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Hirosaki, Japan

Kudoh A.,Hirosaki Municipal Hospital
Japanese Journal of Anesthesiology | Year: 2010

Schizophrenic patients are at increased risk for perioperative complications such as hypotension and hypothermia during anesthesia, postoperative ileus, confusion and pneumonia. In addition, schizophrenic patients are predisposed to developing pulmonary thromboembolism, torsade de pointes, water intoxication and rhabdomyolysis. The increased complications are associated with physical disorders, antipsychotic agents, hazardous health behaviors, and interactions between antipsychotic agents and anesthetic drugs. Increased cortisol, norepinephrine and cytokine concentrations are considered as possible cause of postoperative confusion and ileus. Anesthesia with ketamine, propofol and fentanyl decreased the frequency of the postoperative confusion in schizophrenic patients. Epidural anesthesia with local anesthesia in schizophrenic patients undergoing abdominal surgery minimized postoperative ileus. Antipsychotic drugs administrated to schizophrenic patients should be continued before anesthesia for decreasing postoperative confusion. Thus, anesthesiologists must not only be aware of the perioperative problems of these patients but must also learn how to manage their perioperative course.

Kudoh A.,Hirosaki Municipal Hospital
Japanese Journal of Anesthesiology | Year: 2010

Depressed patients have some problems before, during and after anesthesia such as hypotension, and torsade de pointes during anesthesia, postoperative confusion, serotonin toxicity, increased intraoperative bleeding by selective serotonin reuptake inhibitors. Depressed patients treated by antidepressants have decreased plasma cortisol and interleukin-6 response to surgery and are more at risk for developing postoperative confusion, that is associated with abnormal cortisol response to surgery and more frequent in patients discontinued antidepressants 72 hours before surgery. Depressed patients treated by antidepressants have high postoperative pain score, that depend on their depressed state. A small-dose of ketamine improves postoperative depressive state and relieves postoperative pain in depressed patients and is a suitable anesthetic for depressed patients. As the anesthetic management in depressed patients is becoming increasingly, anesthesiologists should be familiar with medical illness, abnormal response to surgery in depressed patients and must learn their perioperative management.

Taira N.,Okayama University | Iwata H.,Aichi Cancer Center Hospital | Hasegawa Y.,Hirosaki Municipal Hospital | Sakai T.,Cancer Institute Hospital | And 6 more authors.
Breast Cancer Research and Treatment | Year: 2014

Trials of adjuvant endocrine therapy for breast cancer have shown that aromatase inhibitors have little impact on global health-related quality of life (HRQoL), but have significant effects on patient-reported endocrine symptoms (ESs). There are few studies of HRQoL and psychological distress during preoperative endocrine therapy performed to determine endocrine responsiveness. The NEOS trial is a multicenter, phase 3 randomized controlled trial in postmenopausal women with hormone receptor-positive breast cancer. The primary aim of the trial was to evaluate the need for adjuvant chemotherapy in patients with clinical T1c-T2N0M0, hormone receptor-positive tumors who responded to neoadjuvant letrozole (LET) administered for 24-28 weeks before surgery. The primary endpoint was disease-free survival and the secondary endpoints included adverse events, HRQoL, and cost-effectiveness. In a HRQoL sub-study, subjects were assessed at baseline and 4 and 16 weeks after starting neoadjuvant LET, using the functional assessment of cancer therapy-breast and its ES subscale, and the hospital anxiety and depression scale. HRQoL and psychosocial distress were analyzed in the uncontrolled phase during 24-28 weeks of neoadjuvant LET therapy in the NEOS trial. From May 16, 2008, to December 14, 2011, 503 patients were recruited into the HRQoL sub-study. The full analysis set included 497 patients with a mean age of 63-years old. The questionnaire response rates at enrollment and 4 and 16 weeks were 94.4, 90.7, and 89.1 %, respectively. There were no significant changes in the FACT-G or B-trial outcome index over time, but the social and family well-being score and the ES subscale deteriorated significantly, and the number of patients with clinically significant hot flush increased significantly. Anxiety, depression, and emotional well-being improved significantly after neoadjuvant LET. Neoadjuvant endocrine therapy with LET had no impact on global HRQoL, but did influence endocrine-related symptoms such as hot flush. This study is registered as UMIN000001090. © 2014 Springer Science+Business Media New York.

Zhao M.,University of Toyama | Kanegane H.,University of Toyama | Kobayashi C.,Ibaraki Childrens Hospital | Nakazawa Y.,Shinshu University | And 8 more authors.
Cytometry Part B - Clinical Cytometry | Year: 2011

Background: X linked lymphoproliferative syndrome (XLP) is a rare immunodeficiency with extreme vulnerability to Epstein Barr virus (EBV) infection. It presents with fatal infectious mononucleosis, lymphoproliferative disorder, or dysgammaglobulinemia. The majority of affected males have mutations in the SH2D1A/SLAM associated protein (SAP) gene. We previously generated an antihuman SAP monoclonal antibody (KST 3) for a flow cytometric assay and described the activation of T cells to be necessary for the flow cytometric assessment of the SAP expression using an FITC conjugated secondary antibody. Methods: Between 2005 and 2008, we recruited 23 male patients with suspected XLP, including mainly EBV associated hemophagocytic lymphohistiocytosis (HLH), and attempted to evaluate SAP expression in fresh lymphoid cells using Alexa Fluor 488 conjugated secondary antibody instead of an FITC conjugated one. Results: The method demonstrated that SAP was intensely expressed in CD8 + T cells and NK cells in normal fresh blood samples, thus suggesting the possible rapid identification of individuals with SAP deficiency. SH2D1A mutations were identified in six patients with SAP deficiency, but not in patients with normal SAP expression. Conclusion: The outcomes from this trial were verified by a flow cytometric assay using KST 3 and Alexa Fluor 488 secondary antibody. Based on the demonstration SAP deficiency in patients with suspected XLP, including mainly EBV associated HLH, this approach could serve as a method for the early and rapid detection of patients with XLP 1. © 2010 International Clinical Cytometry Society.

Shibata S.,Hirosaki Municipal Hospital | Toyoki Y.,Hirosaki University | Akasaka H.,Hirosaki Municipal Hospital | Akasaka H.,Hirosaki University | And 4 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2014

A man in his 60s was diagnosed with gastric cancer and underwent distal gastrectomy and D2 lymph node dissection. The histological diagnosis was adenocarcinoma (T3, N1, Stage IIB). He was treated with S-1 as adjuvant chemotherapy for 1 year. One year and 2 months after gastrectomy, a computed tomography (CT) scan revealed liver metastasis (S8, 38 mm). The patient was diagnosed with liver metastasis (refractory to S-1), and administered combination chemotherapy with irinotecan and cisplatin. After 4 courses of treatment, a CT scan detected a progressive liver tumor (55 mm). Combination chemotherapy with docetaxel and S-1 was selected as second-line chemotherapy. After 6 courses of treatment, the tumor size reduced to 40 mm in diameter, and no other metastasis was detected. Nine months after the diagnosis of liver metastasis, partial resection of the liver (S8) was performed. A pathological diagnosis of metastatic adenocarcinoma was determined, and the pathological therapeutic effect was rated as Grade 1b. Combination chemotherapy with docetaxel and S-1 was found to be effective, and was thus administrated after the operation. There have been no signs of recurrence for 6 months after the operation. Surgery with perioperative chemotherapy can be an effective treatment for liver metastasis from gastric cancer.

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