INVITED REVIEW ARTICLE
Joint Degree Program for Graduate Students
at the Nagoya University Graduate School of Medicine
Hideki Kasuya, Branko Aleksic, Seiji Sumigama, Itzel Bustos, Hitoki Hasegawa,
Mika P. Kasai, Miho Kobayashi, and Yumiko Samizo
pg(s) 183 - 192
<Abstract> - < PDF >
In a world of increasing academic mobility, most universities seek to give their students opportunities
to experience education in different countries, which is especially true for senior research students. The
Nagoya University Graduate School of Medicine started a joint degree program (JDP) for PhD students
with the University of Adelaide, Faculty of Health Science (Australia) in 2015 and with Lund University
Faculty of Medicine (Sweden) in 2017. Furthermore, we have started a new JDP with the University of
Freiburg, Faculty of Medicine (Germany) in 2018. This article reports the issues specific to counterpart
medical schools, including student’s recruitment, the curriculum, and the general differences between each
schools. JDPs are not only important for educational collaboration, but also as a strategy to encourage
international research collaboration, which is a core criterion to a university’s world-ranking reputation.
Acquiring knowledge about educational strategies that are implemented in different foreign medical schools
represents a unique opportunity to improve our own curriculum.
ORIGINAL PAPERS
Epidemiological overview of metastatic ovarian carcinoma:
long-term experience of TOTSG database
Hiroaki Kajiyama, Shiro Suzuki, Fumi Utsumi, Kimihiro Nishino, Kaoru Niimi,
Mika Mizuno, Nobuhisa Yoshikawa, Michiyasu Kawai, Hidenori Oguchi, Kimio Mizuno,
Osamu Yamamuro, Kiyosumi Shibata, Tetsuro Nagasaka, and Fumitaka Kikkawa
pg(s) 193 - 198
<Abstract> - < PDF >
Malignant ovarian neoplasm is one of the most lethal malignancies among cancers of the female
reproductive system. Occasionally, these tumors originate from non-ovarian organs as metastatic lesions
since the ovary is a frequent metastatic target of many cancers. However, there limited clinical information
on metastatic ovarian carcinoma (MOC) and its hallmarks are unknown. During the period of 1986–2015,
4,284 patients with malignant ovarian neoplasm were identified using the Tokai Ovarian Tumor Study
Group (TOTSG) database. Of these, excluding borderline malignant tumor, 3,478 patients with malignant
ovarian cancer were extracted. The pathological slides were evaluated under central pathological review.
Among them, a total of 143 (4.1%) patients with MOC were identified. The median age of patients with
MOC was 54 (29–82) years. The most and second most frequent original tumors were colorectal (43%,
N=62) and gastric (29%, N=42) carcinoma, respectively. The rates of carcinoma of the appendix, breast,
and pancreas were 8, 6, and 4%, respectively. This is the one of the largest studies clarifying the rates
of MOC among malignant ovarian neoplasms. Although the rate is low, we should keep in mind that
MOC, particularly from colorectal and gastric cancer should be considered when encountering clinical
practice of ovarian cancer.
Health-related behavior of the people who neglect the specific
health guidance for metabolic syndrome control
Yoshihisa Hirakawa, Chifa Chiang, Mayu Yasuda Uemura, and Atsuko Aoyama
pg(s) 199 - 205
<Abstract> - < PDF >
In 2008, Japan introduced a metabolic syndrome screening and intervention program specifically
targeting individuals aged 40 to 74 years of age. However, the consultation and follow-up rates for the
intervention are still low. The present study aims to identify characteristics of health-related behavior of
the people who neglect it. We conducted a group interview targeting public health nurses and qualified
dieticians of “A” prefectural branch office of the Japan Health Insurance Association who were regularly
involved in performing the intervention. Qualitative content analysis was used to analyze the data, and four
themes were extracted: Self-taught practices, Defiance, Hesitation, and Resignation. Our results suggest that
the public health advisors recognize the importance of modification of clients’ health-related misperception,
improve their skills to develop a positive rapport with clients, and be involved in creating a supportive
environment conducive to a healthy lifestyle.
