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Higashiyama T, Sugino K, Hara H, Ito KI, Nakashima N, Onoda N, Tori M, Katoh H, Kiyota N, Ota I, Suganuma N, Hibi Y, Nemoto T, Takahashi S, Yane K, Ioji T, Kojima S, Kaneda H, Sugitani I, Tahara M. Phase II study of the efficacy and safety of lenvatinib for anaplastic thyroid cancer (HOPE). Eur J Cancer 2022; 173:210-218. [PMID: 35932627 DOI: 10.1016/j.ejca.2022.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 04/01/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Anaplastic thyroid cancer (ATC) is a rare and highly aggressive cancer for which effective systemic therapy has long been sought. Here, we assessed the efficacy and safety of lenvatinib in patients with unresectable ATC. PATIENTS AND METHODS The study was investigator-initiated and conducted under a multicenter, open-label, nonrandomized, phase II design. Eligibility criteria included pathologically proven ATC; unresectable measurable lesion as defined by RECIST 1.1; age 20 years or older; ECOG PS 0-2; and adequate organ function. The primary end-point was overall survival. Secondary end-points were progression-free survival, objective response rate, disease control rate, clinical benefit rate, and safety. RESULTS Of 52 patients enrolled from 17 institutions, 42 patients who were confirmed to have ATC were included for efficacy analysis, and 50 patients were included for safety analysis. The estimated 1-year overall survival rate was 11.9% (95% CI, 4.4%-23.6%). One patient (2.4%) achieved complete response, four patients (9.5%) partial response, and 26 patients (61.9%) stable disease, including nine patients (21.4%) who demonstrated durable stable disease, giving an objective response rate of 11.9%, disease control rate of 73.8%, and clinical benefit rate of 33.3%. Adverse events of any grade were observed in 45 patients (90.0%), the most common of which of any grade included loss of appetite (48.0%), fatigue (48.0%), hypertension (44.0%), and palmar-plantar erythrodysesthesia syndrome (26.0%). CONCLUSION Lenvatinib treatment resulted in disappointing survival for unresectable ATC patients. Although the number of responders was small, responses were durable, indicating that lenvatinib may be beneficial for selected patients. Further investigation to identify suitable candidates for lenvatinib monotherapy is needed.
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Affiliation(s)
| | | | - Hisato Hara
- Department of Breast and Endocrine Surgery, Tsukuba University, Tsukuba, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Noriaki Nakashima
- Division of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe, Japan; Department of Breast & Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naomi Kiyota
- Oncology/Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Ichiro Ota
- Nara Medical University, Kashihara, Japan
| | | | - Yatsuka Hibi
- Fujita Health University Hospital, Toyoake, Japan
| | - Toshimitsu Nemoto
- Department of Otorhinolaryngology, Japanese Red Cross Narita Hospital, Chiba, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Katsunari Yane
- Department of Otolaryngology-Head and Neck Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Tetsuya Ioji
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Shinsuke Kojima
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Hideaki Kaneda
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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2
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Brose MS, Smit JWA, Lin CC, Tori M, Bowles DW, Worden F, Shen DHY, Huang SM, Tsai HJ, Alevizaki M, Peeters RP, Takahashi S, Rumyantsev P, Guan R, Babajanyan S, Ozgurdal K, Sugitani I, Pitoia F, Lamartina L. Multikinase Inhibitors for the Treatment of Asymptomatic Radioactive Iodine-Refractory Differentiated Thyroid Cancer: Global Noninterventional Study (RIFTOS MKI). Thyroid 2022; 32:1059-1068. [PMID: 35950621 DOI: 10.1089/thy.2022.0061] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Sorafenib and lenvatinib are multikinase inhibitors (MKIs) approved for patients with radioactive iodine-refractory (RAI-R) differentiated thyroid cancer (DTC). There is no consensus on when to initiate MKI treatment. The objective of this study was to evaluate time to symptomatic progression (TTSP) in patients with RAI-R DTC for whom the decision to treat with an MKI was made at study entry. Methods: International, prospective, open-label, noninterventional cohort study (NCT02303444). Eligible patients had asymptomatic progressive RAI-R DTC, with ≥1 lesion ≥1 cm in diameter and life expectancy ≥6 months. The decision to treat with an MKI was at the treating physician's discretion. Primary endpoint was TTSP from study entry. Two cohorts were evaluated: patients for whom a decision to initiate an MKI was made at study entry (Cohort 1) and patients for whom there was a decision not to initiate an MKI at study entry (Cohort 2). Cohorts were compared descriptively. Results: The full analysis set (FAS) comprised 647 patients. The median duration of observation was 35.5 months (range <1-59.4). Of 344 MKI-treated patients, 209 received sorafenib, 191 received lenvatinib, and 19 received another MKI at some point. Median TTSP was 55.4 months (interquartile range [IQR] 18.6-not estimable [NE]) overall, 55.4 months (IQR 15.2-NE) in Cohort 1 (n = 169), and 51.4 months (IQR 20.0-NE) in Cohort 2 (n = 478). TTSP ≥36 months was achieved in 64.5% of patients overall, 59.5% of patients in Cohort 1, and 66.4% of patients in Cohort 2. Median overall survival from classification as RAI-R was 167 months and median progression-free survival from start of MKI therapy was 19.2 months and from start of sorafenib therapy 16.7 months. Among sorafenib-treated patients, 70% had dose modifications, 35% had a dose reduction, 89% experienced ≥1 treatment-emergent adverse event (TEAE), and 82% experienced ≥1 drug-related TEAE. Conclusions: This real-world study provides valuable insight into outcomes in patients with asymptomatic, progressive RAI-R DTC under observation or receiving MKI treatment. TTSP in the FAS provides insight into the current prognosis for patients with RAI-R DTC in the era of MKIs. Registration: NCT02303444.
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Affiliation(s)
- Marcia S Brose
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Tennoujiku, Osaka, Japan
| | - Daniel W Bowles
- Department of Medicine, Division of Medical Oncology, University of Colorado, Aurora, Colorado, USA
| | - Francis Worden
- Department of Medical Oncology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Hueng-Yuan Shen
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Asian Institute of Thyroid Care, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hui-Jen Tsai
- Asian Institute of Thyroid Care, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Maria Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Pavel Rumyantsev
- Department of Nuclear Medicine, Endocrinology Research Center, Moscow, Russian Federation
| | - Rongjin Guan
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | | | | | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Fabian Pitoia
- Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Livia Lamartina
- Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology, Villejuif, France
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Takahashi S, Tahara M, Ito K, Tori M, Kiyota N, Yoshida K, Sakata Y, Yoshida A. Correction to: Safety and Effectiveness of Lenvatinib in 594 Patients with Unresectable Thyroid Cancer in an All-Case Post-Marketing Observational Study in Japan. Adv Ther 2021; 38:4989-4993. [PMID: 34331259 DOI: 10.1007/s12325-021-01829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Makoto Tahara
- Department of Head and Neck Cancer Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Koichi Ito
- Ito Hospital, 4-3-6 Jingu-mae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, 10-31, Kitayamacho, Tennouji-ku, Osaka, 543-0035, Japan
| | - Naomi Kiyota
- Oncology/Hematology, Kobe University Hospital Cancer Center, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | | | - Yukinori Sakata
- Eisai Co. Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo, 112-8088, Japan
| | - Akira Yoshida
- Kanagawa Health Service Association, Nihon-odori bldg. 58 Nihon-odori, Naka-ku, Yokohama, 231-0021, Japan
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Takaichi S, Tomimaru Y, Kobayashi S, Takeda Y, Nakahira S, Tsujie M, Yukawa M, Shimizu J, Murakami M, Miyamoto A, Asaoka T, Sakai K, Morimoto O, Tori M, Yamamoto T, Fukuchi N, Nagano H, Doki Y, Eguchi H. Drainage after laparoscopic liver surgery in the CSGO-HBP-004 study: propensity score-matched analysis. Br J Surg 2021; 108:e57-e58. [PMID: 33711105 DOI: 10.1093/bjs/znaa018] [Citation(s) in RCA: 1] [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: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- S Takaichi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Tomimaru
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - S Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - S Nakahira
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan.,Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - M Tsujie
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan.,Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - M Yukawa
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - J Shimizu
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.,Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - M Murakami
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.,Department of Surgery, Itami City Hospital, Itami, Japan
| | - A Miyamoto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - T Asaoka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - K Sakai
- Department of Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - O Morimoto
- Department of Surgery, Ikeda City Hospital, Ikeda, Japan
| | - M Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - T Yamamoto
- Department of Surgery, Sakai City Medical Center, Sakai, Japan.,Tamesan Clinic, Toyonaka, Japan
| | - N Fukuchi
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - H Nagano
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - H Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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5
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Takahashi S, Tahara M, Ito K, Tori M, Kiyota N, Yoshida K, Sakata Y, Yoshida A. Safety and Effectiveness of Lenvatinib in 594 Patients with Unresectable Thyroid Cancer in an All-Case Post-Marketing Observational Study in Japan. Adv Ther 2020; 37:3850-3862. [PMID: 32676927 PMCID: PMC7444395 DOI: 10.1007/s12325-020-01433-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lenvatinib is approved in Japan for treating patients with all histological subtypes of unresectable thyroid cancer, including differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC), and anaplastic thyroid cancer (ATC). However, safety and effectiveness data are limited in Japanese patients. Therefore, this prospective, post-marketing observational study evaluated, in daily clinical practice, the safety and effectiveness of lenvatinib in Japanese patients with unresectable thyroid cancer. METHODS All patients with unresectable thyroid cancer first treated with lenvatinib between May and November 2015 were registered. Patients were orally administered lenvatinib and followed up for 12 months. The endpoints included adverse drug reactions (ADRs), overall survival (OS), overall response rate (ORR), and time-to-treatment failure. Post hoc Cox multivariate analyses were performed to assess prognostic factors associated with the 12-month OS rate. RESULTS Of 629 registered patients, 594 were included in the analysis. A total of 442 patients (74.4%) had DTC, 28 (4.7%) had MTC, and 124 (20.9%) had ATC. Hypertension, proteinuria, and palmar-plantar erythrodysesthesia syndrome were the most frequently reported ADRs across all histological subtypes. The median OS was 101.0 days in patients with ATC which was not reached in patients with DTC and patients with MTC, with 12-month OS rates of 15.6%, 75.7%, and 83.0%, respectively. The ORRs were 59.2%, 45.0%, and 43.8% among 368 patients with DTC, 20 with MTC, and 105 with ATC, respectively. Multivariate analyses revealed that Eastern Cooperative Oncology Group performance status (ECOG PS), tumor size, the presence of tumor invasion, and body weight were baseline prognostic factors affecting OS in patients with DTC, while ECOG PS and the presence of liver metastasis were prognostic factors in patients with ATC. CONCLUSION Lenvatinib demonstrated an acceptable safety profile for patients with thyroid cancer in a real-world setting in Japan. The safety profile and effectiveness findings for lenvatinib in this study were consistent with those from previous clinical trials, irrespective of histological subtype.
