Niigata-shi, Japan
Niigata-shi, Japan

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Takeyoshi I.,Gunma University | Makita F.,National Nishi Gunma Hospital | Tanahashi Y.,Shibukawa General Hospital | Iwazaki S.,Tatebayashi Kosei Hospital | And 17 more authors.
Anticancer Research | Year: 2011

Background: Paclitaxel and doxifluridine (5′-DFUR) have distinct mechanisms of action and toxicity profiles. This study evaluated the antitumor activity and toxicities of combination chemotherapy with these drugs in patients with advanced/recurrent gastric cancer (AGC). Patients and Methods: Patients with histologically confirmed AGC, which was either unresectable or metastatic, were included in this study. The treatment consisted of 80 mg/m2 paclitaxel given i.v. on days 1, 8, and 15 every 4 weeks, and 533 mg/m 2 doxifluridine given orally on days 1-5 every week. Results: One hundred and four patients were evaluated for toxicity and 93 patients were evaluated for a therapeutic response. The overall response rate was 33.3% (1st line: 41.7%, 2nd line: 25.0%), including a complete remission in two patients, a partial remission in 29, stable disease in 39, progressive disease in 17; the response was not evaluable in six patients. The median overall survival was 287 days. Commonly observed grade 3/4 adverse events were leukopenia (13.5%), anorexia (3.8%), fatigue (3.8%) and diarrhea (2.9%). Conclusion: Paclitaxel and doxifluridine combination chemotherapy is a well-tolerated and convenient treatment regimen that can be given on an outpatient basis with promising efficacy for AGC.


Takeyoshi I.,Gunma University | Takeyoshi I.,Nishi Gunma National Hospital | Makita F.,Nishi Gunma National Hospital | Iwazaki S.,Tatebayashi Kosei Hospital | And 17 more authors.
Anticancer Research | Year: 2011

Background: The efficacy of systemic chemotherapy for peritoneal dissemination of gastric cancer remains unclear. The efficacy of weekly paclitaxel in combination with doxifluridine (5′-DFUR) in gastric cancer patients with malignant ascites was evaluated. Patients and Methods: Patients with histologically confirmed gastric cancer with ascites were eligible. The treatment consisted of paclitaxel intravenously (i.v.) administered at 80 mg/m 2 on days 1, 8 and 15 every 4 weeks, and doxifluridine administered orally at 533 mg/m 2 on days 1-5 every week. The response rate for patients with ascites was determined based on the Japanese Classification of Gastric Carcinoma. Also, the concentration of paclitaxel in the ascites was measured. Results: Twenty-four patients were investigated. The response rate (RR) was 41.7%, including complete remission (CR) and partial remission (PR) in 4 and 6 patients, respectively. The concentration of paclitaxel in the ascites was maintained between 0.01 μM and 0.05 μM until 72 hours. The median overall survival (OS) was 215 days, and 1-year survival rate was 29.2%. No severe toxicity was noted. Conclusion: Weekly paclitaxel in combination with doxifluridine is effective for gastric cancer patients with malignant ascites with an acceptable toxicity profile.


PubMed | Red Cross, Tohoku University and Ojiya General Hospital
Type: | Journal: Respiratory medicine case reports | Year: 2017

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder caused by heterozygous germline mutations in the tumor suppressor gene


PubMed | Red Cross, Tohoku University and Ojiya General Hospital
Type: Journal Article | Journal: Journal of medical case reports | Year: 2016

Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. Hypertension secondary to pheochromocytoma is often paroxysmal, and patients occasionally present with sudden attacks of alternating hypertension and hypotension. Spontaneous, extensive necrosis within the tumor that is associated with catecholamine crisis is an infrequent complication of adrenal pheochromocytoma, but its pathogenesis remains unclear.A 69-year-old Japanese man developed acute-onset episodic headaches, palpitations, and chest pains. During the episodes, both marked fluctuations in blood pressure (ranging from 40/25 to 300/160mmHg) and high plasma levels of catecholamines were found simultaneously. Radiological findings indicated a 4-cm left adrenal pheochromocytoma. These episodic symptoms disappeared within 2weeks with normalization of plasma catecholamine levels. Two months later, the patient underwent adrenalectomy. Microscopic examinations revealed pheocromocytoma with a large central area of coagulative necrosis. The necrotic material was immunohistochemically positive for chromogranin A. Granulation tissue was adjacent to the necrotic area, accompanied by numerous hemosiderin-laden macrophages and histiocytes with vascular proliferation. Viable tumor cells, detected along the periphery of the tumor, demonstrated pyknosis, and the Ki-67 labeling index was 2% in the hot spot. No embolus or thrombus formation was found in the resected specimen harboring the whole tumor. The Pheochromocytoma of the Adrenal gland Scaled Score was 2 out of 20. The patients postoperative course was unremarkable for > 7years.Presumed causal factors for the extensive necrosis of adrenal pheochromocytoma in previously reported cases include hemorrhage into the tumor, hypotension induced by a phentolamine administration, embolic infarction, high intracapsular pressure due to malignant growth of the tumor, and catecholamine-induced vasoconstriction. In the present case, histopathological and clinical findings suggest that under conditions of chronic ischemia due to catecholamine-induced vasoconstriction, an acute infarction occurred after sudden attacks of alternating hypertension and hypotension. Over the subsequent 2weeks, repetitive massive release of catecholamines from the infarcts into circulation likely accelerated infarction progression by causing repeated attacks of alternating hypertension and hypotension and resulted in the large necrosis. This case highlights the need for physicians to consider acute spontaneous tumor infarction accompanying episodic catecholamine crisis as a rare but severe complication of pheochromocytoma.


