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Biomedical subjects

J Okamura

Publications and source records attributed to J Okamura.

210 records · Page 12Linked to original sources
PubMedDate not supplied

Treatment of standard-risk acute lymphoblastic leukemia in children: the results of protocol AL841 from the Kyushu-Yamaguchi Children's Cancer Study Group in Japan.

A total of 62 patients with standard-risk acute lymphoblastic leukemia received three-drug induction consisting of vincristine, prednisolone, and L-asparaginase (l-Asp) followed by consolidation therapy with intermediate-dose methotrexate (MTX), intrathecal MTX, and 18 Gy of cranial irradiation. Maintenance therapy consisting of 6 drugs including daunorubicin (DNR, 450 mg/m2 in total) was continued for 3 years. Patients were randomized and half of them received weekly l-Asp during maintenance therapy as a late intensification. Complete remission (CR) was achieved in 61/62 (98.4%), and 11 of 61 patients relapsed. At 10 years, the event-free survival (EFS) was 80.6 +/- 5.0% and overall survival was 88.7 +/- 4.0%; median follow-up time was 9.3 years. The 10-year EFS of patients with additional l-Asp (84.8 +/- 6.2%) was superior to that without l-Asp (75.9 +/- 7.9%), although it was not statistically significant. No patients who received a full dose of DNR and maintained CR developed heart failure, although the shortening fraction decreased from 41.0% at diagnosis to 35.2% (median). The protocol AL841 provided good long-term disease control without severe late cardiac dysfunction.

Antineoplastic Combined Chemotherapy Protocols↗
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Detection of hypervascular hepatocellular carcinoma by dynamic MRI and dynamic spiral CT.

OBJECTIVE: Our goal was to evaluate the detectability of hypervascular hepatocellular carcinomas (HCCs) by multislice dynamic MRI and dynamic spiral CT. MATERIALS AND METHODS: Prior to transcatheter arterial chemoembolization (TACE) with iodized oil, the liver was subjected to T1- and T2-weighted SE-MRI, multislice dynamic MRI after intravenous bolus injection of Gd-DTPA, early phase imaging with spiral CT (dynamic spiral CT) after intravenous bolus injection of contrast medium (at a rate of 2 or 3 ml/s), and delayed phase CT in 64 patients with 208 HCC nodules. The detectability of HCCs by MRI and CT was evaluated retrospectively compared with CT after TACE as a gold standard. RESULTS: The detectability of nodules < 1 cm in diameter was superior with dynamic MRI (67%) and dynamic spiral CT (50%) in comparison with SE-MRI (26%) and delayed phase CT (11%) (p < 0.01). The detectability of these tumors with dynamic MRI was significantly superior to that with dynamic spiral CT using an injection rate of 2 ml/s (p < 0.01), but not significantly different from that of dynamic spiral CT using a rate of 3 ml/s. CONCLUSION: Dynamic MRI and dynamic spiral CT are comparable for detecting hypervascular intrahepatic metastases of HCC.

Adult↗
PubMedDate not supplied

Renin-producing hepatoblastoma.

Renin-producing tumors of extrarenal origin are rare in children. An 8-year-old boy with hepatoblastoma and hypertension associated with a high plasma renin level is reported. After chemotherapy, the plasma renin level normalized and the hypertension spontaneously resolved. The patient underwent surgery, and a right trisegmentectomy of the liver and a partial resection of the second and third segments were performed. The tumor was as shown the source of renin by immunohistochemical study and reverse transcriptase-polymerase chain reaction.

Child↗
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Treatment of chemotherapy-induced neutropenia in children with subcutaneously administered recombinant human granulocyte colony-stimulating factor.

Fifty-six children with various malignancies were treated subcutaneously with recombinant human granulocyte colony-stimulating factor (rhG-CSF, KRN 8601) for neutropenia induced by cancer chemotherapy. Patients received the first chemotherapy without rhG-CSF (control course). In the second course, rhG-CSF was given once daily, starting 3 days after completion of identical chemotherapy (day 3) and continuing until day 12. At day 12, the white blood counts and neutrophil counts were found to be 6.8 and 30 times higher in the rhG-CSF course than in the control course (P = .0001) Nadirs of white blood counts and neutrophils were significantly elevated in the rhG-CSF course (P = .003 and .0001, respectively). rhG-CSF administration shortened the neutropenic period in the majority of patients. Children tolerated the rhG-CSF administration well and we have hereby confirmed that rhG-CSF administration is useful for proceeding with chemotherapy in children with cancer.

Adolescent↗
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An effective salvage regimen with aclarubicin for daunorubicin-resistant acute non-lymphocytic leukemia in children.

