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Tanaka N.,Keio University | Miyajima A.,Keio University | Kikuchi E.,Keio University | Matsumoto K.,Keio University | And 6 more authors.
British Journal of Cancer | Year: 2012

Background: The potential role of the renin-angiotensin system (RAS) in the promotion of tumour growth has been investigated, and the administration of RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), may improve disease control in malignancy. We investigated the prognostic impact of RAS inhibitors by analysing data from patients with upper-tract urothelial carcinoma (UTUC). Methods: A total of 279 patients who underwent nephroureterectomy for localised UTUC (pTa-3N0M0) were identified at our three institutions. We retrospectively investigated the prognostic outcomes following nephroureterectomy in patients administered or not administered ACEIs or ARBs. Results: The median follow-up period was 3.4 years. RAS inhibitors were administered to 48 patients (17.2%). Multivariate analysis showed that the appearance of pathological T3, positive lymphovascular invasion, and no RAS inhibitor administration (P=0.027 HR=3.14) were independent risk factors for a decrease in subsequent metastasis-free survival. The 5-year metastasis-free survival rate was 93.0% in patients who administered RAS inhibitors, and 72.8% in their counterparts who did not (P=0.008). Conclusion: The absence of RAS inhibitor administration was an independent risk factor for subsequent tumour metastasis in patients with localised UTUC. We propose RAS inhibitors may be a potent choice as an effective treatment following nephroureterectomy. © 2012 Cancer Research UK All rights reserved.


Tomio R.,Saitama Municipal Hospital | Akiyama T.,Keio University | Shibao S.,Keio University | Yoshida K.,Keio University
Surgical Infections | Year: 2013

Background: Procalcitonin (PCT) has been considered a more reliable marker than others because of its specificity for bacterial infection. Methods: Case report and review of the literature. Results: A 50-year-old male was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage. We performed a ruptured aneurysm clipping and left unilateral external ventricular drainage. We also performed ventriculoperitoneal (VP) shunt placement in the course; however, VP shunt infection was indicated by fever, increased C-reactive protein concentration and leukocytosis. The cerebrospinal fluid culture showed methicillin-resistant Staphylococcus epidermidis but the serum PCT concentration was quite low. Conclusions: Although PCT is considered a more reliable serological marker of bacterial meningitis in several reports, the serum PCT concentration did not reflect the bacterial VP shunt infection that was present in our case. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Seki M.,Keio University | Takahashi K.,Keio University | Koto A.,Yomiuri Land Keiyu Hospital | Mihara B.,Mihara Memorial Hospital | And 11 more authors.
Movement Disorders | Year: 2011

Objective: The aim of this work was to investigate the prevalence of camptocormia and the clinical characteristics of patients with camptocormia in a large population of PD patients. Background: Although camptocormia has been recognized as a prominent phenomenon in PD, the previous epidemiological reports were limited, especially in terms of sample size. Methods:: We evaluated 531 PD patients (disease duration: 7.0 ± 5.5 years, mean ± standard deviation). We examined their clinical features and the prevalence of camptocormia. Results: Camptocormia was detected in 22 patients (4.1%) and found in patients who were older and had more severe motor symptoms and a higher levodopa (L-dopa) dose (P < 0.05), compared to the patients without camptocormia. Patients with camptocormia showed significantly higher frequencies of autonomic symptoms, such as constipation and urinary incontinence (P < 0.05). Conclusions: Camptocormia is uncommon in PD and is associated with disease severity, higher L-dopa dose and higher frequencies of autonomic symptoms. © 2011 Movement Disorder Society.


Nihei Y.,Keio University | Takahashi K.,Keio University | Koto A.,Yomiuri Land Keiyu Hospital | Mihara B.,Mihara Memorial Hospital | And 11 more authors.
Journal of Neurology | Year: 2012

REM sleep behavior disorder (RBD) is known to be observed more frequently in patients with an a-synucleinopathy such as Parkinson's disease (PD) than in the general population. The precise prevalence of RBD in Japanese PD patients is not known. Therefore, we investigated the prevalence and the clinical characteristics of patients with RBD in a large population of Japanese patients with PD. We investigated various clinical features and employed the Japanese version of the RBD screening questionnaire on 469 non-demented Japanese PD patients in this multicenter study. Probable or possible RBD was detected in 146 patients (31.1%) and was significantly associated with longer PD duration, higher Hoehn and Yahr stage, higher Unified Parkinson's Disease Rating Scale part III subscale (7 items), more motor fluctuations, and a higher levodopa-equivalent daily dose (p<0.01). As to the major autonomic dysfunctions, severe constipation was significantly more frequent in PD patients with RBD than in those without it (p<0.01). The RBD symptoms of 53 patients (39.0%) preceded the onset of PD motor symptoms. The median interval from the onset of RBD symptoms to PD motor symptoms was 17.5 years, and 3 patients had intervals of over 50 years. This large-scale multicenter study revealed that RBD is a frequent nonmotor symptom in Japanese patients with PD, which may precede the onset of motor symptoms. Moreover, RBD that increases with the duration and severity of PD may be associated with autonomic dysfunction. © Springer-Verlag 2012.


Matsumoto K.,Tokyo Saiseikai Central Hospital | Tanaka N.,Saitama Municipal Hospital | Hayakawa N.,Tokyo Saiseikai Central Hospital | Ezaki T.,Tokyo Saiseikai Central Hospital | And 4 more authors.
Medical Oncology | Year: 2013

This retrospective chart review study was conducted to evaluate the efficacy of estramustine phosphate sodium hydrate (EMP) monotherapy in patients with castration-resistant prostate cancer (CRPC) and to determine who would benefit from EMP therapy. EMP was administered at a daily dose of 560 mg to 102 patients as a third-line therapy, who had already received combined androgen blockade (CAB) and subsequent alternative antiandrogen therapy. The responses to EMP after its induction and its toxicity were evaluated. We also analyzed the association between the clinicopathological factors of the patients and their responses to EMP therapy. A reduction in the serum prostate-specific antigen (PSA) 4 weeks after induction was observed in 70 patients (68.6 %), while 30 cases (29.4 %) achieved more than 50 % reduction of PSA. Long-term reduction of PSA from baseline for more than 6 months was observed in 31 patients (30.4 %). EMP treatment was discontinued in 11 patients (10.8 %) because of side effects (nausea in six patients, gynecomastia in three patients, eruption in one patient, and liver dysfunction in one patient). Multivariate analysis demonstrated that long duration of prior hormonal therapy was an independent favorable factor for reduced PSA levels, long responses, and overall survival. The data suggest that oral EMP administration as a third-line monotherapy is well tolerated and effective to some degree in patients with CRPC who have already received CAB and subsequent alternative antiandrogen therapy. Thus, EMP can be regarded as one treatment option, especially for patients whose prior duration of hormonal therapy was long. © 2013 Springer Science+Business Media New York.

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