Verification of the Usefulness of an Assessment and Risk Control Sheet that Promotes Management of Cancer Drug Therapy.

Background: Proper management of adverse events is crucial for the safe and effective implementation of anticancer drug treatment. Showa University Hospital uses our interview sheet (assessment and risk control [ARC] sheet) for the accurate evaluation of adverse events. On the day of anticancer drug treatment, a nurse conducts a face-to-face interview. As a feature of the ARC sheet, by separately describing the symptoms the day before treatment and the day of treatment and sharing the information on the medical record, it is possible to clearly determine the status of adverse events. In this study, we hypothesized that the usefulness and points for improvement of the ARC sheet would be clarified by using and evaluating a patient questionnaire. Methods: This study included 174 patients (144 at Showa University Hospital (Hatanodai Hospital) and 30 at Showa University Koto Toyosu Hospital (Toyosu Hospital) who underwent pre-examination interviews by nurses and received cancer chemotherapy at the outpatient center of Hatanodai and Toyosu Hospital. In the questionnaire survey, the ARC sheet's content and quality, respondents' satisfaction, structural strengths, and points for improvement were evaluated on a five-point scale. Results: The patient questionnaire received responses from 160 participants, including the ARC sheet use group (132 people) and the non-use group (28 people). Unlike the ARC sheet non-use group, the ARC sheet use group recognized that the sheet was useful to understand the adverse events of aphthous ulcers (p = 0.017) and dysgeusia (p = 0.006). In the satisfaction survey questionnaire, there was a high sense of security in the pre-examination interviews by nurses using the ARC sheet. Conclusions: The ARC sheet is considered an effective tool for comprehensively evaluating adverse events. Pre-examination interviews by nurses using ARC sheets accurately determined the adverse events experienced by patients with anxiety and tension due to confrontation with physicians.

Tumor angiogenesis, hepatocyte growth factor, and c-Met expression in endometrial carcinoma.

BACKGROUND: This study was designed to evaluate the significance of tumor angiogenesis and angiogenic factors such as hepatocyte growth factor (HGF) and c-Met in determining the prognoses of 93 patients with endometrial carcinoma. METHODS: By immunohistochemical staining, this retrospective study investigated tumor angiogenesis, HGF expression, and c-Met expression, using one tissue slide that was representative of the invasive edge of the tumor. To evaluate tumor angiogenesis, the microvessels within the primary endometrial carcinoma were highlighted by staining their endothelial cells immunohistochemically for von Willebrand factor (VWF). The microvessels were then counted in the most intense areas of neovascularization. HGF and c-Met were identified with specific antibodies. Tumor angiogenesis, HGF expression, and c-Met expression were correlated with both the prognostic variables for and the survival of endometrial carcinoma. RESULTS: A high microvessel count (> or = 110 in a 0.90 mm2 area) was significantly correlated with surgical Stage III and IV, histologic Grade 3, positive lymph node involvement, and shorter patient survival. Expression of c-Met was significantly correlated with surgical Stage III and IV, histologic Grade 3, and shorter survival. HGF expression was significantly correlated with surgical Stage III and IV by semiquantitative analysis. Multivariate analysis showed that surgical Stage III and IV, histologic Grade 3, the score for myometrial invasion > 1/2, and a high microvessel count were independent indicators of the prognoses of patients with endometrial carcinoma. CONCLUSIONS: Both tumor angiogenesis, measured by the microvessel count, and c-Met expression were significant prognostic indicators for patients with endometrial carcinoma.

A case of female adnexal tumor of probable Wolffian origin: histologically, tumor cells showed three different patterns.

We report a 63-year-old woman with a female adnexal tumor of probable Wolffian origin, which arose within the leaves of the broad ligament, connected to the left ovary and the fallopian tube. She remains alive without evidence of disease 2 years after left salpingo-oophorectomy without subsequent adjuvant therapy. Microscopically, tumor cells were arranged in three different patterns; closely packed tubules, solid, and sieve-like. Cells had uniform round or oval nuclei and mitoses were rare. Although the majority of these tumors are benign, a few cases have shown malignant potential. Therefore, such tumors should receive careful follow-up for possible recurrence and/or metastasis.

[Comprehensive evaluation of pharmacokinetic and clinical studies on tazobactam/piperacillin in pediatric field].

