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Saito M.,Niigata University | Abe M.,Niigata University | Furukawa T.,Niitsu Medical Center Hospital | Yagi M.,Brain Disease Center Agano Hospital | And 4 more authors.
Allergology International | Year: 2014

Background: There are problems in diagnosis of allergy to amide-type local anesthetic agents (ALAs), because definitive diagnosis is not obtained by in vivo tests, which are used for the diagnosis. Consequently, patients may be exposed to risk. There are few diagnoses based on in vitro tests, and there are almost no relevant studies. Methods: Authors examined involvement of allergic reaction using the leukocyte migration test (LMT) through multiple standpoints in 43 patients who underwent suspected diagnosis of allergy to ALAs. Results: Rate of LMT-positives was 54%, and especially the positive rate of lidocaine hydrochloride preparations was significantly high. In 15 positives to lidocaine hydrochloride preparations, all cases were indicated as positive in a test with drugs containing antiseptic agent, but only 3 cases were indicated as positive in a test with lidocaine hydrochloride alone. In addition, test with paraben was conducted in 4 cases; 2 cases were confirmed as positive. In relevance of histories of drug or food allergies, development rates of ALAs-allergies were the highest in both allergies, and were 35% and 13%, respectively. Conclusions: There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. Even by allergic reactions, it was assumed that 80% of them might be caused by antiseptic agents such as paraben. In addition, it was suggested that ALAs, especially lidocaine hydrochloride preparations have high antigenicity (sensitizing property). Furthermore, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions. © 2014 Japanese Society of Allergology. Source


Muraki Y.,Fifth Subcommittee | Muraki Y.,Mie University | Kitamura M.,Fifth Subcommittee | Kitamura M.,Jikei University School of Medicine | And 19 more authors.
Infection | Year: 2013

Purpose: In Japan, a national surveillance study of antimicrobial consumption has never been undertaken. This study aimed to describe antimicrobial consumption and resistance to Pseudomonas aeruginosa in 203 Japanese hospitals, to identify targets for quality improvement. Methods: We conducted an ecological study using retrospective data (2010). Antimicrobial consumption was collected in the World Health Organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) format. Rates of imipenem (IPM), meropenem (MEPM), ciprofloxacin (CPFX), or amikacin (AMK) resistance were expressed as the incidence of non-susceptible isolates. Additionally, hospitals were asked to provide data concerning hospital characteristics and infection control policies. Hospitals were classified according to functional categories of the Medical Services Act in Japan. Results: Data were collected from 203 Japanese hospitals (a total of 91,147 beds). The total antimicrobial consumption was 15.49 DDDs/100 bed-days (median), with consumptions for penicillins, carbapenems, quinolones, and glycopeptides being 4.27, 1.60, 0.41, and 0.49, respectively. The median incidences of IPM, MEPM, CPFX, and AMK resistance were 0.15, 0.10, 0.13, and 0.03 isolates per 1,000 patient-days, respectively. Antimicrobial notification and/or approval systems were present in 183 hospitals (90.1 %). In the multivariate analysis, the piperacillin/tazobactam, quinolones, and/or total consumptions and the advanced treatment hospitals showed a significant association with the incidence of P. aeruginosa resistant to IPM, MEPM, CPFX, and AMK [adjusted R 2 (aR 2) values of 0.23, 0.30, 0.22, and 0.35, respectively). Conclusion: This is the first national surveillance study of antimicrobial consumption in Japan. A continuous surveillance program in Japan is necessary in order to evaluate the association among resistance, antimicrobial restriction, and consumption. © 2013 Springer-Verlag Berlin Heidelberg. Source


