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Docetaxel(DTX)is a key drug for breast cancer treatment; however, its formulation contains alcohol, which can cause several problems. We have been preparing original DTX without using its accompanying alcohol-solubilizing solution since 2013 and switched to generic DTX without alcohol in 2015. In this study, we compared adverse events between the original and generic DTX, both of which did not contain alcohol. We retrospectively investigated the occurrence of adverse events in breast cancer patients who were treated with DTX(75 mg/m2)as neoadjuvant or adjuvant chemotherapy from January 2013 to December 2017. 201 patients participated in the study(75/126 in the original/generic groups). The incidence of febrile neutropenia, hypersensitivity reactions, and skin toxicities did not differ between the groups(p=0.620, 0.066, 0.205). The severity of edema and peripheral neuropathy was significantly worse in the patients receiving the generic DTX (p<0.01, <0.01). The findings suggest a difference in the incidence of edema and peripheral neuropathy following treatment with the original and generic DTX, regardless of the inclusion of alcohol.

A 78-year-old woman with bilateral fungal sinusitis, which resulted in right orbital apex syndrome, underwent endoscopic sinus surgery and optic nerve decompression. Two months after the operation, she complained of anxiety and insomnia. Head CT showed subdural hematoma-like effusion and burr hole drainage was conducted. The collected fluid was not hematoma, but bloody, xanthochromic effusion with no pathogenic bacteria. Ten days later, she underwent drainage and dural biopsy after craniotomy because of relapse of subdural hygroma and progression of hypertrophic pachymeningitis associated with aggravation of psychiatric symptoms. A sample of the dura mater showed dense fibrosis with thickening, and Pseudomonas aeruginosa (P. aeruginosa) was detected by culture. Although otitis or sinusitis secondary to P. aeruginosa infection has been reported as a leading cause of infectious pachymeningitis, psychiatric symptoms alone and concomitant refractory subdural hygroma are atypical and unreported manifestations. In patients with pachymeningitis and a history of transnasal endoscopic surgery, P. aeruginosa infection should be considered, irrespective of an atypical clinical course and negative blood or fluid culture. Additionally, dural biopsy might help in detection of pathogenic bacteria.

Intraoperative identification of the parathyroid gland is very important during thyroid and parathyroid surgery.Recently, intrinsic fluorescence of the parathyroid gland was identified and reported.We report the case of a 45-year-old woman with thyroid papillary cancer.Before surgery, neck and chest CT showed a thyroid tumor(20mm)of the right lobe and an aberrant right subclavian artery.Her thyroid cancer(T1N1M0, Stage Ⅰ)was resected in December 2017(right lobectomy and lymph node dissection).During surgery, her parathyroid glands were visually inspected by the surgeon as well as by a ready-made photodynamic eye(PDE-neo)system.Diagnosis was performed using the intraoperative fast pathological method.Her inferior laryngeal nerve was non-recurrent(Toniato ⅡA).This photodynamic eye(PDE-neo)system is an effective and useful method that decreases the operation time and enables faster detection of the parathyroid gland.

We herein report a rare case of fulminant type 1 diabetes mellitus (FT1DM) following acute pancreatitis and hypoglycemia, in which the pancreas was evaluated by serial computed tomography (CT). A 30-year-old male presented to a local hospital with a two-day history of abdominal pain and was diagnosed with acute pancreatitis based on elevated serum amylase and peripancreatic fluid collection on CT images. The patient developed sudden hypoglycemia (plasma glucose, 45mg/dL;serum C-peptide, 3.4ng/mL) the next day and hyperglycemia (plasma glucose, 250-480mg/dL) on admission day four. CT revealed a low attenuation area extending from the pancreatic head to the pancreatic tail. On admission day eight, he was referred to our hospital and diagnosed with FT1DM after he developed ketoacidosis immediately after hospitalization, with a plasma glucose level of 442mg/dL, hemoglobin A1c concentration of 5.7% and undetectable urinary C-peptide with a serum C-peptide level of 0.1ng/mL before and after intravenous glucagon loading. CT imaging revealed dramatic improvement at the time, and no pancreatic islets were detected in the pancreatic biopsy specimens.

