Biomedical subjects

Etsuro Bando

Publications and source records attributed to Etsuro Bando.

13 recordsLinked to original sources

PubMed2006

[A case of complete peritonectomy for primary ovarian pseudomyxoma].

A 64-year-old woman had an abdominal distention in February 2002. She was diagnosed with primary ovarian pseudomyxoma. She received a hysterectomy and bilateral salpingo oophorectomy in April 2002. Then, she was referred to our hospital the same year. In October 2002, she received peritonectomy with resection of the hepatic capsule, diaphragmatic peritoneum, pelvic peritoneum, greater omentum and the spleen. Intraperitoneal CDDP administration was done on days 1 and 2 after peritonectomy. She is still alive without recurrence for 3 years after the peritonectomy operation.

Female↗

PubMed2006

The diagnostic value of PET-CT for peritoneal dissemination of abdominal malignancies.

AIM: To evaluate the diagnostic value of PET-CT for predicting peritoneal metastasis of abdominal malignancies. METHODS: One hundred fifty four (154) cases of malignant tumor, including 141 cases of gastric cancer, 9 cases of colon cancer, 2 cases of ovary cancer, and 2 cases of pseudomyxoma, had accepted PET CT from Nov. 2002 to Jan. 2006. One hundred twenty three (123) had also accepted high speed spiral CT (HSSCT) as control. The results were compared with peritoneal lavage, pathological examination and clinical manifestation. RESULTS: The accuracy of PET-CT for peritoneal metastasis was 87.7%, with sensitivity 72.7%, specificity 93.6%, PPV 82.1% and NPV 89.6%. HSSCT showed an accuracy of 79.7%, sensitivity 47.4%, specificity 94.1%, PPV 78.3%, and NPV 80.0%. PET-CT had significantly better sensitivity than HSSCT (p < 0.05). For gastric cancer patients alone, PET CT had an accuracy of 87.9%, sensitivity 74.4%, specificity 93.1%, PPV 80.6% and NPV 90.5%, significantly better than HSSCT's 78.1, 39.4, 93.8, 72.2, and 79.2% (p < 0.01), respectively. In case of Cy1P0, PET-CT showed a seemingly better sensitivity of 53.3% vs. 13.3% of HSSCT, although not statistically significant because of the number of observations (p = 0.053). And in P1 cases, PET-CT and HSSCT manifested sensitivity of 84.2% vs 63.2%, respectively, without significance (p = 0.141). CONCLUSION: PET-CT is useful in predicting peritoneal metastasis of malignancies.

Abdominal Neoplasms↗

PubMed2006

[The results of surgical treatment for pseudomyxoma peritonei].

The surgical results of 37 patients with pseudomyxoma pertonei are reported. Twenty eight patients received laparotomy and complete cytoreduction (CC-0) could be done in 6 patients. However, 13 patients received incomplete cytoreduction, and 9 patients underwent drainage of ascites and peritoneal washing. The Peritoneal Carcinomatosis Index (PCI) was less than 20 in CC-0 patients. CC-0 patients survived significantly better than patients with residual disease. Accordingly, peritoneal washing to remove free cancer cells should be aimed for complete cytoreduction of the solid mucinous nodules.

Adult↗

PubMed2005

Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels.

Intraabdominal bleeding, the most life-threatening complication following pancreaticoduodenectomy (PD), most often is associated with failure of a pancreaticojejunostomy anastomosis or with intraabdominal infection. We investigated whether placement of an omental flap around the splanchnic vessels in PD could reduce the occurrence of intraabdominal bleeding and other postoperative complications. One hundred consecutive patients who underwent PD at the authors' institution between January 2000 and October 2004 were enrolled in this prospective study. After dissection of the hepatoduodenal ligament, the major splanchnic arteries and the portal vein were covered by the omental flap. Preoperative condition, incidence of pancreatic fistula, intra-abdominal bleeding, other complications, treatment mortality, and hospital stay were analyzed for interrelationships. The frequency of pancreatic fistula (20%) differed little from those in previous reports. However, intraabdominal bleeding was observed in only 1 (1.0%) patient, who was considered to have too thin a flap. No intraabdominal abscess was encountered. No mortality or complications occurred in relation to the omental flap. Thus, wrapping an omental flap around dissected splanchnic vessels in PD reduced postoperative intraabdominal bleeding and infection, but failed to prevent pancreatic fistulas.

