1.Sudden Death as Viewed From Autopsy Findings. A Study of 86 Cases.
Jun YAMAGUCHI ; Yuji SAKUMA ; Reiko TAKAKUWA ; Tomoko GOTO ; Yasukuni SHIKANO
Journal of the Japanese Association of Rural Medicine 2001;50(1):23-28
We examined the rates of sudden death to ordinary deaths of the patients in two hospitals in Obihiro. A total of 130 sudden death cases (89 men and 41 women) out of 1, 088 ordinary deaths were listed (11.9%) during the period of two years from 1992 through 1993.
We also looked into the cause of sudden death in 86 autopsied cases over a 15-year period from 1985 through 1999 from a pathological stand point. Cardiac diseases underlay 49 cases of sudden death. Myocardial infarction (42 cases), cardiomyopathy (2), sarcoidosis (1), amyloidosis (2) and valvular disease (2) were regarded as the causes of death in the 49 cases. Myocardial infarction occurred more frequently in men than in women (27: 15). Next to cardiac diseases came aortic diseases such as ruptured aortic aneurysm (7 cases) and dissecting aneurysm (6). Cardiac diseases (49 cases) and aortic diseases (13) combined to account for 62 of 86 (72.1%) autopsied cases. Among noncardiovascular diseases, respiratory diseases (18 cases) topped the list, followed by alimentary diseases (3) and cerebral bleeding (2). The major cause of respiratory diseases was pulmonary embolism (16). Pulmonary embolism more often occurred in women than in men (14: 2). There was one case of unidentifiable sudden death, namely Pokkuri disease. A decreased incidence of sudden death on Sunday should be noted. A circadian rhythm was evident. The incidence of sudden death started rising from 6: 00 and peaked at 15: 00. Sudden death occurred during rest (42 cases), during routine daily activity (14), during sleep (11), during bathing (1), during defecation (8), during surgery (2), during physical exercise (6) and during agricultural work (2).
2.Outpatient Nurses' Awareness of Their Support for the Decision-making of Cancer Patients Undergoing Surgical Therapy
Noriko KANNO ; Aya GOTO ; Keiko SATO ; Reiko KAWAHARA ; Tomoko HATAKEYAMA
An Official Journal of the Japan Primary Care Association 2019;42(2):78-84
Objective: This study aimed to clarify outpatient nurses' awareness of their support for the decision-making of newly diagnosed cancer patients undergoing surgical therapy.Methods: Semi-structured interviews were conducted with eight outpatient nurses from two hospitals, and transcribed data were analyzed qualitatively.Results: The following four categories of outpatient nurses' awareness were extracted: "Difficult environment for supporting decision-making", "Identifying a patient in need of support", "Collaborating at the organizational level", and "Supporting the patient until a satisfying decision is made". Although the nurses recognized the need to support cancer patients' decision-making when undergoing surgical therapy, they were obliged to prioritize other duties and found it difficult to adequately provide the support needed. Although it was difficult, nurses tried to identify patients requiring support during their routine work, and to assist them until a satisfying decision was made by collaborating with colleagues at the organizational level.Conclusion: In order for outpatient nurses to more effectively support cancer patients' decision-making, it is necessary to allocate an adequate number of personnel, secure interview spaces, and provide training for nurses to improve their skills in decision-making support, in addition to implementing the necessary organizational changes.
3.Characteristic Analysis of Patients Visiting the Gender-Specific Outpatient Clinic for Women at Our Hospital
Sanae TESHIGAWARA ; Hitomi Usui KATAOKA ; Akiko TOKINOBU ; Tomoko KAWABATA ; Yuka GOTO ; Hiroyuki OKUDA ; Jun WADA
An Official Journal of the Japan Primary Care Association 2019;42(3):141-149
Introduction: We started the gender-specific clinic for women to provide sufficient treatment for female patients. The purpose of this study was to clarify the characteristics of patients using the gender-specific clinic for women, and to assess the association among depression, physical and mental subjective symptoms.Methods: This observational study included female patients aged 16-84 years who visited our clinic between June 2012 and December 2015 (N=97). In addition to general attributes, we collected data on physical and mental symptoms, and depression status using the Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS), respectively, at the first visit. We conducted analyses to assess patient characteristics and the association between subjective symptoms and depression, and between physical and mental symptoms by estimating odds ratios (ORs) and 95% confidence intervals (CIs).Results: The average age of subjects was 50.4 years. The average CMI score was 42.7 points and 55.9% of the subjects were suggested to be neurotic. The average SDS score was 45.0 points and 64.0% of them were suggested to be depressed. The association with depression by SDS was observed in subjective symptoms of CMI such as fatigue (OR [95%CI]: 7.66 [2.26-25.99], p-value: 0.001) and anxiety (OR [95%CI]: 11.73 [1.80-∞], p-value: 0.006). Physical symptoms in the cardiovascular system were positively association with some mental symptoms such as tension.Conclusion: As female patients often have mental symptoms, it is essential for doctors engaging in gender-specific medicine for women to approach patients while considering psychological and mental aspects.
