Biomedical subjects

Hiroyuki Katoh

Publications and source records attributed to Hiroyuki Katoh.

At least 55 records · Page 3Linked to original sources

PubMed2004

Expression profiles of 39 HOX genes in normal human adult organs and anaplastic thyroid cancer cell lines by quantitative real-time RT-PCR system.

HOX genes are well known as master control genes in embryonic morphogenesis. We hypothesized that HOX genes give cells spatial information to maintain tissue- or organ-specificity in adult body and that the deregulated expression of HOX genes results in tumor development. We established a comprehensive analysis system to quantify expression of 39 human HOX genes based on the real-time reverse transcription PCR (RT-PCR) method. Analysis of 39 HOX genes of 20 normal adult organs by this system revealed that 5' HOX genes were expressed in organs in the caudal parts of the body, and that the more caudal regions the more numbers of HOX genes were expressed. It was also found that the expression patterns of HOX genes were more similar in the adjacent genes on the same cluster rather than in those belonging to the same paralogs. Compared with normal thyroid tissues, thyroid cancer cell lines showed the altered expression of some HOX genes, especially Abd-B homeobox family genes. Our results showed that HOX genes were organ-specifically expressed in adult body and that the deregulated expressions of Abd-B family genes were implicated in thyroid tumor development.

Actins↗

PubMed2004

Ischemic gastropathy after distal pancreatectomy with celiac axis resection.

PURPOSE: Stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries is a radical operation performed for locally advanced cancer of the pancreatic body. However, it is not known whether the collateral pathways that develop immediately from the superior mesenteric artery to the gastroduodenal and hepatic arteries provide sufficient blood flow to support the hepatobiliary system and the stomach. This article examines the ischemic gastropathy that can occur after this procedure and identifies the predisposing conditions. METHODS: Between 1997 and 2001, nine patients underwent stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries. Concomitant resection of the right gastric artery or gastroduodenal artery was performed due to cancer infiltration in three patients. RESULTS: Irregular, shallow, and wide ulcerations thought to be ischemic in origin developed in these three patients, but all the ulcerations healed in 1-2 weeks with antiulcer medication. None of the other six patients had evidence of gastric ischemia. CONCLUSIONS: Ischemic gastropathy is rare after distal pancreatectomy with celiac axis resection alone; however, division of additional arteries supplying the stomach may predispose to ischemic gastropathy.

Celiac Plexus↗

PubMed2004

Successful resection of a recurrent mediastinal liposarcoma invading the pericardium: report of a case.

Primary liposarcoma of the mediastinum is rare, but cases of recurrence have been reported in the English literature. We successfully resected a recurrent pericardial liposarcoma, detected 5 years after the initial resection of a liposarcoma of the anterior mediastinum invading the pericardium. Routine follow-up computed tomography showed the recurrence and suggested invasion of the pericardial cavity, which was supported by the findings of transesophageal ultrasonography. As cine-magnetic resonance imaging suggested that the tumor was resectable, an operation was performed. Histopathology confirmed the diagnosis of recurrent liposarcoma and showed clear surgical margins.

Heart Neoplasms↗

PubMed2004

Role of hepatectomy in the treatment of hilar bile duct carcinoma.

PURPOSE: To clarify the role of hepatic resection in the surgical treatment of hilar bile duct carcinoma. METHODS: Between 1980 and 1997, 68 patients underwent surgery for hilar bile duct carcinoma. The patients were divided into a hepatectomy group ( n = 40) and a nonhepatectomized group ( n = 28) depending on whether they underwent resection of the bile duct confluence in combination with hepatectomy, or alone, respectively. Background data, operative morbidity and mortality, and survival were retrospectively compared between the two groups. RESULTS: There were no significant differences in morbidity and mortality, or in postoperative survival between the two groups (the 5-year survival rates being 20.6% in the hepatectomized group and 7.1% in the nonhepatectomized group; P = 0.0806). However, patients who underwent curative resection had significantly better postoperative survival than those who underwent noncurative resection ( P = 0.048). Hepatectomy provided a significantly better cancer-free margin than bile duct resection alone ( P = 0.0296). CONCLUSIONS: Although a countermeasure must be taken to decrease mortality, the introduction of hepatectomy with bile duct resection would provide a better cancer-free surgical margin than bile duct resection alone for hilar bile duct carcinoma. Curative resection contributed to long-term survival in this series.

