Biomedical subjects

Yutaka Kimura

Publications and source records attributed to Yutaka Kimura.

At least 19 recordsLinked to original sources

PubMed2026

Real-world outcomes of ipilimumab plus nivolumab in esophageal squamous cell carcinoma: a multi-institutional large cohort study.

BACKGROUND: Combination immune checkpoint inhibition with ipilimumab plus nivolumab (NIVO + IPI) has shown promising efficacy in advanced esophageal squamous cell carcinoma (ESCC) in the CheckMate648 trial. However, real-world evidence regarding its safety, efficacy as first-line therapy, and host-related biomarkers relevant to immunotherapy remains limited. METHODS: This multicenter retrospective study evaluated a large cohort of 111 patients with unresectable advanced or recurrent ESCC who received first-line NIVO + IPI therapy. Treatment response, treatment-related adverse events, and prognostic factors were analyzed. RESULTS: The objective response and disease control rates in cases with target lesions were 44.0% and 70.7%, respectively. Treatment-related adverse events ≥ Grade 2 occurred in 58 (52.3%) patients, including one Grade 4 event (type 1 diabetes) and two Grade 5 events (biliary infection and myocarditis). The median overall survival (OS) and progression-free survival were 22 months (95% confidence interval [CI]: 13-not reached) and 5 months (95% CI 3-8), respectively. OS was significantly affected by lymph node metastasis in unresectable advanced disease and by liver metastasis in recurrent disease. Multivariate analysis of OS identified the C-reactive protein-to-albumin ratio (CAR), a marker of host immune-inflammatory status, as the only independent prognostic parameter (hazard ratio = 2.99, 95% CI 1.35-6.63, P = 0.0071). CONCLUSIONS: In this large real-world cohort, first-line NIVO + IPI therapy demonstrated meaningful clinical activity and an acceptable safety profile in advanced ESCC. Treatment outcomes varied according to metastatic patterns, suggesting an influence of organ-specific immune microenvironments, and CAR emerged as a simple and robust prognostic biomarker. These findings support the real-world applicability of dual immune checkpoint blockade and highlight the importance of host immune context in patient selection.

Humans↗

PubMed2006

Platelet-derived chemokine RANTES may be a sign of restenosis after percutaneous coronary intervention in patients with stable angina pectoris.

Inflammation plays a pathogenic role in the development of restenosis after percutaneous coronary intervention (PCI). We measured and compared the ratio of elevated levels of regulated on activation normally T-cell expressed and secreted (RANTES), monocytic chemotactic peptide-1 (MCP-1), soluble (s) P-selectin and sL-selectin after PCI. Plasma levels of chemokines and soluble markers were measured before, 1, 3 and 7 days after PCI in 52 patients (43 males and nine females, aged 63 +/- 10 years) who underwent PCI and who had repeated angiograms at a 6-month follow-up. Restenosis occurred in 16 (31%) patients. A significant and time-dependent increase in sL-selectin was observed in the restenosis group. However, there were no significant differences in MCP-1 levels with or without restenosis. sP-selectin levels in the restenosis group exhibited a transient elevation at 3 days after PCI. RANTES levels were no different at baseline between patients with or without restenosis. However, a significant and time-dependent decrease in RANTES levels were observed in the non-restenosis group, and patients with restenosis compared with patients without restenosis had a statistically significant ratio of elevated levels of RANTES. These findings suggest that restenosis development after PCI in patients with effort angina pectoris may involve leukocyte activation at an early period after PCI. In addition, platelet-derived chemokine RANTES may be a sign of restenosis after PCI in patients with stable angina pectoris.

Aged↗

PubMed2006

[Prophylactic hepatic arterial infusion chemotherapy after curative surgery of colorectal liver metastases--the viewpoint from patients' quality of life].

