Purpose The short-term effects of intravesical chemoimmunotherapy with epirubicin and Bacillus Calmette-Guerin (BCG) administered repeatedlly for prophylaxis of recurrence of superficial bladder cancer (pTa, pT1) were investigated in 22 patients with a median of 70 years between March, 1995 and February, 1999, and were compared with those of BCG monotherapy in 50 patients between March, 1995 and February, 1999. Patients and Methods The patients underwent intravesical instillation of Tokyo-strain BCG with or without epirubicin after transurethral resection (TUR) of bladder cancer. For the combined treatment, at 1~2 weeks after TUR, epirubicin (40 mg) and BCG (80 mg) were instilled into the bladder by turn once a week for 12 weeks. For the BCG alone group, 80 mg instillation were performed with the same schedule. Thereafter, the patients were followed by cystoscopy and urinary cytology every 3 months for up to 3 years after intravesical therapy. Results and Conclusions The simple recurrence rate was 22.7% (5/21) in patients with chemoimmunotherapy and 32.0% (16/50) in BCG-treated patients. Adverse reactions, including increased frequency of urination, urgency and miction pain, were observed in 18 patients (85.7%) undergoing chemoimmunotherapy and 58.0% undergoing BCG monotherapy. One patient receiving chemoimmunotherapy was withdrawn from treatment because of severe bladder-irritation symptoms due to instillation. Intravesical chemoimmunotherapy using epirubicin and BCG was inferior in comparison with BCG monotherapy for prophylaxis of recurrence of superficial bladder cancer.
We report a case of recurrent advanced urachal carcinoma with right internal iliac node and left lung metastases in a 34-year-old man. After receiving partial cystectomy including en bloc resection of the urachus and with bilateral pelvic lymph node dissection, he was treated with five courses of S-1 and cisplatin combination chemotherapy. He remains free from the disease after a 30-month follow-up period. S-1/cisplatin combination chemotherapy is suggested to be a potent tool for controlling advanced urachal carcinoma.
Abstract Objective This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on inpatient rehabilitation, and to determine the effectiveness of the original infection control measures implemented for the rehabilitation team. Methods In this single-center, retrospective, observational study, we calculated multiple rehabilitation indices of patients discharged from our rehabilitation ward between February 28 and May 25, 2020 when Hokkaido was initially affected by COVID-19, and compared them with those calculated during the same period in 2019. Fisher’s exact test and the Mann-Whitney U test were used for statistical analysis. We also verified the impact of implementing the original infection control measures for the rehabilitation team on preventing nosocomial infections. Results A total of 93 patients (47 of 2020 group, 46 of 2019 group) were included. The median age was 87 and 88 years, respectively, with no differences in age, sex, and main disease between the groups. Training time per day in the ward in 2020 was significantly lower than that in 2019 (p = 0.013). No significant differences were found in the qualitative evaluation indices of Functional Independence Measure (FIM) score at admission, FIM gain, length of ward stay, FIM efficiency, and rate of discharge to home. None of the patients or staff members had confirmed COVID-19 during the study period. Conclusions Early COVID-19 pandemic in Hokkaido affected the quantitative index for inpatient rehabilitation but not the qualitative indices. No symptomatic nosocomial COVID-19 infections were observed with our infection control measures.
To discuss appropriate physical activity (PA) levels during pregnancy, this prospective cohort study examined the relationships between PA levels before and during pregnancy and physical and mental health status. Fixed data for 104,102 pregnant women were used from the Japan Environment and Children's Study, of which data for 82,919 women were analyzed after excluding women with multiple birth and pregnancy complications. PA levels were measured using the International Physical Activity Questionnaire-Short Form. The 8-Item Short Form Health Survey was used to measure outcomes. Logistic regression with multiple imputations showed that moderate PA for over 720 min/wk and vigorous PA before pregnancy were associated with poorer mental health in the first trimester (adjusted odds ratio (AOR): 1.087-1.376. Walking in the second and third trimesters was associated with better physical and mental health (AOR: 0.855-0.932). Moderate PA over 1080 min/wk and vigorous PA in the second and third trimesters were associated with poorer mental health (AOR: 1.223-1.873). Increases over 4135.4 MET-min/wk and decreases in PA levels were associated with poorer mental and physical health (AOR: 1.070-1.333). Namely, pregnant women receiving health benefits prefer continuous walking in addition to avoiding vigorous PA and excessive changes in PA levels during pregnancy.
A 64-year-old woman was diagnosed with dilatation of the pulmonary artery and pulmonary valve stenosis approximately 10 years ago. At the age of 63, she developed hemoptysis and was referred to our hospital. The pulmonary trunk was enlarged to 63 mm with moderate pulmonary valve insufficiency. The transpulmonary valve pressure gradient was 25 mmHg;thus, surgery was performed. A median sternotomy revealed a markedly dilated pulmonary trunk growing into the pericardial cavity. After opening the patient's pulmonary trunk to check the pulmonary valve, a thickened and shortened quadricuspid valve was observed. We replaced the pulmonary valve with a bioprosthetic valve and used a vascular prosthesis to reconstruct the pulmonary artery. The postoperative course was uneventful, and she was discharged 22 days after the surgery. Histopathological examination of the pulmonary artery aneurysm wall revealed cystic medial necrosis.
Abstract Severe mitral annular calcification is frequently encountered in patients with chronic renal failure requiring dialysis. The procedures are described for the implantation of mitral prostheses in two dialysis patients with mitral stenosis who exhibited heavily calcified mitral annuli. In both cases the calcifications extended around the entire mitral annulus as well as the valve leaflets, papillary muscle, atrial wall and ventricular myocardium, making it impossible to secure prosthetic valves to the mitral annuli. Before implantation, the calcification was partially debrided ultrasonically, and an 'atrioventricular channel' created. A mechanical valve with a polyester fabric collar was fixed on the atrial side of the calcified annulus using double sutures and gelatin-resorcin-formol glue. Perivalvular leakage, obstruction of valve opening or tortuous movements of prosthetic valve ring were not observed, and neither patient developed heart failure after surgery. This technique represents a potentially useful approach in the surgical treatment of patients with severely calcified mitral annuli.
