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Tsujino K.,Kinki Central Hospital | Tsujino K.,Osaka University | Kurata T.,Kinki University | Yamamoto S.,National Hospital Organization Kinki Chuo Chest Medical Center | And 7 more authors.
Journal of Thoracic Oncology | Year: 2013

Introduction: The purpose of this study was to evaluate whether consolidation chemotherapy (CCT) after concurrent chemo-radiotherapy is beneficial for patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Methods: We systematically searched PubMed for phase II/III trials published before December 31, 2011, examining survival of LA-NSCLC treated with concurrent chemo-radiotherapy. Median overall survival and other study characteristics were collected from each study and pooled. We extracted log-transformed hazards and standard errors under the assumption that survival follows an exponential distribution, and computed a pooled median overall survival and a 95% confidence interval (CI) using random-effects model. Collected trial arms were categorized as having CCT or not having it, CCT+ and CCT-, respectively. Results: Forty-one studies were identified including seven phase III studies and 34 phase II studies with 45 arms (CCT+: 25; CCT-: 20). Clinical data were comparable for clinical stage, performance status, cancer histology, sex, and median age between the two groups. There was no statistical difference in pooled mOS between CCT+ (19.0 month; 95% CI, 17.3-21.0) and CCT-(17.9 month; 95% CI, 16.1-19.9). Predicted hazard ratio of CCT+ to CCT-was 0.94 (95% CI, 0.81-1.09; p = 0.40). There were no differences between the two groups with regard to grade 3-5 toxicities in pneumonitis, esophagitis, and neutropenia. These models estimated that addition of CCT could not lead to significant survival prolongation or risk reduction in death for LA-NSCLC patients. Conclusion: The pooled analysis based on a publication basis failed to provide evidence that CCT yields significant survival benefit for LA-NSCLC. © 2013 by the International Association for the Study of Lung Cancer.

Murai J.,Kinki Central Hospital | Soga S.,Kinki Central Hospital | Saito H.,Kinki Central Hospital | Koga M.,Kawanishi City Hospital
Endocrine Journal | Year: 2013

Glycated albumin (GA) reflects shorter term glycemic control state than HbA1c. This study evaluated whether GA is useful for early detection of deterioration of glycemic control state after discharge from educational admission. Among the patients with educational admission, this study included 21 diabetic patients who were followed for at least 10 weeks after discharge from educational admission. Deterioration was defined that GA after discharge increased by ≥0.6% compared to the previous GA. Thirteen patients without deterioration up to 10 weeks after discharge were used as controls. In 8 patients with deterioration within 10 weeks after discharge, their HbA1c and GA at the time of admission and the decrease in HbA1c and GA during hospitalization were not significantly different from the control patients. At the time of deterioration, GA in the patients with deterioration increased significantly from 18.7 ± 2.7% to 21.0 ± 2.5%, whereas HbA1c decreased significantly from 9.1 ± 0.7% to 8.3 ± 0.6%. Subsequently, HbA1c increased significantly to 9.0 ± 0.8% together with GA. Thus, GA is useful for early detection of deterioration of glycemic control state after discharge from educational admission.

Koga M.,Kinki Central Hospital | Kasayama S.,Nissay Hospital
Endocrine Journal | Year: 2010

It is known that glycation among various proteins is increased in diabetic patients compared with non-diabetic subjects. Currently, among these glycated proteins, glycated hemoglobin (HbA 1C) is used as the gold standard index of glycemic control in clinical practice for diabetes treatment. However, HbA 1C does not accurately reflect the actual status of glycemic control in some conditions where plasma glucose changes during short term, and in patients who have diseases such as anemia and variant hemoglobin. In comparison, another index of glycemic control, glycated albumin (GA), more accurately reflects changes in plasma glucose during short term and also postprandial plasma glucose. Although GA is not influenced by disorders of hemoglobin metabolism, it is affected by disorders of albumin metabolism. This review summarizes diseases and pathological conditions where GA measurement is useful. These include the status of glycemic control changes during short term, diseases which cause postprandial hyperglycemia, iron deficiency anemia, pregnancy, chronic liver disease (liver cirrhosis), chronic renal failure (diabetic nephropathy), and variant hemoglobin. © The Japan Endocrine Society.

