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Mao T.-L.,National Taiwan University Hospital | Ardighieri L.,Johns Hopkins Medical Institutions | Ayhan A.,Seirei Mikatahara General Hospital | Kuo K.-T.,National Taiwan University Hospital | And 3 more authors.
American Journal of Surgical Pathology | Year: 2013

ARID1A is a recently identified tumor suppressor that functions in chromatin remodeling. Inactivating mutations of ARID1A and loss of its expression most frequently occur in ovarian clear cell carcinoma, ovarian endometrioid carcinoma, and uterine endometrioid carcinoma. In this study, we performed a detailed immunostaining analysis of ARID1A in 246 cases including benign endometrium and endometrioid carcinoma at different stages of progression. Special attention was paid to recording intratumoral heterogeneity of clonal loss of ARID1A immunoreactivity. All normal endometria (n=51) and endometrial polyps (n=14) retained ARID1A expression. Among complex atypical hyperplasias (n=38), 16% exhibited clonal loss of ARID1A, but none showed complete loss. Among low-grade endometrioid carcinomas (n=88), 25% exhibited complete loss and 24% exhibited clonal loss. In contrast, 44% of high-grade endometrioid carcinomas (n=55) showed complete loss of ARID1A, and 9% exhibited clonal loss. We found that 19 high-grade carcinomas also contained concurrent low-grade carcinomas. In the high-grade areas, 63% exhibited complete loss and 11% exhibited clonal loss, whereas in the low-grade areas, 37% exhibited complete loss and 42% clonal loss. In 5 of these 19 cases, progressive loss of ARID1A from retention or clonal loss to complete loss was observed between the low-grade and high-grade areas. Overall, the percentage of complete ARID1A loss increased from 0% in complex atypical hyperplasia, to 25% in low-grade endometrioid carcinoma, to 44% in high-grade endometrioid carcinoma. These findings suggest that loss of ARID1A expression, presumably due to mutation, plays an important role in tumor progression of uterine endometrioid carcinoma. Copyright © 2013 by Lippincott Williams & Wilkins.


Kaneishi K.,Tokyo Kosei Nenkin Hospital | Kawabata M.,Tokyo Kosei Nenkin Hospital | Morita T.,Palliative Care Team | Morita T.,Seirei Mikatahara General Hospital
Journal of Pain and Symptom Management | Year: 2012

Bowel obstruction is one of the most common complications in patients with advanced cancer. Incomplete bowel obstruction is one of the leading causes of nausea and vomiting, which may result in a substantial impairment to quality of life. We explored the antiemetic activity of olanzapine against nausea and vomiting in cancer patients with incomplete bowel obstruction. This retrospective study was carried out on a palliative care unit, using an electronic medical record from 2007 to 2009. The intensity of the symptom was evaluated and classified from the medical records on four scales. The frequency of vomiting also was noted from the medical records. During this study period, 20 patients met the inclusion criteria. The average dose of olanzapine was 4.9 ± 1.2 mg and treatment duration was 23.4 ± 16.2 days. Olanzapine treatment led to a significant decrease in the average intensity score of nausea from 2.4 ± 0.7 to 0.2 ± 0.4 (P < 0.001). Of the 20 patients, 18 (90%) experienced a reduction in the intensity of nausea. The average frequency of vomiting significantly decreased after olanzapine treatment from 1.1 ± 1.3 times/day (median 0.5; range 0-4) before the treatment to 0.3 ± 0.5 times/day (median 0; range 0-1) after the treatment (P < 0.01). Before the treatment, 10 patients experienced vomiting; eight of these patients experienced a decrease in the frequency of vomiting with olanzapine treatment. Our study suggests the potential efficacy of olanzapine for relief of nausea in incomplete bowel obstruction. A prospective trial is promising. © 2012 U.S. Cancer Pain Relief Committee.


