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1.
Medicine (Baltimore) ; 99(3): e18880, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011515

RESUMO

INTRODUCTION: Pleomorphic xanthoastrocytomas (PXA) are rare, typically benign, slow-growing tumors that commonly occur in the cerebral hemispheres. We describe two cases of clinically aggressive PXA with uncommon locations; one was in the tectal plate, and the other had simultaneous multicentric lesions. PATIENT CONCERNS: The both cases presented with severe headache with no significant past medical history. DIAGNOSIS: PXA World Health Organization grade II were histopathologically diagnosed from surgically resected specimens, and immunohistochemical and sequence analysis revealed a high Ki-67 proliferative index and BRAF V600E mutation in both the cases. INTERVENTIONS: The first case presented with multicentric lesions and underwent partial resection, whereas the second case presented with a tectal plate tumor that was managed by gross total surgical resection. Strong 5-aminolevulinic acid (5-ALA)-induced fluorescence was observed in both the lesions. Postoperative radiotherapy plus concomitant and adjuvant temozolomide was administered to both the patients. OUTCOMES: Despite completing adjuvant chemo-radiotherapy, both the patients had local tumor recurrence at 2 and 5 months after the operation, respectively. CONCLUSION: The progressive clinical courses in our cases suggest that additional postoperative therapy should be considered during the treatment of PXA with a high Ki67 index, and that temozolomide with radiotherapy, followed by temozolomide maintenance therapy, may not prevent recurrence in such tumors. Importantly, our experience implies that unlike other subtypes of low grade gliomas, 5-ALA fluorescence is useful for intraoperative visualization of PXA.

2.
J Appl Clin Med Phys ; 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31957975

RESUMO

The aim of this study is to evaluate the patient positioning uncertainty in noncoplanar stereotactic radiosurgery or stereotactic radiotherapy (SRS/SRT) for intracranial lesions with the frameless 6D ExacTrac system. In all, 28 patients treated with SRS/SRT of 70 treatment plans at our institution were evaluated in this study. Two X-ray images with the frameless 6D ExacTrac system were first acquired to correct (XC) and verify (XV) the patient position at a couch angle of 0º. Subsequently, the XC and XV images were also acquired at each planned couch angle for using noncoplanar beams to detect position errors caused by rotating a couch. The translational XC and XV shift values at each couch angle were calculated for each plan. The percentages of the translational XC shift values within 1.0 mm for each planned couch angle for using noncoplanar beams were 77.86%, 72.26%, and 98.47% for the lateral, longitudinal, and vertical directions, respectively. Those within 2.0 mm were 98.22%, 97.96%, and 99.75% for the lateral, longitudinal, and vertical directions, respectively. The maximum absolute values of the translational XC shifts among all planned couch angles for using noncoplanar beams were 2.69, 2.45, and 2.17 mm for the lateral, longitudinal, and vertical directions, respectively. The overall absolute values of the translational XV shifts were less than 1.0 mm for all directions except for one case in the longitudinal direction. The patient position errors were detected after couch rotation for using noncoplanar beams, and they exceeded a planning target volume (PTV) margin of 1.0-2.0 mm used commonly in SRS/SRT treatment. These errors need to be corrected at each planned couch angle, or the PTV margin should be enlarged.