In order to establish a reasonable prophylactic hepatic arterial infusion (HAI) chemotherapy following curative resection of colorectal liver metastases, the authors performed a randomized control study comparing two regimen. A weekly 5 hour-administration of 5-FU (1500 mg) which was repeated for 8 weeks showed a comparable effect to a continuous infusion group with an identical total dosage of 5-FU. Furthermore, adverse events were observed in only several patients of each group with low grade severity, suggesting that this simple regimen with a weekly HAI is promising. We also analyzed the clinical course of patients receiving HAI using a W spiral catheter which has a shape memory alloy in its tip. The catheter was implanted angiographycally without coil fixation to the vascular wall, which allowed us to remove the catheter after cessation of the scheduled chemotherapy. In all of the patients, the catheters were easily removed without any complications. A 3D-CT angiograph revealed that the hepatic arteries were well patent in all of the patients with a 3.3 Fr type catheter. HAI chemotherapy is basically an invasive treatment. In consideration of its efficacies as well as limitations, a reasonable approach is needed from the viewpoint of patients' quality of life.

Angiography↗

PubMed2006

[A case of successfully treated unresectable multiple liver metastases from colon cancer by hepatic arterial infusion chemotherapy and systemic chemotherapy].

Sigmoidectomy was performed for a 69-year-old man with sigmoid colon cancer and unresectable multiple liver metastases. The histological diagnosis was undifferentiated carcinoma of sigmoid colon. Hepatic arterial infusion chemotherapy with 5 FU and systemic chemotherapy with CPT-11 were performed after the operation. A complete response (CR) was achieved for liver metastases. The recurrent sign was not found at 23 months after the operation. This combination therapy is expected to be an alternative treatment of colorectal cancer with unresectable multiple liver metastases.

Aged↗

PubMed2005

Bile acid promotes the proliferation of squamous cell carcinoma of the esophagus, independent of its inducing COX-2 expression.

BACKGROUND: We have reported G1 progression and cyclooxygenase-2 (COX-2) induction during carcinogenesis of the squamous epithelium of the esophagus. As bile acid induces COX-2 expression and promotes carcinogenesis in the digestive tract, we investigated the effect of bile acid on the proliferation of squamous cell carcinoma of the esophagus (ESCC). MATERIALS AND METHODS: MTT assay, Western blot analysis of COX-2 and cell cycle-related molecules in the G1 phase (Rb, CDC25A, cyclin D1), and CDK2 kinase assay were performed on chenodeoxycholic acid (CDCA) exposure to ESCC cell lines (TE2R, TE3, TE13, TE15). RESULTS: In the presence of gradient bile acid concentration (up to 100 microm), growth of ESCC cell lines was stimulated at a low concentration (maximally at 20-30 microm), but suppressed at a higher concentration. Only a low dose of bile acid induced the expression of cyclin D1 and CDC25A and showed high Rb phosphorylation and high CDK2 kinase activity. In contrast, bile acid progressively induced COX-2 expression in a dose-dependent manner, regardless of its biphasic effects on cell proliferation, and a COX-2 specific inhibitor (JTE-522) did not suppress growth stimulation by a low dose of bile acid. CONCLUSIONS: Bile acid at a low dose stimulates the proliferation of ESCC by inducing G1-regulating molecules. However, COX-2 expression, which is also induced by bile acid, does not affect cell proliferation. Further work is needed to elucidate its role in carcinogenesis.

Bile Acids and Salts↗

PubMed2005

Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach.

We report two cases of large gastrointestinal stromal tumor (GIST) of the stomach that were successfully treated by hand-assisted laparoscopic surgery (HALS). Two patients, a 56-year-old woman and a 60-year-old man, were admitted to our department for the treatment of a large submucosal tumor of the stomach. After gastrointestinal endoscopy, ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses, measuring 7.0 cm and 8.0 cm in diameter, respectively, were GISTs in the stomach. However, preoperatively, we could not rule out the possibility of malignant neoplasms, because they had been bleeding or gradually growing. Hand-assisted laparoscopic wedge resection was safely performed for the diagnosis and treatment of the submucosal tumor of the stomach. The immunohistochemical diagnosis in both patients was GIST of the stomach with intermediate-grade malignancy. HALS may be a good indication for large GISTs of the stomach that are difficult to diagnose preoperatively, whether they are malignant or benign, because it is safe and minimally invasive, promoting rapid recovery.

Female↗

PubMed2005

[Primary leiomyoma of the liver: a case report].

