Nara Prefectural Nara Hospital

Nara-shi, Japan

Nara Prefectural Nara Hospital

Nara-shi, Japan
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Kudoh K.,Ohki Memorial Kikuchi Cancer Clinic for Women | Kudoh K.,Nishisaitama Chuo National Hospital | Takano M.,Ohki Memorial Kikuchi Cancer Clinic for Women | Takano M.,National Defense Medical College | And 9 more authors.
Gynecologic Oncology | Year: 2011

Objectives: Currently, pegylated liposomal doxorubicin (PLD) is regarded as one of the standard treatment options in recurrent ovarian cancers (ROC). Bevacizumab has shown significant antitumor activity for ROC in single-agent or in combination with cytotoxic agents. We have conducted a preliminary study to investigate effects of combination of bevacizumab and PLD for heavily pretreated patients with ROC. Methods: Thirty patients with ROC were treated with combination therapy with weekly bevacizumab and PLD, 2 mg/kg of continuous weekly bevacizumab and 10 mg/m2 of PLD (3 weeks on, 1 week off). The treatment was continued until development of disease progression, or unmanageable adverse effects. Response evaluation was based upon Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0, and Gynecologic Cancer Intergroup (GCIG) CA125 response criteria. Adverse effects were analyzed according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Results: Overall response rate was 33%, and clinical benefit rate (CR + PD + SD) was 73%. Median progression-free survival was 6 months (range: 2-20 months), and a 6-months progression-free survival was 47%. Any hematological toxicities more than grade 3 were not observed. Two cases developed non-hematologic toxicities more than grade 2; a case with grade 3 hand-foot syndrome, another with grade 3 gastrointestinal perforation (GIP). The case with GIP was conservatively treated and recovered after 2 months, and there was no case with treatment-related death. Conclusion: The present investigation suggested that combination therapy with bevacizumab and PLD was active and well tolerated for patients with ROC. We recommend the regimen be evaluated in further clinical studies. © 2011 Elsevier Inc.

Tsubamoto H.,Hyogo College of Medicine | Itani Y.,Nara Prefectural Nara Hospital | Ito K.,Kansai Rosai Hospital | Kanazawa R.,Hyogo College of Medicine | And 2 more authors.
Gynecologic Oncology | Year: 2013

Objective: Intraperitoneal chemotherapy (IP) is known to be effective after optimal primary debulking surgery (PDS) for ovarian cancer (OC). Here, we conducted a phase II study to investigate its effectiveness after interval debulking surgery (IDS). Methods: Thirty-seven patients with FIGO stage IIIB-IV and suboptimal (≥ 1 cm diameter) residual disease after PDS were enrolled. Carboplatin (AUC 4 IV, Day 1) and cisplatin (50 mg/m2 IV, Day 3) were given q21d for 3 cycles. After IDS, paclitaxel (175 mg/m2 IV Day 1 or 60 mg/m2 IV Days 1, 8, and 15, since 2000) and cisplatin (75 mg/m2 IP Day 2) were given q21d for 4 cycles. The primary endpoint was progression-free survival (PFS), and secondary endpoints were overall survival (OS) and adverse events (CTCAE ver. 2.0). Clinical manifestations at first recurrence and subsequent treatment were also surveyed. Results: Of the 37 patients, high-grade, serous adenocarcinoma was found in 33. Stages IIIB, IIIC, and IV were found in 2, 24, and 11 patients, respectively. After IDS, 23 patients had no macroscopic residual tumor. No patients had permanent enterostomy, febrile neutropenia, or platelet transfusion. The treatment protocol was completed in 22 patients, and discontinued in 5 due to IP catheter-related complications. Median PFS and OS were 22 and 57 months, respectively. Among the 28 patients with recurrence, 10 had no intraperitoneal disease at first recurrence. Among the 8 patients who underwent surgical cytoreduction, 6 had no residual tumor, while 2 had a < 1-cm-diameter residual tumor. Conclusion: IP after IDS for patients with initially suboptimally debulked OC was effective. © 2012 Elsevier Inc.

