Biomedical subjects

Hitoshi Tonouchi

Publications and source records attributed to Hitoshi Tonouchi.

At least 19 recordsLinked to original sources

PubMed2007

Diagnostic sensitivity of contrast swallow for leakage after gastric resection.

INTRODUCTION: We examined the clinical manifestations and computed tomography findings of patients with leakage after gastrectomy for cancer and determined the sensitivity of the contrast swallow for the leakage diagnosis. METHODS: The medical records of 331 consecutive patients undergoing gastrectomy between January 1992 and December 2003 were reviewed. Routine contrast swallow was performed in all patients before oral intake. Once leakage was suspected, an emergency contrast swallow was performed and its diagnostic sensitivity determined. RESULTS: In total, leakage was diagnosed 9 of 17 times by the contrast swallow, for a diagnostic sensitivity of 53%. The clinical signs or another imaging modality often corrected the misdiagnosis. CONCLUSIONS: The diagnostic sensitivity of contrast swallow for leakage after gastrectomy was low. Therefore, if we employ the contrast swallow technique, we should keep in mind its low sensitivity.

Aged↗

PubMed2006

Evaluation of tap water for surgical handwashing.

PURPOSE: In Japan, sterile water is used for rinsing in surgical handwashing, whereas in Western countries tap water is generally used. We conducted this study to examine the conditions and the equipment that affect bacterial contamination in tap water and to determine whether the tap water in our institute is suitable for surgical handwashing. METHODS: First, we examined the water pipes and measured the free chlorine content in the tap water in the operating room. Next, we recruited 40 volunteers and conducted preliminary tests with sterile water. Thirty of these subjects participated in a handwashing test using tap water. RESULTS: The mean free chlorine levels in the tap water and the sterile water were 0.30 +/- 0.05 and 0.07 +/- 0.03 mg/l, respectively. The handwashing test using tap water showed immediate, persistent, and cumulative bacteria activity within the minimum limits set by the Food and Drug Administration (FDA). CONCLUSION: The free chlorine levels in the tap water in our institute satisfied Japanese health regulations. Moreover, the handwashing test met the criteria of the FDA. Thus, we conclude that this tap water is safe to use for rinsing in surgical handwashing.

Chlorine↗

PubMed2006

Laparoscopic intragastric surgery using GelPort.

In laparoscopic intragastric surgery for early gastric cancer and submucosal tumors, three trocars are routinely inserted in the gastric lumen. We placed a GelPort hand assist device through a 5-cm transverse incision in the upper abdomen, and inserted the trocars into the gastric lumen through the gel seal cap, snapping the gel seal cap on and off during the operation. This makes it possible to use an open technique in which trocars are inserted into the gastric lumen, and to close the trocar sites in the gastric wall. We believe that the technique described here is easier and saves time compared with inserting trocars and closing trocar sites laparoscopically.

Aged, 80 and over↗

PubMed2006

Hemidouble stapling for esophagogastrostomy during laparoscopically assisted proximal gastrectomy.

In esophagogastrostomy during laparoscopically assisted proximal gastrectomy, some problems have occurred; the main ones being reflux esophagitis and the technical difficulty in anastomosis. We have had good results with a hemidouble stapling technique; the center rod of circular stapler is pierced through the left end of the staple line of the stomach. The longest distance from the pylorus to the esophagogastrostomy can be fired in this position. The distance is longer, so alkaline esophagitis is rarer. When the center rod is pierced through the anterior or posterior gastric wall, the operator may be worried about ischemia of the area surrounded by the linear stapler and circular stapler. In hemidouble stapling, an ischemic area is not created at all structurally. Any surgeon can perform a reproducible anastomosis because the place pierced with the center rod is fixed. This technique is easy and safety to operate via minilaparotomy.

Aged↗

PubMed2005

Administration sequence-dependent antitumor effects of paclitaxel and 5-fluorouracil in the human gastric cancer cell line MKN45.

