[Dihydropyrimidine dehydrogenase and thymidylate synthase activities in colonic cancer tissue and sensitivity to 5-fluorouracil].
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Antimetabolites, Antineoplastic↗
Biomedical subjects
H Isomoto
Publications and source records attributed to H Isomoto.
Surgical treatment of lower rectal cancer with sphincter preservation using handsewn coloanal anastomosis.
The present study was designed to evaluate the technical feasibility and oncologic results of performing handsewn coloanal anastomosis (CAA). A total of 46 patients treated for lower rectal cancer using CAA were retrospectively studied, and the oncologic results were compared with those of 105 patients treated with abdominoperineal resection (APR). CAA was performed in patients who had both good mobility of the tumor and a distal clearance margin of more than 1.0 cm. No significant difference was noted in the mortality rates following the two operations (CAA 2.2% vs APR 1.9%). Pelvic recurrence was detected in two patients (4.5%) after CAA and in six patients (7.2%) after APR. The 5-year survival rate after CAA was 79.2% and that after APR was 72.6%. No significant difference was noted in the incidence of pelvic recurrence or the survival rates between the two operations. These results show that CAA could be an excellent reconstructive option in the treatment of lower rectal carcinoma for selected patients.
Adenocarcinoma↗
Acinar cell carcinoma of the pancreas associated with hypoglycemia: involvement of "big" insulin-like growth factor-II.
Apart from insulinomas, pancreatic tumors are rarely complicated by hypoglycemia and some may produce insulin-like growth factor II (IGF-II). To our knowledge, IGF-II-producing pancreatic tumors associated with hypoglycemia have not been reported previously. We describe what we believe to be the first case of "big" IGF-II-producing pancreatic acinar cell carcinoma. A 68-year-old man presented with a history of recurrent hypoglycemia. Abdominal computed tomography scan and magnetic resonance imaging showed a mass, approximately 5 cm in diameter, in the tail of the pancreas and two low-density areas in the liver. Low serum glucose was associated with low insulin levels and high levels of hormones (i.e., glucagon and IGF-II) that are functionally opposite to insulin. Although serum IGF-II level was within the normal range, most IGF-II was of the high molecular weight form, as determined by Western immunoblot analysis. Based on these findings, a diagnosis of hypoglycemia induced by IGF-II-producing pancreatic tumor was made. Surgery was not possible because of the patient's poor general condition. The patient ultimately died as a result of malignant cachexia. At autopsy, a yellowish-white tumor was found in the tail of the pancreas, and a histopathologic diagnosis of acinar cell carcinoma was made. Immunohistologically, the tumor cells contained IGF-II in an irregular staining pattern, suggesting that the hypoglycemia was caused by a pancreatic tumor producing "big" IGF-II.
Aged↗
A new bipolar snare with a needle for endoscopic mucosal resection.
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Colonoscopes↗
Clinical aspects of total colectomy--laparoscopic versus open technique for familial adenomatous polyposis and ulcerative colitis.
Clinical aspects of laparoscopy combined total colectomy (LTC) (n = 10) and open total colectomy (OTC) (n = 29) with ileorectal anastomosis for familial adenomatous polyposis and ulcerative colitis are compared in a retrospective study. The mean operative time was 282 (range, 169 to 420) minutes in the LTC group and 274 (range, 139 to 570) minutes in the OTC group. The mean volume of operative blood loss was 321 (range, 52 to 728) ml and 471 (range, 48 to 1040) ml for the LTC and OTC groups, respectively. Nasogastoric tube could be removed after POD 1.2 vs. 5.8 (p < 0.05), the mean time to passage of stool was 1.9 (range, 1 to 3) vs. 5.2 (range, 3 to 7) days (p < 0.01), and in the LTC group watery stool was soon made solidification after POD 23.4 vs. 84.1 (p < 0.01). Laparoscopy combined total colectomy may prove to have one-stage restorative total colectomy without a temporary ileostomy due to early solidification of watery stool and more benefits than conventional open surgery.
