National Tokyo Medical Center

Tokyo, Japan

National Tokyo Medical Center

Tokyo, Japan
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Izumi K.,Keio University | Izumi K.,National Tokyo Medical Center | Kuda H.,National Tokyo Medical Center | Ushikubo M.,National Tokyo Medical Center | And 4 more authors.
RMD Open | Year: 2015

Polymyalgia rheumatica (PMR) affects older people, and although glucocorticoids are effective in treating PMR, they frequently result in side effects. Therefore, we conducted a retrospective study to assess the effectiveness and safety of tocilizumab as an alternative to glucocorticoids. We included 13 consecutive patients with PMR (11 women and 2 men; median age, 74 years) diagnosed according to Bird's criteria and the 2012 European League Against Rheumatism/ American College of Rheumatology provisional classification criteria. All patients received tocilizumab infusion (8 mg/kg every 4 weeks) at our institutions, between 2008 and 2014, because of PMR relapses (n=12) or insufficient response to initial prednisolone treatment (n=1), without increasing prednisolone dosage. Seven patients were on methotrexate, and all had one or more glucocorticoid-related comorbidities. Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales ( p<0.05). Proximal muscle pain disappeared within 8 weeks, on average, and the Health Assessment Questionnaire-Disability Index scores (p=0.098) and concomitant prednisolone doses (p<0.05) decreased at 12 weeks. Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks. Our findings suggest that tocilizumab is effective and safe for PMR treatment.

Watanabe K.,National Tokyo Medical Center | Tsunoda K.,National Institute of Sensory Organs | Mizuno Y.,National Institute of Sensory Organs | Akiyama K.,National Tokyo Medical Center | Noda T.,National Tokyo Medical Center
JAMA Ophthalmology | Year: 2013

Objective: To determine the relationship between the morphology of the fovea and visual acuity in patients with an untreated idiopathic epiretinal membrane (ERM). Methods: We examined 52 eyes of 45 patients diagnosed with an ERM. The morphology of the foveal area was determined by spectral-domain optical coherence tomography. The relationships between the best-corrected visual acuity (BCVA) and 8 optical coherence tomography features, central retinal thickness, cone outer segment tip (COST) line, photoreceptor inner/outer segment (IS/OS) junction line, foveal bulge of the IS/OS line, external limiting membrane, inner limiting membrane, foveal pit, and ERM over the foveal center, were evaluated. Results: Multiple regression analysis showed that intact COST line, IS/OS junction line, and external limiting membrane independently and significantly contributed to the BCVA. The standardized partial regression coefficient β was 0.415 for the COST line, 0.287 for the IS/OS junction line, and 0.247 for the external limiting membrane. However, the other features, eg, foveal bulge, inner limiting membrane, foveal pit, and ERM, were not significantly associated with the BCVA. The central retinal thickness was significantly correlated with the BCVA (r2=0.274; P<.01). Conclusions: At an early stage of an ERM, only the photoreceptor structures are significantly associated with the BCVA, and the appearance of the COST line was most highly associated. Detailed examinations of the photoreceptor structures using optical coherence tomography may help find photoreceptor dysfunction in cases of idiopathic ERM. © 2013 American Medical Association. All rights reserved.

Suzuki H.,Keio University | Nishizawa T.,National Tokyo Medical Center | Hibi T.,Keio University
Future Microbiology | Year: 2010

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcers and gastric cancer. H. pylori eradication has been shown to have a prophylactic effect against gastric cancer. According to several international guidelines, the first-line therapy for treating H. pylori infection consists of a proton pump inhibitor (PPI) or ranitidine bismuth citrate, with any two antibiotics among amoxicillin, clarithromycin and metronidazole, given for 7-14 days. However, even with these recommended regimens, H. pylori eradication failure is still seen in more than 20% of patients. The failure rate for first-line therapy may be higher in actual clinical practice, owing to the indiscriminate use of antibiotics. The recommended second-line therapy is a quadruple regimen composed of tetracycline, metronidazole, a bismuth salt and a PPI. The combination of PPI-amoxicillin-levofloxacin is a good option as second-line therapy. In the case of failure of second-line therapy, the patients should be evaluated using a case-by-case approach. European guidelines recommend culture before the selection of a third-line treatment based on the microbial antibiotic sensitivity. H. pylori isolates after two eradication failures are often resistant to both metronidazole and clarithromycin. The alternative candidates for third-line therapy are quinolones, tetracycline, rifabutin and furazolidone; high-dose PPI/amoxicillin therapy might also be promising. © 2010 Future Medicine Ltd.

