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Fuchida S.,Social Insurance Kyoto Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2012

A 62-year-old woman diagnosed with asymptomatic IgG multiple myeloma in 1998 received distal gastrectomy because of abdominal fullness and was diagnosed with AL amyloidosis in 2009. She was referred to our hospital and further examination revealed amyloid depositions on the tongue, submandibular glands, heart, and gastrointestinal tract. Combination therapy of melphalan with dexamethasone was ineffective. She then received 13 courses of lenalidomide at 15 mg daily with weekly dexamethasone, which resulted in complete response with no detectable M-protein by immunofixation electrophoresis. Reduced-dose lenalidomide with dexamethasone is effective for patients with multiple myeloma complicated with AL amyloidosis. Source


Ushigome E.,Kyoto Prefectural University of Medicine | Fukui M.,Kyoto Prefectural University of Medicine | Hamaguchi M.,Red Cross | Tanaka T.,Red Cross | And 6 more authors.
Journal of Diabetes Investigation | Year: 2013

Aims/Introduction: Recent studies have shown the association between blood pressure variability and cardiovascular events. The present study was designed to investigate the relationship between antihypertensive drug class and home blood pressure variability in patients with type 2 diabetes. Materials and Methods: We compared home blood pressure variability among patients treated with calcium channel blockers (n = 44), with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (n = 159), and with calcium channel blockers combined with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (n = 183). Next, we analyzed the effect of calcium channel blockers on morning blood pressure variability using multiple linear regression analysis. Results: Coefficient variation of morning systolic blood pressure in patients treated with calcium channel blockers was significantly lower than that in patients treated with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (P = 0.036). Multivariate linear regression analyses showed that treatment with calcium channel blockers was significantly correlated with coefficient variation of morning systolic blood pressure (β = -0.264, P = 0.001). Conclusions: The present study implies a possibility for validity on selecting calcium channel blockers in hypertensive patients with type 2 diabetes to reduce home blood pressure variability. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd. Source


Fukui M.,Kyoto Prefectural University of Medicine | Ushigome E.,Kyoto Prefectural University of Medicine | Tanaka M.,Kyoto Prefectural University of Medicine | Hamaguchi M.,Osaka University | And 6 more authors.
Hypertension Research | Year: 2013

Recent studies have suggested that not only mean blood pressure but also variability in blood pressure might be related to cardiovascular disease. The aim of this study was to investigate the association between home blood pressure variability on one occasion and markers of arterial stiffness in patients with type 2 diabetes. We investigated the relationship between the s.d. of clinic-or home-measured systolic blood pressure on one occasion and pulse wave velocity (PWV) in 332 patients with type 2 diabetes, and we evaluated whether the SD of clinic-or home-measured systolic blood pressure on one occasion was an independent determinant of PWV by multivariate linear regression analysis, after adjustment for known risk factors for arterial stiffness, including sex, age, duration of diabetes, body mass index, hemoglobin A1c, serum total cholesterol, triglycerides, smoking status, drinking alcohol, presence of antihypertensive medication, average systolic blood pressure and heart rate. Age, average morning home-measured systolic blood pressure, heart rate and PWV (r=0.259, P<0.0001) were positively correlated with the s.d. of morning home blood pressure on one occasion. Multiple regression analysis demonstrated that age, average morning home-measured systolic blood pressure (P=0.0019), heart rate and the s.d. of morning home-measured systolic blood pressure on one occasion (P=0.0159) were independently associated with PWV. In conclusion, home blood pressure variability on one occasion was correlated with PWV, independent of other known risk factors, in Japanese patients with type 2 diabetes. © 2013 The Japanese Society of Hypertension All rights reserved. Source


Morimoto A.,Jichi Medical University | Shimazaki C.,Social Insurance Kyoto Hospital | Takahashi S.,University of Tokyo | Yoshikawa K.,Hikone Municipal Hospital | And 7 more authors.
International Journal of Hematology | Year: 2013

Little information is available regarding effective systemic therapies for adult Langerhans cell histiocytosis (LCH). The Japan LCH Study Group has formulated an ambulatory treatment regimen for adult patients with LCH. In total, 14 patients (median age 43 years, range 20-70 years) with multifocal LCH with biopsy-confirmed histology were enrolled. None had received cytoreductive agents for LCH previously. Four had single system (SS) and ten had multi system (MS) disease. All were treated with the Special C regimen, which consists of vinblastine/prednisolone and methotrexate with daily 6-mercaptopurine for 36 weeks. At the end of the therapeutic regimen, all SS patients achieved no active disease (NAD), and six of the ten MS patients showed a response (NAD in two, partial response in four). At the last follow-up (median 34 months), 11 patients were alive (NAD in eight and active disease in three). Of the three deceased, one died of hemorrhage during the Special C treatment, and two of infections during subsequent therapy. Although this study is limited by the small sample size, this ambulatory regimen shows signs of efficacy for adult LCH. This was particularly evident for patients with multifocal SS disease, but half of those with MS disease also benefited. © 2012 The Japanese Society of Hematology. Source


Fuchida S.,Social Insurance Kyoto Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2011

New immunoassay has been developed that allows the measurement of serum free light chains (FLC) more sensitive than currently available methods such as immunoelectrophoresis. This assay is useful especially in the diagnosis of BJP type multiple myeloma (MM), oligosecretory and nonsecretory MM. Baseline FLC value is the prognostic indicator of disease progression from MGUS and solitary plasmacytoma to symptomatic MM, and the prognostic factor of MM. In addition, uniform response criteria using FLC assay has been proposed by International Myeloma Working Group. This review summarized the recent information of the serum FLC assay in the diagnosis and management of MM. Source

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