Biomedical subjects

Toshio Imada

Publications and source records attributed to Toshio Imada.

49 records · Page 3Linked to original sources

PubMedDate not supplied

Extended abdominoperineal resection with partial prostatectomy for T3 rectal cancer.

BACKGROUND/AIMS: To describe and discuss extended abdominoperineal resection with partial prostatectomy using the ultrasonic harmonic scalpel as an alternative to total pelvic exenteration in lower rectal T3 cancer contiguous with the prostate. METHODOLOGY: Extended abdominoperineal resection with partial prostatectomy was performed in 4 patients with lower rectal clinical stage T3 cancer contiguous with the prostate using the ultrasonic harmonic scalpel. The ultrasonic harmonic scalpel permitted en bloc dissection of the rectum and the posterior part of the prostate, removing all tumor and disruption of the normal urinary stream. RESULTS: Blood loss ranged from 600 to 2500 mL. The final pathologic stage was T2 in 1, T3 in 2 and T4 in 1 patient, and the surgical margins were clear in all patients. Urethral injury occurred in 1 patient, and 2 patients had postoperative urinary dysfunction. No patients required a urinary stoma or suffered recurrence. CONCLUSIONS: Extended abdominoperineal resection with partial prostatectomy using the ultrasonic harmonic scalpel is an attractive alternative to total pelvic exenteration for patients with lower rectal T3 cancer contiguous with the prostate.

Aged↗

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Clinical usefulness of intraoperative sentinel-node biopsy in gastric cancer.

BACKGROUND/AIMS: Minimally invasive surgery has been used to improve the quality of life after operation in patients with gastric cancer. Sentinel-lymphnode biopsy can help to limit the extent of lymph node dissection, but the diagnostic and therapeutic usefulness of this technique has not been accurately evaluated in gastric cancer. This study was designed to clarify the role of intraoperative sentinel-node biopsy in patients with gastric cancer. METHODOLOGY: We were conducted to evaluate 1) mapping sentinel nodes according to tumor location 2) comparison sentinel node metastases as assessed by frozen section, permanent section (HE stain) and immunohistochemical diagnoses, and 3) comparison non-sentinel node metastases as assessed by permanent section (HE stain) and immunohistochemical diagnosis. RESULTS: All sentinel nodes were identified in the regional perigastric lymph node group close to the tumor. Four of the 43 sentinel lymph nodes were positive for metastasis. Similar diagnostic results were obtained by the 3 different procedures. Lymph node metastasis was found in 10 (4 sentinel nodes and 6 non-sentinel nodes) of 779 lymph nodes (1.28%) on HE staining. Immunohistochemical studies revealed a similar number of positive sentinel nodes as that obtained on HE staining, but identified metastases in 15 in non-sentinel nodes in 2 patients, as compared with only 6 nodes on HE staining. In one patient, sentinel nodes at No. 1 and No. 3 were negative for metastasis, whereas non-sentinel lymph nodes at NO. 3 were positive for metastasis. The other patient had negative sentinel nodes at No. 3 and No. 4d, but positive non-sentinel nodes at No. 4d. CONCLUSIONS: The results of this small study do not yet provide a firm basis for recommending that sentinel-node biopsy is used to reduce the extent of lymph node dissection.

Frozen Sections↗

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Platelet-derived endothelial cell growth factor (PD-ECGF) is up-regulated in human hepatocellular carcinoma (HCC) and the corresponding hepatitis liver.

