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The aim of this study was to evaluate the influence of withdrawing pioglitazone (Pio) on glycemic control and identify indicators of deterioration of the HbAlc level following Pio withdrawal in 159 type 2 diabetes subjects. The HbAlc levels were retrospectively evaluated 12 months after withdrawal. There were no restrictions on changes in other antidiabetic drugs, the use of which increased in 140 patients (88.1 %) during the observation period. Consequently, the HbAlc levels were found to be elevated by more than 1.5 % following the withdrawal of Pio in 43 patients (27.0 %) at 5.81 ± 2.91 months on average, a rate that was significantly higher than that observed in the control group (27.0 % vs 6.9 %, p< 0.000005). Furthermore, in the logistic regression analysis, a female sex and the use of three or more oral antidiabetic drugs were selected as explanatory variables for deterioration of the HbAlc level following the withdrawal of Pio. Our results indicated a marked increase in HbAlc in approximately 30 % of the subjects who discontinued Pio, with an interval of approximately six months for deterioration. We therefore suggest that withdrawing Pio therapy is likely to result in unfavorable effects on glycemic control, especially in female patients receiving multidrug therapy. Source

Tamada S.,Bellland General Hospital | Omachi T.,Bellland General Hospital | Ito T.,Bellland General Hospital | Kawashima H.,Osaka City University | Nakatani T.,Osaka City University
Japanese Journal of Urology

A 64-year-old man visited our hospital presenting with macroscopic hematuria. Right hydronephrosis and hypertrophy of the prostate were shown by DIP and MRI respectively. A small papillary tumor at the prostatic urethra was found by cystourethroscopy. Then, we performed transurethral resection of the tumor and trans-perineal needle biopsy of the prostate, and diagnosed him as primary urothelial carcinoma of the prostate. Following neo-adjuvant chemotherapy (MVAC), the patient was treated with radical cystoprostatectomy. The histopathological examination showed urothelial carcinoma with concomitant sarcomatous transformation. Six months after the surgery, he had a recurrence of the tumor in the pelvic cavity. He was treated with the second-line chemotherapy using paclitaxel and gemcitabin combined with the radiation therapy, resulting in the disappearance of the tumor. No evidence of the recurrence has been observed for 3 years. © 2010 Japanese Urological Association. Source

Yamazaki K.,Bellland General Hospital | Fujio N.,Bellland General Hospital | Ishikawa N.,Bellland General Hospital | Watanabe H.,Bellland General Hospital | Kameyama M.,Bellland General Hospital
Japanese Journal of Cancer and Chemotherapy

This study compared the efficacy and safety of a 3-day-type transdermal fentanyl patch conversion by the rapid titration method to short-acting oral oxycodone for cancer pain. We evaluated seven hospitalized cancer patients who had moderate to severe cancer pain. Pain intensity was rated using an 11-point (0-10) numerical rating scale (NRS). All 7 patients initially reported their pain intensity at rest as NRS≧4 during treatment by Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Short-acting oral oxycodone (OxiNorm®) 5 mg was administered to all patients. One hour after short-acting oral oxycodone was administered, pain assessment was carried out using NRS by the author. Short-acting oral oxycodone was administered four times a day periodically, and as a rescue dose. If the total daily dose of short-acting oral oxycodone was stable for 2 days, we switched to the 3-day-type transdermal fentanyl patch. The optimal dosage of the 3-day-type transdermal fentanyl patch was determined by titration of short-acting oral oxycodone. All 7 patients reported mild levels (NRS≦2) of cancer pain for 2 days. No serious side effects were reported. The 3-day-type transdermal fentanyl patch conversion by the rapid titration method with short-acting oral oxycodone can be accomplished safely and effectively for patients with moderate cancer pain. Source

Ichikawa T.,Bellland General Hospital | Ogawa M.,Bellland General Hospital | Kawasaki M.,Bellland General Hospital | Demura K.,Bellland General Hospital | And 6 more authors.
Japanese Journal of Gastroenterological Surgery

A 71-year-old woman who complained of vomiting was admitted to our hospital because abdominal computed tomography detected bowel obstruction due to gallstone. C reactive protein markedly elevated although white blood cell counts were not elevated, and serum concentrations of CEA and CA19-9 were within normal range. Gastrointestinal imaging showed cholecystduodenal fistula, aircholangiogram, and gallstone in the ileum. We diagnosed gallstone ileus. An ileus catheter was inserted, and surgery was performed when renal function recovered. A gallstone 3 cm in diameter was found in the ileum 100 cm on the oral side of the ileocecal valve, and atrophic gallbladder with cholecystoduodenal fistula was found. We performed cholecystectomy with resection of the fistula and removed the gallstone in the small intestine. Microscopically, cancer cells were found in the gallbladder mucosa, and immunohistochemically, cancer cells were positive for p53 antibody and MIB-1 antibody respectively. Pseudopyloric gland type metaplasia was found in non-tumorous mucosa, however intestinal metaplasia was not found. Finally, intramucosal gallbladder carcinoma was diagnosed, and the surgical margin was positive. Additionally, a curative resection was performed after 2 months from the first operation. Biliary carcinoma must be carefully considered in patients with internal biliary fistula. © 2012 The Japanese Society of Gastroenterological Surgery. Source

Horiuchi T.,Bellland General Hospital | Noguchi T.,Bellland General Hospital | Kurita N.,Bellland General Hospital | Yamaguchi A.,Bellland General Hospital | And 3 more authors.
Japanese Journal of Anesthesiology

We present two patients developing intraoperative massive bleeding and showed ischemic changes in the electrocardiogram and circulatory collapse accompanied by severe anemia owing to the delay of red blood cell concentrate transfusion. One patient underwent hepatectomy and the other pancreaticoduodenectomy. Their lowest hemoglobin concentration was around 2 g • dl-1, and they showed ischemic changes in the electrocardiogram and severe decreases in blood pressure. The former received compatible red blood cell concentrate and the latter received uncrossmatched same blood group red blood cell concentrate immediately, and their electrocardiogram and blood pressure quickly improved. To avoid life-threatening anemia emergency red blood cell concentrate transfusion including compatible different blood group transfusion should be applied for intraoperative massive bleeding. Source

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