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Tatsuno M, Koganei K, Tatsumi K, Kuroki H, Obara N, Saitoh S, Sugita A. [A case of ulcerative colitis complicated by disseminated intravascular coagulation that improved markedly after surgery]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:680-688. [PMID: 37558415 DOI: 10.11405/nisshoshi.120.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ileoanal canal anastomosis, and ileostomy were performed on the patient. Soon after the surgery, his platelet count and coagulability improved, and he recovered from DIC. Thus, when the cause of DIC is probably UC itself, and medical treatment has limited efficacy in improving the DIC, surgery should be performed as soon as possible to eliminate the cause of DIC, considering the general condition of the patient.
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Affiliation(s)
- Mizuki Tatsuno
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Sayumi Saitoh
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Nakao E, Obara N. Postoperative results and complications of fecal diversion for anorectal Crohn's disease. Surg Today 2023; 53:386-392. [PMID: 35867163 PMCID: PMC9950159 DOI: 10.1007/s00595-022-02556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease. METHODS We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. RESULTS After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). CONCLUSION Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan.
| | - Akira Sugita
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Kazutaka Koganei
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Kenji Tatsumi
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Eiichi Nakao
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Nao Obara
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
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Iwami N, Komiya S, Asada Y, Tatsumi K, Habara T, Kuramoto T, Seki M, Yoshida H, Takeuchi K, Shiotani M, Mukaida T, Odawara Y, Mio Y, Kamiya H. P-384 Efficacy of endometrial microbiome metagenomic analysis with recurrent implantation failure and recurrent pregnancy loss: multicenter study in Japan. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does the result of endometrial microbiome metagenomic analysis (EMMA), a next generation sequencing (NGS)-based test of the intrauterine microbiome, have an impact on pregnancy rate after the test?
Summary answer
After recommend treatment with antimicrobial and probiotic therapy, the group diagnosed as dysbiosis by EMMA achieved pregnancy significantly earlier than the group with Normal result.
What is known already
Using NGS technology, EMMA testing can determine the composition of the endometrial microbiome by analysing bacterial 16S ribosomal RNA with a focus on the lactobacillus population. Endometrial flora in patients undergoing in vitro fertilization (IVF) is often composed of pathogenic microorganisms which decrease implantation rates, such as the Enterobacteriaceae family, Staphylococcus spp., Escherichia coli and Gram-negative bacteria. Other studies also indicate that Lactobacillus spp. is a major microorganism in the endometrium. Especially, lactobacillus-dominated microbiota (LDM, defined as > 90% Lactobacillus spp.) in the endometrium has been reported to lead to better pregnancy outcomes than non-LDM (<90% Lactobacillus spp.).
Study design, size, duration
This study was a prospective, multicenter cohort study of 527 patients (under 42 years old) with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) at 14 IVF treatment facilities in Japan from June 2019 to August 2021. Defining RIF as three or more failed implantation attempts and RPL as two or more miscarriages, we examined the prognosis of two additional embryo transfers (ETs) after the EMMA test in patients who underwent the test.
Participants/materials, setting, methods
Endometrial tissue was obtained by aspiration from patients in day 15-25 of their menstrual cycles, and sample tissues were analyzed by NGS for EMMA. Participant centers treated patients according to the therapies specified in the reports, including antibiotic treatments, probiotic treatments, re-analysis, and embryo transfer. Multivariate analysis was performed using a generalized linear model with the endpoint of ongoing pregnancy. For the time-to-event analyses, we used Kaplan-Meier survival analysis to compare time to ongoing pregnancy.
Main results and the role of chance
The results of the first EMMA were as follows: 229 patients (43.4%) were normal with Lactobacillus spp. >90% (Normal group), 110 patients (20.9%) were abnormal with less than 90% Lactobacillus spp. and predominantly pathogenic bacteria (Abnormal group), and 188 patients (35.7%) were mild with low absolute amounts of bacteria and ultralow biomass indicating almost sterile (Mild + Ultralow group). There were no significant differences in background factors such as age, duration of infertility, number of previous ETs, or history of deliveries among the three groups. Gardnerella was the most pathogenic bacteria detected in patients with Abnormal EMMA results. All patients in the Abnormal group were treated with antimicrobials and probiotics, and those in Mild + Ultralow group were treated with probiotics. Odds ratio for ongoing pregnancy rate was 1.10(95%CI 0.67-1.82, p = 0.699) in Abnormal group and 1.23(95%CI 0.80-1.89, p = 0.342) in Mild + Ultralow group, respectively. After the intervention, ongoing pregnancies were comparable to those in Normal group.Analysis of time to pregnancy using Kaplan-Meier survival curves showed that Abnormal group had a significantly higher rate of ongoing pregnancies during the observation period than the other groups (p = 0.031).
Limitations, reasons for caution
Since this study was not necessarily limited to euploid embryos transferred after testing, an aging bias cannot be excluded. Since this study was conducted with all patients receiving EMMA, the effectiveness of the test needs to be further validated by comparison to patients without EMMA testing.
Wider implications of the findings
This study is the first multicenter study to demonstrate that the intervention based on EMMA reports improve pregnancy outcome in the patients with RIF and RPL. We suggest that the EMMA procedure, which aims at establishing an appropriate uterine microbiome, may be important for implantation and pregnancy continuation.
Trial registration number
UMIN000036917
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Affiliation(s)
- N Iwami
- Kamiya Ladies Clinic, Center of reproduction , Sapporo, Japan
| | - S Komiya
- Horac IVF Grand Front Osaka Clinic, Center of reproduction , Osaka, Japan
| | - Y Asada
- Asada Ladies Clinic, Center of reproduction , Nagoya, Japan
| | - K Tatsumi
- Umegaoka Women’s Clinic, Center of reproduticion , Tokyo, Japan
| | - T Habara
- Okayama Couple's Clinic, Center of reproduction , Okayama, Japan
| | - T Kuramoto
- Kuramoto Women’s Clinic, Center of reproduction , Hukuoka, Japan
| | - M Seki
- Sekiel Ladies Clinic, Center of reproduction , Takasaki, Japan
| | - H Yoshida
- Sendai ART Clinic, Center of reproduction , Sendai, Japan
| | - K Takeuchi
- Takeuchi Ladies Clinic, Center of reproduction , Aira, Japan
| | - M Shiotani
- Hanabusa Women’s Clinic, Center of reproduction , Kobe, Japan
| | - T Mukaida
- Hiroshima HART Clinic, Center of reproduction , Hiroshima, Japan
| | - Y Odawara
- Fertility Clinic Tokyo, Center of reproduction , Tokyo, Japan
| | - Y Mio
- Mio Fertility Clinic, Center of reproduction , Yonago, Japan
| | - H Kamiya
- Kamiya Ladies Clinic, Center of reproduction , Sapporo, Japan
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Kuwabara H, Kimura H, Kunisaki R, Tatsumi K, Koganei K, Sugita A, Katsumata K, Tsuchida A, Endo I. Postoperative complications, bowel function, and prognosis in restorative proctocolectomy for ulcerative colitis-a single-center observational study of 320 patients. Int J Colorectal Dis 2022; 37:563-572. [PMID: 34751417 DOI: 10.1007/s00384-021-04059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the selection criteria, postoperative complications, bowel function, and prognosis of stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA for ulcerative colitis (UC). METHODS We defined our surgical indications and strategy, and compared the postoperative complications, bowel function, and prognoses between patients who underwent stapled and hand-sewn IPAA for UC at the Yokohama City University Medical Center between 2004 and 2017. RESULTS Among 320 patients enrolled, 298 patients underwent stapled IPAA while 22 underwent hand-sewn IPAA. There was no significant difference in the postoperative complications between the two groups. Regarding postoperative bowel function, stapled IPAA caused significantly less soiling (stapled vs hand-sewn: 9.1% vs 41.0%, odds ratio (OR) = 0.14, p < 0.0002), spotting (stapled vs hand-sewn: 23.2% vs 63.6%, OR = 0.17, p < 0.0001), and difficulty in distinguishing feces from flatus (stapled vs hand-sewn: 39.9% vs 63.6%, OR = 0.36, p < 0.026). No postoperative neoplasia was observed at the final follow-up in all patients. CONCLUSION In this study, there was no clear difference in the postoperative complications between stapled and hand-sewn IPAA, but stapled IPAA resulted in better postoperative bowel function. Postoperative oncogenesis from the residual mucosa is rare. However, future cancer risk remains; thus, careful follow-up is required.