3.
Cardiovasc Res ; 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31977013

RESUMO

AIMS: The genetic cause of cardiac conduction system disease (CCSD) has not been fully elucidated. Whole-exome sequencing (WES) can detect various genetic variants; however, the identification of pathogenic variants remains a challenge. We aimed to identify pathogenic or likely pathogenic variants in CCSD patients by using WES and 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines as well as evaluating the usefulness of functional studies for determining them. METHODS AND RESULTS: We performed WES of 23 probands diagnosed with early-onset (<65 years) CCSD and analyzed 117 genes linked to arrhythmogenic diseases or cardiomyopathies. We focused on rare variants (minor allele frequency < 0.1%) that were absent from population databases. Five probands had protein truncating variants in EMD and LMNA which were classified as "pathogenic" by 2015 ACMG standards and guidelines. To evaluate the functional changes brought about by these variants, we generated a knock-out zebrafish with CRISPR-mediated insertions or deletions of the EMD or LMNA homologs in zebrafish. The mean heart rate and conduction velocities in the CRISPR/Cas9-injected embryos and F2 generation embryos with homozygous deletions were significantly decreased. Twenty-one variants of uncertain significance were identified in 11 probands. Cellular electrophysiological study and in vivo zebrafish cardiac assay showed that 2 variants in KCNH2 and SCN5A, 4 variants in SCN10A, and 1 variant in MYH6 damaged each gene, which resulted in the change of the clinical significance of them from "Uncertain significance" to "Likely pathogenic" in 6 probands. CONCLUSIONS: Of 23 CCSD probands, we successfully identified pathogenic or likely pathogenic variants in 11 probands (48%). Functional analyses of a cellular electrophysiological study and in vivo zebrafish cardiac assay might be useful for determining the pathogenicity of rare variants in patients with CCSD. SCN10A may be one of the major genes responsible for CCSD. TRANSLATIONAL PERSPECTIVE: Whole-exome sequencing (WES) may be helpful in determining the causes of cardiac conduction system disease (CCSD), however, the identification of pathogenic variants remains a challenge. We performed WES of 23 probands diagnosed with early-onset CCSD, and identified 12 pathogenic or likely pathogenic variants in 11 of these probands (48%) according to the 2015 ACMG standards and guidelines. In this context, functional analyses of a cellular electrophysiological study and in vivo zebrafish cardiac assay might be useful for determining the pathogenicity of rare variants, and SCN10A may be one of the major development factors in CCSD.

4.
J Radiat Res ; 2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31927580

RESUMO

Modern treatment machines have shown small inter-unit variability regarding beam data. Recently, vendor-provided average beam data, such as the Representative Beam Data (RBD) of the TrueBeam (Varian Medical Systems, Palo Alto, CA, USA), has been used for modeling of the Eclipse (Varian Medical Systems) treatment planning system. However, RBD does not provide multi-leaf collimator (MLC) parameters, such as MLC leaf transmission factor (LTF) and dosimetric leaf gap (DLG). We performed a web-based multi-institutional survey to investigate these parameters as well as the measurement protocols and customization of the parameters for intensity-modulated radiotherapy (IMRT) and/or volumetric modulated radiotherapy (VMAT) commissioning. We collected 69 sets of linear accelerator (linac) data from 58 institutions. In order to measure MLC parameters, most institutions used farmer-type ionization chambers with a sensitive volume of 0.6 cm3, water phantoms, source surface distance of 90 cm with 10 cm depth, and a vendor-provided plan. The LTF showed small inter-unit variabilities, although the DLG showed large variations. For optimization of the parameters for IMRT/VMAT calculations, DLG values were upwardly adjusted at many institutions, whereas the LTF values were modestly changed. We clarified that MLC parameters were measured under the same conditions at more than half of the facilities. Most institutions customized parameters in a similar manner for IMRT/VMAT. The median measured and customized values obtained in our study will be valuable to verify MLC installation accuracy and to shorten the iterative processes of finding the optimal values.

5.
Dev Growth Differ ; 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31943159

RESUMO

Morphogenesis and organ development should be understood based on a thorough description of cellular dynamics. Recent studies have explored the dynamic behaviors of mammalian neural progenitor cells (NPCs) using slice cultures in which three-dimensional systems conserve in vivo-like environments to a considerable degree. However, live observation of NPCs existing truly in vivo, as has long been performed for zebrafish NPCs, has yet to be established in mammals. Here, we performed intravital two-photon microscopic observation of NPCs in the developing cerebral cortex of H2B-EGFP or Fucci transgenic mice in utero. Fetuses in the uterine sac were immobilized using several devices and were observed through a window made in the uterine wall and the amniotic membrane while monitoring blood circulation. Clear visibility was obtained to the level of 300 µm from the scalp surface of the fetus, which enabled us to quantitatively assess NPC behaviors, such as division and interkinetic nuclear migration, within a neuroepithelial structure called the ventricular zone at embryonic day (E) 13 and E14. In fetuses undergoing healthy monitoring in utero for 60 min, the frequency of mitoses observed at the apical surface was similar to those observed in slice cultures and in freshly fixed in vivo specimens. Although the rate and duration of successful in utero observations are still limited (33% for ≥10 min and 14% for 60 min), further improvements based on this study will facilitate future understanding of how organogenetic cellular behaviors occur or are pathologically influenced by the systemic maternal condition and/or maternal-fetal relationships.

