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Rapid Progression of Cerebral Infarction after Intraventricular Hemorrhage in Adult Moyamoya Disease
Matsumoto, Hiroaki,Yoshida, Yasuhisa The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.5
The authors present a rare case of adult moyamoya disease in which a patient experienced rapid progression of cerebral infarction after intraventricular hemorrhage (IVH). A healthy 39-year-old woman was admitted to our hospital with sudden headache, a decreased level of consciousness and mild tetraparesis. Initial magnetic resonance imaging revealed small cerebral infarction and IVH. Although the patient underwent conservative therapy including hypervolemia, hemodilution, keeping moderate hypertension and administration of a free radical scavenger, she showed a fulminant clinical course of cerebral infarction. The authors discuss the possible pathophysiology and suggest the treatment for such cases.
Prognostic value of neutrophil-to-lymphocyte ratio in early-stage ovarian clear-cell carcinoma
Kosuke Yoshida,Nobuhisa Yoshikawa,Akira Shirakawa,Kaoru Niimi,Shiro Suzuki,Hiroaki Kajiyama,Fumitaka Kikkawa 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6
Objectives: There is increasing evidence that systemic inflammatory response (SIR) markersare prognostic factors for various types of cancers. This is the first study to evaluate theusefulness of SIR markers for the prognosis of early-stage ovarian clear-cell carcinoma (OCCC). Methods: We retrospectively investigated 83 patients diagnosed with stage I–II OCCC whounderwent surgery between 2005 and 2017. Initially, receiver operating characteristic curveanalysis for overall survival (OS) was used to determine optimal cut-off values for neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Patients were stratifiedinto 2 groups by the cut-off values (NLR=3.26, PLR=160). Univariate and multivariateanalyses were performed to elucidate the significance of SIR markers as prognostic factors. Results: In the median follow-up period of 64.1 months, 16 patients experienced recurrence,and nine patients died. The Kaplan-Meier curve showed that OS of the NLR-low group wassignificantly longer than the NLR-high group (p=0.021). There was no significant differencein progression-free survival between the 2 groups (p=0.668), but the post-recurrencesurvival of the NLR-low group was significantly longer than the NLR-high group (p=0.019). Furthermore, multivariate analysis showed that increase in NLR is a significant independentprognostic factor for poor prognosis (hazard ratio=7.437, p=0.017). There was no significantdifference between PLR-low and PLR-high group. Conclusion: Results suggest that NLR can be a significant independent prognostic factor forearly-stage OCCC.
Hiroshi Yoshida,Hiroko Machida,Koji Matsuo,Yoshito Terai,Takuma Fujii,Masaki Mandai,Kei Kawana,Hiroaki Kobayashi,Mikio Mikami,Satoru Nagase 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.3
Objective: Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan. Methods: This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015–2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined. Results: A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44–4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%. Conclusion: MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.