Takahashi N.,Gunma University | Takahashi N.,Ojiya General Hospital | Ohya T.,Ojiya General Hospital | Matsumoto H.,Gunma University | And 10 more authors.
Kitakanto Medical Journal | Year: 2011

Early gastric cancer was suspected in a 71-year-old woman during an upper gastrointestinal tract imaging test in November 2008, and she consulted the Department of Gastroenterology at Ojiya General Hospital. Esophagogastroduodenoscopy showed early gastric double cancers, so laparoscopy-assisted distal gastrectomy was performed in December. The final diagnosis was stage IA. Follow-up was conducted in the Department of Gastroenterology. The carcinoembryonic antigen (CEA) level was elevated, at 17ng/mL, in May 2009. Thus, she received a detailed examination. However, a definitive diagnosis of recurrence was not made. As the rise of serum CEA continued, a TS-1/cisdiamine dichloroplatinum treatment was started in August. Chemotherapy was effective, and the CEA levels decreased gradually. Symptoms of anemia were observed in December when the fourth period of chemotherapy treatment had been completed. Esophagogastroduodenoscopy showed a hemorrhagic tumor in the anastomosis in January 2010, so a total remnant gastrectomy was performed in January 2010. Immunohistochemical staining for alpha-fetoprotein (AFP) was positive. A rise in serum AFP occurred just before the total remnant gastrectomy, and we diagnosed it as the gastric cancer producing AFP. After the total remnant gastrectomy, both serum CEA and AFP levels normalized. Although the patient was taking TS-1 after discharge, she developed a recurrence with multiple pulmonary metastases in July, and various systemic chemotherapies are currently being performed.


Ohara N.,Red Cross | Ohara N.,Niigata University | Kaneko M.,Red Cross | Kuriyama H.,Red Cross | And 6 more authors.
Internal Medicine | Year: 2016

A 73-year-old Japanese woman with untreated Graves’ hyperthyroidism developed glucocorticoid-induced adrenal insufficiency (AI) after a supraphysiological dose of prednisolone therapy for bronchial asthma. Days later, she had high plasma adrenocorticotropic hormone (ACTH) levels and was expected to recover from glucocorticoid-induced AI. Her plasma ACTH levels remained high over 3 months during a physiological dose of hydrocortisone replacement. However, she suffered a further decrease in her serum cortisol level and was diagnosed with isolated adrenocorticotropin deficiency (IAD), in which bioinactive ACTH likely caused the high ACTH value. IAD should be considered as an unusual disorder associated with Graves’ disease, especially in older patients. © 2016 The Japanese Society of Internal Medicine.


Kamoi K.,Ojiya General Hospital | Kamoi K.,Niigata University
Clinical and Experimental Hypertension | Year: 2015

Previous cross-sectional studies and 6-year longitudinal study have demonstrated that home blood pressure (HBP) measurements upon awakening have a stronger predictive power for death, micro-and macrovascular complications than clinic blood pressure (CBP) measurements in patients with type 2 diabetes (T2DM). This study investigated which of these measurements offers stronger predictive power for outcomes over 10 years. At baseline, 400 Japanese patients with T2DM were classified as having hypertension (HT) or normotension (NT) based on HBP and CBP. The mean survey duration was 95 months. Primary and secondary end-points were death and new or worsened micro-and macrovascular complications, respectively. Differences in outcomes for each end-point between HT and NT patients were analyzed using Kaplan-Meier survival curves and log-rank testing. Associated risk factors were assessed using Cox proportional hazards analysis. Based on HBP, death and micro-and macrovascular complications were significantly higher in patients with HT than with NT at baseline and end-point. Based on CBP, there were no significant differences in incidence of death, micro-or macrovascular complications between patients with HT and NT at baseline and end-point, although a significant difference in incidence of death was observed between the HT and NT groups at end-point. However, the significance was significantly lower in CBP than in HBP. One risk factor associated with micro-and macrovascular complications in patients with HBP was therapy for HT. This 10-year longitudinal study of patients with T2DM demonstrated that elevated HBP upon awakening is predictive of death, and micro-and macrovascular complications. © 2015 Informa Healthcare USA, Inc.


