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Kojima T.,Nagoya University | Kaneko A.,Nagoya Medical Center | Hirano Y.,Toyohashi Municipal Hospital | Ishikawa H.,Red Cross | And 17 more authors.
Modern Rheumatology | Year: 2012

Biologic agents have proven to be effective against rheumatoid arthritis (RA) in clinical trials and postmarketing surveillance (PMS) studies. However, limited follow-up periods and strict criteria for recruitment might lead to an underestimation of adverse events. To document the long-term course of patients with RA treated with biologics in clinical settings, we established the Tsurumai Biologics Communication Registry (TBCR). First, we retrospectively collected data of patients registered for any biologic PMS study or clinical trial at participatinginstitutes. Thus far, thirteen institutes have joined the registry and 860 patients have been identified. Comparing baseline characteristics by age and initiation year of biologics, young patients had significantly less joint damage and dysfunction and a higher dose of concomitant methotrexate (MTX) compared to older patients. Older age and functional class were significantly related to the incidence of adverse events that resulted in discontinuation of the 1st biologic treatment. The TBCR is in its initial stages, and information on all patients newly starting biologic therapy at participating institutes is being collected prospectively. Differences in baseline characteristics by age and initiation year of biologics need to be carefully evaluated in order to report on drug-related survival and long-term prognosis, using follow-up data in the near future. © Japan College of Rheumatology 2011.


Kojima T.,Nagoya University | Kaneko A.,Nagoya Medical Center | Hirano Y.,Toyohashi Municipal Hospital | Ishikawa H.,Red Cross | And 13 more authors.
Modern Rheumatology | Year: 2012

The goal of treating rheumatoid arthritis (RA) should be remission, for which a new definition was proposed in 2011. To determine which patients can achieve the new Boolean-based definition of remission in clinical practice, we analyzed factors associated with remission in 123 patients who received tocilizumab for 52 weeks. We found that patients with short disease duration (<4.8 years) had a significantly higher rate of remission (31.7%) than those with longer disease duration, and patient global assessment was the most important factor for achieving remission. Multivariate analysis revealed the following predictors of remission: short disease duration [<4.8 years; odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4-4.7] and lower disease activity [28-joint disease activity score- erythrocyte sedimentation rate (DAS28-ESR) <5.23; OR 2.5, 95% CI 1.2-5.1). In this study, we showed that remission, as newly defined using a Boolean approach, is a realistic goal for patients treated with tocilizumab with short disease duration in real-world clinical practice. © Japan College of Rheumatology 2011.


Ichinohe K.,Fukuroi Municipal Hospital
Singapore Medical Journal | Year: 2010

Soft tissue sarcomas are rare biologically and histologically heterogeneous neoplasms that may arise throughout the body. The preferred treatment is total resection with a sufficient margin. Radiotherapy with or without chemotherapy offers another treatment option, but its effectiveness is limited. Hyperthermia, a treatment method that heats tumour tissue by exposing the target tissues to conductive heat sources or non-ionising radiation, is known to enhance the effect of radiotherapy. We report a case of an elderly man with a second recurrent myxofibrosarcoma in the left groin, who responded well to radiotherapy in combination with hyperthermia. This combination treatment was effective in maintaining the patient's quality of life during his remaining years.


Hori K.,Hamamatsu University School of Medicine | Kobayashi N.,Pro Bono Pharmacoepidemiologists Committee | Atsumi H.,Fukuroi Municipal Hospital | Atsumi H.,Chutoen General Medical Center | And 8 more authors.
Supportive Care in Cancer | Year: 2014

