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Fujimura Y.,Taragi Municipal Hospital | Nakahara O.,Taragi Municipal Hospital | Otao R.,Taragi Municipal Hospital | Goto H.,Taragi Municipal Hospital | Baba H.,KumamotoUniversity
Japanese Journal of Cancer and Chemotherapy | Year: 2014

A 73-year-old man was referred to our hospital because of appetite loss and weight loss in January 2009. Endoscopy showed an advanced type II gastric tumor at the middle of the gastric wall, and computed tomography showed multiple liver metastases. Immunohistological examination confirmed a diagnosis of large cell neuroendocrine carcinoma which was chromogranin A (+), CD56 (+), and synaptophysin (+). Oral administration of S-1 (100 mg/body) was given 5 days on and 2 days off, while cisplatin (CDDP 40 mg/body) was administered intravenously once every 2 weeks. The patient achieved a partial response (PR), and no serious adverse effects were observed. This case suggests that S-1/CDDP chemotherapy may be an effective treatment in patients with large cell neuroendocrine carcinoma of the stomach.


Nakamura K.,Taragi Municipal Hospital
Kekkaku : [Tuberculosis] | Year: 2012

Ocular tuberculosis is rare. We report a case of orbital myositis suspected to be infected with tuberculosis. In January 2008, a 34-year-old man experienced discomfort in the right eye. In May 2008, this patient developed right exophthalmos, diplopia, and pain in the right eye, and he was diagnosed with idiopathic orbital myositis. The patient underwent 2 courses of steroid pulse therapy; after which, the dosage of steroids was reduced. The steroid treatment reduced the eye pain, but his diplopia and exophthalmos persisted. By November of the same year, his general malaise had increased, and chest X-ray radiography and computed tomography were performed on 3rd December. On the basis of the imaging results, we suspected active pulmonary tuberculosis of the right upper lobe. The smear made by using the sample obtained after bronchial brushing was negative for acid-fast bacilli, but a Mycobacterium tuberculosis nucleic acid amplification test of the post-bronchoscopic sputum yielded positive results. Therefore, the patient was diagnosed with pulmonary tuberculosis. After the 2HREZ/7HR regimen of treatment, the extent of the tuberculosis lesions of the lung was reduced and the exophthalmos and eye pain were alleviated. Orbital myositis is inflammation of the extraocular muscles and can be either idiopathic, without a known etiology, or secondary to conditions such as tuberculosis, sarcoidosis, or hyperthyroidism. Our patient was not definitively diagnosed with tuberculosis of the eye. A definitive diagnosis of tuberculosis of the eye would require detection of granulomatous lesions in the eye or isolation of Mycobacterium tuberculosis by puncturing the eye muscles; however, our findings suggested the possibility that it was secondary to tuberculosis. We think that a careful examination of the chest should be performed for patients with ocular abnormalities.


Nakamura K.,Taragi Municipal Hospital
Kekkaku : [Tuberculosis] | Year: 2013

We report a case of tuberculous pleurisy that required differentiation from pleurisy caused by Mycoplasma infection. A 28-year-old woman presented to a clinic with fever and pain on the left side of her chest. A chest radiograph revealed pleural effusion in the left thorax, and the condition was diagnosed as bacterial pleurisy. The patient was referred to our hospital because of an increase in the pleural effusion despite antibiotic treatment. Mycoplasma infection was suspected because the patient was young, the white blood cell count was not elevated, and the result of the ImmunoCard Mycoplasma test (IC) for Mycoplasma pneumoniae-specific IgM antibodies was positive. However, the fever persisted even after treatment with azithromycin and pazufloxacin. The left pleural effusion was exudative, with lymphocytosis and high adenosine deaminase (ADA) levels. The results of the QuantiFERON test were positive. Therefore, tuberculous pleurisy was diagnosed, and the effusion subsided after treatment with standard anti-tuberculosis chemotherapy. Although detection of Mycoplasma infection using the IC is rapid and simple, the accuracy of this test is poor. The patient was first diagnosed with pleurisy of Mycoplasma origin because of a single high-particle agglutination titer of 1: 320 and because of the presence of exudative pleural effusion with lymphocytosis and elevated ADA levels, which has been reported in patients with Mycoplasma infection. The results of the IC test and the ADA level of the pleural effusion might not be reliable when distinguishing between tuberculous pleurisy and pleurisy caused by Mycoplasma infection.


