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Biomedical subjects

Toru Watanabe

Publications and source records attributed to Toru Watanabe.

At least 73 records · Page 4Linked to original sources
PubMed2004

[Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter].

Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter.

Adolescent↗
PubMed2004

[A case of hypogonadotrophic hypogonadism causing lumbar stress fracture].

A 57-year-old man was referred to our hospital for further evaluation on hypogonadotrophic hypogonadism causing a stress fracture of the 4th lumbar vertebrae. Azoospermia had been pointed out at the age 30, but hormonal evaluation had not been performed. Physical examination revealed an eunuchoidal body proportion, a stretched phallus length of 4 cm and bilateral scrotal testes of 6 ml. Hormonal evaluation demonstrated a testosterone level of 13 ng/dl (normal, 320 to 1,030 ng/dl), a luteinizing hormone of 0.2 mU/ml (normal, 1.8 to 9.2 mU/ml) and a follicular stimulating hormone of 1.0 mU/ml (normal, 1.6 to 10.7 mU/ml). Results of a stress test of gonadotrophin-releasing hormone was a low delay type. Computerized tomography showed no abnormality in the hypothalamic-pituitary region. The patient was treated with the substitution therapy of androgen. The therapy was discontinued 6 months later because of severe nipple pain. We should perform hormonal evaluation and other examinations for male infertility.

Fractures, Stress↗
PubMed2003

Muscle involvement in a patient with Henoch-Schönlein purpura nephritis.

Although Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis affecting multiple organ systems, muscle involvement has rarely been reported. This report describes muscle pain and weakness in a patient with HSP nephritis (HSPN). A 13-year-old boy suffered from purpura, abdominal pain, and symmetrical muscle pain and weakness of the extremities. He was diagnosed as having HSP with muscle involvement. His abdominal pain and muscle involvement improved 1 week after commencing oral prednisolone therapy. The patient subsequently developed biopsy proven HSPN. It should be noted that, although rare, muscle involvement might occur in HSP as in other systemic vasculitides. The precise pathogenic mechanism underlying its development is currently unclear.

Administration, Oral↗
PubMed2003

A role of Helicobacter pylori infection in the development of duodenal ulcer after adult living-related liver transplantation.

Gastrointestinal bleeding caused by peptic ulcer disease is one of the serious complications of living-related liver transplantation (LRLT). The aim of this study was to clarify the factors involved in peptic ulcer formation in adult LRLT recipients. Forty consecutive adult LRLT recipients without a history of peptic ulcer disease were studied. Twenty-five patients (62.5%) tested positive for Helicobacter pylori. After LRLT, duodenal ulcer (DU) developed in six patients, and all of them tested positive for H. pylori. In contrast, none of the H. pylori-negative patients developed DU. Preoperative serum gastrin levels in patients with DU were significantly higher than in those without DU, irrespective of H. pylori infection. Preoperative pepsinogen I levels in patients with DU were significantly higher than in those without DU with H. pylori infection. These data suggest involvement of H. pylori infection in the development of DU after LRLT. Eradication of H. pylori may prevent the development of DU after LRLT particularly in patients with hypergastrinemia and high serum pepsinogen I.

Adult↗
PubMed2003

Pharmacokinetics of capecitabine (Xeloda) in Japanese and Caucasian patients with breast cancer.

BACKGROUND: Capecitabine (Xeloda) is a novel, oral fluoropyrimidine carbamate rationally designed to generate 5-fluorouracil (5-FU) preferentially in tumor tissue via a three-step enzymatic cascade. PURPOSE: The objective of this study was to compare the pharmacokinetics of capecitabine and its metabolites in Japanese and Caucasian cancer patients. METHODS: The study included 20 Japanese and 24 Caucasian patients with breast cancer. All patients received oral capecitabine 825 mg/m(2) twice daily for 14 days, except for study day 1 when only the morning dose was administered. On study days 1 and 14, blood and urine samples were collected after administration of the first dose and at steady state for the evaluation of the pharmacokinetics of capecitabine and its metabolites. The primary pharmacokinetic parameter was AUC(0-infinity ) of 5'-deoxy-5-fluorouridine (5'-DFUR) on day 14. The pharmacokinetic parameters in Japanese and Caucasian patients were compared using an ANOVA with calculation of the 90% confidence interval (CI) for the ratio of the geometric means. RESULTS: Statistical analysis showed equivalence in the AUC of 5'-DFUR on day 14 with a ratio of 1.01 (90% CI 0.85-1.21). Similarly, no relevant influence of race on the pharmacokinetics of capecitabine, 5'-deoxy-5-fluorocytidine (5'-DFCR), or 5-FU was observed. Systemic exposure to alpha-fluoro-beta-alanine (FBAL) was higher in Caucasian than in Japanese patients. On study day 14, both the AUC and the maximum plasma concentration (C(max)) of FBAL were increased by 47% and 33% in Caucasian patients and Japanese patients, respectively. CONCLUSIONS: No clinically relevant differences in the pharmacokinetics of capecitabine and its key metabolites 5'-DFUR, 5'-DFCR, and 5-FU were found between Japanese and Caucasian patients. Plasma concentrations of FBAL were higher in Caucasian than in Japanese patients but this difference is not clinically relevant as FBAL has no antiproliferative activity and systemic exposure to FBAL does not correlate with the tolerability of capecitabine.