Adenomatous Polyposis Coli↗
Functional outcome of double-stapled and transanal ileal pouch-anal anastomosis after proctocolectomy.
Improvement of functional outcome after proctocolectomy for ulcerative colitis and familial adenomatous polyposis was compared between transanal ileal pouch-anal anastomosis (T-IAA group, n = 29) and double-stapled ileal pouch-anal anastomosis (DS-IAA group, n = 8). Clinical functions were evaluated using a functional scoring system, and physiologic functions by anorectal manometry after one year postoperatively. Although in the T-IAA group 4 of the 29 patients (13.8%) displayed partial incontinence (< 9 points), all of 8 patients in the DS-IAA group showed good results referring to continence (> 10 points). The maximum resting pressure was 44.3 +/- 5.2 cmH2O in the T-IAA group vs. 56.6 +/- 5.8 cmH2O in the DS-IAA group, and postoperatively the maximum squeezing pressure was 96.8 +/- 9.2 cmH2O in the T-IAA group vs. 106.3 +/- 8.1 cmH2O in the DS-IAA group. There was a significant difference of maximum resting pressure and no significant difference of maximum squeezing pressure between the two groups. The length of the high pressure zone in the anal canal was significantly shorter in patients of the T-IAA group (2.1 +/- 0.8 cm) than in those of the DS-IAA group (3.5 +/- 1.1 cm) (p < 0.05). The DS-IAA is associated with excellent objective physiologic and subjective functional results. This reflects the sacrifice of the internal anal sphincter 1.5 cm cephalad necessary to effect this anastomosis at a mean of 1.4 cm from the dentate line.
Adolescent↗
Transsacral rectopexy for complete rectal prolapse.
A prospective study was carried out to analyze the clinical and functional results of transsacral rectopexy with a DEXON mesh in the elderly or poor risk patients with complete rectal prolapse. Six patients with complete rectal prolapse were operated from 1994 to 1996. All patients could be traced for examination with anorectal manometry and defecography. None of the patients had recurrence for the longest three years. In postoperative clinical symptoms, fecal incontinence score recovered from the preoperative mean score of 3.8 to the postoperative 1.2 and constipation was improved in 4 out of 5 cases (80.0%). Straining anorectal angle (S-ARA) by defecography improved from the preoperative value of 120.6 +/- 6.9 degrees to the postoperative value of 98.5 +/- 3.5 degrees (p < 0.05) and the perineal descent (PD) improved from the preoperative value of 16.2 +/- 2.5 cm to the postoperative value 8.1 +/- 1.3 cm (p < 0.05). Maximal resting pressure (MRP) increased from the preoperative value of 20.5 +/- 3.7 cmH2O to the postoperative value of 40.5 +/- 4.8 cmH2O (p < 0.05). Transsacral rectopexy with DEXON mesh for complete rectal prolapse is useful as this technique is simple to conduct, can be applied to the elderly or poor risk patients, replaces rectal prolapse, improves defecation troubles and recovers fecal incontinence.
Aged↗
Intraductal ultrasonography for treatment of Tis and T1 colorectal cancer.
The aim of the study was to determine the treatment for Tis and T1 colorectal cancer and the depth of cancer invasion which was examined preoperatively by intraductal ultrasonography (IDUS) using a 20 MHz high frequency thin sonoprobe. IDUS was performed on 62 patients with Tis and T1 colorectal cancer using 20 MHz radial images. The tumors imaged by IDUS were classified into 3 groups according to the degree of lesions in the 5 layers of the large intestinal wall: Tis showing no changes in the third layer, T1 with slight invasion in which the ruptured region in the third layer occupied less than 50% of the tumor diameter, and T1 with massive invasion in which the ruptured region in the third layer occupied more than 50% of the tumor diameter. The correct preoperative diagnosis of the depth of the lesions was obtained in 21 of the 23 patients with Tis (91.3%), in 18 of the 21 patients with T1 with slight invasion (85.7%), and in 8 of the 11 patients with T1 with massive invasion (72.7%). In conclusion, IDUS can be used for endoscopic examination of the large intestinal cancer to judge whether local treatment or not.