6.
J Appl Clin Med Phys ; 21(1): 78-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31816176

RESUMO

PURPOSE: Detector-dependent interinstitutional variations of the beam data may lead to uncertainties of the delivered dose to patients. Here we evaluated the inter-unit variability of the flattened and flattening filter-free (FFF) beam data of multiple TrueBeam (Varian Medical Systems) linear accelerators focusing on the small-field dosimetry. METHODS: The beam data of 6- and 10-MV photon beams with and without flattening filter measured for modeling of an iPLAN treatment planning system (BrainLAB) were collected from 12 institutions - ten HD120 Multileaf Collimator (MLC) and two Millennium120 MLC. Percent-depth dose (PDD), off-center ratio (OCR), and detector output factors (OFdet ) measured with different detectors were evaluated. To investigate the detector-associated effects, we evaluated the inter-unit variations of the OFdet before and after having applied the output correction factors provided by the International Atomic Energy Agency (IAEA) Technical Reports Series no. 483. RESULTS: PDD measured with a field size of 5 × 5 mm2 showed that the data measured using an ionization chamber had variations exceeding 1% from the median values. The maximum difference from median value was 2.87% for 10 MV photon beam. The maximum variations of the penumbra width for OCR with 10 × 10 mm2 field size were 0.97 mm. The OFdet showed large variations exceeding 15% for a field size of 5 × 5 mm2 . When the output correction factors were applied to the OFdet , the variations were greatly reduced. The relative difference of almost all field output factors were within ± 5% from the median field output factors. CONCLUSION: In this study, the inter-unit variability of small-field dosimetry was evaluated for TrueBeam linear accelerators. The variations were large at a field size of 5 × 5 mm2 , and most occurred in a detector-dependent manner.

7.
J Appl Clin Med Phys ; 21(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31738002

RESUMO

This study evaluates the type of detector influencing the inter-institutional variability in flattening filter-free (FFF) beam-specific parameters for TrueBeam™ linear accelerators (Varian Medical Systems,Palo Alto, CA, USA). Twenty-four beam data sets, including the percent depth dose (PDD), off-center ratio (OCR), and output factor (OPF) for modeling within the Eclipse (Varian Medical Systems) treatment planning system, were collected from 19 institutions. Although many institutions collected the data using CC13 (IBA Dosimetry, Schwarzenbruck, Germany) or PTW31010 semiflex (PTW Freiburg, Freiburg, Germany) ionization chambers, some institutions used diode detectors, diamond detectors, and ionization chambers with smaller cavities. The OCR data included penumbra width, full width at half maximum (FWHM), and FFF beam-specific parameters, including unflatness and slope. The data measured by CC13/PTW31010 ionization chambers were compared with those measured by all other detectors. PDD data demonstrated the variations within ±1% at the dose fall-off region deeper than peak depth. The penumbra widths of the OCR measured with the CC13/PTW31010 detectors were significantly larger than those measured with all other detectors (P < 0.05). Especially the EDGE detector (Sun Nuclear Corp., Melbourne, FL, USA) and the microDiamond detectors (model 60019; PTW Freiburg) demonstrated much smaller penumbra values compared to those of the CC13/PTW31010 detectors for the 30 × 30 mm2 field. There was no difference in the FWHM, unflatness, and slope parameters between the values for the CC13/PTW31010 detectors and all other detectors. OPF curves demonstrated small variations, and the relative difference from the mean value of each data point was almost within 1% for all field sizes. Although the penumbra region exhibited detector-dependent variations, all other parameters showed tiny interunit variations regardless of the detector type.