Fujimura Y.,Taragi Municipal Hospital | Nakahara O.,Taragi Municipal Hospital | Ohshima S.,Taragi Municipal Hospital | Baba H.,Kumamoto University
Japanese Journal of Cancer and Chemotherapy | Year: 2015

We report a case of a 60-year old male esophageal cancer patient who was unable to take oral medication, but was successfully treated using a fentanyl citrate buccal tablet. The patient survived a suicide attempt as a youth in which he ingested poison, but was left with a stricture of the esophagus. It became difficult for him to take nutrition orally, and he underwent an esophageal bypass operation, although he still required frequent endoscopic esophageal dilation. He subsequently presented with an anastomotic stenosis due to anastomotic leakage, and oral intake became completely impossible. The onset of esophageal cancer presented as corrosive esophagitis. We used oxycodone hydrochloride to treat a sharp pain resulting from cataplectic cancer in the jejunal tube, but this provided only limited pain relief. We therefore used a fentanyl citrate oral mucosa absorption preparation with a rescue agent, which did provide effective pain relief. Thus a fentanyl citrate buccal tablet could effectively relief pain in cancer patients who are unable to receive oral medication.


Nakamura K.,Taragi Municipal Hospital | Yamanaka T.,National Hospital Organization
Kekkaku | Year: 2010

Abdominal wall tuberculosis is rare. We report a case of abdominal wall tuberculosis that relapsed after surgery. A 40-year-old man without a past history of tuberculosis visited our hospital complaining of an abdominal wall mass. The mass was resected in the department of orthopedics of our hospital. No bacteriological or histological examination of the resected specimen was done. After 5 months, the patient found swelling of the axillary lymph node. CT revealed left axillary lymph node swelling and chest wall nodules of various sizes. As the pus aspirated from the left axillary lymph node was positive for PCR-TB, the patient was diagnosed with relapsed chest wall tuberculosis and tuberculous lymphadenopathy. Antituberculosis drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) were administered, but resistance to both isoniazid and ethambutol were revealed afterward. So, isoniazid and ethambutol were replaced with levofloxacin and streptomycin. After 6 months of this therapy, the left axillary lymph node decreased remarkably and became scarred. Abdominal tuberculosis should be considered in cases of an abdominal wall mass, regardless of whether the patient has a history of tuberculosis. This case stresses the importance of postoperative anti-tuberculosis treatment, as well as the need for bacteriological and histological examinations of resected specimens.


Fujimura Y.,Taragi Municipal Hospital | Nakahara O.,Taragi Municipal Hospital | Ohshima S.,Taragi Municipal Hospital | Baba H.,Taragi Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

We report a case ofa 60-year old male esophageal cancer patient who was unable to take oral medication, but was successfully treated using a fentanyl citrate buccal tablet. The patient survived a suicide attempt as a youth in which he ingested poison, but was left with a stricture of the esophagus. It became difficult for him to take nutrition orally, and he underwent an esophageal bypass operation, although he still required frequent endoscopic esophageal dilation. He subsequently presented with an anastomotic stenosis due to anastomotic leakage, and oral intake became completely impossible. The onset of esophageal cancer presented as corrosive esophagitis. We used oxycodone hydrochloride to treat a sharp pain resulting from cataplectic cancer in the jejunal tube, but this provided only limited pain relief. We therefore used a fentanyl citrate oral mucosa absorption preparation with a rescue agent, which did provide effective pain relief. Thus a fentanyl citrate buccal tablet could effectively relief pain in cancer patients who are unable to receive oral medication.


PubMed | Taragi Municipal Hospital
Type: Case Reports | Journal: Kekkaku : [Tuberculosis] | Year: 2010

Abdominal wall tuberculosis is rare. We report a case of abdominal wall tuberculosis that relapsed after surgery. A 40-year-old man without a past history of tuberculosis visited our hospital complaining of an abdominal wall mass. The mass was resected in the department of orthopedics of our hospital. No bacteriological or histological examination of the resected specimen was done. After 5 months, the patient found swelling of the axillary lymph node. CT revealed left axillary lymph node swelling and chest wall nodules of various sizes. As the pus aspirated from the left axillary lymph node was positive for PCR-TB, the patient was diagnosed with relapsed chest wall tuberculosis and tuberculous lymphadenopathy. Antituberculosis drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) were administered, but resistance to both isoniazid and ethambutol were revealed afterward. So, isoniazid and ethambutol were replaced with levofloxacin and streptomycin. After 6 months of this therapy, the left axillary lymph node decreased remarkably and became scarred. Abdominal tuberculosis should be considered in cases of an abdominal wall mass, regardless of whether the patient has a history of tuberculosis. This case stresses the importance of postoperative anti-tuberculosis treatment, as well as the need for bacteriological and histological examinations of resected specimens.


