RESUMEN
It may be said that the effective functioning of an integrated community care system depends entirely on home medical care. "Cooperation"is necessary in pushing home medical care forward and it is vital to advance as a system. In Iwaki-city, the municipal government and the medical association have been sponsoring many types of multidisciplinary cooperation workshops for home medical-care promotion. There was administrative participation, and cooperation became the main workshop focus. We hold workshops 2 times a year. The Iwaki City Medical Association holds lectures on home medical care in the town. Doctors who work in medical offices and hospitals attend the lectures, with topics such as family medicine, understanding dementia, advice for the acceptance of medical examination, cancer screening in the local community hall, and gaining a favorable reception. In our hospital, I hold many types of workshops on home medical care in southern Iwaki-city and on facilitating cooperation. These contribute to collaboration, as they facilitate face-to-face interaction in an important area. I also report the actions taken in our hospital.
Asunto(s)
Demencia , Servicios de Atención de Salud a Domicilio , Médicos , Demencia/enfermería , HumanosRESUMEN
BACKGROUND: Chemoradiation therapy (CRT) is one of the most useful treatments for esophageal squamous cell carcinoma (ESCC). However, because some patients respond well to CRT and others do not, it is important to be able to predict response to CRT before beginning treatment by using markers. Aurora-A encodes a cell cycle regulated serine/threonine kinase that has essential functions in centrosome maturation and chromosome segregation. In this study, we investigated the relationship between the expression of Aurora-A and the response to CRT in patients with ESCC. METHODS: We immunohistochemically investigated the expression of Aurora-A in biopsy specimens of untreated primary tumors of 78 patients with ESCC and determined the relationship between Aurora-A levels and patient responses to CRT, which consisted of 5-fluorouracil plus cisplatin and 40 Gy of radiation. RESULTS: Tumors were judged as Aurora-A positive when more than 10% of the cancer cells displayed a distinct positive nuclear anti-Aurora-A immunoreaction by immunohistochemical evaluation. The tumors of 46 of 78 patients (58.9%) displayed positive expression of Aurora-A. In terms of clinical response the percentage of patients showing complete response (CR), incomplete response/stable disease of primary lesion (IR/SD), and progressive disease (PD) was 19.2, 69.2, and 11.5%, respectively. In terms of histological response the tumor grade of the 41 patients who underwent surgery was as follows: grade 1, 48.8%; grade 2, 29.2%; grade 3, 22.0%. CRT was effective for patients who had Aurora-A (+) tumors (clinically: P = 0.0003, histologically: P = 0.036). CONCLUSIONS: Our results suggest that Aurora-A expression in biopsy specimens of primary tumors is associated with CRT efficacy in patients with ESCC. Assessment of Aurora-A expression in biopsy specimens maybe useful for regarding the potential utility of CRT therapy for patients with ESCC before treatment.
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Aurora Quinasa A/biosíntesis , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Quimioradioterapia , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Aurora Quinasa A/genética , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Terapia Combinada , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/patología , Carcinoma de Células Escamosas de Esófago , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Resultado del TratamientoRESUMEN
We report the case of a young patient(under 40 years)with a malignant tumor; this is an age when a person is involved in social activity and is productive. A variety of activity largely has a negative influence on family at death of such a patient. After fighting this illness for a long time, home medical care was administered, and I experienced a case of a 31-year-old patient with malignant melanoma who was administered end-of-life home care. He had a diagnosis of right leg malignant melanoma approximately 5 years ago. Palliative medical care was decided, after aggressive treatment for approximately 5 years, including an operation, and home medical care was hoped, after this was introduced at our department of surgery. I performed pain control in this patient after hospitalization at approximately one week and the patient was shifted to home medical care. The patient could only swallow water, and oral medication could not be ingested because the patient was bedridden. The mother who was the main caregiver quit her work and devoted herself for care. I performed pain control mainly by administering oxycodone and a steroid and an anti-inflammatory, which were given intravenously along with the antianxiety drug. During home medical care, I focused on pain control, but the patient expressed gratitude for the main caregiver that was witnessed by the family. The patient died 26 days after the initiation of at-home care. Nursing care insurance is not available for young patients, and home help is limited. I quit work for the caregiver, and including contrivance of the future life, there is much limitation with the aspect of the income. A younger patient experiences temper, as well as physical pain, enough for mental and social pain is necessary.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Melanoma/terapia , Cuidado Terminal , Adulto , Analgésicos Opioides/uso terapéutico , Humanos , Masculino , Melanoma/complicaciones , Dolor/etiología , Cuidados PaliativosRESUMEN