BACKGROUND: The clinical outcome of gastric cancer patients has been improved by combination of 5-fluorouracil (5-FU) and paclitaxel (PXL). However, the optimal schedule of this combination has not been determined. METHODS: The efficacies of sequential administrations of 5-FU and PXL on the gastric cancer cell line MKN45 were investigated using a WST-8 colorimetric assay. The cell cycle distribution of each drug was evaluated by flow-cytometry. Furthermore, the mechanism of antitumor activity enhancement by the administration sequence was investigated by western blotting. RESULTS: MKN45 cell growth was significantly inhibited by each drug in a dose- and time-dependent manner. The cytotoxicities of PXL followed by 5-FU were significantly greater than those of 5-FU followed by PXL. The flow-cytometric analysis revealed that PXL exposure caused viable cell accumulation in G2/M phase in a dose-dependent manner. Western blotting showed that PXL exposure followed by 5-FU up-regulated Chk1 and Wee1 protein expressions until PXL removal and 5-FU exposure, when these expressions gradually decreased to their basal levels. 14-3-3sigma protein expression was significantly up-regulated upon PXL treatment followed by 5-FU. Interestingly, Mad2 protein expression with PXL treatment followed by 5-FU gradually increased after the PXL removal and 5-FU exposure. CONCLUSIONS: PXL followed by 5-FU administration may be the optimal sequence for treatment of gastric cancer. The enhanced viable cell accumulation after PXL pretreatment may be related to G2 arrest. After PXL removal and 5-FU exposure, the cells progressing to M phase may undergo cell death by mitotic catastrophe due to DNA damage caused by 5-FU exposure.

14-3-3 Proteins↗

PubMed2005

Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity.

Sentinel node (SN) biopsies might be useful for performing minimally invasive surgery without interrupting surgical curability. This study examined the cause of false negativity during laparoscopic lymphatic mapping and SN biopsies for early-stage gastric cancer. Thirty-seven patients with gastric cancer (preoperative stage T1-2 or N0) who underwent laparoscopic lymph node mapping and SN biopsies between March 2001 and June 2004 were enrolled in this study. The tracer, patent blue and technecium-99m-labeled tin colloid, was injected endoscopically. Blue-stained or radioactive nodes were defined as SNs. Gastrectomy with lymphadenectomy was performed then the results of the SN biopsies were compared with the final diagnosis of the removed lymph nodes in permanent sections. Sentinel nodes were successfully identified in 35 patients (94.6%), and they were positive in 3 of 4 patients with metastatic lymph nodes; sensitivity was 75% and specificity was 100%. Sentinel node status could therefore be used to diagnose lymph node status with 97.1% accuracy. Of 6 SNs with metastasis, 5 showed radioactivity, and only 2 were blue stained. In the false negative case, a radioactive SN with metastasis in the right paracardial region was missed during laparoscopic mapping. An error in laparoscopic intracorporeal detection of the radioactive node with metastasis occurred because we could not eliminate the shine-through effect. We found that during laparoscopic SN mapping there is a high risk of false negativity with SNs located in the right paracardial region. To apply laparoscopic SN mapping to early-stage gastric cancer patients, the shine-through effect must be eliminated because radiotracers are essential for this method.

Aged↗

PubMed2005

Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial.

PURPOSE: To evaluate the effectiveness of Seprafilm in preventing abdominal adhesions after radical resection of rectal carcinoma, and to observe whether Seprafilm had any adverse effects in patients treated with radiotherapy and chemotherapy. METHODS: A total of 62 patients participated in this prospective randomized clinical study, which was conducted to compare the outcomes of patients operated on with Seprafilm (SEPRA+) with those operated on without Seprafilm (SEPRA-). All patients received preoperative radiotherapy, followed by a two-stage operation, and 5-fluorouracil (5-FU)-based systemic chemotherapy. The primary endpoint of severity and extent of adhesions were evaluated at the time of ileostomy closure. The secondary endpoint included the recurrence of tumors, late complications, and outcome. RESULTS: Seprafilm significantly reduced the adhesions in both the midline incision area and peristomal area. This in turn reduced the operation time, blood loss, and extent of the incision at ileostomy closure. Seprafilm was not associated with any postoperative complications or chemoradiation-related toxicity, nor did it affect recurrence or survival rates. CONCLUSION: Seprafilm effectively reduced abdominal adhesions in chemoradiated patients, and had no adverse effects on the oncologic results of fully introduced adjuvant therapy. Thus, Seprafilm is a safe and effective tool for use in rectal carcinoma surgery.

Absorbable Implants↗

PubMed2005

Usefulness of a single trocar for intrathoracic anastomosis during open thoracic surgery for esophageal cancer.

When patients with esophageal cancer undergo intrathoracic anastomosis after esophagectomy in our institution, we resect the lesser curvature in the thorax using a surgical instrument after circular-stapled esophagogastric anastomosis. We then place the trocar in the seventh intercostal space on the midaxillary line, except in fifth intercostal anterolateral thoracotomy. A linear stapler applied through the thoracotomy sometimes blocks the operator's view, and so it is not so easy to operate with a rather big head in the thorax. We operate a linear cutter for laparoscopic surgery through the trocar. With this method, the instrument is used in good position in respect to the operator's view, and access to the gastric tube is easy. Moreover, we can adjust the resectional angle with this instrument by using the bending mechanism in its shaft. Furthermore, we can reuse the trocar site for the chest tube.

