Japan Community Health Care Organization Kyushu Hospital

Fukuoka-shi, Japan

Japan Community Health Care Organization Kyushu Hospital

Fukuoka-shi, Japan
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Ito Y.,Kyushu University | Ito Y.,Harasanshin Hospital | Miyamoto T.,Kyushu University | Kamimura T.,Harasanshin Hospital | And 10 more authors.
Clinical Lymphoma, Myeloma and Leukemia | Year: 2015

Introduction Widespread use of tyrosine kinase inhibitors (TKIs) in combination with chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-SCT) has totally changed the existing treatment strategies for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). However, the prognosis after relapse after allo-SCT is still dismal. Patients and Methods We analyzed the clinical outcome of therapy using dasatinib, a second-generation TKI, in 9 patients with relapsed Ph+ALL after allo-SCT. Dasatinib was initiated at a median time of 168 days after allo-SCT at dosages ranging from 20 mg to 100 mg daily. Results Six of 9 patients manifested a marked increase in large granular lymphocytes (LGLs), but all 6 patients discontinued dasatinib because of adverse events (AEs) such as pleural effusion. Four of 6 patients resumed dasatinib, and 3 of them have been alive with molecular complete remission and a persistent increase of LGLs. Conclusion Our results demonstrated that dasatinib therapy can induce LGL expansion accompanied by AEs, but this phenomenon can be associated with long-term survival benefit in a proportion of relapsed Ph+ALL patients after allo-SCT. © 2015 Elsevier Inc. All rights reserved.


Hirano G.,Japan Community Health Care Organization Kyushu Hospital | Makiyama A.,Japan Community Health Care Organization Kyushu Hospital | Makiyama C.,Japan Community Health Care Organization Kyushu Hospital | Esaki T.,National Kyushu Cancer Center | And 13 more authors.
Anticancer Research | Year: 2015

Background: Salvage-line regorafenib monotherapy exhibited a marked survival benefit for metastatic colorectal cancer (mCRC). However, the toxicity of this regimen has resulted in the clinical use of a reduced dose of regorafenib.Patients and Methods: Thirty-two Japanese mCRC patients (median age=61 years) who had been treated with regorafenib were retrospectively examined.Results: Best objective response rate was 0% and stable disease (SD) was 31%. Median progression-free survival was 81 days and median overall survival was 233 days. Adverse events of any grade were observed in all patients: 17 (53%) patients suffered grade 3 or 4 adverse events including fatigue (13%), anorexia (13%), hand-foot skin reaction (22%) and elevations of alanine aminotransferase/aspartate aminotransferase (19%/16%). One patient with grade 5 liver dysfunction was identified (3%). Twenty-nine (91%) patients required treatment dose reduction or a delay in treatment. The relative dose intensity was 59%. Regorafenib treatments were terminated because of disease progression (59%) or adverse events (34%).Conclusion: Despite a decrease in the intensity of regorafenib treatment, because of severe adverse events, a fairly favorable efficacy was achieved in Japanese patients.


PubMed | Hamanomachi Hospital, Japan Community Health Care Organization Kyushu Hospital, University Graduate Center, Kyushu University and 2 more.
Type: Journal Article | Journal: Experimental hematology | Year: 2016

Somatic mutations of calreticulin (CALR) have been observed in many cases of essential thrombocythemia (ET) or primary myelofibrosis that harbor non-mutated Janus kinase 2 (JAK2). CALR mainly localizes within the endoplasmic reticulum lumen, but a small fraction of the total CALR pool is distributed over the cell surface. Cell surface CALR is known to transduce prophagocytic eat me signals to macrophages and acts as one of the important regulators for macrophage engulfment. In this study, we attempted to clarify whether mutant CALR may affect the threshold for macrophage engulfment and play an integral role in the pathogenesis of CALR-mutated ET. First, we compared the surface expression levels of CALR on hematopoietic stem and progenitor cells (HSPCs) and mature blood cells in patients with myeloproliferative neoplasms and found that the surface expression of mutant CALR did not change. Next, we compared the threshold for macrophage phagocytosis of each HSPC fraction and mature blood cells and found no significant change in the efficiency of macrophage engulfment. Our data suggest that CALR mutation does not affect sensitivity to phagocytosis by macrophages. Finally, we analyzed the phosphorylation statuses of molecules downstream of JAK2 at each HSPC level in patients with ET and found that CALR mutations activated the JAK-STAT pathway in a manner similar to that associated with JAK2 mutations. These results indicate that mutant CALR causes myeloproliferation because of the activation of JAK-STAT pathway and not by the inhibition of phagocytosis, which is similar to the myeloproliferation caused by JAK2 V617F mutation.


