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Hirakata, Japan

Komura K.,Osaka Medical College | Inamoto T.,Osaka Medical College | Black P.C.,University of British Columbia | Koyama K.,Osaka Medical College | And 3 more authors.
Nutrition and Cancer | Year: 2011

We investigated the prognostic value of BMI (body mass index) in Asian patients with RCC (renal cell carcinoma). We evaluated 170 Asian patients who underwent surgery for localized RCC (pathologic T1-4 tumors in the absence of nodal or distant metastases) between 1996 and 2004 at our institution. Patients were stratified by BMI: 22 or less vs. greater than 22. Overall, CSS (cancer-specific survival) and RFS (recurrence-free survival) was estimated using the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. The mean age and BMI of all patients was 62.4 ± 11.4 yr and 23.1 ± 3.2 kg/m 2, respectively. Patients' population consisted of 114 (67.1%) men and 56 (32.9%) women. The median follow-up was 50 mo. The BMI was less than 22 in 83 (49%) patients and greater than 22 in 87 (51%). There was a trend toward worse Eastern Cooperative Oncology Group (ECOG) performance status, less likely to have an incidentaloma, higher pathological stage, and more frequent microvascular invasion with lower BMI. Only the correlations between BMI and ECOG performance status (P = 0.003) and pathological stage (P = 0.015) were statistically significant. Of other relevant factors including gender, mode of presentation, ECOG performance status, C-reactive protein, histological type, Fuhrman nuclear grade, microvascular invasion, pathological stage, and adjuvant cytokine therapy, smaller BMI remained an independent predictor for worse CSS (44.5 mo vs. 56.0 mo, P = 0.041, HR = 10.99) and RFS (43.0 mo vs. 55.0 mo, P = 0.03, HR = 2.653), but not for OS (overall survival) (46.0 mo vs. 55.5 mo, P = 0.13, HR = 2.217) on multivariate analysis. Our findings identify increasing BMI in the Asian population as an independent predictor for favorable CSS and RFS in patients with RCC treated by surgery. Further studies, including a multiinstitutional, prospective Asian cohort, are required to confirm these findings. Copyright © 2011, Taylor & Francis Group, LLC.

Komura K.,Osaka Medical College | Inamoto T.,Osaka Medical College | Masuda H.,Aino Hospital | Watsuji T.,Hirakata City Hospital | Azuma H.,Osaka Medical College
Acta Biomedica | Year: 2012

Objectives: To assess the oncologic results of high-intensity focused ultrasound therapy (HIFU) as treatment for clinically localized prostate cancer. Methods: A total of 180 patients with clinically localized prostate cancer underwent HIFU and were retrospectively reviewed. Of those 171 patients primarily treated with HIFU were included in the analysis. They were stratified by prostatic volume, neoadjuvant hormonal ablation (NHA), and post-treatment PSA nadir. PSA level was monitored every month during the first 6 months after the treatment and every 3 months thereafter. According to the latest Phoenix criteria, biochemical failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. Seventy-six (44.4%) patients were offered preoperative NHA in median duration of 3 months (IQR: 3 - 5.75). Preoperative transurethral resection of the prostate (TURP) was performed in 56 (32.7%) patients having the calcification within the prostatic gland. Results: Mean patient age was 68.3 ± 7.0. The median follow-up time was 43 months (IQR: 30 - 55). According to D'amico risk groups 52 (30.4%) patients were identified with low risk, 47 (27.5%) patients with intermediate risk, and 72 (42.1%) with high risk. The overall and cancer-specific survival rates at 5 years were 98.8% and 100%. The metastasis-free survival rate at 5 years was 99.4%.No significant differences were seen in biochemical failure-free survival when stratified according to preoperative prostatic volume and administration of preoperative NHA (p = 0.931 and p = 0.712, respectively). Regardless NHA administration, patients with smaller PSA nadir (0.2 ng/ml) achieved better biochemical failurefree survival ratio. Conclusion: High-intensity focused ultrasound therapy provides sufficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy. © Mattioli 1885.

