Biomedical subjects

Hitoshi Tonouchi

Publications and source records attributed to Hitoshi Tonouchi.

27 records · Page 2Linked to original sources

PubMed2003

Modified pharmacokinetic modulating chemotherapy using 5-fluorouracil, UFT, and taxotere (docetaxel) for advanced gastric cancer.

The efficacy of neoadjuvant chemotherapy for advanced gastric carcinoma is controversial. Moreover, a standard regimen for such chemotherapy has not been clearly established. Pharmacokinetic modulating chemotherapy (PMC), a combination of infused 5-fluorouracil and oral uracil-tegafur, has been proven to be highly effective for the treatment of colorectal carcinoma. We report two patients with advanced gastric carcinoma successfully treated with PMC and infused taxotere (TXT; docetaxel). Preoperative treatment with PMC and TXT significantly decreased the depth of wall penetration of the tumor in one patient and reduced the size of the tumor in the other patient. In both patients, there were significant chemotherapeutic effects on the primary tumor and on regional lymph nodes pathologically. Preoperative PMC plus TXT produced primary tumor downstaging, leading to improved resectability. The responsiveness of metastatic cancer cells in the regional lymph nodes suggested the possibility of nodal downstaging by this regimen.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Allogenic blood transfusion is an independent risk factor for infective complications after less invasive gastrointestinal surgery.

BACKGROUND: The present study aimed to clarify the predisposing factors for postoperative infectious complications after less invasive surgery. METHODS: A total 150 surgical patients were placed in either group H (operative blood loss > or = 500 mL) or group L (<500 mL). The patients' background factors and postoperative inflammatory responses were assessed. RESULTS: The operating time was an independent risk factor for infectious complication in group H. In contrast, allogenic blood transfusion was the only significant risk factor for infection in group L. In the patients who received blood transfusion, exaggerated postoperative interleukin-6 response was found in group H, whereas an increased consumption of interleukin-6 soluble receptor with resultant induction of immunosuppressive acidic protein (IAP) were found in group L. CONCLUSIONS: Perioperative blood transfusion may predominantly contribute to increased susceptibility to infection after less invasive surgery through increased affinity of interleukin-6 soluble receptor and enhanced IAP response.

Aged↗

PubMed2003

Urinary excretion of deoxypyridinoline increases after gastrointestinal surgery.

OBJECTIVES: We investigated the effect of gastrointestinal surgery on bone metabolism with special reference to nutrition status and the systemic inflammatory response (SIR). METHODS: We assessed bone resorption by measuring the urinary excretion of deoxypyridinoline (D-Pyr), a specific marker that reflects the amount of degraded collagen. Twenty patients who underwent gastrectomy or colectomy were enrolled in this study. Daily energy intake, nitrogen, calcium, and phosphate balances, and urinary D-Pyr were examined preoperatively and for 14 days after the operation. The nutritional risk index and prealbumin were measured for nutrition assessment, and SIR was evaluated daily based on scorings of body temperature, pulse rate, respiratory rate, and white blood cell number according to our criteria. RESULTS: Urinary D-Pyr excretion had already increased on postoperative day 1 and continued to increase until postoperative day 14. The amounts of postoperative urinary excretion of D-Pyr correlated positively with the SIR scores and the amount of urinary excretion of cortisol, one of the stress-response hormones, and inversely with pre- and postoperative nutritional risk indices. In addition, the patients who experienced complications during the postoperative period excreted larger amounts of D-Pyr. CONCLUSIONS: Because the amount of excreted D-Pyr reflects the loss of the bone matrix, these results may indicate that bone resorption increases after gastrointestinal surgery. The extent of resorption was parallel to the degree of SIR and nutrition status.

Adult↗

PubMed2002

Intra-tumoral interleukin-6 down-regulation system and genetic mutations of tumor suppressor genes in colorectal carcinoma.

BACKGROUND: The interleukin (IL)-1-IL-6 network, the most potent cascade of pro-inflammatory cytokines, plays an autocrine role in tumor growth. The IL-1-IL-6 network is down-regulated by a phased cytokine inhibitor IL-1 receptor antagonist (ra) and an anti-inflammatory cytokine IL-10. The current study evaluated this down-regulation system in colorectal carcinoma and its relation to the genetic alteration of tumor suppressor genes. METHODS: Seventy-four specimens of primary colorectal carcinoma and normal mucosa were collected to measure tissue concentrations of cytokines. Polymerase chain reaction amplification was performed to investigate the loss of heterozygosity of the microsatellite markers on chromosomes 17p and 18q. RESULTS: The IL-1ra/IL-6 ratio in the carcinoma specimens was lower than ratios in adenomas and normal mucosae and decreased with disease progression. The IL-1ra/IL-6 ratio in early cancers tended to be lower than that in adenomas and normal mucosae. However, the tissue concentrations of IL-1beta and IL-10 were not associated with any clinicopathologic parameters. The tissue IL-1ra concentration correlated with that of IL-6 only in adenomas and early cancers. Immunohistochemically, IL-1ra and IL-6 were localized in the tumor cytoplasm. A reduced tissue IL-1ra/IL-6 ratio in the carcinomas correlated with poor prognosis and was associated with the loss of heterozygosity of the microsatellite markers on chromosomes 18q. CONCLUSIONS: There is an IL-6-IL-1ra network system in colorectal tumors, but this system deteriorates with carcinogenesis and tumor growth. The deterioration of this network system was associated with the allelic loss of a portion of chromosome 18q, reflecting the genetic alteration of tumor suppressor genes.

