Osaka Red Cross Hospital Research Articles

P8-3 Time course of cancer genome panels at Osaka Red Cross Hospital

P8-3 Time course of cancer genome panels at Osaka Red Cross Hospital

Real-World Data of Trifluridine/Tipiracil for Patients With Advanced Gastric Cancer: A Multi-Institutional Retrospective Study.

A trial with trifluridine/tipiracil (FTD/TPI) versus placebo in patients with heavily pretreated metastatic gastric cancer showed that FTD/TPI is effective with manageable toxicity in these patients. However, real-world data on the effects of FTD/TPI in patients with advanced gastric cancer (AGC) are limited. We retrospectively collected and analyzed the clinicopathological data of patients with AGC who received FTD/TPI monotherapy at our institutions (Kobe City Medical Center General Hospital, Osaka Red Cross Hospital, Himeji Red Cross Hospital, and Kansai Medical University Hospital) between September 2019 and July 2021. Tumor responses were evaluated based on the Response Evaluation Criteria in Solid Tumors, version 1.1. Overall survival (OS) and progression-free survival were estimated using the Kaplan-Meier method. A total of 53 patients were included in the study. The median age was 70 (range, 37-85) years; 39 patients (74%) were men; the numbers of patients with Eastern Cooperative Oncology Group performance status scores of 0, 1, and 2 were 10 (19%), 39 (74%), and 4 (8%), respectively; and 27 patients (51%) had diffuse-type histology. A total of 29 patients (56%) had ascites. Prior nivolumab therapy was administered to 49 patients (92%). The response rate and disease control rate (DCR) were 2% and 35%, respectively. The median progression-free survival was 2.4 months, and OS was 5.8 months. Patients with ascites exhibited significantly shorter OS (8.6 vs 4.7 months, P = .0291) than those without ascites, and DCR (54% vs 18%, P = .0055) was significantly worse in patients with ascites. There was no significant difference in the frequency of adverse events of grade 3 or higher between patients with and without ascites. In a real-world setting, FTD/TPI has similar effectiveness as late-line chemotherapy for patients with AGC, including those who previously had received nivolumab.

Clinical study of perioperative oral management at Osaka Red Cross Hospital

Clinical study of perioperative oral management at Osaka Red Cross Hospital

Characterization of patients that can continue conservative treatment for adenomyosis

BackgroundHistorically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis.MethodsWe selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively.ResultsA total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy.ConclusionsPatients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.

Our experience with laparoscopic partial gastrectomy by the 'lift-and-cut method' for gastric gastrointestinal stromal tumor with maximal preservation of the remnant stomach.

Wedge resection is the most commonly used method in laparoscopic partial gastrectomy for gastric gastrointestinal stromal tumor (GIST). However, this method can involve inadvertent resection of additional gastric tissue and cause gastric deformation. To minimize the volume of resected gastric tissue, we have developed a laparoscopic partial gastrectomy with seromyotomy which we call the 'lift-and-cut method' for gastric GIST. Here, we report a case series of this surgery. First, the seromuscular layer around the tumor is cut. Because the mucosa and submucosa are extensible, the tumor is lifted toward the abdominal cavity. After sufficient lifting, the gastric tissue under the tumor is cut at the submucosal layer with a linear stapler (thus 'lift-and-cut method'). Finally, the defect in the seromuscular layer is closed with a hand-sewn suture. From April 2011 to December 2015, 28 patients underwent laparoscopic partial gastrectomy by this method at Osaka Red Cross Hospital. Average operation time was 126min (range 65-302min) and average blood loss was 10ml (range 0-200ml). No intraoperative complications including tumor rupture or postoperative complications regarded as Clavien-Dindo Grade II or higher occurred. All patients took sufficient solid diet at discharge. Median postoperative hospital stay was 7days (range 5-21days). On median follow-up of 26.6months (range 6-54months), no recurrence was reported. Laparoscopic partial gastrectomy by the lift-and-cut method is safe and simple, and widely applicable for gastric GIST.

