Biomedical subjects

Yutaka Sanada

Publications and source records attributed to Yutaka Sanada.

10 recordsLinked to original sources

PubMed2006

Novel NF1 gene mutation in a Japanese patient with neurofibromatosis type 1 and a gastrointestinal stromal tumor.

Many mutations of the NF1 gene have been reported in patients with neurofibromatosis type 1 (NF1); however, there have been no documented NF1 gene mutations in Japanese NF1 patients. In the present study, we used the polymerase chain reaction (PCR) and DNA sequencing analysis to characterize the NF1 gene in a 53-year-old Japanese patient with NF1 who suffered from neurofibroma, pheochromocytoma, and gastrointestinal stromal tumor (GIST). Direct sequence analyses revealed a single base substitution in the splicing donor site of intron 6 (IVS6 888+1, G --> A) in one NF1 allele, resulting in an altered splice site (ss) in the mutated allele. Splicing at the cryptic 5' ss in the mutated allele generated mRNA with an insertion of 60 nucleotides. In addition, we screened for mutations in exons 9, 11, 13, and 17 of the c-kit gene in GIST and the succinate dehydrogenase subunit D (SDHD) gene in the pheochromocytoma, but we did not detect any somatic mutations. We report here the first case of an NF1 patient with four neoplasms: neurofibroma, pheochromocytoma, astrocytoma and GIST. Our results suggest that the molecular pathogenesis of GISTs in NF1 patients is different from that in non-NF1 patients.

Female↗

PubMed2006

[Case study--an elderly patient with Stage IV advanced gastric cancer achieved good performance status (PS) without subjective symptoms for more than two years by chemotherapy].

An 83-year-old male with Stage IV gastric cancer of performance status 1 (PS 1) was treated with fluoropyrimidine (TS-1) since January 2003 in our department. As the patient exhibited decreased renal function due to his age, we set the basic dose at 80% of the recommended dose of 80 mg/body/week. We administered 11 four-week cycles, each with a two-week drug-free washout period, and six two-week cycles, each with a two-week drug free washout period. The first cycle of chemotherapy ameliorated the subjective symptoms; the level of a tumor marker then returned to normal, and the ascites disappeared. The patient's condition was maintained at a favorable PS level without any subjective symptoms for approximately 20 months. In late September 2004, however, an exacerbation of the primary foci was confirmed by routine endoscopic examination. As second-line chemotherapy, we initiated weekly administration of paclitaxel (PTX). Due to the patient's age and high PS level (PS 2) at the time of intervention, we utilized a reduced dose of 70 mg/body/dose. After a short premedication period, the patient was administered PTX intravenously for one hour once a week for three weeks, then given a one-week drug-free washout period (one cycle). After the first cycle of PTX administration, all subjective symptoms disappeared, the PS level returned to zero,and the patient was discharged. In total, four cycles of the PTX regimen were given. Throughout the treatment period, we did not observe any significant adverse events (grade 2 or higher). Treatment achieved a favorable PS level. To design an effective chemotherapy regimen for elderly patients, it is important to establish an effective dose and dosing method based on the patient's chronologic age and a thorough evaluation of the patient's systemic conditions, including the PS level.

Adenocarcinoma, Mucinous↗

PubMed2006

[Thymidylate synthase and dihydropyrimidine dehydrogenase expression and histological effects of preoperative UFT in gastric cancer patients].

UNLABELLED: During DNA synthesis in tumors, fluoropyrimidine anticancer agents target thymidylate synthase (TS) that catalyze the synthesis of dTMP from dUMP and are metabolized by dihydropyrimidine dehydrogenase (DPD). We administered UFT to patients with gastric cancer preoperatively to prevent cancers from advancing while they await surgery or down staging. PATIENTS AND METHODS: We administered UFT to 24 gastric cancer patients at 360 mg/m(2)/day for longer than 3 weeks as a preoperative chemotherapy. TS and DPD expression in the tumor were measured by immunohistochemistry staining before and after (during surgery) chemotherapy and compared with the results of histological assessment. RESULTS: TS and DPD expression decreased significantly after UFT administration (p<0.05). Histological assessment showed Grade 1 b or 2 in 11 of 24 patients (46%). Eight of 15 patients with high DPD (53.3%) exhibited Grade 1 b or 2. CONCLUSIONS: Histological assessment revealed the efficacy of UFT, through a DPD-inhibitory fluoropyrimidine (DIF) effect, in patients with high DPD. This suggests that preoperative administration of UFT can be a useful clinical measure.

Aged↗

PubMed2003

A technique using a rectus abdominis muscle flap in the treatment of adult congenital tracheoesophageal fistulas.

The authors successfully treated an adult with congenital tracheoesophageal fistula (TEF) Gross-C type by the addition of an effective pedicled muscle flap. This patient had undergone 2 thoracotomies when he was an infant at another hospital; however, the fistula recurred. After transection and closure of the fistula, a right rectus abdominis muscle flap between the 2 stumps was interposed. The current case followed a favorable postoperative course; neither fistula nor abdominal hernia occurred.

Adult↗

PubMed2003

[Complete remission of esophageal undifferentiated carcinoma with nedaplatin and 5-FU chemotherapy and endoesophageal brachytherapy].

