National Hospital Organization Kanazawa Medical Center

Kanazawa-shi, Japan

National Hospital Organization Kanazawa Medical Center

Kanazawa-shi, Japan
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PubMed | Yatsuo General City Hospital, Toyama City Hospital, Toyama Prefectural Central Hospital, Kanazawa Medical University and 7 more.
Type: Journal Article | Journal: International journal of clinical oncology | Year: 2016

The purpose of our study was to evaluate the efficacy of a new combination antiemetic therapy consisting of palonosetron, aprepitant, and dexamethasone in gastric cancer patients undergoing chemotherapy with S-1 plus cisplatin.This prospective, multi-institutional observational study assessed patient-reported nausea, vomiting, use of rescue therapy, change of dietary intake, and Functional Living Index-Emesis (FLIE) questionnaire results. The percentages of patients showing complete response (CR; no emesis and non-use of any rescue antiemetics) and complete protection (CP; no significant nausea and non-use of any rescue antiemetics), change of dietary intake, and impact of chemotherapy-induced nausea and vomiting on daily life during the overall (0-120h after cisplatin administration), acute (0-24h), and delayed (24-120h) phases were examined. These findings were compared with our previous study, which used granisetron, aprepitant, and dexamethasone, to assess the relative effectiveness of palonosetron versus granisetron in combination antiemetic therapy.Of the 72 included patients, 66 (91.6%), 70 (97.2%), and 50 (69.1%) achieved CR, and 48 (66.7%), 61 (84.7%) and 49 (68.1%) achieved CP during in the overall, acute, and delayed phases of cisplatin administration, respectively. Approximately half of the patients had some degree of anorexia. FLIE results indicated that 78.6% of patients maintained their quality of life. Palonosetron was not superior to granisetron in combination antiemetic therapy.Three-drug combination antiemetic therapy with palonosetron, aprepitant, and dexamethasone was tolerable in gastric cancer patients undergoing treatment with S-1 plus cisplatin. The predominance of palonosetron to granisetron was not demonstrated in this study.

PubMed | Toyama Prefectural Central Hospital and National Hospital Organization Kanazawa Medical Center
Type: Case Reports | Journal: Clinical journal of gastroenterology | Year: 2016

A man in his 60s visited our hospital because of a pancreatic head tumor. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed that the tumor consisted of a neuroendocrine carcinoma (NEC) and adenocarcinoma, including signet-ring cell carcinoma, and that the ratio of these components was approximately 50:50. Therefore, he was diagnosed with mixed adenoneuroendocrine carcinoma (MANEC). Because of liver and lymph node metastases, systemic chemotherapy was initiated using a regimen for the NEC component based on an increase in neuron-specific enolase (NSE). Although the patient achieved stable disease after two chemotherapy cycles, the tumor increased in size after three cycles, which was associated with a gradual increase in carcinoembryonic antigen and a decrease in NSE level. An EUS-FNA reexamination revealed that the adenocarcinoma component accounted for 90% of the tumor. Thus, an adenocarcinoma chemotherapy regimen was started, and a slight reduction in tumor size was observed. Here, we report an extremely rare and remarkable case of MANEC of the pancreas that demonstrates the effectiveness of EUS-FNA for helping to decide the chemotherapy regimen.

Kita T.,National Hospital Organization Kanazawa Medical Center | Fujimura M.,Kanazawa University | Ogawa H.,Ishikawa Ken Saiseikai Hospital | Nakatsumi Y.,Kanazawa Municipal Hospital | And 4 more authors.
Allergology International | Year: 2010