PubMed | Taragi Municipal Hospital
Type: Case Reports | Journal: Kekkaku : [Tuberculosis] | Year: 2013

We report a case of tuberculous pleurisy that required differentiation from pleurisy caused by Mycoplasma infection. A 28-year-old woman presented to a clinic with fever and pain on the left side of her chest. A chest radiograph revealed pleural effusion in the left thorax, and the condition was diagnosed as bacterial pleurisy. The patient was referred to our hospital because of an increase in the pleural effusion despite antibiotic treatment. Mycoplasma infection was suspected because the patient was young, the white blood cell count was not elevated, and the result of the ImmunoCard Mycoplasma test (IC) for Mycoplasma pneumoniae-specific IgM antibodies was positive. However, the fever persisted even after treatment with azithromycin and pazufloxacin. The left pleural effusion was exudative, with lymphocytosis and high adenosine deaminase (ADA) levels. The results of the QuantiFERON test were positive. Therefore, tuberculous pleurisy was diagnosed, and the effusion subsided after treatment with standard anti-tuberculosis chemotherapy. Although detection of Mycoplasma infection using the IC is rapid and simple, the accuracy of this test is poor. The patient was first diagnosed with pleurisy of Mycoplasma origin because of a single high-particle agglutination titer of 1: 320 and because of the presence of exudative pleural effusion with lymphocytosis and elevated ADA levels, which has been reported in patients with Mycoplasma infection. The results of the IC test and the ADA level of the pleural effusion might not be reliable when distinguishing between tuberculous pleurisy and pleurisy caused by Mycoplasma infection.


PubMed | Kumamoto University and Taragi Municipal Hospital
Type: Journal Article | Journal: Surgical case reports | Year: 2016

Pancreatic pseudocyst is usually treated by percutaneous external drainage, endoscopic internal or external drainage, or surgical internal drainage such as cystogastrostomy. Surgical external drainage is an option if these procedures fail. We describe a case of a 70-year-old man with a pancreatic body pseudocyst that developed postoperatively. It was improved by endoscopic external drainage, and the stent was changed to an internal stent. However, surgery was required as the pseudocyst grew again. A direct approach to the pseudocyst was not possible because of severe adhesion. A distal pancreatectomy with pancreaticojejunostomy was performed, and an external pancreatic stent tube was inserted from the cut end into the duodenum to drain the pseudocyst. One month later, the pseudocyst disappeared, and the stent was removed.


PubMed | Taragi Municipal Hospital
Type: Case Reports | Journal: Kekkaku : [Tuberculosis] | Year: 2012

Ocular tuberculosis is rare. We report a case of orbital myositis suspected to be infected with tuberculosis. In January 2008, a 34-year-old man experienced discomfort in the right eye. In May 2008, this patient developed right exophthalmos, diplopia, and pain in the right eye, and he was diagnosed with idiopathic orbital myositis. The patient underwent 2 courses of steroid pulse therapy; after which, the dosage of steroids was reduced. The steroid treatment reduced the eye pain, but his diplopia and exophthalmos persisted. By November of the same year, his general malaise had increased, and chest X-ray radiography and computed tomography were performed on 3rd December. On the basis of the imaging results, we suspected active pulmonary tuberculosis of the right upper lobe. The smear made by using the sample obtained after bronchial brushing was negative for acid-fast bacilli, but a Mycobacterium tuberculosis nucleic acid amplification test of the post-bronchoscopic sputum yielded positive results. Therefore, the patient was diagnosed with pulmonary tuberculosis. After the 2HREZ/7HR regimen of treatment, the extent of the tuberculosis lesions of the lung was reduced and the exophthalmos and eye pain were alleviated. Orbital myositis is inflammation of the extraocular muscles and can be either idiopathic, without a known etiology, or secondary to conditions such as tuberculosis, sarcoidosis, or hyperthyroidism. Our patient was not definitively diagnosed with tuberculosis of the eye. A definitive diagnosis of tuberculosis of the eye would require detection of granulomatous lesions in the eye or isolation of Mycobacterium tuberculosis by puncturing the eye muscles; however, our findings suggested the possibility that it was secondary to tuberculosis. We think that a careful examination of the chest should be performed for patients with ocular abnormalities.

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