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Kakimoto M.,Tokyo Metropolitan Ohtsuka Hospital | Tokita H.,Tokyo Metropolitan Ohtsuka Hospital | Okamura T.,Tokyo Metropolitan Ohtsuka Hospital | Yoshino K.,Tokyo Metropolitan Komagome Hospital
Journal of Palliative Medicine | Year: 2010

Background: Breast cancer, skin cancer, and head and neck cancer often develops a hemorrhagic malignant wound. Bleeding from the tumor impairs patients' quality of life and can be life threatening, while surgical or electrical hemostasis is often unsuccessful because of the tumor's friability. Methods: We performed a chemical hemostatic treatment for breast cancer hemorrhage with zinc chloride paste (Mohs' paste), which is usually applied as a fixative in micrographic surgery for cutaneous neoplasms. Five patients with bleeding from breast cancer under various circumstances were treated with this technique in 2008. Results: The method was successful on first application for all five patients, and hemostasis was maintained long term. Conclusions: This simple technique is effective for bleeding from malignant wounds and should be learned by health professionals performing cancer care. © 2009, Mary Ann Liebert, Inc.


Suzumura S.,Tokyo Metropolitan Ohtsuka Hospital
Pediatrics International | Year: 2015

Background Parents of children with pervasive developmental disorders (PDD) are likely to experience serious distress. The aims of this study were to (i) assess distress among mothers of preschoolers with high-functioning PDD (HFPDD); and (ii) examine its relation to the child's behavioral characteristics. Methods Participants were 30 mothers of preschoolers with HFPDD, and 30 mothers of a matched control group. Short Form 36 Health Survey Questionnaire (version 2), and the Strengths and Difficulties Questionnaire were used for assessment. The children's autistic traits were assessed using the total number of items for the DSM-IV-TR autistic disorder diagnosis. Results Mothers in the HFPDD group were more distressed mentally than physically. Neither physical nor mental distress in the group was related to the child's autistic traits, while their mental distress was significantly related to the child's behavior problems. Conclusions Mothers in the HFPDD group were at increased risk of impaired mental wellbeing. Maternal mental distress in the group was significantly related to general behavior problems, but not to autistic traits in the child. © 2014 Japan Pediatric Society.


Introduction: Attention Deficit Hyperactivity Disorder (ADHD)-like symptoms are common among children and adolescents with Pervasive Developmental Disorders (PDD). The purpose of this study was to assess the impact of ADHD-like symptoms on the clinical features of adolescents with PDD. Methods: A total of 72 subjects (between the ages of 12 and 17) diagnosed as having PDD were split into higher (ADHD+) and lower (ADHD-) groups according to the presence of ADHD-like symptoms as assessed with the Japanese version of the ADHD Rating Scale-IV (ADHD-RS-IV-J). Group differences in coexisting psychopathology, as assessed by the eight subscales of the Japanese version of the Child Behavior Checklist for Ages 4-18 (CBCL/4-18-J) and autistic core features, as assessed by the adolescent part of the PDD-Autism Society of Japan Rating Scale (PARS), were examined. Results: The ADHD+subjects showed a significantly higher degree of general psychopathology, including both externalizing and internalizing symptoms, as compared to subjects in the ADHD- subgroup. Additionally, the ADHD+subgroup showed greater impairment according to PARS scores. Discussion: These results indicate an important role of ADHD-like symptoms in PDD. Therefore, parents/caregivers may find it useful to know to what extent their child's ADHD-like symptoms deviate from the norm for PDD adolescents and the implications of these symptoms for long-term care. In addition, clinicians would be well advised to consider further systematic assessment of ADHD-like symptoms. © 2012 Blackwell Publishing Asia Pty Ltd.