Effect of an artificial ring on mitral valve function
Jun Yokote, Yoshimori Araki, Shunei Saito, Hiroki Hasegawa, and Akihiko Usui
pg(s) 207 - 215
<Abstract> - < PDF >
Differences of the effect of annuloplasty rings on the mitral annulus and leaflets, and differences between
types of annuloplasty rings are not well known. We analyzed annular motion and leaflet movement with a
rigid or flexible ring and without a ring using an isolated swine working heart model. Hearts of 10 swine
(weight: 40–50 kg) were used for a rigid ring (n=5) and a flexible ring (n=5). Four ultrasound crystal
tips were fixed around the annulus and an annuloplasty ring was implanted in the isolated heart. In the
working heart mode, measurement of mitral annular dimension was acquired by sonomicrometry. Images of
mitral valve motion were acquired by a high-speed video camera. The same analyses were performed after
removing the artificial ring. The antero-posterior diameter of the diastole distance was significantly reduced
in the flexible ring (21.59±0.71 mm) and rigid ring (15.93±1.88 mm) compared with no ring (23.51±2.01
mm). The flexible ring made the transverse diameter shrink significantly more than did the rigid ring. The
contraction range of the transverse diameter was significantly smaller in the flexible ring compared with
no ring. The duration of opening to closing of the mitral leaflet with the rigid (124.7±4.4 ms) and flexible
rings (107.9±3.5 ms) was significantly shorter than that with no ring (168±36.5 ms). Annuloplasty rings
allow simplicity of leaflet motion, regardless of the type of artificial ring. In a flexible ring, the mitral
annulus shows a vertically long shape, suggesting preservation of posterior annular movement.
Experimental study of coil delivery wire insertion force
in intracranial aneurysm embolization: force discrepancy
generated inside the microcatheter through that coil
delivery wire passes
Kazunori Shintai, Noriaki Matsubara, Takashi Izumi, Shigeru Miyachi,
Hiroyuki Yamada, Naoki Marui, and Toshihiko Wakabayashi
pg(s) 217 - 225
<Abstract> - < PDF >
In endovascular coil embolization for intracranial aneurysms, as coils are filled in the aneurysm and the
stage of procedure is advanced, the force to push forward the coil delivery wire (insertion force) increases.
However, the coil insertion force that interventionist’s felt at his fingertips does not directly reflect the stress
of the aneurysm and is affected by the resistance generated inside the microcatheter through that the wire
passes. The authors evaluated this force discrepancy by subtracting the loading force at the tip of delivery
wire from the insertion force of delivery wire and examined the relationship among them. Experiments
were performed with the device that applies a constant loading force to the delivery wire tip with the
coil removed. A force gauge was connected to the end-tip of the delivery wire to measure the insertion
force. The force was measured by changing delivery wire in different coil brands and the conditions of
microcatheter (straight or bent position). The results demonstrated that force discrepancy generated inside
the microcatheter increased as the loading force increased in a linear relationship. Different coil delivery
wires produced differences in the way that force discrepancy changed, thus reflecting the properties of each
wire. Microcatheters with more curvature were associated with a higher force discrepancy. In conclusions,
as the loading force increases, the force discrepancy increases, and it means that the coil insertion force
that the interventionist feels at his fingertips also increases. This force discrepancy is impacted by the
delivery wire properties and microcatheter curvature.
Design of a prospective multicenter randomized controlled
trial evaluating the effects of gastric lavage on coffee-ground
emesis in neonates: study protocol
Takashi Maeda, Yoshiaki Sato, Akihiro Hirakawa, Masahiro Nakatochi, Fumie Kinoshita,
Takeshi Suzuki, Shintaro Ichimura, Ryoichi Ito, Ryuji Kudo, Michio Suzuki,
Shin Hoshino, Yuichiro Sugiyama, Hideki Muramatsu, Hiroyuki Kidokoro,
Jun-ichi Kawada, Yoshiyuki Takahashi, and Nagoya Collaborative Clinical Research Team
pg(s) 227 - 232
<Abstract> - < PDF >
Neonates who swallow a considerable amount of maternal blood may exhibit vomiting and suckling
disorder during the first few days of the postnatal period. Some clinicians treat these neonates with gastric
lavage (GL) to prevent vomiting and the establishment of enteral feeding empirically, but there was no
study assessing the effect of GL for neonates with coffee-ground emesis. We designed a multicenter
randomized controlled trial to evaluate the efficacy and safety of GL in neonates with coffee-ground emesis.
