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Takikawa, Japan

Nishiyama N.,Sapporo Medical University | Kitamura H.,Sapporo Medical University | Hotta H.,Red Cross | Takahashi A.,Hakodate Goryoukaku Hospital | And 8 more authors.
Japanese Journal of Clinical Oncology | Year: 2014

Objective: The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guérin failure classification advocated by Nieder et al. in patients with nonmuscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guérin therapy. Methods: Data from 402 patients who received intravesical bacillus Calmette-Guérin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guérin failure were analyzed for this study. Results: Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guérin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guérin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the followup. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (>70 [P 1/4 0.002]), tumor size (>3 cm [P 1/4 0.015]) and the Nieder classification (bacillus Calmette-Guérin refractory [P, 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P, 0.001). Conclusions: Patients with stage progression at the first recurrence after bacillus Calmette-Gué rin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin into three risk groups based on the number of prognostic factors in each one. © The Author 2014. Published by Oxford University Press. All rights reserved.

Talib A.K.,Asahikawa University | Sato N.,Asahikawa University | Myojo T.,Abashiri Kosei Hospital | Sugiyama E.,Asahikawa University | And 11 more authors.
Heart and Vessels | Year: 2016

The pro-arrhythmic triggers in Brugada and early repolarization syndromes (BrS, ERS) have not been analyzed systematically except for case reports. We clinically investigated the circumstances which precede/predispose to arrhythmic events in these syndromes during long-term follow-up. A detailed history from the patients/witnesses was taken to investigate the antecedent events in the last few hours that preceded syncope/ventricular fibrillation (VF); medical records, ECG and blood test from the emergency room (ER) were reviewed. 19 patients that fulfilled the investigation criteria were followed up for 71 ± 49 months (34–190 months). Prior to the event (syncope/VF), the patients were partaking different activities in the following decreasing order; drinking alcoholic beverage, having meal, and getting up from sleep, exercise. 3 patients reported mental/physical stress prior to the event and 2 patients developed VF several days after starting oral steroid for treatment of bronchial asthma. In the ER, elevated J-wave amplitude (0.27 ± 0.15 mV) was found with 58 % of the patients having hypokalemia. After electrolyte correction and cessation of steroids, the following day plasma K+ (4.2 ± 0.3 mEq/L, P < 0.001) was significantly increased and J-wave amplitude (0.13 ± 0.1 mV, P < 0.001) was remarkably reduced. Three patients were kept on oral spironolactone/potassium supplements. During follow-up for 71 ± 49 (34–190) months, among 4 patients with VF recurrence, one patient developed VF after taking oral steroid. In ERS and BrS, hypokalemia and corticosteroid therapy add substantial pro-arrhythmic effects, but potentially treatable. Stopping steroid therapy and avoiding hypokalemia had excellent long-term outcome. © 2016 Springer Japan

Kimura Y.,Asahikawa Redcross Hospital | Kimura S.,Sapporo Medical University | Inoue H.,Takikawa Municipal Hospital | Yamauchi M.,Sapporo Medical University | Sumita S.,Asahikawa Redcross Hospital
Japanese Journal of Anesthesiology | Year: 2012

Background : The radial artery cannulation is often associated with damped arterial waveforms with the hand moving. We used cannulation of the dorsal branch of the radial artery (DRA) and compared the stability of measurement, safety and complications with those of the radial artery (RA). Methods : The study was a prospective single-blinded comparative study. Seventy-six patients under-going general anesthesia requiring arterial cannulation were included. Patients were divided randomly into two separate groups of 35 patients each according to cannulation site : the radial artery (RA group) or the dorsal branch of the radial artery (DRA group). After induction of general anesthesia, cannulation was performed. Three hours after the successful cannulation, the changes of waveforms were noted with the hand moving. We examined whether there were any complications around the cannulation site after cannula removal. Results : With the wrist flexion at all angles (30, 60 and 90 degrees), the frequency of worsening of arterial waveforms was significantly higher in RA group compared with DRA group. Some difficulties in catheter placement were observed in DRA group. No concomitant complication was noticed. Conclusions : Arterial line monitoring from DRA had better waveforms compared with RA monitoring without any complications.

Kizawa T.,JCHO Sapporo Hokushin Hospital | Ishii-Osai Y.,Sapporo Medical University | Yamashita T.,Sapporo Medical University | Nagai K.,Takikawa Municipal Hospital
Modern Rheumatology | Year: 2016

Cutaneous polyarteritis nodosa (CPAN) is characterized by a necrotizing vasculitis of small and medium-sized arteries in the skin, which can be associated with fever, arthralgia, myalgia, and neuropathy, but, unlike polyarteritis nodosa (PAN), there is no visceral involvement. CPAN is rare in childhood. We report two siblings who developed CPAN during childhood. Interestingly, both had Mediterranean fever gene (MEFV) mutation, i.e. heterozygous E148Q. They also shared HLA-A24, -DR15 alleles. Simultaneous occurrence of MEFV mutation and HLA alleles with CPAN has never been reported in Japan. These cases could provide some hereditary clue for the development of CPAN. © 2016 Japan College of Rheumatology

Kimura Y.,Akuacom | Yamauchi M.,Sapporo Medical University | Inoue H.,Takikawa Municipal Hospital | Kimura S.,Sapporo Medical University | And 3 more authors.
Journal of Anesthesia | Year: 2012

Purpose There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit. Methods We reviewed medical records of patients from April 2007 to March 2010 who underwent open appendectomy for acute appendicitis and were diagnosed pathologically. GD was defined as a larger anteroposterior diameter and larger lateral diameter of the stomach than those of the left kidney in computed tomography (CT) imaging. The primary outcome was the presence of GD. Candidate variables such as patient characteristics, physical findings, and CT imaging findings associated with GD were assessed. Time after beginning of abdominal pain was categorized and compared. Determinants with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models. Results We enrolled 121 patients and divided this cohort into a GD group (44 cases, 36%) and a non-GD group (77 cases, 64%). Results of univariate analysis showed longer duration of time after beginning of abdominal pain (P = 0.016), younger age (P < 0.001), and more frequent distended small bowel (P < 0.001) in the GD group than in the non-GD group. In multivariate analysis, age [odds ratio (OR) = 0.939, P = 0.002] and time after beginning of abdominal pain (OR = 1.807, P = 0.031) were shown to be independent risk factors. Conclusion Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD. © Japanese Society of Anesthesiologists 2012.

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