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Matsubara Y.,Fukuoka City Hospital
Fukuoka igaku zasshi = Hukuoka acta medica | Year: 2012

A-89-year-old male patient who complained dry cough was detected lung mass of 3 cm size in diameter at the right upper lobe by CT. FDG-PET seemed to show hilar and mediastinum lymph nodes metastasis. After three weeks, the mass showed rapid growth with 5 cm diameter in size at CT. Therefore the original tumor was supposed to be undifferentiated carcinoma, above all, pleomorphic carcinoma. He had been done pulmonary resection after short period. The right upper lobectomy with combined resection of the partial middle lobe was performed. Hilar and mediastinum lymph nodes dissection was added. In pathological examination, the tumor was proved pleomorphic carcinoma, however, no lymph node metastasis was recognized. He did not refer any complications and discharged back home at the post-operative 11th day. Pleomorphic carcinoma of the lung is known to be difficult to obtain definite diagnosis in early stage because of rapid growth. Therefore many cases are detected in advanced stage. In addition, chemotherapy is generally not effective, so only operative resection seems to be useful. Our patient was 89-year-old, he tolerated the operation and was alive with no trouble during 6 months after resection. When complete resection seems to be possible, operation should be regarded as an initial treatment. Source


Ogawa E.,Kyushu University | Furusyo N.,Kyushu University | Kajiwara E.,Steel Memorial Yawata Hospital | Takahashi K.,Hamanomachi Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims: The effects of pegylated interferon (PegIFN) α and ribavirin (RBV) treatment of chronic hepatitis C on the incidence of hepatocellular carcinoma (HCC) have not been well established. This study investigated the impact of treatment outcome on the development of HCC by chronic hepatitis C patients treated with PegIFNα2b and RBV. Methods: This large-scale, prospective, multicenter study consisted of 1013 Japanese chronic hepatitis C patients with no history of HCC (non-cirrhosis, n = 863 and cirrhosis, n = 150). All patients were treated with PegIFNα2b and RBV and the follow-up period started at the end of the antiviral treatment (median observation period of 3.6 years). The cumulative incidence rate of HCC was estimated using the Kaplan-Meier method, according to treatment outcome. Results: Forty-seven patients (4.6%) developed HCC during the observation period. In the non-cirrhosis group, the 5-year cumulative incidence rates of HCC for the sustained virological response (SVR) (1.7%) and transient virological response (3.2%) (TVR: defined as relapse or breakthrough) groups were significantly lower than those of the non-virological response (NVR) group (7.6%) (p = 0.003 and p = 0.03, respectively). A significantly low rate of incidence of HCC by TVR patients in comparison with NVR patients was found for patients aged 60 years and over, but not for those under 60 years of age. In the cirrhosis group, the 5-year cumulative incidence rates of HCC for the SVR (18.9%) and TVR groups (20.8%) were also significantly lower than those of the NVR group (39.4%) (p = 0.03 and p = 0.04, respectively). Conclusions: SVR and complete viral suppression during treatment with relapse (TVR) were associated with a lower risk of HCC development when compared with NVR. Source