Tsunoda K.,National Institute of Sensory Organs | Watanabe K.,National Tokyo Medical Center | Akiyama K.,National Tokyo Medical Center | Usui T.,Akiba Eye Clinic | Noda T.,National Tokyo Medical Center
Ophthalmology | Year: 2012

Objective: To report the optical coherence tomography (OCT) findings in eyes with vitreomacular traction (VMT) or with an epiretinal membrane (ERM). Design: Retrospective case series. Participants: Fifty-four eyes of 45 consecutive patients with subjective visual disturbances resulting from VMT or idiopathic ERM were studied. Methods: The morphologic features of the photoreceptor layer at the foveal center were determined and the central foveal thickness (CFT) was measured by spectral-domain (SD) OCT. Main Outcome Measures: The morphologic characteristics of the foveal region observed by SD OCT. Results: A roundish or diffuse highly reflective region was observed between the photoreceptor inner segment/outer segment junction line and the cone outer segment tip line at the center of the fovea. This highly reflective region was present in 7 of 7 cases of VMT and 30 of 47 cases of ERM. In the ERM cases, the mean CFT of the cases with the highly reflective region was significantly thicker than that in cases without it. The highly reflective region disappeared when the inward traction on the fovea was released surgically or spontaneously. Conclusions: The highly reflective region is a characteristic sign observed in the OCT images of eyes with VMT and ERM, and it has been termed the cotton ball sign after its appearance. The presence of the cotton ball sign indicates an inward traction on the fovea and may be a predictor of visual impairment. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.

Conclusion. When excessive height loss occurs in the elderly, which may be indicated by a cervical-bent posture, examination of the head and neck should be performed to detect common carotid artery (CCA) and internal carotid artery (ICA) aberration. In such cases brain magnetic resonance imaging (MRI) examination should be conducted to determine whether infarction is present. Objectives. To examine the relationships among bent posture, height loss, aberration of carotid arteries, and ischemic stroke risk with a case-control study. Methods: Controls (n = 163) were selected from among patients who had undergone MRI of the brain because of otolaryngologic symptoms. Case patients (n = 72) were selected from among those whose primary diagnosis was cerebral infarction in the area served by the ICA. Both groups were age-matched between 65 and 84 years old. The neck and pharyngeal cavity in each of the 235 patients were examined to determine whether the carotid arteries exhibited aberration. Patients' current height and greatest lifetime height were recorded, along with presence or absence of bent posture and other stroke risk factors. Results: Height loss alone could predict stroke risk in 79.1% of patients: 90.2% based on carotid artery aberration and 91.4% when all risk factors (aberration of carotid artery, height loss, bent posture) were analyzed. © 2011 Informa Healthcare.

Yamamoto N.,National Tokyo Medical Center | Minami S.,National Tokyo Medical Center | Kidoguchi M.,National Tokyo Medical Center | Shindo A.,National Tokyo Medical Center | And 2 more authors.
Auris Nasus Larynx | Year: 2014

Large cell neuroendocrine carcinoma (LCNEC) of the salivary gland is extremely rare. We report on a case of LCNEC in the submandibular gland. A 58-year-old male had a four-month history of an enlarging mass in his left submandibular region. He underwent lymph node resection and metastasis of LCNEC was suspected. Magnetic resonance imaging of the neck showed a solid submandibular gland tumor with marginal blurring. Positron-emission tomography and upper gastrointestinal endoscopy showed no evidence of malignancy other than in the left submandibular gland. He underwent left submandibular gland resection and left upper neck dissection. The final diagnosis was LCNEC of the submandibular gland; surgical margin was negative. Fourteen months later he is free of tumors. This is the first report of LCNEC of the submandibular gland. LCNEC of the salivary gland shows high-grade malignancy like that of the lung. According to past reports, two of four patients died despite multidisciplinary treatments. There are no standard treatments for LCNEC of the salivary glands. More studies are needed to define prognostic factors and establish therapeutic methods. © 2013 Elsevier Ireland Ltd.

Yamamoto N.,National Tokyo Medical Center | Minami S.,National Tokyo Medical Center | Fujii M.,Sensory Medical
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2014

Objective Salivary duct carcinoma is a rare and aggressive tumor of the salivary glands. The objectives of this study were to investigate the clinicopathological features of salivary duct carcinoma and to determine whether androgen deprivation therapy should be recommended. Study design and Methods The clinical records of seven patients diagnosed with salivary duct carcinoma between 2002 and 2012 were retrospectively assessed. Tumor specimens were examined for overexpression of human epidermal growth factor receptor 2 (HER2) and androgen receptor by immunohistochemistry. A case of androgen receptor-positive salivary duct carcinoma who received androgen deprivation therapy is presented. Results Of the seven patients, 43% had recurrences and metastases, and the 5-year survival rate was 68.6%. All patients were androgen receptor-positive, and 71% were HER2-positive. One patient, a 66-year-old man with androgen receptor-positive salivary duct carcinoma, received oral bicalutimide for 14 months and practically all lung metastases disappeared. Conclusion Androgen receptor is often overexpressed in salivary duct carcinoma. Androgen deprivation therapy is safe and should be considered for patients with androgen receptor-positive salivary duct carcinoma. © 2014 Elsevier Inc.