Vigorous neonates with birth weight ranging from 2500 g to 3999 g and gestational age between 37w0d
and 41w6d who presented with coffee-ground emesis on more than twice and diagnosed as false melena,
were divided into two groups using computerized randomization. We defined feeding intolerance (FI) as
(1) ≥2 vomiting episodes in 4h or ≥3 episodes in 24h and/or (2) feeding failure on at least two occasions
because of retching or poor sucking. Primary outcome is percentage of infants who present FI within 24
hours from admission. We also assessed the residual volumes, number of vomiting episodes, percentage
of weight reduction at postnatal day 4, rates of body weight gain at 1 month of age, and peak serum
total bilirubin value before discharge. To our knowledge, this is the first study to evaluate the safety and
efficacy of GL for neonates with coffee-ground emesis. This trial is registered at UMIN Clinical Trials
Registry as UMIN000026483.
Phase II study of chemoradiotherapy combined with
gemcitabine plus nab-paclitaxel for unresectable locally
advanced pancreatic ductal adenocarcinoma (NUPAT 05
Trial): study protocol for a single arm phase II study
Nao Takano, Suguru Yamada, Akihiro Hirakawa, Yukihiro Yokoyama, Hiroki Kawashima, Osamu Maeda, Tohru Okada, Eizaburo Ohno, Junpei Yamaguchi, Takuya Ishikawa, Fuminori Sonohara, Masaya Suenaga, Hideki Takami, Masamichi Hayashi, Yukiko Niwa, Yoshiki Hirooka, Yoshiyuki Ito, Shinji Naganawa, Yuichi Ando, Masato Nagino, Hidemi Goto, Tsutomu Fujii, and Yasuhiro Kodera
pg(s) 233 - 239
<Abstract> - < PDF >
The efficacy of nab-paclitaxel combined with gemcitabine (GnP) and of chemoradiotherapy (CRT) for
unresectable locally advanced pancreatic ductal adenocarcinoma (UR-LA PDAC) is still unclear. We previously
conducted a phase I study of CRT using GnP and determined the recommended dose and have now
designed a phase II trial to evaluate the efficacy of CRT incorporating GnP for UR-LA PDAC. Eligibility
criteria are chemotherapy-naïve patients with UR-LA PDAC as defined by the NCCN guidelines version
2. 2016. Study patients will receive 100 mg/m2 nab-paclitaxel and 800 mg/m2 gemcitabine on Days 1, 8,
and 15 per 4-week cycle with concurrent radiation therapy (total dose of 50.4 Gy in 28 fractions of 1.8
Gy per day, 5 days per week). Treatment will be continued until disease progression or surgery, which is
to be performed only for patients in whom the disease is well-controlled at 8 months from beginning the
protocol treatment. Primary endpoint is 2-year overall survival rate and co-primary endpoint is resection
rate. Secondary endpoints are overall survival, progression free survival, time to treatment failure, response
rate, disease control rate, early tumor shrinkage, depth of response, reduction of SUV-max on PET–CT,
serum tumor markers, relative dose intensity, safety, and Quality of life. This study will show the efficacy
and safety of chemoradiotherapy combined with GnP.
The utility of ultrathin endoscopy with flexible spectral
imaging color enhancement for early gastric cancer
Takafumi Yokoyama, Ryoji Miyahara, Kohei Funasaka, Kazuhiro Furukawa,
Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima,
Osamu Watanabe, Yoshiki Hirooka, Akihiro Hirakawa, and Hidemi Goto
pg(s) 241 - 248
<Abstract> - < PDF >
Many researchers suggested that ultrathin endoscopy improves patient acceptance of endoscopic examinations.