PubMed | Miyazaki Prefectural Miyazaki Hospital, Japan Community Health care Organization Kyushu Hospital, Kagoshima University and Kyushu University
Type: Journal Article | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2016

Determining the cause of bowel obstruction without a history of laparotomy (BO without HL) is difficult and can result in delay of treatment and development of a potentially life-threatening situation. We herein investigated the clinical characteristics of pediatric patients who underwent laparotomy due to BO without HL.All surgical pediatric patients aged <16 age who were diagnosed with BO without HL between January 2004 and September 2014 were included. Etiology of BO, intraoperative findings and postoperative outcome were investigated retrospectively.Seventy patients were diagnosed with BO without HL in this period. In these 70 patients, malrotation (n = 34), intussusception (n = 19), internal hernia (n = 6) and Meckels diverticulum (n = 5) were predominantly identified. Regarding preoperative definitive diagnosis, prevalence of internal hernia, Meckels diverticulum or idiopathic volvulus was significantly lower than that of malrotation or intussusception (P < 0.05). Intraoperatively, the rates of strangulation and bowel resection were 55.7% and 30.0%, respectively. The optimal time for emergency operation in order to avoid strangulated bowel resection was <19 h from onset of symptoms.Malrotation and intussusception are major causes of BO without HL in children, but internal hernia, Meckels diverticulum and idiopathic volvulus should always be taken into account, particularly because of the preoperative diagnostic difficulty and resulting high rate of intestinal resection. In order to avoid resection of the bowel, surgery should be done within 19 h before bowel ischemic change occurs.


Matsuo M.,Japan Community Health Care Organization Kyushu Hospital | Tuneyoshi M.,Kyushu University | Mine M.,The Mutual
Diagnostic Pathology | Year: 2016

Background: Primary mucinous carcinoma of the thyroid gland is a rare disease; only 6 cases of primary mucinous carcinoma of the thyroid have been previously reported. Primary mucinous carcinoma of the thyroid gland with incomplete tumor resection tends to be associated with a poor prognosis, resulting in death within a few months. An early and appropriate diagnosis may contribute to improvement in patient prognosis; however, it is extremely difficult to diagnose primary mucinous carcinoma of the thyroid. We present the seventh reported case of primary mucinous carcinoma in the thyroid gland; moreover, rhabdoid cells were detected, which, to our knowledge, is a novel finding. Case presentation: An 81-year-old Japanese woman was initially diagnosed with a poorly differentiated thyroid carcinoma, and she underwent a hemithyroidectomy. Pathological examination revealed the presence of abundant mucus and agglomeration of large atypical cells. Rhabdoid cells were also seen scattered among the tumor cells. Immunostaining was performed for various markers, and on the basis of these results, we diagnosed the lesion as primary mucinous carcinoma with rhabdoid cells in the thyroid gland. Ten months after surgery, recurrence was noted in the paratracheal lymph nodes; therefore, total resection of the residual thyroid gland and paratracheal lymphadenectomy with thyroid-stimulating hormone suppression were performed. The patient is currently alive and disease-free. Conclusions: The current case is of interest not only because of the rare histological findings, but also because the patient achieved long-term survival following diagnosis of a mucinous carcinoma. We believe this report will be helpful for diagnosing future cases of mucinous carcinoma of the thyroid. © 2016 The Author(s).


Fujisawa K.,Japan Community Health Care Organization Kyushu Hospital
Journal of Japanese Society of Gastroenterology | Year: 2015

A woman in her 80s was admitted to our hospital on account of jaundice, abnormal liver function tests, and leukocytosis. She was diagnosed with adult T-cell leukemia on the basis of the presence of anti-human T-cell leukemia virus type I (HTLV-I) and the results of flow cytometric analysis of peripheral blood. She also showed lung consolidation and cavitation, and a sputum smear and culture revealed cryptococcal infection. Therefore, she was diagnosed with pulmonary cryptococcosis. However, the cause of the abnormal liver function tests and jaundice remained unclear, and the patient subsequently died. On autopsy, multiple granulomas were observed throughout the liver, consistent with cryptococcal bodies. Herein we report this rare case of hepatic cryptococcosis with predominant hepatobiliary complaints.


Noshiro H.,Saga University | Kai K.,Saga University | Yoda Y.,Saga University | Kono H.,Saga University | Uchiyama A.,Japan Community Health Care Organization Kyushu Hospital
Esophagus | Year: 2016

Background: Ultrasonic activated devices (USADs) may produce inadvertent injuries due to heat or shock waves. However, thermal injury and shock waves are considered to be avoidable if these devices are used appropriately. Methods: Utilizing a porcine model, we examined the relationship between the occurrence of tissue damage around the iliac artery and sciatic nerve and the usage of an USAD. Thereafter, we prospectively determined the clinical outcomes following the usage of the USAD during dissection along the recurrent laryngeal nerves (RLN) in 114 consecutive patients who underwent thoracoscopic esophageal surgery. Results: The temperatures measured in the pig iliac artery and sciatic nerve more than 2 mm from the activating blade (at a power setting of 70 %, within 2 s) did not increase to 42 °C. In a subsequent clinical series using the short activating technique according to the findings of in vivo experiments, scheduled laryngoscopic studies showed the rate of vocal cord palsy after esophagectomy to be 39 %, which was more sensitive than the substantial presence of hoarseness (28 %). Conclusions: Adverse effects by using the USAD on the nerves may be avoidable if the activation of the current using an USAD is conducted within 2 s at positions more than 2 mm from the nerves. This short activation technique using the USAD is therefore considered to be safe and feasible for lymph node dissection along the RLNs during thoracoscopic esophagectomy, although the apparent reasons for postoperative dysfunction in the vocal cords remain unclear. © 2016 The Japan Esophageal Society and Springer Japan