Iguchi A.,Ojiya General Hospital | Watanabe Y.,Ojiya General Hospital | Iino N.,Niigata University | Kazama J.J.,Niigata University | And 2 more authors.
Nephrology | Year: 2014

Aim: Fibroblast growth factor 23 is reported to be a pivotal regulator for the chronic kidney disease-mineral bone disorders, working in coordinated ways with phosphate, calcium, and parathyroid hormone. However, whether there is a relationship between fibroblast growth factor 23 and magnesium is currently unclear. To address this, we performed a cross-sectional observational study in haemodialysis patients. Methods: We measured the serum levels of fibroblast growth factor 23, magnesium and other factors that are implicated in chronic kidney disease-mineral bone disorders in 225 haemodialysis patients. Results: Simple correlation analysis showed that fibroblast growth factor 23 was not correlated with magnesium. However, upon multiple regression analysis, a significant negative correlation was found between fibroblast growth factor 23 and magunesium (b = -0.164, P = 0.0020). Moreover, the levels of fibroblast growth factor 23 in patients treated with magnesium oxide had significantly lower levels than those without magnesium oxide. Conclusion: We speculate that the magnesium is a potential regulator of fibroblast growth factor 23 levels in haemodialysis patients. Our data suggest that follow-up studies to elucidate the molecular mechanisms that underlie this relationship are warranted. © 2014 Asian Pacific Society of Nephrology.


Imai N.,Ojiya General Hospital | Imai N.,Niigata University | Endo N.,Niigata University | Hoshino T.,Ojiya General Hospital | And 3 more authors.
Journal of Bone and Mineral Metabolism | Year: 2016

Due to the increasing elderly population, the prevalence of osteoporotic hip fractures in Japanese patients continues to rise. It is well established that patients with either hip fracture or both symptomatic and asymptomatic morphometric vertebral compression fracture (VCF) have a poor health prognosis compared with the general population. The purpose of this study was to retrospectively investigate vertebral fracture rates among patients with hip fracture and their influence on mortality. We examined 182 cases of osteoporotic hip fracture in patients admitted to our institution between January 2009 and May 2011. The average age at the time of fracture was 85 years. Radiographs of the lumbar spine were obtained from all of the participants and the lateral spinal radiographs were examined for evidence of VCF. The patients were classified into two groups, those with VCF and those without. A VCF was identified in approximately 78 % of the patients. The mortality rate 1 year after the hip fracture was approximately 22 % and it was significantly higher in patients with VCF. Through multivariate statistics we found that VCF, post-operative complication, loss of ambulation after operation and medication for osteoporosis were statistically significant. In other words, VCF, post-operative complication and loss of ambulation were considered to be poor prognostic factors and medication for osteoporosis was likely to improve the prognosis. We concluded that the risk of mortality after hip fracture is significantly greater in patients who also have VCF compared to patients without VCF, and that medication for osteoporosis is likely to improve prognosis. © 2014, The Japanese Society for Bone and Mineral Research and Springer Japan.


PubMed | Niigata University and Ojiya General Hospital
Type: Journal Article | Journal: Journal of bone and mineral metabolism | Year: 2015

Due to the increasing elderly population, the prevalence of osteoporotic hip fractures in Japanese patients continues to rise. It is well established that patients with either hip fracture or both symptomatic and asymptomatic morphometric vertebral compression fracture (VCF) have a poor health prognosis compared with the general population. The purpose of this study was to retrospectively investigate vertebral fracture rates among patients with hip fracture and their influence on mortality. We examined 182 cases of osteoporotic hip fracture in patients admitted to our institution between January 2009 and May 2011. The average age at the time of fracture was 85 years. Radiographs of the lumbar spine were obtained from all of the participants and the lateral spinal radiographs were examined for evidence of VCF. The patients were classified into two groups, those with VCF and those without. A VCF was identified in approximately 78 % of the patients. The mortality rate 1 year after the hip fracture was approximately 22 % and it was significantly higher in patients with VCF. Through multivariate statistics we found that VCF, post-operative complication, loss of ambulation after operation and medication for osteoporosis were statistically significant. In other words, VCF, post-operative complication and loss of ambulation were considered to be poor prognostic factors and medication for osteoporosis was likely to improve the prognosis. We concluded that the risk of mortality after hip fracture is significantly greater in patients who also have VCF compared to patients without VCF, and that medication for osteoporosis is likely to improve prognosis.

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