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Biomedical subjects

Keiichi Fujiwara

Publications and source records attributed to Keiichi Fujiwara.

48 records · Page 3Linked to original sources
PubMed2002

Irinotecan hydrochloride for the treatment of recurrent and refractory non-Hodgkin lymphoma: a single institution experience.

BACKGROUND: Irinotecan hydrochloride (CPT-11) has a broad range of antitumor activity and has demonstrated little cross-resistance with doxorubicin or vincristine. In the current study, the authors investigated the efficacy and adverse effects of irinotecan in the treatment of recurrent and refractory non-Hodgkin lymphoma, for which current therapies appear to be unsatisfactory. METHODS: Irinotecan was administered by intravenous infusion at a dose of 40 mg/m(2)/day for 3 days, and this regimen was repeated 2-3 times at weekly intervals, followed by 2 weeks off therapy. The subjects were 48 patients with recurrent or refractory non-Hodgkin lymphoma. The histologic classification (Working Formulation) was low grade in 8 patients, intermediate grade in 36 patients, high grade in 1 patient, and other (angiocentric lymphoma, Ki-1 lymphoma, and unidentified) in 3 patients. RESULTS: Forty-five patients were determined to be evaluable. Therapy resulted in a complete disease remission in 2 patients and a partial remission in 15 patients. The response rate was 37.8%. The median duration of response was 64 days and the median time to disease progression was 77 days. The median survival time was 422 days. Major adverse reactions included myelosuppression and gastrointestinal toxicity. Leukopenia, anemia, and thrombocytopenia of Grade 3 or 4 (according to the National Cancer Institute Common Toxicity Criteria) was observed in 63.0%, 30.4%, and 6.5% of the patients, respectively, and Grade 3 or 4 diarrhea occurred in 30.4% of patients. Treatment was withdrawn because of diarrhea in three patients. Because of myelosuppression and diarrhea, approximately 67% of the patients required changes to the regimen, including dose reduction, prolongation of the interval between treatments, and reducing the number of days of consecutive treatment. CONCLUSIONS: The results of the current study suggest the activity of irinotecan as salvage therapy for patients with recurrent and refractory non-Hodgkin lymphoma. However, the optimum dosing schedule remains to be determined.

Adolescent↗
PubMed2002

Cosmetic benefits of lower midline skin incision for pediatric open heart operation. A review of 100 cases.

OBJECTIVE: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach. METHODS AND RESULTS: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt. CONCLUSION: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.

Adolescent↗
PubMed2002

Platelet-sparing effect of paclitaxel in heavily pretreated ovarian cancer patients.

Carboplatin has proven to be effective in the treatment of patients with recurrent ovarian cancer who have responded to platinum-based first-line chemotherapy. However, thrombocytopenia is a problem in heavily pretreated patients. Paclitaxel has a so-called platelet-sparing effect, but until now it was unknown whether this effect could be obtained in heavily pretreated patients. We treated four patients with recurrent epithelial ovarian cancers who had previously undergone heavy chemotherapy. Because these patients had responded to platinum-based first-line therapy, single carboplatin administration was employed. Although satisfactory tumor marker responses were obtained, thrombocytopenia occurred. When paclitaxel was administered before the carboplatin infusion in the subsequent treatments, the thrombocytopenia became milder. It was concluded that a platelet-sparing effect was also observed in patients who had undergone heavy prior chemotherapy.

Antineoplastic Agents↗
PubMed2002

A case of recurrent metastatic thymoma showing a marked response to paclitaxel monotherapy.

We describe a case of recurrent metastatic thymoma showing an excellent response to salvage paclitaxel monotherapy. The patient had undergone a series of platinum-based chemotherapy treatments during the previous 20-month period and the patient's disease was considered resistant to such therapy at the start of treatment with paclitaxel. This is the first report to suggest that paclitaxel has anti-thymoma activity.

Aged↗
PubMed2002

Temporal subtraction for detection of solitary pulmonary nodules on chest radiographs: evaluation of a commercially available computer-aided diagnosis system.

PURPOSE: To evaluate the usefulness of a commercially available computer-aided diagnosis (CAD) system that incorporates temporal subtraction for the detection of solitary pulmonary nodules on chest radiographs by readers with different levels of experience. MATERIALS AND METHODS: Sixty pairs of chest radiographs in 30 patients with newly detected solitary pulmonary nodules and 30 normal cases, all confirmed with serial chest computed tomography (CT), were obtained from screen-film or digital radiographic systems and were digitized (spatial resolution, 0.171 mm/pixel). Temporal subtraction images were produced with an iterative image-warping technique. Five chest radiologists and five residents evaluated both image sets for solitary nodules: set A, current and prior radiographs with temporal subtraction images, and set B, current and prior radiographs only. Assessment was performed with receiver operating characteristic (ROC) analysis of the images on a monitor (pixel size, 1,280 x 1,024) equipped with the system. The reading time needed by each reader was recorded in each case. RESULTS: For the chest radiologists, no statistically significant difference was found between set A (area under the ROC curve [A(z)] = 0.934) and set B (A(z) = 0.964). For the residents, however, observer performance in set A (A(z) = 0.907) was superior to that in set B (A(z) = 0.855) (P <.05). For both groups, the mean reading time per case for set A (chest radiologists, 16.7 seconds; residents, 15.7 seconds) was significantly (P <.05) shorter than that for set B (chest radiologists, 20.4 seconds; residents, 26.2 seconds). CONCLUSION: For the detection of solitary pulmonary nodules, the CAD system with temporal subtraction can promote efficiency for established chest radiologists and improvement in accuracy for less experienced readers.