Ishiro M.,Osaka Medical College | Takaya R.,Osaka Medical College | Mori Y.,Saiseikai Suita Hospital | Takitani K.,Osaka Medical College | And 4 more authors.
Annals of Nutrition and Metabolism | Year: 2013

Background: Hyperuricemia in adults is known to be associated with hypertension, the metabolic syndrome and cardiovascular disease. The purpose of this study was to elucidate the factors associated with hyperuricemia in obese children and early adolescents and to investigate the threshold serum level of uric acid (UA) for the metabolic syndrome in children. Methods: We assessed anthropometric measurements, blood pressure, body composition and biochemical data in 1,559 obese children. To assess endothelial dysfunction, flow-mediated dilatation (FMD) was measured in 92 children. The correlations between serum UA levels and various parameters were examined. The threshold serum UA level for the metabolic syndrome was calculated by receiver-operating characteristic (ROC) curve analysis. Results: Serum UA levels were positively correlated with lipids in both boys and girls, and they were inversely correlated with FMD in the boys but not the girls. The threshold serum UA level for the metabolic syndrome was 5.25 mg/dl in boys and 5.05 mg/dl in girls. However, the specificity and sensitivity of ROC curve analysis are not so striking. Conclusion: The correlation between UA and FMD showed gender differences and might be affected by the hormonal status. The cutoff level of serum UA as a marker of the metabolic syndrome in obese children was affected by both age and gender. Copyright © 2013 S. Karger AG, Basel.

Inamoto T.,Osaka Medical College | Komura K.,Osaka Medical College | Watsuji T.,Hirakata City Hospital | Azuma H.,Osaka Medical College
International Journal of Clinical Oncology | Year: 2012

Purpose We studied the prognostic value of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) of the kidney and ureter. Methods We evaluated 153 patients who underwent surgery for UTUC (any T stage, N0-1, M0) between 1996 and 2009 at our institution. Of the 153 patients screened for the study, 103 patients were found to have comprehensive clinical and pathologic data available, and were included in the analysis. Patients were stratified by BMI = 22 kg/m2 or greater versus less than 22. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival was estimated using the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. Results The mean age and BMI of all patients was 68.62 ± 10.06 years and 22.97 ± 3.44 kg/m2, respectively. The patient population comprised 71 (68.9%) males and 32 (31.1%) females. The BMI was <22 in 38 (36.9%) patients and >22 in 65 (63.1%). The differences between BMI categories in gender (p = 0.013) was statistically significant, but not in other relevant parameters. The median follow-up was 29 months (interquartile range 14-63). Among other relevant descriptive preoperative characteristics, including gender, age, bladder tumor at diagnosis, tumor focality, and tumor side, smaller BMI remained an independent predictor for worse CSS (p = 0.047, HR 2.210) on multivariate analysis. Conclusions Our findings identify increasing BMI as an independent predictor for favorable OS and CSS in patients with UTUC. © 2011 CARS.

Murata S.,Hirakata City Hospital | Aomatsu T.,Osaka Medical College | Yoden A.,Osaka Medical College | Tamai H.,Osaka Medical College
Pediatrics International | Year: 2015

Background Cholelithiasis is one of the side-effects of ceftriaxone (CTRX). Reportedly, the cholelithiasis resolves relatively soon after cessation of CTRX, hence, it is called pseudolithiasis. Previous reports have suggested that biliary pseudolithiasis can cause not only gallstone attacks, but also severe adverse events, such as cholecystitis and pancreatitis. The purpose of this study was to prospectively elucidate the risk factors and clinical features of CTRX-associated pseudolithiasis in pediatric patients. Methods We prospectively examined the incidence and clinical outcome of CTRX-associated biliary pseudolithiasis. Subjects included infants and children who were admitted to hospital with acute disease. Ultrasonography was used to confirm the absence of stones and sludge in the gallbladder before CTRX therapy, and in assessment of pseudolithiasis on days 3, 5, 7 and 10 after initiation of CTRX in all subjects. The pseudolithiasis group was then compared with the non-pseudolithiasis group in terms of age, sex, CTRX dose, CTRX duration, duration of fever, fasting period, period of bed rest, and blood test results. Results Sixty patients were enrolled in the study. Eleven of them had biliary pseudolithiasis on ultrasonography (18.3%). Formation of biliary pseudolithiasis was prevalent in the fasting and bed rest groups, appearing relatively early in these groups. Conclusions Special attention should be paid to the degree of oral intake and patient activity when CTRX is prescribed. We recommend regular ultrasonographic follow up of patients receiving CTRX, to evaluate the formation of biliary pseudolithiasis. © 2015 Japan Pediatric Society.

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