Background : Nelarabine (NEL) is a new purine nucleoside analogue that has recently become available for both adults and children with relapsed or refractory T-cell acute lymphoblastic leukemia (T-ALL) and T-lymphoblastic lymphoma (T-LBL). We studied the drug resistance profile of eight children with T-ALL/LBL using an in vitro cytotoxic assay including NEL. Furthermore, we tried to establish a NEL resistant T-ALL cell line model to investigate the mechanism of NEL resistance.
Results : Four of 8 patients showed a higher 50% lethal concentration (LC₅₀) than the maximum clinical concentration of NEL. There were no correlations in LC₅₀ values between NEL and other drugs. To study the mechanism of NEL resistance, we originally established a nucleoside analogue resistant T-ALL Jurkat cell line model (Jurkat+C) induced by incubation in medium containing cytarabine (AraC) at LC₅₀ of the control. Jurkat+C showed resistance to NEL and Fludarabine as well as AraC but not Daunorubicin. Next, we studied the role of Equivalent Nucleoside Transporter-1 (ENT-1), a major cellular nucleoside transporter, in the acquired drug resistance in Jurkat+C. Nitrobenzylmercaptopurine riboside, an ENT-1- specific inhibitor, showed an inhibitory effect of nucleoside analogues on in vitro toxicity in both Jurkat and Jurkat+C, while no differences in ENT-1 mRNA expression levels between Jurkat and Jurkat+C were found.
Conclusions : In vitro NEL resistance was seen in half of the tested childhood T-ALL cells. We could establish the NEL resistant T-ALL cell line model by AraC exposure. ENT-1 may partly act as a transporter of NEL, but not play a key role in AraC induced NEL resistance. This cell line model may be useful to provide a mechanism to explain NEL resistance.

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This study intends to elucidate the experiences of businessmen who have been involved with people with dementia, and the information they need about on dementia. The study was conduct against 100 members of B association consisting of A bank customers who participated in a lecture on dementia care, and who extended their cooperation in the survey. The methodology comprised an A4-sized self-report questionnaire. The result showed that 68% subjects had prior experience of care for worrying about their relative's dementia, 26% had interacted with them in business, and 62% encountered them daily. Although, most commonly, the subjects were embarrassed when communicating each other with people having dementia, some of them had successful experiences, by accepting the latter through well thought of ways of treating them when they encountered difficulties. The main topics that the subjects had intentions to know were "dementia prevention or its early diagnosis," "matters concerning care," and "services or systems." Furthermore, the proportion of subjects who wished to know about "property management and adult guardianship" was significantly high among elderly subjects aged 70 years or older (p<0.05).

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Purpose : The purpose of this study was to reveal how to use the resilience, a concept mainly used in Europe and the United States, in the area of cancer nursing, as well as its components. Methods : Concept analysis was carried out referring to the approach described by Rodgers (2000). Collected data were subjected to qualitative content analysis, the constructive concept of resilience was revealed, and then the definition and model cases were studied. Results : Attributes associated with resilience in patients with cancer experience were "Stimulation of positive changes" and "Coping strategy." The leading factors were "cancer-related stressors," "inner strength," and "environment surrounding patients." The derived consequences were "positive adjustment," "acquisition of well-being," "improvement of QOL," and "increase in empowerment." Conclusion : Resilience in patients with cancer experience is defined as "a dynamic process toward adaptation in which the cancer patients find positive meaning by correctly understanding their situation, recognizing their acceptance ability and developing their positive feelings, promote positive change by having faith and conviction, control their reactions by identifying a coping strategy, accept their situation, improve their QOL and empowerment, and finally attain well-being." Because the importance of assisting cancer patients to live in their own way will increase with advancement of cancer therapy and the usually lengthy treatment period required, resilience may be expected to be utilized in nursing practice in the future.