A 61-year-old woman was referred to our hospital due to a liver tumor discovered at a medical checkup. A hypervascular tumor located in liver segment I, measuring 45 mm in diameter, was visualized on ultrasonography. The tumor showed strong uniform enhancement from an early phase on computed tomography and angiography. Right hepatectomy with total caudate lobe resection was performed. Pathological examination revealed the tumor to be a primary leiomyoma of the liver, positive for smooth muscle actin and desmin on immunohistochemical examination. Primary liver leiomyoma is very rare and only 18 cases have been reported to date. The clinical features of these cases from the literature are also discussed.

Female↗

PubMed2005

[Hepatic arterial infusion chemotherapy using W-spiral (WS) catheter].

The authors investigated the usefulness of W-Spiral (WS) catheters for hepatic arterial infusion (HAI) chemotherapy especially from the viewpoint of a removable catheter after cessation of chemotherapy. A WS catheter was successfully inserted into the hepatic artery without a coil fixation in 40 out of 47 patients with hepatic malignant disease. A stable position of the catheter tip was maintained throughout the period in all cases. In 20 patients, the catheter was easily and uneventfully removed after chemotherapy, which resulted in improved patients' quality of life. An electron microscope examination revealed that there was no fibrin network formation on the surface of the catheter. Stenosis of the hepatic artery was confirmed in 7 out of 12 patients with 5 Fr catheter by 3DCT angiography, whereas patency of the artery was well preserved in 7 of 8 cases with 3.3 Fr catheter. This catheter has a special shape-memory alloy in its tip, which allows a preferable fixation without coils and removal of the catheter if desired. HAI using this catheter and subsequent removal of it is a reasonable strategy especially for patients who need limited courses of chemotherapy.

Adult↗

PubMed2004

Adjuvant hepatic arterial infusion after curative resection of colorectal liver metastases using removable intra-arterial catheters with shape-memory alloy.

BACKGROUND AND OBJECTIVES: Although there are some reports that adjuvant hepatic arterial infusion (HAI) chemotherapy reduces the hepatic recurrence following curative resection of colorectal liver metastases, problems of indwelling catheters after chemotherapy cessation remains unsolved. The usefulness of adjuvant HAI was investigated using a removable port-catheter system. METHODS: Spiral catheterstrade mark were attempted to be placed in 17 patients who underwent curative hepatectomy. The catheter contains a special shape-memory alloy at its tip, which allows stable fixation to the vascular wall without coiling so the catheter can be removed if necessary. 5-fluorouracil (5-FU) in total dose of 12 g was intra-arterially administered. RESULTS: W spiral catheterstrade mark were successfully placed in the hepatic artery by percutaneous approach in 82% of the patients. All patients underwent scheduled chemotherapy without serious adverse events. Reservoir-catheter system was removed easily and uneventfully after discontinuation of the chemotherapy. 3D-CT angiography revealed that the hepatic artery was well preserved with short-term chemotherapy. Postoperative hepatic recurrence was observed only in 18% of the patients with the median follow-up time of 19.9 months. CONCLUSIONS: Prophylactic 5-FU HAI using W spiral cathetertrade mark and subsequent catheter extirpation is a promising strategy following curative resection of colorectal liver metastases.

Adult↗

PubMed2004

Hand-assisted laparoscopic splenectomy for splenic tumors.

BACKGROUND: The feasibility of hand-assisted laparoscopic splenectomy (HALS) for splenic tumors including benign or malignant neoplasms and the associated clinical outcome of the patients remain unclear. METHODS: A total of 10 patients with splenic tumors undergoing HALS were retrospectively analyzed in this study. The intraoperative course, postoperative course, and postoperative recovery were evaluated. RESULTS: Ten patients with splenic tumors consisted of 5 with benign tumors and 5 with malignant tumors. HALS was not converted to an open splenectomy in any of the patients. Mean operative time was 170 min (range 100-310 min). Mean estimated blood loss was 105 g (range 10-900 g). Mean splenic size and splenic weight was 13 cm and 478 g, respectively. Splenomegaly based on size or weight occurred in 50% of the patients. There were no intra- or postoperative complications. Postoperative chemotherapy was given to 4 patients with malignant tumors including metastatic carcinomas and malignant lymphomas. All the patients were alive at a mean follow-up of 26 months, ranging from 15 to 43 months after surgery. There was no port-site recurrence after surgery in our study. Mean time to first flatus, mean time to first walking, mean time to resumption of oral intake, mean length of hospital stay, and mean duration of epidural analgesia were 1.8, 1, 1.5, 10.8 and 3.1 days, respectively. The results were equal in terms of intra- and postoperative course to those seen with a standard laparoscopic splenectomy for 13 patients with idiopathic thrombocytopenic purpura. CONCLUSION: HALS may be a good indication for malignant tumors as well as benign tumors of the spleen.

