Iwate Prefectural Central Hospital

Iwate, Japan

Iwate Prefectural Central Hospital

Iwate, Japan
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Inoue A.,Tohoku University | Kobayashi K.,International University of Japan | Maemondo M.,Miyagi Cancer Center | Sugawara S.,Sendai Kousei Hospital | And 15 more authors.
Annals of Oncology | Year: 2013

Background: NEJ002 study, comparing gefitinib with carboplatin (CBDCA) and paclitaxel (PTX; Taxol) as the first-line treatment for advanced non-small cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation, previously reported superiority of gefitinib over CBDCA/PTX on progression-free survival (PFS). Subsequent analysis was carried out mainly regarding overall survival (OS). Materials and methods: For all 228 patients in NEJ002, survival data wereupdated in December, 2010. Detailed information regarding subsequent chemotherapy after the protocol treatment was also assessed retrospectively and the impact of some key drugs on OS was evaluated. Results: The median survival time (MST) was 27.7 months for the gefitinib group, and was 26.6 months for the CBDCA/PTX group (HR, 0.887; P = 0.483). The OS of patientswho received platinum throughout their treatment(n = 186) was not statistically different from that of patients who never received platinum (n = 40). The MST of patients treated with gefitinib, platinum, and pemetrexed (PEM) or docetaxel (DOC, Taxotere; n = 76) was around 3 years. Conclusions: No significant difference in OS was observed between gefitinib and CBDCA/PTX in the NEJ002 study,probably due to a high crossover use of gefitinib in the CBDCA/PTX group. Considering the many benefits and the risk of missing anopportunity to use the most effective agent for EGFR-mutated NSCLC, the first-line gefitinib is strongly recommended. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Ichikawa H.,Tohoku University | Miyata G.,Tohoku University | Miyazaki S.,Iwate Prefectural Chubu Hospital | Onodera K.,Tohoku University | And 7 more authors.
Annals of Surgery | Year: 2013

OBJECTIVE: To estimate the oncological feasibility of thoracoscopic- assisted esophagectomy (TAE) for esophageal cancer and to clarify the prognostic impact of perioperative factors after TAE. BACKGROUND: Favorable perioperative outcomes of TAE versus open surgery have been demonstrated. However, survival data after TAE in a large cohort are limited, and no information on the prognostic influence of perioperative factors after TAE is available. METHODS: Prospectively collected data for 315 patients undergoing TAE for esophageal cancer were analyzed. Survival was compared with the Kaplan-Meier analysis and Cox regression analysis between 2 surgical approaches: thoracoscopic and hand-assisted laparoscopic esophagectomy (THLE) and thoracoscopic and open laparotomic esophagectomy (TOE). Factors affecting overall survival were identified with Cox multivariate regression analysis in the whole cohort and the THLE subgroup. RESULTS: THLE and TOE were performed in 153 and 162 patients, respectively. The overall 5-year survival of the whole cohort was 57.8%, with no difference between the THLE and the TOE group. Multivariate analysis of the 315 patients identified the following prognostic factors: blood loss, blood transfusion, intensive care unit stay, cardiovascular complications, pathological T and N stages, lymphatic invasion, intramural metastasis, and number of metastatic nodes. In the THLE subgroup, cerebral comorbidity, histological subtype, pathological T stage, and number of metastatic nodes were independent prognostic factors. CONCLUSIONS: TAE was oncologically feasible. Perioperative factors affected survival in the whole cohort, but did not in the THLE subgroup. However, the reduced perioperative factor effect in this subgroup would be small because the survival rates of the 2 surgical approaches were equal. Copyright © 2013 by Lippincott Williams & Wilkins.


Oe Y.,Tohoku University | Soma J.,Iwate Prefectural Central Hospital | Sato H.,Tohoku University | Ito S.,Tohoku University
Clinical and Experimental Nephrology | Year: 2013

Heavy chain deposition disease (HCDD) is one of three entities of monoclonal immunoglobulin deposition disease, characterized histopathologically by the presence of nodular glomerulosclerosis and glomerular and tubular deposition of monoclonal heavy chains without associated light chains. Although HCDD is an extremely rare disease, >30 cases have been reported to date in the literature. Of these cases, only three cases have been reported in Japan. The majority of the patients presents with nephrotic syndrome, hematuria, and hypertension, and develop progressive renal failure with or without the complication of multiple myeloma. Some cases have been treated successfully using chemotherapy. Because of its rarity, a thorough understanding of HCDD is essential for both accurate diagnosis and adequate subsequent treatment. © 2013 Japanese Society of Nephrology.