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Purpose : To determine the difficulties in life encountered by patients with peripheral neuropathy and the measures taken to counter the effects of this toxicity. Patients and Methods : Patients : Twenty-five outpatients treated with 6 or more courses of FOLFOX treatment. Methods : Semi-constructive interviews were carried out to determine the difficulties encountered by the patients due to the oxaliplatin-induced peripheral neuropathy and the measures taken against them, and the results were analyzed using a qualitative method. Results : The difficulties in life were categorized as "difficulties in daily life due to numbness" with three sub-categories, and "difficulties in social life due to numbness," with four sub-categories. The measures taken were categorized as "measures for appropriately controlling the numbness," with two sub-categories. Conclusions : Peripheral neuropathy affects the patients' favorite activities and outings, and results in a marked reduction in the scope of these activities. Therefore, it is important to not only precisely understand the degree of peripheral neuropathy, but also to understand the favorite life activities and values of the patients, in order to avoid deterioration of the quality of life (QOL) of the patients.

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Purpose : To compare fatigue in breast cancer patients and non-breast cancer patients, and to clarify the characteristics of fatigue in these two patient groups. Subjects and Methods : We carried out a questionnaire survey of 126 breast cancer patients and 76 non-breast cancer patients. All subjects were outpatients of A hospital. The survey items included those related to fatigue, history of chemotherapy, radiotherapy and exercise therapy, Performance Status (PS), etc. The degree of fatigue was assessed using the Cancer Fatigue Scale (CFS). Results : Among the breast cancer patients, significantly higher CFS scores were observed in the PS ?? 1 group (p< 0.005), the painful patient group (p< 0.05), the insomniac patient group (p< 0.001), the feeling-alone patient group (p< 0.05), the breathing-problem patient group (p< 0.05), and the restlessness patient group (p< 0.005). Among the non-breast cancer patients, significantly higher CFS scores were observed in the PS ?? 1 group (p< 0.001), the painful patient group (p< 0.005), and the diarrhea patient group (p< 0.05). When the scores on the CFS were compared between breast cancer patients and non-breast cancer patients and analyzed by disorder, a significant difference of the CFS score was observed only in the patient group with insomnia. Conclusion : It is evident that breast cancer patients show profound fatigue, not only in relation to somatic symptoms, but also in relation to psychotic symptoms, such as feeling alone. Among these symptoms, it is suggested that particular care may be necessary for patients with insomnia.

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The patient was a 59-year-old woman. In September 2006, a chest roentgenogram showed a nodule-like lesion in the right lung. A chest computed tomographic scan revealed a nodule in the right middle lobe (S4). She was admitted to our hospital for diagnosis of the nodule on a suspicion of lung cancer. Transbronchial lung biopsy was performed, and a diagnosis of adenocarcinoma was made (cT1N1M0, StageIIA). Then She underwent a surgical lobectomy (ND2a) in November 2006. Advanced non small cell lung cancer (pathological stage T4N2M0, StageIIIB) was then diagnosed. Carbopolatin plus gemcitabine was administered but was not effective. 18-fluorodeoxyglucose positron emission tomography (PET) showed abnormal uptake in the multiple lung nodules and right supraclavicular lymph node. And then, gefitinib was administered after EGFR mutation (Exon 19 deletion) was found in the tumor specimen. 18-fluorodeoxyglucose PET showed abnormal uptake in the right supraclavicular lymph node and multiple lung metastases in the right pleura and pelvis, and then CT scan and MRI revealed in the bilateral ovarian metastasis in May 2009. Systemic anticancer chemotherapy consisting of amrubicin, pemetrexed and erlotinib did not have any effect and she died. Ovarian metastasis was identified on autopsy. Ovarian metastasis from lung cancer is rare. We report a case with a brief review of the literature.