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Affiliation(s)
- Hiroshi Kuwabara
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kenji Tatsumi
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Kazutaka Koganei
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Akira Sugita
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Itaru Endo
- Department of Gastrointestinal Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa Ward, Yokohama, 236-0004, Japan
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Obara N, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Nakao E, Sugita A. [A case of a patient with Crohn's disease who had vaginal delivery after abdominoperineal resection for severe anorectal complications]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:1079-1084. [PMID: 34759105 DOI: 10.11405/nisshoshi.118.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent abdominoperineal resection for anorectal stenosis, complex anal fistula, and rectovaginal fistula in her early twenties. Seven years later, she got pregnant and gave birth to a healthy boy by vaginal delivery. No recurrence of Crohn's disease was observed during the perinatal period. There is no curative treatment for severe anorectal complications, which may be necessary for young patients to undergo abdominoperineal resection. Further studies are needed to determine the effects of Crohn's disease with anorectal complications on pregnancy and childbirth in affected patients.
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Affiliation(s)
- Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Matsushima S, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Obara N, Nakao E, Sugita A. [Pregnancy and delivery in patients with Crohn's disease who had a history of abdominal surgery]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:742-748. [PMID: 34373393 DOI: 10.11405/nisshoshi.118.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A few studies have focused on pregnancy and childbirth in patients with Crohn's disease (CD) who had a history of abdominal surgery. The objective of this study is to analyze the problems of pregnant patients with CD with a history of abdominal surgery. METHODS The rates of pregnancy-related complications and adverse birth outcomes were retrospectively analyzed in 29 patients with CD (45 pregnancies) with previous intestinal surgery. RESULTS In this study, the following outcomes were observed:normal births occurred in 55.6% of the pregnancies, preterm births in 13.3%, and spontaneous abortions in 20.0%. The vaginal birth and cesarean section rates were 45.7% and 40.0%, respectively. The rate of low-birth weight infants was 14.3%. CONCLUSION Overall, patients with CD with previous abdominal surgery can conceive and give birth. However, care needs to be taken to avoid preterm birth, spontaneous abortion, low birth weight, and cesarean delivery.
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Affiliation(s)
- Sayuri Matsushima
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Nakao E, Obara N, Arai K. Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease. BMC Gastroenterol 2021; 21:168. [PMID: 33849449 PMCID: PMC8045380 DOI: 10.1186/s12876-021-01751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion. METHODS This was a retrospective study based on medical records of patients diagnosed with Crohn's disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen's Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure. RESULTS Among 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. CONCLUSION Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan.
| | - Akira Sugita
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Kazutaka Koganei
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Kenji Tatsumi
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Ryo Futatsuki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Eiichi Nakao
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Nao Obara
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Katsuhiko Arai
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
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Soga F, Tanaka H, Tatsumi K, Mochizuki Y, Sano H, Toki H, Matsumoto K, Shite J, Takaoka H, Doi T, Hirata K. impact of dapagliflozin on left ventricular diastolic function in diabetic patients with heart failure complicating cardiovascular risk factors. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Type 2 diabetes mellitus (T2DM) is a well-known risk factor for heart failure (HF), even in patients without a structural heart disease or a symptom of HF. Diabetes-related cardiomyopathy is presented as an left ventricular (LV) diastolic dysfunction, which, like cardiovascular disease, is a contributor of the development of HF in both patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Furthermore, comorbid factors other than T2DM also have been identified as high risk factors for of progression to HF. Dapagliflozin is a sodium glucose cotransporter type 2 (SGLT2) inhibitor, and represents a new class of anti-hyperglycemic agents for T2DM. A result from a recent large clinical trial showed that dapagliflozin reduced risk of worsening HF or death from cardiovascular causes for patients with HFrEF compared to those who received a placebo, regardless of the presence or absence of T2DM. However, the effect of SGLT2 inhibitors on LV diastolic function in T2DM patients with HF who had cardiovascular risk factors other than T2DM remains uncertain.
Purpose
Our purpose was to investigate the impact of dapagliflozin on LV diastolic function in T2DM patients with stable HF complicating cardiovascular risk factors.
Methods
We analyzed data from our previous prospective multicenter study, which investigate the effect of dapagliflozin on LV diastolic function of 53 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitor started the administration of dapagliflozin. Cardiovascular risk factors other than T2DM was determined as age, gender, hypertension, dyslipidemia, history of cardiovascular events and overweight.
Results
E/e′ significantly decreased from 9.3 to 8.5 cm/s 6 months after administration of dapagliflozin (p = 0.020) as previously described. Multivariate logistic regression analysis showed that dyslipidemia was the only independent determinant of an improvement of E/e’ among cardiovascular risk factors. Furthermore, relative changes in E/e’ from baseline to 6 months after administration of dapagliflozin seen in HFpEF patients with dyslipidemia were significantly larger than those in HFpEF patients without dyslipidemia (-15.2% vs. 29.6%, p = 0.014), but such a difference was not observed in non-HFpEF patients. In addition, relative changes in high-density lipoprotein cholesterol (HDL-C) from baseline to 6 months after administration of dapagliflozin had significant correlation with those in E/e’ (r=-0.300, p = 0.038). However, such correlations were not observed in low-density lipoprotein cholesterol (LDL-C) and triglyceride (r = 0.05, p = 0.72 and r = 0.05, p = 0.73). Conclusion: Dapagliflozin was more beneficial effect on LV diastolic function for T2DM patients with stable HF, especially those with complicating dyslipidemia. Our findings may thus offer a new insight into the management of T2DM patients with HF.
Abstract Figure.
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Affiliation(s)
- F Soga
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Tanaka
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Tatsumi
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Mochizuki
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Sano
- Takatsuki General Hospital, Cardiology, Takatsuki, Japan
| | - H Toki
- Kobe Red Cross Hospital, Cardiology, Kobe, Japan
| | - K Matsumoto
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - J Shite
- Osaka Saiseikai Nakatsu Hospital, Cardiology, Osaka, Japan
| | - H Takaoka
- Takatsuki General Hospital, Cardiology, Takatsuki, Japan
| | - T Doi
- Kobe Red Cross Hospital, Cardiology, Kobe, Japan
| | - K Hirata
- Kobe University Graduate School of Medicine, Kobe, Japan
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Dokuni K, Matsumoto K, Tatsumi K, Shono A, Suzuki M, Sumimoto K, Tanaka Y, Yamashita K, Shibata N, Yokota S, Sutou M, Tanaka H, Kiuchi K, Fukuzawa K, Hirata K. Cardiac resynchronization therapy improves left atrial reservoir function through resynchronization of the left atrium in patients with heart failure. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The structural remodeling of the left atrium (LA) has been proposed as an important determinant of adverse outcomes in patients with heart failure (HF). However, little is known about the potential impact of LA mechanical dyssynchrony on its reservoir function and the prognosis of patients with HF. In addition, it has not been fully investigated whether cardiac resynchronization therapy (CRT) is also beneficial to LA function.
Purposes
The purposes of this study were to test whether left ventricular (LV) dyssynchrony may negatively affect LA synchronicity and reservoir function, and to assess whether residual LA dyssynchrony after CRT affects the prognosis in patients with HF with reduced ejection fraction (HFrEF).
