Clinical trial of low-dose leucovorin plus 5-fluorouracil for patients with metastatic colorectal cancer

BACKGROUND/AIMS: To establish an effective and practical treatment of Japanese patients with metastatic colorectal cancer in an outpatient setting, we conducted a clinical trial using a modified Mayo regimen. METHODOLOGY: A bolus injection of low-dose (20 mg/m2) d,l-leucovorin (LV) was administered, followed one hour later by an intravenous injection of 333 mg/m2 5-fluorouracil (5-FU) for another hour. The two drugs were given on days 1, 2, and 3, and the treatment was repeated every 2 weeks. RESULTS: In the 17 patients enrolled in the study, the tumor response rate was 25%, and time-to-treatment failure and median survival time were 7 and 24 months, respectively. The treatment was well tolerated, with no adverse effects greater than grade 3, and could be completed in all patients in the outpatient setting. One patient with lung, liver, and parailiac lymph node metastasis showed a complete response and survived for more than 6 years with tumor-free status. CONCLUSIONS: These results suggest that although the sample size studied was too small to allow us to draw definitive conclusions, this regimen may be an effective and practical alternative to the Mayo regimen in an outpatient setting for Japanese patients with metastatic colorectal cancer.     

A long-term study of sharps injuries among health care workers in Japan

BACKGROUND: The risk of transmission of occupational blood-borne infection is a serious problem for health care workers (HCWs) in Japan. Although the Japanese version of Exposure Prevention Information Network (EPINet) was introduced in 1997, no published data in the clinical setting have been available yet. OBJECTIVE: To examine the epidemiology of occupational sharps injuries of HCWs in a university hospital using EPINet and to analyze the trends and changes in epidemiologic characteristics of needlestick injuries in a detailed situation. METHODS: The HCWs were requested to report sharps injury incidents to the Infection Control Nurse when the incidents occurred. Those who were involved in the incidents were required to personally complete an EPINET form. RESULTS: A total of 259 cases of sharps injuries occurred during the 7-year period. Registered nurses accounted for 72.2% of the cases, constituting the largest group of the HCWs. The incidents occurred most frequently in the hospital wards. Thirty-three cases (55.9%) of the injuries with syringe-needle units occurred "after use before disposal," whereas 34 cases (73.9%) of the injuries with suture needles occurred "during use of device." More than half of the injuries with a winged steel needle occurred despite the protective mechanism. DISCUSSION: There was no apparent difference in the characteristics of the subjects compared with other reports. The circumstances of the injuries varied with the kinds of instruments. This fact may provide useful information for planning measures to sharps injuries. CONCLUSIONS: With the problem of underreporting aside, a detailed study, such as ours, comprising by job category and by kind of instrument or the like would provide more useful and effective information in terms of sharps injury prevention.     

Control of home heart rate and home blood pressure levels in treated patients with hypertension: the J-HOME study

OBJECTIVE: Recently, it was found that resting heart rate (HR) measured at home (home HR), as well as self-measured blood pressure (BP) at home (home BP), was a strong predictor of the risk of cardiovascular disease mortality in the general Japanese population. It was also reported that home BP levels were not adequately controlled in hypertensive patients. Little information, however, is available on the current status of home HR control in treated patients with hypertension. The objective of this study was to examine the current status of home HR control and home BP control among treated patients with hypertension. METHODS: Home HR and BP were measured using a self-monitored BP measuring device. Morning home HR and BP were obtained in 3183 patients and evening home HR and BP were obtained in 3106 patients. On the basis of an earlier study, we defined a home HR value of >or=70 beats/min as 'high home HR'. RESULTS: The mean home HR value was 67.2+/-9.1 beats/min in the morning and 69.6+/-9.2 beats/min in the evening. Of the 3183 patients, 35.7% had a high home HR in the morning and 46.7% of the 3106 patients had a high home HR in the evening. The prevalence of patients with a high home HR and a controlled home BP (<135/85 mmHg) was 11.3% in the morning and 24.2% in the evening. CONCLUSION: Resting home HR control and home BP control were inadequate.     