Adult↗

PubMed2005

Primary liver cancer with bidirectional differentiation into hepatocytes and biliary epithelium.

A 70-year old Japanese man with hepatitis B infection developed a 4.8-cm liver tumor in the right lobe. Computed tomographic findings suggested hepatocellular carcinoma or combined hepatocellular and cholangiocarcinoma. After right hepatectomy, the cut surface of the resected specimen showed a whitish tumor with indistinct borders. Microscopically, the tumor consisted of pleomorphic, eosinophilic cells forming thickened trabeculae, suggesting hepatocellular carcinoma, and also tumor cells forming glandular structures, suggesting adenocarcinoma. Cells comprising both the trabeculae and the glands were immunoreactive for cytokeratin (CK) 19. In some gland-forming cells, varying immunoreactivity for CK7 and carcinoembryonic antigen (CEA) was observed. In the cytoplasm of cells in the thickened trabeculae, hepatocyte paraffin (HepPar) 1 and alpha-fetoprotein (AFP) were focally reactive. Some of these tumor cells were also reactive for CK19. Accordingly, we concluded that this tumor was a combined hepatocellular and cholangiocarcinoma whose cells had undergone divergent differentiation into hepatocytes and biliary epithelium. Because the tumor expressed markers of both phenotypes, it may have originated from cells intermediate between hepatocytes and biliary epithelium. A few reported cases have shown similar histologic features.

Aged↗

PubMed2004

Intestinal obstruction in the terminal ileum caused by an anomalous congenital vascular band between the mesoappendix and the mesentery: report of a case.

We report a case of intestinal obstruction caused by a congenital abnormal vascular band in a 17-year-old boy. The patient was admitted with acute colicky abdominal pain, and an emergency laparotomy revealed that the ileum was strangulated by a fibrous band with vessels about 2 mm in diameter and 7 cm in length, extending from the antemesenterium of the terminal ileum to the mesoappendix. The affected intestine was resected with the band and the appendix. Histologically, the fibrous band was composed of loose connective tissue containing arteries, veins, and nerve fibers, suggesting that it was congenital and originated from a remnant of the ventral mesentery in the embryonic period. There have been few reports of intestinal obstruction being caused by a congenital vascular band, especially in patients beyond the pediatric age group.

Abdominal Pain↗

PubMed2004

Severe hypoglycemia and hypokalemia in association with liver metastases of gastric cancer.

We report an 80-year-old man who presented with non-islet cell tumor hypoglycemia (NICTH) in association with hepatic recurrence of gastric cancer. His serum potassium was reduced from 3.9 to 3.1 mmol/l 5 weeks after gastrectomy, and he subsequently developed hypoglycemic coma. He was diagnosed as having NICTH because of the presence of serum big IGF-II and positive staining for IGF-II in gastric cancer cells obtained at surgery. A computed tomography showed multiple liver metastases. His hypoglycemia was refractory to steroid therapy. This case suggested that NICTH could develop in association with hepatic metastases of gastric cancer. Unexpected hypokalemia may be a manifestation of occult NICTH.

Adenocarcinoma↗

PubMed2004

[Treatment results of peritoneal dissemination from gastric cancer by neoadjuvant intraperitoneal-systemic chemotherapy].