Methods
This study included total of 90 subjects: 40 HFrEF with a wide-QRS complex (≧130 ms), 28 HFrEF with a narrow-QRS, and 22 age- and sex-matched normal controls. LA global longitudinal strain (LA-GLS) and LA dyssynchrony were quantified using speckle-tracking strain analysis. LA dyssynchrony was defined as the maximal difference of time-to-peak strain (LA time-diff). All wide-QRS HFrEF received CRT, and event-free survival was tracked for 24 months.
Results
At baseline, HFrEF patients showed significant LA remodeling coupled with the reduced LA reservoir function, as evidenced by larger LA volume index (LAVi: 46 ± 16 vs. 30 ± 14 mL/m², P < 0.01) and smaller LA-GLS (13.0 ± 4.8 vs. 30.6 ± 10.7%, P < 0.01). Of note was that, not only LV dyssynchrony (381 ± 178 vs. 177 ± 62 ms, P < 0.01) but also LA dyssynchrony (298 ± 136 vs. 186 ± 78 ms, P < 0.01) were significantly larger in patients with HFrEF compared to normal subjects and this applied even more to patients with a wide-QRS complex. All patients with a wide-QRS complex underwent CRT, and only responders exhibited the significant decrease in LA time-diff (from 338 ± 123 to 245 ± 141 ms, P < 0.05) and increase in LA-GLS (from 11.9 ± 4.7 to 19.6 ± 10.1%, P < 0.05) in parallel with the reduction in LAVi (from 48 ± 17 to 37 ± 18 mL/m², P < 0.05) at 6 months after CRT. Receiver operating characteristic curve analysis identified the optimal cut-off value of LA time-diff at 6 months after CRT as 202 ms (P < 0.05) and that of LA-GLS as 14.6% (P < 0.05) for predicting adverse cardiac events. The patients whose LA time-diff reduced <202 ms after CRT showed significantly favorable event-free survival than the others. Similarly, the patients whose LA-GLS improved >14.6% after CRT exhibited significantly favorable event-free survival than the others (P < 0.05, respectively). Of note was that, when the patients were restricted to CRT responders only, those who showed LA time-diff less than 202 ms at 6 months after CRT almost never experienced cardiac events (P < 0.05).
Conclusions
The improved LV coordination by CRT also resulted in resynchronization of discoordinated LA wall motion and a consecutive improvement of LA reservoir function, which ultimately lead to the favorable outcome for HFrEF patients with wide-QRS complex.
Abstract Figure.
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Affiliation(s)
| | | | | | - A Shono
- Kobe University, Kobe, Japan
| | | | | | | | | | | | | | - M Sutou
- Kobe University, Kobe, Japan
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10
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Nakao E, Tatsumi K, Kuroki H, Futatsuki R, Koganei K, Sugita A, Hayashi H, Yokoyama K. [Preoperative diagnosis of small intestinal cancer associated with Crohn's disease: a case report]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:645-651. [PMID: 34248077 DOI: 10.11405/nisshoshi.118.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The patient was a 46-year-old woman with a history of Crohn's disease for several years. At 45 years of age, a colonoscopy was performed, and a protruding lesion in the terminal ileum was detected. Pathological analysis of a biopsy specimen noted high suspicion for a well differentiated adenocarcinoma. The patient underwent ileocecal resection, and histological examination of the specimen revealed that infiltration of the well differentiated adenocarcinoma was limited to the mucosa. To the best of our knowledge, this is the first known case of early small intestinal cancer associated with Crohn's disease in Japan. Both endoscopy and a biopsy of any protruding lesions may be useful for making a preoperative diagnosis of small intestinal cancer associated with Crohn's disease.
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Affiliation(s)
- Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | | | - Kaoru Yokoyama
- Department of Gastroenterology, Kitasato University School of Medicine
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11
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Tanaka H, Soga F, Tatsumi K, Mochizuki Y, Sano H, Toki H, Matsumoto K, Shite J, Takaoka H, Doi T, Hirata K. Positive effect of dapagliflozin on left ventricular longitudinal function for type 2 diabetic mellitus patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Type 2 diabetes mellitus (T2DM) has come to be considered an independent predictor of mortality, and also a contributor to the development of heart failure (HF) with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Left ventricular (LV) longitudinal myocardial dysfunction as assessed in terms of lower global longitudinal strain (GLS), has been identified even in T2DM patients with preserved LV ejection fraction (LVEF), and should be considered the first marker of a preclinical form of DM-related cardiac dysfunction, leading to HFpEF. Sodium glucose cotransporter type 2 (SGLT2) inhibitors represent a new class of anti-hyperglycemic agents for T2DM, but the effect of SGLT2 inhibitors on LV longitudinal myocardial function in T2DM patients with HF remains uncertain. To examine this effect, as well as the association of LV longitudinal myocardial function with LV diastolic function after administration of SGLT2 inhibitor in T2DM patients with stable HF, we analyzed data from our previous prospective multicenter study, in which we investigated the effect of SGLT2 inhibitor on LV diastolic functional parameters of T2DM patients with stable HF at five institutions in Japan.
Methods
Our previous trial was a prospective multicenter study of 58 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitors started the administration of 5 mg/day of dapagliflozin. Echocardiography was performed at baseline and 6 months after administration of dapagliflozin. LV diastolic function was defined as the ratio of mitral inflow E to mitral e' annular velocities (E/e'). LV longitudinal myocardial function was assessed as GLS based on the current guidelines.
Results
E/e' significantly decreased from 9.3 to 8.5 cm/s 6 months after administration of dapagliflozin (p=0.020) as previously described, while GLS showed significant improvement from 15.5±3.5% to 16.9±4.1% (p<0.01) 6 months after administration of dapagliflozin. Furthermore, improvement of GLS in HFpEF patients was more significant from 17.0±1.9% to 18.7±2.0% (p<0.001), compared to that in HFrEF patients from 11.3±3.8% to 11.8±4.6% (p=0.13). It was noteworthy that multiple regression analysis showed that the change in GLS after administration of dapagliflozin was the only independent determinant parameter for the change in E/e' after administration of dapagliflozin.
Conclusion
Dapagliflozin was found to be associated with improvement of LV longitudinal myocardial function, which led to further improvement of LV diastolic function of T2DM patients with stable HF. GLS-guided management may thus lead to improved management of T2DM patients with stable HF.
Representative case
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - F Soga
- Kobe University, Kobe, Japan
| | | | - Y Mochizuki
- Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - H Sano
- Aijinkai Takatsuki Hospital, Takatsuki, Japan
| | - H Toki
- Kobe Red Cross Hospital, Kobe, Japan
| | | | - J Shite
- Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - H Takaoka
- Aijinkai Takatsuki Hospital, Takatsuki, Japan
| | - T Doi
- Kobe Red Cross Hospital, Kobe, Japan
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12
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Minagawa Y, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Hayashi H, Suga T, Sugita A. [Familial adenomatous polyposis with papillary thyroid cancer:a case report]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:719-725. [PMID: 32779590 DOI: 10.11405/nisshoshi.117.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The patient is 36-year-old woman who complained of proptosis and was diagnosed as thyroid cancer. The pathologic diagnosis of her resected specimen was papillary thyroid cancer, cribriform morular variant (CMV). Subsequently, she was suspected of having familial adenomatous polyposis (FAP), although she had no family history of it. The diagnosis of FAP was confirmed following colonoscopy, which showed multiple polyps, and the biopsies that revealed multiple adenomas and cancers with APC gene mutation. She underwent restorative proctocolectomy, rectal mucosectomy with ileal pouch anal anastomosis, and ileostomy in our department. Cancer in the adenomas was found in four polyps on histopathological examination. CMV is known to be complicated with FAP. However, the number of reported cases remains few. This case was relatively rare, with an initial diagnosis of FAP because of the coexistence of CMV. In patients with papillary thyroid cancer (CMV type), colonoscopy should be considered because of the possibility of FAP.
