Social Insurance Central General Hospital

Shinjuku, Japan

Social Insurance Central General Hospital

Shinjuku, Japan

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Torii H.,Social Insurance Central General Hospital | Sato N.,Jikei University School of Medicine | Yoshinari T.,Jikei University School of Medicine | Nakagawa H.,Mitsubishi Group
Journal of Dermatology | Year: 2012

European S3 Guidelines on the systemic treatment of psoriasis in 2009 propose 75% or more improvement in the Psoriasis Area and Severity Index from baseline (PASI 75) and a Dermatology Life Quality Index (DLQI) of 0 or 1 as treatment goals. However, the relationship of these two parameters is yet to be clarified. Herein, we analyzed the data pooled from two Japanese phase III clinical trials on psoriasis with infliximab to clarify the PASI response necessary to achieve a DLQI of 0 or 1. Of the 90 patients, the mean percent improvement in PASI at week 50 or 66 was 74.5%, and the PASI 75 and PASI 90 response rates were 66.7% and 46.7%, respectively; no difference in the improvement was noted among the body areas. Significant improvements in nail psoriasis were also observed. A negative correlation was shown between the improvement in PASI and DLQI. Patients who achieved a PASI 90 response had a significantly higher percentage of achieving a DLQI of 0 or 1 than the patients who achieved a PASI 75 but not a PASI 90 response. The median serum trough level of infliximab was maintained at 2 μg/mL or more in the PASI 90 responders, whereas it was less than 1 μg/mL at week 30 and on in the others. The present results demonstrate that a PASI 90 response is necessary to achieve a DLQI of 0 or 1. Infliximab is considered a useful drug in meeting the treatment goal of achieving a DLQI of 0 or 1 through the attainment of a PASI 90 response. © 2011 Japanese Dermatological Association.


Naganuma M.,Tokyo Medical and Dental University | Naganuma M.,Keio University | Kunisaki R.,Yokohama City University | Yoshimura N.,Social Insurance Central General Hospital | And 2 more authors.
Journal of Gastroenterology | Year: 2013

Background: Immunosuppressants lead to an increased risk of infection, but few prospective studies have assessed the incidence of opportunistic infections in inflammatory bowel disease (IBD) patients, a high proportion of whom are treated with immunosuppressants. The aim of this study was to assess the age distribution of Japanese IBD patients with opportunistic infections and the risk factors associated with these infections. Methods: A multicenter, prospective study of 570 IBD patients was conducted. The patients were followed for up to 12 months to identify any new infections. The incidence of opportunistic infections and the age distribution of patients with these infections were analyzed. We carried out a case-control study in which 2 non-infected IBD patients were selected as controls for each case (infected IBD patient); the effect of medications on the infection rate was also examined. Results: Fifty-two (9.1 %) of 570 IBD patients developed opportunistic infections. Herpes simplex virus and herpes zoster virus infections were observed in 29 and 16 patients, respectively. No cases of active tuberculosis were observed. The incidence of opportunistic infections in patients aged 50 years or over was significantly higher than that in the other age groups (p = 0.01). The use of steroids (p = 0.02), thiopurine (p < 0.01), and immunosuppressant combination therapy (p < 0.01) was associated with an increased rate of opportunistic infections. However, the use of infliximab was not associated with an increased rate of opportunistic infections (p = 0.62). Multivariate analysis indicated that the use of thiopurine was an independent risk factor for opportunistic infections (p < 0.01). Conclusions: Age ≥50 years and the use of immunosuppressants are risk factors for opportunistic infections in patients with IBD. In our cohort, tuberculosis was not seen as a complication of immunosuppressant therapy. © 2012 Springer Japan.


Sakuma N.,Social Insurance Central General Hospital | Omura M.,Yokohama Rosai Hospital | Oda E.,Medical Toukei Corporation | Saito T.,Social Insurance Central General Hospital
Diabetology International | Year: 2011