However, ultrathin endoscopy provides less image resolution and luminous intensity. Therefore, we
focused on the visibility of early gastric cancer on ultrathin endoscopy with Flexible spectral imaging
color enhancement (FICE) in this study. Thirty-six patients with early gastric cancer were prospectively
enrolled. One endoscopist performed the endoscopic examinations by white light conventional endoscopy
(W-CE), white light ultrathin endoscopy (W-UE), FICE ultrathin endoscopy (F-UE) and white light plus
FICE ultrathin endoscopy (WF-UE) in the patients. Four other endoscopists were asked to evaluate the
visibility of gastric cancer on the W-CE, W-UE, F-UE and WF-UE images with a 5-point Likert scale.
The lesions were classified as uncolored, normocolored or reddish. We examined the color difference
between early gastric cancer and the surrounding mucosa. To examine the relationship between the color
difference and the vessel density, we also measured the difference in vessel density using pathologic
specimens stained with hematoxylin and eosin. The Likert score of WF-UE was significantly higher than
those of the other three methods (p<0.001). The color difference of F-UE was higher than that of W-CE
in the reddish group (p=0.049). The difference in vessel density was higher in the reddish group than in
the normocolored group (p=0.048). In conclusion, the visibility of early gastric cancer from the surrounding
mucosa using ultrathin endoscopy with FICE was better than that using white light conventional endoscopy,
especially for reddish lesions.
Exploration of coping styles in male patients with head and
neck cancer: a prospective cohort study
Naohiro Sato, Hiroyuki Kimura, Yasunori Adachi, Naoki Nishio, Masahiko Ando,
Tatsuya Tokura, Wataru Nagashima, Shinichi Kishi, Aya Yamauchi, Keizo Yoshida,
Mariko Hiramatsu, Yasushi Fujimoto, and Norio Ozaki
pg(s) 249 - 258
<Abstract> - < PDF >
Majority of head and neck cancer (HNC) patients are male, and more than 85% of patients with HNC
have the habit of smoking and drinking. Due to the specific demographic characteristics, HNC patients
are anticipated to have specific coping styles, affecting psychological distress, survival, and quality of life.
We explored the subscales of the Mental Adjustment to Cancer (MAC) Scale in male patients with HNC,
and then examined the correlation between revised subscales of the MAC scale and anxiety/depression.
Participants were 150 male inpatients with HNC, and their demographic and medical data were obtained.
Coping style was assessed by MAC scale. Anxiety and depression were assessed using the Hospital
Anxiety and Depression Scale. Out of 40 items in the original MAC scale, 19 items were excluded by
factor analysis, and the remaining 21 items were divided into three factors: Negative Adjustment, Positive
Adjustment, and Abandonment. Negative and Positive Adjustments were similar to the copings of mixed
gender patients with heterogeneous cancers, and Abandonment was a new subscale specific to male patients
with HNC. This subscale had a weak positive correlation with anxiety and depression. Male HNC patients
revealed a specific coping style of Abandonment, related with psychological distress. We believe that an
understanding of the Abandonment coping style revealed in our study will improve the psychological
support offered to male patients with HNC.
Fibrinogen levels measured by the dry hematology method
are lower than those measured by the Clauss method
under a high concentration of heparin
Shogo Suzuki, Takahiro Tamura, Kazuko Hasegawa, Sho Maeda, Reona Mori,
Motoshi Kainuma, Yushi Adachi, and Kimitoshi Nishiwaki
pg(s) 259 - 267
<Abstract> - < PDF >
The activity of fibrinogen has been reported to decrease soon after the onset of major bleeding and
to be an important determinant of the final extent of bleeding and postoperative outcome. A device that
measures the perioperative fibrinogen level using the dry hematology (DH) method has recently become
available. The aim of this study was to compare perioperative fibrinogen levels measured by the DH method
with those measured by the conventional Clauss method and to assess the effects of heparin on these
measurements. The study included 206 samples from 36 patients undergoing major surgery who received
high-dose heparin (HH group, 23 samples), low-dose heparin (LH group, 57 samples), or no heparin (C
group, 126 control samples). Each sample was measured using the DH and Clauss methods. After excluding
samples outside the effective measurement range, the three study groups (HH group, n=23; LH group,
n=49; C group, n=115) were compared. The mean fibrinogen level measured by the DH method in the
HH group (87.9 ± 3.1%) was significantly lower than that measured by the Clauss method. There were no
significant differences between the fibrinogen measurements obtained by the two methods between the LH
and C groups. In patients on high-dose heparin, the mean fibrinogen level measured by the DH method
was significantly lower than that measured by the Clauss method. When hemorrhage requires emergency
treatment, a method that can measure the fibrinogen level rapidly is important. The DH method may be
useful for decision-making with regard to perioperative coagulation factor replacement.