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Brose M, Smit J, Lin CC, Tori M, Bowles D, Worden F, Shen DY, Huang SM, Alevizaki M, Peeters R, Takahashi S, Rumyantsev P, Guan R, Babajanyan S, Ozgurdal K, Sugitani I, Pitoia F, Lamartina L. 1918P Final analysis of RIFTOS MKI, a global, non-interventional study assessing the use of multikinase inhibitors (MKIs) for the treatment of patients with asymptomatic radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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7
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Takahashi S, Tahara M, Ito K, Tori M, Sakata Y, Ishii M, Yoishida A. Efficacy and safety of lenvatinib in 124 Japanese patients with anaplastic thyroid cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz338.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Ito T, Tori M, Hashigaki S, Kimura N, Sato K, Ohki E, Sawaki A, Okusaka T. Efficacy and safety of sunitinib in Japanese patients with progressive, advanced/metastatic, well-differentiated, unresectable pancreatic neuroendocrine tumors: final analyses from a Phase II study. Jpn J Clin Oncol 2019; 49:354-360. [PMID: 30834940 PMCID: PMC6452620 DOI: 10.1093/jjco/hyz009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/15/2018] [Revised: 10/18/2018] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background In an interim analysis of a Phase II trial in Japanese patients with pancreatic neuroendocrine tumors (panNETs), sunitinib demonstrated antitumor activity with an objective response rate (ORR) of 50% (95% confidence interval [CI], 21–79) and a median progression-free survival (PFS) of 16.8 months (95% CI, 9.3–26.2). Here, we report the final analyses of efficacy and safety, as well as additional analyses, from this Phase II study. Methods This was a multicenter, open-label, Phase II trial (NCT01121562) of sunitinib in Japanese patients with panNETs. Patients received oral sunitinib 37.5 mg/day on a continuous daily dosing schedule. Dose modifications were permitted. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included ORR, PFS, overall survival (OS), safety and pharmacokinetics. Results Of 12 patients enrolled and treated, all discontinued treatment—the majority (n = 8) owing to disease progression. Most patients were male (n = 8), <65 years of age (n = 11) and had a non-functional tumor (n = 10). The median (range) number of days on drug was 323.5 (22–727). The CBR (95% CI) was 75.0% (42.8–94.5). ORR (95% CI) was 50.0% (21.1–78.9). Median (95% CI) PFS was 16.8 (9.3–26.2) months; however, median (95% CI) OS was not reached (22.0–not estimable). Most common adverse events (AEs; all-causality) were diarrhea (n = 10; 83.3%), hand-foot syndrome (n = 8; 66.7%) and hypertension (n = 8; 66.7%). Conclusions These results support the efficacy and safety of sunitinib in Japanese patients with panNETs. Appropriate AE management through dose reduction and interruption may prolong sunitinib treatment and maximize its efficacy.
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Affiliation(s)
- Tetsuhide Ito
- Department of Hepato-Biliary-Pancreatic Medicine, Fukuoka Sanno Hospital, International University of Health and Welfare, Tokyo 814-0001, Japan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | | | | | | | | | - Akira Sawaki
- Department of Medical Oncology, Fujita Health University, Aichi 470-1192, Japan
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
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Tori M, Shimo T. Long-term efficacy of lenvatinib for recurrent papillary thyroid carcinoma after multimodal treatment and management of complications: a case report. BMC Cancer 2018; 18:698. [PMID: 29954369 PMCID: PMC6022486 DOI: 10.1186/s12885-018-4612-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/16/2017] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background The advent of tyrosine kinase inhibitors (TKIs) has changed the treatment of RAI refractory, unresectable recurrent differentiated thyroid cancer (DTC), which was formerly treated with multidisciplinary remedies. Case presentation Here we describe the case of a 64-year-old woman who underwent total thyroidectomy with tracheal resection and suffered from a recurrent tumor in the neck and multiple lung and bone metastases 3 and 11 months, respectively, after the operation. Multimodal therapies, RI (I-131), EBRT, and taxane-based chemotherapy were ineffective, and sorafenib was started as a TKI. However, because of disease progression, sorafenib was replaced by lenvatinib after 9 months. The effect of lenvatinib has continued for more than 1 year and 9 months, and the patient has well survived. During the treatment period, a tracheal pin-hole fistula suddenly emerged, which was naturally cured by the temporary cessation of lenvatinib. Adverse events such as hypertension, proteinuria, and diabetes as innate complications have been successfully managed until the present according to our institute regulations. Conclusions Even where multimodal treatment was ineffective, lenvatinib was suggested to be an alternative treatment option for RAI refractory recurrent DTC and patient could have a chance to be controlled successfully.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan.
| | - Toshirou Shimo
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan
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10
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Tori M, Shimo T, Yoshidome K. Novel operative approach to double primary cancers of the breast and thyroid and its effects on cosmesis and the accuracy of follow-up examinations. Asian J Endosc Surg 2018; 11:185-188. [PMID: 29869842 DOI: 10.1111/ases.12426] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/09/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Abstract
For the treatment of double primary cancer of the breast and thyroid, endoscopic thyroidectomy might be an excellent option in terms of cosmesis; however, it may not offer curability, and it makes the accuracy of follow-up examinations difficult. The postoperative scars after endoscopic thyroidectomy may modify the estimation of recurrence. To achieve improve cosmesis and the accuracy of follow-up examination, we developed a novel method for thyroid surgery: hybrid-type endoscopic thyroidectomy (HET). Here we report two cases of double primary cancer, one synchronous and the other metachronous. HET lobectomy and HET total thyroidectomy were performed in combination with some modifications of breast surgery. In each case, the postoperative course was uneventful, and cosmetic satisfaction was very high. Furthermore, there were no problems during the follow-up period. Based on our results, HET could become a standardized treatment of double primary cancers.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toshirou Shimo
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
| | - Katsuhide Yoshidome
- Department of Endocrine Surgery and Department of Breast Surgery, Osaka Police Hospital, Osaka, Japan
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11
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Yasuoka H, Nakamura Y, Yoshida KI, Shimo T, Tori M, Matsui Y, Sakamaki Y, Tsujimoto M. A rare case of ectopic papillary thyroid carcinoma transformed into squamous cell carcinoma. Pathol Int 2018; 68:246-250. [PMID: 29451347 DOI: 10.1111/pin.12649] [Citation(s) in RCA: 3] [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] [Received: 10/10/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
A rare case of a metastatic ectopic papillary thyroid carcinoma (PTC) of the lung that transformed into a squamous cell carcinoma (SCC) that resembles pulmonary SCC is reported. A subcutaneous ectopic PTC in the left anterior neck area, together with a normal thyroid gland, were excised. The ectopic PTC showed thyroglobulin, TTF-1 and PAX-8 immunoreactivity and a BRAF V600E mutation. During the post-operative follow-up period, a rapidly growing 2 cm nodular lesion in the lower left lobe of the lung was detected. The lung tumor consisted of solid sheets and nests of squamous cells but without the nuclear features of PTC. Neither papillary nor follicular structures of cancer cells were identified. Carcinoma cells were positive for TTF-1, PAX-8, p40, CK14, and p63, while showing a high Ki-67 labeling index and a BRAF V600E mutation. These results support our interpretation of a PTC that originated from ectopic thyroid tissue in the left anterior neck and that developed a lung metastasis showing squamous cell differentiation.
