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Biomedical subjects

Masato Kusunoki

Publications and source records attributed to Masato Kusunoki.

At least 73 records · Page 4Linked to original sources
PubMed2003

Clinical results after restorative proctocolectomy without diverting ileostomy for ulcerative colitis.

BACKGROUND AND AIMS: This study evaluated the postoperative complications and clinical results of restorative proctocolectomy without diverting ileostomy for ulcerative colitis. PATIENTS AND METHODS: One hundred selected patients had a hand-sewn ileal J-pouch anal anastomosis with mucosectomy using an ultrasonically activated scalpel. RESULTS: Three patients with pouch-related complications who needed diverting ileostomy. Five patients showed intestinal obstruction; two of the five needed relaparotomy and division of adhesions. The median number of bowel movements per 24 h was 6.5 (2-13) at 3 months and 5 (3-10) at 12 months. The corresponding nightly frequencies were 0 (0-5) at 3 months and 0 (0-3) at 12 months. After 3 months 82% of patients had no soiling during the daytime, and 45% were fully continent day and night. After 3 months 89% had recovered the ability to distinguish flatus from feces. CONCLUSION: Ileal pouch anal anastomosis can be performed safely without diverting ileostomy using an ultrasonically activated scalpel. The postoperative functional result was stabilized 3 months after the operation.

Adolescent↗
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↗
PubMed2003

Pelvic insufficiency fractures after preoperative radiotherapy for rectal carcinoma.

Insufficiency fractures of the pelvic bones are rare complications of radiotherapy, but they can cause significant morbidity. We report a patient who developed pelvic insufficiency fractures because of preoperative hypofractionated radiotherapy with chemotherapy for rectal carcinoma. She was treated with a four-field box technique, receiving 20 Gy in four fractions, and she underwent concurrent pharmacokinetic modulating chemotherapy (PMC; intravenous infusion of 5-fluorouracil [FU], 750 mg/body per 24 h and oral administration of uracil and futrafur [UFT] 400 mg/day) over a 1-week period. She developed severe buttock and femoral pain 10 months after this preoperative therapy. Physical examination at this time was unremarkable, with an absence of neurological signs, and radiographic examination was also normal, resulting in the patient initially being undiagnosed. However, 2 months after the onset of her initial pain, she was diagnosed as having pelvic insufficiency fractures on conventional radiographs. Although preoperative chemoradiotherapy has been widely accepted for improving local control and survival in patients with primary rectal carcinoma, surgeons need to be aware of this rare complication that can arise even 10 months after preoperative chemoradiotherapy.

Aged↗
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↗
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

Crohn's disease associated with gastric cancer.

An association between Crohn's disease and gastric cancer has not been clearly defined. A 34-year-old man was referred to our hospital for the evaluation of a gastric lesion and treatment of small-bowel Crohn's disease. We diagnosed the gastric lesion as adenocarcinoma, using endoscopy and histological studies. The patient underwent a distal gastrectomy, with well-differentiated adenocarcinoma being found; partial resection of the small bowel was also performed because of an entero-enteric fistula. His postoperative course was uncomplicated.

Adenocarcinoma↗
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

Huge scrotal, flank, and retroperitoneal lymphangioma successfully treated by OK-432 sclerotherapy.

Retroperitoneal lymphangioma is extremely rare. It may obstruct or invade surrounding vital organs, which may result in lethal effects to the host. Although surgical excision has been suggested as the first choice for treatment, complete extirpation is often impossible. Moreover, the rates of postoperative morbidity and disease recurrence remain high. We report a case of a huge retroperitoneal lymphangioma extending to the flank and scrotum that was successfully treated by intralesional OK-432 sclerotherapy without any serious complications.

Abdominal Wall↗
PubMed2002

[A case of colon metastasis to the lung treated successfully with combined chemotherapy of CPT-11 and 5'-DFUR].

We administered pharmacokinetic modulating chemotherapy (PMC, oral tegafur/uracil [UFT] plus fluorouracil infusion) together with irinotecan hydrochloride (CPT-11) in a patient with rectal cancer, who had multiple lung metastases at 2 years and 7 months after surgery. However, because the patient showed resistance, we attempted combination therapy with CPT-11 and doxifluridine (5'-DFUR) on an outpatient basis, which resulted in NC after 9 months. During this period, the therapy was performed safely without any observable adverse reactions such as diarrhea or myelosuppression. This case suggests the efficacy of combination therapy with CPT-11 and 5'-DFUR, which was expected since this is an established treatment for progressive recurrent colon cancer.

Adenocarcinoma↗
PubMed2002

Prognostic values of radiation-induced p53 in adjacent normal mucosa and p21WAF1/CIP1 expression in rectal cancer patients.

