she never accepted the adjuvant treatment. She discontinued her periodic follow-up with and was followed in another hospital. Generally, the prognosis of NEC is poor, and there is no established treatment for a tumor in a gynecologic lesion. However, we anticipate that the accumulation of experience treating such cases will eventually lead to a standard treatment for NEC.
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http://dx.doi.org/10.4081/rt.2017.6958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617910PMC
July 2017

Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch.

Gen Thorac Cardiovasc Surg 2017 Sep 8;65(9):506-511. Epub 2017 Jun 8.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.

Purpose: Pulse wave velocity (PWV), which measures vascular stiffness, is a powerful predictor of cardiovascular event. Treatment of aneurysms with endovascular prosthesis has been reported to increase PWV. The purpose of this study was to evaluate whether an endoskeleton stent graft design has less effect on PWV than the exoskeleton stent graft design.

Methods: Between July 2008 and September 2016, 74 patients underwent endovascular treatment of aortic arch aneurysm in our institution. PWV before and after surgery were compared between those who underwent treatment with Najuta, an endoskeleton stent graft (n = 51), and those treated with other commercially available exoskeleton stent grafts (n = 23).

Results: Preoperative PWV (endoskeleton: 2004 ± 379.2 cm/s vs. exoskeleton: 2083 ± 454.5 cm/s, p = 0.47) was similar between the two groups. Factors that were associated with preoperative PWV were age (r = 0.37, 95% CI 0.15-0.56, p = 0.002) and mean arterial pressure (r = 0.53, 95% CI 0.34-0.68, p < 0.001). There was a significant increase in PWV in patients treated by exoskeleton stent grafts (before: 2083 ± 454.5 cm/s vs. after: 2305 ± 479.7 cm/s, p = 0.023) while endoskeleton stent graft showed no change in PWV (before: 2003 ± 379.2 vs. after: 2010 ± 521.1, p = 0.56). In a multivariate analysis, mean arterial pressure (coef 17.5, 95% CI 6.48-28.59, p = 0.002) and exoskeleton stent graft (coef 359.4, 95% CI 89.36-629.43, p = 0.010) were independently associated with PWV after surgery.

Conclusions: Physiological changes after endovascular treatment should be considered including effect on vascular stiffness. Endoskeleton stent graft may provide aneurysm repair with minimum effect in PWV after surgery.
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http://dx.doi.org/10.1007/s11748-017-0787-8DOI Listing
September 2017

Intravenous leiomyomatosis treated with radical hysterectomy and adjuvant aromatase inhibitor therapy.

J Obstet Gynaecol Res 2016 Oct 19;42(10):1405-1408. Epub 2016 Jul 19.

Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, Japan.

Intravenous leiomyomatosis (IVL), a rare disease that is histologically benign but clinically aggressive, is characterized by the intraluminal growth of benign leiomyoma in the intrauterine and systemic veins. Preoperative diagnosis of IVL is difficult, because the symptoms of early stage IVL are similar to those of uterine leiomyoma. The efficacy of adjuvant hormone therapy after surgical resection of IVL remains unclear. Herein is described a case of IVL that was diagnosed preoperatively, in which successful total resection of the tumor was achieved by radical hysterectomy. The patient, a 50-year-old premenopausal Japanese woman, also underwent aromatase inhibitor treatment and was free of disease at 36 months after surgery. Contrast-enhanced computed tomography is suggested as the best assessment for identifying and diagnosing IVL. Radical hysterectomy can be considered a successful therapy for total resection. Aromatase inhibitor treatment may be effective, especially when the patient has not yet entered menopause.
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http://dx.doi.org/10.1111/jog.13063DOI Listing
October 2016

[Total Aortic Arch Replacement by Minimally Invasive Approach in a Patient with Permanent Tracheostomy;Report of a Case].

Kyobu Geka 2016 Jun;69(6):481-4

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Standard full median sternotomy for total aortic arch replacement in patients with tracheostomy has higher risks for mediastinitis and graft infection. To avoid surgical site infection, it is necessary to keep a sufficient distance between the tracheostomy and the site of surgical skin incision. We herein report a case of a 74-year-old man with permanent tracheostomy after total laryngectomy, who underwent total aortic arch replacement for an aneurysm. Antero-lateral thoracotomy in the 2nd intercostal space with lower partial sternotomy( ALPS approach) provided an enough distance between the tracheostomy and the surgical field. It also provided a good view for surgical procedure and enabled the standard setup of cardiopulmonary bypass with ascending aortic cannulation, venous drainage from the right atrium and the left ventricular venting through the upper right pulmonary vein. The operation was completed in 345 minutes and the patient was discharged on the 11th postoperative day without any complications.
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June 2016

Combined large-cell neuroendocrine carcinoma and endometrioid adenocarcinoma of the endometrium: A case report and survey of related literature.