Miyazaki A.,Osaka Medical College | Kohzuma T.,Asahi Kasei Corporation | Kasayama S.,Nissay Hospital | Koga M.,Kinki Central Hospital
Annals of Clinical Biochemistry | Year: 2012

Background: Asymptomatic variant haemoglobin is increasingly being found in the measurement of glycated haemoglobin (HbA1c) for the management of diabetes mellitus. We compared the Hb1c concentrations measured by high-performance liquid chromatography (HPLC) and immunoassay and glycated albumin (GA) concentrations and calculated the respective ratios in order to classify the variant haemoglobin. Methods: Twenty different haemoglobin variants from 43 subjects were identified by mass spectrometry and DNA analysis. Since GA accurately reflects glycaemic control in patients with variant haemoglobin, we calculated respective ratios of Hb1c and GA. Haemoglobin variants causing a low ratio of Hb1c measured by HPLC (HPLC-Hb1c) to GA with a normal ratio of Hb1c measured by immunoassay (IA-Hb1c) to GA were classified as C1. A further classification of α and β was used with abnormalities of the α chain or β chain in the haemoglobin gene. Other haemoglobin variants were classified as non- C1. Eight diabetic patients with stable glycaemic control were used as controls. Results: Twenty forms of variant haemoglobins were classified as C1α(2 variants; I-Interlaken and Hb J-Meerut), C1β (15 variants) and non-C1 (3 variants; Hb Himeji, Hb Woolwich, Hb Peterborough). Positive correlations between GA and HPLCHb1c or IA-Hb1c were seen in the C1β patients with diabetes mellitus. The regression line between GA and HPLC-Hb1c, but not that betweenGAand IA-Hb1c, showed a downward shift in comparison with the data obtained fromthe diabetic controls. Conclusions: Variant haemoglobin could be classified by calculating the ratios of HPLC-Hb1c, IA-Hb1c and GA.

Koga M.,Kinki Central Hospital | Murai J.,Kinki Central Hospital | Saito H.,Kinki Central Hospital | Kasayama S.,Nissay Hospital
Diabetes Care | Year: 2010

OBJECTIVE- Glycated albumin (GA) relative to A1C is a useful marker of short-term glycemic control. We investigated whether endogenous insulin secretion in type 2 diabetes has different effects on GA and A1C levels. RESEARCH DESIGN AND METHODS- A1C, GA, and GA-to-A1C ratio were compared in 202 type 2 diabetic patients by type of treatment. Effect of β-cell function determined by homeostasis model assessment (HOMA-%β) on GA-to-A1C ratio was examined. In addition, GA-to-A1C ratio was compared between type 2 diabetic patients and 16 patients with type 1 diabetes. RESULTS- In type 2 diabetic patients, GA-to-A1C ratio was significantly higher in those treated with insulin than in those treated with diet or oral hypoglycemic agents. HOMA-%β showed a significant inverse correlation with GA-to-A1C ratio. This ratio was higher in type 1 diabetic patients than in type 2 diabetic patients. CONCLUSIONS- In diabetic patients with decreased insulin secretion, serum GA levels are higher relative to A1C. © 2010 by the American Diabetes Association.