A 51-year-old man was diagnosed with stage IV mantle cell lymphoma based on terminal ileum biopsy and treated with the R-CHOP regimen. Abdominal CT to assess continuous fever after three courses of R-CHOP revealed three low-density areas in the liver. PCR of the fluid obtained by percutaneous drainage revealed Entamoeba histolytica positivity, although the cultures were negative. Metronidazole treatment achieved cure. The patient was not a homosexual but had an 8-month stay in Lesotho 21 years ago, leading to the possibility that E. histolytica infection at the time continued as an asymptomatic colonization until the initiation of corticosteroid-containing chemotherapy.

Exercise increases adult hippocampal neurogenesis (AHN) and enhances memory function. To elucidate optimal exercise, especially exercise intensity, on hippocampus-based cognition, we established treadmill running animal model, in which running speed was defined using the blood lactate threshold (LT). Using this exercise model, we found for the first time that hippocampal neurons were activated after acute mild exercise (ME) below the LT with running stress minimized. In addition, chronic ME enhanced AHN and spatial memory function. We review the beneficial effects of ME and discuss several molecular factors underlying ME-enhanced hippocampal function.

The issue of drug lag in Japan has been rapidly reduced in recent years, and newly approved drugs now become available on Japanese and international markets at the same time. In this context, the risk management plan (RMP) system was introduced in 2012. RMPs describe important safety concerns recognized by Japan's Pharmaceuticals and Medical Devices Agency (PMDA) and marketing authorization holders (MAHs), as well as safety measures that MAHs request healthcare professionals (HCPs) to follow. The publication of RMPs is expected to support the sharing of drug risk management among HCPs during the postmarketing phase. In addition, to encourage risk communication between HCPs and patients, the PMDA website provides drug guides for patients and other information to promote proper understanding of drugs by patients and their families and enable them to identify serious adverse drug reactions at an early stage. However, the results of surveys conducted by the PMDA in FY2014 and FY2015 revealed low levels of awareness of RMPs and drug guides for patients in hospitals and other healthcare institutions. The surveys also showed that information regarding the proper use of drugs from MAHs and the PMDA was not incorporated into practice at healthcare institutions, resulting in the repeated release of identical safety alerts. To facilitate the increased utilization of risk communication tools, the PMDA has been providing and disseminating these tools through its website. This study addresses those efforts and the associated challenges.

This article was retracted by author’s request.

In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29 kg in approximately 5 months. In January 20XX, the subject was first examined as an outpatient at our psychiatric department at the recommendation of her eldest son. Upon diagnosis of anorexia nervosa, the subject underwent outpatient treatment ; however, there was no improvement in the disturbance in self-per- ceived weight or shape, and the subject voiced her desire to lose weight. In May 20XX, the subject complained of chest pain, pharyngeal pain, and respiratory distress after self-induced vomiting and was, thus, examined at the psychiatric outpatient services. Chest X-ray and chest CT revealed pneumomediastinum and subcutaneous emphysema. Spontaneous oesophageal rupture, a fatal condition, was suspected and, therefore, the subject was transferred to a more advanced medical institution capable of esophageal surgery. After admission, spontane- ous oesophageal rupture was ruled out based on the results of upper gastrointestinal endos- copy with esophagography, and spontaneous pneumomediastinum was diagnosed. The pneu- momediastinum disappeared with conservative treatment ; however, after approximately 8 months, spontaneous pneumomediastinum recurred, following self-induced vomiting. For patients with eating disorders and who are involved in self-induce vomiting, we believe that the vomiting can cause pneumomediastinum, and it is assumed that continuation or recommencement of vomiting can potentially increase the risk that pneumomediastinum will recur. We, therefore, report recurring pneumoediastinum as a physical complication caused by self- induced vomiting that should be noted in clinical practice of the psychiatric department.

We hypothesized that a large number of circulating tumor cells(CTCs)may be isolated from samples obtained by using the leukapheresis procedures that are utilized to collect peripheral blood mononuclear cells for dendritic cell vaccine therapy. We utilized the CellSearch System to determine the number of CTCs in samples obtained by using leukapheresis in 7 patients with colorectal cancer, 5 patients with breast cancer, and 3 patients with gastric cancer. In all patients, a large number of CTCs were isolated. The mean number of CTCs per tumor was 17.1(range 10-34)in colorectal cancer, 10.0(range 2-27)in breast cancer, and 24.0(range 2-42)in gastric cancer. We succeeded in culturing the isolated CTCs from 7 patients with colorectal cancer, 5 patients with breast cancer, and 3 patients with gastric cancer. In conclusion, compared to conventional methods, a large number of CTCs can be obtained by using leukapheresis procedures. The molecular analyses of the CTCs isolated by using this method should be promising in the development of personalized cancer treatments.