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A 38-year-old man presented at a nearby hospital in the middle of June, with a complaint of fever and cold symptoms since early June and dyslalia in the middle of the same month. A chest radiograph at the examination showed a infiltration in the right lower lung field. As he has been a staff of a bathing institution, Legionella pneumonia was suspected. He was admitted to the hospital, although Legionella urinary antigen detection test was negative. On the next day, he had a disturbed consciousness and dyspnea, was referred to our hospital. Although Gimenez steining and Legionella urinary antigen detection test were negative, Legionella pneumonia was suspected, he was given CPFX. In the process, Legionella serogroup 2 was detected, he was given a diagnosis of Legionella pneumonia. As he responded poorly to the initial dose : 600mg/day of CPFX, increased dose : 1200mg/day was given. Then he showed remarkable improvement. From this experience, we consider that AUC and Cmax are important indicators to get effective antibacterial response, when CPFX is given. In general, Japanese dosage are set lower than foreign ones. For poorly responded case of CPFX treatment, we consider that dose increasing should be practiced.

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Sunitinib is an orally administered multi-targeted tyrosine kinase inhibitor and has been approved for the treatment of advanced renal cell carcinoma (RCC). It is well known that sunitinib induces hematologic adverse events, such as neutropenia, anemia, and thrombocytopenia, primarily through myelosuppression. Here, we report that the first case of immune-thrombocytopenia occurred in a patient receiving sunitinib for the treatment of metastatic RCC. The thrombocytopenia was refractory to repeated platelet transfusion. The bone marrow aspiration study revealed an increased number of megakaryocytes. No thrombotic microangiopathy was seen. The thrombocytopenia was successfully treated with high-dose corticosteroid, although intravenous immunoglobulin administration was not effective. These findings suggest that an immune-mediated mechanism was responsible for the thrombocytopenia in this patient, which developed during sunitinib administration.

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We report here a case of Paragonimiasis Miyazakii, who showed various chest shadows on computed tomography (CT). A 36-year-old woman, who is from Thailand and came to Japan in her teenager, was introduced to our hospital due to left chest pain and left pleural effusion on chest X-ray. The labolatory data showed the marked elevation of eosinophilic leukocytes (1732/μl) and IgE (6984 IU/ml). The chest CT showed solitary nodular lesions with ground glass opacity in bilateral lung and left pleural effusion. She had a habit of eating raw river crabs. From the elevation of specific antibody against Paragonimiasis Miyazakii and the episode of eating raw river crabs, we diagnosed as a case of Paragonimiasis Miyazakii. The chest CT, after 14 days from the fist CT, showed the new nodular lesion with cavity in right lung, while the nodule in left lung was reducing in size, suggesting the migration of Paragonimiasis Miyazakii. Praziquantel treatment dramatically improved her chest pain, nodular lesions on chest CT, and hyper-eosinophilia. Recently, Paragonimiasis Miyazakii is more prevalent in Japan, because of international cultural exchange and the change of food tastes. This case suggests that it is important to keep in mind the possibility of parasite infection, when we see patients with abnormal chest shadow with hypereosinophilia.

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A 61-year-old male presented with weight loss, appetite loss, and vomiting. Gastrointestinal endoscopy showed advanced gastric cancer, type 5, which was diagnosed as poorly differentiated adenocarcinoma. Computed tomography (CT) showed hugely enlarged lymph nodes (No.3, 4d, 6, 7, 8). Peritoneal dissemination was found at laparotomy. He was treated with combination chemotherapy consisting of weekly paclitaxel and doxifluridine. Paclitaxel was administered at a dose of 80mg/m² on days 1 and 8 and doxifluridine was administered orally at a dose of 533mg/m²/day for 5 days followed by withdrawal for 2 days. After 12 courses of treatment, gastrointestinal endoscopy showed a reduction in the gastric wall thickening. CT showed a reduction in the lymph nodes. Since laparoscopic observation showed no peritoneal dissemination, a total gastrectomy and lymph node dissection was performed successfully.