Mitsui T.,Keio University | Narumi S.,Keio University | Inokuchi M.,Keio University | Nagasaki K.,Niigata University | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: In most patients with hypoparathyroidism (HP), the etiology is not defined clinically. Eight genes (AIRE, CASR, CLDN16, GATA3, GCM2, PTH, TBCE, and TRPM6) are known to be responsible genes associated with HP; however, no previous study has screened the eight responsible genes comprehensively in HP patients.Objectives: This study was conducted to determine the genetic defect in HP patients. We also described clinical and molecular findings of two HP patients with novel GCM2 mutations.Subjects and Methods: We enrolled 20 nonconsanguineous Japanese patients with child-onset permanentHPwithout22q11deletion. Mutationsandgenomicrearrangementsinvolvingtheeightgenes were screened by targeted next-generation sequencing (NGS). We also screened genetic rearrangements by array comparative genomic hybridization (aCGH) in the mutation-negative patients. A putative deletion, which was suspected by NGS, was additionally analyzed by droplet digital PCR (ddPCR) and junction PCR. Identified novel nucleotide-level GCM2 mutants were characterized in vitro.Results: We identified seven patients with a single gene disorder, including a CASR mutation, GATA3 mutations, and novel GCM2 mutations (R367Tfs∗15, T370M, and the deletion encompassing exon 1). This submicroscopic deletion, which had been suspected by NGS, could not be detected by aCGH and was confirmed by ddPCR and junction PCR. Functional studies of R367Tfs∗- and T370M-GCM2 demonstrated a reduction of target gene transactivation in both.Conclusions: Using comprehensive NGS analyses, we identified the genetic defect in 35% of HP patients in our cohort and discovered novel GCM2 mutations including submicroscopic deletion that was undetectable by aCGH. Copyright © 2014 by the Endocrine Society.


Koshiishi H.,Tokyo Metropolitan Ohtsuka Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We describe 3 cases in which the pulmonary metastasis from the urothelial carcinoma of the bladder and upper urinary tract was resected. The duration from the operation of the primary lesion to the occurrence of the pulmonary metastasis was 19, 11, and 4 years in each of the 3 cases. Repeated treatment of the local recurrence was performed in all the 3 cases. Local recurrence in the bladder membrane was observed in 1 case. In 2 cases, computed tomography( CT) scans revealed that the cavitation had penetrated the tumor. Histological findings of the surgical specimen obtained from the 3 cases revealed severe tumor necrosis. Immunostaining of the surgical specimen resulted in a definitive diagnosis of pulmonary metastasis from the urothelial carcinoma in 2 cases in which a differential diagnosis could not identify the primary lung cancer from the pulmonary metastasis. The prognoses in terms of survival in each of the 3 cases were shorter than 32, 19, and 6 months from the operation of the pulmonary metastasis. However, the prognoses could be improved by multidisciplinary treatment, including the resection of the pulmonary metastasis.


Miyawaki S.,Tokyo Metropolitan Ohtsuka Hospital
International Journal of Hematology | Year: 2012

Acute myeloid leukemia (AML) is the most common adult leukemia in Japan. The treatment for AML consists of induction, consolidation, and maintenance therapies. To improve outcomes in the treatment of AML, the Japan Adult Leukemia Study Group has conducted six studies in AML patients aged 15-64 years since 1987. In AML201 study, IDR (12 mg/m2/day for 3 days) or DNR (50 mg/m2/day for 5 days) in combination with Ara-C (100 mg/m2/day continuous infusion for 7 days) was established as the standard induction therapy, and four courses of combination chemotherapy using non-crossresistant agents for non-core binding factor (CBF) AML or three courses of high-dose Ara-C for CBF AML was established as the standard consolidation therapy. The AML97 study showed that allo-HSCT from an HLAidentical sibling donor reduced relapse incidence and improved disease-free survival (DFS), but did not significantly impact overall survival (OS) in poor or intermediate risk patients. Despite these studies by JALSG, only about one-third of AML patients remain free of disease for more than 7 years. The JALSG is now conducting the AML209 study to adapt individual therapies according to genetic alterations. © 2012 The Japanese Society of Hematology.


Tokita H.,Tokyo Metropolitan Ohtsuka Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

A 55-year-old man underwent Miles' operation with a diagnosis of rectal leiomyosarcoma in 1990. From 1998 to 2004, he had liver and lung metastases and local site recurrent tumors which were removed surgically. Immunohistochemically the recurrent tumor was positive for c-kit and CD34, and the diagnosis of GIST was confirmed. He took an adjuvant imatinib mesylate for half a year in 2004. In July 2005, he had a recurrent tumor in upper mediastinum. We restarted an imatinib after radiation therapy, and got a clinical CR. After he had interstitial pneumonitis in 2009, he stopped taking inmatinb. Then he took sunitinb for two months after an operation for the sixth local recurrence in February 2010. But the upper mediastium recurrent tumor occurred again in November 2010. We restarted sunitinb and got a clinical PR. The patient is now alive and well for 21 years after the initial operation by combined therapies.


