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Ota M.,Ome Municipal General Hospital
Nihon Rinshō Men'eki Gakkai kaishi = Japanese journal of clinical immunology | Year: 2012

We describe 3 siblings who suffered from marked eosinophilia with organ involvement. One sibling, who experienced cervical lymphadenopathy and peripheral neuropathy with eosinophilia (5,834 cells/μL) following bronchial asthma, was diagnosed with Churg-Strauss syndrome (CSS) according to the criteria of the American College of Rheumatology. Another sibling, who suffered from severe asthma with persistent polyarthritis and eosinophilia (2,496 cells/μL), was also diagnosed with CSS according to the criteria of the Japanese Ministry of Health, Labour and Welfare. The remaining sibling, who had eosinophilic pleuritis with peripheral blood eosinophilia (699 cells/μL), did not fulfill the widely used criteria for CSS or hypereosinophilic syndrome (HES) ; however, he fit the newly proposed criteria for HES. Glucocorticoid treatment relieved their symptoms. Although the diagnoses and the criteria used for diagnosis differed between the siblings, all 3 patients showed common features such as eosinophilia with organ involvement that required treatment, indicating the possibility of familial eosinophilia (FE). Furthermore, the clinical features observed differed substantially from those of previously reported FE patients, therefore, these 3 siblings may be affected by a type of FE distinguishable from those previously described.


Watanabe T.,Ome Municipal General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

A 70-year-old female with severe tricuspid regurgitation and stenosis was admitted to our institution because of watery diarrhea and peripheral edema. The urinary 5-hydroxyindoleacetic acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. The liver biopsy revealed metastatic carcinoid disease, which was thought as an etiology in severe tricuspid regurgitation and stenosis. We administered long acting somatostatin analog, octreotide to control carcinoid symptoms. After improvement of general condition, she successfully underwent bioprosthetic valve replacement with concomitant octreotide administration. Postoperative course was uneventful. She had been followed up with administration of octreotide at outpatient clinic. Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications. Octreotide is an effective tool to manage manifestation of carcinoid activity. We could performed surgical treatment of carcinoid heart disease safely in the perioperative presence of octreotide.


Takenaka K.,Ome Municipal General Hospital | Ohba T.,Ome Municipal General Hospital | Suhara K.,Ome Municipal General Hospital | Sato Y.,Ome Municipal General Hospital | Nagasaka K.,Ome Municipal General Hospital
Clinical Rheumatology | Year: 2014

A 47-year-old Japanese woman developed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) complicated by a rare combination of aortitis and hypertrophic pachymeningitis. Despite the therapy with prednisolone and cyclophosphamide, the aortitis was not ameliorated. However, after cyclophosphamide was replaced with intravenous tocilizumab, the aortitis was improved, and the prednisolone dose was successfully tapered to 4 mg/day without elevation in C-reactive protein and myeloperoxidase ANCA (MPO-ANCA) levels. Several studies have reported that tocilizumab is effective for aortitis associated with Takayasu's arteritis and giant cell arteritis. On the other hand, we succeeded to improve the aortitis in AAV with monthly administration of tocilizumab. Moreover, we successfully controlled disease activity and enabled the tapering of prednisolone to 4 mg/day without relapses of AAV symptoms and elevated MPO-ANCA levels. It indicates that tocilizumab may be therapeutically beneficial for not only aortitis but also AAV itself. In conclusion, tocilizumab was effective in treating glucocorticoid- and cyclophosphamide-resistant AAV-associated aortitis. This is the first report demonstrating the successful treatment of AAV-associated aortitis using tocilizumab. © 2013 Clinical Rheumatology.


Watanabe T.,Ome Municipal General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

We report a 64-year-old male patient with papillary fibroelastoma of the tricuspid valve associated with moderate mitral regurgitation. Echocardiography had revealed a 10 x 10 mm tumor attaching to the anterior tricuspid leaflet 3 years before. Because the tumor was enlarged to 19 x 15 mm, we excised it with a part of the anterior tricuspid leaflet, and performed tricuspid and mitral valvoplasty. The histological findings suggested papillary fibroelastoma. The postoperative course was uneventful.


Yamazaki H.,Ome Municipal General Hospital | Isogai S.,Ome Municipal General Hospital | Sakurai T.,Sakurai Clinic | Nagasaka K.,Ome Municipal General Hospital
Modern Rheumatology | Year: 2010

A 64-year-old woman with rheumatoid arthritis (RA) began to complain of recurrent non-productive cough 5 months after starting adalimumab. The chest radiograph and high-resolution computed tomographic findings revealed diffuse ground-glass attenuation. Her clinical course suggested that interstitial pneumonia (IP) may have been induced by adalimumab, and she was successfully treated with a medium dose of corticosteroid. This case indicates that adalimumab-associated IP should be considered if a RA patient develops non-productive cough following adalimumab therapy. © 2010 Japan College of Rheumatology.