We conducted home care and home palliative care from the department of home care. We provided home care services to 190 patients(105 men, 85 women)in October 2013. Their average age was 78.7(range: 32-102)years old, and home care had been underway from 1 day to 8 years, 10 months. Among all participants, 168(88.4%)suffered from malignant diseases, 168 patients had died, and over half of deceased patients(88 out of 168)had died at home. We used opioids for control of cancer pain, carried out home parenteral nutrition(HPN), home enteral nutrition(HEN), percutaneous endoscopic gastrostomy( PEG), and removed pleural effusion and ascites during home care. In order to facilitate the practice of palliative care by the palliative care team, which consists of various medical staff in the hospital, we are giving high priority to education and enlightenment in the hospital. To provide enlightenment, education, and cooperation between regional home care and home palliative care, we are also conducting educational lectures in the regional party of the Iwaki city medical associate, and providing combined educational-medical training for home care and home palliative care by various medical staff.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Neoplasias/terapia , Cuidados Paliativos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Twist is a basic helix-loop-helix (bHLH) transcriptional factor that has been identified to play an important role in epithelial-mesenchymal transition (EMT)-mediated metastasis through the regulation of E-cadherin expression. However, few authors have examined the expression of Twist and E-cadherin and their prognostic value in patients with esophageal squamous cell carcinoma (ESCC). The purpose of this study is to evaluate the clinical significance of Twist and E-cadherin expression in ESCC. METHODS: We immunohistochemically investigated the relationship between their expression and clinicopathological factors including prognosis in surgical specimens of primary tumors in 166 patients with ESCC. RESULTS: The expression rate of high Twist was 42.0% and that of preserved E-cadherin was 40.4%. The expression of high Twist and reduced E-cadherin was significantly associated with depth of tumor invasion, lymph node metastasis, distant nodal metastasis, stage and lymphatic invasion, and poor prognosis. High Twist expression significantly correlated with reduced E-cadherin expression. In the preserved E-cadherin group, the 5-year survival rate was better for patients who were low for Twist expression than for those who were high for Twist expression. Multivariate analysis indicated that the combination of low Twist and preserved E-cadherin expression was an independent prognostic factor along with tumor depth, distant nodal metastasis and E-cadherin expression. CONCLUSIONS: Evaluation of Twist and E-cadherin expressions should be useful for determining tumor properties, including prognosis, in patients with ESCC.
Asunto(s)
Biomarcadores de Tumor/análisis , Cadherinas/biosíntesis , Carcinoma de Células Escamosas/metabolismo , Neoplasias Esofágicas/metabolismo , Proteína 1 Relacionada con Twist/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Femenino , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
The chemokine CXCL12, also known as stromal cell-derived factor-1 and its receptor CXCR4 have been shown to play prominent roles in regulating the directional migration and proliferation of various types of cancer cells during the metastatic process. However, few researchers have examined the expression of CXCL12 and CXCR4 and their prognostic value in patients with esophageal squamous cell carcinoma (ESCC). We investigated immunohistochemically the relationship between CXCL12 and CXCR4 expression and clinicopathological factors including prognosis in surgical specimens of primary tumors in 214 patients with ESCC. The positive expression rate of CXCL12 was 53.7% and that of CXCR4 was 84.6%. Positive CXCL12 expression was significantly correlated with lymph node metastasis, tumor stage, gender and lymphatic invasion. The overall and disease-free survival rate was significantly lower in patients with positive CXCL12 expression than in those with negative CXCL12 expression. The expression of CXCR4 had no correlation with clinicopathological variables and prognosis. We showed that positive CXCL12 expression was related to a greater degree to tumor development, compared with CXCR4 expression. Evaluation of CXCL12 expression is useful for determining tumor properties, including nodal metastasis and prognosis in patients with ESCC.
