Combination of 2 test methods, single-picture optotype visual acuity chart and spot™ vision screener, in the eye health screening program for 3-year-old children in Tokyo: A retrospective, observational study.

To evaluate the usefulness of the Tokyo Metropolitan Government's Eye Health Screening Program for 3-year-old children, which combines the Single-Picture Optotype Visual Acuity Chart (SPVAC) and Spot™ Vision Screener (SVS) tests. This was a retrospective, observational, matched study. Patients who underwent the eye health screening program and had abnormalities were classified into 3 groups according to the outcomes of the SPVAC (SPVAC-passed, SPVAC-P; SPVAC-failed, SPVAC-F) and SVS (SVS-passed, SVS-P; SVS-failed, SVS-F) tests as follows: SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F. We evaluated the age at examination, SPVAC and SVS test success rates, and SVS refractive power. Additionally, the rates of refractive error, amblyopia, and strabismus were compared among the 3 groups. The SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F groups comprised 158, 28, and 74 eyes, respectively. The mean age was 37.4 months. The success rates of the SPVAC and SVS tests were 69.8% and 96.2%, respectively. The mean SVS hyperopia value in the SPVAC-F/SVS-F group (2.71 ±â€…1.50 D) was significantly higher than that of the SPVAC-P/SVS-F group. The mean SVS astigmatism and myopia values were -2.21 diopter (D) ±â€…1.09 D and -3.40 ±â€…1.82 D, respectively; they did not differ significantly from that of the SPVAC-P/SVS-F group. Significant differences were observed in the refractive error, amblyopia, and strabismus rates among the 3 groups. Regarding disease determination, no significant difference was observed among participants who passed and failed the SPVAC test, regardless of the outcome of the other test. However, a significant difference was observed between those passing and failing the SVS tests. The SPVAC method used to screen 3-year-old children should be modified to commence at 42 months of age or be replaced with a single Landolt C test. The SVS test is useful for screening younger patients. Furthermore, the SVS test showed that the degree of hyperopia was higher in patients who did not pass the SPVAC test.

[Pharmacokinetics of S-1].

S-1 is an attractive oral fluorouracil antitumor drug, which is being called "a self-rescuing drug". This novel oral fluoropyrimidine is combined with three pharmacological agents: tegafur (FT) which is a prodrug of 5-fluorouracil (5-FU), 5-chloro-2,4-dihydroxypyridine (CDHP) which inhibits dihydropyrimidine dehydrogenase (DPD) activity, and potassium oxonate (Oxo) which reduces gastrointestinal toxicity. Phase I and an early phase II clinical trials were performed about ten years ago, and these results had already been introduced to the Journal "Clinical Cancer Research Vol. 5, pages 2000-2005, 1999". The data of this article in this journal was referred from the results of the figures and tables based on the above trial. Most of the authors in this article have contributed on that pharmacokinetics study and published the above manuscripts. In that study, the pharmacokinetics of 5-FU, intact FT, CDHP and Oxo after administration of the standard dose of S-1 had been performed. These studies were carried out at two hospitals, Department of Surgery (Section 1) Sapporo Medical University and Chemotherapy Cancer Center, Cancer Institute Hospital and Japanese Foundation for Cancer Research (Ohtsuka). The number of patients accepted for this trial is twelve, 5 patients with gastric cancer, 4 with colorectal cancer and 3 with breast cancer. Single administration trial was referred to all patients, but consecutive administration trial was limited to ten patients. The results of plasma concentration, Cmax, Tmax, AUC0-14, and T1/2 of 5-FU, FT, CDHP, and Oxo were ascertained in details. It was a surprise that the indicated data was very similar to that of the intravenous 5-FU continuous infusion. Therefore, the low dose administration of 5-FU (FT) as S-1 may result in good antitumor effects with minimum adverse effects to the patients.

Breast-conserving surgery after chemotherapy: value of MDCT for determining tumor distribution and shrinkage pattern.

OBJECTIVE: For this study, we investigated the usefulness of MDCT in assessing the extent of residual breast cancer after neoadjuvant chemotherapy. To ensure the success of breast-conserving surgery, we evaluated the usefulness of determining the tumor distribution before neoadjuvant chemotherapy and the shrinkage pattern after neoadjuvant chemotherapy. SUBJECTS AND METHODS: MDCT before and after neoadjuvant chemotherapy was performed in 46 consecutive patients with 47 locally advanced breast cancers. The distribution pattern of contrast enhancement on MDCT before neoadjuvant chemotherapy was classified into five categories: solitary lesion, grouped lesion (localized lesion with linear, spotty, or linear and spotty enhancement), separated lesion (multiple foci of contrast enhancement), mixed lesion (grouped lesion with multiple foci), and replaced lesion (diffuse contrast enhancement in whole quadrants). RESULTS: There was agreement between the MDCT assessment and pathologic findings in 44 (94%) of the 47 tumors. In the partial response group with nonreplaced lesions, MDCT revealed three shrinkage patterns: pattern 1a, concentric shrinkage without surrounding lesions; pattern 1b, concentric shrinkage with surrounding lesions; and pattern 2, shrinkage with residual multinodular lesions. Breast-conserving surgery was performed successfully in 14 patients including complete response cases that were detected on the basis of MDCT findings and partial response cases that were detected on the basis of observation of pattern 1 shrinkage. In all five patients with pattern 2 shrinkage, CT underestimated the residual tumor extent by more than 2 cm. CONCLUSION: MDCT classification of tumor distribution before neoadjuvant chemotherapy and of shrinkage patterns after neoadjuvant chemotherapy is important in the preoperative evaluation of patients undergoing breast-conserving surgery.

