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Adachi N.,Adachi Mental Clinic | Adachi N.,National Center Hospital for Mental Nervous and Muscular Disorders | Akanuma N.,National Center Hospital for Mental Nervous and Muscular Disorders | Akanuma N.,South London and Maudley NHS Foundation Trust | And 5 more authors.
Epilepsia | Year: 2012

Purpose: There have been few reports showing the distribution of the duration of interictal psychosis (IIP) episodes and their association with clinical characteristics. To clarify the nature of IIP, we studied the duration of IIP episodes and their related factors. Methods: One hundred fifty-five patients with epilepsy exhibited 320 IIP episodes during our follow-up period (mean 16.9 years). The duration of all the episodes and the longest episode in each patient during the follow-up periods were studied. Characteristics of the patients (e.g., epilepsy type, age of onset, and family history of psychosis) and episode-specific factors (e.g., age of the episode, seizure frequency, administrations of antiepileptic drugs [AEDs] and antipsychotic drugs [APDs]) were analyzed in association with the duration of the episodes. Key Findings: Mean duration of the 320 IIP episodes was 82.7 weeks and that of the longest IIP episodes was 150.1 weeks. During the follow-up period, 17 patients (11.0%) showed all episodes remitting within a month and 54 (34.8%) showed all episodes lasting for 6 months or longer. The IIP episodes that occurred at a younger age were often prolonged. Patients with a family history of psychosis or with early onset of psychosis tended to have more prolonged IIP episodes. Among the episodes treated with APDs, early administration of APDs was significantly associated with shorter IIP duration. Significance: The distribution of the duration of IIP episodes indicated the broad spectrum and heterogeneity of the IIP phenomena. The individual vulnerability to psychosis may be associated with prolonged episodes. Administration of APDs soon after onset of the episodes appeared to be effective in controlling them. These findings support empirical treatment principles for IIP to administer APDs at an early stage of its development. © Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.


PubMed | Red Cross, Sapporo Kiyota Hospital, Asahikawa City Hospital, National Hospital Organization Hokkaido Cancer Center and 15 more.
Type: | Journal: Clinical lymphoma, myeloma & leukemia | Year: 2016

Mogamulizumab, a defucosylated humanized monoclonal antibody targeting C-C chemokine receptor 4, recently became available for the treatment of adult T-cell leukemia/lymphoma (ATL). We conducted a multicenter retrospective study of the efficacy of mogamulizumab in ATL treatment in patients on Hokkaido Island, Japan.A total of 125 patients with ATL treated from January 2010 to December 2014 in 20 hospitals affiliated with the Hokkaido Hematology Study Group were enrolled in the present retrospective study.Of the 125 ATL patients, 62 (46.6%) presented with the acute type, 51 (38.3%) with the lymphoma type, and 12 (9.0%) with the chronic type; the latter group included 7 unfavorable chronic cases. The median age at diagnosis was 68 years (range, 35-86 years). The median survival for those with acute, lymphoma, and unfavorable chronic types was 302, 279, and 921 days, respectively. Advanced age, high lactate dehydrogenase level, poor performance status (3-4), and the existence of B symptoms were unfavorable prognostic factors for overall survival (OS). Survival rate calculated from the day of diagnosis was significantly higher in patients treated with mogamulizumab. The OS of individuals receiving hematopoietic stem cell transplantation (HSCT) was superior to that of the non-HSCT group. The median interval between the last mogamulizumab dose and allogeneic HSCT was 38 days (range, 21-53 days). Of the 22 HSCT recipients who were not treated with mogamulizumab, overall acute graft-versus-host disease (aGVHD) and grade III-IV aGVHD occurred in 12 (54.5%) and 3 (13.6%) patients, respectively. However, overall aGVHD and grade III-IV aGVHD developed in 8 (88.9%) and 3 (33.3%) of the 9 HSCT recipients treated with mogamulizumab, respectively.Mogamulizumab improves OS in patients with ATL, although its use in HSCT patients might trigger severe GVHD. Determining the optimal pre-HSCT mogamulizumab treatment regimen is thus a priority.