BACKGROUND/AIMS: Platelet-derived endothelial cell growth factor (PD-ECGF) is one of the angiogenic factors. The aim of this study was to examine the PD-ECGF concentrations in hepatocellular carcinoma, background liver, and normal liver tissues, and to elucidate their significance on clinicopathological outcomes. METHODOLOGY: The concentration of PD-ECGF in the tissue extract was determined by enzyme-linked immunosorbent assay. RESULTS: PD-ECGF concentrations were significantly higher in hepatocellular carcinoma and background liver tissues compared with normal control liver (p = 0.003, p = 0.001, respectively). PD-ECGF concentrations in hepatocellular carcinoma tissues were positively correlated with intratumoral arteriole densities (r = 0.667, p = 0.009), and were higher in less differentiated carcinomas (p = 0.039). However, tumor PD-ECGF concentration did not affect the patients' disease-free survival rates. Those in the background liver tissues were positively correlated with histological activity index scores (r = 0.650, p = 0.001) and serum alanine aminotransferase levels (r = 0.0452, p = 0.035). CONCLUSIONS: PD-ECGF is up-regulated in hepatocellular carcinoma and the corresponding hepatitis liver. The PD-ECGF concentrations in hepatocellular carcinoma correlated positively with microvessel density, lower differentiation, yet not with patients' prognosis. The concentrations of PD-ECGF in the corresponding hepatitis liver correlated positively with the degree of active hepatitis.

Alanine Transaminase↗

PubMedDate not supplied

How to eradicate Helicobacter pylori using amoxicillin and omeprazole in the remnant stomach.

BACKGROUND/AIMS: We previously investigated the effects of amoxicillin/omeprazole combined therapy on patients who were Helicobacter pylori (H. pylori) positive after gastrectomy for the treatment of gastric cancer, and we determined the difference in amoxicillin dosage between the therapeutic successes and failures. In the present study, assuming that amoxicillin dosage should be determined on the basis of body weight of each patient, we examined whether the eradication of H. pylori would be improved by using this novel dose-selection method. METHODOLOGY: We have previously reported about eradication of H. pylori of remnant stomach as follows. Patients who underwent gastrectomy for the treatment of gastric cancer were enrolled if H. pylori was detected in their remnant stomach after the operation. Of these patients, 22 were treated with amoxicillin at 750 mg/day for 2 weeks and omeprazole at 20 mg/day for 8 weeks. For the evaluation of H. pylori eradication, endoscopic examination and 13C-urea breath test were performed 12 weeks after the initiation of the treatment. The amoxicillin dosage in the therapeutic successes was compared with that in the therapeutic failures, and we found that the dosage was 14.1 +/- 1.5 and 12.5 +/- 1.5 mg/kg/day in the successes and the failures, respectively. Following these results, another 10 H. pylori-positive patients were treated with amoxicillin greater than 16 mg/kg/day for 2 weeks and omeprazole at 20 mg/day for 8 weeks, and H. pylori eradication was evaluated as mentioned above. The efficacy of the drug therapy on H. pylori infection was compared between the two groups that one group (Group A) is treated with amoxicillin 750 mg/day for 2 weeks and omeprazole at 20 mg/day for 8 weeks and the other group (Group B) is treated with 1250 mg/day for 2 weeks and omeprazole at 20 mg/day for 8 weeks. RESULTS: The eradication rate of H. pylori in Group B (84.6%) was higher than that in Group A (42.1%). There was significant difference between the two groups (p = 0.028). CONCLUSIONS: We assumed that the optimal dosage of amoxicillin was over 15.6 mg/kg/day for omeprazole-amoxicillin combined therapy for gastrectomized patients who were H. pylori positive, and the favorable therapeutic effects could be obtained by applying this amoxicillin dosage to the eradication of H. pylori.

Amoxicillin↗

PubMedDate not supplied

A case of primary mesenteric embryonal carcinoma.

We describe a case of primary mesenteric embryonal carcinoma. The patient was a 73-year-old man who presented with a huge mass palpable at the right upper side of the abdomen. Laboratory evaluations showed very high alpha-fetoprotein and PIVKA-II levels, and an abdominal computed tomographic scan demonstrated a mass contiguous with the liver. These findings suggested hepatic cell carcinoma extending beyond the liver. However, angiography showed the mass to be supplied mainly by the middle colic artery and greater omentum artery, suggesting a mesenteric tumor. Gastroscopy demonstrated a IIc lesion in the anterior wall of the antrum. This lesion was histologically diagnosed to be moderately differentiated adenocarcinoma. The large tumor adjacent to the liver was diagnosed to be a primary mesenteric tumor or a metastatic mesenteric tumor from arising gastric cancer. At laparotomy, a huge tumor was found in the gastrocolic ligament. The tumor adhered to the distal part of stomach, the transverse colon, and the gallbladder. En-bloc resection of the tumor was performed, including the distal part of stomach, Part of the transverse colon, and the gall-bladder. The tumor mass measured 26.0 x 21.0 x 9.0 cm, weighted 2750 g, and showed central necrosis and hemorrhage. The histopathological diagnosis was a primary embryonal carcinoma originating in the mesentery. Primary mesenteric embryonal carcinoma is extremely rare. To our knowledge, no other cases have been reported. We describe this case and briefly discuss the related literature.