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An 84-year-old woman was admitted to a hospital near her home for vomiting and fever in January, 2010. She was diagnosed with aspiration pneumonia secondary to a very large esophageal hiatal hernia. Computed tomography showed that the stomach and pancreatic tail had escaped from the abdominal cavity to the mediastinum through the hiatal hernia. Oral ingestion was impossible. An infusion solution and an antibiotic were administered, and her vomiting stopped soon thereafter. However, the vomiting resumed when she began to ingest meals. Because she had been bedridden, due to pneumonia, for a long period of time, she suffered from disuse syndrome. She regained the ability to walk by herself without oxygen after having undergone rehabilitation. She then transferred to our department for surgical repair of her esophageal hiatal hernia in March 2010. A laparoscopic Nissen fundoplication was successfully performed. The postoperative course was uneventful.

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Early gastric cancer was suspected in a 71-year-old woman during an upper gastrointestinal tract imaging test in November 2008, and she consulted the Department of Gastroenterology at Ojiya General Hospital. Esophagogastroduodenoscopy showed early gastric double cancers, so laparoscopy-assisted distal gastrectomy was performed in December. The final diagnosis was stage IA. Follow-up was conducted in the Department of Gastroenterology. The carcinoembryonic antigen (CEA) level was elevated, at 17ng/mL, in May 2009. Thus, she received a detailed examination. However, a definitive diagnosis of recurrence was not made. As the rise of serum CEA continued, a TS-1/cisdiamine dichloroplatinum treatment was started in August. Chemotherapy was effective, and the CEA levels decreased gradually. Symptoms of anemia were observed in December when the fourth period of chemotherapy treatment had been completed. Esophagogastroduodenoscopy showed a hemorrhagic tumor in the anastomosis in January 2010, so a total remnant gastrectomy was performed in January 2010. Immunohistochemical staining for alpha-fetoprotein (AFP) was positive. A rise in serum AFP occurred just before the total remnant gastrectomy, and we diagnosed it as the gastric cancer producing AFP. After the total remnant gastrectomy, both serum CEA and AFP levels normalized. Although the patient was taking TS-1 after discharge, she developed a recurrence with multiple pulmonary metastases in July, and various systemic chemotherapies are currently being performed.

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A splenic tumor was found in a 39-year-old man through abdominal ultrasonography on April 2008. He then consulted the Department of Gastroenterology at Ojiya General Hospital. Dynamic computed tomography (CT) showed an 8.0-cm hypovascular lesion of the spleen in early phase. But the lesion enhanced to the same degree as the surrounding splenic parenchyma in delayed phase. Since the CT radiologic examination of the tumor was equivocal, and inadequate to rule out malignancy, a splenectomy was performed for diagnostic treatment. Microscopically, the lesion was an admixture of spindle cells and inflammatory cells, chiefly lymphocytes, plasma cells and histiocytes. These tumor cells were immunoreactive to CD35, fascin and clusterin. We made a diagnosis of follicular dendritic cell tumor of the spleen. The test for Epstein-Barr virus, (EBV)-encoded RNA1 (EBER1), was negative. The patient has experienced no recurrence in the 31 months after surgery.

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Purpose : To determine the background the patients or the care-giver who need home care visiting services and to examine the support activities needed for users of home care. Subjects and Methods : Thirty users of home care visiting services aged 60 years or above and his/her families were studied. Investigation was performed using a semi-constructive questionnaire. For eight subjects whose interviews were conducted within 6 months of his/her start of home care visiting services, the following items were additionally examined : i) the events encountered until the start of use of home care visiting services, ii) the background for use of home care visiting services, and iii) the mental conflict of families until they decide to use home care visiting service. Results : The persons recommending use of home care visiting services were physicians and nurses among hospital-related personnel, and the family doctor and nursing care managers among the home-related persons. The events that triggered the use of home care visiting services were necessity of medical treatment and reduced ability of the patients to move. Conclusion : It is suggested that a proper understanding of the patients' medical condition by the physicians, nurses, nursing care managers, family doctors, and visiting nurses, and sharing of the patients' information among these personnel, including the patients' families, are important supports needed for proper use of home care visiting services.

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