Adult↗
PubMed2003

Renal involvement in children with influenza A virus infection.

Renal involvement in influenza A virus infection has been rarely reported. To define the clinical characteristics and the factors contributing to the development of renal involvement in influenza A virus infection, we reviewed the clinical characteristics, laboratory data, pediatric risk of mortality (PRISM) score, and the number of systemic inflammatory response syndrome (SIRS) criteria and dysfunctional organs in 45 hospitalized children with influenza A virus infection. Eleven (24.4%) patients had renal involvement. All patients with renal involvement suffered from sepsis and multiple organ dysfunction syndrome (MODS) and 5 developed acute renal failure (ARF). The incidences of dehydration, hypotension, disseminated intravascular coagulation (DIC), and rhabdomyolysis were significantly higher in patients with renal involvement. PRISM scores, the numbers of SIRS criteria and dysfunctional organs, and mortality rate were also higher in patients with renal involvement. Influenza A RNA was absent in the renal tissues of 3 patients with ARF. These results suggested that renal involvement in influenza A virus infection occurred in patients with sepsis and MODS; dehydration, hypotension, DIC, and rhabdomyolysis were factors contributing to its development; direct viral injury to the kidney did not seem to occur in influenza A virus infection.

Acute Kidney Injury↗
PubMed2003

Surgical management of aneurysms of the aortic arch vessels and their branches: report of four cases.

We review the cases of four patients with aneurysms of the aortic arch vessels and their branches. Two patients had a subclavian artery aneurysm, one had an innominate artery aneurysm, and one had a carotid artery aneurysm. We performed surgical reconstruction in all four patients in view of the life-threatening complications of these aneurysms. The approach, methods of surgical repair, and cerebral protection are discussed following these four case reports.

Aged↗
PubMed2003

Unknown primary carcinoma: a feasibility assessment of combination chemotherapy with cisplatin and docetaxel.

BACKGROUND: Docetaxel (Taxotere) and cisplatin are two of the most active single agents used in the treatment of solid tumors. We examined the feasibility of using a combination of docetaxel and cisplatin for the treatment of unknown primary carcinoma in order to prepare a larger scale prospective study. METHODS: Eligible patients were aged 18 to 75 years, with an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less and a life expectancy of 8 weeks or more, and had been diagnosed as having unknown primary carcinoma by the required examinations. Patients were not permitted to have received prior chemotherapy and had to have measurable lesions. Docetaxel (60 mg/m(2)) was given intravenously over a 1-h period immediately before cisplatin (80 mg/m(2)), which was given intravenously over a 2-h period, every 3 weeks. Premedication included dexamethasone, granisetron, and standard hyperhydration. RESULTS: Twenty-six treatment courses in five patients were tested according to the protocol and feasibility was assessed. Adverse events observed included grade 4 neutropenia, leukopenia, grade 3 nausea/vomiting, grade 2 diarrhea, and mucositis. These adverse events were well tolerated, reversible, and manageable. Doses were not reduced and all injections were given or their due date without any delay in all patients. Four patients achieved a partial response and one had stable disease. CONCLUSION: Treatment of patients with unknown primary carcinoma with a combination of docetaxel and cisplatin is feasible. Conduct of a phase II trial of this regimen is warranted.

Adolescent↗
PubMed2003

Hypouricemia in severely disabled children: influence of valproic acid and bed-ridden state.

Although hypouricemia does not directly elicit clinical symptoms, it is a sensitive indicator for detecting renal tubular involvement. To determine the influence of valproic acid (VPA) and a non-ambulatory state on the serum uric acid level in epileptic children, we performed a cross-sectional study of laboratory data including serum and urinary uric acid levels and renal tubular function levels in epileptic children. We studied 93 patients in our outpatient clinic. They were divided into four groups according to two factors; VPA administration and the ambulatory state: non-ambulatory patients taking VPA (24 cases), non-ambulatory patients not taking VPA (18 cases), ambulatory patients taking VPA (29 cases), and ambulatory patients not taking VPA (22 cases). The laboratory data including uric acid levels and renal tubular function in each group were analyzed statistically using analysis of variance. Both VPA (P<0.05) and a non-ambulatory state (P<0.01) significantly decreased the serum uric acid levels with its increased urinary excretion of uric acid. However, in ambulatory patients, the uric acid level was not decreased. Serum uric acid levels was significantly decreased in non-ambulatory, severely disabled children treated with VPA. It should be borne in mind that VPA-induced renal tubular dysfunction may be present in severely disabled children. However, further investigation is necessary to determine the factor in severely disabled children that causes hypouricemia

Adolescent↗
PubMed2003

Standardization of the body surface area (BSA) formula to calculate the dose of anticancer agents in Japan.