UNLABELLED: No standard treatment exists for peritoneal dissemination from gastric cancer. We reviewed our experience using a novel treatment consisting of peritonectomy and intraoperative chemo-hyperthermic peritoneal perfusion (CHPP). Records of all patients who underwent CHPP and cytoreductive surgery from 1992 to 2001 were reviewed. RESULTS: Data from 107 patients (average age, 52 years) were available. P3 dissemination was found in 72 patients, and 8 and 27 patients showed P1 or P2 dissemination, respectively. Peritoneal metastasis was synchronous in 75 and metachronous in 32 patients. All patients received CHPP after cytoreductive surgery. Peritonectomy was performed in 42 patients. Complete cytoreduction (CC-0) was achieved in 47 patients (44%). Peritonectomy, resulted in CC-0 in 69% (29/42), but CC-0 was achieved in 18 of 65 (28%) patients by ordinary surgical techniques. There were 23 postoperative complications (21%) after operation. The overall operative mortality was 2.8% (3/107). Median follow-up for the entire study group was 46 months. Seventeen patients (15%) were disease-free, and 90 patients were dead at the time of analysis. Eighty-seven deaths were related to progression of disease. The median survival of all patients was 16.2 months, with an actual 5-year survival of 6%. Median survival of CHPP plus ordinary cyoreduction was 12.0 months and that after CHPP and peritonectomy was 22.8 months. Completeness of cytoreduction and peritonectomy were significant prognostic factors on univariate analysis and 5-year survival rate was 27%. Lymph node status, grade of peritoneal dissemination (P1-2 vs P3), age (>60 years vs <60 years), tumor volume of dissemination (>2.5 cm vs <2.5 cm in diameter), and histologic type (differentiated vs. poorly differentiated type) did not affect survival. The cox proportional model demonstrated that completeness of cytoreduction was the strongest prognostic factor. Patients who had an incomplete resection had 2.8-fold higher risk of dying from disease than patients who underwent complete cytoreduction. The 5-year survival after complete cytoreduction was 12%, compared with 2% for incomplete resection. Four patients lived more than 5 years. Cytoreduction was incomplete in one 5-year survivor who showed complete response to CHPP. CONCLUSION: Complete cytoreduction using peritonectomy and CHPP may improve survival of patients with peritoneal dissemination from gastric cancer. This procedure is most appropriate for highly motivated patients who are committed to survive as long as possible.

Analysis of Variance↗

PubMed2003

Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer.

BACKGROUND: Peritoneal dissemination is the most frequent mode of recurrence in patients with gastric cancer. We tried to identify factors that predict peritoneal recurrence with high sensitivity. STUDY DESIGN: Clinical and pathologic data from 587 consecutive patients with gastric cancer were reviewed retrospectively. The stepwise Cox proportional hazards regression model was used to assess the prognostic significance of the magnitude of serosal changes. Multiple stepwise logistic regression analysis was used to determine factors associated with peritoneal recurrence in 375 patients who underwent curative resection. RESULTS: The 5-year survival rate of patients with S2 disease (greatest dimension of macroscopic serosal changes >/= 2.5 cm) was 18%, which was worse than S0 (no serosal changes) and S1 disease (macroscopic serosal changes < 2.5 cm)(p < 0.001). Patients with S0 tumors who underwent curative resection had the best 5-year survival rate. Multivariate analyses indicated that the magnitude of serosal changes was an independent prognostic factor for survival both overall and after curative resection. Logistic regression analysis showed that peritoneal recurrence was more than four times as likely with S2 than with S0 or S1 tumors. The sensitivity for predicting peritoneal recurrence was 79%; the sensitivity of cytologic examination was 38%. CONCLUSIONS: Magnitude of serosal changes is easy to measure intraoperatively and predicts peritoneal recurrence of gastric cancer with greater sensitivity than conventional peritoneal lavage cytology.

Gastrectomy↗

PubMed2002

Outcome of ratio of lymph node metastasis in gastric carcinoma.