Adult↗

PubMed2004

Laparoscopic Nissen fundoplication for gastroesophageal reflux disease in Japan.

PURPOSE: Laparoscopic antireflux surgery is the standard treatment for gastroesophageal reflux disease (GERD) in Western countries where this disorder is common; however, it has only recently been introduced in Japan. We examined the effectiveness of laparoscopic antireflux surgery in a small series of Japanese patients. METHODS: Between 1998 and 2001 we performed laparoscopic Nissen fundoplication in 23 patients to evaluate the efficiency of this technique. We examined the following four parameters pre- and postoperatively: symptoms, endoscopic findings, gastroesophagogram findings, and the results of intraesophageal 24-h pH monitoring. We also examined the operation time, blood loss, intraoperative complications, and postoperative complications. RESULTS: The operation was safely performed in all patients, regardless of age, and there were no intraoperative complications. Postoperatively, more than three parameters were effectively normalized in 17 (89.5%) of 19 patients. The only postoperative complications were delayed gastric emptying in three patients and persistent dysphagia in five patients. During follow-up, esophagitis recurred in two patients, one of whom underwent laparoscopic refundoplication, which normalized the condition. CONCLUSION: Laparoscopic Nissen fundoplication is highly effective for GERD and could become the standard surgical treatment in Japan.

Adult↗

PubMed2004

Gastric tube-preserving pancreatoduodenectomy after esophagectomy and reconstruction using the gastric tube: report of a case.

We herein present the case of an intraductal papillary mucinous tumor of the pancreas resected by a gastric tube-preserving pancreatoduodenectomy in a patient who underwent an esophagectomy and reconstruction using the gastric tube. To preserve the gastric tube, the gastroduodenal artery and right gastroepiploic vein must be successfully skeletonized and preserved. In the present case, the vascular anatomy was clarified not only two-dimensionally with the use of selective abdominal angiography, but also three-dimensionally with the use of helical computed tomography. After precisely identifying the location of the tumor in relation of the blood vessels, it was confirmed that a gastric tube-preserving pancreatoduodenectomy was feasible. A detailed analysis of the vascular anatomy should be carried out by helical computed tomography preoperatively. When the radicality of tumor resection is not compromised, a gastric tube-preserving pancreatoduodenectomy can be recommended, due to the fact that it is considered to be less invasive.

Esophageal Neoplasms↗

PubMed2004

Embolization of the replaced common hepatic artery before surgery for pancreatic head cancer: report of a case.

We report the case of a patient with pancreatic head cancer, whose replaced common hepatic artery (RCHA) arose from the superior mesenteric artery (SMA). We performed preoperative embolization of the RCHA, after which the liver blood flow was well maintained by the left gastric artery. The patient underwent a radical operation involving en bloc resection of the RCHA without any serious complications.

Aged↗

PubMed2004

Peptic ulcer-induced acute aortogastric fistula occurring 7 years after a pharyngogastrostomy following a resection for carcinoma of the esophagus: report of a case.

A 46-year-old woman underwent a pharyngogastrostomy, following a laryngoesophagectomy for esophageal carcinoma. Although she had been disease-free for 7 years, she subsequently was admitted to undergo a workup due to fever along with chest and back pain. A few days after admission, the patient suddenly vomited a large volume of blood and went into shock. Bleeding was stopped with a Sengstaken-Blakemore tube, and an emergency thoracotomy was performed. A fistula between the thoracic aorta and an ulcer of the gastric tube was identified. We decided to close the aortic lesion directly because the adhesions were extremely dense and her blood circulation was poor. One week later, we resected the thoracic part of the gastric tube, debrided the fistula, and wrapped the aortic lesion with a patch. However, on the 18th postoperative day, she developed massive hematemesis due to rupture of an infected pseudoaneurysm in the thoracic aorta and died.