J Obstet Gynaecol Res 2016 Feb;42(2):206-10

Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan.

Primary large-cell neuroendocrine carcinoma of the endometrium is extremely rare and has a poor prognosis. This report describes a case of combined large-cell neuroendocrine carcinoma and endometrioid adenocarcinoma of the endometrium diagnosed as stage IIIA. The patient underwent surgery and chemotherapy and has been well with no evidence of disease for 20 months. The optimal treatment for this rare tumor has not been established. Considering its rarity and variability, it is difficult to establish an evidence-based therapeutic regimen.
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http://dx.doi.org/10.1111/jog.12881DOI Listing
February 2016

Urgent Surgical Management of Deep Femoral Artery Aneurysm in a Patient with Pre-Vasculo-Behcet Status.

Ann Vasc Dis 2015 26;8(2):116-9. Epub 2015 May 26.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

We report a case of deep femoral artery (DFA) aneurysm associated with pre-vasculo-Behcet status. A 34-year-old man with a history of recurring oral and genital ulcers was admitted complaining of worsening left thigh pain over the previous 30 days. Computed tomography showed a left DFA aneurysm (60 mm × 70 mm), concomitant aneurysms in the popliteal and carotid arteries, and deep vein thrombosis. Active pre-vasculo-Behcet status was diagnosed, and DFA ligation was performed urgently. Remission was achieved with postoperative prednisolone and colchicine without vascular complications. DFA aneurysm and vascular pathologies were successfully managed by ligation surgery and medical therapy.
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http://dx.doi.org/10.3400/avd.cr.15-00017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485043PMC
July 2015

A Case of Lymphoepithelioma-like Carcinoma in the Uterine Cervix.

Rare Tumors 2015 Feb 26;7(1):5688. Epub 2015 Mar 26.

Department of Obstetrics and Gynecology, Oita, University, Faculty of Medicine , Japan.

Lymphoepithelioma-like carcinoma occurring in the reproductive organs is a rare variant of squamous cell carcinoma, and this tumor of the uterine cervix accounts for 0.7% of all primary cervical uterine neoplasms. Associations with Epstein-Barr virus (EBV) and human papilloma virus (HPV) have been demonstrated in some studies. Some investigators suggested that EBV has an important role in the initiation of lymphoepitheliomalike carcinoma in Asian women. Here we report the case of a 45-year-old Japanese woman, gravida 2 and parity 2. She was admitted due to severe atypical genital bleeding caused by uterine cervical cancer. A >60-mm tumor was detected at the uterine cervix, and no distal metastasis or swallowing of lymph nodes was revealed by magnetic resonance imaging and a computed tomography scan. The cervical cancer stage FIGO Ib2 was diagnosed, and a radical hysterectomy was performed for this malignant tumor. The in situ hybridization for EBV was negative. HVP infection was strongly suspected because the squamous cell carcinoma was observed macroscopically in the uterine cervix. The prognosis of uterine lymphoepithelioma-like carcinoma is thought to be better than those of other cervical cancer types, but careful follow-up at fixed intervals is recommended. The patient has been followed up for 4 months since her surgery, and no evidence of recurrence has been detected.
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http://dx.doi.org/10.4081/rt.2015.5688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387360PMC
February 2015

[Valve replacement after omentum flap for medicastinitis;report of a case].

Kyobu Geka 2015 Feb;68(2):129-32

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

A 71-year-old woman presented with heart failure due to aortic and mitral valve regurgitation. She had developed midiastinitis and graft infection, 15 months before, following replacement of the ascending aorta for acute aortic dissection. Omentum flap operation had been performed and the infection had been controlled. This time, she underwent re-thoracotomy, and replacement of ascending aorta, aortic valve replacement and mitral valve plasty were performed. The omenal tissue was exfoliated without any damage to the heart or the great vessels by using an ultrasonic scalpel. As the omental tissue was viable, it was placed back in the mediastinal space.
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February 2015

Endovascular repair of thoracic aortic aneurysm associated with right-sided aortic arch: report of two cases.

Gen Thorac Cardiovasc Surg 2016 Sep 30;64(9):552-7. Epub 2014 Dec 30.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Amanuma-cho 1-847, Saitama, 330-8503, Japan.

