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Tsujita K.,Kumamoto University | Sugiyama S.,Jinnouchi Hospital | Sumida H.,Kumamoto Central Hospital | Shimomura H.,Fukuoka Tokushukai Medical Center | And 23 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Despite standard statin therapy, a majority of patients retain a high "residual risk" of cardiovascular events. Objectives The aim of this study was to evaluate the effects of ezetimibe plus atorvastatin versus atorvastatin monotherapy on the lipid profile and coronary atherosclerosis in Japanese patients who underwent percutaneous coronary intervention (PCI). Methods This trial was a prospective, randomized, controlled, multicenter study. Eligible patients who underwent PCI were randomly assigned to atorvastatin alone or atorvastatin plus ezetimibe (10 mg) daily. Atorvastatin was uptitrated with a treatment goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dl. Serial volumetric intravascular ultrasound was performed at baseline and again at 9 to 12 months to quantify the coronary plaque response in 202 patients. Results The combination of atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy (63.2 ± 16.3 mg/dl vs. 73.3 ± 20.3 mg/dl; p < 0.001). For the absolute change in percent atheroma volume (PAV), the mean difference between the 2 groups (-1.538%; 95% confidence interval [CI]: -3.079% to 0.003%) did not exceed the pre-defined noninferiority margin of 3%, but the absolute change in PAV did show superiority for the dual lipid-lowering strategy (-1.4%; 95% CI: -3.4% to -0.1% vs. -0.3%; 95% CI: -1.9% to 0.9% with atorvastatin alone; p = 0.001). For PAV, a significantly greater percentage of patients who received atorvastatin/ezetimibe showed coronary plaque regression (78% vs. 58%; p = 0.004). Both strategies had acceptable side effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events. Conclusions Compared with standard statin monotherapy, the combination of statin plus ezetimibe showed greater coronary plaque regression, which might be attributed to cholesterol absorption inhibition-induced aggressive lipid lowering. (Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound [PRECISE-IVUS]; NCT01043380) © 2015 American College of Cardiology Foundation.

Shuto H.,Fukuoka University | Shuto H.,Kurume University | Imakyure O.,Fukuoka Tokushukai Medical Center | Matsumoto J.,Fukuoka University | And 5 more authors.
British Journal of Clinical Pharmacology | Year: 2010

Aims: The present study aimed to evaluate the associations between medication use and falls and to identify high risk medications that acted as a trigger for the onset of falls in an acute care hospital setting. Methods: We applied a case-crossover design wherein cases served as their own controls and comparisons were made within each participant. The 3-day period (days 0 to -2) and the 3-day periods (days -6 to -8, days -9 to -11 and days -12 to -14) before the fall event were defined as the case period and the control periods, respectively. Exposures to medications were compared between the case and control periods. Odds ratios (OR) and 95% confidence intervals (CI) for the onset of falls with respect to medication use were computed using conditional logistic regression analyses. Results: A total of 349 inpatients who fell during their hospitalization were recorded on incident report forms between March 2003 and August 2005. The initial use of antihypertensive, antiparkinsonian, anti-anxiety and hypnotic agents as medication classes was significantly associated with an increased risk of falls, and these ORs (95% CI) were 8.42 (3.12, 22.72), 4.18 (1.75, 10.02), 3.25 (1.62, 6.50) and 2.44 (1.32, 4.51), respectively. The initial use of candesartan, etizolam, biperiden and zopiclone was also identified as a potential risk factor for falls. Conclusions: Medical professionals should be aware of the possibility that starting a new medication such as an antihypertensive agent, including candesartan, and antiparkinsonian, anti-anxiety and hypnotic agents, may act as a trigger for the onset of a fall. © 2010 The British Pharmacological Society.

PubMed | Fukuoka University and Fukuoka Tokushukai Medical Center
Type: | Journal: The American journal of case reports | Year: 2016

BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening syndrome comprising severe skin eruption, fever, eosinophilia, lymphadenopathy, and involvement of internal organs. Here, we describe a case of DRESS syndrome caused by cross-reactivity between vancomycin and subsequent teicoplanin administration. CASE REPORT A 79-year-old male was admitted to our hospital for the treatment of injuries incurred in a traffic accident. Eosinophilia and lung dysfunction appeared after vancomycin administration. These symptoms were improved temporarily by withdrawal of vancomycin and administration of corticosteroid, but exacerbated by subsequent teicoplanin administration. These symptoms disappeared after discontinuation of teicoplanin. Based on comprehensive assessment of the overall clinical course, we judged that DRESS syndrome was induced by cross-reactivity between vancomycin and subsequent teicoplanin administration. Using the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system, we categorized DRESS syndrome related to vancomycin and teicoplanin as probable. We describe, for the first time, DRESS syndrome (defined using the RegiSCAR scoring system) caused by cross-reactivity between vancomycin and subsequent teicoplanin administration. CONCLUSIONS Clinicians should be aware that DRESS syndrome can be induced by cross-reactivity between vancomycin and teicoplanin.

Kikutake T.,Fukuoka Tokushukai Medical Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

The patient is a 42-year-old man who is a Jehovah's Witness. For the duodenal gastrointestinal stromal tumor, duodenal segmental resection and a duodenal jejunum anastomosis were indicated. He took imatinib for 2 years after the operation. After 8 months, recurrent multiple liver metastases were found at S2-3 and S7, which were in contact with the inferior vena cava. Excessive intraoperative bleeding was expected. The patient hoped that a blood transfusion operation would not be required. He took sunitinib to reduce the size of the tumor, and the tumor had become smaller after 8 months. It was possible to resect the tumor without a blood transfusion. The patient has been on imatinib since 1 month after the operation. No recurrence was detected within 1 year of the operation.