Suzuki S.,Asahikawa University | Koga M.,Kinki Central Hospital | Amamiya S.,Sapporo Tokushukai Hospital | Nakao A.,Red Cross | And 8 more authors.
Diabetologia | Year: 2011

Aims/hypothesis It is difficult to use HbA1c as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA1c were compared to evaluate whether they reflect glycaemic control in patients with NDM. Methods This study included five patients with NDM. Age at diagnosis was 38±20 days. Insulin therapy was started in all patients, and levels of GA, HbA1c and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose. Results Plasma glucose and GA were elevated (29.7± 13.1 mmol/l [n=5] and 33.3±6.9% [n=3], respectively) but HbA1c was within normal limits (5.4±2.6% [35.5± 4.9 mmol/mol]; n=4) at diagnosis. With diabetes treatment, aPPG (r=-0.565, p=0.002), GA (r=-0.552, p=0.003) and HbF (r=-0.855, p<0.0001) decreased with age, whereas HbA1c increased (r=0.449, p=0.004). GA was strongly positively correlated with aPPG (r=0.784, p<0.0001), while HbA1c showed no correlation with aPPG (r=0.221, p=0.257) and was significantly inversely correlated with HbF (r=-0.539, p=0.004). Conclusions/interpretation GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA1c is influenced by age-related changes in HbF and does not accurately reflect glycaemic control. © Springer-Verlag 2011.


PubMed | Teine Keijinkai Hospital, Obihiro Kyokai Hospital, Sapporo Satozuka Hospital, Sapporo Medical University and 12 more.
Type: Journal Article | Journal: Acta oncologica (Stockholm, Sweden) | Year: 2016

Intratumoral human epidermal growth factor receptor 2 (HER2) heterogeneity of gastric cancer can be an obstacle to accurate HER2 assessment. Serum HER2, concentrations of the HER2 extracellular domain shed into the bloodstream, has a potential to compensate HER2 immunohistochemistry (IHC) but has not been scrutinized in gastric cancer. This study sought to explore the clinical utility of serum HER2 in gastric cancer.We performed a prospective multicenter trial (SHERLOCK trial) involving patients with all-stage gastric or gastro-esophageal junction cancer. Serum HER2 was measured using direct chemiluminescence while tissue HER2 status was determined using IHC and fluorescent in situ hybridization. For stage IV cases, concordance between local and central laboratories in tissue HER2 assessment was also evaluated.Of 224 patients enrolled, both tissue HER2 status and serum HER2 levels were successfully determined in 212 patients and 21% (45/212) were tissue HER2-positive. Serum HER2 levels, ranged from 4.5 to 148.0ng/ml (median 10.3), correlated with tissue HER2 status (p=0.003). At a cut-off level of 28.0ng/ml determined by receiver operating characteristics analysis, sensitivity, specificity, positive and negative predictive values of serum HER2 were 22.6%, 100%, 100% and 82.3%, respectively. All nine cases with elevated serum HER2 were tissue HER2-positive stage IV cases. Among 61 stage IV cases, the agreement rate for IHC scoring between the local and the central laboratories was 82% and tissue HER2 judgment was conflicting in five (8.2%) cases. Of these five cases, four were confirmed as false-negative and two of these four patients demonstrated elevated serum HER2.Serum HER2 levels correlated with tissue HER2 status in gastric cancer. Although the low sensitivity is a drawback, serum HER2 might be a useful adjunct tool to detect tissue HER2 false-negative gastric cancer.


Tsukahara T.,Sapporo Medical University | Takasawa A.,Sapporo Medical University | Murata M.,Sapporo Medical University | Okumura K.,Tenshi Hospital | And 3 more authors.
Diagnostic Pathology | Year: 2012

Primary lymphoma of adrenal glands is rare, and non-B-cell lymphoma associated with pyothorax is also very rare. Here we report the first autopsy case of non-B-cell lymphoma in bilateral adrenal glands of a 79-year-old woman with pyothorax who had an aggressive clinical course. Immunohistochemically, tumor cells showed CD3+, CD45RO+, CD5-, CD7-, CD4-, CD8-, CD10-, CD20-, CD30-, CD79a-, CD138-, CD56-, granzyme B-, TIA-1+ and ALK- In addition, tumor cells were strongly EBER1-positive by in situ hybridization. In genomic DNA of tumor cells, T-cell receptor rearrangements were not detected by southern blotting. We finally diagnosed this case as extranodal NK/T-cell lymphoma (nasal type).Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8050621197741854. © 2012 Tsukahara et al.; licensee BioMed Central Ltd.


Takahashi T.,Tenshi Hospital
Internal Medicine | Year: 2014

This report describes a patient with autoimmune myelofibrosis accompanied by Sjögren's syndrome (SS). A 36-year-old woman was admitted due to petechiae, purpura, gingival bleeding, dyspnea on exertion, and a lack of concentration. She had pancytopenia and was diagnosed with SS. A bone marrow study showed hypercellular marrow with reticulin fibrosis. Lymphocytic infiltrates and aggregates composed of a mixture of T and B cells in the marrow were also observed. A chromosomal analysis of the marrow cells showed 47, XXX and an analysis of peripheral lymphocytes revealed 47, XXX/46, XX mosaic results. The patient's cytopenia resolved following treatment with oral prednisolone. © 2014 The Japanese Society of Internal Medicine.


