Search

Masataka Taoka,1 Nobuaki Ochi,1 Ayaka Mimura,1 Naruhiko Ichiyama,1 Yasunari Nagasaki,1 Nozomu Nakagawa,1 Hidekazu Nakanishi,1 Hiromichi Yamane,1 Yoshiyuki Oshiro,2 Yasumasa Monobe,3 Nagio Takigawa1 1Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan; 2Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan; 3Department of Pathology, Kawasaki Medical School, Okayama, JapanCorrespondence: Nobuaki OchiDepartment of General Internal Medicine 4, Kawasaki Medical School, 2-6-1, Nakasange, Kita-ku, Okayama, JapanTel +81-86-225-2111Email placidus.aura@gmail.comAbstract: A 72-year-old man with locally advanced lung squamous cell carcinoma experienced red purpura on the lower legs and hematuria when the disease progressed during definitive chemoradiotherapy. He had renal dysfunction and proteinuria. Biopsy specimens of the skin lesion and kidney revealed immunoglobulin A vasculitis. Potential causes such as paraneoplastic syndrome and cancer treatment have been proposed. The administration of steroids rapidly improved the symptoms. The presentation of immunoglobulin A vasculitis is accompanied by malignancies. Clinicians should keep this syndrome in mind, even during curative-intent treatment.Keywords: IgA vasculitis, lung cancer, squamous cell carcinoma, nephritis, paraneoplastic syndrome

Nobuaki Ochi,1 Tokio Wakabayashi,2 Atsushi Urakami,3 Tomoki Yamatsuji,3 Naoto Ikemoto,4 Yasunari Nagasaki,1 Nozomu Nakagawa,1 Yoshihiro Honda,1 Hidekazu Nakanishi,1 Hiromichi Yamane,1 Yasumasa Monobe,5 Takeshi Akisada,2 Hiroshi Katayama,4 Yoshio Naomoto,3 Nagio Takigawa1 1Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan; 2Department of Otolaryngology, Kawasaki Medical School, Okayama, Japan; 3Department of General Surgery, Kawasaki Medical School, Okayama, Japan; 4Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Okayama, Japan; 5Department of Pathology, Kawasaki Medical School, Okayama, Japan Abstract: A 26-year-old man with right lower mandibular and chest pain, fever, and respiratory distress was urgently transported to our hospital. CT images revealed gas collection and an abscess from the neck to the mediastinum with bilateral pleural effusion. Descending necrotizing mediastinitis (DNM) induced by an odontogenic infection of a right mandibular molar abscess was diagnosed. The cervical and mediastinal areas were drained, extensive debridement was performed, necrotic tissue was excised, and broad-spectrum antibiotics were administered immediately. Prompt diagnosis and intensive care were necessary for managing the DNM, and the patient was discharged with no comorbidities. Keywords: descending necrotizing mediastinitis, odontogenic infection, healthy young adult

Hiromichi Yamane, Nobuaki Ochi, Yasunari Nagasaki, Tomoko Yamagishi, Yoshihiro Honda, Nozomu Nakagawa, Masami Takeyama, Hidekazu Nakanishi, Nagio Takigawa Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan Purpose: Cure-oriented treatment of malignant lymphoma (ML) is possible even in an advanced stage; however, the progression of drug-induced interstitial lung disease (DILD) sometimes accounts for poor clinical outcomes. This study aims to assess the incidence and clinical characteristics of DILD among patients with ML and compares the serum level of Krebs von den Lungen-6 (KL-6) with that of circulating thymus and activation-regulated chemokine (TARC)/CC chemokine ligand 17 (CCL17) as a diagnostic biomarker for DILD.Patients and methods: Between July 2011 and August 2016, we enrolled 36 patients with ML who were undergoing systemic chemotherapy at our hospital. Then, we evaluated the serum concentration of KL-6 and TARC/CCL17 by a sandwich-type electrochemiluminescence immunoassay and enzyme-linked immunosorbent assay, respectively.Results: DILD developed in 22.2% of patients with ML. All patients recovered immediately after the discontinuation of causative drug and/or glucocorticoid therapy. Although the sensitivity of both TARC/CCL17 and KL-6 was almost equal, the mean concentration of serum KL-6 after the progression of interstitial lung disease was significantly higher than that before progression.Conclusion: DILD developed in patients who were treated with first-line rituximab combined regimen. Remarkably, TARC/CCL17 and KL-6 seemed approximately equal as a predictive biomarkers for DILD; however, KL-6 was more specific than TARC/CCL17. Keywords: malignant lymphoma, drug-induced interstitial lung disease, KL-6, TARC/CCL17, biomarker

