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Tsujita K.,Kumamoto University | Sugiyama S.,Diabetes Care Center | 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.

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.

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.

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.

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