Maemondo M.,Miyagi Cancer Center | Inoue A.,Tohoku University | Kobayashi K.,International University of Japan | Sugawara S.,Sendai Kousei Hospital | And 19 more authors.
New England Journal of Medicine | Year: 2010

BACKGROUND: Non-small-cell lung cancer with sensitive mutations of the epidermal growth factor receptor (EGFR) is highly responsive to EGFR tyrosine kinase inhibitors such as gefitinib, but little is known about how its efficacy and safety profile compares with that of standard chemotherapy. METHODS: We randomly assigned 230 patients with metastatic, non-small-cell lung cancer and EGFR mutations who had not previously received chemotherapy to receive gefitinib or carboplatin-paclitaxel. The primary end point was progression-free survival; secondary end points included overall survival, response rate, and toxic effects. RESULTS: In the planned interim analysis of data for the first 200 patients, progression-free survival was significantly longer in the gefitinib group than in the standard-chemotherapy group (hazard ratio for death or disease progression with gefitinib, 0.36; P<0.001), resulting in early termination of the study. The gefitinib group had a significantly longer median progression-free survival (10.8 months, vs. 5.4 months in the chemotherapy group; hazard ratio, 0.30; 95% confidence interval, 0.22 to 0.41; P<0.001), as well as a higher response rate (73.7% vs. 30.7%, P<0.001). The median overall survival was 30.5 months in the gefitinib group and 23.6 months in the chemotherapy group (P = 0.31). The most common adverse events in the gefitinib group were rash (71.1%) and elevated amino transferase levels (55.3%), and in the chemotherapy group, neutropenia (77.0%), anemia (64.6%), appetite loss (56.6%), and sensory neuropathy (54.9%). One patient receiving gefitinib died from interstitial lung disease. CONCLUSIONS: First-line gefitinib for patients with advanced non-small-cell lung cancer who were selected on the basis of EGFR mutations improved progression-free survival, with acceptable toxicity, as compared with standard chemotherapy. (UMIN-CTR number, C000000376.) Copyright © 2010 Massachusetts Medical Society.


Nakamura A.,Iwate Prefectural Central Hospital | Nozaki E.,Iwate Prefectural Central Hospital | Fukui S.,Iwate Prefectural Central Hospital | Endo H.,Iwate Prefectural Central Hospital | And 2 more authors.
Heart and Vessels | Year: 2014

Strong psychosocial stress is considered to be a precipitating factor in acute coronary events. To assess the hypothesis that the incidence of acute myocardial infarction (AMI) and its severity was remarkably heightened after the great earthquake, we retrospectively analyzed the clinical data of patients with AMI admitted to our hospital during a 3-week period between March 11 and March 31, 2011 (disaster group) as compared with AMI patients during the corresponding time period of 2010 (non-disaster group). The number of patients with AMI in the disaster group increased by about threefold (22 in the disaster group vs. seven in the non-disaster group). Compared with the previous years 2010 or 2009, the odds ratios [OR] for AMI during a 3-week period in 2011 were 4.40 (95 % confidence interval [CI]: 1.05-18.35), 5.66 (95 % CI: 1.42-22.59), respectively. Although the number of patients who underwent coronary revascularization was higher in the disaster group than in the non-disaster group (68.2 vs. 42.9 %, p = 0.0397), peak serum creatine kinase (CK)-MB level was significantly higher in the disaster group than in the non-disaster group (208.0 ± 159.0 vs. 149.3 ± 102.7 IU/l, p = 0.0431). In the disaster group, four patients died of cardiac causes, whereas no patient died in the non-disaster group (in-hospital mortality rate in the disaster vs. non-disaster group: 18.2 vs. 0 %, p = 0.0281). These results suggest that patients with AMI after the earthquake might be subject to strong psychosocial stress, and that psychological stress brought on by such disaster could trigger cardiac events and cardiac death. © 2013 Springer.


Oura H.,Iwate Prefectural Central Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A very rare case of Askin's tumor is described. A 22-year-old male was admitted to our hospital because of an abnormal shadow on chest roentgenogram. His chest X-ray film showed a tumor shadow (4.0×5.0 cm) of chest wall protruding into the upper right lung field. The tumor shadow had markedly enlarged in size compared to previous examinations of chest X-ray film 1 month before. Chest computed tomography(CT) and magnetic resonance imaging( MRI) revealed an heterogenous tumor fixed on the right 4th rib, which did not infiltrate the surrounding tissues. In the examination of bone scintigram, no abnormal accumulation was seen at the site of the chest wall tumor. Because of the possibility of malignancy, an en bloc excision of the tumor was performed including the surrounding pleura. The histologic examination revealed primitive neuroectodermal tumors of the chest wall (Askin's tumor).The patient underwent both additional adjuvant chemotherapy and radiation therapy postoperatively, being alive and well without any sign of recurrence 10 years after the operation. Askin's tumor is a very rare disease with an extremely poor prognosis, however, the effective treatment has not been established yet. Complete excision at initial operation seemed to be correlated with long-term survival in this case.