Objective: We evaluated the relationship between glycated hemoglobin (HbA1c) in diabetic patients with stable glycemic control and the average fasting blood glucose (FBG) and postprandial blood glucose (PPG) values of 4 weeks prior to HbA1c measurement and compared the results with glycated albumin (GA). Research design and methods: Fifty-one diabetic patients were asked to use self-monitoring blood glucose to measure FBG before breakfast and PPG 1 and 2 h after breakfast 1 day a week for 4 weeks while maintaining normal daily activities. During monthly outpatient visits, HbA1c and GA were measured. Data were analyzed in 40 patients, with <1% variation in HbA1c values over 4 months. Results: HbA1c was best predicted by the average FBG (AvFBG) and the average of 1-h and 2-h PPG (AvMPPG) (adjusted R2 = 0. 51; HbA1c = 4. 35 + 0. 013 AvFBG + 0. 0056 AvMPPG). The contribution ratio was 0. 013:0. 0056, showing about 2. 3 times greater contribution by FBG. GA was best predicted by the AvFBG and the average of 2-h PPG (Av2hPPG) (adjusted R2 = 0. 55; GA = 9. 36 + 0. 0241 AvFBG + 0. 0430 Av2hPPG). The contribution ratio was 0. 024:0. 043, showing about 1. 8 times greater contribution by 2-h PPG. This converse contribution of fasting and postprandial glucose to HbA1c and GA was more prominent in insulin-treated patients than in untreated patients. Conclusions: HbA1c and GA can be satisfactorily predicted by FBG and PPG. HbA1c reflects FBG more so than PPG, whereas GA better reflects PPG. Thus, depending on the characteristics of the glycated protein, a different glycemic status is reflected. © 2011 The Japan Diabetes Society.


Mizutani E.,Social Insurance Central General Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A cystic lymphangioma is a rare mediastinal benign tumor. A 38-year-old male was referred to our hospital because of an mediastinal mass incidentally detected on chest X-ray. The mass had enlarged rapidly during the course of 1 year. Computed tomography (CT) of the chest showed a 7 cm well defined cystic tumor in the left anterior mediastinum. Magnetic resonance imaging (MRI) demonstrated a mass with heterogeneous high signal intensity on enhanced T2-weighted images. The cystic tumor, localized in the mediastinal adipose tissue, was completely resected by a thoracoscopic procedure. A pathological examination confirmed the diagnosis of a cystic lymphangioma.


Tasaka S.,Keio University | Tokuda H.,Social Insurance Central General Hospital
Journal of Infection and Chemotherapy | Year: 2012

In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a well-known opportunistic infection, and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiologic features are the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of PCR and serum β-d-glucan assay for rapid and noninvasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent, and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by person-to-person transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients without HIV infection, although its indication and duration are still controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed. © 2012 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.


Torii H.,Social Insurance Central General Hospital | Nakagawa H.,Jikei University School of Medicine
Journal of Dermatology | Year: 2011

The efficacy and safety of infliximab in patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis (excluding localized type) and psoriatic erythroderma were assessed in clinical practice. Without washout of the existing treatment of psoriasis, treatment was switched to infliximab, which was given at a dose of 5 mg/kg at weeks 0, 2 and 6 and then every 8 weeks up to week 46. The primary end-points were 75% improvement in Psoriasis Area and Severity Index score (PASI 75 response rate) for plaque psoriasis, 20% improvement in American College of Rheumatology criteria (ACR 20 response rate) for psoriatic arthritis, and global improvement in pustular psoriasis and psoriatic erythroderma. The PASI 75 response rate in plaque psoriasis was 72.2% at week 10 and 53.6% at week 50. The ACR 20 response rate in psoriatic arthritis was 66.7% at week 14 and 80.0% at week 46. The response defined as global improvement in pustular psoriasis was between 66.7% and 100.0% during the 2-50-week period. The response defined as global improvement in psoriatic erythroderma was between 75.0% and 100.0% during the week-2-50 period. There were 14 discontinued patients. The most frequently reported reason for discontinuation was the development of adverse events. However, there were no serious respiratory diseases, infections or infusion reactions. In patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma, infliximab was well tolerated, regardless of prior treatment, and also showed superior efficacy over a period of approximately 1 year. © 2010 Japanese Dermatological Association.


Tasaka S.,Keio University | Tokuda H.,Social Insurance Central General Hospital
Expert Opinion on Medical Diagnostics | Year: 2013

Introduction: Pneumocystis jirovecii pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected adults. Although the microscopic demonstration of the organisms in respiratory specimens is still the golden standard of its diagnosis, recent advances in the diagnostic tools have been changing the situation. Areas covered: Colonization of Pneumocystis is highly prevalent among the general population and could be associated with the transmission and development of PCP in immunocompromised individuals. Nested or conventional polymerase chain reaction (PCR) has a high sensitivity, detecting Pneumocystis DNA in induced sputum or oropharyngeal wash, but often produces false positives. Although quantitative real-time PCR is promising for discriminating colonization from PCP, the targeted DNA sequences and the cut-off values remain to be standardized. Serum β-D-glucan is useful as an adjunctive tool for the diagnosis of PCP. High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for evaluation of immunocompromised patients with suspected PCP and normal chest radiography. Expert opinion: Although these new tools have been making the diagnosis of PCP less invasive and more accurate, any one of them can not make a definitive diagnosis by itself. The diagnostic criteria based on the combination of the testing ought to be established. © 2013 Informa UK, Ltd.