Prognosis of Papillary Thyroid Carcinoma with Local Invasion

The aim of this study was to detect prognostic factors in patients with locally advanced papillary thyroid carcinoma. The study included 72 patients (T4a/T4b 72/0, N0/N1a/N1b 25/15/32, M0/M1 68/4, mean follow-up 8.1 4.4 years) who underwent initial surgical treatment at Osaka Red Cross Hospital between April 1993 and April 2011. Eleven patients died of PTC, 3 patients with recurrence died of unrelated disease and 10 patients are alive with recurrence. The overall 5-year survival rate was 88.3%, and the 10-year survival rate was 73.4%. The disease-specific 5-year survival rate was 91.4%, and the 10-year survival rate was 88.6%. The 5-year local control rate was 94.1%, and the 10-year local control rate was 85.4%. Patients with distant metastasis (M1), tracheal invasion and/or multiple organs invasion showed a significantly worse disease-specific survival rate based on a univariate analysis, which also revealed that tracheal invasion, laryngeal invasion, esophageal invasion and multiple organs invasion were risk factors linked to the development of distant metastasis during follow-up (recurrence as distant metastasis). The following were found to be clinically significant risk factors, based on the multivariate analysis among tracheal invasion, laryngeal invasion, esophageal invasion and recurrent laryngeal nerve invasion : Tracheal invasion was a risk factor for disease-specific survival, and tracheal invasion and laryngeal invasion were risk factors for recurrence as distant metastasis. In this study, distant metastasis, multiple organs invasion, tracheal invasion and/or laryngeal invasion were shown to be higher risk factors.

弛緩部型真珠腫における進展度分類と聴力成績の検討

Our surgical treatment for middle ear cholesteatoma is based on the following 2 concepts: (1) Preservation of the physiological morphology and function of the middle ear, that is, maximal preservation of the posterior wall of the external auditory meatus and the middle ear mucosa and (2) Careful resection of the matrix membrane of the cholesteatoma through the continuity of the matrix membrane. In case the cholesteatoma matrix membrane is ruptured, a staged operation should be performed to prevent the development of residual cholesteatoma from the residual matrix. In this study, we classified a total of 238 cases of the pars flaccida cholesteatoma primary operated on Osaka Red Cross Hospital between January 2006 and March 2008 according to the Classification and Staging of Cholesteatoma proposed in 2010. The age of the patients ranged from 4 to 79 years (average: 49.8 years) and there were 123 males and 115 females. Follow up ranged from 1 year to 5 years with a mean follow-up period of 47.8 months. Regarding the stage, 38 (16.0%) ears had stage I cholesteatoma, 155 (65.1%) ears had stage II, and 45 (18.9%) ears had stage III. The successful outcome rate was 97.4% for stage I, 78.7% for stage II and 60.0% for stage III. The rate of the residue and the postoperative recurrence was 2.5% and 4.2%.

当院における肺 <i>Mycobacterium abscessus</i> 症の臨床的検討

Pulmonary Mycobacterium abscessus infection is resistant to many antibiotics and is difficult to treat. We retrospectively analyzed the clinical characteristics of pulmonary infection due to M. abscessus. Eleven cases diagnosed as having pulmonary M. abscessus infection at Osaka Red Cross Hospital from January. 2008, to June, 2012 were enrolled in this study. The average age of the 11 cases was 63 years (all were females). Nine cases showed underlying diseases, comprising 5 cases with Mycobacterium avium complex lung infection, 3 with old pulmonary tuberculosis, and 3 with bronchiectasis. The radiological examination revealed that 10 cases showed the small nodular type, 7 showed the bronchiectatic type, 4 showed a cavity lesion and 4 showed infiltrative shadows. A microbiological definite diagnosis was made from sputum in 10 cases and bronchial lavage fluid in one. As treatment for M. abscessus pulmonary infection, combined multi-drug chemotherapy was carried out in 7 of the 11 cases. No patients were successfully treated with antibiotics alone, whereas 4 patients had no exacerbation of radiological findings without any treatment. One patient received antibiotics including clarithromycin, amikacin and levofloxacin for 2 to 12 months following surgical excision and her sputum cultures have been maintained as negative over the long-term. During the study, none of the 11 patients were known to have died. In this study, we found that M. abscessus pulmonary infection is more common among females, and is found frequently in patients with M. avium complex lung infection. We also found that the clinical course of M. abscessus pulmonary infection was different among patients. We think this is because M. abscessus was shown to comprise three closely related species. M. abscessus is extremely difficult to eradicate, and surgical resection of localized disease or the main lesion or cavity may be significantly effective in preventing the progression of disease.

