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Hiroshima-shi, Japan

Shimizu S.,Hiroshima City Asa Hospital
Asian journal of endoscopic surgery | Year: 2013

Congenital cystic adenomatoid malformation (CCAM) in adolescents or adults is extremely rare. In this case study, a 17-year-old boy was admitted to our clinic for the treatment of a giant bulla in the lower lobe of the right lung. Preoperative imaging studies led to the diagnosis of cystic lung disease. The patient underwent wedge resection of the right lower lobe with VATS, and histological examination confirmed the presentation of type 1 CCAM. A thoracoscopic lobectomy was performed after the second surgery because of postoperative air leakage.Herein, we report a case of CCAM in an adolescent. VATS was a suitable procedure for the operation. Between the parenchyma-saving resection and lobectomy for CCAM, we believe that the lobectomy is the better treatment option when the extent of the disease cannot be determined clearly or it is extremely large. Therefore, strategies for deciding between parenchyma-saving resection and lobectomy for the treatment of CCAM should be developed. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd. Source

We retrospectively investigated increases in large granular lymphocytes (LGL) in peripheral blood during dasatinib treatment in 25 chronic myelogenous leukemia patients. Fifteen of 25 patients (60 %) showed an increase in LGL. All 15 of these patients also showed an increase in NK cells, and 11 showed an increase in CD8+ T cells. High frequencies of clonal rearrangements of TCR-β, -γ, and -λ genes were observed in LGL (+) patients, and at lower frequencies in LGL (-) patients as well. Clinical responses were favorable for all. With respect to their newly obtained complete molecular response after dasatinib treatment, LGL (+) patients showed higher response rates than did LGL (-) patients. In contrast, pleural effusions were more commonly observed in LGL (+) patients (60 %) than in LGL (-) patients (20 %). LGL counts significantly increased at 2 h after oral intake of dasatinib in all 25 patients. This was not observed in treatment with imatinib or nilotinib. Cytomegalovirus (CMV) C7-HRP tests were negative in all patients. Serum CMV-IgM antibodies were positive in only 2 of 25 patients without symptom of infection. Thus, LGL lymphocytosis during dasatinib treatment may be correlated with favorable molecular response, and with increased incidence of pleural effusions. In the clinical setting, CMV reactivation appears uncommon. © 2012 The Japanese Society of Hematology. © 2012 The Japanese Society of Hematology. Source

Kurokawa Y.,Osaka University | Shibata T.,Clinical Data | Ando N.,Tokyo Dental College | Seki S.,Tokyo Medical Center | And 2 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Preoperative treatment is a promising strategy for improving long-term outcomes in advanced esophageal cancer. Two tumor response evaluation criteria for preoperative treatment are available: response evaluation criteria in solid tumors (RECIST) and histological criteria. This prospective study aimed to identify which was a better surrogate end point for survival in the preoperative setting. Methods: We analyzed all eligible patients (n = 164) from the preoperative treatment group in a phase III trial comparing preoperative versus postoperative 5-fluorouracil plus cisplatin for clinical stage II or III esophageal cancer. Intercriteria reliability was evaluated with the proportion of agreement and the kappa coefficient. For validity analyses, hazard ratios (HR) of response to nonresponse and differences in response rates between short- and long-term survivors were evaluated. Results: The clinical and histological response rates were 37.8 % (62 of 164) and 20.1 % (33 of 164), respectively. The proportion of agreement for response to nonresponse between the 2 criteria was 70.3 %, and the kappa coefficient was 0.34. The HR for death in patients with histological response (0.22, 95 % confidence interval 0.09-0.55, P < 0.001) was lower than for those with RECIST response (0.55, 95 % confidence interval 0.33-0.91, P = 0.018). The difference in response rates between short- and long-term survivors according to histological criteria (27 vs. 7 %, P < 0.001) was larger than with RECIST (42 vs. 30 %, P = 0.13). Conclusions: Intercriteria agreement was relatively low, and histological criteria yielded more valid assessments of response than RECIST. Histological response rate seemed to be the better surrogate end point of survival in the preoperative setting. © 2013 Society of Surgical Oncology. Source

Wago M.,Hiroshima City Asa Hospital
Nippon rinsho. Japanese journal of clinical medicine | Year: 2011

The presence of a cytokine storm is recognized as a condition possibly involved in the mechanism for the onset, aggravation and progression of acute encephalitis/encephalopathy. Plasma exchange and slow hemodiafiltration have been used as the means of blood purification to deal with acute encephalitis/encephalopathy. It has been suggested that blood purification can lead to diminution of the cytokine storm, possibly enabling correction of multiple organ failure and disseminated intravascular coagulopathy (DIC). However, additional studies are needed as to the possibility of achieving the diminution of the intracerebral cytokine storm with this approach. Source

Kagawa E.,Hiroshima City Asa Hospital | Kagawa E.,Hiroshima University | Dote K.,Hiroshima City Asa Hospital | Kihara Y.,Hiroshima University
Current Opinion in Cardiology | Year: 2013

Purpose of Review: Sudden cardiac arrest is a major cause of unexpected death, as well as a major clinical issue. Primary percutaneous coronary intervention (PCI) can drastically improve outcomes among patients with ST-elevation myocardial infarction without cardiac arrest. Recent studies reported that using emergency PCI to resuscitate patients has the potential to improve their outcomes. The purpose of this review is to elucidate the effects of PCI among resuscitated patients. Recent Findings: To the best of current understanding, no randomized clinical trial has assessed PCI for postcardiac arrest syndrome. Several observational studies suggested a positive effect of PCI for resuscitated out-of-hospital cardiac arrest (OHCA) patients, and a number of observational studies reported a limited beneficial effect. Several studies reported that a combination of therapeutic hypothermia and PCI may be feasible and effective. However, the presence of bias and unmeasured confounders in these studies may have affected the outcomes. Summary: PCI for postcardiac arrest syndrome may improve outcomes of OHCA patients; however, randomized trials of PCI for postcardiac arrest syndrome are necessary to confirm this issue. Alternative cardiopulmonary resuscitation using venoarterial extracorporeal membrane oxygenation and PCI may have the potential to improve the outcomes of refractory cardiac arrest patients. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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