Matsuo M.,Japan Community Health Care Organization Kyushu Hospital | Miyazaki R.,Japan Community Health Care Organization Kyushu Hospital | Koike K.,Japan Community Health Care Organization Kyushu Hospital
Japanese Journal of Head and Neck Cancer | Year: 2015

The number of hemodialysis (HD) patients is tending to increase, and HD patients can survive longer than before. For these reasons, we sometimes need to treat malignant tumors in HD patients, although such patients are still rare in the head and neck cancer category. We analyzed head and neck cancer patients undergoing HD, and classified the therapeutic methods of the patients into 3 groups. We examined 7 head and neck cancer patients undergoing HD at Kyushu Hospital and 10 reported cases of “Head & neck cancer patients with HD”(searches in PubMed and Japan Medical Abstracts Society). “Noninvasive surgery(e.g. partial resection)” appears to be an acceptable option for HD patients. Under careful observation, “Invasive surgery”(e.g. reconstructive surgery) might be a feasible therapy for HD patients. Regarding the therapeutic efficacy of “Radiation” for HD patients, control was poor and there were severe adverse effects. © 2015, Japan Society for Head and Neck Cancer. All rights reserved.


PubMed | Japan Community Health Care Organization Kyushu Hospital, The Mutual and Kyushu University
Type: Journal Article | Journal: Diagnostic pathology | Year: 2016

Primary mucinous carcinoma of the thyroid gland is a rare disease; only 6 cases of primary mucinous carcinoma of the thyroid have been previously reported. Primary mucinous carcinoma of the thyroid gland with incomplete tumor resection tends to be associated with a poor prognosis, resulting in death within a few months. An early and appropriate diagnosis may contribute to improvement in patient prognosis; however, it is extremely difficult to diagnose primary mucinous carcinoma of the thyroid. We present the seventh reported case of primary mucinous carcinoma in the thyroid gland; moreover, rhabdoid cells were detected, which, to our knowledge, is a novel finding.An 81-year-old Japanese woman was initially diagnosed with a poorly differentiated thyroid carcinoma, and she underwent a hemithyroidectomy. Pathological examination revealed the presence of abundant mucus and agglomeration of large atypical cells. Rhabdoid cells were also seen scattered among the tumor cells. Immunostaining was performed for various markers, and on the basis of these results, we diagnosed the lesion as primary mucinous carcinoma with rhabdoid cells in the thyroid gland. Ten months after surgery, recurrence was noted in the paratracheal lymph nodes; therefore, total resection of the residual thyroid gland and paratracheal lymphadenectomy with thyroid-stimulating hormone suppression were performed. The patient is currently alive and disease-free.The current case is of interest not only because of the rare histological findings, but also because the patient achieved long-term survival following diagnosis of a mucinous carcinoma. We believe this report will be helpful for diagnosing future cases of mucinous carcinoma of the thyroid.


PubMed | Japan Community Health Care Organization Kyushu Hospital and National Hospital Organization Kyushu Cancer Center
Type: | Journal: International journal of surgery case reports | Year: 2016

Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to result in late complications, such as hypopharyngeal perforation, which is very rare.A 65-year-old man, who had undergone chemoradiotherapy for hypopharyngeal cancer 30 months previously, presented with high fever and neck pain. He subsequently developed hypopharyngeal stenosis, hypopharyngeal perforation, and a retropharyngeal abscess followed by pyogenic spondylitis. He underwent surgical treatment (resection with reconstruction) and was administered an antibacterial agent and steroids for an extended period. This treatment regimen was successful, and the patient has survived disease-free without symptoms.Chemoradiotherapy-induced hypopharyngeal perforation is an extremely rare condition. In the present case, the perforation was large (2cm), and the hypopharyngeal cavity was originally constricted. Pharyngeal reconstruction with a jejunal autograft was therefore necessary. Through the present case, we reconfirmed that although the primary purpose of chemoradiotherapy is organ preservation, it can also lead to organ destruction and fatal complications. It is important that physicians be aware of the possibility of hypopharyngeal perforation so as to avoid delayed diagnosis and treatment of similar rare cases.Hypopharyngeal perforation can sometimes be fatal because it can lead to pyogenic spondylitis. Suitable surgical techniques and appropriate doses of antibacterial agents for long-term use were appropriate treatments for the patient in this case.

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