Torii H.,Social Insurance Central General Hospital | Nakagawa H.,Jikei University School of Medicine
Journal of Dermatological Science | Year: 2010

Background: A clinical trial of infliximab in psoriasis has not yet been performed in Asian populations, although infliximab has been approved for the indications of psoriatic arthritis and plaque psoriasis in the US and the EU. Objective: This study aims to validate the efficacy and safety of infliximab in Japanese patients with plaque psoriasis and psoriatic arthritis. Methods: Patients with moderate-to-severe psoriasis, including psoriatic arthritis, were randomized to the induction therapy (Weeks 0, 2 and 6) with infliximab 5. mg/kg (n=37) or placebo (n=17). For the maintenance therapy, infliximab was administered every 8 weeks from Week 14 to Week 62 in the infliximab group, and placebo was switched to infliximab in the placebo group starting at Week 16. The primary efficacy endpoint was the proportion of patients who had achieved at least 75% improvement in the psoriasis area and severity index (PASI 75 response rate) from baseline at Week 10. Results: At Week 10, a total of 68.6% of patients receiving infliximab and none of those receiving placebo, achieved PASI 75 response (p<0.001). A significant improvement in PASI, PGA, DLQI, and patient's pain assessment was seen from Week 6 through Week 14 in the infliximab group compared with the placebo group. Through Week 66, PASI, PGA, DLQI as well as pain relief were better maintained. Conclusion: Infliximab could provide a sustained improvement effect on skin and joint symptoms, and accordingly contributed to a sustained improvement in the QOL of patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. Infliximab was generally well tolerated in most patients. These results corresponded with the results of the trials in the US and the EU. © 2010 Japanese Society for Investigative Dermatology.


Hiraki Y.,Social Insurance Central General Hospital
Kekkaku : [Tuberculosis] | Year: 2012

In 1998, a 51-year-old woman was diagnosed with Mycobacterium avium infection on the basis of chest radiographic findings, positive smear test results, and positive results of polymerase chain reaction (PCR) specific for Mycobacterium avium DNA in bronchial lavage fluid. Antimycobacterial therapy was administered for 11 months, and the chest radiographic findings improved. In 2001, re-treatment was performed because radiographic findings indicated exacerbation of disease and poor response. After 2005, the patient remained both smear and culture positive for mycobacterium. However, the precise species could not be identified using PCR and DNA-DNA hybridization, and her left lung lesions gradually worsened. The culture isolate was subjected to DNA analysis with PCR amplification and sequence analysis; this ultimately revealed the presence of Mycobacterium lentiflavum. Combination antimicrobial therapy was administered for 10 months. The patient's symptoms were alleviated, and the radiographic appearance remained stable.


The efficacy and safety of infliximab in patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis (excluding localized type) and psoriatic erythroderma were assessed in clinical practice. Without washout of the existing treatment of psoriasis, treatment was switched to infliximab, which was given at a dose of 5 mg/kg at weeks 0, 2 and 6 and then every 8 weeks up to week 46. The primary end-points were 75% improvement in Psoriasis Area and Severity Index score (PASI 75 response rate) for plaque psoriasis, 20% improvement in American College of Rheumatology criteria (ACR 20 response rate) for psoriatic arthritis, and global improvement in pustular psoriasis and psoriatic erythroderma. The PASI 75 response rate in plaque psoriasis was 72.2% at week 10 and 53.6% at week 50. The ACR 20 response rate in psoriatic arthritis was 66.7% at week 14 and 80.0% at week 46. The response defined as global improvement in pustular psoriasis was between 66.7% and 100.0% during the 2-50-week period. The response defined as global improvement in psoriatic erythroderma was between 75.0% and 100.0% during the week-2-50 period. There were 14 discontinued patients. The most frequently reported reason for discontinuation was the development of adverse events. However, there were no serious respiratory diseases, infections or infusion reactions. In patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma, infliximab was well tolerated, regardless of prior treatment, and also showed superior efficacy over a period of approximately 1 year. © 2011 Japanese Dermatological Association.

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