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Affiliation(s)
| | - Yasushi Nakamura
- Department of Pathology, Osaka Cytopathological Laboratory, Osaka
| | - Ken-Ichi Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo
| | - Toshiro Shimo
- Department of Endocrine Surgery, Osaka Police Hospital
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital
| | - Yuuki Matsui
- Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yasushi Sakamaki
- Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
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12
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Yasuoka H, Nakamura Y, Hirokawa M, Yoshida KI, Anno K, Tori M, Tsujimoto M. A rare case of poorly differentiated thyroid carcinoma probably arising from a nodular goiter. BMC Clin Pathol 2017; 17:9. [PMID: 28588422 PMCID: PMC5457633 DOI: 10.1186/s12907-017-0048-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/01/2017] [Accepted: 05/25/2017] [Indexed: 02/01/2023] Open
Abstract
Background Some poorly differentiated thyroid carcinomas (PDTC) arise from pre-existing, well-differentiated carcinomas of follicular cell origin; however, others most likely arise de novo. The case of a PDTC adjacent to a pre-existing nodular goiter is very rare. Case presentation A patient had a PDTC, a widely invasive, cellular tumor with cells that lacked the nuclear features of a papillary thyroid carcinoma. Carcinoma cells were arranged in trabecular, solid, and microfollicular histological patterns and displayed high mitotic activity. A nodule partially encapsulated in a thick fibrous capsule was found adjacent to the PDTC. The nodule was composed of small or dilated follicles, without papillary carcinoma-like nuclear features, that were consistent with a nodular goiter. The PDTC showed a high Ki-67 labeling index and an NRAS gene mutation (codon 61, Q61K). Conclusion These results support our diagnosis of a PDTC, probably arising from a nodular goiter.
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Affiliation(s)
- Hironao Yasuoka
- Department of Pathology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka City, Osaka, 543-0035 Japan
| | - Yasushi Nakamura
- Department of Pathology, Osaka Cytopathological Laboratory, 2-2-26, Kunijima, Higashiyodogawa-ku, Osaka City, Osaka, 533-0024 Japan
| | - Mitsuyoshi Hirokawa
- Department of Pathology, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe City, Hyogo 650-0011 Japan
| | - Ken-Ichi Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Kana Anno
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka City, Osaka, 543-0035 Japan
| | - Masayuki Tori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka City, Osaka, 543-0035 Japan
| | - Masahiko Tsujimoto
- Department of Pathology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka City, Osaka, 543-0035 Japan
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Brose MS, Smit J, Lin CC, Pitoia F, Fellous M, DeSanctis Y, Schlumberger M, Tori M, Sugitani I. Timing of multikinase inhibitor initiation in differentiated thyroid cancer. Endocr Relat Cancer 2017; 24:237-242. [PMID: 28270435 PMCID: PMC5446590 DOI: 10.1530/erc-17-0016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/07/2017] [Indexed: 12/14/2022]
Abstract
There are limited treatment options for patients with radioactive iodine refractory, progressive differentiated thyroid cancer. Although there is consensus that multikinase inhibitor therapy should be considered in patients with progressive disease with considerable tumor load or symptomatic disease, uncertainty exists on the optimal timing to treat with a multikinase inhibitor, especially for asymptomatic patients. RIFTOS MKI is an international, prospective, open-label, multicenter, noninterventional study with the primary objective to compare the time to symptomatic progression from study entry in asymptomatic patients with radioactive iodine refractory, progressive differentiated thyroid cancer for whom there is a decision to initiate multikinase inhibitors at study entry (cohort 1) with those for whom there is a decision to not initiate multikinase inhibitors at study entry (cohort 2). Secondary endpoints are overall survival and progression-free survival, which will be compared between cohorts 1 and 2. Additional secondary endpoints are postprogression survival from time of symptomatic progression, duration of and response to each systemic treatment regimen and dosing of sorafenib throughout the treatment period. Asymptomatic, multikinase inhibitor-naive patients aged ≥18 years with histologically/cytologically documented differentiated thyroid cancer that is radioactive iodine refractory are eligible. Patients may receive any therapy for differentiated thyroid cancer, including sorafenib or other multikinase inhibitors if indicated and decided on by the treating physician. In total, 700 patients are estimated to be enrolled from >20 countries. Final analysis will be performed once the last enrolled patient has been followed up with for 24 months (ClinicalTrials.gov identifier: Nbib2303444).
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Affiliation(s)
- Marcia S Brose
- Department of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Stellar-Chance Laboratories Mezzanine, Philadelphia, Pennsylvania, USA
| | - Johannes Smit
- Department of Internal MedicineRadboud University Nijmegen Medical Center, 463 General Internal Medicine, Nijmegen, Netherlands
| | - Chia-Chi Lin
- Department of OncologyNational Taiwan University Hospital, Taipei, Taiwan
| | - Fabian Pitoia
- Division of EndocrinologyHospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marc Fellous
- Bayer HealthCare PharmaceuticalsWhippany, New Jersey, USA
| | | | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine OncologyInstitut Gustave Roussy and Université Paris Saclay, Villejuif, France
| | - Masayuki Tori
- Department of Endocrine SurgeryOsaka Police Hospital, Tennoujiku, Osaka, Japan
| | - Iwao Sugitani
- Department of Endocrine SurgeryNippon Medical School Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan
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Ito T, Okusaka T, Tori M, Hashigaki S, Kimura N, Ohki E, Sawaki A, Nishida T, Yamao K, Imamura M. Final phase II results for sunitinib (SU) in Japanese pts with well-differentiated pancreatic neuroendocrine tumor (NET). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv466.02] [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: 11/13/2022] Open
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Wakasugi M, Tori M, Shimizu J, Kim YK, Noda T, Dono K, Takeda Y, Yamamoto T, Oshima S, Morimoto Y, Asaoka T, Eguchi H, Nagano H, Mori M, Doki Y. Efficacy of preoperative dexamethasone for postoperative nausea and vomiting after laparoscopic cholecystectomy: a large-scale, multicenter, randomized, double-blind, placebo-controlled trial in Japan. J Hepatobiliary Pancreat Sci 2015; 22:802-9. [DOI: 10.1002/jhbp.285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/17/2015] [Indexed: 12/23/2022]
Affiliation(s)
| | - Masayuki Tori
- Department of Surgery; Osaka Police Hospital; Osaka Japan
| | - Junzo Shimizu
- Department of Surgery; Osaka Rosai Hospital; Sakai Japan
| | - Yong Kook Kim
- Department of Surgery; Kaizuka City Hospital; Kaizuka Japan
| | - Takehiro Noda
- Department of Surgery; Toyonaka Municipal Hospital; Toyonaka Japan
| | - Keizo Dono
- Department of Surgery; Toyonaka Municipal Hospital; Toyonaka Japan
| | - Yutaka Takeda
- Department of Surgery; Kansai Rosai Hospital; Amagasaki Japan
| | | | | | | | | | - Hidetoshi Eguchi
- Department of Surgery, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Hiroaki Nagano
- Department of Surgery, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Masaki Mori
- Department of Surgery, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Yuichiro Doki
- Department of Surgery, Graduate School of Medicine; Osaka University; Osaka Japan
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Yasuoka H, Tsujimoto M, Hirokawa M, Tori M, Nakahara M, Miyauchi A, Kodama R, Sanke T, Nakamura Y. Podocalyxin expression in undifferentiated thyroid carcinomas. J Clin Pathol 2015; 61:1228-9. [PMID: 18955579 DOI: 10.1136/jcp.2008.059956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wakasugi M, Masuzawa T, Tei M, Omori T, Ueshima S, Tori M, Akamatsu H. Single-incision laparoscopic totally extraperitoneal obturator hernia repair in a patient on antiplatelet therapy: a case report. Asian J Endosc Surg 2015; 8:83-6. [PMID: 25598062 DOI: 10.1111/ases.12132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Received: 02/23/2014] [Revised: 06/06/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Abstract
An 83-year-old woman who complained of right lower limb discomfort was diagnosed with a right obturator hernia by CT scan. On examination, she had a soft and flat abdomen without signs of peritoneal irritation. The Howship-Romberg sign was present. She had a history of vasospastic angina and paroxysmal supraventricular tachycardia, and took aspirin and dipyridamole until she was admitted to the hospital. Exploratory laparoscopy identified a spontaneously reduced small bowel from the right obturator canal, but there were no signs of ischemic and necrotic bowel. The patient underwent SILS for totally extraperitoneal obturator hernia repair without a dissection balloon. The patient recovered without perioperative complications such as hemorrhage and thrombotic episodes. She remains well, and CT scans showed no signs of obturator hernia recurrence at the 7-month follow-up.