Liraglutide administration in type2 diabetic patients who either received no previous treatment or were treated with an oral hypoglycemic agent showed greater efficacy than that in patients switching from insulin.

Liraglutide, a glucagon-like peptide-1 receptor agonist, is expected to provide a new treatment option for diabetes. However, the suitable timing of liraglutide administration in type2 diabetic patients has not yet been clarified. We reviewed type2 diabetic patients (n=155) who visited the Osaka Red Cross Hospital for glycemic control, with administration of liraglutide at a dose of 0.6mg (average glycated hemoglobin [HbA1c] level, 8.7±0.1%). The effect of liraglutide based on the pretreatment status was compared. We also analyzed the background factors of both a successful and failed group of patients who switched to liraglutide from insulin. An improvement in blood glucose levels was confirmed in 122 of 155 patients. During the 4-month observation period, the improvement in HbA1c levels was significantly greater in the group of drug-naïve/previous oral hypoglycemic agent (9.1±0.2 to 7.2±0.2%) than that in the group switching from insulin (8.6±0.2 to 7.8±0.2%). In addition, C-peptide immunoreactivity levels (fasting >2.2ng/mL; delta >1.6ng/mL; urine >70μg/day), younger age and a smaller number of insulin units used per day were considered important when deciding on switching to liraglutide from insulin. Liraglutide was more effective in patients who had not been treated previously or received oral hypoglycemic agents than in patients switching from insulin. With respect to switching to liraglutide from insulin, the most important factors to be considered were C-peptide immunoreactivity levels, age, and the number of insulin units used per day.

Ear-pick injury as a traumatic ossicular damage in Japan

This retrospective study examined the etiology and treatment results for traumatic, conductive hearing loss in 22 patients who underwent surgery between 1998 and 2008 at Osaka Red Cross Hospital. All patients underwent computed tomography (CT) of the temporal bone preoperatively. The ear surgery comprised closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Their mean age was 30.3 years, and the average delay from injury until treatment was 6.0 years. Of the injuries due to foreign-body insertion, the most common cause was ear-pick injury. Incudostapedial disarticulation was the most common finding, which was diagnosed preoperatively using CT in seven cases and identified at surgery in 15 cases. Closure of the air-bone gap to within 10 and 20 dB was observed in 50.0 and 68.2% of the patients, respectively. The hearing threshold improved by 10 dB or more in 16 (72.7%) patients. If no improvement in hearing loss follows the absorption of hemotympanium or closure of an eardrum perforation, dislocation of the ossicular bones should be suspected. Ossicular reconstruction following trauma produces more stable and better hearing results, even after delayed treatment.

