A Patient with End-stage Bladder Cancer Who Developed Hyperammonemia and Impaired Consciousness and Who Was Found to Have Asymptomatic Bacteriuria and Alkaline Urine

Introduction: The current author encountered a patient with end-stage bladder cancer who developed hyperammonemia and impaired consciousness. Case: A 90-year-old man had repeated bleeding from a bladder tumor, so a urethral catheter was placed. During admission to the Palliative Care Unit, impaired consciousness and hyperammonemia were noted. Liver metastasis was not noted. Urinalysis revealed alkaluria and ammonium magnesium phosphate crystals, so production of ammonia by bacteria with the ability to hydrolyze urea was suspected. Levofloxacin was inefficacious. As a result of administration of metronidazole, however, consciousness improved, blood ammonia levels returned to normal, urine was acidic, and ammonium magnesium phosphate crystals disappeared. The bacterium with the ability to hydrolyze urea could not be identified. Discussion: In patients with advanced or end-stage bladder cancer like the current patient, ammonia produced by bacteria with the ability to hydrolyze urea can cause hyperammonemia and impaired consciousness even if the urinary tract is unobstructed.

Quality indicators for cervical cancer care in Japan / 부인종양

OBJECTIVE: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. METHODS: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. RESULTS: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. CONCLUSION: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.

Refractory Factors in Head and Neck Cancer: ATP Binding Cassette Transporters Expressed in Head and Neck Cancer Cell Lines / Oral Science International

The aim of the present study was to clarify whether ATP binding cassette transporters are refractory factors in head and neck cancer chemotherapy. For <i>in vitro</i> and <i>in vivo</i> chemotherapeutic studies, we employed a human salivary gland adenocarcinoma cell line (HSY) and a human oral squamous cell carcinoma cell line (SCCSK) with vincristine (VCR) at clinically equivalent doses. Western blot analysis, reverse transcription-polymerase chain reaction, <i>in vivo</i> evaluation in xenograft models inoculated with cultured carcinoma cell line and drug efflux analysis were performed. VCR-treated SCCSK and HSY cells, as well as xenografted SCCSK and HSY cells in tumor-bearing nude mice, were found to express MDR1/ABCB1 and MRP1/ ABCC1. In addition to MDR1 and MRP1 mRNA, HSY/VCR and its cloned cells expressed MRP7/ABCC10 mRNA, but SCCSK/VCR did not express MRP7. Furthermore, drug resistance to VCR and docetaxel decreased in HSY/VCR in the presence of a competitive MRP7 inhibitor, 17-beta-estradiol-(17-beta-D-glucuronide). These results indicate that MDR1 and MRP1 expression are refractory factors in head and neck cancer chemotherapy and suggest that induction of MRP7 expression is involved in drug resistance in salivary gland adenocarcinomas.