The treatment of gastric adenoma differs from that of well differentiated adenocarcinoma It is therefore important for these two conditions to be differentially diagnosed endoscopically (e.g. by magnifying endoscopy equipped with narrow band imaging: NBI-ME). A male in his 70s underwent gastrointestinal endoscopy. A whitish, superficial elevated lesion (morphologically 0-IIa) about 1 cm in diameter was recognized in the angulus of the stomach on the greater curvature. Analysis of a biopsy specimen showed that the lesion was a gastric adenoma (histologically low-grade atypia). A decision was made for regular follow-up. Endoscopy 1 year and 9 months later revealed that the lesion had evolved morphologically into a superficial depressed-center and raised-edge type (0-IIc + IIa type) and histologically into well differentiated tubular adenocarcinoma. The 0-IIc + IIa type lesion was diagnosed as well differentiated tubular adenocarcinoma from the NBI-ME findings of "surface uneven fine granular structure", the presence of "minute brownish point-like interstitial microvessels", and the recognizable border along its lateral extent Examination of a biopsy specimen gave the same diagnosis as did the NBI-ME observations. A rare case of superficial elevated gastric adenoma (histologically low-grade atypia, morphologically 0-IIa type) that changed morphologically into a superficial depression with raised-edge type (0-IIc + IIa type) lesion, histologically into well differentiated tubular adenocarcinoma (low-grade atypia), was documented with reference to the literature. Source


Muneoka K.,Niitsu Medical Center Hospital | Shirai Y.,Niigata University | Sasaki M.,Niitsu Medical Center Hospital | Wakai T.,Niigata University | And 4 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2010

Aims: The aim of this study was to evaluate the effect of surgical procedures on the serum levels of 5-fluorouracil (5-FU) in patients undergoing S-1 treatment for pancreaticobiliary malignancy. Methodology: From January 2003 through December 2008, 27 chemotherapy-naive patients who underwent a surgical procedure for pancreaticobiliary malignancy received S-1 chemotherapy for unresectable or recurrent disease. The primary site of disease was: the extrahepatic bile duct (n=10); gallbladder (n=8); pancreas (n=6); or ampulla of Vater (n=3). The surgical procedure was: pylorus-preserving pancreaticoduodenectomy (PPPD) (n=6); combined major hepatic and bile duct resection (n=6); bilioenteric anastomosis (n=4); or exploratory laparotomy (n=11). S-1 (80-120 mg/day) was administered orally twice daily for 28 days, followed by 14 days without therapy. Subsequently, the serum levels of 5-FU were measured using the HPLC-UV method. Results: The median number of cycles administered per patient was 6 (range, 2-13). Although grade 3 watery eye developed in one patient, neither grade 4 toxicities nor treatment-related deaths were observed. The overall response rate was 19%, the median overall survival time was 9 months, and the 1-year cumulative survival rate was 11%. The maximum levels of 5-FU in the sera of individual patients differed significantly according to the surgical procedure (Kruskal-Wallis test; p=0.0049); the patients who underwent PPPD had the highest 5-FU levels, as compared with the other patients (Mann-Whitney test; p= 0.003). Conclusions: The type of operative procedure appears to influence the serum levels of 5-FU in S-1-treated surgical patients with pancreaticobiliary malignancy. Given the possibility of elevated levels of 5-FU in the sera of patients who are treated with S-1 after PPPD, adverse events must be monitored carefully in this cohort. Source


Saito M.,Niigata University | Abe M.,Niigata University | Furukawa T.,Niitsu Medical Center Hospital | Yagi M.,Brain Disease Center Agano Hospital | And 4 more authors.
Biological and Pharmaceutical Bulletin | Year: 2014

In vivo tests may be used for the diagnosis of allergy to iodinated contrast media (ICM); however, the tests do not provide definitive diagnosis and are associated with risks for patients. Diagnoses based on in vitro tests are limited, and there are almost no relevant studies. Herein, the authors examined involvement of allergic reaction from a multilateral standpoint in 39 patients suspected of having ICM allergies using leukocyte migration test (LMT). The positive rate of LMT was 44%. A comparison with the positive rate of LMT in drugs other than ICM (74%) indicated 30% difference, which was significantly low value, suggesting that there is poor involvement of these drugs in the allergic reaction. In LMT positives, 76% of hypersensitivity reactions were skin rash mainly erythema, and 18% was anaphylactic reactions. Cases considered as non-immediate hypersensitivity accounted for about 4 times as many as immediate-type hypersensitivity. In examination of relevancy between a history of drugs or food allergies, the incidence of ICM allergies was 35%. There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. It was suggested that most hypersensitivity reactions were skin rash related to non-immediate hypersensitivity, and approximately 20% of the reaction was immediate anaphylactic reaction. Therefore attention should be paid not only to immediate-type hypersensitivity but also delayed reactions. Moreover, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions. © 2014 The Pharmaceutical Society of Japan. Source

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