Amano M.,Nara Prefectural Nara Hospital | Shimizu T.,Nerima Hikarigaoka Hospital
Internal Medicine | Year: 2014

Emphysematous cystitis (EC) is a rare form of complicated urinary tract infection, its characteristic feature being gas within the bladder wall and lumen. Patients with EC present with variable clinical manifestations ranging from asymptomatic to severe sepsis. EC is typically observed in elderly women with severe diabetes mellitus. Escherichia coli and Klebsiella pneumoniae are often isolated from urine cultures. Imaging methods, such as plain conventional abdominal radiography and computed tomography, are pivotal for obtaining a definitive diagnosis of EC. Most cases can be treated with a combination of antibiotics, bladder drainage and glycemic control. EC is potentially life-threatening, with a mortality rate of 7%. Early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention. In this review, we provide a comprehensive description of the clinical characteristics of EC. © 2014 The Japanese Society of Internal Medicine.

Ito K.,Kansai Rosai Hospital | Tsubamoto H.,Hyogo College of Medicine | Itani Y.,Nara Prefectural Nara Hospital | Kuroboshi H.,Kyoto Prefectural University of Medicine | And 3 more authors.
Gynecologic Oncology | Year: 2011

Objectives.: The optimal chemotherapy regimen for women with endometrial cancer has not been established. We assessed the feasibility, toxicity and clinical efficacy of combination triweekly carboplatin and weekly paclitaxel in women with endometrial cancer. Methods.: Eligible patients had histologically confirmed primary advanced or recurrent endometrial cancer (Group A), or had localized high-risk features (Group B). All were treated with paclitaxel 80 mg/m2 (days 1, 8 and 15) and carboplatin AUC 5 (day 1) each 21-day cycle. A minimum of 3 cycles was planned; if 75% or more of patients were able to receive at least 3 cycles with acceptable toxicity, the regimen was declared "feasible." Results.: Forty patients were enrolled and administered 163 cycles of therapy; 38 (95%) were chemo-naive. No patients received radiation previously. Group A (measurable disease) contained 15 patients (5 with recurrent disease, 7 receiving neo-adjuvant chemotherapy, and 3 treated adjuvantly following suboptimal cytoreduction). Group B (non-measurable disease) contained 25 patients (primary stage I:10, II:5, III:8, IV:1 and relapse 1). Hematological toxicities(G3/G4) were neutropenia (31%/33%) and thrombocytopenia (6%/0%). Reversible G3 hypersensitivity (5%) and G2 cardiotoxicity (3%) was uncommon. Thirty-one patients (78%) completed ≥ 3 cycles (median 4, range: 1-9). Thirteen of 15 (87%) measurable patients responded (3CR, 10PR). Eighty-seven percent of measurable patients were not progressive at 6 months. In Group A, QOL scores were significantly improved after 3 cycles of chemotherapy (p = 0.037), and at the completion of chemotherapy (p = 0.045). QOL scores in Group B did not change during therapy. Conclusions.: This combination chemotherapy is feasible and effective for endometrial cancer patients. © 2010 Elsevier Inc. All rights reserved.

Fujiwara K.,Nara Prefectural Nara Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 60-year-old man had a medical examination because of fever in the emergency hospital and had a diagnosis of pneumonia and was treated, but he was admitted to our hospital 2 days later because there was not the improvement of his symptom. The chest computed tomography(CT)image showed multilocular pleural effusions and lower lobe atelectasis with the air bronchogram on the left side. We diagnosed the case as empyema and inserted a catheter, but drainage was very few and injected 60,000 urokinase units for 3 days from the next day. We removed a drain 2 days after the 3rd infusion, and the pleural thickening became mild, and atelectasis was gradually improved in the chest CT image, and the inflammatory reaction was reduced, too. The intrathoracic washing with urokinase was thought to be effective for empyema with atelectasis.