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Prognostic impact of tissue inhibitor of matrix metalloproteinase-1 in plasma of patients with colorectal cancer.

BACKGROUND: Tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in plasma has been reported to be related to disease progression in patients with colorectal cancer. However, the prognostic significance of plasma TIMP-1 has not been clarified. PATIENTS AND METHODS: Concentrations of TIMP-1 protein were measured by enzyme-linked immunosorbent assay in plasma samples of 87 preoperative patients who subsequently underwent resection, and prognosis was compared. The cut-off value of plasma TIMP-1 was defined as 170 ng/ml. RESULTS: When clinicopathological factors between patients with positive and those with negative plasma TIMP-1 were analyzed, significant differences were observed in lymph node metastasis, serosal invasion, curability and Dukes' classification. Univariate analysis of these factors demonstrated that depth of invasion, metastases to lymph nodes, peritoneum, liver and distant organ, lymphatic and vessel invasions, curability. Dukes' classification and plasma TIMP-1 concentration were significant. By multivariate analysis excluding patients with distant or peritoneal metastases, histological type, lymphatic invasions, lymph node metastasis and plasma TIMP-1 were retained in the final model. CONCLUSION: These results suggested that plasma TIMP-1 may be a useful prognostic marker for survival in patients with colorectal carcinoma.

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Lifting of the colon for laparoscopic-assisted colectomy for colon and rectal cancer.

BACKGROUND AND OBJECTIVES: Laparoscopic-assisted colectomy for colon and rectal cancer causes less surgical trauma than does open colectomy. However, current methods are more costly and require highly skilled staff. In addition, the technique for lymphadenectomy has yet to be standardized. We developed a technique that uses a nylon suture to elevate the colon. This method reduces costs without compromising the completeness of the resection. METHODS: Three trocars are introduced and a 1-0 nylon suture is passed into the abdominal cavity and through the mesocolon. The colon is retracted anteriorly and is fixed by this suture to the abdominal wall. The main mesenteric vessels are under tension, and lymph node dissection is performed easily. This method requires only 2 surgeons, an operator, and a scopist, because the colon is fixed to the abdominal wall. In addition, the working space is more stable because the colon is fixed to the abdominal wall. The procedure is relatively independent of the skill of the first assistant. RESULTS: From April 2000 to August 2002, this method was performed in 52 patients. The mean number of dissected lymph nodes was 16.9+/-9.0 (range, 6 to 41). Nine patients had lymph node metastases (17.3%). One patient developed hepatic recurrence; all patients are alive. No complication occurred that was related to lifting the colon. CONCLUSIONS: Using a suture to lift the colon is a useful method for performing laparoscopic-assisted colectomy with lymphadenectomy. This method reduces the number of surgical staff and the expense of the procedure.

Colectomy↗

PubMedDate not supplied

Successful pancreatoduodenectomy for carcinoma of the ampulla of vater after esophagectomy with remnant gastrectomy.

A 59-year-old man was admitted to our hospital because his serum hepatobiliary enzymes were elevated on the medical check-up in September 2003. In his past history, he had undergone distal gastrectomy for a gastric adenoma 17 years before. Furthermore, he had undergone subtotal esophagectomy with remnant gastrectomy, the right colon and ileum were used for the reconstruction, and a cervical esophago-ileostomy and an abdominal colo-duodenostomy were made in the fashion of an interposition. Duodenoscopy was performed and showed the protruded lesion of the ampulla of Vater, biopsied specimens from this tumor revealed adenocarcinomas. Accordingly, we performed pancreaticoduodenectomy with regional lymph nodes dissection. The problem in this case was that the rt middle colic artery (MCA), and the middle colic vein (MCV) tend to be injured because these vessels are situated near the caudal region of the pancreas. We were able to identify the superior mesenteric vein (SMV) safely due to approaching this vein from the flank and mobilizing the duodenum, dissecting behind the mesenteric trunk from right to left. Double cancer of the ampulla of Vater and the esophagus are extremely rare, with only 4 cases reported. And we recommended the use of the dorsal approach to the SMV to avoid injuring the MCV such as in this case.