Oura H.,Iwate Prefectural Central Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

We performed bronchoplasty for a bronchogenic tumor of low-grade malignancy without lung parenchyma resection. A 69-year-old man visited our hospital in March 2008 because of cough. Chest computed tomography (CT) revealed atelectasis of the entire left upper lobe and a 2-cm mass with strong contrast enhancement in the lumen of the left main bronchus. Bronchoscopy identified a polypoid mass in the left main bronchus, about 3 cm distal to carina, obstructing the lumen. Biopsy led to a diagnosis of typical carcinoid tumor. Surgery : Thoracotomy showed complete atelectasis of the left upper lobe. After lymph node dissection, resection of the left main bronchus including the site of tumor origin was performed. From the extent of expansion, the left upper lobe was decided to be possible to be spared, and end-to-end anastomosis of the bronchus was performed. Postoperative respiratory rehabilitation resulted in improved aeration of the left upper lobe and markedly improved respiratory function. CONCLUSION: The judgment of whether the long-standing atelectatic left upper lobe could be spared or not was a key in choosing this procedure.


Ishida I.,Iwate Prefectural Central Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 78-year-old man who fell from a step ladder was transported to our hospital by ambulance under the diagnosis of multiple rib fractures and right hemothorax. Since he was in shock on arrival, endotracheal intubation and tube thoracotomy were immediately performed. Though 2 liters of blood was evacuated, persistent hemorrhage was observed, requiring continuous rapid infusion and blood transfusion. Emergency thoracic arteriography revealed active bleeding from a branch of the right internal thoracic artery. Transcatheter arterial embolization (TAE) was performed using vascular embolization coils and porous gelatin particles. These procedures successfully controlled active hemorrhage from the chest. Intrathoracic hematoma was evacuated through the 2nd large chest tube. Chest tubes were removed on the 7th day. He was discharged on the 17th day without any complications.


Endo Y.,Iwate Prefectural Central Hospital
Practica Oto-Rhino-Laryngologica | Year: 2013

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant disease that is characterized by repetitive nasal bleeding with familial occurrence, and is frequently associated with difficulty in treating the nasal bleeding. We treated cases of refractory nasal bleeding, consisting of 4 cases of hereditary hemorrhagic telangiectasia and one case of renal cell carcinoma, metastasized to the paranasal sinus, on an out-patient basis with local injection of the esophageal varices sclerosing agent, polidocanol. Following injection sclerotherapy in all five cases, the frequency of nasal bleeding decreased. Since this procedure was able to be performed on an out-patient basis without requiring hospitalization, it was useful in improving patient QOL.


Mariya Y.,Iwate Prefectural Central Hospital
The Tohoku journal of experimental medicine | Year: 2011

Non-small cell lung cancer (NSCLC) is characterized by brain metastases that occur in about 30 to 50% of patients. To control tumor growth potential with maintaining neurocognitive function is important in the recent radiotherapy against brain metastases. From this viewpoint, we investigated the utility of repeat stereotactic radiosurgery (SRS) with a linear accelerator in the management of brain metastases from NSCLC. Between October 1998 and May 2010, 28 patients harboring brain metastases received repeat SRS (20 men and 8 women, with the age ranged from 51 to 79). The total number of SRS sessions ranged from 2 to 5, and the total number of lesions in one patient ranged from 1 to 8. Neurological decline due to uncontrolled brain lesions was identified in 9 of 28 patients after the repeat SRS, while the remaining 19 patients showed no neurological decline. Out of the 28 patients, 18 patients died by July 1, 2010; 12 patients died of active extracranial disease and 6 patients died from progressive brain lesions, considered neurological death. The 2-year and 4-year overall survival rates were 51% and 23%, respectively, and the median survival time was 26 months. In conclusion, repeat SRS is a preferred option to manage brain metastases from NSCLC, leading to a long survival with a decreased neurological decline. Repeat SRS is promising to preserve neurocognition, because the convergent dose distribution decreases the unfavorable influences from radiation on germinal niches, thereby preserving neural stem cells that are responsible for the nervous system repair.

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