Okuda M.,Ishinkai Yao General Hospital | Omokawa S.,Nara Medical University | Okahashi K.,Nara Prefectural Nara Hospital | Akahane M.,Nara Medical University | Tanaka Y.,Nara Medical University
Journal of Orthopaedic Science | Year: 2012

Background: A variety of outcome measures are available to evaluate physical impairment and disability in patients with knee osteoarthritis, and most physician-rated measures are not validated. The objective of this study was to assess the validity and reliability of an observer-based knee scoring system of the Japanese Orthopaedic Association (the JOA) commonly used in Japanese clinical practice, and to determine demographic variables affecting the score. Methods: A consecutive series of 85 patients with primary knee osteoarthritis completed the JOA (four domains pain on walking, pain on ascending or descending stairs, range of motion, and joint effusion), two validated patient-rated measures including the generic instrument of the Medical Outcomes Study 36-Item Short-Form (the SF-36) Health Survey, and the disease-specific scale of the Japanese Knee Osteoarthritis Measure (the JKOM), and a performance based timed-up-and-go test (TUG). Concurrent validity was determined by examining correlations of the JOA with the SF-36 and the JKOM. Construct validity was verified by correlating each domain of the JOA with objective measurements of TUG using Spearman's rank correlation coefficient. Intra- and interobserver reliability and internal consistency of the JOA were evaluated with another cohort of 32 patients who had a knee disorder at baseline and again at a mean of 18 days later. Results: The JOA was significantly correlated with validated patient-rated outcome measures (the JKOM, the SF-36), indicating concurrent validity of the JOA. Domains of the JOA had significant correlations with the TUG, showing adequate construct validity. Intra- and interobserver reliability for the JOA showed a moderate to almost perfect agreement, and internal consistency of Cronbach's α indicated that the JOA score was a highly reliable instrument to assess knee osteoarthritis. As a demographic variable, age was highly correlated with the JOA. Conclusions: The JOA, generally used as an observer-derived knee scoring system, is a valid and reliable tool for evaluating functional status in patients with knee osteoarthritis. © 2012 The Japanese Orthopaedic Association.

Takayama K.,Ishinkai Yao General Hospital | Taoka T.,Nara Medical University | Nakagawa H.,Nara Prefectural Nara Hospital | Myouchin K.,Ishinkai Yao General Hospital | And 6 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: Restenosis after CAS is a postoperative problem, with a reported frequency of approximately 2%-8%. However differences in stent design, procedure, and the anti-platelet agent appear to affect the incidence of restenosis. We assessed the frequency of restenosis and the effect of the antiplatelet agent CLZ in preventing restenosis after CAS by the standard procedure using the CWS. MATERIALS AND METHODS: Between May 2010 and October 2011, 62 lesions in 60 consecutive patients underwent CAS using the CWS at 4 medical institutions, and all patients were followed clinically and assessed by sonography, 3D-CTA, or angiography at 3 and 6 months postoperatively. Restenosis was defined as ≥50% stenosis. The incidence of restenosis and the variation in the incidence of restenosis by the difference in type of antiplatelet agent between the CLZ group (n = 30; aspirin, 100 mg, and CLZ, 200 mg) and the non-CLZ group (n = 32; aspirin, 100 mg, and clopidogrel, 75 mg [n = 29]; or ticlopidine, 100 mg [n = 2] or 200 mg [n = 1]) were retrospectively investigated. Two antiplatelet agents were given starting 1 week preoperatively until at least 3 months postoperatively. RESULTS: Restenosis occurred in 5 patients (8.3%), but all were cases of asymptomatic lesions in the follow-up period. All 5 patients with restenosis were in the non-CLZ group, with no cases of restenosis in the CLZ group; the difference was significant (P = .0239). CONCLUSIONS: The restenosis rate after CAS by using the CWS was 8.3%. CLZ was associated with significant inhibition of restenosis.

