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Fukui-shi, Japan

Sato Y.,Fukui Prefectural Hospital
Gan to kagaku ryoho. Cancer & chemotherapy

We report our experience with a case of colorectal cancer treated with chemotherapy for a liver metastasis patient on hemodialysis. The patient was a 67-year-old man with a history of chronic renal failure, who was on hemodialysis since 2005. High anterior resection was performed for sigmoid colon and rectal cancer in January, 2010. After starting chemotherapy while planning to use FOLFOX6+bevacizumab(BV)as a postoperative standard chemotherapy, in combination with hemodialysis three times a week while performing dose escalation, administration postponement was continued for myelosuppression that was considered to be the effect of oxaliplatin. Oxaliplatin was administered for only 2 courses, and was then changed to BV+sLV5FU2 therapy. We continued treating the metastases approximately on schedule. Imaging revealed, the liver metastases were CR because they had disappeared. The BV use case of the dialysis case had few reports, but was thought to be able to use it by careful administration safely. Source

Horikawa T.,University of North Carolina at Chapel Hill | Horikawa T.,Kanazawa University | Yoshizaki T.,Kanazawa University | Kondo S.,Kanazawa University | And 3 more authors.
British Journal of Cancer

Background:Epstein-Barr Virus (EBV)-associated nasopharyngeal carcinoma (NPC) is distinctive among head-and-neck cancers in its undifferentiated histopathology and highly metastatic character. We have recently investigated the involvement of epithelial-mesenchymal transition (EMT) in NPC. In a previous study, we found a close association of expression of LMP1, the principal EBV oncoprotein, with expression of Twist and induction of EMT.Methods:We analysed expression of Snail in 41 NPC tissues by immunohistochemistry. The role of Twist as well as Snail in EMT of NPC was investigated by using NP69SV40T human nasopharyngeal cells.Results:In NPC tissues, overexpression of Snail is associated with expression of LMP1 in carcinomatous cells. In addition, expression of Snail positively correlated with metastasis and independently correlated inversely with expression of E-cadherin. Expression of Twist had no association with expression of E-cadherin. Further, in a human nasopharyngeal cell line, LMP1 induces EMT and its associated cellular motility and invasiveness. Expression of Snail is induced by LMP1 in these cells, and small hairpin RNA (shRNA) to Snail reversed the cellular changes. By contrast, Twist did not produce EMT in these nasopharyngeal cells.Conclusions:This study strengthens the association of EMT with the metastatic behaviour of NPC. These results suggest that induction of Snail by the EBV oncoprotein LMP1 has a pivotal role in EMT in NPC. © 2011 Cancer Research UK All rights reserved. Source

Tanizaki S.,Fukui Prefectural Hospital
Open Access Emergency Medicine

Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality. © 2015 Tanizaki. Source

Hattori M.,Fukui Prefectural Hospital
[Nippon kōshū eisei zasshi] Japanese journal of public health

PURPOSE: This study was conducted to clarify the efficacy of centralization of cancer treatment using population-based cancer registry data in Fukui prefecture, Japan. METHOD: Associations between hospital procedure volume and cancer survival were analyzed using the population-based cancer registry survival data for Fukui prefecture between 1994 and 1998. Firstly the cancer patients who received primary treatments for each target sites such as esophagus, stomach, colon, liver, gall bladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, and lymphoid tissue were totaled. Then, hospitals were divided into 4 categories according to the number of patients by each site; high, medium, low and very low volume. Stage-matched 5-year relative survival rates for each site were then calculated for each categorized hospital volume, and that most desirable for medical treatment for each target site was decided with reference to age-, sex-, and cancer stage-adjusted hazard ratios. Age-adjusted morality reduction was estimated by the expected survival rate after centralization when all cancer patients had received treatments. RESULTS: The 5-year relative survival rates were higher in hospitals with large numbers of patients. With some target sites, such as the stomach, colon, and breast, the mortality was similar between high and low volume hospitals, whereas the other target sites showed higher mortality in line with decrease in number of patients treated. It was estimated that a 2.06% reduction in the mortality rate might be achieved if each case were treated at the most desirable category of hospital in Fukui prefecture. CONCLUSION: Cancer treatment at hospitals have appropriate procedure volumes is an effective way to increase cancer survival and lower the mortality rate. Source

Kida S.,Fukui Prefectural Hospital
Clinical Neurology

Cerebrospinal fluid (CSF) drains via the cribriform plate and nasal mucosa to cervical lymph nodes. There are no conventional lymphatics in the brain but physiological studies have revealed a substantial and immunologically significant lymphatic drainage from brain to cervical lymph nodes. Interstitial fluid (ISF) and solutes from brain parenchyma drain along capillary and perivascular space of artery, and path through the skull base, then reach to the cervical lymph nodes. CSF and ISF appear to drain by separate routes from the brain, especially in humans. However, there are interrelationships between the two fluid compartments that become more significant when drainage of CSF or ISF is impaired by disease processes. Vessel pulsations appear to be the driving force for the perivascular lymphatic drainage along artery walls, and as vessels stiffen with age, amyloid peptides (Ab) deposit in the drainage pathways as cerebral amyloid angiopathy (CAA). Blockage of lymphatic drainage of ISF and solutes from the brain by CAA may result in loss of homeostasis of the neuronal environment that may contribute to neuronal malfunction and dementia. Such failure of perivascular drainage may associated with the pathoetiology of Alzheimer's disease, cerebral small artery disease and idiopathic normal pressure hydrocephalus (iNPH). Source

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