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Wakasugi M, Ueshima S, Tei M, Tori M, Yoshida KI, Tsujimoto M, Akamatsu H. Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case. Int J Surg Case Rep 2015; 8C:137-40. [PMID: 25679307 PMCID: PMC4353964 DOI: 10.1016/j.ijscr.2015.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 01/08/2023] Open
Abstract
Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors. This report is the first to describe multiple hepatic sclerosing hemangiomas treated by laparoscopic surgery.
Introduction Hepatic sclerosing hemangioma is a very rare benign tumor, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. We report here a rare case of multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor that was successfully treated using laparoscopic surgery. Presentation of case A 67-year-old woman with multiple liver tumors underwent single-incision laparoscopic sigmoidectomy under a diagnosis of advanced sigmoid cancer with multiple liver metastases. Examination of surgical specimens of sigmoid colon revealed moderately differentiated adenocarcinoma invading the serosa, and no lymph node metastases. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 remained within normal limits throughout the course. Two months after sigmoidectomy, the patient underwent laparoscopic partial hepatectomy of S1 and S6 of the liver and cholecystectomy. Histopathological examination showed that the tumors mainly comprised hyalinized tissue and collagen fibers with sporadic vascular spaces on hematoxylin and eosin-stained sections, yielding a diagnosis of multiple hepatic sclerosing hemangioma. No evidence of recurrence has been seen as of 21 months postoperatively. Discussion Differentiating multiple sclerosing hemangiomas from metastatic liver tumors was quite difficult because the radiological findings were closely compatible with liver metastases. Laroscopic hepatectomy provided less blood loss, a shorter duration of hospitalization, and good cosmetic results. Conclusion Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors.
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Affiliation(s)
| | | | - Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Wakasugi M, Yamamoto Y, Jo S, Takada S, Matsumiya K, Tori M, Akamatsu H. Totally extraperitoneal inguinal hernia repair during extraperitoneal laparoscopic radical prostatectomy: Report of a case. Int J Surg Case Rep 2014; 6C:100-3. [PMID: 25528036 PMCID: PMC4334950 DOI: 10.1016/j.ijscr.2014.11.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/20/2014] [Accepted: 11/20/2014] [Indexed: 11/09/2022] Open
Abstract
TEP combined with ELRP appears to be a rational procedure and easy to perform. The incidence of complications related to either TEP or ELRP might not be increased. TEP combined with ELRP might be safely performed for recurrent inguinal hernia after non-mesh hernioplasty.
Introduction The incidence of prostate cancer is increasing, and inguinal hernias are common in the age group of men with prostate cancer. Furthermore, inguinal hernias are now considered to be one of the long-term complications of radical prostatectomy. In this report, we present our experience with the performance of totally extraperitoneal inguinal hernia repair (TEP) along with extraperitoneal laparoscopic radical prostatectomy (ELRP). Presentation of case A 66-year-old man with prostate cancer and bilateral inguinal hernias was admitted to our hospital for surgery. He had a history of right inguinal hernioplasty without mesh placement and ascending colon diverticulitis. With a diagnosis of prostate cancer and bilateral inguinal hernia, concomitant TEP after ELRP was safely performed. Discussion TEP combined with ELRP appears to be a rational procedure and easy to perform. The incidence of complications related to either TEP or ELRP might not be increased. TEP combined with ELRP might be safely performed for recurrent inguinal hernia after non-mesh hernioplasty. Conclusion TEP combined with ELRP might be of use in prostate cancer patients with inguinal hernias.
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Affiliation(s)
- Masaki Wakasugi
- Departments of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka 543-0035, Japan.
| | | | - Sayaka Jo
- Departments of Surgery and Urology, Osaka Police Hospital, Osaka, Japan
| | - Shingo Takada
- Departments of Surgery and Urology, Osaka Police Hospital, Osaka, Japan
| | - Kiyomi Matsumiya
- Departments of Surgery and Urology, Osaka Police Hospital, Osaka, Japan
| | - Masayuki Tori
- Departments of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka 543-0035, Japan
| | - Hiroki Akamatsu
- Departments of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka 543-0035, Japan
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Tori M. Hybrid-type endoscopic thyroidectomy (HET: Tori's method) for differentiated thyroid carcinoma including invasion to the trachea. Surg Endosc 2013; 28:902-9. [PMID: 24263457 PMCID: PMC3931932 DOI: 10.1007/s00464-013-3245-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022]
Abstract
Background Endoscopic thyroidectomy (ET) or robotic thyroidectomy is yet to be applied to thyroid carcinoma invasive to the trachea and to wide lymph node node metastasis. On the other hand, small-incision thyroidectomy lacks sufficient working space and clear vision. The author has newly developed hybrid-type endoscopic thyroidectomy (HET) to overcome these problems. Methods From March 2011 to February 2012, HET was performed for 85 patients. Clinicopathologic characteristics were analyzed. To evaluate the superiority of HET for malignancy representatively, conventional lobectomy with central compartment node dissection (CCND) performed 1 year previously was compared with HET. In lobectomy and node dissection, a single skin incision (1.5 cm) is made above the clavicle, with a port incision (5 mm) made 3 cm below the clavicle. Then CCND is performed directly through the incision by lifting up the isthmus. To obtain sufficient working space for the lobectomy, the strap muscles are taped and pulled toward the head, then hung by the cradle. The thyroid lobe is retracted to the midline with a retractor, followed by isolation of the inferior laryngeal nerve and transection of the inferior thyroid vessels with the monitor of the scope. Lateral lymph nodes dissection can be performed at the same time, if necessary. In total thyroidectomy, the same procedure is performed at the opposite side. The scalpel can be used to shave through each incision in case of tracheal invasion. Results Of the 85 cases, 62 were malignant, involving papillary thyroid carcinoma (PTC), and 23 were benign. Total thyroidectomy was performed for 22 of the PTC cases and CCND for 49 of the cases. Shaving for tracheal invasion was performed for eight patients. No mortality, complications, recurrence, or metastasis was found 1–2 years after the operation. Compared with conventional thyroidectomy, HET was superior in blood loss, visual analog scale, and postoperative hospital stay. Conclusion The author’s method (Tori’s method) might be less invasive, cosmetically excellent, and moreover, safe and feasible for differentiated thyroid carcinoma including invasion to the trachea.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035, Japan,
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Wakasugi M, Tori M, Akamatsu H, Ueshima S, Omori T, Tei M, Masuzawa T, Tsujimoto M, Nishida T. Laparoscopic distal pancreatectomy for multiple epithelial cysts in an intrapancreatic accessory spleen. A case report and review of literature. JOP 2013; 14:636-41. [PMID: 24216550 DOI: 10.6092/1590-8577/1784] [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] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022]
Abstract
CONTEXT Accessory spleen is a congenital abnormality consisting of normal splenic tissue in ectopic sites that is found in approximately 10-15% of the general population. However, an intrapancreatic accessory spleen has seldom been reported and multiple epithelial cysts in the intrapancreatic accessory spleen are extremely rare. CASE REPORT A 37-year-old woman with no clinical manifestations presented with two cystic lesions in the tail of the pancreas. The tumor markers CA 19-9 (251 U/mL) and SPAN-1 (38 U/mL) were increased. Computed tomography showed a multilocular cyst, 40 mm in size, and a unilocular cyst, 20 mm in size, in the tail of the pancreas and gallstones. The cystic component was hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted magnetic resonance images. A laparoscopic distal pancreatectomy was performed with the presumptive diagnosis of a mucinous cystic neoplasm or an intraductal papillary mucinous neoplasm with gallstones. The pathological examination showed that the walls of the two cysts were covered with non-keratinized stratified squamous epithelium, surrounded by normal splenic tissue. The final pathological diagnosis was two epithelial cysts originating from an intrapancreatic accessory spleen. CONCLUSIONS Even though multiple masses were detected in the pancreatic tail, the possibility of epithelial cysts originating from an accessory spleen should be considered. Laparoscopic distal pancreatectomy might be a safe and effective procedure and provide good cosmetic result for a benign or low-grade malignant tumor in the pancreas.