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Affiliation(s)
- Yume Minagawa
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hiroyuki Hayashi
- Department of Pathological Diagnosis, Yokohama Municipal Citizen's Hospital
| | - Tomoaki Suga
- Department of Gastroenterology, Shinshu University Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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13
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Nakao E, Tatsumi K, Kuroki H, Futatsuki R, Koganei K, Sugita A. [A case of ulcerative colitis complicated by internal fistula between the transverse colon and stomach]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:619-625. [PMID: 32655121 DOI: 10.11405/nisshoshi.117.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A case of ulcerative colitis (UC) with an internal fistula was reported;the patient, a 42-year-old male, was admitted to the hospital with a diagnosis of refractory UC. The preoperative examination revealed an internal fistula between the transverse colon and the stomach. UC was diagnosed preoperatively with an internal fistula, but the possibility of Crohn's disease could not be ruled out at that time. The patient underwent subtotal colectomy with end ileostomy, sigmoid colon mucous fistula, and partial gastrectomy. UC was diagnosed histopathologically, and an ileal pouch-anal anastomosis was performed. An internal fistula can complicate UC;a split surgery is recommended with the possibility of Crohn's disease in the patient.
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Affiliation(s)
- Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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14
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Matsushima S, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Obara N, Hayashi H, Sugita A. [A case of ulcerative colitis in an 86-year-old woman undergoing restorative proctocolectomy with ileal pouch-anal canal anastomosis]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:321-326. [PMID: 32281573 DOI: 10.11405/nisshoshi.117.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 86-year-old woman was diagnosed with ulcerative colitis (UC) in the 1970s. A colonoscopy performed 40 years thereafter revealed a 0-Is lesion in the upper rectum, and pathological examination showed well-differentiated adenocarcinoma. The lesion was diagnosed as colitic cancer based on the pathological findings and the 40-year interval since the diagnosis of total colitis type of UC. The patient was in good overall health with good anal function, based on the clinical examination and manometric study;she wished to undergo sphincter-preserving operation. Restorative proctocolectomy with ileal pouch-anal canal anastomosis that preserved the anal canal mucosa was performed. The postoperative course was good, with a defecation frequency of 4-5 times/day without fecal incontinence, and the patient resumed her preoperative lifestyle with very few alterations. Even in elderly patients aged >80 years who have UC, restorative proctocolectomy is feasible for those in good general health and with relatively good anal function, determined based on the daily defecation activity and anal manometry.
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Affiliation(s)
- Sayuri Matsushima
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | | | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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15
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Arai K. Two cases of esophageal ulcer after surgical treatment for ulcerative colitis. Clin J Gastroenterol 2019; 13:495-500. [PMID: 31863310 DOI: 10.1007/s12328-019-01082-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/11/2019] [Indexed: 01/29/2023]
Abstract
The incidence of postoperative esophageal ulcers has been rarely reported associated with severe ulcerative colitis (UC). We report two cases of esophageal ulcers accompanied by acute necrotizing esophagitis after undergoing surgery for severe UC. Both patients, 47- and 53-year-old, were diagnosed with severe UC and underwent subtotal colectomy with sigmoid mucous fistula and ileostomy. In both cases, they had epigastralgia or digestive track bleeding and upper gastrointestinal endoscopy revealed an esophageal ulcer with acute necrotizing esophagitis accompanied by a black degeneration of mucosa after surgery. Conservative treatments improved the lesions. Esophageal stricture requiring endoscopic dilatation occurred in both cases. An acute UC requiring surgery seems to warrant caution in the merger of esophageal ulcer and acute necrotizing esophagitis.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan.
| | - Akira Sugita
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Kazutaka Koganei
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Kenji Tatsumi
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Ryo Futatsuki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Katsuhiko Arai
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
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16
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Kimura H, Fukushima T. Postoperative functional outcomes and complications of partially intraanal canal anastomosis in stapled ileal pouch anal anastomosis for ulcerative colitis. Int J Colorectal Dis 2019; 34:1317-1323. [PMID: 31175423 DOI: 10.1007/s00384-019-03322-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 02/04/2023]
Abstract
AIM For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall ("Partially intraanal canal anastomosis": PICA) to reduce the remnant mucosa were evaluated. METHODS Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control. RESULTS One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control. CONCLUSION Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.
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Affiliation(s)
- Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan.
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Kyoko Yamada
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
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17
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Obara N, Arai K, Fukushima T. Crohn's disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures. Int J Surg Case Rep 2018; 53:70-74. [PMID: 30390487 PMCID: PMC6215960 DOI: 10.1016/j.ijscr.2018.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023] Open
Abstract
Urachal tumor or umbilical discharge in Crohn’s disease are examined for internal fistula from diseased ileum to urachus. En broc resection with intestinal lesion and urachus is performed with successful outcome. Partial cystectomy is sometimes performed with urinary bladder inflamed.
Introduction: A fistula involving a patent urachus in a patient with Crohn’s disease is rare. Here we report ileourachal fistula formation in two patients with Crohn’ disease. Case presentations: The first patient was a 29-year-old man with Crohn’s disease and ileitis, and the second patient was a 43-year-old man with Crohn’s disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn’s disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn’s disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both. Conclusion: In cases of Crohn’s disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Akira Sugita
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kazutaka Koganei
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Ryo Futatsuki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Nao Obara
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Katsuhiko Arai
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Tsuneo Fukushima
- Matsushima Clinic, 220-0045 3-138 Isecho Nishi-ku, Yokohama City, Japan.
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Jung TS, Hegel TM, Bentzen TW, Egli K, Jessup L, Kienzler M, Kuba K, Kukka PM, Russell K, Suitor MP, Tatsumi K. Accuracy and performance of low-feature GPS collars deployed on bison Bison bison and caribou Rangifer tarandus. Wildlife Biology 2018. [DOI: 10.2981/wlb.00404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Thomas S. Jung
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Troy M. Hegel
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Torsten W. Bentzen
- T. W. Bentzen, Alaska Dept of Fish and Game, Fairbanks, Alaska, 99701-1551, USA
| | - Katherina Egli
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Lars Jessup
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Martin Kienzler
- M. Kienzler and M. P. Suitor, Yukon Dept of Environment, Dawson City, Yukon, Y0B 1G0, Canada
| | - Kazuhisa Kuba
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Piia M. Kukka
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Kyle Russell
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
| | - Michael P. Suitor
- M. Kienzler and M. P. Suitor, Yukon Dept of Environment, Dawson City, Yukon, Y0B 1G0, Canada
| | - Kenji Tatsumi
- T. S. Jung , T. M. Hegel, K. Egli, L. Jessup, K. Kuba, P. M. Kukka, K. Russel
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Tada Y, Morinaga T, Sekine I, Suzuki T, Shimomura I, Tatsumi K, Takiguchi Y, Shimada H, Hiroshima K, Tagawa M. P2.06-34 Inhibition of the HGF/c-Met Pathway for Malignant Mesothelioma with an Intra-Thoracic Injection of the NK4 Expressing Adenoviral Vectors. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Uchino M, Ikeuchi H, Sugita A, Futami K, Watanabe T, Fukushima K, Tatsumi K, Koganei K, Kimura H, Hata K, Takahashi K, Watanabe K, Mizushima T, Funayama Y, Higashi D, Araki T, Kusunoki M, Ueda T, Koyama F, Itabashi M, Nezu R, Suzuki Y. Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 2018; 53:642-651. [PMID: 28884201 DOI: 10.1007/s00535-017-1389-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. METHODS We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. RESULTS A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. CONCLUSION The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
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Affiliation(s)
- Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Kouhei Fukushima
- Laboratory of Gastro Intestinal Tract Reconstruction, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | | | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tsunekazu Mizushima
- Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Funayama
- Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan
| | - Daijiro Higashi
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | - Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Ueda
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Michio Itabashi
- Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Riichiro Nezu
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
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21
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Kuroki H, Koganei K, Tatsumi K, Futatsuki R, Yamada K, Arai K, Obara N, Kimura H, Sugita A, Fukushima T. [Diagnosis and treatment of six patients with Crohn's disease complicated by recto-perineal-urethral fistula]. Nihon Shokakibyo Gakkai Zasshi 2018; 115:108-116. [PMID: 29353847 DOI: 10.11405/nisshoshi.115.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recto-perineal-urethral fistula caused by Crohn's disease is a rare, for which fundamental treatment has not been established yet. We analyzed the clinical characteristics, diagnosis, treatment, and prognosis of six male patients with anorectal lesions caused by Crohn's disease. Three patients were treated with abdominoperineal resection and the other three with rectal excision without anastomosis. Excluding one case, which presented worsening immediately after surgery, symptoms of urethral fistula improved without urethral stenosis, dysuria, or sexual dysfunction. Recto-perineal-urethral fistula is currently treated with various treatment modalities, including colostomy and drug therapy. Although the evaluation of these modalities is required, abdominoperineal resection or rectal excision without anastomosis may be a valuable treatment option because these approaches improve the urethral fistula while sparing the urethra without any significant complications.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kyoko Yamada
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Katsuhiko Arai
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center
| | - Akira Sugita
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
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22
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Matsuda S, Suzuki S, Morimoto K, Aono A, Nishio K, Asakura T, Sasaki Y, Namkoong H, Nishimura T, Ogata H, Hasegawa N, Kurashima A, Ishii M, Tatsumi K, Mitarai S, Goto H. Mycobacterium triplex pulmonary disease with acquired macrolide resistance in immunocompetent patients. Clin Microbiol Infect 2018; 24:671-672. [PMID: 29309938 DOI: 10.1016/j.cmi.2017.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/25/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022]
Affiliation(s)
- S Matsuda
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - S Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - K Morimoto
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
| | - A Aono
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - K Nishio
- Department of Respiratory Medicine, Kawasaki Municipal Ida Hospital, Kanagawa, Japan
| | - T Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Y Sasaki
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - H Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - T Nishimura
- Health Centre, Keio University, Tokyo, Japan
| | - H Ogata
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - N Hasegawa
- Centre for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan
| | - A Kurashima
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - M Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - K Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Mitarai
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - H Goto
- Respiratory Disease Centre, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
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23
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Koganei K, Tatsumi K, Futatsuki R. Surgical treatment for Crohn's disease. Nihon Rinsho 2017; 75:426-432. [PMID: 30566786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenosis with obstruction, internal and external fistulas, severe anorectal disease, and medical failure. The principle of surgery is a minimal resection of intestine responsible for uncontrolled symptoms and repair of involved organs such as intestine, urinary bladder and abdominal wall. Strictureplasties are an effective alternative for stenosis which preserve the intestine. Seton treatment is often employed for complex perianal fistula. Surgery relieves the refractory symptoms well and should be employed at optimal time for the patients with severe symptoms which impaired their quality of lives.
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24
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Obara N, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Arai K, Sugita A, Hayashi H, Fukushima T. A case of Crohn's disease complicated with simultaneous double cancers of the small bowel. Nihon Shokakibyo Gakkai Zasshi 2016; 113:1901-1908. [PMID: 27829602 DOI: 10.11405/nisshoshi.113.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A case of Crohn's disease complicated with simultaneous double cancers of the small bowel is reported. The patient is a 66-year-old man who had suffered from Crohn's disease for 20 years. He underwent surgery to identify the source of repeated episodes of intestinal obstruction. Two short segments of strictures and proximal dilatations were found in the distal ileum. Therefore, we performed an en bloc resection of the two stenotic sections instead of strictureplasty. Histological examination of the resected specimen revealed not only Crohn's disease but also a well-differentiated adenocarcinoma within each of the two strictures. One had invaded to the muscular layer and the other to the subserosal layer. In cases of Crohn's disease with longstanding stenosis, the probability of carcinoma should be considered.
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Affiliation(s)
- Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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25
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H. [Epidemiology of colitis complicating cancer-postoperative cancer in ulcerative colitis and anorectal cancer in Crohn's disease]. Nihon Rinsho 2016; 74:1796-1801. [PMID: 30550684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Colitis complicating inflammatory bowel disease is gradually increasing in Japan. Although the postoperative cancer in ulcerative colitis is rare, careful postoperative follow up is nec- essary. Anorectal cancer including cancer of anal fistulae in Crohn's disease is the most common cancer in Japan and our original cancer surveillance program in which biopsy for anorectal lesion is performed for longstanding anal lesion (more than 10 years) is suggested to be effective for the detection of early cancer.
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26
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Fujioka M, Gi M, Kawachi S, Tatsumi K, Kumada K, Wanibuchi H. Evaluation of in vivo mutagenicity of iAsIII and DMAV in gpt delta F344 rat. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Kimura H, Kunisaki R, Tatsumi K, Koganei K, Sugita A, Endo I. Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis. Dig Surg 2016; 33:182-9. [PMID: 26859413 DOI: 10.1159/000442676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/22/2015] [Indexed: 12/10/2022]
Abstract
AIMS To determine the risk factors of surgical complications and the optimal timing of surgery for patients with severe ulcerative colitis (UC). METHODS One hundred one UC patients who had undergone surgery for a severe indication were retrospectively reviewed. Indications included severe disease unresponsive to medical therapy, massive bleeding, toxic megacolon, and colon perforation. Outcomes were compared based on the occurrence or absence of surgical complications. Patients with severe disease unresponsive to medical therapy were investigated separately to determine the optimal timing of surgery. RESULTS There was no significant difference regarding the use of rescue therapy. The duration of all medical therapy for a severe attack was the only significant factor associated with a surgical complication (p = 0.032). In patients with severe disease unresponsive to medical therapy, the receiver operating characteristic curve analysis showed that 30.5 days was the length of medical therapy after which the risk of surgical complications significantly increased. CONCLUSIONS In patients with severe UC, rescue therapy itself was not related to an increased risk of surgical complications. However, prolonged medical therapy increased the risk of surgical complications. Patients should undergo surgery within 30 days from the institution of medical therapy for a severe attack.
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Affiliation(s)
- Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
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28
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Li Q, Sato A, Shimozato O, Shingyoji M, Tada Y, Tatsumi K, Shimada H, Hiroshima K, Tagawa M. Administration of DNA Encoding the Interleukin-27 Gene Augments Antitumour Responses through Non-adaptive Immunity. Scand J Immunol 2015; 82:320-7. [PMID: 26095954 DOI: 10.1111/sji.12321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/05/2015] [Indexed: 01/05/2023]
Abstract
DNA-mediated immunization of a tumour antigen is a possible immunotherapy for cancer, and interleukin (IL)-27 has diverse functions in adaptive immunity. In this study, we examined whether IL-27 DNA administration enhanced antitumour effects in mice vaccinated with DNA encoding a putative tumour antigen, β-galactosidase (β-gal). An intramuscular injection of cardiotoxin before DNA administration facilitated the exogenous gene expression. In mice received β-gal and IL-27 DNA, growth of β-gal-positive P815 tumours was retarded and survival of the mice was prolonged. Development of β-gal-positive Colon 26 tumours was suppressed by vaccination of β-gal DNA and further inhibited by additional IL-27 DNA administration or IL-12 family cytokines. Nevertheless, a population of β-gal-specific CD8(+) T cells did not increase, and production of anti-β-gal antibody was not enhanced by IL-27 DNA administration. Spleen cells from mice bearing IL-27-expressing Colon 26 tumours showed greater YAC-1-targeted cytotoxicity although CD3(-)/DX5(+) natural killer (NK) cell numbers remained unchanged. Recombinant IL-27 enhanced YAC-1-targeted cytotoxicity of IL-2-primed splenic NK cells and augmented a phosphorylation of signal transducer and activator of transcription 3 and an expression of perforin. These data collectively indicate that IL-27 DNA administration activates NK cells and augments vaccination effects of DNA encoding a tumour antigen through non-adaptive immune responses.
