PubMed | Red Cross, Nara Prefectural Gojo Hospital, Tachikawa General Hospital, Fujiyoshida Municipal Hospital and 46 more.
Type: Journal Article | Journal: Gastroenterology research | Year: 2016
To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia.We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements.Till October 31st 2010, 1,353 patients with Alzheimers dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia.These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.
Sakata-Yanagimoto M.,University of Tsukuba |
Enami T.,University of Tsukuba |
Yoshida K.,University of Tokyo |
Yoshida K.,Kyoto University |
And 38 more authors.
Nature Genetics | Year: 2014
Angioimmunoblastic T cell lymphoma (AITL) is a distinct subtype of peripheral T cell lymphoma characterized by generalized lymphadenopathy and frequent autoimmune-like manifestations. Although frequent mutations in TET2, IDH2 and DNMT3A, which are common to various hematologic malignancies, have been identified in AITL, the molecular pathogenesis specific to this lymphoma subtype is unknown. Here we report somatic RHOA mutations encoding a p.Gly17Val alteration in 68% of AITL samples. Remarkably, all cases with the mutation encoding p.Gly17Val also had TET2 mutations. The RHOA mutation encoding p.Gly17Val was specifically identified in tumor cells, whereas TET2 mutations were found in both tumor cells and non-tumor hematopoietic cells. RHOA encodes a small GTPase that regulates diverse biological processes. We demonstrated that the Gly17Val RHOA mutant did not bind GTP and also inhibited wild-type RHOA function. Our findings suggest that impaired RHOA function in cooperation with preceding loss of TET2 function contributes to AITL-specific pathogenesis. © 2014 Nature America, Inc.
Tanaka T.,Toride Medical Center |
Maeda Y.,Toride Medical Center
Japanese Journal of Nephrology | Year: 2015
A 68-year-old woman visited JA Toride Medical Center with asymptomatic proteinuria. Bence Jones protein-λ was identified in her serum and urine samples, and subsequent bone marrow aspiration revealed multiple myeloma (MM). Simultaneous renal biopsy showed only minor glomerular abnormality and preserved interstitium. Since the clinical stage was not advanced, aggressive treatment was avoided. During the following six months, her renal function gradually deteriorated with sustained elevation of urine protein and β2 microglobulin excretion, although other routine blood tests yielded stable results. In contrast to the first renal biopsy, the second biopsy specimen exhibited findings suggestive of inflammatory cell infiltration associated with light chain deposition along the tubular basement membrane. However, her myeloma did not cause symptoms other than mild renal disorder and remained in the category of indolent myeloma. Therefore a moderate dose of steroid therapy according to the regimen of common interstitial nephritis was initiated and her renal function and urinary findings partially recovered. Subsequently, her condition was diagnosed as infiltration of plasma cells with positive λ-light chain deposition. Since direct infiltration of myeloma cells into the renal interstitium rarely causes renal failure especially at the initial stage, we did not conduct intensive chemotherapy with possible severe side effects. More intensive chemotherapy would have been administered if the patient had suffered from other organ damage. There are no reports of cases in whom steroid alone was effective against multiple myeloma, hence this case is of clinical significance in providing a treatment option for renal dysfunction caused by restricted infiltration of myeloma cells, especially for cases where intensive chemotherapy is contraindicated.
Shintani S.,Toride Medical Center
Journal of Clinical Neuroscience | Year: 2013
Outcomes, particularly survival, for home-care patients with neurologic impairments who receive artificial nutrition, such as home parenteral nutrition (HPN) or percutaneous endoscopic gastrostomy (PEG) feeding, remain unclear. The efficacy of tube feeding for life prolongation in elderly patients remains controversial. The aim of this study was to assess the survival of elderly patients with neurologic impairments after the start of HPN or PEG. We retrospectively evaluated 80 patients with neurologic impairments who had received home care before they died. They were divided into three groups according to feeding method: oral-intake group (n = 23), HPN group (n = 21) and PEG group (n = 36). The factors considered were: age; survival period after commencement of home care; swallowing function; serum albumin concentration; level of activities of daily living (ADL); and behavioral, cognitive and communication functions. Survival periods of the patients in the PEG (736 ± 765 days) and HPN (725 ± 616 days) groups were twice that of the self-feeding oral-intake group (399 ± 257 days) despite lower serum albumin concentration (for PEG patients), reduced swallowing function and cognitive function, and poorer levels of ADL at the start of home care. Almost all patients were incapable of deciding whether they should receive artificial nutrition due to dementia or poor comprehension. Physicians should provide clinical evidence to families before commencing PEG feeding or HPN and support their decisions to maintain the dignity of the patient. © 2012 Elsevier Ltd. All rights reserved.