Blood Loss, Surgical↗

PubMed2004

Double congenital bronchoesophageal fistulae in an adult.

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.

Bronchial Fistula↗

PubMed2004

Hepatic arterial infusion of paclitaxel for liver metastasis from gastric cancer.

Little is known about hepatic arterial infusion (HAI) of paclitaxel for hepatic malignancies. The authors administered paclitaxel via the HAI port in two patients with liver metastases from gastric cancer. Both patients were uneventfully treated without any serious complications, and its anti-tumor effect on 5-fluouracil resistant liver metastases was confirmed. However, the kinetics of venous paclitaxel concentration following HAI was similar to that after intravenous injection. Our findings did not support the advantage of paclitaxel HAI therapy, although HAI of this agent was well tolerated.

Adult↗

PubMed2004

Delayed development of foreign body granuloma from an implanted permanent cardiac pacemaker.

We report a case of a late-developing cutaneous mass on the chest wall that proved to be non-specific mixed cell granuloma adjacent to the lead-electrode parts of a permanent cardiac-pacemaker that had been implanted in the left chest of an 81-year-old man 6 years previously. The lesion was treated by cardiac surgeons, whose management consisted of cutting only the intradermal part of the lead-electrodes followed by tissue curettage, leaving the other portion embedded in the subendocardium because its removal could cause serious complications. Dermatologists should be alert to such late complications of embedded permanent pacemakers. Their removal requires close cooperation with cardiac surgeons to avoid unexpected complications.

Aged↗

PubMed2004

CCR4 Expression by atypical T cells in systemic pilotropic lymphoma: its behavior under treatment with interferon gamma, topical PUVA and systemic retinoid.

We describe an 88-year-old Japanese patient with pilotropic T cell lymphoma involving the peripheral blood as well as lymph nodes. This patient presented with multiple red follicular papules, confluent, infiltrated erythematous plaques and nodules. Moreover, he was conspicuous for the presence of total alopecia of the scalp and eyebrows. Histopathologically, the lesional skin showed dense follicular and perifollicular infiltrates of atypical lymphocytes. The flow cytometry disclosed the presence of weakly CD4+ CCR4+ cell populations that would not be detected in the peripheral blood from healthy controls. The patient responded well to topical PUVA and systemic etretinate (retinoid-PUVA) and intravenous IFN-gamma. Parallel with the decrease in atypical cells in the peripheral blood, the percentage of weakly CD4+ CCR4+ T cells declined. However, about 1 week after we discontinued this treatment because of the side effects, the lymph node swelling became prominent, and, 4 weeks later, the patient died before restarting any specific chemotherapy.

Aged↗

PubMed2004

Increased level of oxidized LDL-dependent monocyte-derived microparticles in acute coronary syndrome.

We measured and compared the levels of plasma soluble (s) P-selectin, sCD40L, platelet-derived microparticles (PDMP), monocyte-derived microparticles (MDMP), and anti-oxidized LDL antibody, to obtain a better understanding of their potential contribution to vascular complications in acute coronary syndrome (ACS). The concentrations of sP-selectin, sCD40L, PDMP, and MDMP in ACS patients were significantly higher than those in normal controls and patients with stable angina. When levels of these markers were compared with differences in concentration of anti-oxidized LDL antibody, all markers were significantly higher in ACS patients with a high level of anti-oxidized LDL antibody. Next, a monocytic cell line (THP-1) was incubated with high shear stress-induced platelet aggregates and PDMP. After incubation,THP-1 cells generated tissue factor-expressing MDMPs. This finding was particularly significant in the presence of oxidized LDL. These findings suggest that elevated levels of MDMPs may be a sign of atherosclerotic development in ACS patients, particularly those who exhibit anti-oxidized LDL antibodies.