Prognostic significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in various staging systems for hepatocellular carcinoma : Akiko Saitoh, Tokyo Women's Medical College, Tokyo Japan; Kazuki ito, Shizuoka General Hospital, Shizuoka Japan; Takashi Kumada, Ogaki Municipal Hospital, Ogaki Japan; Hiroko Oka, Osaka City General Hospital, Osaka Japan; Hiroshi Kasugai, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Japan; Toshihito Seki, Kansai

Prognostic significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in various staging systems for hepatocellular carcinoma : Akiko Saitoh, Tokyo Women's Medical College, Tokyo Japan; Kazuki ito, Shizuoka General Hospital, Shizuoka Japan; Takashi Kumada, Ogaki Municipal Hospital, Ogaki Japan; Hiroko Oka, Osaka City General Hospital, Osaka Japan; Hiroshi Kasugai, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Japan; Toshihito Seki, Kansai

薬学部病院実務実習生を対象とした理解度調査により浮かび上がった問題点

The Department of Pharmacy at Osaka Red Cross Hospital, a general hospital, accepts pharmaceutical trainees every year. However, as no one is specifically in charge of training, all of our staff undertake the task of teaching. In order to ensure that teaching is effective and thorough, we prepared a textbook for the trainees' practical training. We also conducted a questionnaire to ascertain how well they understood the various aspects of the training and how useful they thought the textbook was. Responses showed that trainees had a better understanding of almost all of the topics after receiving training in them. Topics for which understanding remained the same were those that had not been covered in introductory lectures at the trainees' universities, which were thus considered to be lacking in certain respects.The results of this questionnaire indicated that the preparation of good teaching plan is essential to ensuring that training is effective and of high quality. We also feel that is important to cooperate more closely with universities so that hospital training for pharmacists can be made even better.

乳幼児の気管・気管支異物症例

We reviewed 14 cases of tracheobronchial foreign bodies in infants treated between 1982 and 1996 at the Osaka Red-Cross Hospital. In all cases, the foreign bodies were successfully removed using a ventilation bronchoscope under general anesthesia. The most common foreign body was a peanut, as noted in other reports. Chest X-ray findings suggested hype lucency in 7 cases, pneumonia in 2 and mediastinal shift in 2, while there were no remarkable changes found in 3 cases. Major signs and symptoms were dyspnea, wheezing and coughs in 13 cases, fever in 10 and cyanosis in 7. Preoperative administration of steroids was effective in facilitating removal of a lonstanding foreign body. We suggest that steroids should be preoperatively administered to patients who have retained a foreign body for a long period.

喉頭枠組手術 再手術例の検討

Between 1988 and 1995, 54 patients underwent laryngeal framework surgery, to treat glottal insufficiency due to unilateral vocal cord paralysis at Osaka Red Cross Hospital. Thyroplasty type I was performed initially in 33 patients, arytenoid adduction was performed in 18 patients, and combined thyroplasty type I and arytenoid adduction was performed in 3 patients. To date, 5 patients who had poor results from their initial surgery have undergone revision laryngeal framework surgery. Three patients who initially underwent arytenoid adduction underwent revision thyroplasty type I as a secondary procedure. Patients with vocal cord atrophy initially had to undergo combined thyroplasty type I and arytenoid adduction. Two patients who initially underwent thyroplasty type I underwent revision thyroplasty type I, with placement of a larger silicon block implant. At surgery, the tissue adjacent to the previously implanted silicon block exhibited the formation of a thin fibrous capsule. The silicon block implant was easily removed and replaced with a different, largersized, silicon block implant. The results of the revision surgery were satisfactory in all five patients.

甲状軟骨形成術Ｉ型と後部声門閉鎖不全 従来の手術法の再評価と新手術法の検討

Closure of the posterior glottis after thyroplasty type 1 was retrospectively evaluated with fiberscopic video recordings of patients treated at the Osaka Red-Cross Hospital. It was revealed that this surgery was not an effective treatment of posterior glottis incompetence.Results of an experimental study with excised human larynges indicated that a posterior window, incision of the inner perichondrial membrane and a medial compression in 8 to 10 mm of the vocal process of the arytenoid cartilage were necessary for the mobilization of the posterior vocal cord to the midline of the larynx.The modified thyroplasty type 1 described above was performed for a patient with unilateral recurrent laryngeal nerve paralysis and a large gap in the posterior glottis. Normal voice and complete closure of the posterior glottis were obtained after surgery. This method was inferred to be useful for the improvement of posterior glottis incompetence.

