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Sawai T.,Nagasaki Harbor Medical Center City Hospital | Umeyama Y.,Nagasaki Harbor Medical Center City Hospital | Yoshioka S.,Nagasaki Harbor Medical Center City Hospital | Matsuo N.,Nagasaki Harbor Medical Center City Hospital | And 2 more authors.
Journal of Medical Case Reports | Year: 2014

Introduction. Pulmonary alveolar proteinosis is a rare pulmonary disease characterized by excessive alveolar accumulation of surfactant due to defective alveolar clearance by macrophages. There are only a few published case reports of pulmonary alveolar proteinosis occurring in association with solid cancers. To the best of our knowledge, there are no previously reported cases of pulmonary alveolar proteinosis associated with breast cancer. Case presentation. A 48-year-old Asian woman, a nonsmoker, presented to our institution with a right breast mass. Biopsy examination of the lesion revealed scirrhous carcinoma. A chest computed tomography scan for metastases showed abnormal shadows in both upper lung fields. As a result of flexible fiberscopic bronchoscopy, this patient was diagnosed as having pulmonary alveolar proteinosis. This case was categorized as autoimmune pulmonary alveolar proteinosis due to the positive anti-granulocyte-macrophage colony-stimulating factor antibody. Pulmonary alveolar proteinosis decreased gradually after mastectomy. Conclusions: The present case involved the coincident occurrence of autoimmune pulmonary alveolar proteinosis with breast cancer; breast cancer may be a factor during pulmonary alveolar proteinosis development. © 2014 SAWAI et al.; licensee BioMed Central Ltd.

Kawasaki E.,Nagasaki Harbor Medical Center City Hospital
Clinical Pediatric Endocrinology | Year: 2014

Type 1 diabetes (T1D) is an organ-specific autoimmune disease caused by the autoimmune response against pancreatic β cells. T1D is often complicated with other autoimmune diseases, and anti-islet autoantibodies precede the clinical onset of disease. The most common coexisting organ-specific autoimmune disease in patients with T1D is autoimmune thyroid disease, and its frequency is estimated at > 90% among patients with T1D and autoimmune diseases. The prevalence of anti-thyroid antibodies in children with T1D at disease onset is about 20% and is particularly common in girls. Furthermore, patients with anti-thyroid antibodies are 18 times more likely to develop thyroid disease than patients without anti-thyroid antibodies. Therefore, for early detection of autoimmune thyroid disease in children with T1D, measurement of anti-thyroid antibodies and TSH at T1D onset and in yearly intervals after the age of 12 yr is recommended. Anti-islet autoantibodies are predictive and diagnostic markers for T1D. The most frequently detected autoantibodies in Japanese patients are GAD autoantibodies (~80%) followed by IA-2 autoantibodies (~60%), insulin autoantibodies (~55%) and ZnT8 autoantibodies (~50%). In a combined analysis, 94% of Japanese patients with T1D can be defined as having type 1A diabetes. Furthermore, autoantibodies to ZnT8 and IA-2 are associated with childhood-onset and acute-onset patients. Thus, it is important to develop a diagnostic strategy for patients with type 1A diabetes in consideration of the age or mode of disease onset. © 2014 by The Japanese Society for Pediatric Endocrinology.

Kotaka M.,Gastrointestinal Cancer Center | Yoshino T.,National Cancer Center Hospital East | Oba K.,University of Tokyo | Shinozaki K.,Hiroshima Prefectural Hospital | And 11 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2015

Purpose: Adjuvant FOLFOX is a widely accepted standard therapy for resected colon cancer. The incidence of grade 3-4 peripheral sensory neuropathy (PSN) was 12.4 and 5.7 % in the MOSAIC and Eastern MASCOT trials, while that of grade 3-4 allergic reactions (AR) was 2.9 and 3.1 %, respectively. The JFMC41-1001-C2 trial (JOIN trial) investigated the tolerability of modified FOLFOX6 (mFOLFOX6) in Japanese colon cancer patients. Methods: Twelve cycles of mFOLFOX6 were given to patients with the same eligibility criteria as in the MOSAIC study: stage II or III curatively resected colon cancer, performance status of 0-1, aged 20 years or older, starting mFOLFOX6 within 7 weeks of surgery, and adequate organ function. The primary endpoints were the incidence of PSN persisting for ≥8 days that interfered with daily activities and the incidence of grade 3-4 AR. The target sample size was 800. Results: From November 2010 to March 2012, 882 patients were enrolled at 198 institutions. Safety was analyzed in 828 patients with finalized data out of 848 patients receiving mFOLFOX6. The incidence of PSN persisting ≥8 days was 3.3 % [95 % confidence interval (CI) 2.2-4.7], while that of grade 3-4 AR was 1.7 % (95 % CI 0.9-2.8). The treatment completion rate was 67.0 %. The median total dosage of oxaliplatin was 811.1 mg/m2. The overall incidence of grade 3-4 PSN was 5.8 %. Interstitial pneumonitis occurred in one patient. There were no treatment-related deaths. Conclusions: Adjuvant mFOLFOX6 is tolerable for Japanese patients with colon cancer. © 2015 The Author(s).

Miuma S.,Nagasaki University | Ichikawa T.,Nagasaki University | Ichikawa T.,Nagasaki Harbor Medical Center City Hospital | Miyaaki H.,Nagasaki University | And 9 more authors.
Journal of Interferon and Cytokine Research | Year: 2016

Pegylated interferon and ribavirin plus simeprevir therapy (simeprevir-based triple therapy) has been recently introduced, providing excellent results for nontransplant patients with hepatitis C virus (HCV) infection. However, there are limited data available on its effect on liver transplant recipients. In the present study, we evaluated the efficacy and tolerability of simeprevir-based triple therapy in liver transplant recipients. We treated 9 liver transplant recipients for genotype 1b HCV reinfection with simeprevir-based triple therapy. The efficacy and adverse effects were evaluated until 24 weeks after therapy. All recipients continued immunosuppressive therapy at the same dose as that before therapy induction. Seven of the 9 recipients (77.8%) achieved sustained virological response at 24 weeks. Two recipients (22.2%) experienced viral breakthrough (BT) at 12 and 16 weeks; NS3 HCV mutations conferring resistance to simeprevir were detected in both these patients after BT. Anemia was the most common adverse effect, requiring ribavirin dose reduction and blood transfusion. However, all recipients, except those with BT, completed the 24-week therapy. No recipient experienced cellular rejection during therapy. In conclusion, simeprevir-based triple therapy exhibited high efficacy and tolerability in liver transplant recipients with genotype 1b HCV reinfection. © Copyright 2016, Mary Ann Liebert, Inc.

Shibata H.,Nagasaki University | Kitayama M.,Nagasaki University | Kamo Y.,Nagasaki University | Honda T.,Nagasaki University | And 6 more authors.
Acta Hepatologica Japonica | Year: 2015

We report of interferon-β (IFN-β) therapy with or without ribavirin in five patients with chronic hepatitis and mental disorder. Two of three patients diagnosed with depression and one of two patients diagnosed with chronic schizophrenic psychosis had developed a viral response after IFN-β therapy. Symptoms of depression or psychosis are well-known side effects of IFN-α therapy. Therefore, patients with mental disorders are often hesitant toward receiving interferon therapy. Direct acting antivirals (DAAs) will probably become mainstream therapy for IFN-α intolerant patients in the near future. However, the risk of developing mutations related to drug resistance should not be neglected. Therefore, experience with IFN-β therapy used as an alternative to DAAs is required. © 2014 The Japan Society of Hepatology.

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