Anastomosis, Surgical↗

PubMed2005

Prospective study of arterial infusion chemotherapy followed by radiofrequency ablation for the treatment of liver metastasis of gastric cancer.

This prospective study was conducted to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) with use of an implanted port followed by radiofrequency (RF) ablation for the treatment of liver metastasis of gastric cancer. Seven patients without extrahepatic metastasis were enrolled. The maximum tumor size was less than 3 cm in one patient and 3.2-6.0 cm in the other six patients (mean, 4.4 cm +/- 1.5). Two patients had single lesions and the other five patients had two to six lesions each. The maximum tumor size was reduced to 3 cm or less (mean, 2.4 cm +/- 0.4; P < .03) after HAIC in all patients. The total number of tumors was reduced from 25 to 16. RF ablation was performed for all residual liver tumors, resulting in complete tumor necrosis. All but one patient are still living without intrahepatic recurrence, with a median survival time of 16.5 months.

Adult↗

PubMed2005

Hyaluronic acid-carboxycellulose membrane (Seprafilm) reduces early postoperative small bowel obstruction in gastrointestinal surgery.

This study aimed to evaluate the efficacy of sodium hyaluronate and carboxymethylcellulose membrane (Seprafilm) on early postoperative small bowel obstruction (EPSBO). It also examined whether using Seprafilm affected surgical site infection rates in gastrointestinal surgery. One hundred eighty-four patients who had Seprafilm placed during gastrointestinal surgery between October 2000 and December 2003 were included in the study (Seprafilm group) and were compared with a matched cohort (control group) of patients operated on without Seprafilm. All patients were retrospectively assessed for EPSBO and surgical site infections. The incidence of EPSBO was significantly lower (P < 0.05) in the Seprafilm group (12/184) than in the control group (26/183). The incidence of surgical site infection between the Seprafilm (15.2%) and control (13.7%) groups was not statistically significant. The placement of Seprafilm helped to prevent EPSBO and had no significant adverse affect on surgical site infections.

Adolescent↗

PubMed2004

Serum monocyte chemoattractant protein-1 in patients with postoperative infectious complications from gastrointestinal surgery for cancer.

We examined the kinetics of serum monocyte chemoattractant protein-1 (MCP-1) perioperatively and clarified its significance regarding the development of infectious complications. We studied 94 patients who underwent gastrointestinal surgery for gastric or colorectal cancer at Mie University Hospital from 1996 to 2000. Serum concentrations of MCP-1 and interleukin-6 (IL-6) were measured perioperatively. The number of circulating lymphocytes and neutrophils were counted to assess the apoptotic rate of neutrophils. Patients were divided into two groups at the median preoperative MCP-1 level obtained from 40 gender- and age-matched healthy volunteers. The rate of developing infectious complications was significantly higher and tumor size was significantly larger in the low MCP-1 group than in the high MCP-1 group. The increasing IL-6 ratio (postoperative/preoperative IL-6 level) in the low MCP-1 group was about twofold greater than that in the high MCP-1 group. The neutrophil level calculated for the low MCP-1 group was significantly higher than that in the high MCP-1 group on postoperative day 3. We concluded that a decreased level of serum MCP-1 reflected tumor-related immunosuppression. Low MCP-1 levels were associated with an exaggerated postoperative IL-6 response and delayed neutrophil apoptosis, which affected the incidence of postoperative infectious complications developing in patients with gastrointestinal malignancies.

Adult↗

PubMed2004

Trocar site hernia.

OBJECTIVE: To review the relationship between the pathogenesis and clinical manifestations of trocar site hernias seeking to confirm the definition of trocar site hernias by classification. DATA SOURCES: We searched this subject in English on MEDLINE by combining the words "trocar," "port," "hernia, and "laparoscopy."Data Extraction and STUDY SELECTION: We limited the main operations to cholecystectomy, colon and rectal surgery, fundoplication, and gastric surgery; finding 44 reports on these procedures. Of these, 19 were case reports, 18 were original articles (setting criteria; the incidence of the trocar site hernia was clarified, and involved >100 patients), and 7 technical notes on "how to do it" were collected. We obtained 19 additional reports using the references of those previously obtained. We, thus, reviewed 63 reports (24 case reports, 27 original articles, 7 technical notes, and 5 review articles). DATA SYNTHESIS: Trocar site hernia was classified into 3 types. The early-onset type that occurred immediately after the operation, with a small-bowel obstruction, especially the Richter hernia, frequently developing. The late-onset type that occurred several months after the operation, mostly with local abdominal bulging with no small-bowel obstruction developing. The special type that occurred indicated the protrusion of the intestine and/or omentum. Trocar site hernias with fascial defects of 10 mm or larger should be closed, including the peritoneum. Opinion varied if a 5-mm trocar site defect should be closed. CONCLUSION: It is useful to clearly classify trocar site hernias to improve management of laparoscopic procedures.

