Nishimino Kosei Hospital

Yoro, Japan

Nishimino Kosei Hospital

Yoro, Japan
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PubMed | Red Cross, Nara Prefectural Gojo Hospital, Tachikawa General Hospital, Fujiyoshida Municipal Hospital and 46 more.
Type: Journal Article | Journal: Gastroenterology research | Year: 2016

To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia.We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements.Till October 31st 2010, 1,353 patients with Alzheimers dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia.These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.

PubMed | Kariya Toyota General Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Nishimino Kosei Hospital, Kasukabe Municipal Hospital and 9 more.
Type: Journal Article | Journal: Oncology reports | Year: 2014

Although 5-fluorouracil (5-FU) is an important drug for colorectal cancer (CRC) treatment, no useful biomarker is currently available to predict treatment response. Since 5-FU is converted into active or inactive forms by orotate phosphoribosyltransferase (OPRT) or dihydropyrimidine dehydrogenase (DPD), a correlation between these enzymes and response to 5-FU has been suggested. However, such a correlation has not been investigated prospectively. Therefore, in the present study, we aimed to prospectively evaluate whether OPRT and DPD were predictive factors of the response to 5-FU treatment in patients with resectable CRC. The present investigation was designed as a multicenter prospective cohort study. OPRT and DPD activities were assessed in biopsy samples, obtained surgically from patients with resectable CRC. The OPRT/DPD ratio was calculated and the cut-off values for this ratio were determined for 5-year disease-free survival (DFS) and overall survival (OS). Patients were treated with 5-FU/leucovorin(LV) regimens and oral 5-FU. The endpoint of this study was the correlation between the OPRT/DPD ratio and 5-year DFS and OS. The cut-off value for the OPRT/DPD ratio was determined by using the maximum 2 statistic method against 5-year DFS and OS. Sixty-eight patients were enrolled from July 2003 to May 2005. The median follow-up period was 1925 days. The OPRT/DPD ratio cut-off values for 5-year DFS and OS were 0.015 and 0.013, respectively. During the 5-year DFS and OS periods, patients with higher cut-off values had a better prognosis than those with lower ratios (P=0.03 and 0.02, respectively). In conclusion, our results suggest that the OPRT/DPD ratio could be a predictive factor for response to 5-FU/LV adjuvant chemotherapy.

Nishiwaki S.,Nishimino Kosei Hospital | Araki H.,Gifu University | Fang J.C.,University of Utah | Hayashi M.,Nishimino Kosei Hospital | And 7 more authors.
Gastrointestinal Endoscopy | Year: 2011

Background: Feeding device replacement is often required for long-term maintenance after initial percutaneous endoscopic gastrostomy or jejunostomy placement. Although there are several case reports on serious complications of gastrostomy device replacement, there are few reports of an overall analysis of the complications associated with feeding device replacement. Objective: To evaluate the frequency and variety of complications of transcutaneous replacement of feeding devices. Design: A retrospective study. Setting: Single center: Nishimino Kosei Hospital. Patients: This study involved 363 consecutive patients undergoing a total of 1265 percutaneous gastrostomy or jejunostomy device replacements from March 2000 to September 2010. Intervention: A new replacement device was inserted through the ostomy tract by using an obturator after traction removal of the previous device. Endoscopic treatments were performed in the cases of fistula disruption or hemorrhage. Main Outcome Measurements: Complications and their outcomes. Results: Gastrostomy and jejunostomy devices were replaced 1126 and 139 times, respectively. There were 16 complications (1.3% of total replacements) consisting of 10 cases of fistula disruption caused by misplacement of replacement devices into the peritoneal cavity, 4 cases of hemorrhage, and 1 case each of colocutaneous fistula and device breakage. Anticoagulation or antiplatelet medications were continued in all 4 hemorrhage cases but in only 27 of 347 (7.7%) complication-free cases (P <.0001). There were no replacement-related adverse events that required surgical repair. Limitations: A single center, retrospective analysis. Conclusion: Fistula disruption and hemorrhage were the most common complications associated with device replacement. In patients on anticoagulants, caution is necessary to avoid hemorrhage after replacement. It is also important to verify that the replaced device is located in the GI tract lumen before feeding. © 2011 American Society for Gastrointestinal Endoscopy.

