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T Boku

Publications and source records attributed to T Boku.

At least 19 recordsLinked to original sources
PubMed1997

Jejunal pouch and interposition reconstruction after total gastrectomy for cancer.

The authors modified the operative procedures used in pouch and interposition (PI) reconstruction in an attempt to improve the surgical results after total gastrectomy, because a randomized controlled trial had revealed that the clinical assessment of PI was quite poor, even though it is a physiological route. In most of the treated patients, the gastric emptying test revealed delayed emptying, and an X-ray video film showed folding and twisting of the jejunal conduit between the pouch and duodenum, which disturbed the transmission of nutrition. Modified PI (m-PI) was performed by decreasing the length of the jejunal conduit and widening the mesenteric pedicle to preserve the blood and nerve supply. This procedure was retrospectively compared with the previously used PI reconstruction by evaluating the postprandial symptoms, food intake, body weight, serum nutritional parameters, and emptying time of the gastric substitute. The m-PI group (n = 6) showed a lower incidence of symptoms, a greater food intake, and a greater weight recovery than the PI group (n = 6). The gastric emptying test also revealed an acceptable degree of emptying. We thus conclude that the m-PI reconstruction is more useful for improving the postoperative quality of life than the previously used method of PI reconstruction.

Adult↗
PubMed1995

Three-dimensional reconstruction of the biliary tract using spiral computed tomography.

Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.

Adult↗
PubMed1995

Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial.

OBJECTIVE: The authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients. SUMMARY BACKGROUND DATA: Gastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted. METHODS: A randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated. RESULTS: The PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group. CONCLUSIONS: Pouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.

Adult↗
PubMed1995

[Computed tomography with continuous transport and continuous scanner rotation for laparoscopic cholecystectomy].

We investigated the 58 cases of cholecystolithiasis including 8 cases of choledocholithiasis treated with laparoscopic cholecystectomy. All patients received spiral CT scanning with drip infusion cholangiography (DIC-SCT), and 1.6 patients received endoscopic retrograde cholangiography (ERC), and the detection rates of the gallbladder, the bile duct and the cystic duct were compared. The gallbladder could be seen in 86.2% of cases with DIC-SCT and in 63.8% of cases with conventional DIC. The junction between the cystic duct and the common bile duct could be seen in 18 of 58 cases with DIC and in 49 of 58 cases with DIC-SCT. The DIC-SCT showed significantly superior anatomical details compared with images with conventional DIC. A comparison of DIC, ERC and DIC-SCT revealed that the junction between the cystic duct and the common bile duct could be identified in 14 of 16 cases undergoing ERC, in 13 of 16 cases receiving DIC-SCT and in 4 of 16 cases receiving DIC. Significant differences were noted among DIC-SCT, ERC and conventional DIC. We concluded that DIC-SCT is easy, non-invasive and useful for the preoperative assessment of laparoscopic cholecystectomy and also helpful for avoiding damage to the bile duct.

Adolescent↗
PubMed1995

[A case of acute myelogenous leukemia accompanied with myelofibrosis and megakaryocyte-like giant bizarre blasts].

A 45-year-old man was admitted with high fever and leukocytosis in August 1993. The diagnosis of acute myelogenous leukemia (AML; M2) was made on the basis of morphological, cytochemical and immunological characteristics of the blasts in the bone marrow. The induction therapy with BHAC, daunorubicin, 6-MP was unsuccessful in achieving remission; the bone marrow biopsy specimen revealed the proliferation of the remaining leukemic cells and massive fibrosis accompanied with unusual megakaryocyte-like giant bizarre cells. These megakaryocyte-like giant cells were positive for myeloperoxidase and CD34, but not GPIIIa and factor VIII, indicating that those were derived from myelogenous stem cells. Following the low-dose Ara-C therapy, improvement of fibrosis and disappearance of these giant cells were observed in the bone marrow. After the reinduction therapy with high-dose Ara-C and MIT against markedly increased blasts, the patient died of systemic fungal infection. The presence of myelofibrosis and giant atypical blasts might allow resistance to therapy and poor prognosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients.

BACKGROUND: The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) determination in patients with gastric cancer has been controversial. METHODS: The correlation between preoperative serum CEA levels and clinicopathologic factors was evaluated in 865 patients with gastric cancer who underwent gastrectomy between 1980 and 1990. The authors also investigated whether preoperative CEA levels represented a prognostic parameter using Cox's proportional hazard model. RESULTS: Of the 865 patients, 249 (28.8%) were positive for CEA. The positivity rate was higher in the elderly, in male patients whose tumors were located in the lower third of the stomach, and in those with Borrmann types 2 and 3. It was also significantly correlated with tumor size, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. The higher the serum CEA level, the more advanced the cancer stage, and the rate of curative resection also decreased as CEA levels were elevated. There was a significant difference between patients with CEA levels below 10 ng/ml and those with levels exceeding 10 ng/ml with regard to tumor progression and curability. Multivariate analysis showed a strong and highly significant association between preoperative serum CEA level and survival time. The prognosis was also significantly poorer when the CEA level was above 10 ng/ml, even in patients in the same stage (Stages 1, 2, and 3). CONCLUSIONS: Preoperative serum CEA determination in patients with gastric cancer valuable for predicting tumor progression and prognosis. Further, in patients in Stages 1, 2, and 3, CEA levels exceeding 10 ng/ml are clinically significant and provide more prognostic information than that obtained by conventional staging methods.

