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Fushida S.,Kanazawa University | Nashimoto A.,Niigata Cancer Center Hospital | Fukushima N.,Yamagata Prefectural Central Hospital | Kawachi Y.,Nagaoka Chuo General Hospital | And 3 more authors.
Japanese Journal of Clinical Oncology | Year: 2012

The standard treatment for T4 locally advanced gastric cancer is gastrectomy with D2 lymph node dissection followed by adjuvant chemotherapy with S-1 for 12 months; however, prognostic outcome in Stage IIIb has been insufficient. It is expected that survival is improved by preoperative treatment with a triplet regimen of docetaxel, cisplatin and S-1 (divided DCS therapy). A multicenter Phase II study has been conducted to evaluate the safety and efficacy of two courses of preoperative chemotherapy followed by gastrectomy. Fifty-five patients are required for this study. The primary endpoint of the study is pathological response rate of primary lesions. Secondary endpoints are overall survival, disease-free survival, R0 resection rate and adverse events. © The Author 2011. Published by Oxford University Press. All rights reserved. Source

Yamaguchi R.,Hamamatsu University School of Medicine | Kato F.,Hamamatsu University School of Medicine | Hasegawa T.,Keio University | Katsumata N.,National Health Research Institute | And 4 more authors.
Endocrine Journal | Year: 2013

Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by primary hypocortisolism and normal mineralocorticoid production. Recently, NNT encoding the nicotinamide nucleotide transhydrogenase has been identified as a causative gene for FGD. Thus, we examined NNT in six Japanese FGD patients with no recognizable mutation in the previously known four responsible genes for FGD (MC2R, MRAP, STAR, and MCM4), and identified a novel homozygous substitution (c.644T>C; p.Phe215Ser) in a single 17.5-year-old boy. His parents were heterozygous for this mutation. This substitution was absent from 120 Japanese control subjects and was not registered in public databases including JSNP Database. The phenylalanine residue at the 215th codon was evolutionally conserved, and the p.Phe215Ser was assessed to be a pathologic mutation by in silico protein function analyses. The results, in conjunction with the previous data, imply that NNT mutations account for 5-10% of FGD patients, and that underlying factor(s) still remains to be clarified in a substantial fraction of FGD patients. © The Japan Endocrine Society. Source

Tanaka H.,Nagaoka Chuo General Hospital
Therapeutic Research | Year: 2011

Objective : To compare the efficacy of betahistine mesilate for the treatment of attacks of vertigo, especially Meniere's disease, between 18 mg/day, a dose which is common, and 36 mg/day, a dose shown to be useful in a double-blind placebo-controlled study in Japan. Method: In this retrospective study, the clinical response was evaluated in 30 and 34 patients who received betahistine mesilate at a dose of 18 mg/day and 36 mg/day, respectively, for three months. Patients had been prescribed with Travelmin Combination Tablets to be taken as needed during attacks of vertigo. Outcome measures included the number of Travelmin tablets taken to attacks of vertigo, the number of hospitalizations for attacks of vertigo, and the number of outpatient intravenous infusions required at visit with attacks of vertigo. Result : The age and gender of the study population were similar between the dose groups. The total number of Travelmin tablets taken for attacks of vertigo during the three-month treatment with betahistine mesilate was significantly lower in the 36 mg/day group (6.03±7.23 tablets in average) compared to the 18 mg/day group (13.7±14.44 tablets in average) (p<0.05). The number of hospitalizations and outpatient intravenous infusions were also lower in the 36 mg/day group, but not significantly. Conclusion : Betahistine mesilate at 36 mg/day (12 mg t. i. d), a dose used in the double-blind comparative study, was considered to be more appropriate in improving symptoms of vertigo and equilibrium function. Source

Okamura T.,Nagaoka Chuo General Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report a case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy. An 80-year-old man underwent right hemicolectomy for cecal cancer. After 10 months, surgical resection was performed for its local recurrence. He was then treated with FOLFIRI therapy, and during the fifth course, he presented with a sudden onset of congestive disturbances. Through radiographic examination and laboratory data, only hyperammonemia was found; he was therefore diagnosed with hyperammonemic encephalopathy. By starting branchedamino acid solutions for its treatment, his consciousness and serum ammonia were promptly improved. Hyperammonemic encephalopathy related 5-FU is caused by increasing ammonia production and its metabolic inhibition, and is worsened by renal dysfunction, dehydration, constipation, infections, or body weight loss. On account of the potential decrease of metabolic function of liver and kidney, an aged person tends to have hyperammonnemia more than a youth. Clinicians should be aware of the adverse events associated with hyperammonemia when then administer a large amount of 5-FU to elderly patients. Source

Sorimachi T.,Niigata University | Nishino K.,Niigata University | Morita K.,Niigata University | Takeuchi S.,Nagaoka Chuo General Hospital | And 2 more authors.
American Journal of Neuroradiology | Year: 2011

BACKGROUND AND PURPOSE: If blood flow in the ICA is reduced by the use of a distal filter during CAS, flow stagnation proximal to the filter occurs and this increases the probability of floating debris. The floating debris that remains after filter retrieval may cause cerebral embolism. However, if blood flow is increased by aspiration of blood from the ICA through an aspiration catheter, debris could be removed while the filter is still in place. The purpose of this study was to investigate blood flow changes in the ICA induced by filter use and aspiration. MATERIAL AND METHODS: A filter-protection device (AngioGuard XP) was used during CAS in 13 consecutive patients with carotid stenosis. Blood flow velocity in the ICA was measured by carotid Doppler sonography during filter deployment, filter retrieval, and catheter aspiration. RESULTS: Blood flow velocity significantly decreased with filter placement and significantly increased with filter retrieval in patients with normal angiographic flow (P < .05). Aspiration of a 20-mL blood sample from the proximal ICA column significantly increased the blood flow velocity (P < .05). CONCLUSIONS: The blood flow changes in the ICA induced by the use of a distal filter may cause cerebral embolism in filter-protected CAS. A routine aspiration method can potentially reduce the amount of migrating debris during CAS, even in cases with angiographic normal flow. Source

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