Acute Disease↗

PubMed2004

Thirteen cases with intramural metastasis to the stomach in 1259 patients with oesophageal squamous cell carcinoma.

Among a total of 1259 patients with oesophageal cancer who underwent surgical resection, intramural metastasis (IMM) was verified in 93 patients (7.4%), of which IMM to the stomach (IMMS) constituted 13 patients (1.0%). In all 13 cases, the primary cancer was located in the middle or lower thoracic oesophagus and all had lymph nodes metastasis, while 12 of the 13 (92.3%) had lymphatic invasion. In our series, as the depth of invasion advanced, the number of patients with IMM or IMMS increased, although even superficial IMMS was revealed. The gross appearance of the metastatic tumours in the stomach resembled submucosal tumours. The possibility exists that metastasis via a lymphatic duct allows expansive growth in the gastric submucosae. These findings suggest that oesophageal cancer metastasizes to the stomach via a lymph duct. In conclusion, oesophageal cancer with lymphatic invasion may lead to IMM and IMMS. Therefore, careful examination for the existence of IMM, including the stomach, is required.

Adult↗

PubMed2004

Prediction of lymph node metastasis by analysis of gene expression profiles in non-small cell lung cancer.

OBJECTIVE: Non-small cell lung carcinoma (NSCLC) is one of the leading causes of death in the world. Lymph node metastasis is not only an important factor in estimating the extent and the metastatic potential of an NSCLC but also in prognosticating the patient outcome. Preoperative prediction of lymph node metastasis might greatly facilitate the choice of appropriate surgical and medical options in patients with NSCLC. METHODS AND RESULTS: Using a cDNA array, we analyzed the expression profiles of 1,289 genes in 92 cancer tissues of NSCLC (37 squamous cell carcinomas and 55 adenocarcinomas). We divided the patients into two groups (classes) for each of various pathological factors, such as lymph node metastasis and pT-stage. For each pair of classes, we searched for an optimal combination of genes to classify the cases using a sequential forward selection algorithm starting from a gene set that showed significant difference in expression between the classes. We used the leave-one-out error cross-validation on a k-nearest neighbor classifier to sequentially choose the gene. Using the optimized set of genes, it was possible to stratify the patients for lymph node metastasis (pN-stage) and pT-stage at, respectively, 100% (23 genes) and 100% (55 genes) for cases with squamous cell carcinomas and 94% (43 genes) and 92% (35 genes) for those with adenocarcinomas. CONCLUSION: We conclude that expression profiling using feature selection provides a powerful means of stratification (personalization) of NSCLC patients and choice in treatment options, particularly for factors such as lymph node metastasis whose radiological diagnosis is presently incomplete.

Adenocarcinoma↗

PubMed2004

Prediction of lymph node metastasis and perineural invasion of biliary tract cancer by selected features from cDNA array data.

OBJECTIVE: To better understand the nature of the malignancy of biliary tract carcinoma and evaluate the feasibility of its prediction by gene expression profiles. METHODS AND RESULTS: We explored the gene expression profiles characteristic of progression and invasiveness in the cDNA array data obtained from 37 biliary tract carcinomas (15 bile duct, 11 gallbladder, 11 of ampulla of Vater). We pre-selected 51 and 100 genes for the presence versus absence of lymph node metastasis and perineural invasion on the basis of statistical difference. To search optimized sets of genes for prediction, we applied a sequential forward feature selection, minimizing leave-one-out error rates on a k-nearest neighbor classifier. We could predict lymph node metastasis and perineural invasion with an accuracy of 94 and 100%, respectively. When the 6-stage IA cancers without perineural invasion were precluded, a marked difference in gene expression (147 gene), discriminable with 100% accuracy, was noted between positive versus negative perineural invasion, suggesting that the acquisition of invasive character is rather a later molecular pathological event in biliary tract cancer. CONCLUSION: The present method provides a powerful means of classifying biliary tract carcinomas. We also suggest that perineural invasion is an important target of array databased pattern classification, which may predict patient outcomes and facilitate the determination of the extent of surgery to minimize the risk of recurrence.

Biliary Tract↗

PubMed2004

The role of radiotherapy for thymic carcinoma.