Outbreak detection of influenza-like illness in Prey Veng
Province, Cambodia: a community-based surveillance
Puthik Long-Hay, Eiko Yamamoto, Sreng Bun, Thai Savuth, So Buntha, Soy Sokdaro,
Tetsuyoshi Kariya, Yu Mon Saw, Yi Sengdoeurn, and Nobuyuki Hamajima
pg(s) 269 - 280
<Abstract> - < PDF >
On June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with
influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the
outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the
village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and
patients’ records in health facilities. The team interviewed all households in the village from May 1 to
June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms,
and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected
ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases,
including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0
per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5–14
years followed by 0–4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven
nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms
had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal
influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and
sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable
to identify this epidemic, it needs to be improved.
Cognitive function measured with the Revised Hasegawa’s
Dementia Scale among elderly individuals in Lao PDR
Sengchanh Kounnavong, Kethmany Ratsavong, Khouanchay Soundavong, Syda Xayavong,
Tetsuyoshi Kariya, Yu Mon Saw, Eiko Yamamoto, Kentaro Horibe, Kenji Toba,
and Nobuyuki Hamajima
pg(s) 281 - 290
<Abstract> - < PDF >
In Lao PDR, measurement of cognitive function has rarely been conducted among elderly individuals.
This study aimed to investigate the cognitive function among elderly individuals who lived at their homes
with family in Lao PDR. Participants were elderly individuals aged 60 years or over registered with the
local government in urban (Vientiane capital; VC) and rural areas (Khammouane province; KP). Those with
serious mental/physical diseases, those who could not walk by themselves, or those who could not speak
the Lao language were excluded. The information was collected through interviews with the participants
and their family members. A newly developed Lao version of the Revised Hasegawa’s Dementia Scale
(HDS-R) was applied to measure cognitive function. The participants were 414 elderly individuals (224
males and 190 females) aged 60 to 98 years. The average HDS-R score was 23.0 among 115 men in
VC, 22.7 among 92 women in VC, 20.3 among 109 men in KP, and 17.5 among 98 women in KP. The
main caregiver was a daughter (40.6%) followed by a spouse (31.4%). Among 414 elderly individuals, 42
(10.0%) stated the necessity of support. Those with HDS-R < 20 accounted for 38.8% in men and 48.9%
in women. The adjusted odds ratio of HDS-R < 20 was significant for those in rural areas (3.83) relative
to those in urban areas. Among superficially healthy elderly individuals residing with their families, those
with reduced cognitive function were more common among women and in rural areas.