4.Objective evaluation of neck muscle tension and static balance in patients with chronic dizziness.
Youji ASAMA ; Fumiyuki GOTO ; Tomoko TSUTSUMI ; Kaoru OGAWA
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2013;27(3):144-146
Adult
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Aged
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Case-Control Studies
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Chronic Disease
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Dizziness
;
physiopathology
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Female
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Humans
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Male
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Middle Aged
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Muscle Tonus
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Neck Muscles
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physiopathology
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Postural Balance
5.A Case of Intractable Suspected Perilymph Fistula with Severe Depression.
Fumiyuki GOTO ; Naoki OISHI ; Tomoko TSUTSUMI ; Kaoru OGAWA
Psychiatry Investigation 2014;11(4):499-501
A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient's finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment.
Aged
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Antidepressive Agents
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Comorbidity
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Depression*
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Dizziness
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Ear
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Fatigue
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Female
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Fingers
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Fistula*
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Humans
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Perilymph*
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Rehabilitation
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Sleep Initiation and Maintenance Disorders
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Tinnitus
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Vertigo
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Weight Loss
6.DNA mismatch repair-related protein loss as a prognostic factor in endometrial cancers.
Masafumi KATO ; Masashi TAKANO ; Morikazu MIYAMOTO ; Naoki SASAKI ; Tomoko GOTO ; Hitoshi TSUDA ; Kenichi FURUYA
Journal of Gynecologic Oncology 2015;26(1):40-45
OBJECTIVE: Recent investigations have revealed DNA mismatch repair (MMR) gene mutations are closely related with carcinogenesis of endometrial cancer; however the impact of MMR protein expression on prognosis is not determined. Correlations between MMR-related protein expression and clinicopathological factors of endometrial cancers are analyzed in the present study. METHODS: A total of 191 endometrial cancer tissues treated between 1990 and 2007 in our hospital were enrolled. Immunoreactions for MSH2, MLH1, MSH6, and PMS2 on tissue microarray specimens and clinicopathological features were analyzed retrospectively. RESULTS: Seventy-six cases (40%) had at least one immunohistochemical alteration in MMR proteins (MMR-deficient group). There were statistically significant differences of histology, International Federation of Gynecology and Obstetrics (FIGO) stage, and histological grade between MMR-deficient group and the other cases (MMR-retained group). Response rate of first-line chemotherapy in evaluable cases was slightly higher in MMR-deficient cases (67% vs. 44%, p=0.34). MMR-deficient cases had significantly better progression-free and overall survival (OS) compared with MMR-retained cases. Multivariate analysis revealed MMR status was an independent prognostic factor for OS in endometrial cancers. CONCLUSION: MMR-related proteins expression was identified as an independent prognostic factor for OS, suggesting that MMR was a key biomarker for further investigations of endometrial cancers.
Adaptor Proteins, Signal Transducing/deficiency/metabolism
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Adenosine Triphosphatases/deficiency/metabolism
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Adult
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Aged
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Aged, 80 and over
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Chemotherapy, Adjuvant
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*DNA Mismatch Repair
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DNA Repair Enzymes/deficiency/*metabolism
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DNA-Binding Proteins/deficiency/*metabolism
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Endometrial Neoplasms/*diagnosis/drug therapy/genetics/pathology
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Female
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Humans
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Kaplan-Meier Estimate
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Middle Aged
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MutS Homolog 2 Protein/deficiency/metabolism
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Neoplasm Proteins/deficiency/metabolism
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Nuclear Proteins/deficiency/metabolism
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Prognosis
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Retrospective Studies
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Tumor Markers, Biological/*metabolism
7.Clear cell histology as a poor prognostic factor for advanced epithelial ovarian cancer: a single institutional case series through central pathologic review.