Background: Chronic cough is the only symptom of cough variant asthma (CVA) and atopic cough (AC). Cys-teinyl leukotriene receptor antagonists have been shown to be effective in CVA, but there are no reports on their effectiveness in AC. To evaluate the antitussive effect of montelukast, a leukotriene receptor antagonist, in CVA and AC. Methods: Seventy-five patients with chronic cough received diagnostic bronchodilator therapy with oral clen-buterol hydrochloride for 6 days. Of the 75 patients, 48 and 27 met the simplified diagnostic criteria for CVA and AC, respectively. Patients with CVA were randomly divided into 3 groups: montelukast, clenbuterol, and mon-telukast plus clenbuterol. Patients with AC were randomly divided into 2 groups: montelukast and placebo. The efficacy of cough treatment was assessed with a subjective cough symptom scale (0 meant no cough and 10 denoted cough as bad as at first visit). The cough scale, pulmonary function test, and peak expiratory flow rate (PEF) were evaluated before and after 2 weeks of treatment. Results: In patients with CVA, 2-week treatment with montelukast, clenbuterol, and montelukast plus clen-buterol all significantly decreased cough scores and treatment with montelukast plus clenbuterol was superior to treatment with montelukast alone. In the montelukast plus clenbuterol group, PEF values in the morning and evening significantly increased after 2 weeks compared with values before treatment. In patients with AC, scores on the cough scale did not differ significantly between the montelukast group and the placebo group. Conclusions: Montelukast was confirmed to suppress chronic non-productive cough in CVA, whereas it was not effective in non-productive cough in AC. © 2010 Japanese Society of Allergology.

Kadono Y.,Kanazawa University | Ueno S.,Kanazawa University | Yaegashi H.,Kanazawa University | Ofude M.,Kanazawa University | And 6 more authors.
Urology | Year: 2014

Objective To evaluate continence status and mechanism of urinary incontinence immediately after robot-assisted radical prostatectomy (RARP) by performing urodynamic evaluation. Methods A total of 87 patients with localized prostate cancer who underwent RARP were included. Filling cystometry, urethral pressure profilometry, and abdominal leak point pressure (ALPP) tests were performed before and immediately after RARP. Results The mean urine loss ratio (ULR), calculated by dividing the total urine volume by the weight of urine loss after RARP, was 17.8%. Nerve-sparing (NS) surgery significantly affected ULR compared with non-NS surgery. In the comparison between preoperative and postoperative results, the mean maximal cystometric capacity (MCC) and maximal closure urethral pressure (MUCP) decreased from 341 mL and 84.6 cm H 2O to 250 mL and 35.6 cm H2O, respectively. No urine leakage was observed in ALPP test preoperatively; however, urine leakage was observed postoperatively in 75 patients (86%), with a mean ALPP of 47.7 cm H2O. Multivariate analysis revealed that MCC, MUCP, and ALPP after RARP were predictive factors for ULR. Linear correlations were found between ULR and MUCP and between ULR and ALPP after RARP. NS status and MUCP after RARP (r = 0.247; P =.021) and the ALPP (r = 0.254; P =.018) were significantly correlated. Conclusion In urodynamic evaluation immediately after RARP, MCC, MUCP, and ALPP were found to predictive factors for urinary incontinence. The NS procedure contributed to continence status after RARP. © 2014 Elsevier Inc.

Wada Y.,Kanazawa University | Wada Y.,National Hospital Organization Kanazawa Medical Center | Higashide T.,Kanazawa University | Nagata A.,Kanazawa University | And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2016

