[Case of removal of a sewing needle in the periotoneal cavity].
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Adolescent↗
Biomedical subjects
Y Hiki
Publications and source records attributed to Y Hiki.
Modified treatment of early gastric cancer: evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups.
The results of endoscopic treatment of early gastric cancers were evaluated. The lesions were divided into two groups: the group with an absolute indication (AI) and the other with a relative indication (RI) for endoscopic treatment. Endoscopic mucosal resection (EMR) was performed on 106 lesions in 104 patients. In addition, 108 patients were treated by laser irradiation (LI). The status of the patients were serially assessed during the postoperative period. The residual rate in AI patients who underwent EMR was 30.3%, whereas the rate in RI patients was 80%. The residual rate in 70 AI patients who underwent LI was 0%. Although the recurrence rate was 4.2%, the cumulative curative rate after additional treatments was 100%. The residual rate in RI patients who underwent LI was 17.4%, and the recurrence rate was 13.2%. The cumulative curative rate after additional treatments was 97.4%. In AI patients, the initial mode of treatment use was EMR. Patients who exhibited residual cancerous tissue after EMR or those in whom EMR was difficult to perform, either technically or otherwise, underwent LI. EMR was the first choice therapeutic technique because endoscopic specimens obtained could be subjected to histopathologic examination. In RI patients, the conventional operation was the therapeutic technique of first choice. The LI procedure was performed in those who either refused surgery or who could not undergo operative treatment for various reasons.
Combined Modality Therapy↗
Paramesangial destructive lesions in immunoglobulin A nephritis.
Paramesangial lesions leading to segmental extracapillary damage were observed in the glomeruli of immunoglobulin A nephritis. Subepithelial accumulation of proteinaceous materials from the mesangium could result in the degeneration and exfoliation of podocytes, apparently with subsequent formation of segmental extracapillary lesions or adhesion to Bowman's capsule (or both). Paramesangial destructive lesions may be initiated by the overloading of the mesangial pathway in glomerular inflammation.
Adult↗
Thymidine phosphorylase expression and effect of doxifluridine: a phase II study.
Doxifluridine (5'-DFUR), an active intermediate metabolite of capecitabine, is converted to 5-fluorouracil by thymidine phosphorylase (TP). We used immunohistochemical staining to investigate the relation between TP expression and 5'-DFUR effects in 40 patients with advanced/recurrent lung metastases from colorectal cancer. Cox regression analysis suggested that TP-positive cancer cells (risk ratio 3.72), were independent factors in survival whereas factors in progression-free survival were TP-positive cancer cells (2.93), and TP-positive stromal cells (0.24). It is suggested that TP expression in cancer cells and in stromal cells are opposite prognostic factors in patients treated with 5'-DFUR.
Adult↗
Does gastrojejunostomy for unresectable cancer of the gastric antrum offer satisfactory palliation?
BACKGROUND/AIMS: Gastrojejunostomy is the procedure of choice for patients with obstruction or stenosis of the gastric outlet or duodenum. However, the palliative benefits of this procedure in gastric cancer remain uncertain. Thus, the present study was performed to address this problem. METHODOLOGY: In the present study, 52 patients who had undergone gastrojejunostomy for unresectable cancer of the gastric antrum at Kitasato University Hospital and Kitasato University East Hospital in Japan between 1972 and 1994 were examined. RESULTS: The median survival time in these 52 patients was 5.0 months. The duration of palliation ranged from 0-13 months, with an average of 2.8 months. No significant difference between clinicopathologic factors and duration of palliation was found and location of tumor was the only independent prognostic factor (coefficient: 0.890; hazard ratio: 2.435). CONCLUSIONS: Although gastrojejunostomy for unresectable cancer of the gastric antrum is the procedure most often chosen at laparotomy, the palliative benefits of gastrojejunostomy do not sufficiently compensate for the patients' limited post-operative survival and quality of life.
Adult↗
The management of bleeding peptic ulcer in the elderly with heater probe thermocoagulation.
BACKGROUND/AIMS: The aim of this study was to compare the clinical characteristics of bleeding peptic ulcers in the elderly with those in younger patients, retrospectively. METHODOLOGY: Between 1986 and 1994, 274 patients with bleeding peptic ulcers were treated with heater probe endoscopically. They were divided into 2 groups: 48 in the elder group (70 years of age or older) and 226 in the younger group (<70). We evaluated the rate of concomitant disease, rebleeding rate, incidence of emergency surgery, mortality and blood transfusion requirement between the 2 groups. RESULTS: The incidence of concomitant disease was significantly higher in the elderly group (83.3%) than in the younger group (33.3%) (p<0.01). The rate of rebleeding (younger group 23.5% vs. elderly group 31.3%), the incidence of emergency surgery (5.8% vs. 6.3%, respectively) and the rate of mortality due to hemorrhage (2.2% vs. 4.2%, respectively) were similar in the 2 groups. There was no significant difference in the mean volume of blood transfused. CONCLUSIONS: It was revealed that aggressive endoscopic hemostasis improved the mortality rate and the incidence of emergency surgery in elderly patients as well as in younger patients, provided that their general condition was monitored carefully.
