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Tsubamoto H.,Hyogo College of Medicine | Sonoda T.,Kohnan Hospital | Yamasaki M.,Shinko Hospital | Inoue K.,Meiwa General Hospital
Anticancer Research | Year: 2014

Background: After progression during chemotherapy, persistent ovarian cancer rarely responds to cytotoxic agents. We evaluated the use of adjunctive itraconazole for treating refractory ovarian cancer. Patients and Methods: Medical records of patients with ovarian cancer were retrospectively reviewed to select those with a history of platinum and taxane administration, clinical progression within six months of the last platinum administration, continuation of chemotherapy after the first progression during chemotherapy. Results: Among 55 patients, itraconazole in combination with chemotherapy was administered to 19 patients. The median progressionfree survival (PFS) was 103 days and 53 days for chemotherapy with and without itraconazole, respectively (p=0.014). The corresponding median overall survival was 642 days and 139 days, respectively (p=0.006). The hazard ratio for PFS was 0.24 (p=0.002) and for overall survival was 0.27 (p=0.006) for therapy with itraconazole. Conclusion: Adjunctive itraconazole is promising for patients with refractory ovarian cancer.

Tsubamoto H.,Hyogo College of Medicine | Sonoda T.,Kohnan Hospital | Yamasaki M.,Shinko Hospital | Inoue K.,Meiwa General Hospital
Anticancer Research | Year: 2014

Background: Recurrent ovarian clear cell carcinoma (CCC) rarely responds to cytotoxic agents. Itraconazole is a potent inhibitor of the P-glycoprotein efflux pump, angiogenesis, and the Hedgehog pathway. We evaluated the efficacy of chemotherapy with itraconazole for CCC. Patients and Methods: Medical charts of patients with CCC who had received chemotherapy with itraconazole were retrospectively reviewed. Results: Among nine patients with CCC, five had a history of progression with paclitaxel and carboplatin, and none had received prior treatment with bevacizumab or other targeted therapy. Eight patients received docetaxel (35 mg/m2, day 1) and carboplatin-based (area under the curve, 4 mg·; min-1· mL-1; day 1) chemotherapy with an oral itraconazole solution (400 mg, days -2 to 2), repeated every two weeks. The response rate, median progression-free survival and overall survival were 44% (95% confidence interval [(CI)=12-77%], 544 days (95% CI=82-544 days) and 1,047 days (95% CI=462-1332 days), respectively. Conclusion: Chemotherapy with itraconazole is promising for patients with CCC.

Sakane-Ishikawa E.,Shinko Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2013

We report a patient with aggressive systemic mastocytosis (SM), who exhibited eosinophilia and unusual destructive bone lesions. A 43-year-old female was referred to our hospital because of a vertebral compression fracture, multiple lytic bone lesions, and eosinophilia in February 2011. A diagnosis of aggressive SM was made on the basis of abnormal mast cells in the bone marrow, high serum tryptase levels, and multiple lytic bone lesions including vertebral compression fractures. Polymerase chain reaction and subsequent sequencing of its products to identify mutations of c-kit yielded negative results and imatinib mesylate failed to improve the SM of the patient. She was then treated with interferon-α, with considerable improvement of the disease, although severe myelosuppression prevented the continued administration of a sufficient dose of this agent. In August 2011, the patient suddenly developed paraplegia of the lower extremities. Magnetic resonance imaging demonstrated epidural mass lesions at the levels from Th9 to Th11, compressing the spinal cord. Emergent laminectomy and subsequent irradiation of the tumors were performed without improvement of the paraplegia. Histopathologic examination of the epidural tumors, from samples obtained intraoperatively, confirmed the diagnosis of SM. She was further treated with dasatinib and then cladribine without obvious improvement, although the latter reduced the eosinophilia to some extent ; however, she died of sepsis in September 2011.