Takazawa R.,Tokyo Metropolitan Ohtsuka Hospital | Kitayama S.,Tokyo Metropolitan Ohtsuka Hospital | Tsujii T.,Tokyo Metropolitan Ohtsuka Hospital
International Journal of Urology | Year: 2012

Although percutaneous nephrolithotomy has been recommended as the first-line treatment for renal stones larger than 2cm, its major complication rate is not negligible and less invasive approaches are to be explored. Thanks to the recent advances in endoscopic technology, flexible ureteroscopy has become another option in this setting. Herein we report our most recent experience with flexible ureteroscopy for large renal stones. Between September 2008 and May 2011, 20 patients with renal stones ≥2cm underwent a total of 28 procedures of ureteroscopy with holmium laser lithotripsy, using the Olympus URF-P5 and a ureteral access sheath. The number of procedures, operative time, stone-free rates, stone compositions and complications were evaluated. Stone-free status was defined as the absence of fragments or fragments of ≤4mm. Mean stone size was 3.1cm (range 2.0-5.0). The average number of procedures was 1.4. One, two and three procedures were required in 13, six and one patients, respectively. Overall, the stone-free rate was 90%. The stone-free rate for preoperative stone size of 2 to ≤4cm and >4cm was 100% (14/14) and 67% (4/6), respectively. No major intraoperative complications were identified. Postoperative high-grade fever was observed in three patients, including one patient who developed sepsis. All these patients were successfully treated conservatively. Our findings suggest that ureteroscopy represents a favorable option for selected patients with renal stones, especially those 2 to ≤4cm in size. © 2011 The Japanese Urological Association.


Takazawa R.,Tokyo Metropolitan Ohtsuka Hospital | Kitayama S.,Tokyo Metropolitan Ohtsuka Hospital | Tsujii T.,Tokyo Metropolitan Ohtsuka Hospital
International Journal of Urology | Year: 2012

Multiple stones are found in 20-25% of patients with urolithiasis. The stone multiplicity is a powerful adverse factor influencing the treatment outcome after shockwave lithotripsy, although guidelines for the treatment of multiple stones have not been well established yet. Herein we report our most recent experience of a single-session ureteroscopy for multiple stones. Between September 2008 and December 2011, 51 patients with multiple stones (total 146 stones) in different locations (37unilateral, 14 bilateral) underwent a total of 65 ureteroscopic procedures. Operative time, stone-free rates and complications were evaluated. Stone-free status was defined as no fragments in the ureter and the absence of >2mm fragments in the kidney. The mean stone number per patient was 2.9±1.7 and the mean stone burden (cumulative stone length) was 21.5±11.6mm. The mean number of procedures was 1.3±0.6. Overall, the stone-free rate after a single session was 80% (41/51). In patients with stone burden <20mm and ≥20mm, stone-free rates after a single session were 92% (23/25) and 69% (18/26), respectively. Multivariate analysis showed that the stone burden and the presence of impacted stones were the factors significantly influencing the treatment outcome. Stone location did not have a strong influence on the outcome. No major intraoperative complications were identified. Our findings suggest that ureteroscopy is an efficient treatment for multiple stones. For patients with stone burden <20mm, either unilaterally or bilaterally, a single session of ureteroscopy is a favorable treatment option with a high stone-free rate. © 2012 The Japanese Urological Association.


Mibe J.,Tokyo Metropolitan Ohtsuka Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2013

Control of the disease activity is enabled due to the progress of drug therapy for rheumatoid arthritis. However, surgical treatments are necessary for unresponsive cases to the drug or for achieving higher QOL, and we can attain more tight control or cure by combination of drug therapy and surgical treatments. Total joint arthroplasty provides indolence, mobility, stability and is an useful joint reconstruction method. Shoulder and elbow joint work as a reach function together, and total joint arthroplasty become adaptation when extensive joint destruction or severe pain occurrs. With the usage of biologic agents joint repair is possible in small joints, but if the joint destruction progress in weight-bearing joints, repair is impossible and total joint arthroplasty can be required.

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