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Maeda T.,Kasugai Municipal Hospital | Hayakawa T.,Hokkaido Pharmaceutical University School of Pharmacy
Progress in Palliative Care | Year: 2017

Dyspnea negatively affects the survival and quality of life of patients with terminal cancer. Although corticosteroids are currently used to treat dyspnea, the association between corticosteroid dosage and survival remains unclear. This retrospective study was conducted to determine the relationship betweencorticosteroid doses, administered to hospitalized patients with terminal cancer for dyspnea alleviation, and survival. Subsequently, we investigated the associations between corticosteroid doses, which were classified into three categories, and the length of survival in days after stratifying 52 patients treated between January 2012 and December 2015 into corticosteroid responders and non-responders. The mean daily corticosteroid doses were 28.68 ± 14.4 mg for responders and 29.13 ± 18.5 mg for non-responders. The mean corticosteroid doses on the first day were 27.86 ± 14.9 mg for responders and 27.73 ± 19.5 mg for non-responders. The mean total corticosteroid doses administered during the first 2 days of treatment were 56.84 ± 29.2 mg for responders and 57.16 ± 38.5 mg for non-responders. The mean survival was 11.33 ± 7.5 days and 5.27 ± 3.35 days among responders and non-responders, respectively. In conclusion, the administration of corticosteroid for dyspnea alleviation did not correlate with survival. However, reactivity to corticosteroids increased the duration of corticosteroid use, which may have contributed to survival. © 2017 Informa UK Limited, trading as Taylor & Francis Group.


PubMed | Nagoya Ekisaikai Hospital, Handa City Hospital, Kasugai Municipal Hospital, Nagoya University and 2 more.
Type: | Journal: The British journal of surgery | Year: 2017

Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS).Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis.In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (548 per cent). The estimated cumulative probability of recurrence was 543 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (141 per cent) and initial distant recurrence in 168 (432 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (116 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0001 and P = 0009 respectively), pancreatic invasion (both P <0001) and lymph node metastasis (both P <0001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 706 per cent for patients without any risk factors, 503 per cent for patients with one factor, 318 per cent for those with two factors, and 134 per cent when three factors were present.More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.


Nozaki H.,Niigata University | Sekine Y.,Niigata University | Fukutake T.,Kameda Medical Center | Nishimoto Y.,Keio University | And 7 more authors.
Neurology | Year: 2015

Objectives: The objective of this study was to clarify the characteristic brain MRI findings for genetically diagnosed CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy). Methods: Seven patients with CARASIL carrying HTRA1 mutations (representing 6 Japanese families) were included in this study. Eighteen brain MRIs were reviewed and evaluated with a new rating scale based on scoring for abnormal hyperintense lesions and atrophy. Results: At the last follow-up MRI, all patients had hyperintense lesions on T2-weighted images of the frontal white matter, anterior temporal lobe, external capsules, and thalami. Patients with longer time from the onset of cognitive impairment had higher MRI severity score. The atrophy advanced, followed by white matter lesion progression. During the early stage, hyperintense lesions were observed in the frontal white matter, external capsule, and pons. During the late stage, the arc-shaped hyperintense lesion from the pons to the middle cerebellar peduncles, which we designated the "arc sign," became evident. The arc sign was a characteristic finding for CARASIL in the advanced stage. Conclusions: These characteristic MRI findings for CARASIL are useful for selecting patients for genetic testing. The rating scale correlates well with disease duration and might be useful for assessing disease progression. © © 2015 American Academy of Neurology.


Shoji T.,Osaka City University | Masakane I.,Yabuki Shima Clinic | Watanabe Y.,Kasugai Municipal Hospital | Iseki K.,University of Ryukyus | Tsubakihara Y.,Osaka General Medical Center
Clinical Journal of the American Society of Nephrology | Year: 2011

Summary Background and objectives Dialysis patients show "reverse causality" between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients. Design, setting, participants, & measurements This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year. Results The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non-HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non-HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non-HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels. Conclusions In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events. © 2011 by the American Society of Nephrology.