Matsuda T.,Seirei Mikatahara General Hospital
Asian journal of endoscopic surgery | Year: 2013

Until now, no data have been available on the incidence of chylous ascites after laparoscopic colorectal surgery. From January 2007 to December 2011, 137 patients with colorectal cancer underwent laparoscopic surgery at our institution. The clinical data of the patients with postoperative chylous ascites were compared with those of the patients without chylous ascites. Chylous ascites developed in 9 of the 137 patients (6.5%). Blood loss, operative time, tumor location, and extent of lymph node dissection were not associated with postoperative chylous ascites. Mean postoperative hospital stay for patients with chylous ascites was significantly longer than that for patients without any complications (14 days vs 10 days; P < 0.001). Recurrence was observed in two of the nine patients with chylous ascites; it developed locally and in the liver in one patient, and peritoneal dissemination was seen in the other. The recurrence rate in the chylous ascites group (22.2%) was significantly higher than that in the non-chylous ascites group (3.9%; P = 0.016). The 3-year disease-free survival in the chylous ascites group (76.2%) was significantly lower than that in the non-chylous ascites group (93.4%; P = 0.020); however, the 3-year overall survival rates did not differ between the groups (87.5% vs 94.4%, respectively; P = 0.332). Chylous ascites are not a rare complication of laparoscopic colorectal surgery. It was managed conservatively in all cases but was associated with longer hospital stays. We recommend careful tissue dissection at a suitable plane and meticulous clipping during lymphadenectomy to prevent chyle leakage when lymphatic invasion is suspected. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.


Arai M.,Seirei Mikatahara General Hospital
Neuroendocrinology Letters | Year: 2011

OBJECTIVE: Several cases of syndrome of inappropriate antidiuresis induced by antiparkinson agents have been previously reported. However, the effect of antiparkinson agents on plasma arginine vasopressin (AVP) levels remains unknown in Parkinsons disease (PD) patients. The aim of the present study is to determine plasma AVP levels in PD patients and the effects of antiparkinson agents on these levels. METHODS: PD patients who visited our clinic between November 2008 and September 2009 were included in this study. Patients were excluded if they had at least one condition that could be associated with high AVP levels. PD patients who had been treated with antiparkinson agents participated in this study (treated PD group, n=76). De novo PD patients were also included (n=25). RESULTS: Mean plasma AVP levels were significantly higher in treated PD patients than those in treatment-naïve patients. Neither disease severity nor L-dopa dosage correlated with plasma AVP levels. Multiple linear regression analysis identified the male gender and pergolide dosage as weak independent predictors of high plasma AVP levels. While no difference in plasma AVP levels between genders in treatment-naive patients was observed, mean plasma AVP levels were significantly higher in male patients than in female patients administered antiparkinson agents. Mean plasma AVP levels in pergolide users were significantly higher than those in dopamine agonist nonusers with corresponding disease duration and L-dopa/carbidopa dosage. In some patients, plasma AVP levels appeared to be dependent on pramipexole dosage. CONCLUSION: Dopamine agonists may cause increased plasma AVP levels in some PD patients. ©2011 Neuroendocrinology Letters.


Arai M.,Seirei Mikatahara General Hospital | Osaka H.,Kanagawa Childrens Medical Center
Epilepsia | Year: 2011

A 19-year-old university student with no personal or family history of neurologic disorders developed convulsions and was administered phenytoin. Two months later, he developed lower limb-dominant acute demyelinating polyneuropathy, from which he recovered within 2 months. At age 20, he rapidly developed visual disturbances and paraplegia from phenytoin intoxication. Cranial magnetic resonance imaging (MRI) revealed leukoencephalopathy with no evidence of thrombosis or vasoconstriction. Hyperhomocysteinemia, hypomethioninemia, low serum folate concentration, and an absence of megaloblastic anemia were consistent with the diagnosis of methylenetetrahydrofolate reductase (MTHFR) deficiency. A genomic DNA sequence analysis demonstrated compound heterozygosity for two missense mutations in the MTHFR gene, namely, [458G>T + 459C>T] (Gly149Val) and 358G>A (Ala116Thr), both of which are known pathogenic mutations. An absence of leukoencephalopathic changes on MRI scans performed 9 months previously strongly suggested that phenytoin intoxication caused acute leukoencephalopathy. Therefore, phenytoin may be an aggravating factor of remethylation defects in patients with MTHFR deficiency. © 2011 International League Against Epilepsy.


