Toshihiko Ueyama

Publications (3)6.52 Total impact

• Article: Anatomie resection for severe blunt liver trauma in 100 patients: Significant differences between young and elderly

  Kouji Tsugawa, Nobuhiro Koyanagi, Makoto Hashizume, Katsuhiko Ayukawa, Hiroya Wada, Morimasa Tomikawa, Toshihiko Ueyama, Keizo Sugimachi
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  ABSTRACT: The liver is the organ most commonly injured during blunt abdominal trauma. As our society ages, emergency surgery for active elderly patients increases, but data on aggressive emergency hepatic resection remain scarce in the literature. The purpose of this study was to determine whether the elderly (70 years of age or older) can tolerate major liver injury and subsequent hepatic resection. We investigated 100 patients who were treated by an anatomic resection for severe blunt liver trauma (29 elderly patients who were 70 years of age or older and 71 young patients who were younger than 70 years of age) in a retrospective study. The elderly patients were more severely injured as demonstrated by a higher Injury Severity Score, a lower Glascow Coma Scale, and lower survival (80.3% vs. 65.5%; p<0.05). The total number of associated injuries was greater in elderly patients. Motor vehicle accidents were responsible for 71.8% of the injuries in the young group, and the predominant mechanism in the elderly patients was also motor vehicle accidents (51.7%). The 71 anatomic hepatic resections performed on the young patients included right hemihepatectomy (n=45), left lateral segment resection (n=14), bisegmentectomy (n=5), and others. The 29 anatomic hepatic resections performed for the elderly patients were right hemihepatectomy (n=15), left lateral segment resection (n=5), left hemihepatectomy (n=4), and others. Pneumonia, subphrenic abscess, and urosepsis occurred at a significantly higher frequency in elderly patients than in young patients. Our data clearly indicated that (1) the mechanism of injury, grade of associated intraabdominal injuries, distribution of surgical procedures, and complications differ significantly between young and elderly patients; and (2) the survival rate (65.5%) in elderly patients may be sufficient to consider anatomic hepatic resection to be a useful, safe procedure. Le foie est l’organe le plus souvent lésé lors des traumatismes fermés de l’abdomen. En raison du vieillissement de notre société, le besoin d’envisager une chirurgie d’urgence pour les gens âgés augmente. Cependant, les données dans la littérature sur les résections hépatiques agressives en urgence sont très rares. Le but de cette étude a été de déterminer comment le sujet âgé de 70 ans ou plus supporte des lésions hépatiques majeures et ensuite comment il supporte une résection hépatique en conséquence. Nous avons revu rétrospectivement les dossiers de 100 patients traités par résection réglée pour traumatisme fermé sévère du foie (29 patients âgés qui avaient 70 ans ou plus, et 71 patients plus jeunes, moins de 70 ans). Les patients âgés de 70 ans ou plus avaient des lésions plus graves comme on pouvait le constater par un score ISS plus élevé, un score de Glasgow plus bas, et un taux de survie plus bas (80.3 vs. 65.5%, p<0.05). Le nombre total de lésions associées était plus élevé chez les patients plus âgés. Les accidents de voitures étaient responsables de 71.8% des lésions chez les plus jeunes; ils étaient également la cause principale chez les personnes âgées (51.7%). Parmi les 71 résections hépatiques réglées chez le sujet jeune, on note, parmi les interventions principales, l’hémihépatectomie droite (n=45), la résection segmentaire latérale gauche (n=14) et la bisegmentectomie (n=5). Parmi les 29 résections hépatiques réglées chez les sujets plus âgés, on note principalement l’hémi hépatectomie droite (n=15), la résection segmentaire latérale gauche (n=5) et l’hémihépatectomie gauche (n=4). On a noté plus de complications comme l’infection pulmonaire, les abcès sous-phréniques et les infections urinaires chez les patients plus âgés que chez le patient plus jeune. Nos données indiquent clairement que: (1) le mécanisme des lésions, le degré des lésions intra-abdominales associées et les complications diffèrent significativement entre les patients ages et jeunes, et (2) le taux de survie (65.5%) chez les patients plus âgés est une preuve que la résection hépatique réglée chez le sujet est utile et sure. El hígado es la víscera que con más frecuencia se lesiona en los traumatismos cerrados de abdomen. Dado que nuestra sociedad envejece más, la cirugía de urgencia en pacientes añosos es cada vez más frecuente. Sin embargo, la bibliografía sobre las resecciones hepáticas urgentes es escasa. El objetivo del trabajo fue averiguar si los viejos (de 70 o más años) pueden o no soportar traumatismos hepáticos mayores, así como la subsiguiente resección hepática. Se estudiaron retrospectivamente 100 pacientes que por grave traumatismo cerrado de hígado requirieron una resección hepática anatómica (29 tenÍan 70 o más años y 71 menos de 70 años). Los pacientes añosos presentaron traumatismos más graves como demostraba su alta puntuación en la escala ISS, la baja puntuación en la GCS y la escasa supervivencia (80.3 vs 65.5%, p<0.05). El número total de traumatismos asociados fue mayor en los pacientes añosos. Los accidentes viarios fueron la causa etiológica más frecuente tanto en los traumatizados jóvenes (71.8%) como en los viejos (51.7%). En pacientes jóvenes se practicaron 71 hepatectomías anatómicas que comprendieron: hemihepatectomía derecha (n=45), resección segmenteria lateral izquierda (n=14), bisegmentectomía (n=5) y otros tipos de resección. En ancianos, se realizaron 29 resecciones hepáticas anatómicas: hemihepatectomía derecha (n=15), resección segmentaria lateral izquierda (n=5), hemihepatectomía izquierda (n=4) y otros tipos de resecciones. Complicaciones tales como pneumonías, abscesos subfrénicos, urosepsis, fueron mucho más frecuentes en los pacientes añosos. Nuestros hallazgos demuestran: (1) que el mecanismo del trauma, el número de lesiones traumáticas asociadas intraabdominales, el tipo de intervención quirúrgica y las complicaciones son totalmente diferentes en pacientes jóvenes que en los viejos y (2) que la supervivencia (65.5%) en los pacientes añosos es alta, por lo que la resección hepática anatómica puede considerarse un procedimiento útil y seguro.
  World Journal of Surgery 04/2012; 26(5):544-549. · 2.36 Impact Factor
• Article: The risk factors for mortality of community-acquired pneumonia in Japan.