Hayashi N.,Shinko Hospital
Rinsho byori. The Japanese journal of clinical pathology | Year: 2010

Rheumatoid arthritis (RA) is a severe, progressive, systemic inflammatory disease of unknown etiology. Early diagnosis of RA is important to identify individuals who will develop severe destructive disease, so that effective treatment can be initiated before irreversible damage occurs. Rheumatoid factor (RF) has been commonly used as a serological marker for RA, although RF had a tolerable sensitivity of 75.9% for RA, but low specificity of 78.7% and 75.4% for patients with other rheumatic diseases and chronic inflammatory disease, respectively. Antibodies to citrullinated protein/peptide antigens, i.e., to peptides post-translationally modified by the conversion of arginine to cilrulline (ACPA), are specific serological markers for RA. Not only did anti-cyclic citrullinated peptide antibody (anti-CCP) demonstrate a higher sensitivity of 78.5% when compared to RF, but anti-CCP also had a much higher specificity of 95.9% and 97.9% for other rheumatic diseases and chronic inflammatory disease patients, respectively. Moreover, meta-analysis revealed that pooled sensitivity and pooled specificity were 67% and 95% for anti-CCP, 69% and 85% for RF, respectively, and that anti-CCP was more specific than RF for diagnosing RA. In 2009, ACPA (anti-CCP) was included in the new Criteria for RA from the American College of Rheumatology and the European League Against Rheumatism. Anti-CCP testing is particularly useful in the diagnosis of RA, being present early in the disease process, and able to predict severe disease and irreversible damage. In addition, the titers might be early predictors of the efficacy of anti-TNF therapy. In this review, we discuss the historical background of anti-CCP as well as its diagnostic performance, usefulness for early diagnosis, prognostic capability, and pathogenesis of RA.

Tsunemine H.,Shinko Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2013

A 47-year-old man was diagnosed with Philadelphia chromosome-positive chronic myeloid leukemia (CML) in October 2005. He could not receive treatment with imatinib mesylate due to his economic circumstances. He was consequently treated with hydroxyurea with partial hematological remission until June 2008. Although imatinib mesylate was started thereafter, the adherence to this treatment was poor because of his occupational circumstances. In September 2009, imatinib mesylate was switched to nilotinib, with a subsequent phase of acceleration of the disease, presumably due to his poor adherence to the treatment. Dasatinib was started in September 2010, with transient hematological response and final blastic crisis of the disease in January 2011, regardless of improved adherence. Blast cells showed immature monocytic morphology and were positive for α-naphtylbutyrate esterase staining. They also expressed surface CD14 and CD64 antigens. A diagnosis of rare monocytic crisis of CML was made. He was treated with low-dose nilotinib following cytoreduction with MEC (mitoxantrone, etoposide, and cytarabine) chemotherapy. Severe leucopenia without circulating leukemic cells continued for about 2 months with sustained hepatosplenomegaly, and he died of pneumonia in March 2012. Necropsy showed severe bone marrow hypoplasia with focal infiltration of mature leukemic cells and similar infiltration in the liver.

Akasaka H.,Shinko Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2012

A 68-year-old female with palmoplantar pustulosis was referred to our hospital in July, 2009 because of liver dysfunction, a positive test for HTLV-1, and circulating abnormal lymphocytes with irregularly shaped nuclei. A diagnosis of acute type adult T cell leukemia/lymphoma (ATLL) was made based on generalized lymph node swelling and high levels of serum LDH, in addition to the findings described above. The associated palmoplantar pustulosis responded to some extent to antibiotics, steroid ointment, and narrow band UBV light irradiation. For ATLL, she was serially treated with CHOP chemotherapy, an LSG 15 protocol, and CytaBOM protocol with consequent partial remission. These chemotherapies did not affect the palmoplantar pustulosis. For ATLL in partial remission, we performed allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from a related donor (HTLV-1-negative) with a conditioning regimen consisting of fludarabine, melphalan, and total body irradiation with 3 Gy in February, 2010. After the engraftment of donor hematopoietic cells, ATLL cells disappeared and the patient currently (as of April, 2012) remains in complete remission (CR). The residual palmoplantar pustulosis was further improved soon after allo-PBSCT and disappeared on Day 84 after transplantation. This refractory skin disease has also been in CR to date.