Nakamura T.,Seirei Mikatahara General Hospital | Nakamura T.,Tokyo Medical and Dental University | Fujishima I.,Hamamatsu City Rehabilitation Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

In Japan, ice massage is widely used as the prefeeding technique to facilitate dry swallowing, to improve swallowing apraxia for initiating the swallowing action, and in daily swallowing training. In a crossover study, we evaluated the usefulness of ice massage for eliciting the swallowing response. The subjects were 24 dysphagic patients with stroke and cerebrovascular disease. We measured the latency between the command of dry swallowing and the triggering of the swallow reflex by videofluoroscopic examination of swallowing, with and without ice massage. When a subject could not swallow all the 4 trials we recorded whether he or she could swallow or not. And we counted how many times he or she could swallow with and without ice massage. Our results suggest that ice massage significantly shortened the latency to triggering of the swallow reflex and often initiated swallowing even in those subjects who could not swallow without the massage. These results demonstrate that ice massage has an immediate effect on triggering of the swallow reflex. The effect of ice massage was especially remarkable in the 15 subjects who had supranuclear lesions compared with the subjects with nuclear lesions. Thus, ice massage could activate the damaged supranuclear tract and/or the normal nucleus and subnuclear tract for swallowing. Ice massage has proven useful in many clinical dysphagia training sessions. © 2013 by National Stroke Association.


Ando M.,St. Mary's College | Morita T.,Seirei Mikatahara General Hospital | Akechi T.,Nagoya City University | Okamoto T.,Toya Onsen Hospital
Journal of Pain and Symptom Management | Year: 2010

Context: There is a little information about effective psychotherapies to enhance the spiritual well-being of terminally ill cancer patients. Objectives: The primary aim of the study was to examine the efficacy of a one-week Short-Term Life Review for the enhancement of spiritual well-being, using a randomized controlled trial. The secondary aim was to assess the effect of this therapy on anxiety and depression, suffering, and elements of a good death. Methods: The subjects were 68 terminally ill cancer patients randomly allocated to a Short-Term Life-Review interview group or a control group. The patients completed questionnaires pre- and post-treatment, including the meaning of life domain from the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) scale, the Hospital Anxiety and Depression Scale (HADS), a numeric scale for psychological suffering, and items from the Good Death Inventory (Hope, Burden, Life Completion, and Preparation). Results: The FACIT-Sp, Hope, Life Completion, and Preparation scores in the intervention group showed significantly greater improvement compared with those of the control group (FACIT-Sp, P < 0.001; Hope, P < 0.001; Life Completion, P < 0.001; and Preparation, P < 0.001). HADS, Burden, and Suffering scores in the intervention group also had suggested greater alleviation of suffering compared with the control group (HADS, P < 0.001; Burden, P < 0.007; Suffering, P < 0.001). Conclusion: We conclude that the Short-Term Life Review is effective in improving the spiritual well-being of terminally ill cancer patients, and alleviating psychosocial distress and promoting a good death. © 2010 U.S. Cancer Pain Relief Committee.


Morita T.,Seirei Mikatahara General Hospital | Kizawa Y.,University of Tsukuba
Current Opinion in Supportive and Palliative Care | Year: 2013

Purpose of review Providing palliative care in Japan is one of the most important health issues. Understanding palliative care delivery systems of other countries is useful when developing and modifying palliative care systems worldwide. This review summarizes the current status of palliative care in Japan, focusing on the structure and process development. Recent findings Palliative care units and hospital palliative care consultation teams are the two main specialized palliative care services in Japan. The number of palliative care units is 215 (involved in 8.4% of all cancer deaths), and there are approximately 500 hospital palliative care teams. Conversely, specialized home care services are one of the most undeveloped areas in Japan. However, the government has been trying to develop more efficient home care services through modifying laws, healthcare systems, and multiple educational and cooperative projects. The numbers of palliative care specialists are increasing across all disciplines: cancer pain nurses (1365), palliative care nurses (1100), palliative care physicians (646), and palliative care pharmacists (238). Postgraduate education for physicians is performed via the special nationwide efforts of the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) project - a 2-day program adopting a trainer-trainee strategy. Over 30 000 physicians have participated in the PEACE program. A total of 1298 and 544 physicians have completed a trainer course for palliative medicine and psycho-oncology, respectively. Multiple structure and process evaluation, bereaved family surveys in palliative care units, and patient and family evaluation in the regional palliative care program indicate many improvements. Summary Palliative care in Japan has progressed rapidly, and the Cancer Control Act has played a very important role in developing palliative medicine. Challenges include developing a structure for palliative care in the community or regional palliative care programs, establishing a method to measure and improve the quality of palliative care at a national level, developing evidence-based medicine and policy making, and palliative care for the noncancerous population. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Matsuda T.,Seirei Mikatahara General Hospital
Asian journal of endoscopic surgery | Year: 2013