Shimada S.,Toride Medical Center
BMJ case reports | Year: 2013
Malignant gastric lymphoma, accounting only for 1% of primary gastric carcinoma, is usually a diffuse large B-cell lymphoma. Toyota et al reported that 37% of gastric perforations involved malignancy, generally gastric carcinoma. Fukuda et al found that less than 5% of malignant gastric lymphomas perforate. While it is relatively well known that perforations often take place during chemotherapy, they are rare in patients not receiving chemotherapy. To our knowledge, spontaneous perforation is rare in gastric malignant lymphoma, having been reported in the Japanese literature only 26 times, including this case, in the last 25 years.
Shimada S.,Toride Medical Center |
Gen T.,Toride Medical Center |
Okamoto H.,Toride Medical Center
BMJ Case Reports | Year: 2013
Malignant gastric lymphoma, accounting only for 1% of primary gastric carcinoma, is usually a diffuse large B-cell lymphoma. Toyota et al reported that 37% of gastric perforations involved malignancy, generally gastric carcinoma. Fukuda et al found that less than 5% of malignant gastric lymphomas perforate. While it is relatively well known that perforations often take place during chemotherapy, they are rare in patients not receiving chemotherapy. To our knowledge, spontaneous perforation is rare in gastric malignant lymphoma, having been reported in the Japanese literature only 26 times, including this case, in the last 25 years. Copyright 2013 BMJ Publishing Group. All rights reserved.
Kuboyama O.,Tsukuba Heart Clinic |
Tokunaga T.,Toride Medical Center
Clinical Trials and Regulatory Science in Cardiology | Year: 2016
Background Contrast-induced acute kidney injury (CI-AKI) is associated with adverse outcomes. However, the problem complicating CI-AKI relates to its definition. More than 30 definitions of AKI have been used in the literature. We examined the prevalence of CI-AKI according to three criteria. Prevalence of cardiovascular events according to each criterion was also investigated. Methods We studied 247 consecutive patients with acute myocardial infarction (66.7 ± 9.0 years, 189 males) who underwent primary percutaneous coronary intervention in our hospital. Three definitions of CI-AKI were applied: (i) traditional CI-AKI, (ii) CI-AKI derived from RIFLE criteria, (iii) CI-AKI derived from AKIN criteria. Cardiovascular events comprised in-hospital death, sudden death, cerebral infarction, heart failure, and acute coronary syndrome. Results Prevalence of CI-AKI was 27.1% (67/247) according to the traditional CI-AKI definition, 23.9% (59/247) according to the CI-AKI definition derived from RIFLE criteria, and 15.8% (39/247) according to the CI-AKI definition derived from AKIN criteria. Prevalence of cardiovascular events was 13.8% (34/247). Prevalence of cardiovascular events with and without CI-AKI was 19.4% (13/67) and 11.7% (21/180) according to the traditional CI-AKI definition (P = 0.13), 22.0% (13/59) and 11.2% (21/188) in the CI-AKI definition derived from RIFLE criteria (P = 0.035), and 35.9%(14/39) and 9.6% (20/208) according to the CI-AKI derived from AKIN criteria (P = 0.00001). Conclusion Prevalence of CI-AKI varies widely depending on the criteria used. The CI-AKI definition derived from AKIN criteria was the most effective predictor of cardiovascular events. © 2015 Published by Elsevier Ltd.