PURPOSE. To investigate longitudinal changes in mean blur rate (MBR) measured by laser speckle flowgraphy (LSFG) in the rat optic nerve head (ONH), and the reproducibility of MBR. METHODS. Rats were dilated under general anesthesia. Intraocular pressure (IOP), blood pressure, ocular perfusion pressure (OPP), heart rate, and LSFG were measured 30 minutes later. Mean blur rate in the ONH was determined using LSFG-Micro and was subdivided into MBR of the total area (MA), vessel region (MV), and tissue region (MT). Mean blur rate measurements were repeated at 10, 11, 13, 19, and 20 weeks, then every 5 weeks until 60 weeks of age. Intrasession repeatability, intrasession reproducibility, and intersession reproducibility were evaluated. RESULTS. Coefficient of variation of MBR was 0.3 to 6.2%, 1.3 to 5.2%, and 5.8 to 30.4% for intrasession repeatability, intrasession reproducibility, and intersession reproducibility, respectively. Mean blur rate of the total area, MV, and MT increased similarly until 19 weeks of age, but stabilized thereafter until 60 weeks. Mean blur rate of the total area in the inferior quadrant was significantly higher than in the temporal quadrant from 19 to 55 weeks. These changes exceeded a range of corresponding coefficient of reproducibility. There were no significant changes in IOP, blood pressure, or OPP during the experimental period. CONCLUSIONS. Mean blur rate in the rat ONH changed over time, increased from 10 to 19 weeks of age, then stabilized until 60 weeks. Mean blur rate of the total area exhibited regional differences: higher in the inferior quadrant than in the temporal quadrant. Laser speckle flowgraphy-Micro may provide reliable information for evaluating longitudinal changes of rat ONH blood flow. © 2016, Association for Research in Vision and Ophthalmology Inc. All rights reserved.

Shimizu M.,Kanazawa University | Furuichi K.,Kanazawa University | Toyama T.,Kanazawa University | Kitajima S.,Kanazawa University | And 9 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-We evaluated the structural-functional relationships and the prognostic factors for renal events, cardiovascular events, and all-cause mortality in type 2 diabetic patients with biopsy-proven diabetic nephropathy. RESEARCH DESIGN AND METHODS-Japanese type 2 diabetic patients with biopsyproven diabetic nephropathy (n = 260) were enrolled. Patients were stratified by albuminuria (proteinuria) and estimated glomerular filtration rate (eGFR) at the time of renal biopsy. The outcomes were the first occurrence of renal events (requirement of dialysis or a 50% decline in eGFR from baseline), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, coronary interventions, or nonfatal stroke), and all-cause mortality. RESULTS-The factors associated with albuminuria (proteinuria) regardless of eGFR were hematuria, diabetic retinopathy, low hemoglobin, and glomerular lesions. The factors associated with low eGFR regardless of albuminuria (proteinuria) were age and diffuse, nodular, tubulointerstitial, and vascular lesions. The glomerular, tubulointerstitial, and vascular lesions in patients with normoalbuminuria (normal proteinuria) and low eGFR were more advanced compared to those in patients with normoalbuminuria (normal proteinuria) and maintained eGFR. In addition, compared to patients with micro-/macroalbuminuria (mild/severe proteinuria) and low eGFR, their tubulointerstitial and vascular lesions were similar or more advanced in contrast to glomerular lesions. The mean follow-up period was 8.1 years. There were 118 renal events, 62 cardiovascular events, and 45 deaths. The pathological determinants were glomerular lesions, interstitial fibrosis and tubular atrophy (IFTA), and arteriosclerosis for renal events, arteriosclerosis for cardiovascular events, and IFTAfor all-cause mortality.Themajor clinical determinant for renal events and all-cause mortality was macroalbuminuria (severe proteinuria). CONCLUSIONS-Our study suggests that the characteristic pathological lesions as well as macroalbuminuria (severe proteinuria) were closely related to the long-termoutcomes of biopsyproven diabetic nephropathy in type 2 diabetes. © 2013 by the American Diabetes Association.

PubMed | National Hospital Organization Kanazawa Medical Center and Kanazawa University
Type: | Journal: Journal of pharmaceutical health care and sciences | Year: 2016