OBJECTIVE: The aim of this study is to evaluate retrospectively the role of radiotherapy for thymic carcinoma. METHODS: Between 1973 and 1998, 14 patients with thymic carcinoma were treated at Gunma Prefectural Cancer Center. Two patients who had hematogenous metastasis were excluded from this study, therefore 12 patients were analyzed. The Masaoka staging system was used; four patients were diagnosed with stage III disease and eight patients with stage IV disease. The pathological subtype according to the World Health Organization histological criteria for thymic tumors was squamous cell carcinoma (low-grade histology) in six cases and undifferentiated carcinoma (high-grade histology) in six. Ten patients underwent thoracotomy, and two patients underwent excisional biopsy without thoracotomy. Ten patients (83%) received radiotherapy as a curative intent, and the median dose was 60 Gy. Systemic chemotherapy was administered to four patients (33%), and the majority (75%) of the regimens contained cisplatin. RESULTS: The 3-year overall survival rate was 25%. Histological subtype (low-grade versus high-grade), surgical resection (complete versus incomplete), radiotherapy and chemotherapy were evaluated as prognostic factors in a univariate analysis. Low-grade histology and complete resection were good prognostic factors, although these were not statistically significant. Patients who received radiotherapy had a better outcome than those who did not. The major sites of recurrence were the pleura and pericardium. Recurrence within the radiation field was observed in one of seven patients in whom failure patterns could be evaluated. CONCLUSION: Complete resection is mandatory if possible. Radiotherapy plays an important role in treating thymic carcinoma in terms of reducing local recurrence and prolonging survival time. Establishment of an innovative treatment protocol that includes chemotherapy is necessary to control intrathoracic relapse and distant metastasis.

Adult↗

PubMed2004

CD8+ tumor-infiltrating lymphocytes together with CD4+ tumor-infiltrating lymphocytes and dendritic cells improve the prognosis of patients with pancreatic adenocarcinoma.

OBJECTIVE: Recent studies have demonstrated the importance of tumor immunity for a cancer patient's prognosis. In some types of cancer, it has been shown through immunohistochemical analysis that the existence of CD8+ tumor-infiltrating lymphocytes (TILs) is a crucial factor in determining prognosis. In an experimental model, CD4+ lymphocytes together with CD8+ lymphocytes contributed significantly to tumor immunity. METHODS: Specimens were taken from 80 surgically resected pancreatic adenocarcinomas between 1992 and 1999. Immunohistochemical staining of CD4, CD8, and S100 protein was performed, and the levels of these proteins were determined by microscopic analysis. The percentages of patients in the CD4(+) and CD8(+) groups were 59% (47/80) and 25% (16/80), respectively. When separated into 4 groups, CD4/8(+/+), CD4/8(+/-), CD4/8(-/+) and CD4/8(-/-), the overall survival rate was significantly higher in CD4/8(+/+) patients (13 cases) compared with those in all other groups combined (67 cases; P = 0.0098). CD4/8(+/+) status was negatively correlated with tumor depth and TNM stage. Multivariate analyses showed that CD4/8(+/+) status was an independent favorable prognostic factor. The number of tumor-infiltrating S100 protein positive cells was also significantly higher in the CD4/8(+/+) group than in others (P = 0.0084). CONCLUSIONS: In pancreatic adenocarcinoma, the presence of CD4+ TILs together with CD8+ TILs serves as a good indicator of the patient's outcome after surgical treatment.

Adenocarcinoma↗

PubMed2004

Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study.