The purpose of this study was to evaluate the safety and feasibility of laparoscopic partial nephrectomy with a small renal tumor. Between September 2004 and October 2014, 69 patients who underwent laparoscopic partial nephrectomy in Kansai Rosai Hospial were examined. The mean patient age was 60.3 years, and the mean tumor size was 24.5 mm. The mean estimated blood loss was 111 cc. The mean cold ischemic time was 59.7 minutes, and the mean warm ischemic time was 31.3 minutes. There were 5 complications : intraoperative ureteral injury, blood transfusion, postoperative perinephric hematoma, portsite bleeding, urinary fistula, respectively. All of the cases were cured with non-surgical treatment except ureteral injury which was repaired intraoperatively. The postoperative eGFR loss was 11%. At present, no patients have developed local recurrence or distant metastasis. The initial outcome of laparoscopic partial nephrectomy in our hospital was satisfactory in terms of safety, renal function and cancer control.

Deep neck abscesses are relatively rare in children compared with adults. Diagnosis can be difficult in pediatric patients because of the various clinical symptoms, therefore, it is important to correctly understand the pathology. We report herein on a rare pediatric case of a deep neck abscess that caused multiple instances of cranial nerve palsy. The patient was a 7-year-old boy who, despite treatment by a local physician for fever, swelling of the left neck and neck pain, developed torticollis, dysarthria, dysphagia and hoarseness and consequently consulted our department. We observed palsy associated with the IX, X, and XII left cranial nerves and a retropharyngeal abscess was diagnosed based on the computed tomography findings. The patient was hospitalized and underwent conservative treatment, and on day 21 of hospitalization, the patient was discharged after his symptoms had eased and the size of the abscess had reduced. We believe that palsy of the cranial nerves in the present case occurred as a result of pressure being applied to the cranial nerves in the carotid space due to an abscess in the retropharyngeal space.

As for the lymphoma, the cell origin and the tumorigenic process are not unitary and the biological property of lymphoma is various. The cellular origin and the etiology of the lymphoma were gradually elucidated by immunological, cytogenetical and molecular biological progress. Recently the pathological classification of lymphoma was gathered in WHO-2008 classification. On the other hand, changes of the clinical staging system and the criteria of curative effects of lymphoma therapy depended on the progress of the diagnostic imaging especially the computed tomography (CT) and the 18F-fluorodeoxyglucose positron emission tomography(FDG-PET). They were gathered in International Working Group (IWG)-2007 criteria. As for the diagnostic classification and the criteria of the curative effects of treatments, update and revision will be unavoidable with accumulation of proposal of new disease concepts and development of the laboratory procedure in future.

A 46-year-old man developed central respiratory failure in the subacute phase of unilateral lateral medullary infarction. He complained of sudden headache and nausea at first. Neurological examination revealed Wallenberg's syndrome. Acute right lateral medullary infarction caused by the dissecting right vertebral artery was identified by magnetic resonance images. He was transferred to our hospital on the 3rd day after the onset. He was alert and conscious on admission, and became restless gradually later. He was intubated for sudden respiratory failure on the 9th day. Blood gas analysis showed hypercapnia and hypoxia. Central respiratory failure was indicated by the fact that various examinations showed no change of his infarction, no subarachnoid hemorrhage, or no worsening of pneumonia. Ventilatory support was required for a month because of repetitive CO2 narcosis. He was weaned from the ventilator on the 39th day. Only a few reports are available on central respiratory failure associated with the subacute phase of unilateral medullary infarction. Delayed central respiratory failure may be lethal. Careful observation is required on the subacute phase of Wallenberg's syndrome.

Hydrogen sulfide (H2S), a potentially toxic gas, is also an important signaling molecule in various mammalian cells and tissues. H2S is involved in the neuroprotection, neuromodulation, cardioprotection, vasodilatation and the regulation of inflammatory response. In pancreatic beta-cells, H2S can be produced by cystathionine beta-synthase (CBS) or cystathionine gamma-lyase (CSE). The produced H2S inhibits insulin release and regulates beta-cell survival. We demonstrated that glucose stimulation increase CSE expression in mouse pancreatic islets. We also indicated that H2S protects beta-cells that are chronically exposed to high glucose. Loss of beta-cell mass is important in the pathogenesis and/or progression of diabetes mellitus; therefore, molecular analyses of the mechanisms of H2S production and its protective effects on beta-cells may lead to new insights into diabetes mellitus.