Furusyo N.,Kyushu University | Ogawa E.,Kyushu University | Nakamuta M.,Kyushu Medical Center | Kajiwara E.,Steel Memorial Yawata Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims This study was performed to evaluate the efficacy of a triple therapy in older Japanese patients; telaprevir (TVR) was added to pegylated interferon α2b and ribavirin. Methods This prospective study enrolled 120 genotype 1b patients with chronic hepatitis C who received 12 weeks of triple therapy followed by a 12-week dual therapy that included pegylated interferon α2b and ribavirin. Patients were categorized according to age: group A, 64 patients aged >60 and group B, 56 patients aged ≤60. Serum HCV RNA levels were monitored by COBAS TaqMan HCV test. Results The rates of undetectable HCV RNA at week 4 (rapid virological response, RVR) were 73.4% in group A and 73.2% in group B. No significant difference in sustained virological response (SVR) was found between groups A (76.6%) and B (83.9%) (p = 0.314). The SVR rates for patients with interleukin 28B (IL28B) (rs8099917) TT allele (89.4% and 91.9% for groups A and B) were significantly higher than for those with the IL28B TG/GG allele (41.2% and 68.4%, respectively) (both p <0.05). Multivariate analysis extracted IL28B TT and RVR as independent factors associated with SVR. Adverse effects resulted in treatment discontinuation by 12.5% in each group. Hemoglobin decrease significantly differed between groups A and B: the decrease to ≥100 g/L, to 85 - <100 g/L, and to <85 g/L, was 9.4%, 40.6%, and 50% in group A patients, respectively, and 41.1%, 25%, and 33.9% in group B patients, respectively (p = 0.0006). Conclusions TVR-based triple therapy can be successfully used to treat older patients with genotype 1b chronic hepatitis C. © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Source


Ogawa E.,Kyushu University | Furusyo N.,Kyushu University | Nakamuta M.,Kyushu Medical Center | Kajiwara E.,Steel Memorial Yawata Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims Anemia is a common adverse effect of telaprevir (TVR) in combination with pegylated interferon (PegIFN)α and ribavirin (RBV) therapy. It occurs at a higher incidence with the TVR relative to PegIFNα and RBV alone. We herein evaluate the baseline and on-treatment predictors of the development of severe anemia by chronic hepatitis C virus (HCV) patients receiving TVR-based triple therapy. Methods This prospective, multicenter study consisted of 292 patients (median age: 62 years) infected with HCV genotype 1. All received 12 weeks of TVR in combination with 24 weeks of PegIFNα2b and RBV. The definition of severe anemia during antiviral treatment is hemoglobin (Hb) <85 g/L. Results 101 (34.6%) patients developed severe anemia during the treatment period. Multivariable logistic regression analysis of possible pretreatment predictors of the development of severe anemia extracted baseline Hb <135 g/L (Hazard ratio [HR], 2.53; p = 0.0013), estimated glomerular filtration rate <80 ml/min/1.73 m2 (HR, 1.83; p = 0.0265), and inosine triphosphatase (ITPA) CC genotype (rs1127354) (HR, 2.91; p = 0.0024). For patients with ITPA CC (n = 227), multivariable logistic regression analysis of possible pretreatment and on-treatment predictors of the development of severe anemia extracted Hb level at week 2 (HR, 0.96; p = 0.0085) and the initial four weeks of weight-adjusted TVR (HR, 1.05; p = 0.0281). Conclusions Anemia remains a risk for all patients treated with TVR-based triple therapy. However, ITPA polymorphism (rs1127354) is useful for predicting the development of severe anemia and will be helpful in the management of treatment. © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Source


Okuyama T.,Fukuoka City Hospital
Fukuoka igaku zasshi = Hukuoka acta medica | Year: 2012

The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the Fukuoka Medical Rally (FMR) and the disaster relief team (DRT) were also reviewed and analyzed. Departments of neurology, neurosurgery, emergency, and cardiology were opened sequentially, starting in 2003, with an establishment of facilities of an emergency room (ER), intensive care unit (ICU), stroke care unit (SCU), and coronary care unit (CCU). Regarding educational programs, lectures and demonstrations on basic and advanced life support techniques were given to all staff annually starting in 2004, and resident doctors completed rotations in the ER and the ICU for three months. FCH staff consistently obtained excellent results at the FMR. Ambulance crews attended lectures and received training on EM and intra-tracheal intubation. The numbers of patients taken by ambulance to FCH increased from 129 in 2002 to 2,316 in 2011. The DRT was dispatched to respond to disasters that occurred in Japan. As a secondary emergency hospital, FCH has developed a system to accept emergency patients. This project will contribute to the improvement of the EM system in the area. Source

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