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Sugitani I, Hasegawa Y, Sugasawa M, Tori M, Higashiyama T, Miyazaki M, Hosoi H, Orita Y, Kitano H. Super-radical surgery for anaplastic thyroid carcinoma: A large cohort study using the anaplastic thyroid carcinoma research consortium of Japan database. Head Neck 2013; 36:328-33. [DOI: 10.1002/hed.23295] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Iwao Sugitani
- Division of Head and Neck; Cancer Institute Hospital; Tokyo Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery; Aichi Cancer Center; Aichi Japan
| | - Masashi Sugasawa
- Department of Head and Neck Oncology; Saitama Medical University International Medical Center; Saitama Japan
| | - Masayuki Tori
- Department of Surgery; Osaka Police Hospital; Osaka Japan
| | | | - Masakazu Miyazaki
- Head and Neck Surgery Division; National Cancer Center Hospital East; Chiba Japan
| | - Hiroshi Hosoi
- Department of Otorhinolaryngology-Head and Neck Surgery; Nara Medical University; Nara Japan
| | - Yorihisa Orita
- Department of Otolaryngology; Okayama Saiseikai General Hospital; Okayama Japan
| | - Hiroya Kitano
- Division of Otolaryngology; Head and Neck Surgery; Tottori University; Tottori Japan
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Wakasugi M, Akamatsu H, Tori M, Ueshima S, Omori T, Tei M, Masuzawa T, Nishida T. Short-term outcome of single-incision laparoscopic totally extra-peritoneal inguinal hernia repair. Asian J Endosc Surg 2013; 6:143-6. [PMID: 23602002 DOI: 10.1111/ases.12011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 07/30/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
We performed single-incision laparoscopic surgery for totally extra-peritoneal (SILS-TEP) repair using a lightweight mesh fixed by absorbable tacks and without balloon dilation. Thirty-four patients (mean age, 66.5 years) underwent SILS-TEP repair in our hospital between September 2011 and April 2012; 30 patients had unilateral hernia and 4 had bilateral hernias. Mean operative time was 85.6 min for unilateral hernia and 137.7 min for bilateral hernias. All patients underwent successful SILS-TEP repair. Mean hospital stay was 3.4 days. Mean duration of follow-up was 7.1 months. Four seromas were observed, but no recurrences or major complications occurred. SILS-TEP is an economical and useful method for decreasing postoperative complications, such as neuralgia and recurrence, and it could be an attractive approach for inguinal hernia.
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Nishida T, Yoshidome K, Tori M. [Gastrointestinal stromal tumor (GIST)--tyrosine kinase inhibitors]. Nihon Rinsho 2012; 70 Suppl 8:452-456. [PMID: 23513883] [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]
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Wakasugi M, Ueshima S, Akamatsu H, Tori M, Oshita M, Tsujimoto M, Nishida T. Gallbladder metastasis from hepatocellular carcinoma: Report of a case and review of literature. Int J Surg Case Rep 2012; 3:455-9. [PMID: 22743008 DOI: 10.1016/j.ijscr.2012.05.011] [Citation(s) in RCA: 5] [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: 04/27/2012] [Accepted: 05/12/2012] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The incidence of metastasis of hepatocellular carcinoma (HCC) to the gallbladder is low. Here, we report a case of HCC with metastasis to the gallbladder and discuss the pattern of spread and the treatment. PRESENTATION OF CASE A 74-year-old man was diagnosed with advanced hepatocellular carcinoma. Computed tomography and magnetic resonance imaging demonstrated a tumor in the right lobe of the liver with a thrombus in the bifurcation of the portal vein. Because intraoperative ultrasonography showed portal vein tumor thrombosis from the main tumor reaching the umbilical portion, we performed only a cholecystectomy for the elimination of postoperative cholecystitis. Pathological examination showed gallbladder vein tumor thrombosis from poorly differentiated hepatocellular carcinoma. DISCUSSION A preoperative diagnosis of metastatic HCC to the gallbladder is difficult because there are no specific findings in the imaging tests. Cancer cells in the liver were thought to migrate to the gallbladder via the connection between the portal system and the cholecystic veins, and grow in the lumen of the veins in our case. The survival rate, in all reported cases including the present case, was increased in patients who underwent radical resection, compared to patients who underwent palliative surgery. CONCLUSION The resection of metastatic HCC to the gallbladder might appear to prolong survival.
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Jokoji R, Tsuji H, Tsujimoto M, Shinno N, Tori M. Intraductal tubulopapillary neoplasm of pancreas with stromal osseous and cartilaginous metaplasia; a case report. Pathol Int 2012; 62:339-43. [DOI: 10.1111/j.1440-1827.2012.02791.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamabe A, Ueshima S, Akamatsu H, Tori M, Omori T, Urakawa S, Tsujimoto M, Nishida T. Infected pancreatic necrosis occurring in a jejunal aberrant pancreas: report of a case. Surg Today 2012; 42:583-8. [PMID: 22218871 DOI: 10.1007/s00595-011-0104-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 06/02/2011] [Indexed: 11/30/2022]
Abstract
Acute pancreatitis occurring in an aberrant pancreas (acute aberrant pancreatitis) is a rare clinical condition. A 67-year-old male was referred to the emergency department complaining of severe epigastralgia. He was evaluated by computed tomography, and the findings suggested jejunal penetration into the mesentery and abscess formation. We performed emergency surgery and found a mass located in the jejunal mesentery. Intraoperatively, we diagnosed it to be a malignant tumor complicated by penetration, and we performed a partial resection of the jejunum to remove the mass. Based on the pathological results, it was evident that this was a case of acute aberrant pancreatitis occurring on a background of chronic pancreatitis. The patient had an uneventful postoperative course. This report is the first presentation describing the possible mechanism that contributes to the process of infected pancreatic necrosis in an aberrant pancreas.
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Affiliation(s)
- Atsushi Hamabe
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka, Japan.
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Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T. Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc 2011; 26:1490-4. [PMID: 22044985 DOI: 10.1007/s00464-011-2034-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/15/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE The intracorporeal anastomotic procedure is one of the most difficult components in single-incision laparoscopic gastrectomy. We describe a simple surgical technique for intracorporeal circular-stapled Billroth I gastroduodenostomy with transumbilical introduction of the instrument. SURGICAL TECHNIQUE After standard laparoscopic mobilization of the distal stomach using a mini-loop retractor (diameter, 2 mm), a semi-circumference duodenotomy was made just distal to the pyloric ring. The anvil of a circular stapling device, secured with a Prolene suture with a needle, was introduced via the duodenotomy. The suture was advanced anteriorly such that an anvil shaft transfixed the anterior duodenal wall. The duodenum was staple-transected at this point, and the anvil shaft was removed from the duodenum by pulling the thread. The anvil shaft was advanced against the posterior wall of the stomach and tightly grasped by the mini-loop retractor to avoid slippage. After the cartridge-carrying instrument was introduced transumbilically with the pneumoperitoneum maintained using a surgical glove, the anvil shaft was connected with the center rod of the instrument under fine laparoscopic view. The instrument was fired to complete the circular-stapled gastroduodenostomy. RESULTS We employed this technique in 20 patients. Neither postoperative complications, including anastomotic leakage and stricture, nor postoperative mortality were observed. CONCLUSIONS Our modified technique for intracorporeal Billroth I reconstruction in single-incision laparoscopic distal gastrectomy is safe and feasible. This technique could be an attractive surgical option for all laparoscopic reconstructive procedures using circular stapling devices.