Asunto(s)
Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/patología , Quimiocina CXCL12/biosíntesis , Neoplasias Esofágicas/patología , Receptores CXCR4/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/mortalidad , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
BACKGROUND AND OBJECTIVES: The chemokine CXCL12 and its receptor CXCR4 are involved in cell migration, proliferation, and angiogenesis, and promote organ-specific localization of distant metastases in various carcinomas. We examined their expression and microvessel density (MVD) in submucosal esophageal squamous cell carcinoma (ESCC) and analyzed their connection to clinicopathological findings including lymph node micrometastasis (LMM). METHODS: Eighty-six patients with submucosal ESCC underwent curative resection from 1985 to 2002. Immunohistochemical staining of CXCL12, CXCR4, and CD34 was performed with primary tumors, and staining of cytokeratin was performed with dissected lymph nodes. MVD was calculated from CD34 expression, and LMM detected by cytokeratin staining. RESULTS: Expression of CXCL12, but not CXCR4, correlated with lymph node metastasis. There was no significant correlation between the expression of CXCL12 and/or CXCR4 and MVD. LMM was detected in 8 cases and 14 lymph nodes. CXCL12 expression and high MVD were found in tumors with lymph node metastasis including LMM. Furthermore, in the CXCR4-positive tumors, positive CXCL12 expression was more significantly correlated with lymph node metastasis and/or LMM than negative CXCL12 expression. CONCLUSIONS: Evaluation of CXCL12 and CXCR4 expression should assist detection of lymph node metastasis including LMM in submucosal ESCC.
Asunto(s)
Carcinoma de Células Escamosas/metabolismo , Quimiocina CXCL12/metabolismo , Neoplasias Esofágicas/metabolismo , Metástasis Linfática , Receptores CXCR4/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antígenos CD34/metabolismo , Carcinoma de Células Escamosas/irrigación sanguínea , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/irrigación sanguínea , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esofagectomía , Femenino , Humanos , Inmunohistoquímica , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Snail is a zinc-finger transcription factor that triggers the epithelial-mesenchymal transition (EMT) by directly repressing E-cadherin expression. However, the relationship between E-cadherin and Snail expression remains unclear in esophageal squamous cell carcinoma (ESCC). The purpose of the present study was to evaluate the clinical significance of E-cadherin and Snail expression in ESCC. Immunohistochemistry was used to investigate the expression of E-cadherin and Snail proteins in 194 patients with ESCC. The relationship between expression of these proteins and clinicopathological factors was analyzed, and the usefulness of Snail in disease prognosis was evaluated in relation to E-cadherin expression. E-cadherin expression was preserved in 41.2% of tumors, and Snail expression was confirmed in 61.7%. Tumors with reduced E-cadherin expression invaded deeper (P<0.0001), had more lymph node metastasis (P<0.0001) and had more lymphatic invasion (P=0.0011) than tumors with preserved expression. Tumors that were positive for Snail expression invaded deeper (P=0.0385), had more distant lymph node metastasis (pM) (P=0.0051) and had a more advanced stage (P=0.0044) than those that were negative for Snail expression. Snail expression was not significantly correlated with reduced E-cadherin expression. Patients with reduced E-cadherin expression or positive Snail expression had poor clinical outcomes. In the preserved E-cadherin group, overall survival rate was better in patients with negative Snail expression than in those with positive Snail expression (P=0.035). Snail appears to play a key role in preserved E-cadherin expression. Further studies on other molecules in the pathways related to reduced E-cadherin expression in ESCC from the view-point of EMT are necessary.
Asunto(s)
Biomarcadores de Tumor/análisis , Cadherinas/biosíntesis , Carcinoma de Células Escamosas/metabolismo , Neoplasias Esofágicas/metabolismo , Factores de Transcripción/biosíntesis , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Transcripción de la Familia Snail , Análisis de SupervivenciaRESUMEN
Pancreatic pseudocysts have been successfully managed with endoscopic drainage recently. This report describes a case of endoscopic transgastric drainage using endoscopic ultrasonography (EUS) and an Nd:YAG laser. EUS was used to detect an optimal puncture site of the pseudocyst and to reduce the risk of bleeding and perforation. An Nd:YAG laser was used to minimize the risk of bleeding and to penetrate the thick wall of the pseudocyst. After transgastric cystgastrostomy was performed, an internal stent was placed between the pseudocyst and the stomach. There were no complications associated with endoscopic interventions. Complete resolution of the pseudocyst was observed. Endoscopic transgastric drainage of pancreatic pseudocysts is a recommended approach for selected patients with pancreatic pseudocysts that are uncomplicated and are located adjacent to the stomach. Safe and effective drainage can be achieved without hemorrhage and perforation with the use of EUS, an Nd:YAG laser, and a stent. Furthermore, the Nd:YAG laser facilitated passage through a markedly indurated pseudocyst wall and it seemed to be an effective instrument, especially for pseudocysts with a thick wall.