Carcinoembryonic Antigen↗
PubMed1994

[Evaluation of surgical treatment of gastric cancer in the aged].

Patients with gastric cancer aged 70 years or over were divided into 3 age groups (70-74, 75-79, 80 years or over) and were compared with patients aged 60-69 years, (which is the age group with the highest incidence of stomach cancer) with regard to the incidence of postoperative complications. In addition, factors which might be associated with increased mortality were investigated. There were no significant differences with regard to the incidence of postoperative complications (16-21%) or the mortality rate (0-3%, within 30 days after surgery) between the various age groups. However, the incidence of those complications which later proved fatal was higher in those aged 75 years or over. Factors associated with the development of complications in each age group were the type of surgical technique used, the operation time, and the severity of hemorrhage during surgery. The prognosis for gastric resection was poor in patients aged 80 years or over. Our findings indicated that curative resections should be performed for gastric cancers in the elderly if the general physical condition of the patients permits. A more conservative approach is desirable when the general condition is not favorable.

Age Factors↗
PubMed1993

Prognostic differences of adenocarcinoma arising from the cardia and the upper third of the stomach.

Of 1,012 patients who underwent gastrectomy for carcinoma of the stomach from 1980 to 1990, 33 with adenocarcinoma arising from the gastroesophageal junction (group C) and 55 with adenocarcinoma of the upper third of the stomach (group U) were compared with regard to their clinicopathologic features. Twenty-five patients (76%) in group C and 49 patients (89%) in group U underwent curative resection. The 5-year survival rates following curative resection were 32 and 70 per cent, respectively (P < 0.001). The poor prognosis of group C was ascribed to a greater propensity for esophageal invasion and nodal involvement, as well as to more advanced disease at diagnosis. The rich lymphatic drainage around the cardia may account for the wide spread of such tumors. Most patients presented with an advanced disease, so earlier detection of carcinoma of the cardia is mandatory to improve the results of surgery. At operation, it is important to dissect all the involved lymph nodes from the mediastinum to the abdominal paraaortic nodes and to ensure a tumor-free esophageal margin.

Adenocarcinoma↗
PubMed1991

[Prognostic factors of "pm" gastric cancer].

Clinicopathological and DNA ploidy studies were carried out to evaluate the prognostic factors of gastric cancer invading to the layer of muscularis propria. Seven hundred and ninety four patients with gastric cancer underwent gastrectomy between 1980 and 1988. Of these 85 were found to be "pm" gastric cancer. The unfavorable prognostic factors were as follows: 1) location of the tumor in the upper third of the stomach, 2) deeper cancer invasion in the muscularis propria, 3) presence of lymphnode in which cancer cells involve more than half of its histological section and 4) DNA aneuploid cancer.

Aneuploidy↗
PubMed1990

Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer.

Survival rates after curative gastrectomy for advanced gastric cancer among 238 patients in whom the cancer was invading the serosa were compared with 283 patients without serosal invasion. Generalized Wilcoxon estimates for 5-year survival rate were 47.1 per cent for patients exhibiting serosal invasion and 75.9 per cent for patients without serosal invasion. The frequency of lymph node metastasis increased proportionately with the extent of serosal invasion: 18.4 per cent in cases of S0; 53.8 per cent in cases of S1; 80.0 per cent in cases of S2; and 91.4 per cent in cases of S3. The higher the aggregate total of S (serosal invasion) and n (lymph node metastasis) factors, the lower the 5-year survival rate. In addition, patients with serosal invasion had a propensity for peritoneal dissemination of cancer cells; the percentage of cases with intraperitoneal free cancer cells increased with the extent of serosal invasion. It is worth noting that when cancer infiltration proceeded to the deeper layers and was accompanied by nodal metastasis, cancerous invasion of the perinodal fatty tissue was frequently evident. Therefore, unfavourable prognosis after curative resection in gastric cancer patients with serosal invasion may be largely dependent on whether or not the cancer has invaded the peritoneal cavity and the perinodal fatty tissue.

Adult↗
PubMed1990

Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma.

We investigated whether or not the survival rate after curative gastrectomy was related to the total number of lymph nodal metastases and the frequency of the metastases (number of nodes with metastases among number of dissected nodes) in 433 patients with carcinoma of the stomach. Of these patients, 45.3 per cent had lymph nodal metastases, and of a total of 10,130 dissected lymph nodes, 13.0 per cent had metastases. The present findings suggest that both the number and frequency of lymph nodal metastases are closely related to other prognostic factors, such as depth of invasion, histologic type, gross findings, histologic staging and vascular invasion. The five year survival rate significantly decreased as the number and frequency of metastases increased. Thus, it appears the number and frequency of involved lymph nodes are parameters of prognostic significance.

Gastrectomy↗