Yamazaki H.,Ome Municipal General Hospital | Nagasaka K.,Ome Municipal General Hospital
Modern Rheumatology | Year: 2011

A 76-year-old woman with rheumatoid arthritis who had been taking methotrexate (MTX) for 9 months was admitted because of acute respiratory failure. A chest radiograph revealed diffuse ground-glass attenuation. MTX-induced interstitial pneumonia (IP) was strongly suspected. Her respiratory failure worsened in spite of steroid pulse therapy. Intravenous administration of ulinastatin, however, dramatically improved her clinical condition. The second ulinastatin treatment was also effective. This case suggests that peripherally administered ulinastatin may be effective for steroid-resistant MTX-induced IP. © 2010 Japan College of Rheumatology.


Makino K.,Ome Municipal General Hospital | Yoda K.,Ome Municipal General Hospital | Tomoishi J.,Ome Municipal General Hospital | Kume H.,University of Tokyo
BMC Research Notes | Year: 2015

Background: Sunitinib, an oral multitarget tyrosine kinase inhibitor and standard first-line treatment for metastatic renal cell carcinoma (mRCC), is generally administered on a 6-week schedule (4 weeks on/2 weeks off). However, drug toxicity often leads to temporary treatment interruption, resulting in reduced treatment efficacy. In this report, we investigated whether sunitinib administration of at a dose of 25 mg/day in a 2-weeks-on/1-week-off cycle would reduce the incidence of drug-related side effects while maintaining drug efficacy. Findings: A total of six patients with mRCC were orally administered sunitinib at a dose of 25 mg/day in a 2-weeks-on/1-week-off regimen until intolerable toxicities occurred. All enrolled patients were assessed for toxicity and response. The median treatment period was 24 months (range, 9-40 months). Objective responses were as follows: disease stabilization of >6 months was achieved in all patients. The most important toxicities were neutropenia, fatigue, and proteinuria, but all were controlled. Conclusions: Oral sunitinib at 25 mg/day in a 2-weeks-on/1-week-off regimen to Japanese patients can avoid drug-related toxicities while achieving the same dose intensity as a 6-week schedule. Because these data were derived from a small number of patients, future prospective studies of modified sunitinib administration schedules are warranted. © 2014 Makino et al.; licensee BioMed Central Ltd.


Shirasu T.,University of Tokyo | Hoshina K.,University of Tokyo | Yamamoto S.,Ome Municipal General Hospital | Shigematsu K.,University of Tokyo | And 2 more authors.
Circulation Journal | Year: 2015

Background: Some patients with critical limb ischemia (CLI) lack symptoms of intermittent claudication (IC) before the onset of CLI. We studied the outcome of such patients, because this is currently unknown. Methods and Results: For retrospective exploratory analysis, we divided 225 patients (265 limbs) with CLI into 2 groups: 142 patients (172 limbs) without a history of IC (non-IC group) and 83 patients (93 limbs) with IC (IC group). We examined comorbid factors and found that a higher proportion of patients in the non-IC group failed to undergo arterial revascularization (49% vs. 20%, P<0.0001) due to progressed limb ischemia and infection. We then analyzed 140 patients (161 limbs) with revascularization. Patients in the non-IC group were more likely to have diabetes mellitus (P=0.03), hypoalbuminemia (P=0.02), advanced Rutherford’s classification (P=0.0007), worse ambulatory function (P=0.009), and longer postoperative stay (P=0.04). Amputation-free survival was lower in the non-IC group (P=0.005). On Cox regression anlaysis, hemodialysis (P=0.002), coronary artery disease (P=0.04), cerebrovascular disease (P=0.02), non-ambulatory status (P=0.02), and non-IC (P=0.01) were independent risk factors for lower amputation-free survival. Conclusions: Patients without IC before CLI onset have several unique features, and non-IC is an independent risk factor for poor outcome. © 2015, Japanese Circulation Society. All rights reserved.


Akiyama H.,Ome Municipal General Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2013

A 44-year-old man with advanced follicular lymphoma received 8 cycles of chemotherapy, which resulted in the complete disappearance of the original disease. However, a new abdominal mass with positive (18)F-FDG PET/CT uptake appeared after 5 cycles and this was maintained until 3 weeks after the completion of 8 cycles. Open biopsy showed a benign mass with fat necrosis. Although PET/CT is useful in evaluating residual lymphoma after chemotherapy, various benign conditions such as a result of post-chemotherapy inflammation, even in new locations without prior disease, should be noted as causes of false positive uptake.


Hara Y.,Ome Municipal General Hospital
Nihon Geka Gakkai zasshi | Year: 2013

A model project to determine the cause of deaths related to medical practice began in 2005. Since 2010, it has been managed by the Japan Medical Safety Research Organization (JMSRO), which is supported financially by the government and a majority of medical societies and organizations. There is a central office in Tokyo and nine local offices nationwide. When the JMSRO accepts a case, it makes a report on the cause of death and measures to prevent recurrence after detailed autopsy and clinical evaluation. So far, 180 cases have been accepted, of which 156 have been completed. A system to achieve the goals of the project has been established. About 80% of families of the deceased and medical organizations stated that they were satisfied with the results. Four families have initiated civil actions, and another four could potentially do so. No criminal charges have been filed. A new concept to establish an official third-party organization to analyze causes of medical practice-related deaths has been proposed by a committee under the JMSRO, and efforts should be made to put that proposal into practice.

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