Adenocarcinoma↗

PubMedDate not supplied

Phase II study of docetaxel plus cisplatin as a second-line combined therapy in patients with advanced gastric carcinoma.

BACKGROUND: We conducted a pilot phase II study to evaluate the efficacy and safety of docetaxel and cisplatin as a combination second-line therapy for advanced gastric cancer. PATIENTS AND METHODS: Between 2000 and 2003, 30 patients were enrolled into this study. Chemotherapy consisted of 60 mg/m2 of docetaxel followed by 60 mg/m2 of cisplatin. This regimen was repeated at least three times at 3-week intervals. RESULTS: The overall response rate was 26.7%. The median time to disease progression was 4.5 months. The median survival time was 13 months from the start of the first-line therapy and 6 months from the second-line therapy. With respect to toxicity, the major adverse effect was leukopenia, which reached grades 3-4 in 26.7%. Non-hematological toxicities were usually moderate, and no deaths were attributable to the adverse effects of the drugs. CONCLUSION: This combination therapy was effective as a second-line treatment for advanced gastric cancer with acceptable toxic side-effects.

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Telomerase activity in esophageal squamous cell carcinoma and lesions unstained with Lugol's solution.

BACKGROUND/AIMS: Telomerase is a ribonucleoprotein enzyme that protects erosion of telomeres at the ends of chromosomes and its activity has been detected in immortalized cells and most human cancers. METHODOLOGY: We analyzed telomerase activity in primary esophageal squamous cell carcinomas (SCCs) without any preoperative treatment and lesions unstained with Lugol's solution, using a telomeric repeat amplification protocol (a TRAP) assay. RESULTS: Strong telomerase activities were detected in all resected specimens of esophageal SCCs, and in 33 of 40 endoscopic biopsy specimens of lesions unstained with Lugol's solution. Among lesions unstained with Lugol's solution, 19 of 19 esophageal SCCs, and 13 of 13 dysplasias, which are considered as clinically precancerous lesions had strong telomerase activities. CONCLUSIONS: These results indicate that reactivation of telomerase may occur at an early stage in the carcinogenesis of esophageal SCCs, and telomerase activity may be a practically useful molecular biological marker for supporting the diagnosis of early esophageal SCCs.

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A phase I study of bi-weekly combination therapy with S-1 and docetaxel for advanced or recurrent gastric cancer.