To evaluate the pharmacokinetic and clinical effects of the newly developed combination antibiotic tazobactam/piperacillin (TAZ/PIPC, YP-14) on various infections in pediatric field, a study group was organized, and a joint research by 17 institutions and their related hospitals was conducted. Informed consents of subjects were obtained prior to the study. The results obtained in this study are as follows: 1. Blood concentration and urinary excretion Pharmacokinetics of TAZ/PIPC was studied in children at doses of 25 and 50 mg/kg through intravenous injection or intravenous drip infusion. With intravenous injection, maximum blood concentrations (Cmax's) of TAZ and PIPC were achieved 5 minutes after the administration. Cmax's of TAZ were 26.9 micrograms/ml with 25 mg/kg and 45.1 micrograms/ml with 50 mg/kg, and those of PIPC were 131.0 and 199.6 micrograms/ml, respectively. Values of the total area under the blood concentration curve (AUC's) of TAZ were 14.2 micrograms.hr/ml with 25 mg/kg and 26.1 micrograms.hr/ml with 50 mg/kg, and those of PIPC were 64.0 and 112.8 micrograms.hr/ml, respectively; thus dose dependency was observed with both TAZ and PIPC. The Cmax's of desethyl piperacillin (DEt-PIPC), the active metabolite of PIPC, achieved at 60 minutes after administration, were 1.2 and 2.0 micrograms/ml, respectively. The AUC's of DEt-PIPC were 2.6 and 4.2 micrograms.hr/ml, respectively. The half-lives (T 1/2's) of TAZ were 0.60 and 0.54 hour, respectively, and those of PIPC were 0.62 and 0.65 hour, respectively. In the first 6 hours after the initiation of administration, the cumulative recovery rates of TAZ in the urine were 46.7 and 56.0% respectively, those of PIPC were 46.1 and 57.2%, respectively, and those of DEt-PIPC were 5.9 and 3.0%, respectively. With intravenous drip infusion, the Cmax's of both TAZ and PIPC were achieved at the completion of drip; the Cmax's of TAZ were 12.1 micrograms/ml with 25 mg/kg and 28.9 micrograms/ml with 50 mg/kg, and those of PIPC were 54.6 and 137.9 micrograms/ml, respectively. The AUC's of TAZ were 11.6 micrograms.hr/ml with 25 mg/kg and 25.6 micrograms.hr/ml with 50 mg/kg, and those of PIPC were 49.0 and 117.2 micrograms.hr/ml, respectively; thus dose dependency was observed with both TAZ and PIPC. Cmax's of DEt-PIPC, achieved at 60 minutes after completion of drip, were 0.9 and 1.7 micrograms/ml, respectively. The AUC's of DEt-PIPC were 2.0 and 3.8 micrograms.hr/ml, respectively. The half-lives (T 1/2's) of TAZ were 0.59 and 0.62 hour, respectively, and those of PIPC were 0.58 and 0.57 hour, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

The incidence of vertical transmission of hepatitis C virus.

This study was undertaken to clarify the incidence of the vertical transmission of hepatitis C virus (HCV). During the third trimester, 2015 pregnant women were examined as to anti-HCV antibodies. Anti-HCV antibody seropositive women were examined for HCV-RNA in peripheral blood at labor and in breast milk. Their offspring were also examined for HCV-RNA in umbilical cord blood and peripheral blood one week after birth and during subsequent outpatient visits. The following results were obtained: (1) Twelve of the 2015 pregnant women (0.6%) were seropositive for anti-HCV antibodies; (2) Seven of the twelve women (58%) seropositive for anti-HCV antibodies were also seropositive for HCV-RNA; (3) Three newborns of the seven HCV-RNA seropositive women (43%) were found to have HCV-RNA in the cord blood; (4) In the three newborns HCV-RNA had disappeared from the peripheral blood within one month after birth; (5) Two of the seven HCV-RNA seropositive women (29%) had HCV-RNA positive breast milk; (6) The possibility of infection via breast milk was shown in one infant at ten months after birth. Based on these results, it is indicated that HCV vertical transmission is possible in more than half of the HCV-RNA seropositive mothers. However, because of the disappearance of HCV from the infants' peripheral blood, further following study is needed.

Smooth pursuit eye movements in epileptics under antiepileptic medication.

1) Smooth pursuit eye movements (SPEM) were recorded in 18 normal, 20 schizophrenic and 50 epileptic subjects. Most of the schizophrenic and epileptic subjects were under medication, antipsychotic drugs in the former and antiepileptic drugs in the latter. 2) In schizophrenics and epileptics, rate of the saccadic component in SPEM was higher than that of normal controls. The rate of large amplitude saccades was higher in epileptics than in schizophrenics. 3) Though small amplitude saccades were usually superimposed on SPEM in schizophrenic patients, both large and small amplitude saccades superimposed irregularly on the smooth tracking curve were observed in epileptics, and overshoots or undershoots were also seen frequently. 4) SPEM disorder in epileptics was observed in more than half of patients receiving antiepileptic medication, especially in patients with a long period of treatment. SPEM disorder in epileptics tended to occur frequently in patients who received phenytoin in doses higher than a certain level; i.e. approximately 150 mg per day for a long period of time. 5) It is conceivable that the SPEM disorder represents a latent or subclinical cerebellar dysfunction due to phenytoin medication. It is suggested that the SPEM measurement is a useful tool to find out subclinical side effects of antiepileptic drug in the treatment of epilepsy.