8.
World J Surg Oncol ; 17(1): 197, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31771590

RESUMO

BACKGROUND: In Japan, the majority of gastrointestinal tract neuroendocrine tumors (NETs) have been reported to originate from the rectum, and appendiceal NETs are relatively rare. Preoperative diagnosis is very difficult and it is diagnosed after appendectomy. Pediatric appendiceal NET is a disease with a good prognosis. However, in rare cases, lymph node metastasis could occur and additional resection is required. CASE PRESENTATION: A 10-year-old boy complained of right lower quadrant abdominal pain and underwent an appendectomy under a diagnosis of acute appendicitis in previous hospital. The final diagnosis was appendiceal NET, so he was referred to our department for additional resection. The tumor was found in the base of the appendix and invasively reached the subserosal layer with obvious vascular invasion. His Ki-67 index was 1 to 2%, so we classified it as appendiceal NET G1 according to the WHO 2015 classification. We considered the possibility of a tumor remnant or lymph node metastasis, so we performed single-incision laparoscopy with D3 lymph node dissection. The pathological diagnosis revealed no tumor remnant but metastasis to one lymph node. He was discharged on the 9th postoperative day. There has been no recurrence at 3 years and 7 months after surgery. CONCLUSION: When the tumor size is 10-20 mm, the frequency of lymph node metastasis in some reports is variable, and there is no consensus yet on the indications for additional resection. However, there are definitely a certain number of cases with lymph node metastasis that require additional resection. In the present patient, long-term survival can be obtained by additional resection. At present, factors such as the presence of vascular or lymph node invasion and the malignancy grade and tumor's location must be considered on a case-by-case basis. Although the incidence rate of appendiceal NET is rare, the diagnosis can be made only during postoperative pathological examination; thus, reliable histopathological examination is required.

9.
World J Surg Oncol ; 17(1): 178, 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677643

RESUMO

BACKGROUND: In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major complication related to patients' quality of life and prognosis. METHODS: This study was a retrospective, single-institution study of 101 rectal cancer patients who underwent laparoscopic low anterior resection (LAR) with DST anastomosis (excluding simultaneous resection of other organs and construction of protective diverting stoma) between February 2008 and November 2017 at the Gifu University Graduate School of Medicine. This study aimed to identify risk and early predictive factors of AL. RESULTS: Among 101 patients, symptomatic AL occurred in 13 patients (12.9%), of whom 10 were male and 3 were female. Their median BMI was 22.7 kg/m2 (range, 17.9-26.4 kg/m2). Among the pre- and intraoperative factors, AL was significantly associated with tumor location (lower rectum), distance from the anal verge (< 6 cm), intraoperative blood loss (≥ 50 ml), and the number of linear staples (≥ 2) in univariate analysis. In multivariate analysis, only intraoperative blood loss (≥ 50 ml, odds ratio [OR] 4.59; 95% confidence interval [CI] 1.04-19.52; p = 0.045) was identified as an independent risk factor for AL. Among the postoperative factors, AL was significantly associated with tachycardia-POD1 (≥ 100 bpm), CRP-POD3 (≥ 15 mg/dl), fever on postoperative day (fever-POD) 3 (≥ 38 °C), and first defecation day after surgery (< POD3) in univariate analysis. In multivariate analysis, fever-POD3 (≥ 38 °C, OR 30.97; 95% CI 4.68-311.22; p = 0.0003) and first defecation day after surgery (< POD3, OR 5.82; 95% CI 1.34-31.30; p = 0.019) were identified as early predictive factors for AL. CONCLUSION: In this study, intraoperative blood loss was an indicator of difficulty in a transection and anastomosing procedure, and fever-POD3 and early first defecation day after surgery were independent early predictive factors for AL. Careful surgery using an appropriate technique and standardized procedures with minimal bleeding and careful postoperative management paying attention to fever and defecation may prevent the onset and severity of AL.

10.
Rep Pract Oncol Radiother ; 24(6): 576-584, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31719798

RESUMO

Aim: This study compared volumetric-modulated arc therapy (VMAT) plans for head and neck cancers with and without an external body contour extended technique (EBCT). Background: Dose calculation algorisms for VMAT have limitations in the buildup region. Materials and methods: Three VMAT plans were enrolled, with one case having a metal artifact from an artificial tooth. The proper dose was calculated using Eclipse version 11.0. The body contours were extended 2 cm outward from the skin surface in three-dimensional space, and the dose was recalculated with an anisotropic analytical algorithm (AAA) and Acuros XB (AXB). Monitor units (MUs) were set, and the dose distributions in the planning target volume (PTV), clinical target volume, and organ at risk (OAR) and conformity index (CI) with and without an EBCT were compared. The influence of a metal artifact outside of the thermoplastic head mask was also compared. Results: The coverage of PTV by the 95% dose line near the patient's skin was increased drastically by using an EBCT. Plan renormalization had a negligible impact on MUs and doses delivered to OARs. CI of PTV with a 6-MV photon beam was closer to 1 than that with a 10-MV photon beam when both AAA and AXB were used in all cases. Metal artifacts outside the head mask had no effect on dose distribution. Conclusions: An EBCT is needed to estimate the proper dose at object volumes near the patient's skin and can improve the accuracy of the calculated dose at target volumes.

