Background & Aims : True local recurrences (TR) and new primary tumors (NP) in the conserved breast after breast-conserving surgery with radiation therapy are determined by the initial surgical margin, the location of recurrent tumors and the histological consistency between initial tumors and recurrent tumors. Methods : A total of 15 patients with breast recurrence out of a group of 389 women with breast cancer who underwent breast-conserving therapy between 1991 and 2003 were included in this study. The biological differences between TR and NP were examined. Results : Eight patients had TR, and seven had NP. The disease-free interval was 34.6 months in the TR group and 94.1 in the NP group. Breast-free survival was significantly better in the NP group than the TR group. The accumulated 10-year overall survival after salvage surgery in patients with TR or NP tumors was 85.1%. The accumulated overall survival after salvage surgery was better in the NP group than the TR group. Conclusions : Patients with NP tumors have a favorable prognosis compared to those with TR tumors. It is important to determine the type of breast recurrence in order to accurately predict the prognosis of patients with breast recurrence.

View full abstract

In 1987 we started renal transplantation program with cyclosporine at our institution, Department of Urology in Gunma University Hospital.In this 20-year period we have performed 62 living donor renal transplantations.The graft survival rates were 92% (1 year), 81% (5 years), 62% (10 years), and patient survival rates were 95% (1 year), 91% (5 years), 91% (10 years). These results were similar to those of nationwide study and reports from other institutions.

View full abstract

Purposes : The purposes of this study are to identify outcome measures in dementia care and to develop an Original outcome assessment tool. Methods : We reviewed the literature, conducted a questionnaire survey. And we examined outcome measures by experts. Results : Outcome measures (dementia symptoms, living behavior, happiness, quality of life, and care giving burden) were identified by the current literature review. The results of the survey in 239 persons who experienced dementia care revealed outcome measures such as psychological stability, living behavior, dementia symptoms and will of continuous care at home. "Smile, secured living without anxiety, enjoy, and pleasure" were highly important in 25 persons who experienced dementia care at home. Conclusion : We developed the outcome assessment tool with the following characteristics by expert review. (1) Primary outcome measures were "dementia symptoms/psychological stability," "living/self-care behavior," "individual living style," and "caregiver's burden". (2) Conditions at two time points should be assessed, applicable number should be recorded, and a judgment should be made whether it is "maintaining at the maximum level, improving, maintaining the current level, deteriorating, or maintaining at the minimum level". (3) Care items were developed to improve the outcomes.

View full abstract

Background and Purpose : A lot of bacteria which are in the oral cavity cause not only local diseases but also systemic diseases. Therefore oral care is regarded as important from the viewpoint of systemic disease prevention. In this paper, we investigated the oral bacteria decreasing effect of various gargle solutions. Materials and Methods : Twenty-one healthy volunteers were applied to the following examination. We used 3 gargle solutions -30 times diluted 7 % povidone-iodine, undiluted Listerine® and undiluted cool mint Listerine®. Saliva was harvested as specimen before and after 15 seconds gargle with 30 ml of each gargle solution, and cultured. The number of bacteria and Candida colonies detected were compared. Results : Oral bacteria were detected in all specimens before gargle, and decreased in 69-93% of specimens after gargle. Candida were detected in 27-47% of specimens before gargle, and decreased in 25-88% of specimens after gargle. A rate of decline of oral bacteria and Candida was highest with undiluted Listerine®. Conclusions : The gargle solutions were effective in decreasing oral bacteria and Candida and Listerine® had the highest drug efficacy.

View full abstract

A 67-year-old man suffered from retroperitoneal abscess and sepsis after left hemicolectomy due to advanced colon carcinoma, resulting in disseminated intravascular coagulation (DIC). Enhanced computed tomography (CT) showed a lack of cortical enhancement in the arterial phase images despite normally enhanced renal arteries and branches, and well-enhanced renal medulla with a narrow subcapsular cortical enhancement on the parenchymal phase images. These CT findings were typical of acute renal cortical necrosis (ARCN) and obviate the need for renal biopsy, which has been considered to the gold standard for diagnosis.

View full abstract

A 74-year-old Japanese man was admitted to our hospital due to repeated episodes of upper gastrointestinal (GI) bleeding, anemia and melena, which he had suffered for the preceding two years. We performed several panendoscopic and angiographic examinations, but could not discover the cause of his anemia. In addition, we performed jejunectomy because arteriovenous malformation (AVM) was suspected to exist in the jejunum. However, we found no evidence of AVM in the resected portion of the jejunum. During an endoscopic GI study on his seventh admission, we found hemorrhaging gastric angiodysplasia (AGD) in the upper body of the stomach. Moreover, we found another small AGD in the lower body of the stomach. We treated these lesions endoscopically using a combination of hemoclip, endoscopic band ligation and argon plasma coagulation.
When diagnosing patients presenting with the symptoms described herein, the physician should consider small AGDs and check the GI tract accordingly, to prevent unnecessary resections. In the present subject, there has been no further bleeding and no other lesions have been detected in his upper GI on endoscopic examination during a 12-month follow up.

View full abstract

Extramedullary plasmacytoma (EMP) of the gastrointestinal tract is an uncommon-type of neoplasms. This report describes a case of EMP in the small intestine. A 78-year-old male, with abdominal discomfort and vomiting, was found to have a 7-cm sized tumor of the small intestine and swollen lymph nodes. He underwent resection of the bowel and lymph nodes. Histological examination of the resected specimens revealed compact tumor cells from mucosa to subserosa and infiltrate into the fat tissue of the mesentery and the lymph nodes. Pathological examination of the resected specimen revealed plasma cell-like round cells, Dutcher bodies, and Russell bodies. Immunohistochemical examination showed that the cytoplasm of the tumor cells were positive for CD138 and the nuclei were positive for cyclin D1. Four months after surgical resection, the patient had recurrence of tumor cells in the para-aortic lymph nodes and lumbar vertebrae. Chemotherapy treatment was ineffective. Surgical resection followed by chemotherapy is thought to be effective in the case of intestinal obstruction, although there is a possibility of devastation which is resistant to chemotherapy. We propose that tumor cells positive for cyclin D1 may play a key role in devastation and could be a useful indicator of prognosis.

View full abstract