Digestive System Surgical Procedures↗

PubMed2004

Operative morbidity associated with groin dissections.

PURPOSE: Groin dissection remains the treatment of choice for malignant neoplasms of the skin in the lower extremities and perineum. We sought to quantify the hospital complications after groin dissection, and to identify the patient- and procedure-related factors affecting these complications. METHODS: We reviewed 20 consecutive patients who underwent a collective 25 groin dissections for malignant neoplasms of the skin between 1996 and 2002 to determine the incidence and degree of morbidity, and to analyze the clinical factors associated with morbidity. An S-shaped incision was used for the first 8 procedures, whereas a straight incision was used for the next 17. RESULTS: The overall incidences of complications were 24% for wound infection, 52% for skin flap problems, 32% for seromas, 40% for edema, and 4% for hemorrhage, whereas the incidences of moderate to severe complications were 16% for wound infection, 16% for skin flap problems, 12% for seromas, 4% for edema, and 4% for hemorrhage. The incidence of wound infection tended to be higher after S-shaped incisions than after straight incisions ( P = 0.059), and the incidence of leg edema was significantly higher after S-shaped incisions than after straight incisions ( P = 0.028). CONCLUSION: S-shaped incisions more often resulted in lymphatic collection and stagnation, with a higher incidence of wound infections and leg edema than straight incisions. Therefore, we now perform straight incisions to minimize the risk of wound infections and leg edema.

Adult↗

PubMed2004

Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer, using surgical ligation and subsequent OK-432 (Picibanil) sclerotherapy.

Postoperative hepatic lymphorrhea is a very rare complication after abdominal surgery. Hepatic lymphorrhea, not containing chyle, involves an internal lymph fistula between the lymphatic channels toward the cisterna chyli and the peritoneal cavity. Over the past 20 years, 17 cases have been reported in Japan. Here, we report a further case, of a patient with successfully treated intractable hepatic lymphorrhea following gastrectomy for early gastric cancer. We review 18 cases, including the present case, with respect to the management of postoperative lymphorrhea refractory to conventional medical treatment.

Aged↗

PubMed2004

The clinical implication of 14-3-3 sigma expression in primary gastrointestinal malignancy.

14-3-3 Sigma is a checkpoint control gene that promotes G2 arrest following DNA damage. The inactivation of the 14-3-3 sigma gene, primarily by methylation-mediated silencing, has been reported in various human cancers. The loss of 14-3-3 sigma expression may contribute to malignant transformation by impairing the G2/M cell cycle checkpoint function, allowing an accumulation of genetic defects. In this report, we measured 14-3-3 sigma expression in 34 gastric and 35 colorectal cancers by using semi-quantitative reverse transcription-polymerase chain reaction and Western blot analysis. We also analyzed the association between 14-3-3 sigma expression and clinicopathological parameters including p53 status. Semi-quantitative reverse transcription-polymerase chain reaction and Western blot analysis showed that 14-3-3 sigma was significantly overexpressed in gastric and colorectal cancer tissues compared with normal ones (P<0.01). The immunoreactive 14-3-3 sigma protein was mainly detected in cytoplasm of cancer cells. Sigma overexpression tended to be associated with lymph node metastasis (P=0.08) in colorectal cancer. There was significant correlation between 14-3-3 sigma protein expression and the Ki-67 labeling index in gastric cancer (P=0.001). No significant association was observed between 14-3-3 sigma expression and p53 status. These results suggest that overexpressed 14-3-3 sigma in cancer cells might be induced by the p53 independent pathway, and that increased 14-3-3 sigma expression could contribute to cancer cell proliferation and the development and/or progression of human gastrointestinal cancers.

14-3-3 Proteins↗

PubMed2004

Laparoscopically assisted total gastrectomy with sentinel node biopsy for early gastric cancer: preliminary results.

