Gan to kagaku ryoho. Cancer & chemotherapy
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Rituximab is commonly incorporated into CD20-positive B-cell lymphoma therapy to improve response and prognosis. With increasing use, resistance to rituximab is a continuing concern, but CD20 mutation as a cause of resistance has not previously been reported. Freshly collected lymphoma cells from 50 patients with previously untreated or relapsed/resistant non-Hodgkin's B-cell lymphomas(diffuse large B cell, n=22; follicular, n=7; mucosa associated lymphoid tissue, n=16; chronic lymphocytic leukemia, n=2; small lymphocytic lymphoma, n=1; lymphoplasmacytic, n =1; mantle cell lymphoma, n=1)were assessed for CD20 expression by flow cytometry, and CD20 gene sequencing was performed on extracted DNA. ⋯ It is possible that C-terminal deletion mutations of CD20 may be related to relapse/resistance after rituximab therapy. These mutations should be examined in patients showing progression of disease after partial remission. Other mechanisms are also discussed.
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Sunitinib malate(SU11248)is an oral multitargeted receptor tyrosine kinase inhibitor(MTI)that has antitumor activities for patients with gastrointestinal stromal tumor; GIST after failure of Imatinib. Sunitinib has demonstrated significant clinical benefits, including PFS, RR and OS in the USA and Japan. ⋯ Now, clinical trials of several new MTIs are ongoing in Western countries. Inhibition of the KIT gene cis-mutations and antiangiogenesis activities may be essential for the strategy for Imatinib/Sunitinibresistant GIST.
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Gan To Kagaku Ryoho · Mar 2009
Controlled Clinical Trial[Efficacy of oral cavity care in preventing stomatitis (mucositis) in cancer chemotherapy].
Stomatitis is a common side effect during cancer chemotherapy. We hypothesized that careful oral cavity care using patient guidance and cleanliness index prevents stomatitis in cancer chemotherapy. We introduced oral care patient guidance including teaching good brushing methods, O'Leary's Plaque Control Record(PCR)as a cleanliness index, and Eilers' Oral Assessment Guide(OAG)as an overall index after April 2006. ⋯ Introduction of oral care patient guidance decreased the incidence of stomatitis. Both PCR and OAG indexes were useful in evaluating the objective condition of the oral cavity and in sharing patients' information among a medical team. These indexes encouraged the patients to clean their oral cavities.
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Patients with malignancies are subject to developing a set of complications that require emergency evaluation and treatment. Emergencies in the cancer patients are particularly complex. Since the severity of emergency situations varies individually, the appropriate treatment should be determined based on the clinical condition of individual patients. ⋯ An oncogenic emergency involving respiratory malignant disease is rare, but special medical knowledge and skills are required. Therefore, we should train for that situation in a medical examination. In this review, we suggest the diagnosis and initial therapy for common emergencies involving respiratory malignant disease, such as severe airway obstruction, massive hemoptysis, pneumothorax, and hemoneumothorax.
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Gan To Kagaku Ryoho · Dec 2008
[Problems of home hospice care related to duration--home hospice care for cancer patients who died at home within a week after the start of home hospice care].
The following results regarding the frequencies of home visits by nurses were obtained by comparing a group consisting of those who died within a week after the initiation of home hospice care (Short cases) and of those who had lived more than two weeks after starting the home hospice care (Control cases). 1) The frequencies of both scheduled and emergency home visits in Short cases were statistically higher than in Control ones. 2) Among the nurse's visits, scheduled home visits were of great importance leading not only to lessening the frequency of emergency visits but also to the palliation of anxiety for the patient/family. If the scheduled home visits were done appropriately, the frequency of emergency visits for the Short cases was just as low as for the Control cases. Thus, we reached the conclusion that home hospice care should start as soon as possible and that prolongation of inpatient care should be avoided.