Ito M.,Tenshi Hospital
Epilepsy and Behavior | Year: 2010

Postictal behavioral changes (PBCs), including psychosis, aggression, and mood change, are commonly observed in patients with epilepsy. Recognition and description of the clinical manifestations of PBCs would help in understanding and treating patients. Additionally, various quantified objective scales that are widely available in clinical psychiatry could be used to assess the clinical symptoms of PBCs. There are few reports in which objective rating scales have been used to assess neuropsychiatric symptoms in patients with epilepsy. However, there have been a small number of studies on interictal psychosis and depression in which either the Brief Psychiatric Rating Scale or the Hamilton Depression Scale was used. These inventories are likely to be useful for the assessment of PBCs. Other rating scales used for schizophrenia, depression, mania, and aggressive behavior are reviewed here. The author suggests that cross-sectional and longitudinal neuropsychiatric measurement combined with other modalities, including functional neuroimaging, could provide clues to the pathophysiology of PBCs. © 2010 Elsevier Inc.


Yoneshiro T.,Tenshi College | Aita S.,Tenshi College | Matsushita M.,Tenshi College | Okamatsu-Ogura Y.,Hokkaido University | And 5 more authors.
Obesity | Year: 2011

Brown adipose tissue (BAT) can be identified by 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) combined with X-ray computed tomography (CT) in adult humans. The objective of this study was to clarify the relationship between BAT and adiposity in healthy adult humans, particularly to test the idea that decreased BAT activity may be associated with body fat accumulation with age. One hundred and sixty-two healthy volunteers aged 20-73 years (103 males and 59 females) underwent FDG-PET/CT after 2-h cold exposure at 19 °C with light clothing. Cold-activated BAT was detected in 41% of the subjects (BAT-positive). Compared with the BAT-negative group, the BAT-positive group was younger (P<0.01) and showed a lower BMI (P<0.01), body fat content (P<0.01), and abdominal fat (P<0.01). The incidence of cold-activated BAT decreased with age (P<0.01), being more than 50% in the twenties, but less than 10% in the fifties and sixties. The adiposity-related parameters showed some sex differences, but increased with age in the BAT-negative group (P<0.01), while they remained unchanged from the twenties to forties in the BAT-positive group, in both sexes. These results suggest that decreased BAT activity may be associated with accumulation of body fat with age. © 2011 The Obesity Society.


Nakajima N.,Higashi Sapporo Hospital | Hata Y.,Sapporo Social Insurance General Hospital | Kusumuto K.,Tenshi Hospital
Journal of Palliative Medicine | Year: 2013

Background: Current discrepancies in the practice of artificial hydration therapy for terminally ill cancer patients have the potential to cause serious clinical problems. Purpose: The study's purpose was to explore the influence of hydration volume on the sings during the last three weeks of life in terminally ill cancer patients. Methods: This was a prospective, observational study of 75 consecutive terminally ill patients with abdominal malignancies during the last four years. Primary responsible physicians evaluated the severity of membranous dehydration (calculated on the basis of three physical findings), peripheral edema (calculated on the basis of seven physical findings), ascites and pleural effusion (rated as physically undetectable to symptomatic), bronchial secretion, and hyperactive delirium. Results: Patients were classified into two groups: the hydration group (n=32), receiving 1000 mL or more of artificial hydration per day, one and three weeks before death, and the nonhydration group (n=43). The percentage of patients with deterioration in dehydration score in the final three weeks was significantly higher in the nonhydration group than in the hydration group (35% versus 13%, p=0.027), while the percentages of patients whose symptom scores for edema, ascites, and bronchial secretion increased were significantly higher in the hydration group than in the nonhydration group (57% versus 33%, p=0.040; 34% versus 14%, p=0.037; 41% versus 19%, p=0.036, respectively). There were no significant differences in the degree of pleural effusion or the prevalence of hyperactive delirium between these groups. Conclusions: The potential benefits of artificial hydration therapy should be balanced with the risk of worsening fluid retention signs. © Mary Ann Liebert, Inc.


A 64 year-old woman with steroid-dependent immune thrombocytopenia developed anemia. Esophagogastroduodenoscopy revealed the presence of a tumor, which was diagnosed to be diffuse large B-cell lymphoma, in the second portion of the duodenum.

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