This study sought to describe a procedure involving laparoscopically assisted total gastrectomy (LATG) with sentinel node biopsy (SNB) and to evaluate the results of the first three patients. LATG for early gastric cancer was performed with sentinel node (SN) identification using a combined patent blue-violet dye and 99mtechnetium-labeled tin colloid technique. Laparoscopically resected SNs were processed for frozen section examination by routine hematoxylin and eosin (H&E) and immunohistochemical cytokeratin (IHC-CK) stains. LATG consists of a four-surgical port technique, removal of the specimen through a small 5-cm laparotomy, and stapled Roux-en-Y esophagojejunostomy. Five patients were candidates for LATG with SNB between March 2001 and June 2003; two had open surgery because of a tumor extending the serosal surface and peritoneal dissemination, whereas in the remaining three, SNs were successfully identified and evaluated with no evidence of sentinel node (micro) metastases intraoperatively. Based on the results of SNB, three patients underwent LATG with adequate lymphadenectomy. Mean operative time and blood loss were 375 min and 219 mL, respectively. No dissected lymph nodes had evidence of metastasis by H&E and IHC-CK on permanent sections. LATG with SNB followed by adequate lymphadenectomy is technically feasible, and with its acceptable operative time and blood loss, presents an excellent therapeutic option for early gastric cancer; while SNB and subsequent frozen section analysis by H&E and IHC-CK staining is a rapid and reliable diagnostic method for intraoperative detection of SN (micro) metastasis. This combination treatment is a promising alternative to laparoscopic gastrectomy with conventional lymphadenectomy.

Adenocarcinoma↗

PubMed2003

Serum immunosuppressive acidic protein as an interleukin-6 related index of deteriorating condition in gastric cancer patients.

BACKGROUND/AIMS: Immunosuppressive acidic protein (IAP) is an acute-phase reactant which has a close correlation with the impairment of the host's immunity. The present study aims to investigate the significance of serum IAP as an index of cytokine-related disease status in gastric cancer patients. METHODS: Serum IAP levels were determined in 76 gastric cancer patients and 20 healthy subjects. In a subgroup of 39 patients, tissue interleukin-6 (IL-6) concentrations and expression of IL-6 protein in tumor tissues were also examined. RESULTS: The mean serum IAP level in the patients was significantly higher than that in the normal controls. The serum IAP level in the patients was associated with clinicopathological features, such as tumor size and serosal invasion. The prognosis of patients with high IAP levels was significantly worse than that of those with low IAP levels. Moreover, the serum IAP level was closely correlated with various parameters reflecting the host's nutritional and immunological conditions. Immunohistochemically, IL-6 was overexpressed in the cytoplasm of tumor cells. The IL-6 concentration and immunoreactivity of IL-6 protein in tumor tissue was significantly correlated with the serum IAP level. CONCLUSIONS: Elevated serum IAP, which may be upregulated by an activated IL-6 network in tumor tissue, may reflect not only tumor progression, but also a deteriorated condition that is associated with malnutrition and immunosuppression in gastric cancer patients.

Adult↗

PubMed2003

Lymphatic mapping and sentinel node biopsy during laparoscopic gastrectomy for early cancer.

BACKGROUND/AIMS: Intraoperative lymphatic mapping and sentinel node (SN) biopsy can potentially be combined with minimally invasive surgery, but there are few reports of laparoscopic lymphatic mapping for gastrointestinal cancer. We examined the feasibility and accuracy of laparoscopic lymphatic mapping in predicting lymph node status in patients with gastric cancer. METHODS: Seventeen patients with gastric cancer invading the mucosal or submucosal layers (T1) underwent laparoscopic gastrectomy with lymphatic mapping between March 2001 and May 2002. The day before surgery, a technetium-99m-labelled tin colloid solution was injected endoscopically around the tumor. Immediately after the pneumoperitoneum, patent blue was injected. Gastrectomy was performed in all patients, and blue-stained or radioactive nodes were defined as SNs. Fresh SNs were immediately processed for frozen-section examination by hematoxylin-eosin (H and E) and immunohistochemical (IHC) staining. All non-SNs harvested from resected specimens were subjected to histological examination with H and E. RESULTS: SNs were detected in all patients by combination of the two kinds of tracers. Three patients had lymph node metastases in their final examination, and SNs in these 3 were operatively diagnosed as positive by H and E or IHC staining. Lymphatic mapping and SN biopsy under laparoscopic surgery were performed with 100% accuracy. CONCLUSION: Our preliminary study shows the feasibility of intraoperative lymphatic mapping in laparoscopic gastrectomy for T1 gastric cancer.

Adult↗