Uraoka T.,National Tokyo Medical Center | Uraoka T.,Keio University | Hosoe N.,Keio University | Yahagi N.,Keio University
Expert Review of Gastroenterology and Hepatology | Year: 2014

A broad range of modalities for colorectal cancer (CRC) screening are available worldwide. Although recent studies have been demonstrating developments of CRC screening modalities including colonoscopy, computed tomography colonography or colon video capsule colonoscopy remains the gold standard for the early detection of adenoma or CRC. Because patient preferences and availability of resources play an important role in the selection of CRC screening options, further improvement of each screening modality and its associated research is necessary to consider its involvement in clinical practice. © 2015 Informa UK, Ltd.

PubMed | Keiyu Hospital, Japan National Cardiovascular Center Research Institute, Kohnodai Hospital, Tokyo Eki Center Building Clinic and 14 more.
Type: Journal Article | Journal: Journal of gastroenterology and hepatology | Year: 2016

We recently conducted a randomized placebo-controlled trial on the efficacy and safety of rikkunshito, a standardized Japanese herbal medicine, for the treatment of functional dyspepsia (FD). The present post-hoc study aimed to evaluate the differences in clinical characteristics between responders and non-responders among FD patients who received rikkunshito for 8weeks.Rikkunshito responders were defined by using a global patient assessment. Candidate predictors included age, gender, smoking, alcohol consumption, body mass index, comorbidity, Helicobacter pylori infection, plasma levels of acyl ghrelin and des-acyl ghrelin, severity of dyspeptic symptoms, FD subgroup, previous medication, and the type of recruiting institution (clinic or hospital). We calculated hazard ratios (HRs) by using Cox regression analysis with the factors that were indicated to be associated with responders.We assigned 83 and 42 patients to responder and non-responder categories, respectively. Lack of alcohol consumption (HR, 2.04; 95% confidence interval, 1.08-3.88) and low plasma des-acyl ghrelin levels (<177fmol/mL; HR, 2.42; 95% confidence interval, 1.24-4.73) were significantly associated with the efficacy of rikkunshito. Lack of alcohol consumption was associated with the efficacy of rikkunshito especially among H.pylori-infected participants. On the other hand, the low plasma des-acyl ghrelin was associated with the efficacy of rikkunshito especially among H.pylori-negative participants.A low baseline level of plasma des-acyl ghrelin was associated with an increased treatment efficacy of rikkunshito against FD. Lack of alcohol consumption was also clinically useful for predicting the response to rikkunshito.

PubMed | Fukuoka University, Juntendo University, National Cancer Center Hospital East, Cancer Institute Hospital and 5 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

207 Background: Salvage radiotherapy (S-RT) for patients with prostate cancer who developed PSA failure after radical prostatectomy is widely applied. However, current status of this approach in Japan has not been surveyed so far. The aim of this study was to reveal the present conditions and outcomes of S-RT for Japanese patients with biochemically recurrent prostate cancer.Clinical data of the S-RT was gathered by sending a questionnaire to participating facilities to the Japanese Radiation Oncology Study Group (JROSG). The S-RT was defined as external-beam radiotherapy delivered to the prostate bed to patients with prostate cancer who eventually developed PSA failure, although their PSA value had once reached <0.2 ng/ml after prostatectomy. In addition, the interval between prostatectomy and the S-RT should essentially be six months or longer. PSA failure-free survival (PFFS) and clinical failure-free survival (CFFS) was calculated by the Kaplan-Meier estimation.371 cases were registered from 38 facilities. Among them, hormonal therapy was combined with S-RT in 151 patients. In 3 cases, chemotherapy was combined before or after the S-RT. The rests of the cases were treated by S-RT alone. However, prognostic information was insufficient in 28 cases, and PSA nadir was >0.2 ng/ml in 3 cases. Therefore, outcome studies were conducted in the remaining 186 cases. The median age was 67 years old. The nadir value of the PSA after prostatectomy and the PSA value at the initiation of S-RT were 0.0135 ng/ml and 0.292 ng/ml, respectively. The median period between prostatectomy and the S-RT was 18.6 months. Median follow-up period was 58 months. The 5-year PFFS and CFFS were 50.1% (95%CI: 42.8 - 57.9) and 90.1% (95%CI: 86.4 - 95.7), respectively. PFFS was significantly superior in patients with PSA values <= 0.3 ng/ml at the initiation of S-RT than those of PSA values > 0.3. (57.5% vs. 40.5%, p = 0.027) Conclusions: In Japan, hormonal therapy was combined with S-RT in about 40% of the cases. The 5-year PFFS and CFFS rates of cases treated by S-RT alone were 50.1% and 90.1%, respectively. A PSA value of 0.3 was significant cut-off point for predicting PFFS.

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