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Shirone N.,Takai Hospital | Shinkai T.,Nara Medical University | Yamane T.,Institute of Biomedical Research and Innovation | Uto F.,Takai Hospital | And 7 more authors.
Annals of Nuclear Medicine | Year: 2012

Objective 2- [ 18F]fluoro-2-deoxy-D-glucose (FDG) is known to accumulate in benign conditions such as infection and inflammation as well as in malignancy. Vaccination may cause transient inflammation of lymph nodes, which may induce false-positive findings on FDG-positron emission tomography (PET) imaging. This study investigated the influence of influenza vaccination on FDG-PET/CT imaging in normal subjects. Methods Between November 2008 and March 2009, a total of 172 examinees underwent FDG-PET/CT during an annual cancer-screening program at our hospital, 83 of whom had a history of recent non-adjuvanted seasonal influenza vaccination. They were asked the date and injection site of the vaccination. Examinees were divided into 2 groups based on the interval after vaccination using a cutoff value of 7 days (1 week). Two double boardcertified nuclear medicine physicians and radiologists visually interpreted the FDG-PET/CT images with reference to PET/CT fusion and CT images and checked the location and the number of abnormal accumulations by consensus reading. Results Intervals between vaccination and FDG-PET were less than 7 days in 5 examinees, and 7 days or more in 78 examinees. Unexpected accumulations were visualized in 4 examinees in the axilla and medial upper arm, and all of them belonged to the group who underwent vaccination less than 7 days previously. In the second group there was no abnormal FDG accumulation. Conclusions Recent influenza vaccination before FDGPET/ CT examination may cause ipsilateral axillary lymph node accumulations, especially within several days after vaccination. Questionnaires about vaccination can help to avoid false interpretation of FDG avid axillary lymph nodes. © The Japanese Society of Nuclear Medicine 2012.

Nishimura Y.,Kinki University | Hiraoka M.,Kyoto University | Koike R.,Kinki University | Nakamatsu K.,Kinki University | And 7 more authors.
Japanese Journal of Clinical Oncology | Year: 2012

Objective: Long-term survival and late toxicities of a randomized Phase II study of chemoradiotherapy for esophageal cancer were analyzed. Methods: Eligible patients were <75 years old and performance status 0-2, and had Stages II-IVA esophageal cancer. For arm A (short-term infusion), cisplatin 70 mg/m. 2 Days 1 and 29 and 5-fluorouracil 700 mg/m. 2 Days 1-5 and 29-33 were given concurrently with radiotherapy of 60 Gy/30 fr/7 weeks (1 week split). For arm B (protracted infusion), cisplatin 7 mg/m. 2 Days 1-5, 8-12, 29-33 and 36-40, and 5-fluorouracil 250 mg/m. 2 Days 1-14 and 29-42 were given with the same radiotherapy. Two cycles of consolidation cisplatin/5-fluorouracil chemotherapy were given to both arms. Results: Between 2001 and 2006, 91 patients were enrolled; 46 were randomized to arm A, and 45 to arm B. The 2- and 5-year overall survival rates for arm A were 46 and 35% (95% confidence interval: 22-48%), while those for arm B were 44 and 22% (11-35%), respectively. Excluding four patients with early death, seven (17%) patients in arm A and eight (18%) in arm B showed late toxicities of Grade 3 or more. Most of the toxicities were cardiac or pleural toxicities. Patients with severe late toxicities often had coexistent hypothyroidism. There were three patients with a secondary malignancy possibly related to treatment. Conclusions: Low-dose protracted infusion chemotherapy with radiotherapy is not superior to full-dose short-term infusion chemotherapy with radiotherapy for esophageal cancer. Late toxicities, including cardiac and pleural toxicities, hypothyroidism and secondary malignancy, should be carefully monitored. © The Author 2012. Published by Oxford University Press. All rights reserved.