Ito T.,Red Cross | Hagiwara H.,Kasugai Municipal Hospital | Maekawa A.,Red Cross
General Thoracic and Cardiovascular Surgery | Year: 2012

Objectives: Surgical results for post-infarction ventricular septal rupture (VSR) remain poor, even today. The aim of this study was the establishment and clinical evaluation of a simple, standardized septal patch technique for this disease. Methods: From 1999 to 2011, 16 consecutive patients with a mean age of 73.1 ± 10.1 (range 55-89) underwent emergency repair of VSR following anterior myocardial infarction. Entire septal patch technique, in which a large pericardial patch is fixed reciprocally between transmural sutures placed in the posterior free wall adjacent to the ventricular septum and anterior left ventriculotomy closing sutures, thus almost entirely covering the septal wall, was used in all cases. Results: Mean interval between the onset of septal rupture and surgery was 1.3 ± 0.6 (range 1-3) days. Eight patients presented cardiogenic shock and 14 patients underwent preoperative intra-aortic balloon pumping. Average operation, cardiopulmonary bypass, and aortic clamp time were 233 ± 71 (145-360), 128 ± 51 (82-240), and 46 ± 15 (29-76) min, respectively. Coronary artery bypass grafting was performed concomitantly in five cases. Average intraoperative blood loss was 340 ± 184 (123-740) g. Thirty-day mortality was 0 %, and in-hospital mortality was 13.3 % (2/16). Significant residual shunt occurred in one patient. All hospital survivors were followed up with a mean period of 44.5 ± 40 (5-131) months. Five-year survival of all operated patients was 69 ± 14 %. Conclusions: Entire septal patch technique proved to be an easily reproducible method for anterior VSR that demonstrated stable early and late results. © The Japanese Association for Thoracic Surgery 2012.


Maeda T.,Kasugai Municipal Hospital | Tatematsu M.,Aichi Cancer Center Hospital | Muro K.,Aichi Cancer Center Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2011

We retrospectively investigated the incidence of infusion reactions following cetuximab chemotherapy in 93 patients with colorectal cancer. Patients received chemotherapy treatment from September 2008 to February 2010 at Aichi Cancer Center Hospital. The initial cetuximab dose was 400 mg/m2, followed weekly by an additional 250 mg/m2; and biweekly by 500 mg/m2. Infusion reactions were observed in 12 patients (13%), with grade 1 reactions in 6 patients and grade 2 reactions in 6 patients. Eleven of the 12 patients (92%) experienced infusion reactions during the first treatment. Typical grade 1 adverse events were fever and chills, nausea, vomiting and pruritus. Non-steroidal anti-inflammatory drugs were given for fever and chills. Grade 2 adverse events included dyspnea and wheezing, eruption, facial flushing and convulsions. Steroids were given for these symptoms. Infusion reactions were observed in 3 of the 12 patients (25%) < 15 min after intravenous injection, 16-60 min after injection in 3 more patients (25%), and 61-120 min after injection in the remaining 6 patients (50%).


Terasawa A.,Kasugai Municipal Hospital | Yokoi T.,Kasugai Municipal Hospital | Kondo K.,Kasugai Municipal Hospital
Journal of Invasive Cardiology | Year: 2013

Coronary artery aneurysms are uncommon diseases with potential complications including rupture and ischemia from embolic events or thrombosis. No consensus has been established regarding the optimal therapy for coronary artery aneurysms. Percutaneous catheter-based treatments using membrane-covered stents and coil embolization have been described. However, only few reports of stent-assisted coil embolization for coronary artery aneurysms have been published to date. Therefore, we report a case of coronary artery aneurysm successfully treated with stent-assisted coil embolization.