[The role of the pharmacist to an inpatient in order to switch from inpatient treatment to a home-based care of an outpatient--the usefulness of a patient record notebook in cancer chemotherapy].

We have been successfully using a patient's record notebook in home-based outpatient cancer chemotherapy since 2003. Many of the patients expressed their satisfaction carrying a patient record notebook through our questionnaires designed to illicit details of their side effects during the chemotherapy. There are so many tasks the patient has to do by his own once he leaves the hospital and to become an outpatient. One of the important tasks the patient has to do is how to take care of the side effect by himself. In fact, some of the patients had a difficulty in evaluating their own side effect symptoms. In evaluating the side effect of patients by a pharmacist, he should not rely on the patient record notebook alone, but careful attention has to be paid to a patient's general condition by our medical team members consisting of inpatient pharmacists, surgeons, chemotherapists, palliative care physicians, nurses, social workers and others. In order to proceed with the safety of chemotherapy, it is critical to have a consensus based on medical policies concerning the reduction of side effects and to support the fight against cancer with the medical team members. The results also suggest that the patient record notebook is more useful for pharmacists in controlling of side effects and to adopt a prudent policy for chemotherapy.

[Current status and problems in the chemotherapy of our outpatient clinic in the department of clinical oncology].

The department of clinical oncology performed an analysis of the current situation and problems inherent to 4500 chemotherapies of the outpatient clinic for the last 20 months using a new department of the outpatient clinical treatment. Divided into primary organs and the application of chemotherapy are as follow: breast cancer 49%, and gastrointestinal cancer 47% (esophageal cancer 4%, stomach cancer 28%, colorectal cancer 15%) and others 4%. In terms of time consumed by chemotherapy, there were differences in the tumors, regimens and ages. Within one hour, 40% of all chemotherapies mainly included those of breast cancers. From one to two hours, 40% included half breast cancers and half gastro-intestinal cancers, two to three hours, 15% the same as one to two hours. Over 3 hours, 5% mainly include those of gastro-intestinal cancers. In outpatient clinical chemotherapy, there were no human errors such as the use of wrong drugs and wrong intravenous injections. There were a few patients with adverse effects of chemotherapy including high fever with bone marrow suppression and severe diarrhea, who had an emergency admission to the hospital. As we perform an outpatient clinical chemotherapy with safe, it is important to coordinate with family doctors. To decrease the patients' effort of outpatient clinic, we request the treatment of high fever and the dose of G-CSF for bone marrow suppression to family doctors. The outpatient clinical chemotherapy enables to offer the suitable tailor-made treatment for each individual and to control the adverse effects of any regimen. But, patients' waiting period is still longer due to lack of numbers of doctors. To improve these statuses, careful consideration will be required for the trusting relationship with paramedical staffs' in the Department of Clinical Oncology.

Successful combination therapy with trastuzumab and Paclitaxel for adriamycin- and docetaxel-resistant inflammatory breast cancer.

We present a case of adriamycin-and docetaxel-resistant inflammatory breast cancer (IBC) in which partial response was achieved with combination therapy using trastuzumab and paclitaxel. A 48-year old woman noticed a lump in her right breast. She was diagnosed with IBC and the disease was staged as T4d N1 M0, stage III B. The patient was started on neoadjuvant chemotherapy with adriamycin (50 mg/m2) and docetaxel (60 mg/m2) administered every three weeks. Six courses were performed and the response was evaluated as no change. After one month, contralateral breast swelling indicated bilateral IBC. Bilatera1 mastectomy using the Halsted method was performed. The immunohistochemical results of the Hercep Test was strongly positive (3+). After the mastectomy, right pleural effusion appeared, and cytological examination revealed the cells to be classV(adenocarcinoma). To treat the clinically advanced breast cancer, combination therapy with trastuzumab (initially 4 mg/kg followed by two or more cycles of 2 mg/kg) and paclitaxel (80 mg/m2) were given intravenously every week for eight cycles and then every two weeks thereafter. A total of 32 courses of therapy were performed, the pleural effusion completely disappeared and partial response was maintained for a duration of 482 days. The adverse reactions were mild, and it was possible for her to be treated as an outpatient with high quality of life. This report suggests that weekly combination therapy of trastuzumab and paclitaxel was useful for treatment of adriamycin-and docetaxel-resistant metastatic breast cancer.