The patient was a 74-year-old female. Type 1 undifferentiated carcinoma (non-small cell type) was detected in the middle of the thoracic esophagus in August 1999. Although the lesion was diagnosed as T2, N0, and Stage II, the patient was judged to be a poor risk, inoperable case because of a complex past history of renal and respiratory dysfunctions, and dysbasia. Intravenous administration of nedaplatin at 15.8 mg/m2 and 5-FU 590.6 mg/m2 were carried out for 5 consecutive days as chemotherapy. The second cycle of chemotherapy was performed with nedaplatin reduced to 11.8 mg/m2 on the basis of the adverse reactions observed after the first cycle, and PR was attained. As for radiotherapy, additional extracorporeal irradiation was judged to be too dangerous from her history, so endoesophageal brachytherapy alone was added, and CR was obtained. The patient has maintained a CR for more than 2 years after discharge. In this poor risk case with a highly malignant undifferentiated carcinoma, an "individualization strategy" was effective.

Aged↗

PubMed2002

Hepatocellular carcinoma in a patient with acromegaly and high serum levels of insulin-like growth factor I: report of a case.

A 64-year-old woman with high serum levels of growth hormone, insulin-like growth factor-I (IGF-I), and alpha-fetoprotein resulting from partially treated acromegaly was found to have a tumor under the left diaphragm. The patient also had a history of type C viral hepatitis. Laparotomy revealed that the tumor was fixed to the diaphragm and connected to the liver and spleen. The tumor was excised with partial resection of the diaphragm, liver, and spleen, and a diagnosis of left-sided pedunculated hepatocellular carcinoma (HCC) was made. Further examination showed a higher level of IGF-I receptor mRNA in the tumor than in the normal liver parenchyma. We believe it is likely that the high serum levels of IGF-I may have played a role in the development of the pedunculated HCC in this patient.

Acromegaly↗

PubMed2002

[Assessing liver function by magnetic resonance imaging two-dimensional phase-shift flow measurement of portal venous blood flow after oral intake of glucose].

We have already reported that the ratio of portal venous flow 30 min after oral intake of glucose 75 g to that before intake (PVFR30), measured using pulsed-Doppler ultrasonography (US), correlated significantly with other indicators of liver function and that it could be used to estimate hepatic function before surgery, including liver resection. In this study, to assess the disadvantages of pulsed-Doppler ultrasonography, PVFR30 was measured using two-dimensional (2D) phase-shift (PS) magnetic resonance imaging (MRI). PVFR30 was measured in 17 patients and 7 volunteers: 13 with liver cirrhosis (LC) and 11 without LC (non-LC). Portal venous flow could be measured in all patients without any disturbance of intestinal gas or patient fat, or the high degree of technical skill that Doppler US requires. PVFR30 was significantly lower in the LC group than in the non-LC group. In addition, it correlated significantly with other indicators of liver function, including the indocyanine green clearance test, prothrombin time, hepaplastin test, and cholinesterase activity. These results suggest that PVFR30 measured by 2D PS MRI can be used to estimate liver function, and that this MRI method can be performed more easily than pulsed-Doppler US.

Administration, Oral↗

PubMedDate not supplied

Prediction of pancreatic fistula by amylase levels of drainage fluid on the first day after pancreatectomy.

BACKGROUND/AIMS: We investigated whether it would be useful to monitor amylase levels of drainage fluid after pancreatic surgery for prediction of pancreatic fistula. METHODOLOGY: Twenty-six cases in which amylase levels of drainage fluid were determined after pancreatic surgery, were divided into 14 cases who did not develop pancreatic fistula and 12 cases who developed pancreatic fistula. Changes in amylase levels of sera and urine as well as drainage fluid were monitored. RESULTS: Amylase levels of drainage fluid were significantly higher in cases with pancreatic fistula than in cases without pancreatic fistula on the first postoperative day, but those levels in both groups decreased until the 7th postoperative day without significant difference. However, those levels in cases with pancreatic fistula significantly increased from the 9th postoperative day whereas the levels in cases without pancreatic fistula further decreased. There was no significant difference in amylase levels of sera or urine. CONCLUSIONS: Amylase levels of drainage fluid on the first postoperative day may be useful to predict development of pancreatic fistula and to plan appropriate management.

Aged↗

PubMedDate not supplied

Tumor thrombus in the splenic vein originated from gastric carcinoma that produced alpha-fetoprotein.

A 72-year-old man was referred with an endoscopic diagnosis of Borrmann 2 type advanced gastric cancer. Further examination revealed tumor thrombus in the splenic vein and high serum level of alpha-fetoprotein without liver disease. Intraoperative ultrasonography revealed that tumor thrombus originated from gastric cancer extended to the splenic vein through the left gastric vein. Total gastrectomy combined with distal pancreatectomy and splenectomy was done to obtain complete resection of cancer and tumor thrombus. Tumor and its thrombus in the splenic vein were diagnosed as a poorly differentiated adenocarcinoma that produced alpha-fetoprotein. We report the case, and discuss about the gastric cancer with portal tumor thrombus and high serum levels of alpha-fetoprotein.

Adenocarcinoma↗

PubMedDate not supplied

Is fenestration a safe treatment for adult polycystic liver disease?: A report of refractory complications.

We report a 67-year-old man with highly symptomatic polycystic liver disease. Fenestration was selected to treat symptoms because the cysts were scattered diffusely and the normal liver volume was limited. Although this patient was relieved from symptoms of liver cysts consequently, several severe postoperative complications including disseminated intravascular coagulation, respiratory failure, liver failure, and biliary leakage occurred resulting in a 6-month postoperative hospital stay. Although various treatments for symptomatic adult polycystic liver disease have been advocated, a definitive treatment remains controversial, especially in diffuse adult polycystic liver disease. Fenestration is one of the alternative treatments for the patients whose cysts are difficult to resect. However high morbidity rate should be carefully assessed, if extensive fenestration is needed to treat diffuse adult polycystic liver disease. Further consideration of appropriate treatments for diffuse adult polycystic liver disease is needed.

Aged↗