Evaluation of intra-tumoral blood feeding to predict
the effect of induction therapy in patients
with locally advanced lung cancer
Koji Kawaguchi, Takayuki Fukui, Masaki Goto, Shota Nakamura, Shuhei Hakiri,
Naoki Ozeki, Taketo Kato, Shunsuke Mori, Kumiko Hashimoto, Shingo Iwano,
and Kohei Yokoi
pg(s) 291 - 301
<Abstract> - < PDF >
There is little known about predictors of the effects of induction therapy in locally advanced lung
cancer, including superior sulcus tumors. We analyzed whether intra-tumoral blood feeding could predict
a pathologic complete response (pCR). Patients who underwent induction therapy followed by surgery for
locally advanced lung cancer were retrospectively reviewed. The intra-tumoral blood feeding was defined
by the CT value (HU, Hounsfield unit), which was calculated by subtracting the non-enhanced value
from the contrast-enhanced value (divided into the early and delayed phase) at the maximum diameter
of the tumor on dynamic CT. The cases were classified, according to the efficacy of induction therapy,
into the pCR and residual tumor (pRT) group. There were 38 cases of T3 and 12 of T4; the induction
therapy consisted of chemoradiotherapy in 39 patients, chemotherapy in 6, and radiotherapy in 5. A pCR
was obtained in 15 (30%) patients. The mean CT values of the early and delayed phases in the pCR
group were 14.8 and 30.7 HU, while those in the pRT were 15.3 and 32.2 HU, respectively. A logistic
regression analysis revealed that a smaller tumor size (< 42 mm) was a non-significant predictor of a
pCR (p = 0.09); the maximum standardized uptake value on FDG-PET and the CT values on the early
and delayed phases of dynamic CT were not associated with the achievement of a pCR. In conclusion,
intra-tumoral blood feeding of the locally advanced lung cancer did not predict the effects of induction
therapy, whereas smaller sized tumors tended to show a better response.
Gatekeeping in an inpatient rehabilitation facility to reduce
morbidity and mortality due to cardiac disease: screening
program using of BNP and ECG Auto-diagnosis
Naoaki Kano, Toyonori Kato, Takiko Tomohara, Yukiko Futamura, Shogo Yoshida,
Takahiro Okumura, Kengo Maeda, Toyoaki Murohara, and Koji Oda
pg(s) 303 - 312
<Abstract> - < PDF >
The Kaifukuki-Rehabilitation Ward (KRW) is a type of inpatient rehabilitation facility in Japan. In the
KRW of our institute, mortality and frequency of emergency referrals in 2013 were rather high, 2.6% and
4.3%, respectively. We aimed to investigate the usefulness of an original gatekeeping system to reduce
mortality and morbidity from cardiac complications, and to improve the quality of medical care in the
KRW. A total of 370 consecutive patients admitted to the KRW of Kobayashi Memorial Hospital between 1
May 2015 and 31 March 2016 were enrolled in this prospective observational study. All patients underwent
a screening evaluation in which we defined patients as being screen positive (SC-positive) if they had
at least one of 20 diagnostic ECG codes and/or BNP level over 140 pg/dL at admission. A cardiologist
provided weekly interventions to those among SC-positive patients who needed cardiac disease treatment
during hospitalization. In all, 129 patients were classified as SC-positive (mean age 80 years, 124 [32%]
male), and weekly intervention was needed in 28 patients, including start of cardiac medication in 17
cases. Mortality and frequency of emergency transfer due to cardiac disease during hospital stay were
0.3% and 0.3%, respectively. Our gatekeeping system involving a screening evaluation at admission and
weekly intervention in selected patients by a cardiologist may be useful in reducing mortality and rate of
transfer due to cardiac disease and may improve quality of medical care in KRWs.
Clinical outcomes of rotational atherectomy in severely
calcified in-stent restenosis: a single-center,
retrospective study
Yusuke Uemura, Kenji Takemoto, Masayoshi Koyasu, Shinji Ishikawa, Hideki Ishii,
Toyoaki Murohara, and Masato Watarai
pg(s) 313 - 323
<Abstract> - < PDF >
Neointimal calcification after stent implantation has been reported as one of the forms of neoatherosclerosis.
There are a few patients with in-stent restenosis (ISR) and an undilatable calcified neointima
who require rotational atherectomy to achieve sufficient acute gain in lumen diameter. However, the
clinical outcomes of rotational atherectomy for undilatable calcified ISR have not been fully elucidated.
Therefore, we investigated the safety and efficacy of rotational atherectomy for treating calcified ISR. This
retrospective study included 17 patients (20 lesions) who had undergone percutaneous coronary intervention
including rotational atherectomy to treat ISR with severely calcified neointima. Kaplan-Meier analysis was
used to analyze the data. The mean age of the enrolled patients was 67±18 years, and 71% were men.