Onogi F.,Gifu University | Araki H.,Gifu University | Ibuka T.,Gifu University | Manabe Y.,Nagahama City Hospital | And 3 more authors.
Endoscopy | Year: 2010

Background and study aims: A small amount of free air, visible on CT but not on plain chest radiography, which appeared following endoscopic submucosal dissection (ESD) of a gastric neoplasm without endoscopically visible perforation, was defined as a transmural air leak, and a prospective, consecutive entry study was performed to determine its incidence and clinical significance. Patients and methods: Between January 2006 and September 2008, ESD was performed for 246 gastric lesions in 246 consecutive patients. Abdominal CT scan was performed 1 day after ESD. In addition, chest radiography and blood biochemistry tests were performed at different time points before and after ESD. Results: Two hundred and nineteen lesions (89%) were curatively removed by ESD. Among the total of 246 patients, we encountered endoscopically visible perforation during ESD in 2 patients (0.8%), and clinically suspected perforation diagnosed by the presence of free air on chest radiography but invisible during ESD in 3 patients (1%), while transmural air leak was observed in another 33 (13%). Air leak occurred in cases where resection size was larger, procedure time longer, and the muscularis propria on the ulcer base was exposed at the end of ESD. Patients with air leaks developed pyrexia at a higher rate than those without (36% vs. 16%, P=0.018). These patients recovered with antibiotics and required no endoscopic or surgical intervention. The presence of an air leak did not affect the duration of hospital stay. Conclusions: A transmural air leak was observed in 13% of the patients undergoing ESD. Larger resection size, prolonged procedure time, and exposure of the muscularis propria on the ulcer base were risk factors for transmural air leak, but the outcome of patients with this complication was good. © Georg Thieme Verlag KG Stuttgart.

Nishiwaki S.,Nishimino Kosei Hospital | Iwashita M.,Nishimino Kosei Hospital | Goto N.,Gifu University | Hayashi M.,Nishimino Kosei Hospital | And 7 more authors.
Clinical Nutrition | Year: 2011

Background & aims: Trace element deficiencies are known to occur during long-term enteral nutrition feeding. We compared the serum concentrations of trace elements between patients treated with gastrostomy and those treated with jejunostomy. Methods: Our subjects were 36 patients who underwent percutaneous endoscopic gastrostomy (PEG group) and 23 patients who underwent percutaneous endoscopic jejunostomy (PEJ group) and were maintained with enteral tube feeding for more than one year. The serum concentrations of copper, zinc, selenium, and iron were measured in the two groups. Clinical manifestations and the effectiveness of supplementation therapy against copper deficiency were also investigated. Results: From 6 months after the onset of enteral feeding, the copper concentration of the PEJ group was significantly decreased compared with that of the PEG group (p<. 0.001). There were no significant differences in the concentrations of zinc, selenium, or iron between the two groups. Severe copper deficiency was observed in 6 patients of the PEJ group and was accompanied with neutropenia and anemia. The copper deficiency was successfully treated in all of these patients by supplementation with 10-40. g of cocoa powder a day which was equivalent to a total daily dose of 1.36-2.56. mg of copper. Conclusions: Prolonged PEJ tube nutrition tends to result in copper deficiency, and cocoa supplementation is effective for treating such copper deficiency. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Saito K.,Nishimino Kosei Hospital
Journal of Japanese Society of Gastroenterology | Year: 2010

A 72-year-old woman received combination therapy with peginterferon α and ribavirin for treatment of chronic hepatitis C. Approximately 40 weeks after starting treatment, she developed an eruption in the left inner canthus and sarcoidosis was diagnosed after biopsy of the eruption. Combination therapy was discontinued, and further detailed examinations revealed bilateral hilar lymphadenopathy, uveitis, and complete atrioventricular block. A permanent cardiac pacemaker was implanted, and her sarcoidosis improved upon administration of corticosteroids.

Maeda T.,Nishimino Kosei Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

COPD is an independent risk factor for lung cancer. There is emerging evidence that chronic inflammation may play a significant role in the pathogenesis of lung cancer as a tumor promoter. Cigarette smoke exponentially up-regulates the production of cytokines. After stopping smoking, the risk of lung cancer remains increased in patients with COPD. We report 3 patients with COPD in whom lung cancer was detected within 16 months after smoking cessation. All were outpatients of our hospital, and participated in a program for smoking cessation according to their doctor's advice. Two successfully stopped smoking, and the other was in the program for smoking cessation. It was difficult to detect lung cancers on chest X-ray films 8-11 months previously. Periodic medical examination chest X-ray films revealed lung cancers 2-16 months after smoking cessation. Heavy smokers, especially COPD patients, have a high risk of developing lung cancer at the start of smoking cessation, and therefore have a high risk of contracting lung cancer even after halting smoking. Generally, most patients do not visit hospitals for the purpose of only smoking cessation after successfully halting smoking. Nevertheless, it is necessary for previously heavy smokers, especially COPD patients, to undergo repeated careful medical examination to detect lung cancer.

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