OBJECTIVE: Our objective was to perform a prospective study of surgical treatment of hilar cholangiocarcinoma according to newly established guidelines for performing safe and curative resections. SUMMARY BACKGROUND DATA: The poor survival rate after resection of hilar cholangiocarcinoma is considered to be mainly the result of in-hospital death and positive ductal margins. METHODS: Between July 1999 and December 2002, 40 of 42 surgically explored patients with hilar cholangiocarcinoma underwent resection. They were managed with preoperative biliary decompression, portal embolization, cholangiographic evaluation, and a choice of surgical procedures and techniques. RESULTS: Hospital or 30-day mortality and morbidity rates were 0% and 48%, respectively. Hepatic failure was not encountered. Histopathologic examination revealed no positive ductal margins in all 40 patients, but 2 showed positive separation margins from the right hepatic artery. The overall 3-year survival rate and median survival time were 40% and 27 months. Survival of patients with Bismuth type III or IV tumors or of patients who underwent right hepatectomy was significantly better. Survival of patients who underwent concomitant vascular resection was similar to survival of those who did not. Univariate analysis indicated the type of hepatectomy, histopathologic grade, Bismuth classification, concomitant hepatic artery resection, and International Union Against Cancer stage as significant prognostic factors. CONCLUSIONS: No postoperative mortality and no positive ductal margins were achieved according to the above guidelines in a high-volume expert center. Long-term results, however, have not been significantly improved. A survival analysis of the patient series with homogeneous conditions derived from a short study period suggests the need for additional strategies including right hepatectomy for Bismuth type I or II tumors.

Adult↗

PubMed2004

[Appropriate duration of postoperative oral adjuvant chemotherapy with HCFU for colorectal cancer].

We conducted a joint study of different duration of drug administration for oral adjuvant chemotherapy using camphor (HCFU) with patients having advanced colorectal cancer who underwent curative resection. The patients were randomly divided into 2 groups, according to length of HCFU administration (6-month group and 2-year group), and followed up for 5 years postoperatively. In total, 239 patients were originally enrolled, out of which 155 were chosen as subjects for this study. There was significant difference in the overall cumulative 5-year survival rate between the short-term group and the long-term group (78.1% vs 89.6%). Between the respective subgroup that was defined by tumor location (colon or rectum), no differences were observed, but there was significant difference in the subgroup that was defined by the presence/absence of lymph node metastasis (59.4% vs 83.9%). It appears that oral adjuvant chemotherapy with HCFU is more effective when administered for 2 years than for 6 months.

Administration, Oral↗

PubMed2004

Survival and prognostic factors in resected cN2-pN0 non-small cell lung cancer.

This study retrospectively examined the records of patients with clinical N2 (cN2) stage non-small cell lung cancer (NSCLC) who were surgically treated but who actually had pathologic N0 (pN0) stage disease. From 1982 to 1997, 94 patients with cN2 NSCLC underwent surgery. Forty-five patients proved to have pN0 disease, with an overall 5-year survival rate of 67.3%. According to the Cox model, visceral pleural invasion (p=0.01) and a carcinoembryonic antigen (CEA) concentration > or =2.5 ng/mL (p=0.03) negatively influenced survival. The six patients with both visceral pleural involvement and a CEA > or =2.5 ng/mL all died within five years compared with a 78.1% 5-year survival for the 21 patients who had neither factor. For the subgroup of patients who have poor prognostic factors, multimodality therapy should be considered. Our previous report found that parietal pleural invasion, elevated CEA concentration, and the number of involved mediastinal lymph node (MLN) stations correlated with survival in 40 patients with cN2-pN2 disease who underwent resection. These data show how important it is to assess pleural status carefully and measure the CEA concentration, as is to determine the MLN status in patients with cN2 disease.

Aged↗

PubMed2004

[Medical ethics in surgery].

Medical ethics have been developed over the long term to foster the necessary basic attitude of physicians who are responsible for the lives of others. As medical science continues to advance, physicians have an obligation to acquire up-to-date knowledge and skill levels to offer the best medical care. Since the clinical practice of surgeons is based on cooperation with physicians in other specialties, it is necessary for surgeons to supervise their own ethics strictly and receive objective assessments from others.

Ethics, Medical↗

PubMed2004

[Evidence-based surgical therapy: the significance of randomized controlled trials].

Evidence-based medicine supplies the information to solve clinical questions but there are specific problems of randomized controlled trials in surgery. First, placebo-controlled trials are need to determine the placebo effects, but patients sometimes refuse the placebo surgery. Furthermore, it remains difficult to decide on standard surgical procedures because the participating surgeons vary in skill and experience. However, randomized controlled trials are essential for the further development of a high-quality surgical standard.

Evidence-Based Medicine↗