Koga M.,Kinki Central Hospital | Murai J.,Kinki Central Hospital | Saito H.,Kinki Central Hospital | Kasayama S.,Nissay Hospital
Journal of Diabetes Investigation | Year: 2011

Aims/Introduction: In the present study, whether near-future glycated hemoglobin (A1C) levels could be predicted by changes in glycated albumin (GA) levels before and after treatment for diabetes was investigated. Materials and Methods: After starting diabetes treatment, GA and A1C levels are assumed to change exponentially. From this assumption, the equation for predicting near-future GA and A1C levels was derived.A total of 54 patients with type 2 diabetes mellitus in whom diabetes treatment was initiated or altered were enrolled. By incorporating GA and A1C values before and 2-4 weeks after starting treatment (second visit) into the equation, the predicted GA and A1C levels at the third visit (5-7 weeks after treatment) were obtained. Results: A strong and positive correlation was observed between predicted GA and measured GA at the third visit (R = 0.669, P < 0.0001). Similarly, a strong and positive correlation was observed between the predicted A1C and the measured A1C at the third visit (R = 0.795, P < 0.0001). Conclusions: GA and A1C levels 1-3 months after starting diabetes treatment could be predicted using the equation developed. The prediction of near-future A1C levels using GA levels at two points would be useful for judging the effectiveness of ongoing diabetes treatment at an earlier stage. © 2011 Asian Association for the Study of Diabetes and Blackwell Publishing Asia Pty Ltd.

We report a case of long-term survival of a patient with locally advanced unresectable pancreatic cancer treated with gemcitabine after chemoradiation therapy( CRTx). A 61-year-old woman was diagnosed as having locally advanced unresectable pancreatic cancer, 3.0 cm in diameter, which had invaded the superior mesenteric artery by computed tomography (CT). She was treated with CRTx( gemcitabine[ GEM] at 250 mg/m2/week for 6 weeks+liniac irradiation of 50.2 Gy) followed by systemic chemotherapy (gemcitabine (GEM) at 1,000 mg/m2). Reassessment after CRTx yielded a diagnosis of stable disease (according to the Response Evaluation Criteria in Solid Tumors [RECIST] 1.1). To date, the patient has undergone 57 courses of chemotherapy in the outpatient clinic; however, she did require biliary stent placement because of occlusive jaundice.

Tominaga A.,Kinki Central Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2012

Synovial chondromatosis of the small joints of the hand is rare. Here, we present a case of synovial chondromatosis in the metacarpophalangeal joint that did not show calcification on radiographs. Synovectomy and resection of cartilagenous loose bodies was successful and there was no recurrence after eight months.

Tanizaki K.,Kinki Central Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

The patient was an 84-year-old man, who was diagnosed with cT3N2 (101L, 109L) M0, stage III esophageal cancer. The tumor, immunohistochemically, was stained positive for CD56 and NSE yielding a definitive diagnosis of endocrine cell carcinoma of the esophagus. We selected chemo-radiation therapy (5-FU/CDDP and 2 Gy/day total 60 Gy) for this patient. As adjuvant chemotherapy, 7 courses of chemotherapy with 5-FU/CDDP, was performed. At 8 months from the chemo-radiation therapy, the disease was diagnosed as cCR. But two years later, lung metastasis appeared, so we started chemotherapy with docetaxel/CDDP/5-FU. After 2 courses, lung metastasis was almost disappeared. He has been survived for four years and five months after chemo-radiation. This case suggests that chemo( FP) -radiation therapy and adjuvant chemotherapy could be an effective treatment for endocrine cell carcinoma of the esophagus.

Asakura M.,Kinki Central Hospital | Miura H.,Kinki Central Hospital
Dermatologic Therapy | Year: 2011

Many reports have shown the efficacy of topical imiquimod in patients with skin carcinoma. This effect is based on the activity of imiquimod as an immune-response modifier. The present authors hypothesized that this agent could also be used to treat skin metastatic lesion from renal cell carcinoma. The present authors report the case of a 54-year-old man who presented with a metastasis renal cell carcinoma lesion on his nose. He had a history of right nephrectomy performed 4 years previously. The present authors started him on topical treatment with imiquimod 5% cream three times a week for his nose lesion. A reduction of the lesion was observed after 2 months, and during the following 12 months no sign of recurrence was observed. © 2011 Wiley Periodicals, Inc.

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