[Denucleation of the erythroblast].
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Anemia, Hemolytic↗
Biomedical subjects
K Hajiro
Publications and source records attributed to K Hajiro.
Treatment results of esophageal carcinoma of clinical T3, T4M0: historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery.
We investigated results for thoracic T3-T4 esophageal squamous cell carcinoma in two strategies. The protocol group (46 patients) consisted of neoadjuvant chemoradiotherapy (44 Gy, CDDP, 5-FU), followed by either definitive radiotherapy (total 70 Gy) for responders or surgery for non-responders. The surgery group (26 patients) underwent esophagectomy with regional lymph node dissection. Nineteen of them received postoperative radiotherapy. Surgical candidates in both groups received intraoperative radiotherapy for abdominal lymphatics since 1991. In the protocol group, 23 patients underwent radical surgery after neoadjuvant chemoradiotherapy and the remaining 23 underwent definitive radiotherapy. The rates of recurrence were 64% in the protocol group, and 62% in the surgery group. Overall 3- and 5-year survival rates were 48% and 31% in the protocol group compared to those of 30% and 30% in the surgery group. The rate of the was 39% in the protocol group. There was no mortality in either group. Our protocol had at least comparable prognostic values with historical conventional surgery, and was excellent in having feasibility for organ preservation.
Carcinoma, Squamous Cell↗
Case report of 14-year survival after radiotherapy for clinical T3 esophageal carcinoma, with local recurrence finally rescued by surgery.
A 51-year-old man with increasing dysphasia was admitted to our hospital on March 18, 1985. Several examinations revealed thoracic esophageal squamous cell carcinoma 11 cm in length staged T3N0M0 (stage IIA) by UICC 1987. As he rejected our proposal of surgery, definitive radiotherapy (60 Gy) was delivered, and complete response was obtained. The patient had been doing well for 5 years after radiotherapy until superficial local recurrence was discovered at a periodic endoscopic examination. High-dose-rate intraluminal brachytherapy (10 Gy/2 Fr) was administered. After a 3-year disease-free interval, superficial recurrence developed in the same location, and early gastric cancer was detected as a secondary cancer. Radical salvage surgery was performed. The patient was alive and disease free 5 years and 5 months after surgery. We present this rare case of a patient who survived 14 years after the initial radiotherapy. The present case demonstrated the importance of long-term follow-up after radiotherapy, long-term local controllability of relatively low doses of intraluminal brachytherapy after superficial recurrence, and the feasibility of salvage surgery as long as local recurrence is limited to within the mucosal layer.
Carcinoma, Squamous Cell↗
Diffuse intrahepatic recurrence after resection of hepatocellular carcinoma.
BACKGROUND/AIMS: An early diffuse type in the pattern of the postoperative intrahepatic recurrence of hepatocellular carcinoma has been recognized. The purpose of this study was to elucidate risk factors for diffuse recurrence of hepatocellular carcinoma. METHODOLOGY: The subjects involved in the present study were 114 patients with hepatocellular carcinomas resected in Tenri Hospital during the past 12 years. Univariate analysis was used for retrospective determination of the factors related to diffuse recurrences after surgery in 10 cases among 114 patients. RESULTS: The risk factors linked to diffuse recurrence were microscopical portal infiltration (P < 0.01), elevated alpha-fetoprotein (more than 1000 ng/mL) (P < 0.05), the absence of preoperative transcatheter arterial embolization (P < 0.01), and two or more segmentectomies of the liver (P < 0.01). Six of 10 patients with microscopical portal infiltration and elevated alpha-fetoprotein (more than 1000 ng/mL) had diffuse recurrence (P < 0.01). Six of 8 patients with two or more segmentectomies without preoperative TAE had diffuse recurrence (P < 0.01). CONCLUSIONS: When patients with the diagnosis of operable hepatocellular carcinoma have portal infiltration and elevated alpha-fetoprotein (more than 1000 ng/mL), two or more segmentectomies of the liver without preoperative transcatheter arterial embolization should be avoided.
Carcinoma, Hepatocellular↗
Histopathological assessment of lymph node metastasis in patients with gastric cancer.
