Mino, Japan
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Imamura H.,Sakai Municipal Hospital | Kurokawa Y.,Osaka University | Tsujinaka T.,Osaka National Hospital | Inoue K.,Osaka Medical College | And 4 more authors.
The Lancet Infectious Diseases | Year: 2012

Background: Although evidence for the efficacy of postoperative antimicrobial prophylaxis is scarce, many patients routinely receive such treatment after major surgeries. We aimed to compare the incidence of surgical-site infections with intraoperative antimicrobial prophylaxis alone versus intraoperative plus postoperative administration. Methods: We did a prospective, open-label, phase 3, randomised study at seven hospitals in Japan. Patients with gastric cancer that was potentially curable with a distal gastrectomy were randomly assigned (1:1) to receive either intraoperative antimicrobial prophylaxis alone (cefazolin 1 g before the surgical incision and every 3 h as intraoperative supplements) or extended antimicrobial prophylaxis (intraoperative administration plus cefazolin 1 g once after closure and twice daily for 2 postoperative days). Randomisation was stratified using Pocock and Simon's minimisation method for institution and American Society of Anesthesiologists scores, and Mersenne twister was used for random number generation. The primary endpoint was the incidence of surgical-site infections. We assessed non-inferiority of intraoperative therapy with a margin of 5%. Analysis was by intention-to-treat. During hospital stay, infection-control personnel assessed patients for infection, and the principal surgeons were required to check for surgical-site infections at outpatient clinics until 30 days after surgery. This study is registered with UMIN-CTR, UMIN000000631. Findings: Between June 2, 2005, and Dec 6, 2007, 355 patients were randomly assigned to receive either intraoperative antimicrobial prophylaxis alone (n=176) or extended antimicrobial prophylaxis (n=179). Eight patients (5%, 95% CI 2-9%) had surgical-site infections in the intraoperative group compared with 16 (9%, 5-14) in the extended group. The relative risk of surgical-site infections with intraoperative antimicrobial prophylaxis was 0·51 (0·22-1·16), which revealed statistically significant non-inferiority (p<0·0001). Interpretation: Elimination of postoperative antimicrobial prophylaxis did not increase the incidence of surgical-site infections after a gastrectomy. Therefore, this treatment is not recommended after gastric cancer surgery. Funding: Osaka Gastrointestinal Cancer Chemotherapy Study Group. © 2012 Elsevier Ltd.

Kato M.,Osaka University | Nishida T.,Osaka University | Yamamoto K.,Toyonaka Municipal Hospital | Hayashi S.,Toyonaka Municipal Hospital | And 15 more authors.
Gut | Year: 2013

Background: After endoscopic submucosal dissection (ESD) of early gastric cancer (EGC), patients are at high risk for synchronous or metachronous multiple gastric cancers. Objective: To elucidate the time at which multiple cancers develop and to determine whether scheduled endoscopic surveillance might control their development. Design: A multicentre retrospective cohort study from 12 hospitals was conducted. Patients with EGC who underwent ESD with en bloc margin-negative curative resection were included. Synchronous cancer was classified as concomitant cancer or missed cancer. The cumulative incidence of metachronous cancers and overall survival rate were calculated using the Kaplan-Meier method. Results: From April 1999 to December 2010, 1258 patients met the inclusion criteria. Synchronous or metachronous multiple cancers were detected in 175 patients (13.9%) during a mean of 26.8 months. Among the 110 synchronous cancers, 21 were missed at the time of the initial ESD. Many of the missed lesions existed in the upper third of the stomach and the miss rate was associated with the endoscopist's inexperience (<500 oesophagogastroduodenoscopy cases). The cumulative incidence of metachronous cancers increased linearly and the mean annual incidence rate was 3.5%. The incidence rate did not differ between patients with or without Helicobacter pylori eradication. Four lesions (0.32%) were detected as massively invading cancers during the follow-up. Conclusions: Nineteen per cent of synchronous cancers were not detected until the initial ESD. The incidence rate of metachronous cancer after ESD was constant. Scheduled endoscopic surveillance showed that almost all recurrent lesions were treatable by endoscopic resection.