Titers of Epstein-Barr virus-related antibodies in nasopharyngeal carcinoma in Japan.

It is thought that nonkeratinizing or undifferentiated squamous cell carcinoma in the nasopharynx (NPC) is intimately correlated with Epstein-Barr Virus (EBV). Twenty-one patients with NPC were followed in Kyoto University Hospital and 4 in Osaka Red Cross Hospital during the past 2 years from 1980 to 1981. These patients were classified histopathologically according to the WHO classification in 1978 and staged with the TNM classification in Union Internationale Contre le Cancer (UICC) in 1978. The incidence rate of NPC among the head and neck tumors was 5.6% in the authors' university from 1980 to 1981. The sex ratio of male to female was nearly equal. The mean age of NPC patients was 56.7 years. Sera from these 25 patients with nasopharyngeal carcinoma were collected at intervals of 3 to 8 months over a 2-year period, and were examined for their spectra and titers of antibodies of EBV-related antigens. They were titrated for IgG, IgA and IgM antibodies to EB viral capsid antigen (VCA), for IgG and IgA antibodies to early antigen-DR component (EA) and for antibodies to EBV-associated nuclear antigen (EBNA). All of these patients were primarily treated with radiation, while a few who did not respond to this therapy were subsequently treated with surgery or chemotherapy. EBV antibodies of VCA-IgG, -IgA, EA(DR)-IgG, and -IgA and EBNA were elevated in 73% and 90% of the nonkeratinizing and undifferentiated NPC patients, respectively. The VCA-IgM was elevated in almost none of the cases. In contrast to this, these values were all in a normal range in the NPC patients with keratinizing squamous cell carcinoma and malignant lymphoma. Also 9% and 10% of nonkeratinizing and undifferentiated carcinomas showed the normal ranges of EBV antibodies, possibly indicating a nonassociation with EBV. When NPC disappeared with radiation therapy, EBV antibodies became normal for 6-18 months. However, those whose NPC did not respond to the combined therapy with radiation, surgery and chemotherapy maintained high titers of EBV antibodies. The prognosis was the poorest in the patients with undifferentiated carcinoma, 40% of whom died within 4 years after diagnosis.

Study on the Articulation Test in Pronunciation in Esophageal Voice

In order to estimate the articulation grade of pronunciation of an esophageal voice, the pronunciation test which had reported by Okamoto and others were undertaken in seven laryngectomized patients who were operated at the Department of Esophagobronchology of the Osaka Red Cross Hospital. The results were as follows:1) Percentage of the correct articulation grade of pronunciation of esophageal voice which can commonly talk with man were between 60% and 70%. This percentage would not be change unless the general condition of the patients become worse. And there were no difference between “talk with man fluently” and “talk with man” in view of study.2) The correct pronounced syllables were /Su/ /So/ /Na/ /Chu/ and /Nya/, and the incorrect pronounced syllables were /Ha/ /Ho/ /Hyu/ /Hi/ and /He/.3) In order to estimate the correct articulation grade of pronunciation of esophageal voice, the author had selected 100 Japanese syllables. And from this study, it would be available better to select Taguchi's test words.

Clinico-statistical Observation on the Endosopy in Osaka Redcross Hospital

Clinico-statistical observation of the endoscopy during the past 7 years (from 1963 to 1970) at the department of bronchoesophagology in Osaka Redcross Hospital were made and reported the foreignbody cases during that period. The total number of the endoscopy was 1006 cases (_??_ 629 _??_ 377) and among that cases about 450 cases were bronchoscopy and esophagoscopy and about 100 cases weve direkt laryngoscopy.About 40% of total number were over 51 years of age and the sex ratio in that age was with males prependerating (7: 3).About 60% of foreign body cases were under 5 years of age and in trachea pins and beans were most frequently seen and in esophagus coins were most frequently seen.