11.
Am J Med ; 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31743659

RESUMO

BACKGROUND: Erectile dysfunction has been associated with atrial fibrillation in cross-sectional studies, but the association of erectile dysfunction with incident atrial fibrillation is less well established. PURPOSE: To determine whether erectile dysfunction is independently associated with incident atrial fibrillation after adjusting for conventional risk factors. METHODS: We studied 1760 male participants (mean age 68 ± 9 years) from the Multi-Ethnic Study of Atherosclerosis (MESA), who completed self-reported erectile dysfunction assessment at MESA Exam 5 (2010-2012). Cumulative incidence of atrial fibrillation was estimated by Kaplan-Meier analysis. Cox proportional hazards regression was used to calculate the unadjusted and adjusted hazard ratios (HR) using three models in which variables were added in a stepwise manner. In Model 3, HR was adjusted for age, race/ethnicity, education, smoking status, alcohol use, systolic blood pressure, body mass index, diabetes, anti-hypertensive medication use, lipid-lowering medication use, total cholesterol, and estimated glomerular filtration rate. RESULTS: During the median follow-up of 3.8 (interquartile range, 3.5 - 4.2) years, 94 cases of incident atrial fibrillation were observed. There was a significant difference between men with and without erectile dysfunction for cumulative incident atrial fibrillation rates at 4 years (9.6 vs 2.9%, respectively, p < 0.01). In the fully adjusted model, erectile dysfunction remained associated with incident atrial fibrillation (Model 3; HR, 1.66; 95% Confidence Interval 1.01 - 2.72, p = 0.044). CONCLUSIONS: Among older male participants in this prospective study, we found that self-reported erectile dysfunction was associated with incident atrial fibrillation.

13.
PLoS One ; 14(10): e0223930, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31639140

RESUMO

This study sought to investigate whether force perceptual bias was affected by differences in posture while steering an automobile using a psychophysical experiment to examine the relationship with muscle activity. The human perceptual characteristics of weight and force are known to be nonlinear, and a perceptual bias can occur, that is, bias that causes a perception of something that is larger or smaller than the actual scale. This is considered to be caused by physical and/or psychological conditions. Sense of effort is believed to be one influential factor. It is known to correlate with muscle activity intensity, and bias may be caused by muscle activity changes. In the current study, we hypothesized that force perceptual bias would depend on posture due to the intensity of muscle activity changes caused by changing postures during steering operation. By investigating this hypothesis, we can clarify the relationship between sense of effort and muscle activity. To investigate this issue, we conducted a psychophysical experiment to confirm postural dependence, and estimated muscle activity using a three-dimensional musculoskeletal model simulation with postural and arm force data during the experiment. In addition, prediction of bias was conducted based on a simulation in the psychophysical experiment using these data. The results revealed that bias existed, as measured by differences in postures. Additionally, a significant moderate correlation was found between the predicted bias and the actual bias, indicating the existence of a relationship between muscle activity and bias.