Colonoscopy↗
Endoscopic removal with clipping for colonic lipomas.
Endoscopic removal of colonic lipoma of 2 cm in size or more is not widely used because of the risk of complications which are a hemorrhage and a perforation associated with endoscopic resection. We report here safety endoscopic removal using a bipolar snare and clipping the mucosa of the defective region in three cases with large colonic lipoma. We consider that this technique enhanced the safety of the endoscopic procedure.
Aged↗
Histocompatibility leukocyte antigen-A2402-restricted cytotoxic T lymphocytes recognizing adenocarcinoma in tumor-infiltrating lymphocytes of patients with colon cancer.
To cast light on T cell-mediated specific immunity at the tumor site of colon cancer, we investigated whether interleukin-2 (IL-2)-activated tumor-infiltrating lymphocytes (TIL) from colon cancer show histocompatibility leukocyte antigen (HLA)-class I-restricted cytotoxicity against adenocarcinoma. IL 2-activated TIL from all four HLA-A24 patients examined lysed HLA-A2402+ adenocarcinomas, but not HLA-A2402- tumors. Those of two of the four cases also lysed HLA-A2402+ squamous cell carcinomas. CD8+ cytotoxic T lymphocyte (CTL) clones recognizing HLA-A2402+ adenocarcinomas were established from one CTL line. This CTL line produced IFN-gamma upon recognition of an HLA-A2402- adenocarcinoma transfected with HLA-A2402 cDNA. These results suggest the presence of HLA-A2402-restricted CTL recognizing adenocarcinoma at the tumor site of colon cancer. Furthermore, HLA-A31-restricted CTL activity was found in IL-2-activated TIL from one of two HLA-A31+ patients, suggesting the existence of HLA-class I-restricted CTL involving an allele other than A24.
Adenocarcinoma↗
[Successful eradication of H. pylori in an elderly patient with gastric cancer after effective UFT-E therapy].
The patient was a 83-year-old female with 2' T2-type gastric cancer associated with positive H. pylori in the lesser curvature of the stomach. The patient was treated with oral UFT-E alone in a daily dose of 400 mg. The tumor exhibited an O' IIa + IIc-like appearance 4 weeks after the start of administration and became scarred 8 weeks later, revealing marked tumor reduction in a short period of time. At 8 weeks, biopsy showed marked polymorphonuclear cells infiltration of gastric mucosa with no evidence of malignancy. In an attempt to eradicate H. pylori, 30 mg of lansoprazole, 400 mg of clarithromycin, and 2.0 g of ecabet-Na (3.0 g of Gastrom) were administered for 2 weeks. H. pylori was found to have been successfully eradicated, and the inflammatory lesions were no longer visible histologically. UFT-E was highly effective in this patient, and the eradication of H. pylori may contribute to the prevention of cancer recurrence.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Total pelvic exenteration for locally advanced colorectal carcinoma.
Twenty-six patients who underwent total pelvic exenteration for locally advanced colorectal cancer were studied retrospectively. The operative mortality rate was 8 per cent (two deaths). In patients with stage II primary disease the recurrence rate after curative surgery was three of seven, although the mean survival time was 58 months and the 5-year survival rate 71 per cent. Patients with stage III primary disease had a shorter mean survival time regardless of supposed curability (curative 14 months versus non-curative 9 months). Patients with stage IV disease had a mean survival time of 5 months. In patients who underwent curative surgery for recurrent disease the mean survival time was 33 months and 5-year survival rate 25 per cent, although in those receiving non-curative surgery the survival time was significantly shorter at 10 months (P < 0.05). Total pelvic exenteration is warranted for patients with stage II locally advanced colorectal carcinoma and is an option for those with recurrent carcinoma when performed with curvative intent.