Shigemura K.,Shinko Hospital | Motoyama S.,Shinko Hospital | Yamashita M.,Shinko Hospital
Urologia Internationalis | Year: 2012

Background: The comparison of systematic prostate biopsies (PBx) with PBx including additional cores based on magnetic resonance imaging (MRI) of lesions suspicious for prostate cancer (PCa) has been controversial. This study focuses on additional cores based on MRI findings for better cancer detection. Methods: Data were collected from 491 men who underwent transrectal ultrasound-guided PBx: a 12-core PBx (group 1: 395 cases) and a 12-core PBx plus 1-3 additional cores based on MRI (group 2: 96 cases). Comparison of two groups revealed how the additional cores taken with MRI findings affected PCa detection. Results: Group 1 had 205 cases (51.9%) and group 2 had 55 cases (57.3%) of PCa detected. This difference was not statistically significant (p = 0.3444). Only 1 of the 55 patients (1.82%) in group 2 had cancer only in the additional cores based on MRI. In other words, only 1/96 (1.04%) patients was diagnosed with PCa only by the additional core PBx. Conclusions: We suggest that systematic 12-core PBx (sextant peripheral zone + 4 transitional zone + 2 far lateral peripheral zone) can be considered an excellent tool for PCa detection and there may be no need for additional cores based on MRI findings for PCa detection. © 2012 S. Karger AG, Basel.

Yuen K.,Shinko Hospital | Miura T.,Shinko Hospital | Sakai I.,Shinko Hospital | Kiyosue A.,Shinko Hospital | Yamashita M.,Shinko Hospital
Journal of Urology | Year: 2015

Purpose We investigated the feasibility and validity of intraoperative fluorescence imaging using indocyanine green for the detection of sentinel lymph nodes and lymphatic vessels during open prostatectomy. Materials and Methods Indocyanine green was injected into the prostate under transrectal ultrasound guidance just before surgery. Intraoperative fluorescence imaging was performed using a near-infrared camera system in 66 consecutive patients with clinically localized prostate cancer after a 10-patient pilot test to optimize indocyanine green dosing, observation timing and injection method. Lymphatic vessels were visualized and followed to identify the sentinel lymph nodes. Confirmatory pelvic lymph node dissection including all fluorescent nodes and open radical prostatectomy were performed in all patients. Results Lymphatic vessels were successfully visualized in 65 patients (98%) and sentinel lymph nodes in 64 patients (97%). Sentinel lymph nodes were located in the obturator fossa, internal and external iliac regions, and rarely in the common iliac and presacral regions. A median of 4 sentinel lymph nodes per patient was detected. Three lymphatic pathways, the paravesical, internal and lateral routes, were identified. Pathological examination revealed metastases to 9 sentinel lymph nodes in 6 patients (9%). All pathologically positive lymph nodes were detected as sentinel lymph nodes using this imaging. No adverse reactions due to the use of indocyanine green were observed. Conclusions Intraoperative fluorescence imaging using indocyanine green during open prostatectomy enables the detection of lymphatic vessels and sentinel lymph nodes with high sensitivity. This novel method is technically feasible, safe and easy to apply with minimal additional operative time. © 2015 American Urological Association Education and Research, Inc.

Kubota H.,Shinko Hospital
Japanese Journal of Clinical Radiology | Year: 2015

Central venous (CV) catheterization can be lifesaving but is associated with considerable complication rates. Most complications are minor, but some of these can be fatal. In this article, we review various complications related to CV catheterization and access port implantation, and discuss how to avoid and treat the complications.

Fukumitsu K.,Shinko Hospital
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2012

A 30-year-old woman was admitted to our hospital with high fever and chest pain. She had a ventricular septal defect, but was asymptomatic and had not undergone surgical repair. She also had had atopic dermatitis since childhood that had not been adequately treated. Chest computed tomography showed multiple peripheral nodules and infiltrates in both lungs. A transthoracic echocardiogram detected vegetation on the wall of the right ventricle, and Staphylococcus aureus was cultured from a peripheral blood sample. She was diagnosed as having a septic pulmonary embolism associated with right-sided infective endocarditis caused by S. aureus. She was treated with Cefazolin, resulting in gradual improvement of laboratory and chest radiographic findings. Recent studies have revealed that atopic dermatitis is one of the risk factors for infective endocarditis. In this case, uncontrolled atopic dermatitis might have caused the right-sided infective endocarditis.

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