The patients had highly atherogenic characteristics: 65% had diabetes mellitus and 53% were receiving
hemodialysis. Procedural success was obtained in 19 (95%) patients, and the acute gain in lumen diameter
was acceptable (1.7±0.6 mm). However, during a median follow-up of 571 days, the incidences of major
adverse cardiac and cerebrovascular events per patient and clinical-driven target lesion revascularizations
per lesion were relatively high. There were no differences in clinical outcomes according to the baseline
characteristics, type of restenotic stents, and therapeutic strategy. In conclusion, clinical outcomes of
rotational atherectomy for severely calcified ISR were unfavorable despite a high success rate and acceptable
acute gain in lumen diameter.
CASE REPORTS
A long-term survival case of Sister Mary Joseph’s nodule
caused by colon cancer and treated with
a multidisciplinary approach
Yoshinori Iwata, Takashi Kinoshita, Kenya Kimura, Koji Komori, Daisuke Hayashi,
Tomoyuki Akazawa, Itaru Shigeyoshi, Masayuki Tsutsuyama, Jiro Kawakami,
Akira Ouchi, Seiji Natsume, Norihisa Uemura, Yuichi Ito, Kazunari Misawa,
Yoshiki Senda, Tetsuya Abe, Seiji Ito, Masahiro Tajika, Yasushi Yatabe,
Kazuhiro Yoshida, and Yasuhiro Shimizu
pg(s) 325 - 329
<Abstract> - < PDF >
Umbilical metastasis from intra-abdominal or pelvic malignancy, which is called Sister Mary Joseph’s
nodule (SMJN), is rare, and it has a poor prognosis. Its most common primary sites are the stomach
and ovaries. SMJN caused by colon cancer is uncommon. A 42-year-old woman visited local clinics
with complaints of an umbilical mass. After a detailed examination, she was diagnosed with peritoneal
and umbilical metastasis caused by colon cancer. A radical surgery was performed after 12 months of
chemotherapy. 6 months later, local recurrence and ovarian metastasis were suspected. Further radical
surgery was performed, and 14 months after that (50 months after starting treatment), no recurrences have
been observed. We experienced a long-term survival case of SMJN caused by colon cancer and treated
with a multidisciplinary approach.
Use of the autologous spiral vein graft: a two-stage iliac
bypass in a potentially fatal case of pelvic trauma and
contaminated tissues
Gokalp Altun, Zerrin Pulathan, and Dogus Hemsinli
pg(s) 331 - 336
<Abstract> - < PDF >
Serious problems may be encountered in arterial or venous reconstruction in cases of severe trauma
and contaminated tissues. We report the use of a spiral venous graft (SVG) in a case of two-stage bypass
aimed at saving first life, and then the extremity.
Severe open and contaminated injury was present in the lower abdomen and pelvic region of 29-yearold
woman brought to the emergency department following a traffic accident. The patient was in shock,
and was taken for emergency surgery jointly with the relevant departments. Interposition bypasses with
synthetic graft were performed in the first stage. The synthetic grafts were subsequently removed due to
problems developing secondary to infection at subsequent follow-up, and revascularization was established
with autologous grafts together with SVG.
SVGs are alternative grafts in cases with contaminated tissues and requiring major vessel reconstruction.
This technique can add to the therapeutic options available.
Pre-surgical sunitinib treatment enabling nephron-sparing
surgery in a patient with renal cell carcinoma
in a solitary kidney
Kosuke Tochigi, Yasuhito Funahashi, Aya Mori, Yoshihisa Matsukawa, Masashi Kato, and
Momokazu Gotoh
pg(s) 337 - 340
<Abstract> - < PDF >
A 55-year-old man with a solitary kidney was diagnosed with an 8.5 cm renal cell carcinoma in the
right kidney without metastasis. Twenty five months of sunitinib treatment reduced the tumor from 8.5 to
5.5 cm and enabled nephron-sparing surgery. He has no evidence of recurrence 58 months after the surgery.