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Affiliation(s)
- Q Li
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chuo-ku, Chiba, Japan.,Department of Immunology, Hebei Medical University, Shijiazhuang, China.,Cell Therapy Center, The 1st Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - A Sato
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chuo-ku, Chiba, Japan.,Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.,Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - O Shimozato
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chuo-ku, Chiba, Japan
| | - M Shingyoji
- Department of Thoracic Diseases, Chiba Cancer Center, Chuo-ku, Chiba, Japan
| | - Y Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - K Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - H Shimada
- Department of Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - K Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Owada-Shinden, Yachiyo, Japan
| | - M Tagawa
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chuo-ku, Chiba, Japan.,Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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29
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Kimura H, Takahashi K, Futami K, Ikeuchi H, Tatsumi K, Watanabe K, Maeda K, Watadani Y, Nezu R, Kameyama H, Nakao S, Kurachi K, Hotokezaka M, Otsuka K, Watanabe T, Ozawa H. Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan. Surg Today 2015; 46:930-8. [PMID: 26467558 DOI: 10.1007/s00595-015-1259-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/17/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of the study is to assess the relationship between the introduction of biologic and immunosuppressant therapy and the number of patients undergoing surgery for ulcerative colitis (UC). METHODS A questionnaire survey about patients undergoing surgery for UC was sent to 26 teaching hospitals throughout Japan. The questionnaire period spanned from 2008 to 2013, to account for the introduction of tacrolimus (2009) and infliximab (2010). RESULTS The total number of patients who underwent surgery was 297, 291, 273, 255, 300, and 305 in 2008, 2009, 2010, 2011 2012, and 2013, respectively. The emergency surgery rate remained stable at 32-34 % each year. The proportion of patients who underwent surgery for cancer increased from 13.8 % in 2008 to 20 % in 2013. In 2013, 41, 38, and 6 % of patients who underwent surgery had received treatment with a biologic, tacrolimus, and cyclosporine, respectively. No institution reported an increase in postoperative complications among patients treated with immunosuppressive drugs. CONCLUSIONS The number of patients undergoing surgery decreased temporarily soon after infliximab and tacrolimus first became widely available, but subsequently increased again. The emergency surgery rate remained unchanged throughout the study period. These data show that immunosuppressive drugs have had little effect on the risk of postoperative complications.
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Affiliation(s)
- Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Kanagawa, Japan.
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hiroki Ikeuchi
- Inflammatory Bowel Disease Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kenji Tatsumi
- Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kiyoshi Maeda
- Department of Surgical Oncology, Osaka City University School of Medicine, Osaka, Japan
| | - Yusuke Watadani
- Department of Surgery, Hiroshima University, Hiroshima, Japan
| | - Riichiro Nezu
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University, Niigata, Japan
| | - Sayumi Nakao
- Second Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyotaka Kurachi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | | | - Koki Otsuka
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Heita Ozawa
- Division of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
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30
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Takei Y, Okamoto S, Kawamura K, Jiang Y, Morinaga T, Shingyoji M, Sekine I, Kubo S, Tada Y, Tatsumi K, Shimada H, Hiroshima K, Yamaguchi N, Tagawa M. Expression of p53 synergistically augments caspases-mediated apoptosis induced by replication-competent adenoviruses in pancreatic carcinoma cells. Cancer Gene Ther 2015; 22:445-53. [DOI: 10.1038/cgt.2015.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 12/16/2022]
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31
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Tatsumi K, Kawano K, Okui H, Shintani H, Nakabe K. Analysis and measurement of dielectrophoretic manipulation of particles and lymphocytes using rail-type electrodes. Med Eng Phys 2015; 38:24-32. [PMID: 26054808 DOI: 10.1016/j.medengphy.2015.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/08/2015] [Accepted: 05/11/2015] [Indexed: 01/09/2023]
Abstract
A particle manipulation and sorting device using the dielectrophoretic (DEP) force is described in this study. The device consists of "ladder-type", "flip-type" and "oblique rail-type" electrode regions. The ladder-type and rail-type electrodes can generate a DEP force distribution that captures the particles, the DEP force of which is negative, in the area located at the center of the electrodes. The ladder-type electrode can align the particles with equal spacing in the streamwise direction. Using the flip-type electrode, which pushes the particles away, in combination with these electrodes, the direction of the particle and timing can be selected with high accuracy, reliability, and response. In the first half of this study, a numerical simulation is carried out to calculate the particle motion and evaluate the performance of the ladder-type electrode. Several models are used to investigate the influences of the non-uniformity of the electric field and the electric interaction of the surface charges and polarizations. Experiments are then carried out to demonstrate the motions of the particles and the sorting reliability. The trajectories and the probability density functions of the particles at the inlet and outlet of the electrode region showed that by using these electrodes the particles can be aligned, sorted, and guided accurately.
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Affiliation(s)
- K Tatsumi
- Department of Mechanical Engineering and Science, Kyoto University, Japan.
| | - K Kawano
- Department of Mechanical Engineering and Science, Kyoto University, Japan
| | - H Okui
- Department of Mechanical Engineering and Science, Kyoto University, Japan
| | - H Shintani
- Department of Mechanical Engineering and Science, Kyoto University, Japan
| | - K Nakabe
- Department of Mechanical Engineering and Science, Kyoto University, Japan
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32
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Yamagata M, Ikeda K, Tsushima K, Iesato K, Abe M, Ito T, Kashiwakuma D, Iwamoto I, Nakagomi D, Sugiyama T, Furuta S, Jayne D, Tatsumi K, Nakajima H. OP0239 Comprehensive Analyses of Lung Abnormalities on Chest Computed Tomography in Patients with Microscopic Polyangiitis before Receiving Immunosuppressive Treatment. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Arai K, Fukushima T. [Recent advances in medical and surgical treatment of ulcerative colitis]. Nihon Geka Gakkai Zasshi 2015; 116:99-103. [PMID: 26050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.
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34
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Ishibe A, Ota M, Kanazawa A, Watanabe J, Tatsumi K, Watanabe K, Godai T, Yamagishi S, Fujii S, Ichikawa Y, Kunisaki C, Endo I. Nutritional management of anastomotic leakage after colorectal cancer surgery using elemental diet jelly. Hepatogastroenterology 2015; 62:30-33. [PMID: 25911862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Anastomotic leakage is major complication of colorectal surgery. Total parenteral nutrition (TPN) and fasting are conservative treatments for leakage in the absence of peritonitis in Japan. Elemental diet (ED) jelly is a completely digested formula and is easily absorbed without secretion of digestive juices. The purpose of this study was to assess the safety of ED jelly in management of anastomotic leakage. METHODOLOGY Six hundred and two patients who underwent elective surgery for left side colorectal cancer from January 2008 to December 2011 were included in the study. Pelvic drainage was performed for all patients. Sixty-three (10.5%) patients were diagnosed with an anastomotic leakage, and of these, 31 (5.2%) without diverting stoma were enrolled in this study. RESULTS Sixteen patients received TPN (TPN group) and 15 patients received ED jelly (ED group). The duration of intravenous infusion was significantly shorter in the ED group than in the TPN group (15 days versus 25 days, P= 0.008). In the TPN group, catheter infection was occurred in 2 patients who required re-insertion of the catheter. CONCLUSION Conservative management of anastomotic leakage after colorectal surgery with ED jelly appears to be a safe and useful approach.
