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Chitose, Japan

Objective: We investigated whether objective evaluation by using the palliative prognostic index (PPI), controlling nutritional status (COUNT), and prognostic nutritional index (PNI) can provide prognostic information during the transition from chemotherapy to palliative care in patients with advanced or recurrent gastrointestinal cancer.Methods: The subjects were 28 patients with gastrointestinal cancer who died of their disease between January 2009 and June 2012. We compared the PPI, COUNT, and PNI scores between patients who died within 90 days of completing chemotherapy (Group A, n=14) and patients who survived for 90 or more days (Group B, n=14).Results: The PPI score for Group A (4.0) was significantly higher than that for Group B (0.8) (p<0.001). The COUNT score was also significantly higher for Group A (6.3) than for Group B (3.9) (p=0.033). A significant difference in survival was evident when the cutoff value for PNI was set at 40 in the critical region (58/118, p=0.04).Conclusion: Our study suggests that the PPI, COUNT, and PNI may be useful for objective evaluation during the transition from chemotherapy to palliative care.

Namiki M.,Chitose City Hospital | Ota K.,Ebetsu City Hospital | Namiki A.,Sapporo Medical College
Japanese Journal of Anesthesiology | Year: 2010

An 83-year-old woman had felt malaise. Blood examination showed renal failure, anemia, and hypoproteinemia. On the 7th day, she suddenly had tarry stool. But, gastroscopy and colonfiberscopy disclosed no remarkable abnormality on the mucosal surface of the stomach, the duodenum and the large intestine. On the 10th day, her symptom became aggravated, and emergency laparotomy and endoscopy in the small intestine was scheduled. After the jejunotomy, she underwent endoscopy of the small intestine. The endoscopic examination showed multiple ulcer of the jejunum, and she underwent jejunectomy. Pathologic examination diagnosed her as having non specific multiple ulcer of the small intestine with jejunal lesion.

Saito H.,Hokkaido University | Nakayama N.,Hokkaido University | Takikawa S.,Chitose City Hospital | Ushikoshi S.,Hokkaido Medical Center | And 3 more authors.
Neurological Surgery | Year: 2012

Isolated abducens nerve palsies associated with the rupture of intracranial aneurysms have rarely been reported. We report two cases of isolated bilateral abducens nerve palsies occurring after subarachnoid hemorrhage due to the rupture of an intracranial aneurysm. Case 1 : A 49-year-old woman had bilateral abducens nerve palsies following subarachnoid hemorrhage due to the rupture of the left vertebral artery-posterior inferior cerebellar artery aneurysm. Case 2: A 55-year-old man had bilateral abducens nerve palsies following subarachnoid hemorrhage due to dissecting aneurysm of the right vertebral artery. Case 1 and 2 were treated with surgical clipping of the aneurysm and internal occlusion of the parent artery. In both cases, bilateral abducens nerve palsies achieved almost full recovery several months after treatment. It is speculated that the main causes of palsies are compression and stretching of the bilateral abducens nerves by a thick clot in the prepontine cistern. Although most of the abducens palsies may be reversible and have good prognosis, it is important that they are kept in mind as isolated symptoms of subarachnoid hemorrhage.

Emori M.,Sapporo Medical University | Kaya M.,Chitose City Hospital | Sasaki M.,Sapporo Medical University | Wada T.,Sapporo Medical University | And 2 more authors.
Japanese Journal of Clinical Oncology | Year: 2012

The management of giant cell tumor of the proximal humerus that extends to the joint is challenging. Here, we report a case of proximal humerus giant cell tumor with cortical bone destruction extending to the shoulder joint. Pre-operative selective arterial embolization induced peripheral tumor ossification. Subsequently, the lesion was removed by intralesional curettage, and the cavity was filled with cement. Macroscopically, the inner wall of the cavity was found to be lined with a thick fibrous membrane. Histologically, massive fibrosis and resultant remodeling of the destroyed cortical bone were induced, which was consistent with the peripheral ossification on the plain radiograph. We believe that selective arterial embolization can be an effective neoadjuvant therapy for giant cell tumors of the extremities, especially for tumors with large cortical defects or joint involvement. © The Author 2012. Published by Oxford University Press. All rights reserved.

Sato Y.,Sapporo Medical University | Takayama T.,Tokushima University | Sagawa T.,Sapporo Medical University | Takahashi Y.,Hokkaido Cancer Center | And 15 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2010

Purpose: We evaluated the activity and toxicity of docetaxel, cisplatin, and S-1 (DCS) combination chemotherapy in patients with unresectable metastatic gastric cancer. Methods: Patients with histologically proven, unresectable metastatic gastric adenocarcinoma, performance status (PS) 0-2, and no prior chemotherapy were eligible. Patients received oral S-1 (40 mg/m2 b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m2) and docetaxel (60 mg/m2) on day 8 every 3 weeks. Results: Thirty-four patients were enrolled between March 2005 and April 2007. Three patients were considered ineligible and did not receive the DSC therapy. Clinical characteristics were as follows: median age, 63 years (range, 44-77); PS, 0/1/2:23/8/0; women/men, 8/23; and well-differentiated/undifferentiated adenocarcinoma, 10/21. The objective response rate was 87.1% with 1 complete response (3.2%) and 26 partial responses (83.9%) in 31 assessable patients. Four had stable disease (12.9%) but none had progressive disease. Of these 27 responders, 8 (25.8%) achieved downstaging and 7 (22.6%) underwent curative surgery. The median survival time and progression-free survival were 687 days [confidence interval (95% CI), 600.0-1,138.1] and 226 days (95% CI, 182.5-379.3), respectively. Most common grade 3/4 hematologic toxicity was neutropenia (77.4%). Most common grade 3 nonhematologic toxicities included anorexia (35.5%) and nausea (32.3%). All treatment-related toxicities resolved, and no toxic deaths were observed. Conclusions: DCS combination chemotherapy is highly active against unresectable metastatic gastric cancer and can be given safely with proper management of adverse events. Further studies of this combination are warranted. © Springer-Verlag 2009.

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