DNA damage induces p53-mediated cell cycle arrest in which p21WAF1/CIP1, a cyclin-dependent kinase inhibitor, may play a critical role by being regulated via wild-type p53. Although adjuvant preoperative radiotherapy in rectal carcinoma is generally believed to improve the prognosis, it remains unclear which factors control the response. We investigated the interactions between the underlying mechanisms of cell cycle perturbation in response to radiotherapy, and local recurrence and distant metastasis in patients undergoing radical surgery for rectal carcinoma. A retrospective review was carried out in which 63 cases of Dukes' B or C, well or moderately differentiated rectal carcinomas in the lower two-thirds of the rectum, with or without preoperative radiotherapy, were immunohistochemically analyzed using antibodies to p53 and p21WAF1/CIP1. Induced p53 expression in adjacent normal mucosa, as seen in seven of 35 cases with radiotherapy, and mutually exclusive p21WAF1/CIP1 immunoreactivity, was strongly associated with local recurrence (P=0.0001). Furthermore, high p21WAF1/CIP1 expression was associated with a lack of distant metastasis (P=0.032). Our data suggest that there are some cases in which p53 overexpression in adjacent normal mucosa induced by radiotherapeutic treatment might heighten the risk of local recurrence, and that p21WAF1/CIP1 induction independent of the status of the p53 gene showing radiosensitivity might lead to a less distant metastasis.

Adenocarcinoma↗
PubMed2002

[A case of multiple liver metastases from colon cancer successfully treated with modified pharmacokinetic modulating chemotherapy using Leucovorin].

A 51-year-old man underwent right hemicolectomy due to ascending colon cancer with multiple liver metastases. Administration of modified pharmacokinetic modulating chemotherapy (PMC) using Leucovorin (intravenous infusion of 5-FU, 600 mg/m2/24 hours; oral administration of UFT, Taiho Pharmaceutical Co., Tokyo, Japan, 400 mg/day; and Isovorin, Wyeth Lederle Co., Tokyo Japan, 250 mg/body) was started postoperatively. Two months of modified PMC produced a drastic tumor reduction without any adverse reactions such as diarrhea or myelosuppression observed. At present the patient continues to tolerate the chemotherapy and is being followed as an outpatient clinic. This case suggests the usefulness of modified PMC using Leucovorin for progressive recurrent colon cancer.

Adenocarcinoma↗
PubMedDate not supplied

Rapid emergence of mammary preneoplastic and malignant lesions in human c-Ha-ras proto-oncogene transgenic rats: possible application for screening of chemopreventive agents.

For comparison of mammary gland whole mounts with examination of 2 histologic sections of mammary gland, 56 Hras128 rats were intravenously injected with 50 mg/kg body weight of N-methyl-N-nitrosourea at 50 days of age and then sacrificed at days 5, 10, 15, 20, 25, and 56. Comparison of detection sensitivity between the whole mounts and histologic sections revealed no lesions apparent in whole mounts on day 10, although intraductal proliferation was clearly detected in histologic sections in 44% of treated rats. Proliferative lesions were first detected in whole mounts at a 44% incidence on day 15, while intraductal proliferations and atypical hyperplasias were apparent in the sections at 89% and 44% incidences, respectively. On day 20, atypical hyperplasias and small adenocarcinomas in histologic sections were found in almost all animals. In conclusion, examination of 2 histologic sections from mammary tissues was found to be practical for detection of small malignant lesions as early as 15 days after MNU injection, and suppressive effects of soy isoflavones were clearly evident within 20 days after carcinogen exposure. These results suggest that this model has practical utility for short-term screening of chemopreventive agents for mammary carcinogenesis.

Adenocarcinoma↗
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

Evaluation of genetic mutations of tumor suppresser genes in colorectal cancer patients.

BACKGROUND/AIMS: The mutation of tumor suppresser genes of colorectal cancer was evaluated to clarify its significance in the clinical management of colorectal cancer patients. METHODOLOGY: Polymerase chain reaction amplification was performed to investigate the loss of heterozygosity (LOH) of the DCC (deleted-in-colorectal-carcinoma) gene and p53 gene in 76 colorectal cancers. RESULTS: Thirty-five of 76 tumors showed LOH at the p53 locus. LOH at the DCC locus was observed in 30 of 76 tumors. Tumors with DCC LOH had a significantly higher rate of p53 LOH. DCC LOH was associated with both liver metastasis and lymph node metastasis. Moreover, younger patients and patients with a well-differentiated adenocarcinoma had a higher risk of liver and lymph node metastasis when the tumor had DCC LOH. The association between liver or lymph node metastasis and clinicopathological factors was stronger in tumors with smaller size and negative serosal invasion. CONCLUSIONS: The careful exploration of the liver and regional lymph nodes is advocated when the tumor has a DCC alteration, even at an early stage of the disease and especially in younger patients and patients with a well-differentiated carcinoma. The assessment of DCC LOH may be useful for selecting patients for extensive surgical intervention or adjuvant chemotherapy.

Adult↗