Tohoku University Graduate School of Medicine has established the Tohoku-RITM Collaborative Research Center on Emerging and Re-emerging Diseases at Research Institute for Tropical Medicine (RITM) in the Philippines in 2008. Our aim of the center is to conduct operational researches, which can contribute to control of infectious diseases in the Philippines. Therefore most of our researches in the Philippines are being conducted in the fields. Main research themes include severe acute respiratory infections in children, influenza disease burden study, molecular epidemiology of rabies, and viral etiology of acute diarrhea. The study on severe acute respiratory infections in children in Leyte Island has recruited hospitalized cases with severe pneumonia. We showed that enterovirus 68 was one of important causative agents in severe pneumonia cases. We also conducted other analyses including molecular epidemiology of respiratory syncytial virus (RSV) and pathogenesis of human rhinoviruses (HRV). Based on these studies, we initiated more comprehensive researches in the Philippines since 2010.

A 31-year-old man visited our hospital with a persistent cough. Computed tomography (CT) scans of his chest showed a very large mass and multiple nodular lesions in the right lung field, mediastinal and hilar lymph node enlargement and splenomegaly. Laboratory analysis showed polyclonal hyperimmunoglobulinemia and increased levels of serum C-reactive protein (14.05 mg/dl) and interleukin-6 (44.2 pg/ml). The pathological findings of lung specimens obtained using video-assisted thoracoscopy revealed hyperplasia of the lymphoid follicles with germinal centers, plasma cell infiltration which stained positively with either anti-kappa chain or anti-lambda chain antibodies, and fibrosis in the alveolar septum. We made a diagnosis of multicentric Castleman disease based on high levels of serum IL-6, multiple lymph node enlargement and splenomegaly, although this case had histological findings in common not only with Castleman disease but also with inflammatory myofibroblastic tumor. His abnormal chest radiography findings and laboratory data significantly improved 6 months after his first visit, without any treatment. Multicentric Castleman disease showing a very large mass is extremely rare.

A 34-year-old woman developed polydipsia, polyuria, amenorrhea and loss of pubic hair in 2001, but did not seek medical advice. On September 7th, 2009, she was admitted to our hospital complaining of acute exacerbation of dyspnea on exertion. Chest computed tomography (CT) showed multiple cystic lesions, predominantly in bilateral lower lung fields. Non-segmental, diffuse ground-glass attenuated areas and thickened bronchovascular bundles were also seen in bilateral lung fields. Pathological findings of lung specimens from a surgical lung biopsy (right S6 and S8) 14 years previously showed infiltration of S100 protein-positive histiocytoid cells in the bronchiolar wall. As a result, pulmonary Langerhans cell histiocytosis (PLCH) was diagnosed. Moreover, panhypopituitarism due to LCH was identified on endocrine testing. Dyspnea on exertion, reduction of carbon-monoxide diffusing capacity (D(LCO)) and ground-glass attenuation areas on CT were improved by smoking cessation alone, and she was discharged. However, similar acute deterioration of PLCH recurred 4 months after first admission. Her dyspnea on exertion, reduction of D(LCO) and ground-glass attenuation areas on CT were improved again by 500 mg/day methylprednisolone pulse therapy for 3 days. This case was a unique combination of panhypopituitarism and the appearance and disappearance of ground-glass attenuation areas on CT, paralleling PLCH disease activity.

The aim of this study was to evaluate the role of home medical care support system to relieve the symptom and regional alliances for elderly cancer patients. We investigated clinical parameters to study the features of this system. The home medical care support system is designed for patients who are B75-year-old with decrease in activities of daily living and severe dementia. The support system plays a significant role in patients with impaired oral ingestion, dyspnea, delirium, and a poor general status.