BACKGROUND: The purpose of this study was to clarify the outcome of the ratio of the metastatic lymph nodes (RML) in gastric cancer patients. METHODS: The postoperative survival of 650 patients with gastric cancer who underwent D2 curative gastrectomy was analyzed with regard to the RML. The location, number, and RML in the N1 station and in all (N1 and N2) stations were analyzed. These data were compared from the viewpoints of staging accuracy and patient survival. RESULTS: The RML was classified as follows: RML 0, no involvement; RML 1, 0 to.1; RML 2,.1 to.25; and RML 3, >or=.25. The 5-year survival rates stratified by RML were RML 0, 86%; RML 1, 68%; RML 2, 35%; and RML 3, 16%. Cox model identified all methods of classifying lymph node metastases as independent prognostic indicators in each calculation. However, a second Cox regression revealed that RML was the only independent prognostic factor among the three methods (P <.001). Stage migration was present in 35 cases (15%) when the number was considered. However, only 15 cases (7%) were underdiagnosed when RML was used. CONCLUSIONS: RML is a useful classification of patients with gastric cancer. It may prevent the phenomenon of stage migration.

Carcinoma↗

PubMed2002

[Multidisciplinary therapy for peritoneal dissemination using peritonectomy].

An aggressive approach to peritoneal dissemination involves peritonectomy procedures combined with preoperative intraperitoneal chemotherapy, intraoperative chemo-hyperthermia, and postoperative systemic chemotherapy. We have been performing multimodal therapy consisting of peritonectomy plus perioperative chemotherapy for the treatment of patients with peritoneal dissemination. Fifty-seven patients with established peritoneal dissemination from gastric cancer (n = 32), colon cancer (n = 17), ovarian cancer (n = 7), and mesothelioma (n = 1) have been treated with peritonectomy and intraoperative chemo-hyperthermia. Five-year survival rates of patients with gastric and colon cancer were 18% and 38%, respectively. Among various clinical factors, complete tumor resection was the most significant prognostic factor, and the prognosis of patients who underwent complete cytoreduction was significantly better than those who received incomplete cytoreduction. A multimodal therapy consisting of perioperative chemotherapy and peritonectomy with complete cytoreduction may be the most powerful method to treat patients with established peritoneal dissemination.

Colonic Neoplasms↗

PubMed2002

[A case of stage IV gastric carcinoma with lymph nodes metastases of the paraaorta responding markedly to TS-1].

A 64-year-old man had undergone subtotal gastrectomy with a D2 lymphadenectomy for advanced carcinoma of the stomach with paraaortic lymph nodes metastases 12 months earlier. The histopathological findings revealed a well differentiated adenocarcinoma [type 2 macroscopic findings, SE, INF beta, ly2, v1, N2, M1 (LYM)]. On admission, biochemical investigations showed an elevation of CEA, CA19-9, and CA 125. An abdominal ultrasonography and a computed tomography (CT) revealed lymph node swelling of the paraaorta. After non-curative operation, he has received adjuvant chemotherapy with TS-1 plus CDDP. At first, 100 mg/day of TS-1 was orally administered for three weeks followed by two drug-free weeks, with CDDP (60 mg/m2/day) infused on day 8. Next, the treatment course consisted of four-week consecutive administration of TS-1 (80 mg/day) followed by two drug-free weeks, with biweekly infusion of CDDP at a dose of 15 mg/m2. The CT findings revealed that an almost complete reduction of the metastatic paraaortic lymphnodes was obtained after completion of course 1, and was maintained thereafter. No noteworthy adverse reactions were observed and the patient has a good QOL. The patient is now in a good health and continues to undergo low dose TS-1 plus CDDP chemotherapy as an outpatient.

Adenocarcinoma↗

PubMedDate not supplied

Long-term survival of a patient with primary papillary serous carcinoma of the peritoneum treated by subtotal peritonectomy plus intraoperative chemohyperthermia.

We report the long-term survival of a patient with primary papillary serous carcinoma of the peritoneum, treated by subtotal peritonectomy combined with continuous hyperthermic peritoneal perfusion. After subtotal peritonectomy and continuous hyperthermic peritoneal perfusion, early postoperative intraperitoneal chemotherapy with cisplatin and three cycles of cisplatin-based intravenous chemotherapy were administered. The patient currently remains alive 23 months after surgery. This long-term survival suggests that treatment of primary papillary serous carcinoma of the peritoneum requires aggressive cytoreduction surgery followed by chemotherapy using adequate methods to enhance chemosensitivity.

Adult↗