Adult↗
PubMed2002

Temporal subtraction for the detection of hazy pulmonary opacities on chest radiography.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of temporal subtraction with a commercially available computer-assisted diagnosis system for the detection of multifocal hazy pulmonary opacities on chest radiographs, which are sometimes difficult to detect directly on chest radiographs. MATERIALS AND METHODS: Thirty healthy patients and 30 patients with new multifocal hazy pulmonary opacities that were confirmed by serial chest CT examinations were evaluated with and without temporal subtraction images. Chest radiographs were taken from either film-screen or digital radiography images and were digitized with a spatial resolution of 0.171 mm per pixel. Temporal subtraction images were produced by an iterative image-warping technique. We designed an observer performance study in which observers (six chest radiologists and four residents) indicated their confidence level for the presence or absence of hazy pulmonary opacities on two sets of images, current and previous radiographs only (set A), and current and previous radiographs with temporal subtraction images (set B). Receiver operating characteristic curves were generated. RESULTS: For chest radiologists, observer performance with set B (with temporal subtraction images; A(z) = 0.947) was superior to that with set A (without temporal subtraction images; A(z) = 0.916) (p < 0.05). For residents, no statistically significant difference was found between sets A and B. CONCLUSION: The temporal subtraction technique clearly improves diagnostic accuracy for the detection of multifocal hazy pulmonary opacities on chest radiographs, especially when the observers are experienced chest radiologists who have sufficient skill to evaluate the patient's condition as revealed on the images.

Humans↗
PubMed2002

[Treatment of vulvar cancer--updated information].

Over the past 20 years, the management of vulvar cancer has changed dramatically. The radical vulvectomy that was previously believed to be the only effective treatment for vulvar cancer has now been replaced by more individualized treatments. These include conservative surgery for patients with isolated lesions, omission of groin lymph node dissection in T1A tumors with stromal invasion < 1 mm, elimination of routine pelvic lymphadenectomy, groin lymph node dissection with separate groin incision, omission of contralateral groin lymph node dissection in T1 tumor with negative ipsilateral node metastasis, use of preoperative radiotherapy to avoid pelvic exenteration in advanced cases, and postoperative radiotherapy to decrease the incidence of groin recurrence in patients with multiple positive groin nodes. In addition to these changes, the identification of sentinel lymph nodes and chemoradiation therapy are currently under investigation. In this review, we discuss these issues along with the evidence upon which these therapies are based.

Female↗
PubMedDate not supplied

Fractionated administration of irinotecan and cisplatin for treatment of extensive-disease small-cell lung cancer: a phase II study.

BACKGROUND: A combination of irinotecan (CPT-11) and cisplatin (CDDP) was shown to be effective for extensive-disease small-cell lung cancer (ED-SCLC). To take maximum advantage of the synergistic effect between CPT-11 and CDDP, we designed a fractionated administration schedule. PATIENTS AND METHODS: Between August 1995 and September 1998, 15 previously untreated patients with ED-SCLC were enrolled. Both CPT-11 at a dose of 50 mg/m2 and CDDP at a dose of 60 mg/m2 were given on days 1 and 8, and repeated every 4 weeks up to four cycles. RESULTS: Fifteen patients were assessed for response and survival, and fourteen for toxicity. Although twelve patients (80.0%; 95% confidence interval, 51.9-95.7) achieved an objective response, complete response (CR) was not obtained. The median survival time and the actual 1-year survival rate were 9.4 months and 40.0%, respectively. Grade 3 or 4 leukopenia, neutropenia and diarrhea occurred in 71.4%, 100% and 14.3% of the patients, respectively. Enrollment into this study was stopped because CR, which was the primary endpoint, was not obtained in the consecutive 15 patients and the survival appeared to be inferior to the previous multi-institutional study (Kudoh et al, Clin Oncol 16: 1068-1074, 1998). The projected dose intensity in the present study was lower in CPT-11 and higher in CDDP compared to that in the previous report. CONCLUSION: These results suggest that the dose intensity of CPT-11 may have a major role on the activity of SCLC in this combination.

Adult↗
PubMedDate not supplied

Expression of cyclooxygenase-2, Fas and Fas ligand in pulmonary adenocarcinoma and atypical adenomatous hyperplasia.

BACKGROUND: Atypical adenomatous hyperplasia (AAH) has been reported to be a precancerous lesion of pulmonary adenocarcinoma. Cyclooxygenase-2 (COX-2), Fas and Fas ligand (FasL) are believed to be involved in the pathogenesis and progression of cancer. PATIENTS AND METHODS: We examined the expression of COX-2, Fas and FasL in 31 tissue specimens of adenocarcinoma and 9 of AAH using an immunohistochemical method. RESULTS: COX-2 staining was observed in 20 (65%) specimens of adenocarcinoma and 2 (22%) of AAH. There was a significant difference in incidence of expression between these two groups (p = 0.025). All tumor specimens obtained from three patients with simultaneous multiple adenocarcinoma showed positive COX-2 staining. In two patients having both adenocarcinoma and AAH, COX-2 expression was detected in adenocarcinoma but not in AAH. Fas was expressed in 5 (16%) adenocarcinoma and 2 (22%) AAH specimens. FasL was detected in 3 (9.7%) adenocarcinoma and 1 (11%) AAH specimen. CONCLUSION: These findings suggest that COX-2 might play a role in the progression from AAH to adenocarcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Gefitinib ('Iressa', ZD1839) may restore chemosensitivity in NSCLC patients?

Gefitinib ('Iressa, ZD1839) has promising antitumor activity in non-small cell lung cancer (NSCLC). However, patients with advanced NSCLC have few treatment options available if they are refractory to gefitinib. We describe four cases of patients with advanced NSCLC who previously responded to gefitinib and obtained significant tumor regression through retreatment with other cytotoxic agents. Gefitinib might restore chemosensitivity to previously chemorefractory patients.

Adult↗