  Rei Fujiki, Tomotaka Kawayama, Toshihiko Ueyama, Masao Ichiki, Hisamichi Aizawa
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  ABSTRACT: Community-acquired pneumonia remains one of the most important diseases associated with mortality. The aim of this study was to identify the risk factors for mortality in patients with community-acquired pneumonia in Japan. This prospective study was carried out at the Social Insurance Tagawa Hospital, Fukuoka, Japan. All patients were managed according to the 1993 American Thoracic Society guidelines for community-acquired pneumonia, after an evaluation of the risk class by the pneumonia Patient Outcome Research Team (PORT) study. A comparison of several factors, including demographic findings, clinical signs, underlying diseases, results of medical examinations, severity of diseases, and causative pathogens in both survival and fatal groups, was carried out from 227 episodes of community-acquired pneumonia in 208 hospitalized patients (128 men, mean age 67.7 years). The presence of a risk of aspiration, low systolic blood pressure, low PaO(2)/FIO(2) ratio, a high pneumonia score, and the presence of severe congestive heart failure were found to be independent risk factors for mortality from community-acquired pneumonia. The mortality in risk classes IV and V was 17.5% and 54.2%, respectively, and there was a significant correlation between risk classes. The risk factors we identify here are generally similar to those given in previous reports in Western countries. According to the prediction rule of the pneumonia PORT study, the risk classes were strongly associated with the mortality, and would be suitable and helpful for the management of patients with community-acquired pneumonia in Japan.
  Journal of Infection and Chemotherapy 07/2007; 13(3):157-65. · 1.80 Impact Factor
• Article: Anatomic resection for severe blunt liver trauma in 100 patients: significant differences between young and elderly.

  Kouji Tsugawa, Nobuhiro Koyanagi, Makoto Hashizume, Katsuhiko Ayukawa, Hiroya Wada, Morimasa Tomikawa, Toshihiko Ueyama, Keizo Sugimachi
  [show abstract] [hide abstract]
  ABSTRACT: The liver is the organ most commonly injured during blunt abdominal trauma. As our society ages, emergency surgery for active elderly patients increases, but data on aggressive emergency hepatic resection remain scarce in the literature. The purpose of this study was to determine whether the elderly (70 years of age or older) can tolerate major liver injury and subsequent hepatic resection. We investigated 100 patients who were treated by an anatomic resection for severe blunt liver trauma (29 elderly patients who were 70 years of age or older and 71 young patients who were younger than 70 years of age) in a retrospective study. The elderly patients were more severely injured as demonstrated by a higher Injury Severity Score, a lower Glascow Coma Scale, and lower survival (80.3% vs. 65.5%; p < 0.05). The total number of associated injuries was greater in elderly patients. Motor vehicle accidents were responsible for 71.8% of the injuries in the young group, and the predominant mechanism in the elderly patients was also motor vehicle accidents (51.7%). The 71 anatomic hepatic resections performed on the young patients included right hemihepatectomy (n = 45), left lateral segment resection (n = 14), bisegmentectomy (n = 5), and others. The 29 anatomic hepatic resections performed for the elderly patients were right hemihepatectomy (n = 15), left lateral segment resection (n = 5), left hemihepatectomy (n = 4), and others. Pneumonia, subphrenic abscess, and urosepsis occurred at a significantly higher frequency in elderly patients than in young patients. Our data clearly indicated that (1) the mechanism of injury, grade of associated intraabdominal injuries, distribution of surgical procedures, and complications differ significantly between young and elderly patients; and (2) the survival rate (65.5%) in elderly patients may be sufficient to consider anatomic hepatic resection to be a useful, safe procedure.
  World Journal of Surgery 05/2002; 26(5):544-9; discussion 549. · 2.36 Impact Factor