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Shiozawa E.,Showa University | Yamochi-Onizuka T.,Showa University | Saruta Y.,Showa University | Umemura Y.,Showa University | And 9 more authors.
Journal of the Showa Medical Association | Year: 2010

We report a 62-year-old man who was a human T-lymphotropic virus type 1 (HTLV-1) carrier with strongyloidiasis. He was born in Okinawa, Japan, an area endemic for both Strongyloides stercoralis and HTLV-1. On admission he presented with nausea and abdominal bloating and then he developed severe respiratory distress with septic shock. S.stercoralis rhabditiform larvae were found by sputum microscopy and then he was diagnosed as a disseminated strongyloidiasis with severe pulmonary strongyloidiasis. HTLV-1 carriers are at increased risk of developing severe strongyloidiasis.


Fukuda N.,Kawasaki Kyodo Hospital | Wada J.,Kawasaki Kyodo Hospital | Niki M.,Kawasaki Kyodo Hospital | Sugiyama Y.,Teikyo University | Mushiake H.,Teikyo University
World Journal of Emergency Surgery | Year: 2012

Objective: This study aimed to investigate clinical features of abdominal emergency surgery in elderly patients, and to determine factors predicting mortality in these patients.Methods: The study population included 94 patients aged 80 years or older who underwent emergency surgery for acute abdominal diseases between 2000 and 2010. Thirty-six patients (38.3%) were male and fifty-eight patients (61.7%) were female (mean age, 85.6 years). Main outcome measures included background of the patient's physical condition (concomitant medical disease, and performance status), cause of disease, morbidity and mortality, and disease scoring system (APACHE II, and POSSUM). Prognostic factors affecting mortality of the patient were also evaluated by univariate analysis using Fisher's exact test and Mann-Whitney U-test, and by multivariate analysis using multiple logistic regression analysis.Results: Of the 94 patients, 71 (75.5%) had a co-existing medical disease; most patients had hypertension (46.8%). The most frequent surgical indications were acute cholecystitis in 23 patients (24.5%), followed by intestinal obstruction in 18 patients (19.1%). Forty-one patients (43.6%) had complications during hospital stay; the most frequent were surgical site infection (SSI) in 21 patients (22.3%) and pneumonia in 12 patients (12.8%). Fifteen patients died (overall mortality, 16%) within 1 month after operation. The most common causes of death were sepsis related to pan-peritonitis in 5 patients (5.3%), and pneumonia in 4 patients (4.3%). Multiple logistic regression analysis showed that time from onset of symptoms to hospital admission and the POSSUM scoring system could be prognostic factors for mortality.Conclusions: Mortality in elderly patients who underwent emergency surgery for acute abdominal disease can be predicted using the disease scoring system (POSSUM) and on the basis of delay in hospital admission. © 2012 Fukuda et al.; licensee BioMed Central Ltd.


Fukuda N.,Kawasaki Kyodo Hospital | Niki M.,Kawasaki Kyodo Hospital | Sano M.,Kawasaki Kyodo Hospital | Ogura R.,Kawasaki Kyodo Hospital | Wada J.,Kawasaki Kyodo Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2014

The patient was a 58-year-old man diagnosed with type 2 advanced gastric cancer located at the fundus with multiple liver, lung, and lymph node metastases (Stage IV). Examination of an endoscopically obtained biopsy specimen revealed poorly differentiated adenocarcinoma (por), which stained positive for human epidermal growth factor receptor 2 (HER2) on immunohistochemistry. We started chemotherapy with S-1 plus cisplatin (CDDP) plus trastuzumab. The treatment was effective, as the tumor had reduced in size by 22.5% and 36.2% (partial response [PR]) after 3 and 6 courses, respectively. Adverse events related to the treatment were limited to grade 1 fever, nausea, vomiting, and diarrhea. The patient's chief complaints of right upper abdominal pain and abdominal fullness remarkably improved after treatment initiation. Although the therapy was effective against the multiple liver metastases and could be continued for 11 courses, the lymph nodes metastases did not respond to therapy (progressive disease [PD]), and the patient died 9 months after the start of treatment. Chemotherapy with S-1 pus CDDP plus trastuzumab may be effective for HER2-positive advanced gastric cancer with liver metastasis.

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