Objective: Prophylaxis of chemotherapy (CT)-induced nausea and vomiting (CINV) is important for patient's quality of life and adherence to CT. Neurokinin receptor antagonist (NK1 antagonist) was marketed in Japan in December 2009 and the first guideline for antiemetics for CINV was released in May 2010 from Japan Society of Clinical Oncology (JSCO). We assessed changes in compliance with the JSCO guideline during the first 18 months from the launch of NK1 antagonist in Japan. Methods: Patient-level data was extracted locally using a nationwide distributed research network consisting of 39 hospitals. Monthly compliance rates for acute (day of CT) and delayed (days 2-5) phases were summarized according to the emetic risks. Results: In total, 81,739 CTs for 9,978 patients were analyzed. Prescription of oral NK1 antagonist was started in 31/39 hospitals during the study period. The compliance in acute phase for high emetic risk (HER) CTs gradually improved up to 39.3 % whereas it reached only to 10-15 % in delayed phase. The extra use of antiemetics decreased inversely to the increased compliance. Better compliance for HER CTs was associated with opioid use, younger age, second or later cycles, and CT regimens. Compliance in acute phase was better in inpatient whereas that in delayed phase was better in outpatients. Conclusions: A multi-hospital survey revealed that more than half of the HER CTs remained without accompanying the standard antiemetic therapies. Association with the compliance and CINV outcomes would be also interesting to explore. © 2013 Springer-Verlag.


Ohguchi S.,Fukuroi Municipal Hospital | Morishima I.,Ogaki Municipal Hospital | Mutou M.,Hamamatsu Medical Center | Isobe T.,Fukuroi Municipal Hospital | And 4 more authors.
Journal of Arrhythmia | Year: 2012

An 87-year-old woman with complete atrioventricular block was admitted for permanent pacemaker implantation. The patient had a large thoracic aortic aneurysm that had been conservatively treated. Lead placement was not possible via the superior vena cava or the epicardial route because of the aneurysm. Therefore, we implanted a VVI pacemaker via the femoral approach. A unit was placed in a pouch on the right lower abdominal wall, and a lead was introduced into the right ventricle via the right femoral vein. The femoral vein approach is rarely used; however, it should be recognized as an effective alternative when the usual approach is difficult or impossible to be performed. © 2012 Japanese Heart Rhythm Society.


Yoshimura K.,Kyoto University | Uehara K.,Nagoya University | Tojima Y.,Chukyo Hospital | Kawai S.,Tsushima City Hospital | And 6 more authors.
Trials | Year: 2013

Background: Although, in Western countries, oxaliplatin-based regimens have been established as a gold standard treatment for patients with stage III or high risk stage II colon cancer after curative resection, in Japan fluorouracil-based regimens have been widely accepted and recommended in the guidelines for adjuvant settings in patients with stage III colon cancer. S-1, an oral preparation evolved from uracil and tegafur, has equivalent efficacy to uracil and tegafur/leucovorin for treating patients with advanced colorectal cancer and might be a suitable regimen in an adjuvant setting. However, the completion rate of the standard six-week cycle of the S-1 regimen is poor and the establishment of an optimal treatment schedule is critical. Therefore, we will conduct a multicenter randomized phase II trial to compare six-week and three-week cycles to establish the optimal schedule of S-1 adjuvant therapy for patients with stage III colon cancer after curative resection.Methods/Design: The study is an open-label, multicenter randomized phase II trial. The primary endpoint of this study is three-year disease-free survival rate. Secondary endpoints are the completion rate of the treatment, relative dose intensity, overall survival, disease-free survival, and incidence of adverse events. The sample size was 200, determined with a significance level of 0.20, power of 0.80, and non-inferiority margin of a 10% absolute difference in the primary endpoint.Discussion: Although S-1 has not been approved yet as a standard treatment of colon cancer in an adjuvant setting, it is a promising option. Moreover, in Japan S-1 is a standard treatment for patients with stage II/III gastric cancer after curative resection and a promising option for patients with colorectal liver metastases in an adjuvant setting. However, a six-week cycle of treatment is not considered to be the best schedule, and some clinicians use a modified schedule, such as a three-week cycle to keep a sufficient dose intensity with few adverse events. Therefore, it will be useful to determine whether a three-week cycle has an equal or greater efficacy and tolerance to side-effects compared with the standard six-week cycle schedule, and thus may be the most suitable treatment schedule for S-1 treatment.Trial registration: The University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000006750. © 2013 Yoshimura et al.; licensee BioMed Central Ltd.