Rituximab, a chimeric monoclonal antibody against the CD20 protein, has an antineoplastic effect resulting from antibody dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC). In patients with rituximab-combined chemotherapy, a decline in immunoglobulin can be observed. This is more likely to cause virus reactivation, such as Herpes (H) zoster. However, this fact has not reported in a large-scale study. In order to research immunodeficiency conditions in patients with rituximab-combined therapy, we examined the alteration in immunoglobulin level throughout the treatment among 205 cases with B-cell lymphoma. We also studied the prevalence of H. zoster in those cases. The IgG level throughout the treatment was measured in 89 patients in the research. The median post-chemotherapy IgG level was 41.1% lower than its pre-chemotherapy IgG level. In 58 cases, the IgG level following chemotherapy was below the normal level. In 22 cases, the IgG level dropped to less than half of the pre-chemotherapy level. H. zoster developed in 17 cases (8.3%). There was no significant difference in IgG level between H. zoster-onset cases and non-H. zoster-onset cases. Antibody-mediated immunity can decrease greatly and prolong in cases with rituximab in combination with chemotherapy. Therefore, infection control is considered to be important.

As for the esophageal terminal stage patient with enteral feeding when the patient was hospitalized, an oral nourishment intake support was given with a cooperation of nurse and registered dietician. After that, the patient was transferred to home care and was seceded from PEG. It has been suggested that an early assessment of the problems with the terminal stage patient, ascertainment of home care timing and the team support consisted of multi professionals were all important ingredients.

A 30-year-old man was admitted to our hospital due to infectious bulla. His chest X-ray and computed tomography (CT) showed bilateral multiple emphysematous bullae and a left bulla with effusion. He underwent partial lung resection including the bulla with video-assisted thoracic surgery. The bacterial diagnosis of the effusion was infection of Aspergillus. Further, Aspergillus was detected inside the wall in pathological diagnosis. Treatment with itraconazole 100 mg a day was started after surgery, and 6 months later the patient is well without recurrence.

A 49-year-old woman visited our clinic on July 12th, 2006, complaining of discomfort in fingers of both hands, edema of both lower limbs, and pain in the right shoulder and chest. Chest X-ray examination showed an infiltrative shadow with pleural effusion and loss of lung volume in the left lower lung field. She was treated with CTRX, but it was ineffective, and she was therefore admitted to Kurume University Hospital on July 21st, 2006. Chest CT demonstrated pyothorax and loss of lung volume in the left lung. Culture of a sample obtained by thoracentesis yielded Nocardia asteroides. The pulmonary nocardiosis improved after oral administration of trimethoprim-sulfamethoxazole, and the patient was discharged on August 25th 2006. No immunological impairment was observed, and the serum levels of ACHT and cortisol were normal. In February 2007, however, she developed facial acne, facial edema ("moon" face), centripetal obesity, and weight gain. Cushing syndrome was diagnosed on the basis of tests including a low-dose dexamethasone suppression test. To the best of our knowledge, there has been no previous report of pulmonary nocardiosis with pyothorax in a patient with Cushing syndrome. We assume that the present patient had pre-(sub-) clinical Cushing syndrome when she presented with pulmonary nocardiosis and pyothorax.

An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.

Throat swab specimens collected from 439 patients with influenza-like symptoms visiting a clinic in the 2004-2005 influenza season were subjected to cell culture virus isolation and viral antigen detection using a rapid diagnostic kit, QuickVue Rapid SP influ (Quidel Corporation, San Diego, CA, U.S.A.). The sensitivity and specificity of diagnostic kit results were analyzed based on cell culture results, considered the diagnostic standard. Kit sensitivity was 87.8% (72/82) and specificity 90.2% (322/357) for type A influenza, and 80.4% (176/219) and 95.0% (209/220) for type B influenza, roughly comparable to results reported so far for nasopharyngeal swabs and/or nasal aspirates. Sensitivity and specificity calculated separately dividing patient age but no significant difference was seen. The antigen-detection kit thus appears clinically useful in diagnosing influenza, provided that is collected and processed properly.

The first evaluated case was a 71-year-old man with melaena. A huge tumor mass was observed in the tale of the pancreas, which we diagnosed as pancreatic carcinoma. Pathological findings confirmed that it was anaplastic pancreas carcinoma (giant cell type). The second case was a 61-year-old woman with upper abdominal pain. Irregular tumors with scattered cysts were observed in the tale of the pancreas, which rapidly increased. Autopsy findings confirmed that it was anaplastic pancreas carcinoma (pleomorphic type). Both cases showed positive for epithelial marker and mesenchymal markers and decrease in stainability by E-cadherin staining, a result which suggested diversity of tumor cells in anaplastic pancreas carcinomas.