BACKGROUND: S-1 is a novel oral fluorouracil antitumor drug that contains a combination of 3 pharmacological agents: tegafur (FT), a 5-fluorouracil (5-FU) prodrug, 5-chloro-2,4-dihydroxypyridine (CDHP), which inhibits the activity of dihydropyrimidine dehydrogenase (DPD), and potassium oxonate (Oxo), which reduces the gastrointestinal toxicity of 5-FU. S-1 and docetaxel have both been identified as effective agents for the treatment of gastric cancer. However, little is known about the effects and/or adverse effects of a combination of these drugs in the treatment of gastric cancer. The aim of this phase I study was to determine the maximum-tolerated dose (MTD) and the recommended dose of docetaxel with a fixed dose of S-1 in patients with advanced or recurrent gastric cancer. PATIENTS AND METHODS: Patients with metastatic, recurrent, or unresectable gastric cancer received docetaxel at a starting dose of 25 mg/m2 by i.v. infusion over 1 h on days 1, 15 and 29, and S-1 at the full dose of 80 mg/m2 daily for 4 weeks of every 6 weeks. Nine patients were treated with increasing dosages of docetaxel as follows: (docetaxel/S-1, mg/m2): 25/80 (level 1), 30/80 (level 2) and 35/80 (level 3). All cases were assessable for drug safety and 7 were assessable for response. Colony-stimulating factor (CSF) was not used in this study. The adverse effects of treatment were analyzed according to NCI-CTC, version 2 and the response was assessed according to the Japanese Classification of Gastric Cancer, 13th Ed. RESULTS: The MTD was reached at the 35/80 mg/m2 dose-level in 3 out of 3 patients. These patients experienced some dose-limiting toxicity (DLT) or grade 3 anemia. The reported DLTs included diarrhea, stomatitis and general fatigue. Due to these results, 3 additional patients were not enrolled at this dose-level. No hematological or non-hematological adverse effects (more severe than grade 2) were observed in any of the level 1 or 2 patients. However, among the level 1 patients, 66.7% developed grade 2 leukocytopenia and 33.3% developed grade 2 neutropenia. Among the level 2 patients, 33.3% developed grade 2 appetite loss, diarrhea and general fatigue. Partial responses were achieved in 3 (42.9%) out of the 7 patients with evaluable lesions. These results indicated that the appropriate doses of the 2 drugs in combination therapy are 30 mg/m2 for docetaxel and 80 mg/m2 for S-1. CONCLUSION: The S-1/docetaxel drug combination showed a good safety profile, with diarrhea and general fatigue being common, but manageable, adverse reactions. Moreover, the responses observed in this study suggest that the drug combination shows a high degree of efficacy in patients with advanced and/or recurrent gastric cancer.

Adult↗

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Prognostic factors after chemoradiotherapy for patients with inoperable esophageal squamous cell carcinoma.

BACKGROUND/AIMS: It is important to clarify the predictive and prognostic factors for chemoradiotherapy (CRT) in patients with inoperable esophageal cancer. METHODOLOGY: Forty-one patients with inoperable advanced esophageal cancer were evaluated. The predictive factors for the response to CRT (low-dose 5-FU and Cisplatin (FP) therapy plus 60 Gy of radiation) and the prognostic factors after CRT were analyzed. RESULTS: Of the 41 patients, seven achieved complete remission, 21 achieved partial remission, nine showed no change and four showed progressive disease. The median survival time was 19 months in patients with a tumor response, compared to 7 months in patients with non-responsive tumors. Only the serum cytokeratin (CYFRA) level independently predicted the responsiveness to treatment. In the multivariate analysis, the serum CYFRA level and the p53 gene mutation independently influenced prognosis. CONCLUSIONS: The presence of a p53 mutation in the biopsy specimen or a high serum CYFRA level may be predictive of an adverse therapeutic outcome.

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Reduction therapy of alanine aminotransferase levels prevent HCC development in patients with HCV-associated cirrhosis.

BACKGROUND: To find a way to prevent the development of hepatocellular carcinoma (HCC) from hepatitis C virus-associated liver cirrhosis (HCV-LC), an analysis of the HCV-LC patients who had received reduction therapy of the alanine aminotransferase (ALT) levels was performed. PATIENTS AND METHODS: Seventy-four consecutive HCV-LC patients of Child Stage A were followed for >10 years for the development of HCC. They were divided into two groups: in group A, the reduction therapy for the ALT levels was aggressively performed, while in group B, the reduction therapy was not performed aggressively. The patients were subdivided into three sub-groups according to their serum ALT levels. In groups A and B, the high ALT group was comprised, respectively, of nine and five patients whose annual average serum ALT levels were persistently high (> or =80 IU), while the low ALT group was comprised of 19 and 20 patients whose annual average serum ALT levels were persistently low (<80 IU). The remaining eleven and ten patients had annual average serum ALT levels which fluctuated and were unclassified (unclassified group). RESULTS: In group B, 65.7% of the patients had developed HCC in 13 years, in contrast to only 41.0% of group A (p=0.039). In group A, the median HCC development time was 12.8 years, in contrast to only 3.8 years in group B (p=0.0013). Multivariate analysis demonstrated that the mode of reduction therapy and ALT levels were the significant factors affecting HCC development. CONCLUSION: The chances of surviving for more than ten years without developing HCC for HCV-LC patients

Alanine Transaminase↗