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Affiliation(s)
- Takeshi Omori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
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Hamabe A, Omori T, Oyama T, Akamatsu H, Yoshidome K, Tori M, Ueshima S, Tsujimoto M, Nishida T. A case of Helicobacter pylori infection complicated with gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma, and idiopathic thrombocytopenic purpura successfully treated with laparoscopy-assisted total gastrectomy and splenectomy. Asian J Endosc Surg 2011; 4:32-5. [PMID: 22776172 DOI: 10.1111/j.1758-5910.2010.00067.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Indexed: 12/17/2022]
Abstract
Helicobacter pylori infection plays a key role in the pathogenesis of H. pylori-associated diseases, including gastroduodenal and non-gastroduodenal diseases. A 71-year-old man was evaluated for a positive fecal occult blood test by upper gastrointestinal endoscopy, which revealed H. pylori infection, two adenocarcinomas and two gastric mucosa-associated lymphoid tissue lymphomas. Hematological examination revealed low platelet-count, elevated platelet-associated immunoglobulin G and anti-H. pylori immunoglobulin G antibodies. We diagnosed H. pylori infection complicated by simultaneous occurrence of gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma, and idiopathic thrombocytopenic purpura. These diseases were successfully treated with laparoscopy-assisted total gastrectomy and splenectomy, and there was no evidence of recurrence for about 2 years. This is the first reported case of H. pylori infection complicated by these three diseases and cured with laparoscopic surgery.
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Affiliation(s)
- A Hamabe
- Department of Surgery, Osaka Police Hospital, Osaka, Japan.
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Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T. Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 2009; 23:2605-9. [PMID: 19266229 DOI: 10.1007/s00464-009-0406-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 01/27/2009] [Accepted: 02/11/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current techniques of laparoscopic colectomy require an abdominal incision for extraction of the specimen. Although this incision is smaller than that for open laparotomy incision, it may reduce the advantages of laparoscopic surgery. In totally laparoscopic sigmoid colectomy, intracorporeal anastomosis is technically difficult. A safe and simple technique for circularly stapled intracorporeal anastomosis is described. METHODS After mobilization of the colon and division of the mesentery, a semicircumferential colotomy is made at the anterior colonic wall just proximal to the transection site. The anvil of a circular stapling device, secured with a Prolene suture, is introduced via the colotomy. The suture is advanced anteriorly so that the center rod of the circular stapling device penetrates the colonic wall. The colon is staple-transected at this point to secure the anvil on the proximal colon. A grasping forceps is brought through the rectum, and the specimen is extracted through the colotomy made at the distal staple line. After the colotomy is reclosed with a linear stapler, anastomosis is established using a hemidouble stapling technique. RESULTS Totally laparoscopic sigmoid colectomies were performed for 16 patients with colon cancers. All the patients were treated laparoscopically without any complications. The average operation time was 180 min. Although one patient experienced wound infection, no major complications occurred. There was no mortality in this series. CONCLUSIONS The procedure of totally intracorporeal anastomosis combined with transanal extraction of the specimen can be performed easily, enabling surgeons to achieve minimal invasiveness comparable with that of hybrid natural orifice translumenal endoscopic surgery (NOTES).
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Affiliation(s)
- Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
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Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nishida T, Nakahara M, Abe T. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique. Dig Surg 2009; 26:446-50. [PMID: 20068315 DOI: 10.1159/000239761] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopically assisted low anterior resection is difficult even for experienced surgeons because of difficulties in selecting the appropriate transection line and completing anastomosis in the narrow pelvic space. The prolapsing technique resolves these problems. We combined our new technique for intracorporeal anastomosis with this prolapsing technique and achieved a totally laparoscopic low anterior resection. METHODS After the total mesorectal excision, a semi-circumferential colotomy is made at the anterior colonic wall just proximal to the proximal transection site. The anvil of a circular stapling device, secured with a Prolene suture, is introduced via the colotomy. The suture is advanced anteriorly so that the center rod of the anvil penetrates the colonic wall. The colon is staple-transected at this point to secure the anvil on the proximal colon. The distal rectum is everted and pulled transanally outside the body using a grasping forceps inserted from the anus. Staple-closure and transection of the distal rectum is performed under direct vision. Anastomosis is established using the double-stapling technique. RESULTS Totally laparoscopic low anterior resections using this technique were performed for 7 patients with rectal cancer. There was no anastomotic leakage/stenosis. CONCLUSIONS Our procedure can be performed easily, which enables surgeons to achieve minimal invasiveness compared with hybrid NOTES.
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Affiliation(s)
- Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Japan.
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Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nakahara M, Toshirou N. A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique. Dig Surg 2009; 26:441-5. [PMID: 20068314 DOI: 10.1159/000239760] [Citation(s) in RCA: 21] [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] [Indexed: 12/16/2022]
Abstract
AIM To describe a simple technique for intracorporeal circular-stapled gastrojejunostomy in laparoscopic distal gastrectomy with Roux-en-Y reconstruction. METHODS After the stomach and duodenum were mobilized, gastrotomy was established in the anterior gastric wall. An anvil, which was secured with a suture needle, was inserted completely through the gastrotomy. The needle was advanced to the greater curvature of the gastric wall to enable penetration of the central rod into the gastric wall. Subsequently, the stomach was cut using a linear stapler to secure the anvil on the stomach and was sequentially transected using another linear stapler to achieve distal gastrectomy. Circular-stapled gastrojejunostomy was then performed intracorporeally using the hemidouble-stapling technique, while handling the shaft of the instrument via the umbilical incision. The jejunal stump was closed using a linear stapler. RESULTS Gastrojejunostomies were successfully performed in 20 gastric cancer patients using this technique. None of the patients showed anastomotic leakage and/or stenosis. There were no mortalities in this series. CONCLUSIONS Gastrojejunostomy performed using the above-mentioned technique was safe and simple. The most important feature of the technique was the elimination of the need for purse-string suture placement, as well as the achievement of better cosmesis using the transumbilical approach.
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Affiliation(s)
- Takeshi Omori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Japan.
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Yamagami Y, Ueshima S, Mizutani S, Uchikoshi F, Ohyama T, Yoshidome K, Tori M, Hiraoka K, Takahashi H, Sueyoshi K, Taira M, Kido T, Sakamaki Y, Yasukawa M, Oka K, Tsujimoto M, Nakahara M, Nakao K. [An autopsied case of giant small cell carcinoma of the pancreas]. Gan To Kagaku Ryoho 2009; 36:123-125. [PMID: 19151577] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 58-year-old man who complained of an abdominal tumor was admitted to our hospital. Abdominal CT scan showed that a 15-cm tumor occupied the entire right upper abdomen and that there were ascites and liver metastases. A liver biopsy was performed. The liver biopsy showed a small cell carcinoma pattern, but no definitive origin of the tumor was determined. Considering the extensive peritoneal invasion and multiple liver metastases, he received 2 / courses of cisplatin/etoposide chemotherapy, but his tumor became larger with concomitant abdominal pain and nausea. The patient suddenly died due to multiple organ failure caused by tumor necrosis. The autopsy revealed a pathological diagnosis of primary small cell carcinoma of the pancreas.
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Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 2009; 197:e13-7. [DOI: 10.1016/j.amjsurg.2008.04.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/03/2008] [Accepted: 04/03/2008] [Indexed: 12/15/2022]
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Yamagami Y, Tori M, Sakaki M, Ohtake S, Nakahara M, Nakao K. Thyroid carcinoma with extensive tumor thrombus in the atrium. Gen Thorac Cardiovasc Surg 2008; 56:555-8. [PMID: 19002756 DOI: 10.1007/s11748-008-0307-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 06/24/2008] [Indexed: 12/26/2022]
Abstract
To our knowledge, only a few cases of thyroid carcinoma with an extensive tumor thrombus in the atrium have been reported in literature. We describe a unique case of papillary carcinoma of the thyroid with extensive tumor thrombus in the atrium. A 74-year-old man consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus in the atrium. Computed tomography (CT) revealed a 2-cm tumor with extensive continuous tumor thrombus in the left jugular vein, innominate vein, superior vena cava, and atrium. The tumor was resected to reduce the risk of sudden death from tumor embolism into the pulmonary arteries. Histologically, the diagnosis was papillary carcinoma of the thyroid. Thyroid carcinoma, especially papillary carcinoma, rarely develops a macroscopic tumor thrombus. Patients with an extensive tumor thrombus generally have poor prognoses and high mortality. This patient has been followed for 7 months after successful operation without recurrence.
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Affiliation(s)
- Yuko Yamagami
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan.