The patient was a 70-year-old woman who underwent combined chemotherapy of paclitaxel (PTX) and S-1 after diagnosis of non-resectable advanced gastric cancer with Schnitzler's metastases. The administration schedule was as follows: 120 mg/m(2) of PTX on days 1 and 15 intravenously and 80 mg/m(2) of S-1 on days 1-14 orally. One course lasted for 4 weeks. The abdominal pain and appetite loss improved after the first course of chemotherapy, and therapeutic efficacy was rated PR. At present, there is no evidence of relapse or adverse reactions that require intervention after 4 courses. PTX and S-1 combination treatment promises good therapeutic efficacy and improves QOL in patients with advanced gastric cancer associated with Schnitzler's metastases.

We report a patient who attempted suicide by taking warfarin as a coumarin rodenticide twice, and showed oral bleeding and an abnormally prolonged bleeding tendency after 10 days. He was conscious. His body temperature was 36.6 degrees C, the respiratory rate was 23/min, and blood pressure was 142/87 mmHg. A bite wound showing continuous bleeding was observed on the right side of the oral cavity. CT of the head and upper gastrointestinal endoscopy showed no intracranial and gastrointestinal bleeding,respectively. The PT and INR were extremely high, and complete blood count revealed anemia. Blood chemistry showed hypoproteinemia. Occult blood was strongly positive. Routine urine examination and electrocardiography showed neither abnormal nor characteristic findings. In drug/ poison screening tests, GC/MS analysis revealed warfarin artifacts in serum and urine samples. Warfarin was isolated from each sample, converted to a TMS derivative, and quantified by SIM analysis of GC/MS. During the clinical course, KaytwoN (vitamin K) was intravenously administered at a dose of 20 mg since the INR at the first consultation was 20.89. After admission to the ICU, 20 mg Kaywan (vitamin K) was orally administered, and the INR after 5 hours improved to 2.32. Kaywan administration (20 mg/day) was initiated, and he improved and was discharged 5 days after admission. The definite cause could be clarified by drug/poison analysis, and effective treatment could be performed.

Since S-1 was approved in 1999, the response rate and the disease control rate of this chemotherapy for advanced or recurrent gastric cancer has been improved. Aa a result, we can plan for chemotherapy in patients with advanced or recurrent gastric cancer, because the median survival time (MST) with advanced or recurrent gastric cancer was over 20 months. We examined the characteristic findings of long- and short-term survivors in chemotherapy patients with advanced or recurrent gastric cancer. The prognosis for advanced gastric cancer is better than that for recurrent gastric cancer (p <0.02). In patients with only recurrent gastric cancer, the interval from surgery to recurrence is a significant prognostic factor. We thus show the results of chemotherapy for advanced or recurrent gastric cancer in our hospital and the characteristic findings in long- and short-term survivors for chemotherapy, and discuss effective planning of chemotherapy for each patient with advanced or recurrent gastric cancer.

Since S-1 was approved in 1999, the response rate and the disease control rate of the chemotherapy for advanced or recurrent gastric cancer have improved. It is important to perform chemotherapy using key drugs and to plan the chemotherapy for each case. Of the 32 patients in our hospital, the median survival time (MST) was 21 months for chemotherapy in advanced or recurrent gastric cancer during 2003-2006. MST for patients who had up to second- or third-line treatment was longer than for patients with up to first-line treatment. In addition, it there was no difference in prognosis for patients using CPT-11 or taxane at second-line after using S-1 at first-line treatment. The first-line chemotherapy for advanced or recurrent gastric cancer should be decided by the disease condition of each patient and the characteristics of each anti-cancer drug. In addition, the prognosis of patients will improve if second- or third-line chemotherapy can be performed.

Serum parathyroid hormone concentrations decrease progressively during the first 3 to 6 month after successful renal transplantation. However 1 year after transplantation, persistent hyperparathyroidism is common. Hypercalcemia due to persistent hyperparathyroidism cause graft dysfunction and cardiovascular calcification. Renal transplant recipients with persistent hyperparathyroidism need treatment with vitamin D and calcium, in some cases parathyroidectomy has to be considered.