PubMed | Tokyo Medical and Dental University, Tokyo Kyosai Hospital and Toride Medical Center
Type: Journal Article | Journal: PloS one | Year: 2016
Atherosclerosis is often a complication of chronic kidney disease (CKD) because of dyslipidemia and CKD-mineral and bone disorder. High-density lipoproteins (HDLs) are grouped into various subclasses composed of multiple proteins and lipids, and their transformation is altered in CKD. We investigated the roles of lipoprotein subclasses in CKD progression, and atherosclerosis, and the relationships with Klotho and fibroblast growth factor (FGF) 23.Seventy-one CKD patients were enrolled in this prospective cohort study in Japan. The proportions of cholesterol level to total cholesterol level (cholesterol proportion) and lipoprotein particle numbers in 20 lipoprotein fractions were measured by a newly developed high-performance gel permeation chromatography.Diabetic nephropathy was observed in 23.9% of the patients. The mean age was 75.0 years and estimated glomerular filtration rate (eGFR) was 17.2 ml/min./1.73m2. The lipoprotein particle numbers in small HDLs were higher in Stage 4 group than in Stage 5 group (p = 0.002). Multivariate regression analysis adjusted for baseline characteristics showed that the cholesterol proportions in very small HDLs were associated with eGFR change rate [F19 = -17.63, p = 0.036] and ABI [F19 = 0.047, p = 0.047] in Stage 4 group, and that serum soluble -Klotho level was associated with the lipoprotein particle numbers in very small HDLs [F19 = 0.00026, p = 0.012; F20 = 0.00041, p = 0.036] in Stage 5 group.This study showed that HDL subclasses are associated with CKD progression, ABI, and Klotho level in CKD-stage-specific manner.
PubMed | Toride Medical Center
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016
A 72-year-old female patient was referred to our department because she felt pain at the anus with pus discharge. Physical examination revealed a tumor on the left side of the anus, and a subcutaneous induration near the tumor. Abdominal CT scan revealed an irregularly shaped tumor with abscess formation. There were no enlarged lymph nodes or distant metastasis. Anal canal carcinoma (cStage ) with a complication of perianal abscess was suspected, so we performed surgical incision and drainage. A biopsy of the tumor led to the diagnosis of squamous cell carcinoma. However, because surgical drainage alone was not effective for treatment of the abscess, colostomy of the sigmoid colon was carried out 14 days after admission. After chemoradiation therapy (5-FU 800 mg/m2/day on days 1-4 and 29-32, mitomycin C [MMC] 10 mg/m2 on days 1 and 29, and radiation with a total dose 54 Gy), the tumor disappeared completely, considered to be a complete response. Twenty months after chemoradiation, there were no signs of recurrence.
PubMed | Toride Medical Center
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016
We report a case of brain metastasis from rectal cancer a long time after the initial resection. A 62-year-old woman, diagnosed with lower rectal cancer with multiple synchronous liver and lung metastases, underwent abdominoperineal resection after preoperative radiochemotherapy (40 Gy at the pelvis, using the de Gramont regimen FL therapy: 1 kur). The histological diagnosis was a moderately differentiated adenocarcinoma. Various regimens of chemotherapy for unresectable and metastatic colorectal cancer were administered, and a partial response was obtained; thereby, the metastatic lesions became resectable. The patient underwent partial resection of the liver and lung metastases. Pathological findings confirmed that both the liver and lung lesions were metastases from the rectal cancer. A disease-free period occurred for several months; however, there were recurrences of the lung metastases, so we started another round of chemotherapy. After 8 months, she complained of vertigo and dizziness. A left cerebellar tumor about 3 cm in diameter was revealed by MRI and neurosurgical excision was performed. Pathological findings confirmed a cerebellar metastasis from the rectal cancer. Twenty months after resection of the brain tumor, the patient complained of a severe headache. A brain MRI showed hydrocephalia, and carcinomatous meningitis from rectal cancer was diagnosed by a spinal fluid cytology test. A ventriculo-peritoneal shunt was inserted, but the cerebrospinal pressure did not decreased and she died 20 months after the first surgery. Although brain metastasis from colorectal cancer is rare, the number of patients with brain metastasis is thought to increase in the near future. Chemotherapy for colorectal cancer is effective enough to prolong the survival period even if multiple metastases have occurred. However, after a long survival period with lung metastases such as in our case, there is a high probability of developing brain metastases.