Adenocarcinoma↗
Hepatic arterial chemotherapy for liver metastases from colorectal cancer.
We have investigated the complications, toxicities, tumor response and survival rate with hepatic arterial (HA) chemotherapy for liver metastases from colorectal cancer. Forty-three patients with measurable liver metastases and 10 patients after the resection of liver metastases were treated with HA bolus mitomycin C (MMC) or continuous fluorouracil (5-FU) infusion between 1986 and 1994. The catheter- or reservoir-related complications such as catheter induced infection, subcutaneous reservoir pocket infection, or catheter or hepatic artery occlusion occurred in 14 patients (26%) mainly in our early cases. Severe gastritis or a gastroduodenal ulcer developed in 12 patients (23%), in particular after treatment with continuous infusion of 5-FU and when the catheter was placed into the gastroduodenal artery during laparotomy. An ulcer often caused a serious complication such as a duodeno-biliary fistula, penetration into the hepatic artery or duodenal perforation. Also noted were upper gastrointestinal symptoms in 26 patients, hepatic toxicities in 3 patients, and bone marrow depression in 4 patients. Because of these complications and toxicities, HA therapy was discontinued in more than 60% of the cases. The overall tumor response rate was 17%. However, in the cases which were treated by 5-FU continuous infusion for longer than 3 months, the response rate was higher than 60%. There was no significant difference in survival rate between HA therapy and systemic palliative chemotherapy. These results suggest that it is important to prevent gastrointestinal toxicities in order to allow continuation of HA continuous 5-FU infusion therapy which could provide a higher response rate and a better survival for colorectal cancer patients with liver metastases.
Colorectal Neoplasms↗
[Optimal dosage of UFT + MMC combination chemotherapy for advanced colorectal cancer--phase I/II study of combination chemotherapy of MMC with 2-week intervals and intermittent UFT administration--Study Group of UFTM Therapy for Advanced Colorectal Cancer].
A combined phase I/II study (UFTM) of tegafururacil (UFT) and mitomycin C (MMC) was performed to find the optimal dosage for advanced colorectal cancer. The study consisted of two parts. The first part confirmed the safety of UFTM and determined the administered doses. The second part evaluated the clinical response of UFTM. Based on the first part, the dosage regimen in the second part was established as follows; the treatment course consisted of 4 weeks and a bolus dose of MMC 6 mg/m2 was given every 2 weeks with daily oral UFT 400 mg/m2 for 5 consecutive days followed by 2 drug-free days; MMC was not given in the third course, and the treatment cycle of the above-mentioned 3 courses was repeated thereafter. In the second part, 26 of 28 patients could be evaluated for toxicity. Grade 3 or 4 toxicities were: anorexia 2, nausea and vomiting 1, leukopenia 1, and 2 cases of thrombocytopenia. The clinical responses of UFTM showed 1 CR and 4 PR in the 21 patients who could be evaluated for response (23.8%). The response rate was 38.5% (5/13) in patients naive to chemotherapy. UFTM can be performed effectively at outpatient clinics as long-term chemotherapy.
Adolescent↗
[Study of hepatic arterial chemoinfusion with continuous CDDP, 5-FU low dose administration for advanced gallbladder cancer].
Eight unresectable cases of gallbladder cancer underwent hepatic-artery infusion (HAI) with a consequent combination of cisplatin (CDDP) and 5-fluorouracil (5-FU) administration at a continuous low dose. Five cases (62.5%) showed a partial response (PR). Median survival time was 481.9 days. Cytoreductive surgery was performed in three patients of PR. One case has been disease free and alive over 52 months postoperatively. Gallbladder cancer is well known as a chemoresistant cancer, whereas the higher response rate and the longer survival were achieved with HAI. These results suggested CDDP, 5-FU HAI is a useful chemotherapy for advanced gallbladder cancer, and it is also worthwhile to introduce the preoperative down-staging for consequent cytoreduction surgery.
Adult↗
Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery.