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Tatsumi K, Antoniak S, Monroe DM, Khorana AA, Mackman N. Evaluation of a new commercial assay to measure microparticle tissue factor activity in plasma: communication from the SSC of the ISTH. J Thromb Haemost 2014; 12:1932-4. [PMID: 25186801 DOI: 10.1111/jth.12718] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- K Tatsumi
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ota M, Tatsumi K, Suwa H, Watanabe J, Watanabe K, Osada S, Tanaka K, Shoichi F, Ichikawa Y, Kunisaki C, Endo I. The Effect of Pyridoxine for Prevention of Hand-Foot Syndrome in Colorectal Cancer Patients with Adjuvant Chemotherapy Using Capecitabine: A Randomized Study. Hepatogastroenterology 2014; 61:1008-1013. [PMID: 26158157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED BACKGROUND/Aims: To determine the effect of the pyridoxine for prevention of hand-foot syndrome in colorectal cancer patients with adjuvant chemotherapy using capecitabine. METHODOLOGY Colorectal cancer patients scheduled for capecitabine chemotherapy as adjuvant setting were randomly assigned to with or without concurrent oral pyridoxine (60 mg/d) groups. Patients were monitored whether being a development of National Cancer Institute Common Toxicity Criteria grade 2 or worse HFS until chemotherapy ended. RESULTS Sixty patients were enrolled in this study. Relative dose intensity was 89.5% in total. The median number of chemotherapy cycles to grade 2 or worse HFS was four in both groups. Grade 2 or worse HES developed in 18 (60.0%) of 30 control patients and in 18 (60.0%) of 30 pyridoxine patients. The cumulative dose of capecitabine to grade 2 or worse HFS was not different between the two groups. CONCLUSIONS Pyridoxine is not effective in prevention of capecitabine-associated HFS.
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Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, Ishibe A, Watanabe K, Akiyama H, Ichikawa Y, Morita S, Endo I. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis 2014; 29:343-51. [PMID: 24297037 DOI: 10.1007/s00384-013-1803-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Although obesity is considered as a risk factor for postoperative morbidity in abdominal surgery, its effect on the outcomes of laparoscopic-assisted colectomy (LAC) is still unclear. The technical difficulty and risk factor for postoperative complication in LAC are thought to be influenced by visceral obesity. The aim of this prospective study was to evaluate the impact of visceral fat on the surgical outcomes of LAC. METHODS Between April 2005 and December 2010, consecutive patients with preoperatively diagnosed colon cancer, excluding medium and low rectal cancer, who underwent LAC, were enrolled. Their visceral fat area (VFA) and body mass index (BMI) were prospectively collected. The VFA was assessed by Fat Scan software. The patients were classified into two groups as follows: VFA nonobese with VFA <100 cm(2) (VNO) and VFA obese with VFA ≧100 cm(2) (VO). The predictive factors for surgical complications of LAC were evaluated by univariate and logistic regression analyses. RESULTS A total of 338 consecutive patients were enrolled in this study. Of the 338 patients, 194 (57.4 %) and 138 (42.6 %) were classified into the VNO and VO groups, respectively. Logistic regression analysis showed that high BMI (≧25 kg/m(2)) and VO independently predicted the incidence of overall postoperative complications (p = 0.040 and 0.007, respectively). VO was more highly related to the incidence of overall postoperative complications, anastomotic leakage (p = 0.021), and surgical site infection (SSI) (p = 0.013) than high BMI. CONCLUSIONS VFA is a more useful parameter than BMI in predicting surgical outcomes after LAC.
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Affiliation(s)
- Jun Watanabe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan,
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Ikari J, Inamine A, Yamamoto T, Watanabe-Takano H, Yoshida N, Fujimura L, Taniguchi T, Sakamoto A, Hatano M, Tatsumi K, Tokuhisa T, Arima M. Plant homeodomain finger protein 11 promotes class switch recombination to IgE in murine activated B cells. Allergy 2014; 69:223-30. [PMID: 24286306 DOI: 10.1111/all.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Polymorphisms of the Plant homeodomain finger protein 11 (PHF11) are strongly associated with high serum IgE levels and clinical severity of atopic patients. However, the precise mechanism has not been fully elucidated. We investigated the role of Phf11 in class switch recombination (CSR) to IgE by activated B cells. METHODS We generated Phf11 transgenic (Lckd-Phf11-Tg) mice that express the exogenous murine Phf11 in lymphocytes under the control of distal Lck promoter. We examined IL-4-induced CSR to IgE in activated Lckd-Phf11-Tg B cells in vitro. We analyzed production of ovalbumin (OVA)-specific IgE and nose-scratching symptoms in Lckd-Phf11-Tg mice using an OVA-induced allergic rhinitis model. RESULTS The exogenous Phf11 promoted CSR to IgG1 and IgE in activated B cells with an increase in germ line transcript (GLT) γ1 and GLT ε expression. The exogenous Phf11 augmented transcriptional activity of the GLT γ1 and GLT ε promoters through permissive histone modifications and binding of NF-κB and STAT6. Furthermore, the exogenous Phf11 bound to the GLT ε promoter with increased binding of NF-κB. Silencing of the endogenous Phf11 reduced the frequency of CSR to IgE and GLT ε expression, but not to IgG1 or GLT γ1 expression, in activated B cells. In an allergic rhinitis model, Lckd-Phf11-Tg mice showed a significant increase in the production of OVA-specific IgE and the frequency of nose scratching. CONCLUSION Phf11 accelerates CSR to IgE in activated B cells by increasing the transcriptional activity of GLT ε promoter and contributes to the exacerbation of allergic responses. These findings provide a novel therapeutic target for allergic diseases.
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Affiliation(s)
- J. Ikari
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
- Department of Respirology (B2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - A. Inamine
- Department of Otorhinolaryngology (J2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - T. Yamamoto
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - H. Watanabe-Takano
- Department of Biomedical Science (M14); Graduate School of Medicine; Chiba University; Chiba Japan
| | - N. Yoshida
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - L. Fujimura
- Biomedical Research Center; Chiba University; Chiba Japan
| | - T. Taniguchi
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - A. Sakamoto
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - M. Hatano
- Department of Biomedical Science (M14); Graduate School of Medicine; Chiba University; Chiba Japan
- Biomedical Research Center; Chiba University; Chiba Japan
| | - K. Tatsumi
- Department of Respirology (B2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - T. Tokuhisa
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
| | - M. Arima
- Department of Developmental Genetics (H2); Graduate School of Medicine; Chiba University; Chiba Japan
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Ma G, Kawamura K, Shan Y, Okamoto S, Li Q, Namba M, Shingyoji M, Tada Y, Tatsumi K, Hiroshima K, Shimada H, Tagawa M. Combination of adenoviruses expressing melanoma differentiation-associated gene-7 and chemotherapeutic agents produces enhanced cytotoxicity on esophageal carcinoma. Cancer Gene Ther 2014; 21:31-7. [PMID: 24434574 DOI: 10.1038/cgt.2013.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/23/2013] [Indexed: 11/09/2022]
Abstract
We examined the combinatory antitumor effects of adenoviruses expressing human mda-7/IL-24 gene (Ad-mda-7) and chemotherapeutic agents on nine kinds of human esophageal carcinoma cells. All the carcinoma cells expressed the melanoma differentiation-associated gene-7/interleukin-24 (MDA-7/IL-24) receptor complexes, IL-20R2 and either IL-20R1 or IL-22R1, and were susceptible to Ad-mda-7, whereas fibroblasts were positive only for IL-20R2 gene and resistant to Ad-mda-7-mediated cytotoxicity. Sensitivity of these esophageal carcinoma cells to Ad-mda-7 was however lower than that to Ad expressing the wild-type p53 gene. We thereby investigated a possible combination of Ad-mda-7 and anticancer agents and found that Ad-mda-7 with 5-fluorouracil (5-FU), cisplatin, mitomycin C or etoposide produced greater cytotoxic effects than those by Ad-mda-7 or the agent alone. Half-maximal inhibitory concentration values of the agents in respective cells were decreased by the combination with Ad-mda-7. Cell cycle analyses showed that Ad-mda-7 and 5-FU increased G2/M-phase and S-phase populations, respectively, and the combination augmented sub-G1 populations. Ad-mda-7-treated cells showed cleavages of caspase-8, -9 and -3 and poly (ADP-ribose) polymerase, but the cleavage levels were not different from those of the combination-treated cells. Ad-mda-7 treatments upregulated Akt phosphorylation but suppressed IκB-α levels, whereas 5-FU treatments induced phosphorylation of p53 and extracellular signal-regulated protein kinases 1 and 2. Molecular changes caused by the combination were similar to those by Ad-mda-7 treatments, but the Ad-mda-7-mediated upregulation of Akt phosphorylation decreased with the combination. These data collectively suggest that Ad-mda-7 induced apoptosis despite Akt activation and that the combinatory antitumor effects with 5-FU were produced partly by downregulating the Ad-mda-7-induced Akt activation.