Minowa H.,Nara Prefectural NARA Hospital | Mima A.,Nara Prefectural NARA Hospital | Ikeda Y.,Nara Prefectural NARA Hospital | Yasuhara H.,Nara Prefectural NARA Hospital | And 2 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2014

Objective: To report the polygraphic findings of infants with respiratory inhibition after crying (RIAC). Methods: We screened for RIAC among infants with a gestational age ≥36 weeks using our established method with cranial ultrasonography, SpO2 monitoring and polygraphy. RIAC is defined as central apnea that occurred immediately after crying with a decrease in SpO2 to <60%, followed by repeated irregular respiration and apnea as the respiration gradually recovered. The subjects were infants with RIAC for whom we could study the polygraphic findings in detail. Results: Forty-seven RIAC cases were included in the present analysis. The frequency of RIAC was 2.1 (1.2-7.0) times per 24 h. The maximum duration of respiratory inhibition was 78.0 (52.6-109.0) s. The maximum duration of SpO2 <60% during RIAC was 39.0 (9.8-93.2) s. The minimum SpO2 value during RIAC was 53.0% (42.2-58.0%). The minimum heart rate during RIAC was 103.0 (79.1-127.1) bpm. Conclusions: RIAC is observed among healthy infants, and they experience repeated prolonged hypoxemia. © 2014 Informa UK Ltd. All rights reserved.

Nishiwaki T.,Nara Prefectural Nara Hospital | Sawa N.,Nara Prefectural Nara Hospital | Kikui S.,Nara Prefectural Nara Hospital
Brain and Nerve | Year: 2011

A 72-year-old man with subacute right upper limb palsy was diagnosed with cerebral infarction at another hospital. However, the head magnetic resonance imaging (MRI) scans showed no abnormalities. He was later transferred to our hospital because of cognitive dysfunctions. Because his symptoms had gradually worsened, a second head MRI was performed on admission. The scans showed an abnormality in the left frontal-parietal lobe, and the serum measles IgM level was elevated. Measles encephalitis was consequently diagnosed and steroid pulse therapy was immediately initiated. The patient recovered with no limb palsy or cognitive dysfunctions. With widespread administration of the measles vaccine, we expect that the incidence of modified measles will increase in the future. Hence the serum titer of the measles virus should be measured when patients with subacute meningoencephalitis of unclear origin are identitied.

PubMed | Nara Prefectural Nara Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

e15560 Background: To compare the size of lymph nodes (LNs) of para-aortic or pelvic area between metastatic and non-metastatic LNs retrospectively in pathologically confirmed lymph node positive gynecologic malignancy.The lengths of major axis and thickness of all dissected LNs were measured by gage on specimen slides in pathologically confirmed LN positive (LN+) 18 gynecologic malignant patients. Student t test was used for statistically analysis.The size of 821 LNs, 196 para-arotic LNs (PAN) and 625 pelvic LNs (PN) were measured from 8 of cervical cancer, 5 of endometrial cancer, and 5 of ovarian cancer. The median number of dissected LNs was 44 (ranged 16 to 97) per case. Twenty-seven PAN (PAN+) and 62 PN (PN+) were ascertained with metastasis of primary cancer. Median major axis and thickness of LN+ were 9.7mm (95% confidential interval (CI); 9.0, 10.5) and 5.4mm (95%CI; 5.0, 5.8) and median those of non-metastasized LN (LN-) were 4.2mm (95%CI; 3.9, 4.4) and 2.2mm (95%CI; 2.1, 2.4). There were statistically differences between the two groups (p<0.0001). In subgroup analysis, median major axis (8.5mm [95%CI; 7.2, 9.7]) and thickness (4.8mm [95%CI; 4.2, 5.5]) of PAN+ were statistically larger (p<0.0001) than those (3.9mm [95%CI; 3.4, 4 .4] and 2.3 mm [95%CI; 2.0, 2.6]) of PAN-. And also, median major axis (10.3mm [95%CI; 9.3, 11.2]) and thickness (5.7mm [95%CI; 5.2, 6.2]) of PN+ were statistically larger (p<0.0001) than those (4.2mm [95%CI; 3.9 4.5] and 2.2 mm [95%CI; 2.1, 2.4]) of PN-.The size of metastatic LNs increases in both major axis and thickness. If we could detect 7.2 mm in major axis or 4.2 mm in thickness of PAN or 9.3 mm in major axis or 5.2 mm in thickness of PN, it would be possible to skip lymphadenectomy of para-aortic or pelvic area with 95%CI by pre- or intra-surgical evaluation.

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