BACKGROUND: Ascertaining the optimal distal margin of resection in sphincter-preserving surgery has become an important problem. This study was designed to examine distal rectal spread of rectal carcinoma and to determine the optimal distal margin of resection for sphincter-preserving surgery. METHODS: Six hundred ten consecutive specimens of resected rectal carcinomas were analyzed retrospectively and pathologically. RESULTS: Sixty-one patients (10%) had distal spread. In patients who underwent curative surgery, distal spread was observed in only 3.8% (19/505). Distal spread was not found in patients with Stage I disease (0/150), according to the International Union Against Cancer stage. Only 1.2% (2/162) of patients with Stage II disease and 5.1% (10/195) with Stage III disease had slight spread but this was confined within a 1 cm length. Most patients with distal spread had a lower survival rate and died of distant metastasis rather than local recurrence, even after curative surgery. CONCLUSIONS: Distal spread seems to be an important risk factor for distant metastasis. Distal margin of resection of 1 cm may be appropriate clearance for most rectal cancers.
Female↗
Surgical treatment for patients with pulmonary metastases after resection of primary colorectal carcinoma.
BACKGROUND: The optimum treatment for patients with pulmonary metastases from colorectal carcinoma is still controversial. METHODS: To evaluate the results of pulmonary resection in 22 patients with pulmonary metastases after resection of primary colorectal carcinoma, patients' characteristics were examined retrospectively. Eighteen patients had a solitary metastatic lesion and four had two lesions. RESULTS: Postthoracotomy recurrence occurred in 17 of the 22 patients (77.3%), and showed no correlation with the type of pulmonary resection. In 11 patients with a solitary lesion of less than 3.0 cm in greatest dimension, the 3- and 5-year postthoracotomy survival rates (PTSR) were 71.6% and 36.8%, respectively. Six of these patients received two or more thoracotomies for pulmonary recurrence. The 3-year PTSR for seven patients with a solitary lesion greater than or equal to 3.0 cm was 19.0%, and for the four patients with two lesions, 25.0%. A significant difference was noted in the survival rate according to both number and size of the metastatic lesions (P < 0.05). CONCLUSIONS: The number and size of metastatic lesions appear to be important prognostic determinants. Repeated thoracotomy can prolong survival for selected patients.
Adenocarcinoma↗
Carcinomatous lymphatic permeation. Prognostic significance in patients with rectal carcinoma--a long term prospective study.
BACKGROUND: The question of whether lymphatic permeation in rectal carcinoma is an index of prognosis remains controversial. METHODS: A long term prospective study of lymphatic permeation of 288 rectal carcinomas was performed. The degree of lymphatic permeation was divided into four stages (Ly0 through Ly3). The median follow-up for the surviving patients was 84 months (range, 23 to 151 months). RESULTS: In patients with UICC Stage I or II disease, there was no correlation between the Ly0 and Ly1-3 groups' recurrence or survival rates. In patients with Stage IIIa disease, the rate of postoperative recurrence was significantly higher in the Ly1 or Ly2 + Ly3 groups compared with the Ly0 group. The 10-year survival and disease free survival rates in patients with Stage IIIa disease were both 90.0% in the Ly0 group, 63.6% and 62.5% in the Ly1 group, and 52.0% and 45.5% in the Ly2 + Ly3 groups, respectively. A significant difference was noted in the survival rates between the Ly0 and Ly2 + Ly3 groups (P < 0.05), and was noted in the disease free survival rates between the Ly0 and Ly1 (or Ly2 + Ly3) groups (P < 0.05, P < 0.005). In patients with Stage IIIb disease, there were trends toward higher recurrence, lower survival, or disease free survival rates in the Ly2 + Ly3 groups compared with the Ly1 group (P < 0.1). CONCLUSIONS: The degree of lymphatic permeation is an important prognostic factor in patients with Stage III disease, especially in those with Stage IIIa disease. It should be classified as a clinical subgroup.
Aged↗