We evaluated the efficacy and toxicity of aclarubicin for acute non-lymphocytic leukemia (ANLL) refractory to daunorubicin in childhood. Twenty-four patients were treated with aclarubicin and prednisolone with or without 6-mercaptopurine and behenoyl-cytosine arabinoside daily for 5 to 14 days. Of 21 evaluable patients, 14 (67%) responded: 12 obtained complete remission and 2 partial remission. The median time to reach complete remission was 37 days (range, 16 to 60 days), and the median duration of complete remission was 5.5 months (range, 2 to 41 months). The cumulative dose of anthracycline administered before the study was not considered significant for the response. The only major complication was severe bone marrow suppression; infectious episodes occurred in 14 patients (58%) and three died of sepsis and/or bleeding. The observed non-hematologic toxicities included hematuria, an elevation of serum amylase, nausea/vomiting, and angitis. In addition, one patient showed abnormal cardiac function. Aclarubicin is therefore considered a highly active drug for remission reinduction of previously treated children suffering from ANLL with an acceptable toxicity.

Aclarubicin↗
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An adolescent case of retroperitoneal pure choriocarcinoma: successful treatment with MCNU-containing high-dose chemotherapy followed by autologous bone marrow transplantation after multiple brain metastases.

Choriocarcinoma is a rare disease in pediatric neoplasms. The prognosis of the disease is extremely poor once when patients relapse or become refractory to cisplatin (CDDP). A 17-year-old male who had retroperitoneal pure choriocarcinoma of advanced stage was treated with CDDP-based intensive chemotherapy. In spite of the initial good response to CDDP-based intensive chemotherapy, the tumor metastasized to multiple areas of the brain during chemotherapy. Since the brain in this case was thought to be a sanctuary, after radiotherapy to the whole cranium, the patient was treated with high-dose chemotherapy consisting of etoposide, carboplatin, and ranimustine (MCNU), which can penetrate the blood-brain barrier, followed by autologous bone marrow transplantation (ABMT). Twenty-four months after ABMT, the patient had no sign of disease recurrence. MCNU-containing high-dose chemotherapy with ABMT appears to be quite effective in cases that present with relapsing multiple brain metastases during CDDP-based chemotherapy.

Adolescent↗
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Surgical treatment of hepatic caudate lobe metastases originating from colorectal primaries.

Malignant tumor resection of the hepatic caudate lobe has recently received attention. However, there are few reports about metastatic liver tumor in the caudate lobe from colorectal carcinoma, and its clinical features still remain unknown. In this paper, three patients operated on in our institute and 15 reported cases from the published literature were analyzed in order to reveal clinical features of this disease. Many cases had advanced liver tumors, such as invasion in to major vessels at the time of operation. Isolated complete caudate lobectomy was performed in 8 patients and major hepatectomy was carried out in 6 instances. Seven cases also underwent partial resection of the inferior vena cava. Recurrence of disease was observed in 11 patients: seven cases had relapse only in the residual liver, five of whom underwent another hepatectomy. The median survival time of those patients who died was 25 months, and that of seven cases with IVC resection, 18 months. Two patients out of five who received a second hepatectomy survived for longer than 90 months. It is suggested that aggressive surgical treatment including repeated hepatectomy results in the prolongation of survival. Earlier diagnosis and surgical treatment at a more appropriate stage of the disease may further improve the survival rate.

Aged↗
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Gastric carcinoma associated with dermatomyositis. Case report.

A case of gastric carcinoma associated with dermatomyositis is reported. Total gastrectomy was performed and subsequently excision of hepatic metastasis. Although the cause-effect relationship between dermatomyositis and internal malignancy remains controversial, the obvious dependence of the clinical course of dermatomyositis on that of the gastric carcinoma in this case suggests a causal involvement.

Adenocarcinoma↗
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The prognostic significance of macroscopic growth pattern of hepatocellular carcinoma.

The relationship between macroscopic growth pattern of main tumor and postoperative survival was retrospectively investigated in 155 patients with resectable hepatocellular carcinoma. The survival of single nodular type (type I, n = 75) was significantly better than that of single nodular type with proliferation into the surrounding area (type II, n = 53) or massive type (type V, n = 13). The frequency of intrahepatic metastasis or portal tumor thrombus in the resected specimens was significantly lower in patients with type I than in those with type II or V (p < 0.05). Patients with type I undergoing segmentectomy (Hr1) had better survival than those with hepatic resections of less than 1 segment (Hr0, p < 0.05). However, such difference was not observed in patients with either type II or V. Moreover, the presence of a cancer-free surgical margin (1 cm or more) significantly affected the long-term prognosis (5-7 years after surgery) in type I but not in type II, suggesting that the intrahepatic spread of tumor might be localized around the main tumor in type I. On the other hand, intrahepatic metastasis and portal involvement were frequently observed in type V and the prognosis was extremely poor even when major hepatic resections were performed. These results indicate that the macroscopic growth pattern of main tumor is an important predictor for hepatocellular carcinoma.

Adult↗
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Unusual pulmonary metastasis of neuroblastoma: a case report.

A case of unusual pulmonary metastasis of neuroblastoma in an 8-year-old girl is presented. Nodular opacities mimicking pulmonary tuberculosis first appeared in lung apices on chest radiographs. They subsequently developed into extensive consolidations with mediastinal involvement. Metastasis of neuroblastoma was confirmed at autopsy.

Child↗