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Abstract
We report an extremely rare case of recurrent ascending colon cancer manifesting as inferior vena cava (IVC) thrombus. A 77-year-old woman previously diagnosed with ascending colon cancer underwent right hemicolectomy with lymph node dissection. Though the tumor invaded the retroperitoneum and involved the right ovarian artery and vein, curative operation was performed. The patient took 5-FU p.o. Two and a half years later, tumor thrombus in the IVC extending into the right atrium was incidentally found and diagnosed as recurrence of colon cancer by biopsy. RF-induced hyperthermia using 5-FU and CDDP i.v. was immediately performed, but she died after 6 months because of multiple liver and pulmonary metastases. In treating colon cancers invading the retroperitoneum, it should be recalled that some cases recur as tumor thrombus in the IVC and that close follow-up is therefore necessary.
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Affiliation(s)
- Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Abstract
Takotsubo cardiomyopathy (TC) is a rare reversible circulatory syndrome often detected in elderly patients after general surgery. We report the case of an 85-year-old woman who was admitted for obstructive jaundice and underwent ERCP and ENBD before operation. She finally underwent cholecystectomy and choledocholithotomy with the diagnosis of gallbladder and common bile duct stones. In the evening just after the operation, without symptoms of cardiac failure, her ECG suddenly exhibited abnormal ST-T elevation in leads II, III, and V2-V6, though neither CPK(MB) nor troponin T was elevated. Echocardiogram demonstrated basal hyperkinesis and apical dyskinesis, suggesting TC. Conservative treatment enabled recovery, ECG was normalized in a month, and the postoperative course was satisfactory. The stress on her during treatment might have been a cause of this unique cardiomyopathy, and it should be recalled that TC is a potential complication of hepato-biliary-pancreatic surgery.
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Affiliation(s)
- Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Mizutani S, Oyama T, Uchikoshi F, Yoshidome K, Tori M, Ueshima S, Hiraoka K, Yamagami Y, Takahashi H, Nakahara M. [A case of advanced gastric cancer with peritoneal dissemination responding to S-1/CDDP neoadjuvant chemotherapy]. Gan To Kagaku Ryoho 2007; 34:1853-1856. [PMID: 18030023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The patient was a 72-year-old male diagnosed with type III poorly-differentiated adenocarcinoma in the lesser curvature by gastric fiberscopy. An abdominal computed tomography (CT) scan showed the thickness of the gastric wall and the enlarged lymph node around the stomach and laparoscopic examination revealed peritoneal dissemination. The patient received neoadjuvant combined chemotherapy with S-1 and CDDP. S-1 (100 mg/day) was orally administered for 3 weeks followed by 2 drug-free weeks as a course, and CDDP (100 mg/body) was administered by intravenous drip on day 8. After the third course, significant tumor reduction was obtained. Total gastrectomy, splenectomy and D2 nodal dissection were performed. Peritoneal dissemination disappeared, and the histological diagnosis revealed complete disappearance of cancer cells in the ascites and no metastasis in all lymph nodes. The patient has now been in good health with no recurrence for 22 months after surgery. The combined neoadjuvant chemotherapy with S-1 and CDDP can be an effective treatment of choice for advanced gastric carcinoma with peritoneal dissemination.
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Ito T, Shimada K, Gang M, Uchikoshi F, Tori M, Komoda H, Fumimoto Y, Ohmori K, Kawamoto K, Tanemura M, Nozawa M. Pancreas transplantation using type I and type II spontaneously diabetic rats--our experimental experience. Microsurgery 2007; 27:305-11. [PMID: 17477403 DOI: 10.1002/micr.20361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pancreas transplantation (PTx) is the only therapy that can cure type 1 diabetes mellitus. With the recent advance of surgical procedures and immunosuppression, the outcome of PTx has become better than it used to be before, but some problems still remain. It is rather difficult to induce tolerance and to reverse rejection once it occurred because pancreas graft itself has a strong immunogenicity. Another important issue is regarding the recurrence of autoimmune disease in the pancreatic graft, therefore, some animal models are necessary to delineate and regulate those immune responses specific for PTx. Recently, PTx is also clinically applicable for type 2 diabetic patients with end-stage renal disease. It has been shown that insulin resistance was improved by PTx in type 2 diabetic recipients. In the current study, we have introduced some useful type 1 and type 2 diabetic models mainly based on our experimental experiences.
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MESH Headings
- Age Factors
- Animals
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/surgery
- Diabetes Mellitus, Type 2/immunology
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/surgery
- Disease Models, Animal
- Feasibility Studies
- Glucose/analysis
- Glucose Tolerance Test
- Graft Survival
- Islets of Langerhans/cytology
- Islets of Langerhans/physiology
- Pancreas Transplantation/immunology
- Pancreas Transplantation/methods
- Rats
- Rats, Inbred BB
- Rats, Mutant Strains
- Regeneration/physiology
- Transplantation, Isogeneic
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Affiliation(s)
- Toshinori Ito
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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Hiraoka K, Mizutani S, Oyama T, Uchikoshi F, Yoshidome K, Tori M, Ueshima S, Yamagami Y, Takahashi H, Nakahara M, Tsujimoto M. [A case of stage IV advanced gastric cancer responding to TS-1/CDDP neoadjuvant chemotherapy which leads to a pathological complete response]. Gan To Kagaku Ryoho 2007; 34:93-5. [PMID: 17220679] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A 72-year-old male with advanced gastric cancer (cT3N2M0H0P0CY1, cStage IV) was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (60 mg/m(2)/day) was orally administered for 3 weeks followed by 2 drug free weeks as a course, and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. After the fourth course,a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D 2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, which is a so-called pathological complete response. The patient has now been in good health without a recurrence for 24 months after surgery. This case suggests that neoadjuvant chemotherapy with TS-1/CDDP is a potential regimen for advanced gastric cancer.
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Mizutani S, Oyama T, Hatanaka N, Uchikoshi F, Yoshidome K, Tori M, Ueshima S, Nakahara M, Nakao K. Unresectable gastric cancer with multiple liver metastases effectively treated with combined paclitaxel and doxifluridine chemotherapy. Int J Clin Oncol 2006; 11:471-4. [PMID: 17180517 DOI: 10.1007/s10147-006-0597-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
We report a 72-year-old man who was diagnosed by gastroscopy as having a type III poorly differentiated adenocarcinoma in the lesser curvature, with the longest diameter being 10 cm. An abdominal computed tomography (CT) scan revealed multiple liver metastases, thickening of the gastric wall, and an enlarged paraaortic lymph node. The serum carcinoembryonic antigen (CEA) level was 60 ng/ml and the carbohydrate antigen (CA) 19-9 level was 1355 U/ml. The patient received combined chemotherapy with doxifluridine (800 mg/body per day) and paclitaxel (one course comprised three weekly infusions at a dose of 70 mg/m(2) followed by 1-week rest). After the completion of three courses, the patient achieved a complete response (CR), with complete disappearance of the primary tumor, the metastatic foci in the liver, and the enlarged abdominal lymph nodes; as well, the tumor markers were normalized. Adverse effects included only mild anorexia that was limited to grade 1. He maintained a CR for 1 year and 2 months. Combination chemotherapy with paclitaxel and doxifluridine can be an effective treatment for unresectable advanced gastric carcinoma.
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Affiliation(s)
- Shin Mizutani
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan.
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Tori M, Nakahara M, Akamatsu H, Ueshima S, Shimizu M, Nakao K. Significance of intraoperative monitoring of arterial blood flow velocity and hepatic venous oxygen saturation for performing minimally invasive surgery in a patient with multiple calcified pancreaticoduodenal aneurysms with celiac artery occlusion. ACTA ACUST UNITED AC 2006; 13:472-6. [PMID: 17013726 DOI: 10.1007/s00534-006-1105-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
Even for patients with multiple pancreaticoduodenal aneurysms, successful treatment with noninvasive operative procedures can be employed, if intraoperative devices are considered. A 73-year-old man, without any symptoms, was admitted to our hospital and had computed tomography (CT) scanning to examine his liver for hepatitis C virus (HCV). Selective superior mesenteric artery (SMA) angiography confirmed multiple aneurysms in the anterior inferior pancreaticoduodenal artery (AIPDA), one aneurysm in the posterior inferior mesenteric artery (PIPDA), and another in the occluded celiac trunk, all with severe calcification. All of the aneurysms were thought to communicate with each other. With the celiac artery occlusion, the right hepatic artery (RHA) was revealed to be supplied by collateral arteries from the aneurysms in the AIPDA, and the left hepatic artery was shown to be supplied by collaterals from the left gastric artery. Intraoperative Doppler echography, at the time of the clamping of both IPDAs, demonstrated a marked decrease of blood velocity in all aneurysms (before clamping, >50 cm/s; after, <10 cm/s), although loss of pulsation and a marked decrease of flow in the RHA were inevitable. Therefore, each of these two IPDAs were ligated on the proximal side to the aneurysm, thus preserving the blood flow of the pancreas head fed by the PIPDA; bypass grafting from the AIPDA to the RHA, using the great saphenous vein, was done at the same time. After the creation of an anastomosis, the hepatic venous oxygen saturation (ShvO2) increased from 38% (at the time of ligation of the IPDAs) to 57% under ventilation. The patient's postoperative clinical course was uneventful. We describe and discuss our successful noninvasive operative management of multiple pancreaticoduodenal aneurysms, done while monitoring the blood flow and ShvO2, with some consideration of the literature.
