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Kinoshita M.,JA Aichi Anjo Kosei Hospital | Tokudome Y.,Nagoya University of Arts and Sciences | Takagi K.,Nagoya University | Kato S.,Sankuro Hospital | Hotta Y.,KIBO
Japanese Journal of Geriatrics | Year: 2011

AIM: To apply nutrition care management to elderly female patients, we predicted serum albumin (s-Alb) levels by noninvasive factors. METHODS: After excluding patients with lesions/diseases which were directly related to s-Alb levels, we investigated 147 elderly women aged 75-years or over who were taking meals orally and were hospitalized from April 2008 to April 2009 at a hospital in Toyota. The patients were classified into 2 groups, one of patients with s-Alb levels of 3.5 g/dl or below (n=80), and the other of those with s-Alb levels of over 3.5 g/dl (n=67). Between the 2 groups, we examined differences in age, body mass index (BMI), living arrangements, necessary nursing care level (NNCL), bed confinement level (BCL), OH scale level (OHSL), and dietary intake either by the Student t-test, Mann-Whitney U test or chi-square test. Pearson correlation coefficients were calculated among s-Alb levels and selected variables. Taking into account the correlation coefficients, we conducted multiple regression analysis adopting the s-Alb level as a dependent variable and non-invasive factors as independent variables. For all the performed tests and analyses, a p value of less than 0.05 (on two-tailed analysis) was assumed to represent a statistically significant difference. RESULTS: S-Alb level was significantly associated with variables, including age, BMI, NNCL, BCL, OHSL, and percentage of protein intake (PPI). Multiple regression analysis revealed 4 significant variables: age, BCL, OHSL, and PPI. The multiple regression equation was y=4.977-(0.098×OHSL)- (0.080×BCL)- (0.016×age) + (0.003×PPI), and the multiple correlation coefficient R2 was 0.398 (p<0.001). CONCLUSIONS: S-Alb levels among elderly female patients may be predicted by 4 non-invasive variables: age, BCL, OHSL, and PPI.

Akita H.,JA Aichi Anjo Kosei Hospital | Nakane A.,JA Aichi Anjo Kosei Hospital | Ando R.,JA Aichi Anjo Kosei Hospital | Yamada K.,JA Aichi Anjo Kosei Hospital | And 3 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2013

While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. Materials and Methods: From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. Results: There was a significant difference in operative time between the 2-port RP and LRP groups (286.5±63.3 and 351.8±72.4 min: p=0.0019, without any variation in blood loss (including urine) (945.1±479.6 vs 1271.1±871.8ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance (5.6±1.8 vs 8.0±5.6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

Okamura T.,JA Aichi Anjo Kosei Hospital | Akita H.,JA Aichi Anjo Kosei Hospital | Hashimoto Y.,Nagoya City University | Tozawa K.,Nagoya City University | And 3 more authors.
Current Urology | Year: 2010

Objective: Bacillus Calmette-Guérin (BCG) is used as the gold standard for prevention of recurrence after transurethral resection of bladder tumor of non muscle invasive bladder cancer. However, in some cases the outcome is not optimal. In order to assess the possible impact of different variables on outcome, the present clinical evaluation of initially failed cases was performed. Patients and Methods: A total of 68 patients treated with BCG were evaluated. All suffered recurrence. Their original urothelial carcinomas were: G1/G2/G3 = 13/41/14, and Ta/T1 = 30/38. Thirteen high-risk T1G3 cases were included. Intravesical chemotherapy pretreatment was given to 10 cases. Results: The overall progression-free survival rates at 3, 5 and 10 years were 83.3, 80.9, and 72.0% respectively, with cancer-specific survival rates of 98.3, 89.0 and 89.0%. High-risk T1G3 patients were confirmed to have higher progression rates (p = 0.03, log-rank test). Total cystectomy was performed in 5 of 13 T1G3 patients, one died during the follow-up. Additional BCG treatments were performed for 8 patients, and all of them remain alive at the present time. Conclusions: These findings indicate that the response to BCG is definitely influenced by high-risk category, so that early selection of total cystectomy may improve the prognosis with T1G3 patients. However, it was also suggested that more than 1 course of BCG is a feasible option in some cases with a tendency for a worse outcome when pretreated with anti-cancer drugs. Copyright © 2010 S. Karger AG.

Okamura T.,JA Aichi Anjo Kosei Hospital | Ando R.,JA Aichi Anjo Kosei Hospital | Ando R.,Nagoya City University | Akita H.,JA Aichi Anjo Kosei Hospital | And 4 more authors.
Current Urology Reports | Year: 2014

Guidelines change every few years regarding the prophylactic use of Bacille Calmette-Guérin (BCG) against non-muscle invasive bladder cancer. We performed a retrospective comparison to clarify the differences in BCG efficacy, based on time period, between Japan and Western countries . Published literature on 18 Japanese and 28 Western patient studies were compared to evaluate differences in BCG efficacy. Additionally, Internet searches were performed to obtain comparative Japanese and Western data. BCG efficacy in Japanese literature tended to show decreasing nonrecurrence rates by time period. Non-recurrence rates in Western countries increased each year. This discrepancy may stem from a number of factors, including changes in accepted BCG indications, the introduction of restaging transurethral resection (re-TUR), the concept of BCG maintenance, and the evolution of histopathological diagnostic criteria. © The Author(s) 2013.

Okamura T.,JA Aichi Anjo Kosei Hospital | Akita H.,JA Aichi Anjo Kosei Hospital | Ando R.,JA Aichi Anjo Kosei Hospital | Kawai Y.,Nagoya City University | And 2 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2010

Instruction: With T1G3 bladder cancer, it remains unresolved whether the best treatment option is bladder preservation or total cystectomy. To assess the feasibility of the first option, we performed a clinical evaluation of the efficacy of intravesical instillation of bacillus Calmette-Guérin (BCG) for prevention of T1G3 bladder cancer recurrence after transurethral resection of bladder tumor (TUR-Bt). Methods: A total of 30 patients with T1G3 bladder cancers received 6 to 8 weekly instillations of BCG followed in some cases by further applications at monthly intervals. Results: Recurrence occurred in 13 cases. There were 6 patients with progression, total cystectomy being performed for 5 of these. Further BCG-including treatments were performed in 7 patients, and all of them were alive at the end of the follow-up period. Finally, bladder preservation proved successful in 24 of 30 cases. Conclusion: Intravesical instillation of BCG in high-risk T1G3 cases, including additional BCG treatment, proved effective and satisfactory in our series. Therefore, this option warrants emphasis with regard to its relative merit compared to total cystectomy.

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