Adenoma↗

PubMed2002

Spontaneous regression of a metastatic liver tumor: report of a case.

A 60-year-old man, who suffered from advanced rectal cancer accompanied with liver metastasis, underwent an abdominoperineal resection and a partial hepatectomy. He remained well until 4 months after surgery when he developed a biopsy-proven recurrent intrapelvic mass and multiple liver tumors. At 6 months after surgery, the metastatic liver tumors grew larger and almost completely occupied both lobes of the liver. However, 9 months after surgery, the liver tumors regressed remarkably and his clinical condition improved without any specific treatment for cancer. Although he died of cancerous peritonitis 18 months after surgery, the autopsy findings did not indicate any apparent regrowth of the liver tumors. To date, only one case report of a spontaneous regression of a metastatic liver tumor from colorectal cancer has been published in the English literature. We herein describe this rare case and discuss some of the reasons potentially responsible for the regression.

Carcinoma, Adenosquamous↗

PubMed2002

Vascular endothelial growth factor as an age-dependent prognostic factor in gastric cancer patients.

BACKGROUND: We investigated whether vascular endothelial growth factor (VEGF) plays an important role in maintaining constant tumor growth in wasted elderly patients, in whom oxygen and glucose supply are often unable to meet the demands of the body. METHODS: Tissue concentrations of VEGF in 70 gastric carcinomas and 70 normal mucosas were determined. The expression of VEGF was evaluated immunohistochemically. RESULTS: The net balance between the concentration of VEGF in the cancer and normal mucosa (VEGF Ca/N ratio: the cancer tissue VEGF concentration divided by normal mucosa VEGF concentration) increased with age and was associated with disease progression only in elderly patients. VEGF Ca/N ratio increased in response to systemic hypo-oxygenation and nutritional depletion only in elderly patients. CONCLUSIONS: The systemic-local regulating mechanism of VEGF production may play an important role in the constant growth of tumor cells, especially in elderly gastric cancer patients.

Adult↗

PubMed2002

Successful repair of an aortoesophageal fistula with aneurysm from esophageal diverticulum.

Aortoesophageal fistula is a rare, frequently fatal, cause of upper gastrointestinal bleeding, and there are few reported survivors of it. We report a successful surgical case of aortoesophageal fistula associated with an infective thoracic aortic aneurysm. The patient had been diagnosed as having an esophageal diverticulum 8 months before admission. The aortoesophageal fistula was completely resected, followed by esophagojejunum anastomosis and patch closure for the entry of the aneurysm and omental coverage to the wall of the descending aorta in one stage. In this case, esophageal diverticulum was diagnosed before the development of an aortoesophageal fistula associated with an aneurysm.

Aged↗

PubMedDate not supplied

5-FU improves p27-related poor prognosis in patients with Astler-Coller B2-C colorectal carcinoma.

p27kip1 induces cell cycle arrest at the G1-S transition. To investigate the effect of UFT on the prognosis of colorectal cancer with respect to p27kip1 expression, survival curves of patients with p27kip1 overexpression (group A) and without p27kip1 expression (group B) were evaluated following chemotherapy using UFT (tegafur and uracil). Although there was no significant overall survival difference between group A and B patients, the patients without p27kip1 expression had a significantly lower survival rate when they did not receive UFT treatment. UFT, 5-FU masked compound may improve the p27-related poor prognosis in colorectal cancer patients.

Adenocarcinoma↗

PubMedDate not supplied

Fatal and non-fatal complications after surgical resection for gastric cancer.

BACKGROUND/AIMS: We divided overall complications after surgical resection for gastric cancer into fatal and non-fatal, and examined them in view of risk factors. Next we examined the meaning of dividing complications into two groups. METHODOLOGY: Records of 331 patients who underwent gastrectomies for cancer between 1992 and 2003 were used. Any postoperative overall complications were divided into fatal and non-fatal according to the association with mortality. RESULTS: Leakage and respiratory complication were defined as fatal complications. Tumor size (cm) (OR=1.14, 95% CI 1.05-1.25, p=0.003) and patient age (OR=1.06, 95% CI 1.06-1.10, p=0.007) were shown to be risk factors for fatal complications. Total gastrectomy (vs. distal gastrectomy) was a risk factor for non-fatal complications (OR= 1.63, 95% CI 0.99-2.7, p=0.05). Extended lymphadenectomy was a further possible risk factor for non-fatal complications (OR=1.71, 95% CI 0.98-3.0, p=0.06). On the other hand, intra-operative blood loss (mL) was only a risk factor for overall complications (OR=1.001, 95% CI 1.0-1.001, p=0.009). CONCLUSIONS: Independent risk factors for fatal complications and those for non-fatal complications did not include that for overall complications. To divide overall complications into fatal or non-fatal was useful for finding the real reason for complications. We could not prepare preventive measures for complications until analyzing the divided groups.

Aged↗