The post-infection outcomes of influenza and acute respiratory infection in patients above 50 years of age in Japan: an observational study.

OBJECTIVES: Influenza can be a serious illness, especially for older people, and reducing the impact of influenza in elderly is important. The objective of this study was to estimate the prevalence and postinfection outcomes of influenza among the over-50 population in Japan. DESIGN: An observational study was designed to ascertain the proportion of influenza cases in a population aged ≥ 50 years with acute respiratory infection (ARI) and to determine the postinfection outcomes of their illness during the 2008-09 influenza season in Japan. Respiratory specimens obtained from a total of 401 patients were tested by PCR for influenza viruses, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV). The effectiveness of the seasonal trivalent influenza vaccine was estimated by a test-negative case control analysis. SETTING: Seventeen outpatient clinics located in four separate areas of Japan. SAMPLE: Respiratory swab specimens from the ARI patients aged ≥ 50 years. MAIN OUTCOME MEASURES: Laboratory confirmed influenza in patients presenting with ARI. RESULTS: In all, 89 (22.2%) of the patients were positive for one of the tested viruses; 70 (78.7%) with influenza, 17 (19.1%) with RSV, and 2 (2.2%) with hMPV. Cough (95.7% vs 73.4%), loss of appetite (67.1% vs 35.5%), absence from work (50.0% vs 23.0%), impact on daily activity (90.0% vs 62.5%), and caregiver absence from work (5.7% vs 0.6%) were observed higher in influenza patients. The duration of feeling weakness (6.3 ± 5.4 vs 3.6 ± 1.9 days) and average days of reduced activity (5.2 vs 3.6 days) were longer for influenza patients. Vaccine effectiveness was estimated to be 32.1% (95% CI: -14.9, 59.9%). CONCLUSIONS: Influenza was the dominant ARI-causing virus and the clinical and socio-economic outcomes imposed on patients over 50 years of age was high for influenza.

[A case of hepatocellular carcinoma with tumor thrombi in the first branch of the portal vein and hepatic vein trunks treated by transcatheter hepatic arterial chemoembolization and hepatic arterial infusion chemotherapy--two years and six months follow-up].

The patient was a 73-year-old man. In March 2002, abdominal computed tomography revealed hepatocellular carcinoma (HCC) with tumor thrombi in the first branch of the portal vein (Vp3) and two hepatic vein trunks (Vv2). He had no hepatitis virus. Serum AFP and PIVKA-II levels were as high as 6,919 ng/ml and 91,700 mAU/ ml, respectively. He was treated by transcatheter hepatic arterial chemoembolization (TACE) 3 times. On post 1st TACE week 8, he received hepatic arterial infusion chemotherapy (low-dose cisplatin and 5-FU) for Vp3 Vv2 HCC. The patient is still alive with no recurrence after two years and six months since the initial TACE treatment.

Alpha-fetoprotein- and des-gamma-carboxy prothrombin-producing advanced gastric cancer.

A case of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) producing gastric cancer with multiple liver metastasis is reported. The simultaneous presence of Borrmann I gastric cancer and IIa aggregating type gastric cancer was noted. Borrmann I gastric cancer was a poorly differentiated adenocarcinoma, while IIa aggregating type gastric cancer was a moderately differentiated adenocarcinoma. Plasma levels of AFP and DCP were 247,000 ng/ml and 320,000 mAU/ml, respectively. Immunohistochemical staining confirmed the production of these two proteins in Borrmann I gastric cancer.