Nobuaki Ochi,1 Kento Takahashi,2 Hiromichi Yamane,1 Nagio Takigawa1 1Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan; 2Clinical Education and Training Center, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Japan Abstract: Acute necrotizing encephalopathy following influenza infection is a rapidly progressing disease with high morbidity. Although the neurological disorder is sometimes reported in children, it is very rare in adults. We herein describe an adult with acute necrotizing encephalopathy captured on a series of brain magnetic resonance images. A 55-year-old man had fever and impaired consciousness. He was diagnosed with influenza A (H1N1). Brain magnetic resonance imaging revealed symmetrical lesions in the cerebellum and basal nucleus, showing typical acute necrotizing encephalopathy. Physicians should know that influenza-associated acute necrotizing encephalopathy can occur even in middle-aged adults. Keywords: acute necrotizing encephalopathy, influenza A, magnetic resonance imaging, adult

Hiromichi Yamane,1 Toshiyuki Kunisada,2 Toshifumi Ozaki,2 Nobuaki Ochi,1 Yoshihiro Honda,1 Yasunari Nagasaki,1 Nozomu Nakagawa,1 Tomoko Yamagishi,1 Hidekazu Nakanishi,1 Nagio Takigawa1 1Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan; 2Department of Orthopedics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Purpose: “Rare cancer” is defined as malignancy with a disease prevalence (age-adjusted incidence rate) of less than six per 100,000 population. Proper treatments which these patients need cannot always be performed unless they find dedicated facilities. Patients tend to be desperate, searching for advice and care. Thus, they are called “cancer refugees”. Osteosarcoma and soft tissue sarcoma (OS/STS) are representative rare cancers in Japan. We conducted a retrospective analysis of patients with OS/STS to improve the current treatment modalities in a Japanese regional city. Patients and methods: Twenty-one patients with OS/STS who were hospitalized to receive standard chemotherapy or palliative treatment were enrolled between October 2011 and January 2017. Patients with non-Hodgkin’s lymphoma (NHL) and advanced cancer who were treated in the palliative care unit (PCU) of the Kawasaki Medical School General Medical Center were recruited as the control groups. We analyzed the difference in residential area between patients with OS/STS and the control groups. Results: Approximately one-third of patients with OS/STS were referred from hospitals outside of Okayama prefecture. The ratio of patients with OS/STS referred from Okayama city and/or the same medical administration area of Okayama prefecture was lower than that of patients with NHL and advanced cancer who were treated in the PCU. Conclusion: Because the medical environment of patients with OS/STS in Japanese local cities has not been consolidated, completing medical care within the patient’s own medical administration area is difficult. Thus, some patients with OS/STS may become “cancer refugees” who are unable to receive standard therapy near their residence. Keywords: osteosarcoma, soft tissue sarcoma, rare cancer, cancer refugee

Hiromichi Yamane,1 Yasumasa Monobe,2 Tomohiro Tanikawa,3 Nobuaki Ochi,1 Yoshihiro Honda,1 Hirofumi Kawamoto,3 Nagio Takigawa1 1Department of General Internal Medicine 4, 2Department of Pathology, 3Department of General Internal Medicine 2, Kawasaki Medical School, Kita-ku, Okayama, Japan Abstract: A 76-year-old Japanese woman presented to our hospital with anorexia. Two years before, she was diagnosed with non-Hodgkin’s lymphoma and had received ten cycles of systemic chemotherapy. After salvage chemotherapy with bendamustine and rituximab (B–R), bone marrow suppression had lasted >3 months. Esophagogastroscopy revealed polynesic white protrusions in the mid-esophagus. These lesions were diagnosed as herpetic esophagitis. To the best of our knowledge, there is no other report in which herpetic esophagitis has been documented as an adverse event of B–R regimen. Because the complication could cause symptomatic gastrointestinal discomfort, physicians should be aware of this disease. Keywords: bendamustine, herpetic esophagitis, immunodeficiency, non-Hodgkin’s lymphoma, rituximab