BACKGROUND/AIMS: Lymph node dissection has been carried out for two decades in Japan, resulting in improved survival of patients with gastric cancer. By analyzing dissected nodes of resected advanced gastric cancers, we intend to determine which parameter(s) are more concerned in node metastasis. PATIENTS AND METHODS: Curative gastrectomy with dissection of lymph nodes was performed for 78 of the 108 patients with advanced gastric cancer. Metastases were found in 171 of 1359 nodes (13%) dissected. In each node, the maximum and minimum diameters were measured, and the ratio of the former to the latter was calculated. RESULTS: The minimum diameter of node was closely related to node metastasis. When the minimum diameter in node metastatic criteria was "3 mm or more", a sensitivity of 81% and specificity of 54% were calculated. In false negative node, signet-ring cell carcinoma (SIG) (33%) and poorly differentiated adenocarcinoma (POR) (22%) were more frequently found as primary lesions. Half or more of these nodes were invaded by only a few carcinoma cells. When the primary lesion is histologically SIG or POR, endoscopic treatment is contraindicated for possible nodes metastasis. CONCLUSIONS: It is impossible to distinguish nodes with micrometastasis from nodes without metastasis. The minimum diameter of node is more important in node metastasis of gastric cancer than the maximum diameter of node or the ratio of both.
Adenocarcinoma↗
Clinical features of serologically non-B non-C chronic liver disease.
BACKGROUND/AIMS: To clarify the clinical features of serologically non-B non-C chronic liver disease (SNBNCLD). MATERIAL AND METHODS: Two hundred-eleven Japanese patients hospitalized for clinical manifestations associated with non-alcoholic chronic liver disease were tested by hepatitis B surface antigen (HBsAg) by reversed passive hemagglutination (RPHA) and the second generation hepatitis C antibody (HCVAb) by passive hemagglutination (PHA). RESULTS: Twenty-two patients (10.4%, 15 men and 7 women) were diagnosed as having SNBNCLD, evaluated clinically and compared with other close etiologies. Their clinical manifestations and severity of liver disease were similar to those of other etiologies. The average age was higher than hepatitis B (p < 0.001), primary biliary cirrhosis (PBC, p < 0.05), autoimmune hepatitis (AIH, p < 0.05) and hepatitis C. None of them had a history of blood transfusion before the onset. Concomitance of hepatoma was seen in 40.9%, being uncommon compared with hepatitis B (p < 0.01) and hepatitis C (p < 0.005). No significant difference of the survival rate was shown compared to other etiologies. HBsAb was more frequent (36.4%) than in hepatitis C (p < 0.05), and disappearance of HBsAg was seen in two hepatitis B patients during the follow-up period. CONCLUSION: Our data suggest that SNBNCLD is unique and important clinical entity associated with previous hepatitis B.
Aged↗
Clinical subgroup of autoimmune hepatitis type 1 sustaining remission without additional drugs.
BACKGROUND/AIMS: Many patients with autoimmune hepatitis type 1 need additional non-steroidal immunosuppressants to maintain remissions, but the indication should be limited to avoid the unnecessary side effects. The aim of this study is to clarify the clinical subgroups of autoimmune hepatitis type 1 sustaining remission without additional drugs. METHODOLOGY: We studied 20 patients with autoimmune hepatitis type 1, in whom complete remissions were achieved in the natural course or by prednisolone alone. Remissions were maintained with none or less than 10 mg/day of prednisolone. RESULTS: In the course (average: 6 years), 8 patients (40%) remained in remission for more than three years. In the remitted group, initial values of serum gamma-globulin (p<0.05) and serum immunoglobulin G (p<0.01) were lower than those in the relapsed group. The group with less than 30 mg/ml of gamma-globulin and 3000 mg/dl of immunoglobulin G showed a significantly lower relapse rate than the other one (p<0.01). CONCLUSIONS: There is a clinical subgroup of autoimmune hepatitis type 1 that sustains remission with low-dose prednisolone alone. Additional immunosuppressive drugs may not be needed to maintain remissions in such patients.
Anti-Inflammatory Agents↗