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Affiliation(s)
- G Ma
- 1] Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan [2] Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - K Kawamura
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Y Shan
- 1] Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan [2] Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Okamoto
- 1] Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan [2] Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Q Li
- 1] Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan [2] Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - M Shingyoji
- Department of Thoracic Diseases, Chiba Cancer Center, Chiba, Japan
| | - Y Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - H Shimada
- Department of Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - M Tagawa
- 1] Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan [2] Department of Molecular Biology and Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tatsumi K, Sugita A, Koganei K, Futatsuki R, Kuroki H, Yamada K, Nakao S, Sako M, Kimura H, Arai K, Fukushima T. [Long-term outcomes of ileal pouch-anal canal anastomosis in children with ulcerative colitis]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:2081-2088. [PMID: 24305096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present study investigated the long-term outcomes of restorative proctocolectomy in pediatric patients with ulcerative colitis (UC). We report a series of 25 patients who underwent total proctocolectomy with ileal pouch-anal canal anastomosis (IACA). Surgery was performed for medically intractable colitis and severe colitis in 14 and 11 patients, respectively. Early and late complications were observed in 6 (24%) and 14 (56%) patients, respectively. The long-term quality of life outcomes were satisfactory, including both bowel function and social function. Growth retardation was observed in 6 patients. Five patients exhibited catch-up growth and 3 patients overcame growth retardation. Patients with growth retardation tended to have a younger onset and longer duration of UC, as well as a longer duration and higher total dose of steroid use. In conclusion, the long-term outcomes of pediatric patients with UC undergoing IACA are satisfactory. Furthermore, to minimize the risk of growth retardation, surgery should be performed without delay.
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Affiliation(s)
- Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital
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Ozawa K, Funabashi N, Kataoka A, Yanagawa N, Tanabe N, Tatsumi K, Kobayashi Y. Two dimensional global longitudinal strain of right ventricle using transthoracic echocardiography can detect right ventricular fibrosis confirmed by 320 slice CT in pulmonary hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ozawa K, Funabashi N, Kataoka A, Yanagawa N, Tanabe N, Tatsumi K, Kobayashi Y. Diagnosis of right ventricular myocardial fibrosis using right ventricular myocardial CT attenuation, wall thickness and motion on ECG-gated 320 slice CT in subjects with pulmonary hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ozawa K, Funabashi N, Kataoka A, Yanagawa N, Tanabe N, Tatsumi K, Kobayashi Y. Comprehensive evaluation of right ventricular myocardium on ECG-gated 320 slice CT: morphological and functional information and their prognostic values in subjects with pulmonary hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Matsumoto K, Tanaka H, Tatsumi K, Miyoshi T, Hiraishi M, Kaneko A, Fukuda Y, Onishi T, Kawai H, Hirata K. Left atrial functional reserve in reservoir and passive emptying during dobutamine stress have prognostic impact on cardiac events in patients with dilated cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ozawa K, Funabashi N, Kataoka A, Yanagawa N, Tanabe N, Tatsumi K, Kobayashi Y. Two and 3-dimensional global longitudinal strain of right ventricular free wall using transthoracic echocardiography could be an accurate indicator of 3-dimensional right ventricular systolic function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tatsumi K, Ohashi K, Kanegae K, Shim IK, Okano T. Perioperative haemostatic management of haemophilic mice using normal mouse plasma. Haemophilia 2013; 19:e335-43. [PMID: 23855819 DOI: 10.1111/hae.12211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 12/31/2022]
Abstract
Intense haemostatic interventions are required to avoid bleeding complications when surgical procedures are performed on haemophilia patients. The objective of this study was to establish an appropriate protocol for perioperative haemostatic management of haemophilic mice. We assessed the prophylactic haemostatic effects of normal mouse plasma (NMP) on haemophilia B (HB) mice for both a skin flap procedure and a laparotomy. When 500 μL of NMP was administered to the mice, plasma factor IX (FIX:C) levels peaked at 15.1% immediately after intravenous (IV) administration, at 6.1% 2 h after intraperitoneal (IP) administration and at 2.7% 6 h after subcutaneous administration. Administering 500 μL of NMP via IP or IV 30 min in advance enabled the skin flap procedure to be performed safely without any complications. After the laparotomy procedure, several mice in the IP administration group exhibited lethal bleeding, but all mice survived in the IV administration group. Anti-mouse FIX inhibitors did not develop, even after repetitive administrations of NMP. However, human FIX concentrates, especially plasma-derived concentrates, elicited the anti-human FIX inhibitors. The results show that administering 500 μL of NMP via IV or IP 30 min in advance enables surgical procedures to be safely performed on HB mice, and that IV administration is more desirable than IP if the procedure requires opening of the abdominal wall.
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Affiliation(s)
- K Tatsumi
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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Sugita A, Koganei K, Tatsumi K, Yamada K, Futatsuki R, Kuroki H, Kimura H, Kitou F, Fukushima T. [Management of rectal cancer including cancer in the anal fistula with Crohn's disease]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:396-402. [PMID: 23459533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital, Japan.
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Muto S, Tatsumi K, Rusz J. Parameter-free extraction of EMCD from an energy-filtered diffraction datacube using multivariate curve resolution. Ultramicroscopy 2013; 125:89-96. [DOI: 10.1016/j.ultramic.2012.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 09/15/2012] [Accepted: 09/23/2012] [Indexed: 11/30/2022]
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Kitamura A, Takiguchi Y, Kurosu K, Takigawa N, Saegusa F, Hiroshima K, Nakajima T, Tanabe N, Nakatani Y, Yoshino I, Tatsumi K. Feasibility of cytological diagnosis of sarcoidosis with endobronchial US-guided transbronchial aspiration. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29:82-89. [PMID: 23461069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic value in sarcoidosis if the obtained histological specimen is indicative of a non-caseating epithelioid-cell granuloma. However, EBUS-TBNA in sacoidosis sometimes affords solely cytological specimens. OBJECTIVE To investigate the relevance of EBUS-TBNA cytology specimens in diagnosing sarcoidosis. DESIGN The study population comprised 72 patients with sarcoidosis and 116 patients who had thoracic malignancies and intrathoracic lymphadenopathy but were eventually proven to be metastasis-free (controls). The EBUS-TBNA samples obtained for these subjects were blindly evaluated for the presence of epithelioid cell clusters by 2 independent cytoscreeners and a pathologist. RESULTS Interobserver variability in the specimen grading was minimal. The sensitivity and specificity were 65.3% and 94.0%, respectively. The sensitivity was high, at 87.5%, for the combined cytological and histological examinations. Of 7 controls whose cytological specimens showed epithelioid cell clusters, 3 were also deemed positive for sarcoidosis on histological examination, which indicated that they had sarcoid reaction to cancer. CONCLUSIONS Cytological evaluation of the EBUS-TBNA specimens had higher sensitivity than histological evaluation alone for intrathoracic lymphadenopathy due to sarcoidosis. It should be recognized, however, that up to 6% of patients with thoracic malignancy may have sarcoid reaction in non-metastatic lymph nodes.
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Affiliation(s)
- A Kitamura
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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Tanaka H, Matsumoto K, Hiraishi M, Miyoshi T, Kaneko A, Tsuji T, Ryo K, Fukuda Y, Tatsumi K, Yoshida A, Kawai H, Hirata KI. Multidirectional left ventricular performance detected with three-dimensional speckle-tracking strain in patients with chronic right ventricular pacing and preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2012; 13:849-56. [DOI: 10.1093/ehjci/jes056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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