Matsuoka T.,Fukuoka Tokushukai Medical Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We encountered a case of delayed subcutaneous metastases of gastric carcinoma. The patient underwent distal gastrectomy for advanced gastric carcinoma 11 years ago. Postoperative pathological diagnosis indicated stage IIIB disease, poorly differentiated adenocarcinoma (scirrhous, T4a, ly2, v2, N2, H0, P0). Three courses of adjuvant chemotherapy with 5-fluorouracil (5-FU)+cisplatin (CDDP) were administered; however, the patient discontinued the treatment. No signs of recurrence were observed for 11 years after the treatment. However, subcutaneous metastases in the front portion of the head and the back and an ovarian tumor were detected after the remission period. The specimen from the resected subcutaneous tumor from the back indicated signet-ring cell carcinoma, and delayed subcutaneous and ovarian metastases of the gastric carcinoma was diagnosed. Therefore, 8 courses of the S-1+CDDP combination therapy were administered. The cutaneous metastases disappeared, but the ovarian tumor progressed and was therefore resected. Analysis of the resected ovarian tumor also indicated signet-ring cell carcinoma. We report a case of delayed recurrence of gastric carcinoma that was effectively treated with chemotherapy.

Kikutake T.,Fukuoka Tokushukai Medical Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

A 77-year-old woman consulted our hospital because of an indolent mass in the right submandibular region, which developed approximately 4 months previously. Ultrasonography revealed a 19.5×9.2 mm homogeneous low echoic mass in the submandibular region and a 9.8×3.1 mm low echoic mass in the left thyroid lobe. Blood examinations revealed high levels of carcinoembryonic antigen (CEA) and calcitonin. Analysis of the cytological specimens obtained from the submandibular tumors indicated class IV disease. First, we resected the mandibular tumor for diagnosis, and the specimen showed medullary carcinoma. Later, the patient underwent left thyroid lobe resection. The pathological diagnosis was adenomatous goiter. We report a rare case of ectopic medullary carcinoma in the right mandibular region.

Kawamoto S.,Fukuoka Tokushukai Medical Center | Yoshida T.,Fukuoka Tokushukai Medical Center
Japanese Journal of Cancer and Chemotherapy | Year: 2010

A 71 -year-old man was admitted by systemically massive edema and advanced rectal cancer. His hemoglobin or serum albumin level was 7.5g/dl-or 1.2g/dL Proteinuria ranged from 1.8 to 3.8g/day. Massive effusion in chest and abdomen was obvious with low oxygenation and unstable hemodynamic state. Renal biopsy showed membranous nephropathy. Abdomino-perineal resection of the rectum was performed. Specimens showed poorly differentiated adenocarcinoma. The classification was type 1, 90 × 85 mm, pAI (seminal grand), pN3, sHO, sPO, cMO: fStage Hlb. The nephrotic syndrome was evidently improved with no urinary excretion of albumin at forty-postoperative day. The perioperative management allowed a surgical resection to be undertaken that led the clinical curability in rectal cancer as well as nephrotic syndrome.

A 68-year-old woman was brought by ambulance due to abrupt anal bleeding. Elastic hard and solid mass was found in rectal examination. The pathological diagnosis of the tumor revealed adenocarcinoma. The metastatic 40 × 40 mm liver tumor was also found at CT scan. Acute bleeding with hemoglobin level of 6 .0 g/dL necessitated an urgent arterial embolization of bilateral internal iliac artery and superior rectal artery. After recovery from the systemic condition, radical operation was performed, comprising abdomino-perineal resection of the rectum with extended lymph node dissection involving paraaortic area followed by synchronous liver resection. Arterial infusion of 5-FU (11.0 g in total) via proper hepatic artery was added postoperatively. She was followed for over 12 years, and no recurrence was observed.

Umemoto S.,Fukuoka Tokushukai Medical Center
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

A 72-year-old man was admitted to our hospital complaining of upper abdominal pain and back pain. Advanced gastric cancer was found at the fundus of the stomach, and severe dysplasia was found at the lower esophagus. We proceeded with neoadjuvant chemotherapy (S-1+CDDP) because the lymph nodes in the lesser curvature of the stomach were metastasized and invasion of the pancreas and some vessels was suspected by computed tomography. The tumor size was reduced remarkably, the esophageal dysplasia disappeared after preoperative chemotherapy, and we were able to perform total gastrectomy.

PubMed | Fukuoka Tokushukai Medical Center
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

We report a case of locally far-advanced colon cancer resected by laparoscopic surgery after colonic stent insertion and neoadjuvant chemotherapy. A 71-year-old man with obstructive symptoms was admitted to our hospital in July 2015. CT revealed a sigmoid colon tumor infiltrating the retroperitoneum and small intestine. Lower gastrointestinal endoscopy showed a sigmoid colon cancer. Self-expandable metallic stent insertion for obstructive colon cancer alleviated the patients symptoms quickly. Four courses of neoadjuvant chemotherapy(XELOX)reduced the primary tumor in size, allowing for laparoscopic surgical resection. Combination therapy with colonic stenting and neoadjuvant chemotherapy can be an effective treatment for obstructive colon cancer. However, further studies and additional cases are needed to assess the safety and efficacy of this combination therapy.

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