Background: As an increasing number of cancer patients have been cured of the disease in recent decades, clinicians need to determine whether cancer therapies will actually cure the disease or merely prolong time to death and what percentage of patients will be cured. These questions can be answered by the Boag model (parametric cure model) with its three parameters including the cure rate and mean log survival time, whereas conventional Cox model fails to distinguish between cure and delayed death. One may argue, however, that the Boag model compared with the Cox one-parameter model may have superfluous parameters. We assess the redundancy of the Boag model and the relationship between its regression coefficients with that of the Cox model. Methods: We used follow-up data from 1410 gastric cancer patients who were randomized to receive high-dose or low-dose adjuvant chemotherapy after curative gastrectomy. Each of 18 explanatory variables were converted to a binary covariate and entered into three modifications of the Gamel-Boag regression models and into the Cox regression model, to obtain maximum likelihood estimates of regression coefficients representing the covariate effects on the cure rate, mean survival time and hazard ratio. The adequacy of the Gamel-Boag models was assessed by the Akaike information criterion and the relationship between the Gamel-Boag and Cox regression coefficients was examined by regression analysis. Results: The assumption that chemotherapy and other factors affect the cure rate alone is comparable with the assumption that chemotherapy affects both the cure rate and survival time. The Gamel-Boag regression coefficients for cure rate were highly correlated with and proportional to the Cox regression coefficient for hazard ratio (|r|= 0.99, P < 0.0001); the Gamel-Boag regression coefficients for survival time were less strongly correlated with the Cox regression coefficient. Conclusion: In curable subsets of cancer patients, the hazard ratio may be used to test whether or not treatment is curative; the Gamel-Boag regression coefficient for survival time may be a superfluous parameter. To assess the survival benefits of treatment, however, the Gamel-Boag parametric analysis should be done.

Purpose: Impaired lipid metabolism has yet to be controlled satisfactorily. We investigated the effect and safety of ezetimibe, which is an inhibitor of small intestinal cholesterol transporter, in dislipidemic patients. Methods: A total of 55 patients, including 22 males, received 10 mg of ezetimibe daily for 6 months as a single drug or in combination with statin. Data were collected before, and at three and six months after the start of ezetimibe. The data were analyzed by repeated measure analysis of variance, in which LDL-cholesterol (LDL-C), HDL-cholesterol or triglyceride (TG) was used as a dependent variable, and combinations of administration of statin, gender, and hypertension were used as between-subject covariates. Results: Only two factors showed significant effects: Ezetimibe lowered the mean LDL-C by 31 mg/dl at three months; also, it was 34 mg/dl lower with statin than without. This effect was additive, and no interaction was observed between any two factors. No significant change was found when HDL-cholesterol or triglyceride was used as dependent variable. Conclusion: Ezetimibe improved the dyslipidemic state by reducing LDL-C, displaying adequate tolerability and safety in high risk patients with diabetes and hypertension. We hope that ezetimibe could contribute to the reduction of cardiovascular events in Japan. Combined administration of ezetimibe and statin might be useful if ezetimibe alone is ineffective.

Background: Neuromyelitis optica (NMO) has clinical features in common with optic spinal multiple sclerosis (OSMS), which is predominant among patients with multiple sclerosis (MS) in Asian countries, but it has certain traits distinct from classical MS, which is common in western countries. An antibody specific to a water channel protein, aquaporin 4 (AQP4), has recently allowed us to differentiate NMO from MS. We made an assay to detect anti-AQP4 antibody in our hospital and confirmed the value of this assay. Method: We used indirect immunohistochemistry with HEK293 cells expressing human AQP4 conjugated with green fluorescent protein (GFP). We incubated these cells with sera of two patients, one clinically defined as NMO and the other as classical MS; then we stained with red fluorescence-labeled anti-human IgG. Results: The AQP4-expressing cells incubated with the serum obtained from the NMO patient showed red dotted fluorescence on their surface, indicating positivity of the serum, while the cells incubated with the serum from the MS patient did not. In addition, the serum from the NMO patient did not bind to HEK293 cells not expressing AQP4, suggesting that the serum specifically recognized AQP4 molecules. Conclusion: These results confirm the value of our assay in diagnosing NMO.

Background: Home parenteral nutrition (HPN) remains controversial for endstage cancer patients incapable of oral or enteral food intake. We retrospectively reviewed data from patients treated for such conditions in our hospital or at home, paying particular attention to life expectancy. Methods: Of 124 patients who were incapable of oral intake and were treated by total parenteral nutrition for advanced abdominal malignancies, 76 patients were discharged so as to receive HPN (HPN group) after completing education in the management. The remaining 48 patients died in the hospital (non-HPN group). Patients' data were compared between the two groups, and their survival time was estimated using multiple regression analysis. Results: The median durations of HPN and TPN were 33.5 and 108.5 days in the HPN group, compared with a median of 32.0 days in the non-HPN group. In 71% of the HPN group, nutrition was managed by the patient alone or with a single family member, posing a problem about nutritional support at home. In the majority of the non-HPN group, the shift to HPN was hindered by aggravated disease. The observed survival time was significantly correlated with the Onodera nutritional prognostic index, and with the survival time estimated by our multiple regression analysis using serum albumin and the lymphcite count. Individual prediction of life expectancy was not successful, however. Conclusion: Retrospective analysis of patients receiving TPN for endstage intra-abdominal malignancies shows that prediction of survival time of individuals has yet to be refined requiring multiple regression analysis with additional predictors.

We report a case of hypothyroidism due to excess iodine ingestion and refeeding syndrome in 42-year-old female. The patient had eating disorder and visited a clinic suffering from emaciation and edema. Because of abnormal liver function test results and hypothyroidism she was referred to Tenri Hospital. She developed delusions and was hospitalized to a psychiatric ward, following which acute liver damage and hypophosphatemia became apparent. After oral replenishment of phosphate, liver function tests returned to normal. Hypothyroidism also improved after she accepted an ordinary hospital diet.

We report a case of superior mediastinal lymphangioma in a 28-year-old man, who presented with a mass in the superior mediastinum shown on chest X-ray. Computerized tomography revealed a cystic mass extending from the back of the aortic arch to the inferior margin of the thyroid gland, causing bronchial stenosis. The mass was completely removed by the cervical approach alone; this contributed to his rapid recovery. Postoperative X-ray showed relief of the bronchial stenosis. Microscopically, the mass was diagnosed as lymphangioma.

A24 year old male complained of fever (around 40℃) lasting for two weeks and pain in the left hypochondrium, due to splenic infarction; he was diagnosed as having infective endocarditis caused by Haemophilus parainfluenzae. We used cefepime (1 g) twice daily for three days, and ceftriaxone (2 g) daily for three days. His condition did not improve, so we increased ceftriaxone to 2 g twice daily for a further six weeks, after which he complained of pain in the right hypochondrium. Upon examination we found cholecystolithiasis, which he had not had when admitted. We therefore diagnosed him with cholecystolithiasis due to ceftriaxone. With ceftriaxone-induced cholecystolithiasis, stones usually disappear without any treatment. He complained of frequent abdominal pain, however. We decided to perform laparoscopic cholecystectomy. We analyzed the bile and stone, and detected ceftriaxone in both. When ceftriaxone is used in adults, cholecystolithiasis is very rare, and laparoscopic cholecystectomy is rarely undertaken. The risk of cholecystolithiasis due to long-term ceftriaxone treatment demands to be clarified.