14.
Mol Clin Oncol ; 11(4): 390-396, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475067

RESUMO

The combination regimen of TAS-102, a novel oral nucleoside antitumor agent containing trifluridine and tipiracil hydrochloride, with bevacizumab (C-TASK FORCE), a selective monoclonal antibody inhibitor of vascular endothelial growth factor-A, as salvage-line therapy for metastatic colorectal cancer (mCRC) was established based on its high clinical effectiveness. The aim of the present study was to evaluate the prognostic accuracy of the modified Glasgow Prognostic Score (mGPS) in patients receiving TAS-102 plus bevacizumab. The study included 17 patients (12 men and 5 women, mean age 60.4±13.4 years) with unresectable mCRC who were confirmed to have wild-type or mutant RAS genes. The patients received salvage-line treatment with TAS-102 plus bevacizumab at the Surgical Oncology Department of Gifu University School of Medicine between March 2016 and August 2018. The study population was heavily pretreated; the majority of the patients (71%) had received ≥4 prior regimens and, in addition to fluoropyrimidine, irinotecan and oxaliplatin, all had received bevacizumab (100%) and either cetuximab or panitumumab (47%). The RAS status was wild-type in 9 (53%) and mutant in 8 (47%) patients. The primary tumor locations included the right-sided colon in 5 patients (29%; cecum in 2 and transverse colon in 3 cases) and left-sided colorectum in 12 patients [71%; sigmoid colon in 4, rectosigmoid (Rs) in 4, and rectum above/below the peritoneal reflection (Ra/b) in 4 cases]. Metastatic sites included the liver in 15 (88%), lung in 13 (76%), lymph nodes in 7 (41%), and peritoneal dissemination in 5 (24%) patients. The number of metastatic sites was 1 in 3 (18%) and >2 in 14 (82%) patients. Their first staging imaging scans (after 2 cycles of therapy) were available for review in all 17 patients. At first evaluation, 5 (29%) patients had progressive disease (PD), 12 (71%) had stable disease, and none had a partial response to TAS-102 plus bevacizumab. The median overall survival (OS) of 14.1 months and progression-free survival (PFS) of 6.8 months were comparable to the 11.2 and 5.6 months, respectively, in the C-TASK FORCE study. Upon considering three groups, namely mGPS 0, mGPS 1 and mGPS 2, the median PFS times were significantly different (mGPS 0 vs. mGPS 2, P=0.02; and mGPS 1 vs. mGPS 2, P=0.06). The median PFS times in the mGPS 0, 1 and 2 groups were 12.1, 4.8 and 2.3 months, respectively. Median OS was also significantly different (mGPS 0 vs. mGPS 2, P=0.01; and mGPS 1 vs. mGPS 2, P=0.04). The median OS times in the mGPS 0, 1 and 2 groups were 14.0, not reached, and 2 months, respectively. The present study demonstrated the efficacy and safety of the TAS-102 plus bevacizumab combination as salvage-line treatment. This combination therapy (the TAS-102 plus bevacizumab) has obtained valid results with PFS OS as well as C-TASK.FORCE study. The results of the present study also confirmed the prognostic accuracy of mGPS in salvage-line treatment of patients with mCRC.

15.
Anticancer Res ; 39(8): 4441-4448, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366542

RESUMO

BACKGROUND/AIM: Oral mucositis (OM) is one of the frequent adverse events experienced by patients receiving chemotherapy. Most diagnoses of OM are based on complaints from patients. The aim of this study was to develop a tool to diagnose OM accurately. MATERIALS AND METHODS: A central review system (CRS) was created to allow judgment when the patient background is completely unknown. The primary endpoint was the rate of grade 2 or higher OM, and the secondary endpoint was the difference in grade between each institution's clinician judgement and that of the CRS. RESULTS: In total, 53 patients were registered from four institutions. CRS successfully detected grade 2 or higher OM in 16 (30.2%) of the 53 patients. The detection rate of all grades of OM was 41.5% (22 of 53 patients) by each institution's clinician judgement and 84.9% (45 of 53 patients) by CRS judgement (p<0.0001). CONCLUSION: OM during chemotherapy may be underestimated.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/epidemiologia , Estomatite/epidemiologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Estudos de Coortes , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estomatite/induzido quimicamente , Estomatite/patologia
16.
Intern Med ; 58(21): 3103-3106, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292391

RESUMO

We herein report the first case of purulent pericarditis associated with aortic stent-graft infection in an 80-year-old Japanese man that was caused by methicillin-susceptible Staphylococcus aureus, which appropriate antibiotics failed to treat. The detailed clinical course and autopsy images revealed that purulent pericarditis associated with aortic stent-graft infection caused cardiac tamponade and eventually led to mortality. We therefore suggest that surgical procedures, including drainage, should be introduced for such cases.

17.
Mol Clin Oncol ; 11(2): 189-191, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31281655

RESUMO

Development of diabetic ketoacidosis (DKA) caused by fulminant type 1 diabetes (FT1D) during administration of uracil-tegafur (UFT) with leucovorin (LV) as adjuvant chemotherapy is extremely rare. Here, we report a case of DKA caused by FT1D during administration of UFT with LV as adjuvant chemotherapy for colon cancer. A woman in her 60s was transferred to the emergency medical center of our hospital with complaints of impaired consciousness and vomiting. She had undergone left hemicolectomy and D3 lymph node dissection for transverse colon cancer 8 months earlier. She was provided UFT with LV as adjuvant chemotherapy. Laboratory analysis revealed hyperglycemia, high anion gap metabolic acidosis and urinary ketones. She was diagnosed with DKA and was started on intravenous infusion of fluid and continuous subcutaneous insulin injections. Following admission, she was examined and diagnosed with FT1D. The present case describes an extremely rare case of DKA caused by FT1D during adjuvant chemotherapy with UFT + LV for colon cancer.