Okita K.,Social Insurance Alliance Shimonoseki Kohsei Hospital | Kawazoe S.,Saga Prefectural Hospital Koseikan | Hasebe C.,Yoshida Hospital | Kajimura K.,Kishiwada City Hospital | And 40 more authors.
Hepatology Research | Year: 2014

Aim: Liver cirrhosis represents the end stage of any chronic liver disease, and it is associated with hepatic edema such as ascites. Many patients with ascites do not respond to diuretic therapy or require administration of diuretics at high doses that can cause adverse events. This 7-day, multicenter, double-blind trial of tolvaptan was designed to determine the optimal dose of tolvaptan for producing the intended pharmacological effect in hepatic edema. Methods: Liver cirrhosis patients with inadequate diuretic response despite having received a conventional diuretic therapy were enrolled in the trial. Participants were stratified randomly to four groups receiving tolvaptan at 7.5, 15 or 30mg/day, or placebo as an add-on to conventional diuretics once daily for 7days. Changes in bodyweight and abdominal circumference were analyzed. Serum sodium concentrations were measured. Safety assessment was performed. Results: Tolvaptan at 7.5-30mg/day reduced bodyweight and abdominal circumference compared with placebo. Serum sodium concentrations remained within the normal range in all tolvaptan groups. Serious adverse events were not observed, and most common adverse event was thirst. Tolvaptan at 7.5mg/day showed the maximum change in bodyweight and abdominal circumference together with preferable tolerability. Conclusion: Tolvaptan at 7.5mg/day was considered the optimal dose in liver cirrhosis patients with hepatic edema who showed inadequate response to conventional diuretics. © 2013 The Japan Society of Hepatology.

Kitai T.,Nara Social Insurance Hospital | Kitai T.,Kyoto University | Kawashima M.,Nara Social Insurance Hospital
Breast Cancer | Year: 2012

Background: Indocyanine green (ICG) fluorescence navigation is a useful option in sentinel node biopsy (SNB) for breast cancer. However, several technical difficulties still exist. Since the sentinel node (SN) cannot be recognized over the skin, subcutaneous lymphatic vessels (LVs) must be carefully dissected without injury. In addition, the dissecting procedures are often interrupted by turning off the operating light during fluorescence observation. In this report, we introduce a new approach using the axillary compression technique to overcome these problems. Materials and methods: In the original procedure of the ICG fluorescence method, the subcutaneous lymphatic drainage pathway from the breast to the axilla was observed in fluorescence images, but no signal could be obtained in the axilla. When the axillary skin was compressed against the chest wall using a plastic device, the signals from the deeper lymphatic structures could be observed. By tracing the compression-inducible fluorescence signal towards the axilla, transcutaneous detection and direct approach to the SN were achieved. The benefit of this approach is that there is no risk of injury of LVs, and the procedures are interrupted less frequently by fluorescence observation. The axillary compression technique was used in 50 patients with early breast cancer. Results: SNs were successfully removed in all patients. Transcutaneous detection and direct approach were possible in 47 patients. This approach was also effective in obese patients. Conclusions: Axillary compression technique is a simple way to facilitate the surgical procedures of ICG fluorescence-navigated SNB for breast cancer. © 2011 The Japanese Breast Cancer Society.

Kawashima M.,Nara Social Insurance Hospital | Kitai T.,Nara Social Insurance Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2012

A 62-year-old woman had suffered from interstitial pneumonitis caused by collagen disease and had received steroids and immunosuppressants for twenty years. She was diagnosed as pseudomyxoma peritonei by CT examination and underwent palliative cytoreduction two years ago, but peritoneal relapse occurred one year later. At her first visit to our office, she complained of abdominal distension and respiratory distress of Hugh-Jones classification 2-3. CT showed interstitial pneumonitis and a massive intra-abdominal mucinous tumor. Complete cytoreduction by peritonectomy procedures, combined with intraperitoneal chemotherapy with 50mg of cisplatin, was performed. The duration of the operation was 860 minutes and the blood loss was 7, 000 mL. Postoperative steroidal replacement was performed and neither acute exacerbation of interstitial pneumonitis nor any other severe complication occurred. Today, in the 3-year follow-up period, she is doing well without any sign of recurrence of pseudomyxoma peritonei.

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