Adolescent↗
Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis?
BACKGROUND/AIMS: The optimal extent of lymphadenectomy in patients with gastric cancer and simultaneous peritoneal metastasis upon non-curative resection remains unclear. The aim of the present study was to evaluate the efficacy of extended lymphadenectomy in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis. METHODOLOGY: The significance and limit of extended lymphadenectomy according to the extent of peritoneal metastasis was analyzed retrospectively in 110 patients with gastric cancer and simultaneous peritoneal metastasis who had undergone palliative gastrectomy. RESULTS: Of the 47 patients with P1 metastasis, the median survival period of the 23 patients who underwent extended lymphadenectomy and the 24 patients who underwent limited lymphadenectomy was 21.7 months and 17.2 months, respectively. Of the 63 patients with P2 or P3 metastasis, the median survival period of the 16 patients who underwent extended lymphadenectomy and the 47 patients who underwent limited lymphadenectomy was 10.4 months and 12.8 months, respectively. No significant differences in survival time based on extent of lymphadenectomy were observed either in the patients with P2 or P3 metastasis (P = 0.262) or in those with P1 metastasis (P = 0.277). CONCLUSIONS: The results of the present study demonstrate that extended lymphadenectomy in gastric cancer yields no positive impact on survival upon non-curative resection either in patients with gastric cancer and simultaneous metastases to the adjacent peritoneum (P1) or to the distant peritoneum (P2 or P3).
Female↗
Three-dimensional reconstruction of colorectal tumors from serial tissue sections by computer graphics: a preliminary study.
BACKGROUND/AIMS: We present herein the three-dimensional reconstruction of colorectal tumors, with particular reference to growth pattern into each layer of the colorectal wall, and measurement of tumor volume and surface area. METHODOLOGY: Conventional tissue section images of colorectal tumors were analyzed using a computer graphics analysis program. The two-dimensional extent of invasion by each tumor into each layer of intestinal wall were determined from the images of each section. Based on data from multiple sections, tumor and surrounding normal tissue layers were reconstructed three-dimensionally, and volume and surface area of the tumors were determined. RESULTS: Using this technique, three-dimensional morphology of tumor and tumor progression into colorectal wall could be determined. Volume and surface area of the colon tumor were 4871 mm3 and 1741 mm2, respectively. Volume and surface area of the rectal tumor were 1090 mm3 and 877 mm2, respectively. CONCLUSIONS: This technique may provide a new approach for pathological analysis of colorectal carcinoma.
Colonic Neoplasms↗
Surgical outcome of curative resection in patients with Borrmann type IV gastric carcinoma with particular reference to the extent of lymph node metastasis.
BACKGROUND/AIMS: The prognosis after curative resection for Borrmann type IV carcinoma, according to the extent of lymph node metastasis, is poorly understood. METHODOLOGY: The surgical outcome of curative resection was examined in 78 patients with T2-T3 Borrmann type IV gastric carcinomas, with particular reference to the extent of lymph node metastasis. RESULTS: The 5-year survival rate was 35.7% for the n0 patients, 27.8% for the n1 patients, 18.2% for the n2 patients and 0% for the n3 or n4 patients. The survival curve for the n3 or n4 patients differed significantly from those of the n0 (P < 0.0001), n1 (P = 0.0009) and n2 (P = 0.0203) patients. However, no other statistically significant differences between the curves were found. CONCLUSIONS: The results of the present study indicate that patients with Borrmann type IV carcinoma of the stomach may indeed be cured by curative surgery, and that the surgical outcome of this disease does not depend on the extent of lymph node metastasis under curative resection if lymph node metastasis is restricted to the n2 lymph nodes.
Female↗
An in-vitro model of scirrhous carcinoma of the stomach using stomach fibroblasts derived from gastric cancer patients.
BACKGROUND/AIMS: The mechanisms of the particular stromal changes that occur upon cancer invasion by scirrhous carcinoma of the stomach, in particular, the relationships among cancer cells, stomach fibroblasts and collagen, a major constituent of the stroma of the invasive tumor, have yet to be clarified. METHODOLOGY: Three different human fibroblast cell lines (TIG-101, MF-2, MKF-1) and a cancer cell line derived from scirrhous carcinoma of the stomach (KATO III) were cultured three-dimensionally in collagen gels to investigate collagen gel contraction by these cells as a model of scirrhous carcinoma of the stomach. RESULTS: The gels contracted and gradually decreased in size in all of the fibroblast (TIG-101, MF-2 and MKF-1) cultures, but not in the KATO III culture, and the extent of gel contraction was not uniform among the fibroblast cell lines. The extent of gel contraction when fibroblasts derived from stomach (MF-2, MKF-1) were co-cultured with KATO III cells in collagen gel was almost similar to that of fibroblasts alone. Moreover, microscopic examination following Masson's trichrome staining revealed condensation and remodeling of collagen fibrils only around the fibroblast cells. CONCLUSIONS: The extent of collagen gel contraction by fibroblasts may depend on their in vivo origin. This property appears to be characteristic of fibroblasts, but not of malignant epithelial cells, under this culture system. Furthermore, the results of the present study demonstrate that stomach fibroblasts may play an important role in the stromal changes associated with scirrhous gastric cancer.