18.
Asian J Endosc Surg ; 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31332934

RESUMO

An intractable fistula caused by idiopathic esophageal rupture is a rare but severe condition. In the present case, a 69-year-old man had been treated conservatively at another hospital for esophageal rupture but had developed an abscess in the left thoracic cavity due to an intractable fistula at the rupture site. He was referred to our hospital for treatment 19 months after the esophageal rupture. On admission, the intractable fistula was found to be continuous with an abscess in the left thoracic cavity. Preoperative continuous enteral nutrition was administered to improve the patient's nutritional status, and drainage was performed to reduce the size of the abscess. Then, to minimize the invasion of the intractable fistula, thoracoscopic subtotal esophagectomy was performed via a right thoracic cavity approach 20 months after the esophageal rupture. Preoperative management and thoracoscopic surgery via an opposite chest cavity approach was found to be safe and feasible for the intractable fistula caused by idiopathic esophageal rupture.

19.
J Clin Neurosci ; 67: 124-128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31221574

RESUMO

The incidence of traumatic brain injury (TBI) in elderly patients is increasing. We retrospectively investigated the poor prognostic factors at discharge in elderly patients aged 75 years or older admitted to hospital with mild TBI. We continuously enrolled 83 patients aged 75 years or older with mild TBI, in a private general Japanese hospital. The Glasgow Coma Scale scores on admission were within the range of 13-15. Patients with good recovery or moderate disability were included in the "good outcome" group, and those with severe disability, in a persistent vegetative state, or who died were included in the "poor outcome" group. We performed statistical analyses using 8 parameters. We conducted a univariate analysis on each item. Next, we conducted a logistic regression analysis on variables where the p < 0.20 in the univariate analysis. Elderly patients had a poor prognosis when they had dementia (odds ratio [OR]: 20.357, 95% confidence interval [CI]: 2.075-199.683, p = 0.010), cancer (OR: 14.005, 95% CI: 1.262-154.444, p = 0.032), or a history of antithrombotic therapy before admission (OR: 6.673, 95% CI: 1.072-41.526, p = 0.042). When elderly patients aged 75 years or older with mild TBI have the 3 poor prognostic factors of dementia, cancer, or a history of antithrombotic therapy, their outcomes might be worse compared to other elderly patients. Elderly patients who have these factors should be carefully managed.


Assuntos
Concussão Encefálica/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas , Feminino , Escala de Coma de Glasgow , Humanos , Incidência , Masculino , Alta do Paciente , Estado Vegetativo Persistente , Prognóstico , Estudos Retrospectivos
20.
Anticancer Res ; 39(5): 2615-2625, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092460

RESUMO

BACKGROUND/AIM: This study aimed to assess whether low-molecular-weight heparin (LMWH) is effective and safe in preventing postoperative venous thromboembolism (VTE) in patients undergoing esophageal cancer surgery. PATIENTS AND METHODS: In this single-institution, prospective, randomized trial, 73 patients with esophageal cancer undergoing esophagectomy were randomly divided into the enoxaparin group (E group) and intermittent pneumatic compression group (I group). The primary endpoint was efficacy of enoxaparin, and secondary endpoints were evidence of bleeding and serum anti-Xa activity in the E group. RESULTS: The E group comprised 42 patients and the I group comprised 31 patients. Deep vein thrombosis was observed in 0 (0%) patients in the E group and 7 (22.6%) patients in the I group (p=0.002). Soluble fibrin monomer complex was significantly lower in the E versus I group on day 8 (p<0.001). D-dimer was significantly lower in the E versus I group on days 2, 8, and 15 (p=0.008, p<0.001, p<0.001, respectively). CONCLUSION: VTE was significantly reduced by using enoxaparin.


Assuntos
Enoxaparina/administração & dosagem , Neoplasias Esofágicas/complicações , Esofagectomia/efeitos adversos , Tromboembolia Venosa/tratamento farmacológico , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/patologia , Heparina de Baixo Peso Molecular , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Tromboembolia Venosa/etiologia , Trombose Venosa/diagnóstico , Trombose Venosa/patologia , Trombose Venosa/prevenção & controle
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