Histologic breast cancer extent after neoadjuvant chemotherapy: comparison with multidetector-row CT and dynamic MRI.

PURPOSE: To evaluate the efficacy of dynamic multidetector-row CT (MDCT) in assessing residual cancer extent after neoadjuvant chemotherapy (NAC), and to compare MDCT results with those derived from dynamic three-dimensional MRI using the volumetric interpolated breath-hold examination (VIBE) sequence. MATERIALS AND METHODS: MDCT before and after NAC was performed in 19 consecutive patients with breast cancer. MRI was also performed before surgery. The early phase of MDCT and MRI was started 60 sec after commencing contrast injection. The late phase was started at a 4-min delay from the injection. The injection rate was 3 mL/sec. The distribution pattern of contrast enhancement (CE) by CT before NAC was classified into two groups: replaced lesion (diffuse CE in whole quadrants) and non-replaced lesion (localized CE). RESULTS: Pathological complete response (pCR) was obtained in one case. In replaced lesions, accuracy for the detection of tumor extent with a deviation of less than 2 cm in length was 0% (0/7) with early-phase CT/MRI and 100% (7/7) with late-phase CT/MRI. In non-replaced lesions, accuracy was 55% (6/11) with early-phase CT/MRI and 82% (9/11) with late-phase CT/MRI. One case of ductal carcinoma in situ (DCIS) could be detected only with late phase MRI. CONCLUSION: Late-phase images obtained by MDCT and MRI may be accurate in the diagnosis of residual cancer extent after NAC. The tumor distribution determined by MDCT before NAC is thought to be useful in the evaluation of shrinkage pattern following NAC.

[Successful induction of complete cytogenetic response with high-dose imatinib mesylate and subsequent allogeneic stem cell transplantation for CML blastic crisis].

A 29-year-old man was referred to our hospital with leukocytosis on March 7th, 2002. The white blood cell count was 132.9 x 10(3)/microliter with 42.0% blast cells. We diagnosed Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in a blast crisis and started imatinib mesylate therapy at a dose of 800 mg/day on March 9th, 2002. The patient's peripheral blood blasts had disappeared by March 22nd, 2002, and the percentage of blasts in the bone marrow was 0.6% on May 2nd, 2002. The patient achieved a complete cytogenetic response on May 13th, 2002, and underwent allogeneic peripheral blood stem cell transplantation from his HLA-identical sibling donor on May 30th, 2002. Although adverse reactions such as grade 3/4 of hematological events (leukopenia, anemia, thrombocytopenia and neutropenia) and grade 1/2 of non-hematological events (hyperbilirubinemia, dermatitis and edema) were observed, these adverse reactions were clinically managed. This case suggested the usefulness of imatinib mesylate in the management of the CML-associated blast crisis.

[Adverse reactions of cancer chemotherapy and fluid replacement].

Clinical oncologists and physicians handling anticancer drugs need to be thoroughly aware of anticancer drug adverse reactions, and have all the necessary skills to deal with such events if they occur. This chapter discusses anticancer drug adverse reactions requiring fluid replacement. Adverse reactions that require fluid replacement are in general considered serious. Most are at least grade 3 events (serious/high toxicity) based on the NCI-CTC ver 2 classification and require immediate treatment. Here we discuss the general view of fluid replacement for dehydration caused by gastrointestinal toxicity, fluid replacement for nephrotoxicity, hemorrhagic cystitis, tumor lysis syndrome that sometimes requires substantial fluid replacement and SIADH that is a condition requiring a prudent approach to fluid therapy, including also specific methods of fluid replacement.

[Intravascular large B cell lymphoma with migratory local high density shadow by chest CT and diagnosed by transbronchial lung biopsy].

The intravascular large B cell lymphoma (IVL) is a rare subtype characterized by the presence of lymphoma cells in the lumina of small vessels. Reported here is the case of a 68-year-old woman with a high-grade fever uncontrolled by antibiotics or antipyretic drugs, and elevation of the serum LDH and sIL-2R levels. After she was admitted, dyspnea, hypoxia, and severe body weight gain with leg edema gradually developed. Chest computed tomography (CT) revealed a characteristic migratory local high density area typical of atelectasis. A diagnosis of IVL was made with a transbronchial lung biopsy (TBLB) and immunohistochemical analysis. The patient was treated with combination chemotherapy (modified CHOP), and her symptoms of dyspnea, hypoxia, pyrexia and leg edema were quickly resolved. The level of LDH and sIL-2R returned to normal, and a complete response was obtained. Although diagnosis of IVL is difficult, an early and appropriate diagnostic procedure (biopsy of tissue with vessels, such as lung and skin, is required) will improve the prognosis of IVL.