Ichinohe K.,Fukuroi Municipal Hospital | Ijima M.,Kakegawa City Hospital | Usami T.,Fukujukai Hiryu Clinic | Baba S.,Hamamatsu University School of Medicine
Annals of the Royal College of Surgeons of England | Year: 2013

Primary retroperitoneal transitional cell carcinomas (TCCs) are extremely rare neoplasms for which prognosis is very poor. We present a case that underwent complete remission after radiotherapy and concurrent oral chemotherapy. A 68-year-old woman presented with acute onset of bloody stool. Urgent colonoscopy only detected haemorrhoids. Subsequent abdominal ultrasonography revealed a mass of 7cm in maximal diameter in the left iliac fossa. Laparotomy disclosed a retroperitoneal mass that could not be dissected and therefore only incision biopsy was performed. After a final diagnosis of primary retroperitoneal TCC, chemotherapy with tegafur-uracil (UFT) was initiated but was not effective. Subsequently, radiotherapy was initiated concurrently with UFT at a total dose of 50Gy in 25 fractions. At 20 months after radiotherapy, the tumour seemed to have completely remitted. At the last follow-up, ten years from radiotherapy, computed tomography revealed no recurrence. We identified only three single case reports regarding primary retroperitoneal TCC over the last five decades. All patients died from the tumour 8-24 months after diagnosis or treatment. Based on the success of our case, radiotherapy with concurrent oral chemotherapy should be considered as an option for unresected cases.


Sugimoto H.,Fukuroi Municipal Hospital | Shibahara H.,Fukuroi Municipal Hospital | Kawasaki H.,Hamamatsu University School of Medicine
Journal of Japanese Society of Gastroenterology | Year: 2010

The patient was a 52-year-old woman in whom CT revealed a huge tumor located mainly in the mesenterium. On the 5th day, clinical symptoms progressed rapidly and chemotherapy for malignant lymphoma was performed after percutaneous core needle biopsy. However, the patient died on the 9th day. After her death, the pathological diagnosis proved to be neuroblastoma based on the core needle biopsy. This disease is extremely rare in adults, but should be taken into consideration since rapid progression may sometimes occur.


PubMed | Fukuroi Municipal Hospital
Type: Case Reports | Journal: Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2010

A 95-year-old woman who presented with ischemic heart disease was admitted due to a sensation of chest compression. Endoscopy was performed due to anemia which showed an irregular ulcerative lesion in the duodenal bulb which a biopsy revealed to be high-grade neuroendocrine carcinoma. Distant metastasis was found and the patient died from the original disease 3 months after the first medical examination. The result of autopsy was neuroendocrine carcinoma of duodenum and invasion and metastases to multiple organs. We report a case of neuroendocrine carcinoma originating from the duodenum excluding the papilla which is extremely rare in Japan.


PubMed | Fukuroi Municipal Hospital
Type: Case Reports | Journal: Singapore medical journal | Year: 2010

Soft tissue sarcomas are rare biologically and histologically heterogeneous neoplasms that may arise throughout the body. The preferred treatment is total resection with a sufficient margin. Radiotherapy with or without chemotherapy offers another treatment option, but its effectiveness is limited. Hyperthermia, a treatment method that heats tumour tissue by exposing the target tissues to conductive heat sources or non-ionising radiation, is known to enhance the effect of radiotherapy. We report a case of an elderly man with a second recurrent myxofibrosarcoma in the left groin, who responded well to radiotherapy in combination with hyperthermia. This combination treatment was effective in maintaining the patients quality of life during his remaining years.

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