Tateyama H.,Kasugai Municipal Hospital | Sugiura H.,Kasugai Municipal Hospital | Yamatani C.,Kasugai Municipal Hospital | Yano M.,Nagoya City University
Human Pathology | Year: 2011

Recent studies have shown that podoplanin overexpression is associated with lymph node metastasis and poor clinical outcome in several malignant tumors. To investigate the role of podoplanin in thymoma, we examined 111 thymomas by immunohistochemistry using monoclonal antibody D2-40, which recognizes podoplanin. The tumors consisted of 8 type A, 40 type AB, 15 type B1, 23 type B2, 15 type B3, and 10 combined thymomas according to the World Health Organization histological classification system and of 41 stage I, 28 stage II, 16 stage III, 20 stage IVa, and 6 stage IVb thymomas according to the Masaoka staging system. We have found podoplanin expression in 0 (0%) type A, 4 (10%) type AB, 4 (27%) type B1, 16 (70%) type B2, 10 (67%) type B3, and 7 (70%) combined thymomas and in 5 (12%) cases of stage I, 7 (25%) of stage II, 11 (69%) of stage III, 12 (60%) of stage IVa, and all (100%) of stage IVb thymomas. Podoplanin was significantly expressed in B2/B3/combined thymomas and advanced stage thymomas (P < .0001). On survival analysis, podoplanin expression was significantly associated with an increased risk of death for the whole group of thymomas (P = .0002), although it was not identified as an independent prognostic factor in multivariate analysis. The significant survival curve differences of podoplanin expression were also seen for stage III/IVa/IVb thymomas (P = .0409) and B2/B3/combined thymomas (P = .0478). In conclusion, D2-40 immunostaining seems to be valuable for predicting the aggressive and metastatic potential of thymomas and the prognosis of the patients. © 2011 Elsevier Inc. All rights reserved.


Terasawa A.,Kasugai Municipal Hospital | Ishida K.,Kasugai Municipal Hospital | Inoue Y.,Kasugai Municipal Hospital | Hayashi Y.,Kasugai Municipal Hospital | Kondo K.,Kasugai Municipal Hospital
International Heart Journal | Year: 2012

Acute myocardial infarction is sometimes complicated in patients with coronary spastic angina. The mechanisms are known to be plaque rupture and thrombosis induced by spasm, and reduced coronary flow due to prolonged spasm. We describe the case of a 45-year-old woman with coronary spastic angina who had a complication of an acute myocardial infarction. A specimen obtained with thrombectomy was the disrupted coronary artery wall accompanied by massive intramural hemorrhage. The cause of the acute myocardial infarction was thought to be an embolism of the coronary arterial wall that was disrupted by spasm and intramural hemorrhage.


Nakamura S.,Nagoya University | Tateyama H.,Kasugai Municipal Hospital | Taniguchi T.,Nagoya University | Ishikawa Y.,Nagoya University | And 5 more authors.
American Journal of Surgical Pathology | Year: 2012

Multilocular thymic cysts (MTCs) are considered to be acquired lesions associated with various inflammatory conditions and/or malignant tumors. MTCs associated with thymomas are rare, with only 11 cases having been reported. On reviewing 110 consecutive patients with thymomas, we found 20 cases of MTCs. The patients included 18 men and 2 women aged 32 to 65 years (median 52 y). Eleven of the patients were symptomatic, and 6 presented with symptoms associated with inflammation. Computed tomography images were available for 11 patients, and cystic lesions were identified in 4 patients. The histologic subtypes of thymoma observed were: 3 tumors of type AB, 4 tumors of type B1, 9 tumors of type B2, and 4 tumors of type B3. In addition, 2 tumors were in advanced stages. Multilocular cystic structures accompanied by acute and chronic inflammation were observed in the remnant thymic tissues. Immunohistochemically, CK13 was diffusely expressed in the inner surface cells lining the cysts, whereas CK5/6 and p63 were primarily expressed in the basal cells of the cysts. D2-40 was weakly expressed in a small number of basal epithelial cells. The immunohistochemical profiles of the cysts were similar to those of Hassall corpuscles of normal thymi. A clinical follow-up showed that 15 patients continued to be alive without any evidence of disease, 1 patient with tumor recurrence continued to be alive, and 3 patients had died of other diseases. Our results suggest that MTCs associated with thymomas are not as uncommon as thought and may develop from the promotion of differentiation of increased numbers of epithelial cells into Hassall corpuscles by inflammatory processes. Our data also suggest a better clinical behavior for patients with thymomas accompanied by MTCs than patients with thymomas unaccompanied by those cysts, although further investigation is needed. Copyright © 2012 by Lippincott Williams & Wilkins.

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