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Tomakomai, Japan

Nishiyama N.,Sapporo Medical University | Kitamura H.,Sapporo Medical University | Hotta H.,Red Cross | Takahashi A.,Hakodate Goryoukaku Hospital | And 8 more authors.
Japanese Journal of Clinical Oncology | Year: 2014

Objective: The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guérin failure classification advocated by Nieder et al. in patients with nonmuscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guérin therapy. Methods: Data from 402 patients who received intravesical bacillus Calmette-Guérin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guérin failure were analyzed for this study. Results: Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guérin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guérin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the followup. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (>70 [P 1/4 0.002]), tumor size (>3 cm [P 1/4 0.015]) and the Nieder classification (bacillus Calmette-Guérin refractory [P, 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P, 0.001). Conclusions: Patients with stage progression at the first recurrence after bacillus Calmette-Gué rin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin into three risk groups based on the number of prognostic factors in each one. © The Author 2014. Published by Oxford University Press. All rights reserved. Source


Kawai M.,Asahikawa University | Nakabayashi S.,Asahikawa University | Shimizu K.,Oji General Hospital | Hanada K.,Asahikawa University | Yoshida A.,Asahikawa University
Case Reports in Ophthalmology | Year: 2014

Purpose: To report a case of autologous transplantation of a free Tenon's graft to repair excessive bleb leakage after trabeculectomy. Case Report: A 39-year-old Japanese woman presented with severe hypotony in her left eye. She had undergone trabeculectomy with mitomycin C 14 years ago. Slit-lamp examination showed an ischemic and ruptured bleb, excessive bleb leakage, and an extremely shallow anterior chamber. A large scleral defect was vaguely observed through the bleb conjunctiva. The hypotony was attributed to excessive bleb leakage. A surgical revision was required. First, the avascular bleb conjunctiva and the melted scleral flap were excised. A scleral defect was observed. Thick fibrotic tissue, i.e., the autologous Tenon's graft, was separated from the underlying sclera, cut to the desired size to cover the defect, and sutured to the sclera with 10-0 nylon sutures. Irrigation with balanced salt solution through the paracentesis confirmed deepening of the anterior chamber with no bleb leakage. In the current case, a layer of amniotic membrane was applied to cover the largely exposed sclera. Two weeks postoperatively, the surgical site was totally re-epithelialized with no aqueous leakage. Three months postoperatively, vascularization into the surgical site was observed. The intraocular pressure remained within normal levels without recurrent bleb leakage. Conclusions: Autologous transplantation of a free Tenon's graft successfully repaired excessive bleb leakage through a scleral defect after trabeculectomy. This technique is easier, safer, and may be more cost effective for repairing excessive bleb leakage after trabeculectomy than conventional management techniques. © 2014 S. Karger AG, Basel. Source


Fujimi A.,Oji General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2013

A 69-year-old male was referred to our hospital because of anemia, renal insufficiency, and a positive urine test for Bence-Jones protein. A bone marrow examination showed 73.7% of myeloma cells with lymphoplasmacytic morphology, the strong expressions of CD20 and CD23 by flow cytometry, and the chromosomal aberration of CCND1/IGH by FISH analysis. He was diagnosed with multiple myeloma, IgG-λ type. The initial treatment with bortezomib plus dexamethasone (BD) provided a rapid decrease in the level of IgG; however, he developed bortezomib-induced recurrent paralytic ileus accompanied by aspiration pneumonia during the second course. Interestingly, CD23 expression on myeloma cells decreased from 87.7% to 2.2% after 2 courses of BD. Negative CD23 expression was maintained following lenalidomide plus dexamethasone therapy. There are extremely few reports on CD23 expression on myeloma cells, and this is the first case report of multiple myeloma in which CD23 expression was lost after BD therapy. Source


Kikuchi C.,Obihiro Kyoukai Hospital | Tonozaki S.,Sapporo Medical University | Gi E.,Sapporo Medical University | Watanabe M.,Oji General Hospital | Shimizu H.,JR Sapporo Medical Hospital
Japanese Journal of Anesthesiology | Year: 2014

Background : Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space. Methods : Women with ASA physical status I or II undergoing elective or emergency cesarean delivery under CSEA at our hospital were enrolled in this study. In all women, it was investigated whether shoulder-tip pain occurred or not during and after cesarean delivery. In some of the parturient women in this study, 2 to 5 degree head-up position was employed during the operation (head-up group). We compared the frequency of shoulder-tip pain in the head-up group with that in women who were maintained in a horizontal position (horizontal group). Results : One hundred and twelve of the 242 women recruited to this study experienced shoulder-tip pain. The pain was usually mild to moderate and was relieved in a few days, but 14 patients experienced severe pain as "can not breathe". One hundred and twenty-six of the 160 women lying on an operating table in a head-up position were classified as a head-up group. Shoulder-tip pain was less frequent in the head-up group than horizontal group (50/126 vs. 62/164, P<0.05). Conclusions : This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region. Source


Kanno M.,Oji General Hospital | Edanaga M.,Sapporo Medical University | Mizukami N.,Ebetsu City Hospital | Tokinaga Y.,Sapporo Medical University | And 2 more authors.
Japanese Journal of Anesthesiology | Year: 2015

Anti-coagulant management of cardiopulmonary bypass for the patient complicated with heparininduced thrombocytopenia (HIT) is difficult A woman of late 50's with a previous history of HIT was scheduled for mitral valve replacement, tricuspid valvuloplasty and coronary artery bypass graft We knew that heparin antibody was negative by serologic and functional assay before the operation. According to the HIT guideline, we planned to use heparin only during cardiopulmonary bypass and to use argatroban for other catheters. Although the platelet count continued decreasing up to the 5th postoperative day unless the transfusion of platelets, heparin antibody was negative on the first postoperative day. But it was thought that HIT would develop from 5 days to 10 days after using heparin. Therefore, we had to examine heparin antibody on the 5th postoperative day at least for the patients with a history of HIT. In the future, it is important to observe the patient carefully and examine heparin antibody. Source

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