Acute Disease↗

PubMed2004

Haemoglobin level influences plasma brain natriuretic peptide concentration.

OBJECTIVE: It has been demonstrated that the haemoglobin (Hb) level is associated with the prognosis of congestive heart failure (CHF). Correction of anaemia has improved CHF outcomes even in patients without anaemia. Lower Hb level may play a more important role in left ventricular (LV) dysfunction than previously recognized. This study aimed to evaluate the association of Hb level with plasma brain natriuretic peptide (BNP) level as a marker of LV function adjusted for known determinants of BNP. METHODS AND RESULTS: Association of Hb level with plasma BNP level was studied in 279 outpatients of cardiology (mean age 61 +/- 16, 54% men) using multivariate regression analysis. Mean Hb level was 13.7 +/- 1.5 g/dl and 14% of patients had anaemia. Median BNP level was 28 pg/ml (range < 4 to 580 pg/ml). In total subjects, the multivariate model adjusted for age, sex, history of CHF, atrial fibrillation, serum creatinine level, LV wall motion abnormality, end-diastolic LV dimension, LV mass index, and cardiovascular risk factors showed that a lower Hb level was significantly associated with higher BNP level (p = 0.0243). In "normal" subjects who did not have a history of CHF, atrial fibrillation, LV wall motion abnormality, LV dilatation, valvular abnormality, or LV hypertrophy, a lower Hb level was significantly associated with a higher BNP level (p = 0.0012) after adjustment for age, sex, serum creatinine level, and cardiovascular risk factors. CONCLUSIONS: Lower Hb levels are associated with higher plasma BNP levels independent of age, sex, serum creatinine level, LV wall motion abnormality, LV hypertrophy, history of CHF, atrial fibrillation, and cardiovascular risk factors.

Aged↗

PubMed2004

[Weekly administration of paclitaxel as a second-line chemotherapy for advanced and recurrent gastric cancer].

Chemotherapy with TS-1 has recently become the first-line chemotherapy for recurrent and unresectable gastric cancer in Japan. Therefore, the establishment of a second-line chemotherapy is needed for cases that show resistance and aberrant effect to TS-1. In this study, 7 patients were treated with weekly administrations of paclitaxel after TS-1 treatment. We assessed the therapeutic effect and feasibility of chemotherapy with weekly administration of paclitaxel. Our results showed that weekly administration of paclitaxel could be a promising regimen as a second-line chemotherapy after TS-1.

Aged↗

PubMed2004

[Two cases of recurrent lung cancer successfully treated with concurrent radiochemotherapy with vinorelbine plus cisplatin].

Case 1:A 62-year-old man, who had undergone right upper lobectomy for lung squamous cell carcinoma (pT2pN2M0, stage IIA) 4 months earlier, was diagnosed as mediastinal lymph node recurrence by chest CT. Case 2: A 63-year-old woman, who had undergone right middle-lower lobectomy for lung squamous cell carcinoma (pT2pN1M0, stage IIB) 16 months earlier, was diagnosed as hilar lymph node recurrence by chest CT. Both patients underwent radiochemotherapy with 2 cycles of cisplatin (CDDP) 80 mg/m2 on day 1 and vinorelbine (VNR) 15 mg/m2 on day 1 and another day (day 8-16), and concurrent radiation (60 Gy/30 fr) for mediastinum. After this treatment, a partial response (PR) in case 1 and a complete response (CR) in case 2 were achieved, and neither patient showed any relapse after 3 years of the treatment. Adverse reactions were grade 3 neutropenia in both patients and transient hemiparalysis in case 2. Concurrent radiochemotherapy with cisplatin and vinorelbine is considered effective without serious side effects for postoperative recurrence in localized mediastinal lymph nodes of non-small-cell lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