A case of genital Chlamydia trachomatis infection with acute post renal failure

A 29-year-old woman presented with bilateral hydronephroses concomitant with acute renal failure. Retrograde pyelography demonstrated bilateral ureteral strictures located at the lower segment of ureters. Computed tomography revealed inflammation of the left ovary and severe colon adhesion. She received the operation, i.e. left ovariectomy and colon adhesiotomy, because of a possibility of gynecological disease including endometriosis and malignant tumors. Clinical and pathological findings showed non-specific inflammation in the pelvis and ovary. A pelvic inflammatory disease due to a genital Chlamydia trachomatis was highly suspected and she was treated with targeted antibiotics. There have been no signs of hydronephroses or renal failure during six years' follow-up after the treatment. We discus this rare case of bilateral hydronephroses due to genital Chlamydia trachomatis.     

Experience of high-dose-rate brachytherapy for head and neck cancer treated by a customized intraoral mold technique

Radiotherapy of head and neck cancer has become more successful with the advances in treatment modalities and use of a multidisciplinary approach. Higher quality treatment and a team approach to radiotherapy have thus been required for head and neck cancer. This study presents the clinical experience of high-dose-rate (HDR) brachytherapy for head and neck cancer treated by a customized intraoral mold technique. Two patients are reported for whom we created dental prostheses as the radiation carriers for HDR brachytherapy of their head and neck cancers. HDR brachytherapy with the dental prostheses reported here was feasible and effective for eradicating the head and neck cancer. It has been demonstrated that HDR brachytherapy using a customized intraoral technique can be a treatment option for patients who are not candidates for surgery or external irradiation. It is strongly suggested that specialized dentists are needed who are familiar with not only the anatomy and function of the head and neck region but also radiotherapy. Dental radiologists should take responsibility for constructing irradiation prostheses. If they do, they have the potential to improve the quality of life of patients who undergo radiotherapy for head and neck cancer.     

Altered expression of COX-2 in subdivisions of the hippocampus during aging and in Alzheimer's disease: the Hisayama Study

BACKGROUND: It has been reported that nonsteroidal anti-inflammatory drugs may delay the onset of Alzheimer's disease (AD). Since nonsteroidal anti-inflammatory drugs inhibit cyclooxygenase (COX), COX-2, an inducible form of COX, may be involved in the pathology of AD in association with the arachidonic acid cascade. In addition, it has been suggested that alterations in the balance of polyunsaturated fatty acids are associated with brain dysfunctions such as neurodegerative pathologies of the aging brain. METHOD: To explore COX-2 expression in the hippocampus, we analyzed 45 consecutive autopsy subjects without dementia and 25 AD patients derived from the town of Hisayama, Japan. RESULTS: The neuronal expression of COX-2 in the CA3 subdivision of the hippocampus, subiculum, entorhinal cortex and transentorhinal cortex were consistently observed in both nondemented and AD brains, and COX-2 immunoreactivity correlated with age in nondemented brains. In AD patients, neurons of CA1 exhibited increased COX-2 immunoreactivity which correlated with the severity of AD pathology. This correlation was not apparent in nondemented subjects. CONCLUSION: These results suggest that COX-2 expression may be differentially regulated among subdivisions of the hippocampus and that elevated COX-2 expression in the CA1 of AD brains may be associated with AD pathology and thus cognitive dysfunction.     

Acute Stanford type B dissection and cardiac tamponade: rupture from around ductus arteriosus

Pericardial tamponade is rarely associated with acute Stanford type B aortic dissection. We encountered this unusual combination in a 59-year-old patient. He underwent an emergency drainage procedure through a midline sternotomy. Operative findings strongly suggested that the dissected aorta ruptured into the pericardial cavity from around the ductus arteriosus. Clinicians should be aware that Stanford type B aortic dissection can cause pericardial tamponade.