Doi T.,Minoh City Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

Superior sulcus tumor( SST) is a rare type of lung cancer. Treatment usually consists of surgical resection after chemoradiotherapy. We report a case of a woman in her fifties who underwent carbon ion radiotherapy for SST. The patient complained of left shoulder pain, and imaging studies revealed a 5.2×3.5-cm local solid tumor at the apex of the left lung, invasion to the ribs, and no lymph node swelling. The level of tumor marker, carcinoembryonic antigen (CEA), was 5.7 ng/mL. Needle biopsy specimen revealed adenocarcinoma. The diagnosis was SST, T3N0M0, stage IIB. We did not detect Horner syndrome. Carbon ion radiotherapy at 66 Gy equivalent dose per 10 fractions was administered to the SST site. Subsequently, the tumor size decreased to 4.5×1.9-cm. The adverse effect was Grade 1 skin and pulmonary toxicity. Six months later, Grade 2 left shoulder connective tissue toxicity was observed; it was difficult to differentiate this from tumor recurrence. After 2.5 years from radiotherapy, the patient is free from recurrence. Carbon ion radiotherapy is effective and safe and can be considered as an important treatment option for SST.

A 70-year-old man with advanced gastric cancer was treated with neoadjuvant chemotherapy consisting of S-1 plus cisplatin( CDDP). He exhibited symptoms of cerebral infarction during the second course of chemotherapy. Distal gastrectomy was performed and the histological diagnosis was pT3N3aM0, pStage IIIB. Adjuvant chemotherapy was administered; however, after the second course, gastric cancer recurred in the lymph nodes. Second-line chemotherapy with irinotecan (CPT-11) and CDDP was initiated. Thereafter, third-line chemotherapy with docetaxel was performed. However, the response to treatment was progressive disease (PD). Subsequently, fourth-line chemotherapy was performed with capecitabine and CDDP (XP chemotherapy). After the fourth course of XP chemotherapy, the response was partial response (PR). Moreover, PR was maintained after 20 courses of chemotherapy.

Miyo M.,Minoh City Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

A man in his fifties was referred to our hospital for anorexia and vomiting. Upper gastrointestinal endoscopy showed a gastric cancer (Borrmann Type 3) with pyloric stenosis. We performed gastrojejunostomy to allow oral intake for a tumor invading the pancreas head (cT4bN1H0P0CY1, Stage IV). After the operation, systemic chemotherapy with S-1 (120 mg/m 2) was administered from July 2007, which caused grade 3 mucositis oral and drug rash after one week. Then, bi- weekly administration of CPT-11 (60 mg/m 2) and CDDP (30 mg/m 2) was started from August 2007 as second-line chemotherapy. The treatment was repeated for 14 courses till an allergic reaction happened. A weekly paclitaxel (PTX) therapy (80 mg/m 2) was started from January 2009 as third-line. After 6 courses, CT showed that direct invasion to the pancreas was not clear any more, so a distal gastrectomy with D1 lymphadenectomy was performed on August 2009 (ypT3N- 1P0CY0, Stage IIB). The patient received 9 courses of weekly PTX therapy and after that the treatment has been discontinued. Recurrence was not observed for 48 months after an initial treatment.

Oshima S.,Minoh City Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

Case 1 involved a 74-year-old man. After transcatheter arterial chemoembolization( TACE) for hepatocellular carcinoma (HCC), abdominal computed tomography (CT) revealed a gas-containing lesion in the liver. The patient was diagnosed as having a gas-containing liver abscess, necessitating emergency drainage under laparotomy. Blood culture revealed Clostridium perfringens. He was discharged on day 63 after surgery. Case 2 involved a 70-year-old man who was admitted to our hospital for obstructive jaundice caused by HCC. He was treated with TACE after endoscopic retrograde biliary tract drainage (ERBD). On the second day, he was diagnosed as having a ruptured gas-containing liver abscess with massive hemolysis, necessitating emergency drainage under laparotomy. He died the next day after surgery. The clinical course of liver abscess caused by Clostridium perfringens can be fulminant and fatal with massive hemolysis.