Adenocarcinoma, Scirrhous↗
Marginal ulcer on the jejunum after proximal gastrectomy by jejunal interposition.
Marginal ulcer after proximal gastrectomy has never been previously reported, despite that this procedure preserves the fundic gland area of the stomach, which secretes gastric acid. In this report, we describe a patient who developed a marginal ulcer on the oral side of the gastrojejunal anastomosis after proximal gastrectomy by jejunal interposition. This case serves as a reminder that gastric acid secretion of the remnant stomach must be carefully monitored after proximal gastrectomy in gastric cancer surgery.
Anastomosis, Surgical↗
Recent results in the surgical treatment of gastric cancer according to the Japanese and TNM classification.
BACKGROUND: Recent outcomes based on surgical long-term follow-up of patients with gastric cancer using current staging systems have not been fully evaluated. MATERIALS AND METHODS: A total of 1357 patients with primary gastric carcinoma (911 males and 446 females, ranging in age from 20 to 87 years; average 59.1 years) who had undergone gastric resection between 1986 and 1996 were examined with respect to their clinicopathological features, surgical procedures and patient survival according to Japanese and UICC-TNM classifications. RESULTS: The 5-year survival rate was 95.3% for stage Ia, 85.5% for stage Ib, 73.8% for stage II, 45.7% for stage IIIa, 20.9% for stage IIIb, 17.3% for stage IVa and 5.8% for stage IVb (8.8% for IVa and IVb) on the Japanese classification. By way of contrast, the 5-year survival rate was 95.6% for stage Ia, 85.0% for stage Ib, 72.1% for stage II, 49.3% for stage IIIa, 30.2% for stage IIIb and 12.0% for stage IV on the TNM classification. CONCLUSION: Although minor problems are associated with both the Japanese and TNM classification systems, both appear to be clinically significant and appropriate independent predictors of prognosis. The findings of the present study provide important information for comparing results among different institutes and for introducing new clinical trials for gastric cancer at the beginning of the new century.
Adult↗
Results of resection of gastric cancer with distant metastases.
BACKGROUND/AIMS: The present study was carried out in order to examine the outcome of resection in cases of gastric cancer with distant metastases. METHODOLOGY: The survival rates of two hundred and eighty-one patients who had undergone resection for primary carcinomas of the stomach, and who had distant metastases according to the TNM classification, were studied. RESULTS: The 5-year survival rates for patients with metastasis to the peritoneum or group 3 nodes were 8.9% and 15.3% respectively and were significantly higher than the survival rates for patients with metastasis to the liver (0%), to group 4 nodes (2.2%) or to more than one site among the liver, lymph nodes and peritoneum (3.5%). Moreover, the 5-year survival rates for patients with metastasis to the peritoneum and N3 nodes increased significantly to 29.4% and 24.2%, respectively, when curative surgery was performed. CONCLUSIONS: The findings of the present study suggests that metastases to the adjacent peritoneum or group 3 nodes have a greater chance of being cured using radical surgery, and that gastrectomy with extended lymphadenectomy (D2-D3) may be used for advanced gastric cancer if there is no gross evidence of metastasis to the distant peritoneum, liver or group 4 nodes.
Case-Control Studies↗
Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience.
BACKGROUND/AIMS: The efficacy of palliative gastrectomy in gastric cancer with peritoneal metastases remains uncertain. The aim of the present study was to evaluate the benefits of gastrectomy on the postoperative course of patients with gastric cancer and simultaneous metastases to the distant peritoneum. METHODOLOGY: A total of 122 patients who had gastric cancer and metastases to the distant peritoneum were studied with respect to survival. RESULTS: The extent of peritoneal metastases did not significantly affect the prognosis. Moreover, multivariate analysis indicated that surgery without gastrectomy was the only significant prognostic factor (relative risk, 2.587). CONCLUSIONS: Our results suggest that the decision to perform gastrectomy does not depend on the extent of peritoneal metastasis in gastric cancer. Furthermore, palliative gastrectomy, if feasible, seems to have a beneficial effect on the postoperative course and is indicated for patients regardless of metastasis to the peritoneum, if the primary tumor is surgically resectable and there is no evidence of liver metastasis.
Female↗