It is important for pharmacists to manage cancer chemotherapy regimens in order to achieve safe treatment. We examined whether there was a useful pharmacoeconomic benefit of compliance the exclusion criteria of neutropenia, and the importance of a pharmacists intervention was considered.A prospective observational cohort study was conducted at a community-based medical center. Among 374 patients who received chemotherapy between April 2010 and March 2011, 108 patients developed neutropenia and pharmacists recommended suspension of chemotherapy. These patients were divided into a group in whom chemotherapy was suspended (complying group) and a group in whom it was continued (non-complying group). Then the relative dose intensity (RDI) was compared between the two groups, and medical expenses related to the treatment of neutropenia (neutropenia-related costs: NRC) were compared. Analysis was carried out from the perspective of the health insurance provider, so only the direct medical costs were evaluated.There was a significant difference of the RDI between a complying group (85.210.0%) and a non-complying group (79.315.0%) (P=0.021). The average NRC per patient showed a significant difference between the two groups (complying group: 1,944412 dollars, non-complying group: 4,394837 dollars, P=0.044). The economic effect over one year was 54,205 dollars.The present findings suggest that ensuring compliance with chemotherapy regimens (including the criteria for neutropenia) is effective from a pharmacoeconomic perspective. Accordingly, pharmacists should intervene as required to improve regimen compliance.

PubMed | National Hospital Organization Kanazawa Medical Center
Type: Case Reports | Journal: Rinsho shinkeigaku = Clinical neurology | Year: 2015

We describe a case of 20-year-old woman with visual impairment in her left eye. Her left visual acuity was 0.07 and an ophthalmoscopic examination demonstrated bilateral intermediate uveitis (IU). A neurological examination on admission revealed lower nasal quadrantanopsia in her left eye and an exaggerated right patellar tendon reflex. A T2-weighted MRI showed multiple high-intensity lesions in the bilateral periventricular region, corpus callosum, medulla. A short T1 inversion recovery MRI also showed a swollen left retrobulbar optic nerve and posterior thoracic cord lesion at Th 9 level. The latter longitudinal length was approximately 20mm. Laboratory investigation demonstrated no abnormalities including an anti-aquaporin-4 antibody. A cerebrospinal fluid examination revealed an increased IgG-index (1.21) with oligoclonal IgG babds. Initially, a diagnosis of retrobulbar optic neuritis with IU was made. She received subtenon corticosteroid injection with intravenous methylprednisolone pulse and oral prednisolone therapy. An immediate improvement of her visual symptoms and MRI abnormalities was observed. Approximately 1 year later, a new high-intensity lesion in the right internal capsule was present on a follow-up T2-weighted brain MRI, established a diagnosis of multiple sclerosis (MS) based on the McDonald criteria in 2010. Previous reports in Japan demonstrated few cases of uveitis in patients with MS and this is the first report of MS with IU in Japan.

PubMed | National Hospital Organization Kanazawa Medical Center and Kanazawa University
Type: | Journal: Journal of pharmaceutical health care and sciences | Year: 2016

[This corrects the article DOI: 10.1186/s40780-014-0007-y.].

PubMed | Kanazawa University and National Hospital Organization Kanazawa Medical Center
Type: Journal Article | Journal: Clinical and experimental nephrology | Year: 2015

The prevention of relapse and infection complications during remission maintenance therapy is required to improve the prognosis of patients with microscopic polyangiitis (MPA) showing rapidly progressive glomerulonephritis (RPGN). The clinicopathological characteristics of patients with ANCA-positive MPA were examined to determine the risk factors for relapse or infectious complications after remission induction therapy.The study population consisted of 52 patients diagnosed as ANCA-positive MPA showing RPGN from 2002 to 2012, after publication of the Japanese guideline for RPGN. The clinicopathological findings were examined between the presence and absence of relapse or infectious complications.The value of vasculitis damage index (VDI) was high for the relapse group and VDI value was identified as the leading factor associated with relapse [hazard ratio (HR) 3.36, 95% confidence interval (CI) 1.58-7.12, P<0.01]. On the other hand, the values of Birmingham Vasculitis Activity Score, clinical grade category of RPGN at diagnosis, and VDI at remission were high in the infectious group. Furthermore, clinical grade category of RPGN was the leading factor associated with infectious complications (HR 5.30, 95% CI 1.41-19.9, P=0.01).The disease activity at diagnosis and severity of organ damage at remission were associated with relapse and infectious complications during remission maintenance therapy and infectious complication affected kidney survival and all-cause mortality in patients with ANCA-positive MPA exhibiting RPGN.

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