Right-sided aortic arch (RAA) is a rare congenital disorder. We describe herein two cases of thoracic aortic aneurysm with a right aortic arch and right-sided descending aorta treated with thoracic endovascular aortic repair (TEVAR). In one case, a 70-year-old man with Edwards type 1 RAA underwent TEVAR using a Relay stent-graft (Bolton Medical, Barcelona, Spain). In another case, a 72-year-old woman with Edwards type 3 RAA underwent TEVAR using a Kawasumi Najuta stent-graft (Kawasumi Laboratories, Inc., Tokyo, Japan) with the "buffalo horn chimney technique", our original method for left subclavian artery flow preservation. The postoperative courses were uneventful. Postoperative computed tomography showed complete exclusion of the aneurysm without endoleakage. Compared to conventional open surgical repair, TEVAR is challenging in patients with a RAA and right-sided descending aorta. However, our results showed that TEVAR might be feasible and a treatment option even in a patient with a RAA and right-sided descending aorta.
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http://dx.doi.org/10.1007/s11748-014-0514-7DOI Listing
September 2016

Three cases of immature teratoma diagnosed after laparoscopic operation.

Clin Med Insights Case Rep 2014 3;7:91-4. Epub 2014 Sep 3.

Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan.

While mature cystic teratoma of the ovary is the most common ovarian tumor in young women, immature teratoma is a very rare tumor, representing only 1% of all ovarian cancers. In the three cases presented here, young women who were suspected to have mature cystic teratoma, based on CT scan and MRI, were ultimately diagnosed with immature teratoma Ic (b) G1 after laparoscopic operation. They underwent salpingo-oophorectomy of the affected side only and have shown no sign of recurrence during follow-up. We sometimes encounter patients with immature teratoma who have no findings pointing to malignancy on CT or MRI. Generally, if the components of immature nerve cells that represent immature teratoma are very few, it is difficult to diagnose the entity as immature teratoma with imaging evaluations such as CT or MRI. In many hospitals, laparoscopic surgery is selected for patients with ovarian mature teratoma. Therefore, it is essential to attempt as much as possible not to disseminate the fluid content of the tumor into the intra-abdominal space during laparoscopic operation, because in rare cases the tumor turns out not to be benign mature teratoma.
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http://dx.doi.org/10.4137/CCRep.S17455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159361PMC
September 2014

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection.

J Thorac Cardiovasc Surg 2015 Feb 13;149(2 Suppl):S91-8.e1. Epub 2014 Aug 13.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Objective: We investigated the long-term outcomes of repair for acute type A aortic dissection on the basis of false lumen status and assessed treatment modalities for the enlarged downstream aorta.

Methods: Between January 1990 and March 2013, 534 patients underwent surgery for acute type A aortic dissection. In-hospital mortality was 9.3% (50/534), and follow-up was 98% (472/484). Of the 472 hospital survivors, 451 (96%) underwent contrast-enhanced computed tomography within 1 month of surgery. Risk-adjusted survival and distal aortic events were investigated in these 451 patients. Surgical outcomes of distal reoperations were assessed in 37 patients.

Results: Postoperative false lumen patency was 62% (280/451). Eighteen patients died of aortic rupture, 17 (94%) with a patent false lumen. A patent false lumen decreased survival (hazard ratio [HR], 1.70; P = .012) and increased distal aortic events (HR, 4.11; P = .001). Other predictors identified were age (HR, 1.07; P < .001) and male sex (HR, 1.89; P = .002) for late mortality, and Marfan syndrome (HR, 6.6; P < .001), distal aortic diameter greater than 45 mm (HR, 4.4; P < .001), and nonresection of the primary entry (HR, 2.3; P = .005) for distal aortic events. Distal reoperations comprised open repair of the arch (n = 13), descending aorta (n = 16), or thoracoabdominal aorta (n = 7) or thoracic endovascular aortic repair (n = 7), with no in-hospital death or paraplegia. Although thoracic endovascular aortic repair yielded false lumen thrombosis around the stent graft in 80% of patients (4/5), complete false lumen thrombosis was achieved in 20% (1/5).

Conclusions: False lumen patency influences the late outcomes of acute type A aortic dissection repair. Outcomes of distal reoperation were acceptable; thus, careful follow-up and timely reoperation may improve the late outcomes.
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http://dx.doi.org/10.1016/j.jtcvs.2014.08.008DOI Listing
February 2015
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