BACKGROUND: The importance of deciding the appropriate dose of anticancer agents cannot be overemphasized. Body surface area (BSA) has been used to calculate the dose in anticancer therapy since the 1950s. Japanese oncologists, often use their own Japanese BSA formula instead of western BSA formulae. However, it is not widely known that some discrepancies exist between the BSA products of the Japanese and western styles. On the other hand, recently dose-calculations according to BSA were criticized from the standpoint of pharmacokinetics (PK). Lately, we have had many opportunities for international collaborations, which make it necessary to review these BSA formulae, and the BSA-based dosing method. A unified BSA formula in cancer therapy is needed in Japan. METHODS: We searched and compiled frequently used BSA formulae across the world using the MEDLINE search, oncology text, a web search on cancer clinical trial groups, and personally communicated with medical oncologists from western countries. Using these formulae, we calculated BSA for a typical Japanese individual, and compared their products. We calculated BSA using these formulae for individuals of widely varying physique, from 140 to 185 cm in height, and from 30 to 96 kg in weight, and estimated the amount of discrepancies among them. RESULTS: Among the various BSA formulae used in western countries, the DuBois formula is the standard. In Japan, the Fujimoto formula has been used frequently. The Fujimoto formula was based on a study of 201 Japanese subjects in 1949. For the average Japanese individual, the BSA calculated using the Fujimoto formula was about 3% lower than that which was calculated by western formulae. The BSA calculated for all heights and body weights using the Fujimoto formula, ranged between 0.7 and 4.8% less than those calculated by using the DuBois formula. The other western formulae showed larger discrepancies than the Fujimoto and DuBois formulae. CONCLUSION: BSA-based dosing has failed to standardize the variation in PK for most anticancer agents, and individual dosing techniques are currently being investigated. However, until their clinical utilities are confirmed, it is necessary to depend on the BSA-based calculation for determining the dose of most anticancer agents. The DuBois formula, which is the western standard formula, is validated to a greater extent and its accuracy has been confirmed more than others, including the Fujimoto formula. We recommend the use of the DuBois formula instead of the Fujimoto formula in cancer chemotherapy and propose the standardization of this formula in Japan.

Adult↗
PubMed2003

Pertussis pneumonia complicated by a hyponatremic seizure.

We present the case of a 6-week-old male infant who had a convulsion due to pertussis pneumonia. He was admitted to our emergency department because of lethargy and hypothermia. He developed a generalized tonic-clonic convulsion, requiring various treatments, including artificial ventilation. A chest CT showed bilateral pneumonia and laboratory data revealed hyponatremia with other features of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Although SIADH has been recognized as a cause of hyponatremia in association with pneumonia, there is little in the literature regarding SIADH caused by pertussis. Hyponatremia caused by SIADH must be considered as a differential diagnosis of seizures in pertussis infection of infants.

Bradycardia↗
PubMed2003

Phase II study of concurrent administration of doxorubicin and docetaxel as first-line chemotherapy for metastatic breast cancer.

OBJECTIVE: To evaluate the efficacy and toxicity of concurrent administration of doxorubicin and docetaxel, without prophylactic use of granulocyte colony-stimulating factor, as first-line chemotherapy in patients with metastatic breast cancer (MBC). METHODS: This multi-institutional study enrolled 40 women; 37 were assessable for efficacy and all 40 patients were evaluated for toxicity. Treatment consisted of 50 mg/m(2) doxorubicin and 60 mg/m(2) docetaxel on day 1 every 3-4 weeks. RESULTS: Patients received a total of 251 cycles of chemotherapy (median, 5 cycles; range, 1-13 cycles). Of the 37 patients assessable for efficacy, 2 had a complete response and 24 had partial responses, which accounted for a 70% objective response rate (95% confidence interval, 53-84%). The median time to treatment failure was 30.1 weeks (range, 3.3-80.7 weeks). Grade 4 neutropenia was observed in 88% of patients and was the most frequent haematological toxicity. Febrile neutropenia was seen in 40% of patients, but no severe infections were observed. Non-haematological toxicity was generally tolerable. There were 2 grade 4 adverse events, which included 1 bleeding duodenal ulcer and 1 hypersensitivity reaction, but grade 3 episodes were infrequent. None of the patients developed congestive heart failure or asymptomatic decrease of left ventricular ejection fraction to less than 50%. Fluid retention syndrome <or= grade 2 was observed in 25% of patients at a median cumulative dose of docetaxel of 270 mg/m(2). CONCLUSION: Concurrent administration of 50 mg/m(2) doxorubicin and 60 mg/m(2) docetaxel is active with a manageable toxicity profile as first-line chemotherapy for MBC.

Adult↗