Kanayama S.,Minoh City Hospital
International ophthalmology | Year: 2011

To report clinical and histopathologic findings in a case of a failed AlphaCor artificial cornea explanted due to corneal stromal melting. We describe the case of a 77-year-old man who received multiple penetrating keratoplasties (PKPs) and subsequent placement of an AlphaCor artificial cornea. Examination showed total corneal infiltration as well as an AlphaCor that was partially dehisced from the host cornea. After explantation, the implant and adjacent host tissue underwent hematoxylin and eosin staining and high-resolution scanning electron microscopy (HR-SEM). Histopathologic analysis of the specimens revealed infiltration of the skirt pores by reactive corneal fibroblasts. Although the AlphaCor implant is an established method of treating multiple failed PKPs, in this case, HR-SEM imaging strongly suggests that the strength of the interface between the implant and corneal tissue is highly dependent on collagen deposition between the pores found in the implant skirt. Collagen deposition then increases the mechanical strength of the cornea-skirt interface.

Ogura S.,Minoh City Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

We report a case of a woman in her fifties presenting with abdominal pain, headache and high fever. Blood examination showed a high CRP level and liver dysfunction, and then abdominal CT scan showed multiple liver masses and a 5 cm submucosal tumor of the small intestine. We diagnosed the multiple liver masses as liver abscesses, so we administered antibiotics. We suspected that the tumor was a cause of liver abscesses, and then performed a resection of the tumor and partial small intestine on the third day of hospitalization. We diagnosed the tumor as GIST because it was positive for c-kit and CD34 by immunohistochemistry. One of the resected liver nodules showed negative for c-kit and CD34, and we diagnosed it as a liver abscess. We performed percutaneous transhepatic abscess drainage (PTAD) because she ran into high fever after the operation, and then she recovered. We consider she has the possibility of liver metastasis, so we administered imatinib mesylate to her. No recurrence was found for 11 months after the operation. This case provides valuable information because there are few reports of GIST with liver abscesses.

Yamamoto T.,Minoh City Hospital
Clinical calcium | Year: 2010

Vitamin D related osteomalacia consisted of vitamin D deficient and resistant forms. Vitamin D deficiency was frequently suggested as a complication of osteoporosis. Vitamin D was synthesized in the skin from pro vitamin D by sunlight. And the elderly residents in the nursing home who do not want to come outside frequently are at high risk. Also, the people taking anti-convulsant are the case, because the medications promoted the catabolism of vitamin D through the induction of an enzyme linked to cytochrome P450. Since the effect of bisphosphonate was reported to be decreased in vitamin D deficiency, we have to keep in mind for adding native or active vitamin D for the target people of osteoporosis.

Yamamoto T.,Minoh City Hospital
Clinical calcium | Year: 2013

FGF23 related rickets/osteomalacia was mainly composed of XLH, ADHR, ARHR1, ARHR2 and tumor induced rickets/osteomalacia. Although the mechanism for increasing serum FGF23 levels was different from disease to disease, therapies for these patients were basically the same ; pharmacological doses of active vitamin D and phosphate administration. It is noted that phosphate therapy is associated with the occurrence of secondary hyperparathyroidism and nephrocalcinosis. Moreover, recent evidences indicated that these combination therapies increased serum FGF23 levels. On the basis of these data, it is suggested that appropriate doses of active vitamin D and phosphate are to be selected according to the data of serum PTH, ALP and the amount of urinary excretion of calcium. For the children, the recovery of growth velocity is also an important factor for deciding the suitable doses of the therapies.

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