Morikazu MIYAMOTO ; Masashi TAKANO ; Tomoko GOTO ; Masafumi KATO ; Naoki SASAKI ; Hitoshi TSUDA ; Kenichi FURUYA
Journal of Gynecologic Oncology 2013;24(1):37-43
OBJECTIVE: Compared with serous adenocarcinoma (SAC), clear cell carcinoma (CCC) often shows chemo-resistance, which would potentially lead to a poor prognosis. On the other hand, there have been arguments over prognoses of CCC and SAC disease. In the present study, multivariate analysis to compare prognosis of CCC patients with that of SAC was aimed for the patients selected from central pathologic review. METHODS: Between 1984 and 2009, a total of 500 ovarian cancer patients were treated at our university hospital. Among them, 111 patients with CCC and 199 patients with SAC were identified through central pathological review. Overall survival and progression-free survival were compared using Kaplan-Meier method, and prognostic factors were investigated by multiple regression analyses. RESULTS: Median age was 52 years for CCC and 55 years for SAC (p=0.03). The ratio of stage I patients were significantly higher in CCC compared with SAC (55% vs. 13%, p<0.01). Among evaluable cases, response rate was significantly lower in CCC than that in SAC (32% vs. 78%, p<0.01). No significant differences of progression-free survival and overall survival were observed in stage I patients; however, prognoses of CCC were significantly poorer than those of SAC in advanced-stage disease. In stage II-IV patients, not only residual tumors and clinical stages, but also clear cell histology were identified as predictors for poor prognosis. CONCLUSION: Clear cell histology was identified as a prognostic factor for advanced-stage ovarian cancers. Histologic subtypes should be considered in further clinical studies, especially for advanced epithelial ovarian cancers.
Adenocarcinoma
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Adenocarcinoma, Clear Cell
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Chlormequat
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Cystadenocarcinoma, Serous
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Disease-Free Survival
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Hand
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Humans
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Multivariate Analysis
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Neoplasm, Residual
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Ovarian Neoplasms
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Prognosis
8.A Case of a Meningeal Carcinomatosis of the Internal Auditory Meatus Treated as Sudden Deafness
Fumiyuki GOTO ; Miki ARAI ; Takeshi WAKABAYASHI ; Tomoko OTOMO ; Ryoto NAGAI ; Shuujiro MINAMI ; Takanobu SHIMADA ; Masato FUJII
Journal of the Korean Balance Society 2015;14(4):139-142
We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma
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Audiometry
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Brain
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Cerebrospinal Fluid
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Diagnosis
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Dizziness
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Ear, Inner
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Female
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Head
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Hearing
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Hearing Loss
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Hearing Loss, Bilateral
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Hearing Loss, Sudden
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Humans
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Lung
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Lymphocytes
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Magnetic Resonance Imaging
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Meningeal Carcinomatosis
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Middle Aged
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Neoplasm Metastasis
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Radiography, Thoracic
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Spinal Puncture
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Steroids
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Temporal Bone
9.Bronchial Schwannoma Masquerading as Cause of Hemoptysis in a Patient with Pulmonary Embolism
Tomoko Nagatomo ; Takeshi Saraya ; Masuo Nakamura ; Yasutaka Tanaka ; Akira Nakajima ; Atsuko Yamada ; Yukari Ogawa ; Naoki Tsujimoto ; Erei Sohara ; Toshiya Inui ; Mitsuru Sada ; Manabu Ishida ; Miku Oda ; Ichiro Hirukawa ; Masachika Fujiwara ; Teruaki Oka ; Hidefumi Takei ; Tomoyuki Goya ; Hajime Takizawa ; Hajime Goto
General Medicine 2013;14(1):67-71
A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.
10.Studies on Therapeutic Effects and Pathological Features of an Antithrombin Preparation in Septic Disseminated Intravascular Coagulation Patients.
Yuichiro SAKAMOTO ; Satoshi INOUE ; Takashi IWAMURA ; Tomoko YAMASHITA ; Atsushi NAKASHIMA ; Yoichi NISHIMURA ; Hiroyuki KOAMI ; Hisashi IMAHASE ; Akiko GOTO ; Kosuke Chris YAMADA ; Kunihiro MASHIKO ; Hiroyuki YOKOTA
Yonsei Medical Journal 2013;54(3):686-689
PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Aged
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Disseminated Intravascular Coagulation/complications/diagnosis/*drug therapy
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Female
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Fibrinolytic Agents/*therapeutic use
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Humans
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Male
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Middle Aged
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Sepsis/complications/diagnosis/*drug therapy
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Time Factors
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Treatment Outcome