Hiromichi Yamane, Nobuaki Ochi, Tomoko Yamagishi, Yoshihiro Honda, Masami Takeyama, Nagio TakigawaDepartment of General Internal Medicine 4, Kawasaki Medical School, Kita-ku, Okayama, JapanIntroduction: Serum Krebs von den Lungen-6 (KL-6) level is an established diagnostic marker of interstitial lung disease (ILD). However, it is also elevated in patients with non-small cell lung cancer (NSCLC). The significance of circulating thymus and activation-regulated chemokine (TARC)/CC chemokine ligand 17 (CCL17) in malignant diseases remains unknown.Methods: We measured circulating TARC/CCL17 and KL-6 using enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay, respectively, in 26 patients with malignant disease and six patients with benign lung disease (BLD). The cutoff levels were 500 U/mL for KL-6 and 450 pg/mL for TARC/CCL17. The significance of the markers was evaluated in relationship to the presence of ILD (n=10). The statistical significance was set at P

Nobuaki Ochi,1,2 Hiromichi Yamane,1 Katsuyuki Hotta,3 Hiromi Fujii,4 Hideko Isozaki,2,5 Yoshihiro Honda,1,2 Tomoko Yamagishi,1 Toshio Kubo,6 Mitsune Tanimoto,2,3 Katsuyuki Kiura,6 Nagio Takigawa1 1Department of General Internal Medicine 4, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan; 2Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; 3Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; 4Department of Pharmacy, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan; 5Department of Clinical Pharmaceutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; 6Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan Introduction: Widespread use of generic drugs is considered to be indispensable if reductions in total health care costs are to be achieved, but the market share of such drugs remains low. In general, generic drugs have the same active ingredients as brand-name drugs, but this is not always the case. Thus, toxicity profiles may vary when brand-name and generic drugs are compared. We retrospectively investigated the incidence of hyponatremia in patients receiving brand-name cisplatin (CDDP) and a generic counterpart thereof. Methods: We reviewed the medical records of patients treated with brand-name CDDP (n=53) and a generic formulation (n=26), and compared the incidences of hyponatremia and renal toxicity. Toxicities were graded using the Common Terminology Criteria for Adverse Events, version 4.0. Differences between groups were evaluated using the Student’s t-test, and the odds ratio for hyponatremia was estimated via logistic regression analysis. Results: Serum creatinine levels after chemotherapy increased significantly in both the brand-name and generic CDDP groups; no significant difference was evident between the two groups. Hyponatremia of grade 3 or above developed in 30.7% of the generic CDDP group compared to 15.1% of the brand-name CDDP group (P=0.011). Multivariate analysis showed that the use of generic CDDP increased the incidence of hyponatremia (odds ratio =5.661, 95% confidence interval =1.403–22.839; P=0.015). Conclusion: Oncologists should be aware that use of a generic CDDP might be associated with more hyponatremia than would use of brand-name CDDP. Keywords: cisplatin, hyponatremia, brand-name, generic drug

In the hybrid experiment on Mt.Chacaltaya, we can observe three different components of airshowers, that is, air-shower size, burst-density and high energy families (a bundle of high energy particles). Burst-density in each block of hadron calorimeters are newly recalculated in simulations in oder to compare directly to the experimental data. Energy deposits in the scintillators of the hadron calorimeters are calculated using GEANT4 for every particle, incident upon the hadron calorimeter, in the air-showers simulated using CORSIKA, and are converted into burst-density, taking into consideration the exact structure of experimental hadron calorimeter. We study correlations among three observable components in the air-showers. Correlations between air-shower size and burst-density and those between air-shower size and accompanied family energy can be explained by model calculations by adjusting primary particle composition, the former correlation is in favor of proton-primaries but the latter iron-primaries. No model can describe well observed correlations between burst-density and family energy. That is, the observed family energy accompanied by the air-showers with larger burst-density is systematically smaller than that expected in the simulated events. Effects of a fluctuation in the cross-section of hadronic interactions are studied to settle the disagreement between experimental data and simulations.

This paper deals with a newly developed fault locating system. This fault locating system helps to shorten the time required for restoration of service after the occurrence of a busbar fault in an air-insulated distribution substation. Recent optical and electronic technologies allow highly accurate and compact fault locating system, which consists of optical current detectors using Faraday effect and a fault locating processor employing digital data processing technique. The fault location is made by discriminating the direction of zero-sequence currents. Through various tests and field operations, it has been confirmed that the system has sufficient performance for practical application.