The feasibility, safety and oncological outcomes of laparoscopic surgery for transverse and descending colon cancers in a community hospital setting were evaluated. Twenty-six patients with transverse or descending colon cancers who underwent laparoscopic surgery at our hospital were included in this retrospective analysis (group A). Their outcomes were compared with those of 71 patients who underwent laparoscopic surgery for colon cancer at other tumor sites (group B). There were no significant differences between the two groups in terms of operative time, estimated blood loss, postoperative hospital stay and morbidity rate. Extended lymphadenectomy was performed more frequently and the number of harvested lymph nodes was significantly higher in group B than in group A. However, no recurrence developed in group A, while recurrence occurred in four patients from group B. The 3-year disease-free survival rates were 100% for group A and 93.5% for group B. The 3-year overall survival rates were 100% for group A and 91.6% for group B. Laparoscopic surgery for transverse and descending colon cancers can be performed safely with oncological validity in a community hospital setting, provided there is careful selection of the patients and adequate lymphadenectomy considering the clinical stage of their disease. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.


Morita T.,Seirei Mikatahara General Hospital | Miyashita M.,Tohoku University | Yamagishi A.,Keio University | Akiyama M.,Keio University | And 8 more authors.
The Lancet Oncology | Year: 2013

Background: Improvement of palliative care is an important public health issue, but knowledge about how to deliver palliative care throughout a region remains inadequate. We used surveys and in-depth interviews to assess changes in the quality of palliative care after regional interventions and to gain insights for improvement of palliative care at a regional level. Methods: In this mixed-methods study, a comprehensive programme of interventions for regional palliative care for patients with cancer was implemented from April 1, 2008, to March 31, 2011 in Tsuruoka, Kashiwa, Hamamatsu, and Nagasaki in Japan. Interventions included education, specialist support, and networking. We surveyed patients, bereaved family members, physicians, and nurses before and after the interventions were introduced. We also did qualitative interviews with health-care professionals after the interventions were introduced. Primary endpoints were numbers of home deaths, coverage of specialist services, and patient-reported and family-reported qualities of care. This trial is registered with UMIN Clinical Trial Registry, Japan (UMIN000001274). Findings: 859 patients, 1110 bereaved family members, 911 physicians, and 2378 nurses provided analysable preintervention surveys; 857 patients, 1137 bereaved family members, 706 physicians, and 2236 nurses provided analysable postintervention surveys. Proportions of home deaths increased significantly, from 348 of 5147 (6·76%) before the intervention programme to 581 of 5546 (10·48%) after the intervention programme (p<0·0001). Furthermore, 194 of 221 (87·78%) family members of patients who died at home answered that these patients had wanted to die at home. The ratio of patients who received palliative care services to all patients who died of cancer increased significantly (from 0·31 to 0·50; p<0·0001). The patient-reported (effect size 0·14; adjusted p=0·0027) and family-reported (0·23; p<0·0001) qualities of care were significantly better after interventions than before interventions. Physician-reported and nurse-reported difficulties decreased significantly after the introduction of the interventions. Qualitative interviews showed improved communication and cooperation between health-care professionals because of greater opportunities for interactions at various levels. Interpretation: A regional programme of interventions could improve the quality of palliative care. Improvement of communication between health-care professionals is key to improvement of services. Funding: Third Term Comprehensive Control Research for Cancer Health and Labor Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan. © 2013 Elsevier Ltd.

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