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Affiliation(s)
- Masayuki Tori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama, Tennouji-ku, Osaka, 552-0007, Japan
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Mizutani S, Oyama T, Hatanaka N, Uchikoshi F, Yoshidome K, Tori M, Ueshima S, Okuma K, Hiraoka K, Yamagami Y, Takahashi H, Sueyoshi K, Taira M, Nakahara M, Nakao K. [Combined chemotherapy with weekly Paclitaxel and doxifluridine for advanced and recurrent gastric cancers]. Gan To Kagaku Ryoho 2006; 33:327-31. [PMID: 16531712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We conducted combined therapy of weekly paclitaxel and doxifluridine (5'-DFUR) for 23 cases of advanced and recurrent gastric carcinomas to investigate their efficacy and safety. Subjects included 7 unresectable cases, 5 noncurative resection cases, and 11 recurrent cases. Twenty of the 23 subjects had a history of prior treatment with another anticancer drug. The treatment regime consisted of one course comprising 70 mg/m(2)of paclitaxel weekly for three consecutive weeks followed by one week rest, combined with 800 mg/day of 5'-DFUR orally. Results revealed a response rate of 17.6% (3/17), with 2 cases of CR, 1 case of PR, 10 cases of NC, and 4 cases of PD. One of the CR cases was an unresectable case involving a primary tumor, liver metastasis, and abdominal lymph node metastasis, while the other was a recurrent case involving abdominal lymph node metastasis. The median survival period was 387 days. The one-and two-year survival rates were 52% and 24%, respectively. In terms of adverse effects, there were only single cases of grade 3 leukopenia and grade 3 neutropenia, with no cases of grade 4 hemotoxicity. Both patients could be treated as outpatients. Combination therapy of weekly paclitaxel and 5'-DFUR can be an effective and safe therapy for advanced and recurrent gastric carcinomas.
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Abstract
A 72-year-old male was diagnosed as having a thoracic tumor in the left chest wall five years after resection of primary pancreatic somatostatinoma. The tumor was suggestive of metastasis to the chest wall or to the left lung from the previously resected somatostatinoma based on the abnormally elevated serum somatostatin level. Percutaneous biopsy confirmed that the lesion was an islet cell tumor and thoracotomy demonstrated metastasis to the left third rib without involvement of the left lung. Our case represents a rare documentation of somatostatinoma metastatic to the chest wall for which complete resection was performed.
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Affiliation(s)
- Yasushi Sakamaki
- Department of Chest Surgery, Osaka Police Hospital, Tennouji, Japan
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45
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Ito T, Uchikoshi F, Tori M, Miao G, Tanaka S, Maeda A, Akamaru Y, Matsuda H, Nozawa M. Immunological characteristics of pancreas transplantation: review and our experimental experience. Pancreas 2003; 27:31-7. [PMID: 12826903 DOI: 10.1097/00006676-200307000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Pancreas and islet transplantation is the only treatment that can cure type 1 diabetes mellitus (DM). With the recent advances of operative procedure and immunosuppression, pancreas graft survivals have become better than before, but some problems still remain. It is extremely difficult to establish tolerance and to reverse rejection once it has been initiated because the pancreas graft itself has a strong immunogenicity. It is also known that pancreatic graft failure is sometimes due to autoimmune recurrence. In the clinical situation, however, these immunologic events actually coexist within the pancreatic graft. Thus, it is rather difficult to analyze each of them independently, but possible to delineate each of these immunologic mechanisms with using animal models of type 1 DM such as BB (BioBreeding) rats or NOD (nonobese diabetic) mice. In the current study, we reviewed the immunological characteristics in pancreas transplantation (PTx) based on our experimental experiences together with that of others and investigated the possibility of tolerance induction in PTx.
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Affiliation(s)
- Toshinori Ito
- Department of Surgery (E1), Osaka University Graduate School of Medicine, Osaka, Suita, Japan.
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Li Z, Kitagawa-Sakakida S, Horiguchi K, Tori M, Shirakura R. Antibody Deposition in Rat Heart Which Develops Transplant Vasculopathy in (Donor × Recipient) F1 Environment. Surg Today 2003; 33:509-17. [PMID: 14506995 DOI: 10.1007/s10595-002-2541-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We studied the gene expression in rat cardiac allografts retransplanted into (donor x recipient) F1 animals to identify unknown or unexpected genes whose expression might contribute to the progression of transplant vasculopathy. METHODS Gene expression was first studied using a mRNA differential display, then it was further investigated using quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. RESULTS We found that the rat immunoglobulin kappa chain gene was preferentially induced in retransplanted cardiac allografts in which transplant vasculopathy was developing. The diseased vessels in the same allografts were heavily infiltrated with CD45R-positive B cells. The expression of two genes related to B-cell responses, B-lymphocyte chemoattractant, and CD40 ligand, showed a similar time course to that of the immunoglobulin kappa chain gene. We observed a heavy deposit of both IgM and IgG on the pathological neointima late in the development of transplant vasculopathy (i.e., 30 days after retransplantation) that was absent from the allografts immediately after retransplantation. CONCLUSION During the development of transplant vasculopathy in a (donor x recipient) F1 environment, B cells were selectively recruited into the allografts and stimulated; meanwhile, antibodies against the pathological neointima were formed. These antibodies may be involved in the pathogenesis of transplant vasculopathy.
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Affiliation(s)
- Zhanzhuo Li
- Department of Organ Transplantation, Osaka University Graduate School of Medicine (E9), 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Akamaru Y, Ito T, Uchikoshi F, Maeda A, Tori M, Kiyomoto T, Komoda H, Miao G, Matsuda H. Ex vivo and systemic transfer of adenovirus-mediated CTLA4Ig gene combined with a short course of FK506 therapy prolongs islet graft survival. Transpl Immunol 2003; 11:91-100. [PMID: 12727480 DOI: 10.1016/s0966-3274(02)00153-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adenovirus-mediated CTLA4Ig gene transfer has been reported to enhance graft survival in several rodent transplantation models. In this study, we investigated the efficacy of ex vivo and systemic transfer of the CTLA4Ig gene by adenoviral vectors in pancreatic islet allo-transplantation. Islet grafts from BN rats were transplanted to chemically induced diabetic LEW rats. First, ex vivo CTLA4Ig gene transfer into isolated islets was performed prior to transplantation. Survival of transduced grafts under the kidney capsule was slightly prolonged (8.6+/-1.3 days) compared with survival of untransduced grafts (6.7+/-1.2 days); when combined with a short course of FK506, graft survival was further extended (32.6+/-10.7 days vs. 13.7+/-1.0 days with FK506 alone). Secondly, systemic gene transfer was accomplished by intravenous administration immediately after the transplantation procedure. In these animals, islet grafts under the kidney capsule survived longer (15.2+/-3.3 days) than in controls (6.7+/-1.2 days), and when FK506 was administered perioperatively, all the islet grafts survived for more than 100 days. In systemically transduced recipients, the survival of islet grafts transplanted into the liver was not significantly different from that of the grafts placed under the kidney capsule. In order to examine organ-specific immunogenicity, heterotopic BN cardiac grafts were transplanted to LEW rats intra-abdominally, with the virus transferred systemically as in the islet model. In contrast to the islet grafts, all the cardiac grafts were accepted for longer than 100 days, even without FK506 therapy. Finally, the LEW recipients with long-surviving islet or cardiac grafts were re-transplanted with islet grafts from the same donor strain (BN) on day 100. The second islet grafts survived longer than 100 days in half of the cardiac recipients, but consistently failed in the islet recipients. We conclude that in this transplant model, CTLA4Ig gene transfer and FK506 treatment synergistically improved islet graft survival, systemic transfer of the gene was more effective than ex vivo transfer to the islets, and donor-specific tolerance could not be achieved for islet transplantation but was achieved for cardiac transplantation.
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Affiliation(s)
- Yusuke Akamaru
- Department of Surgery (E1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Saito S, Fukushima N, Kobayashi Y, Tori M, Tsukamoto Y, Matsuda H, Shirakura R. The effects of cryopreserved aortic xenografts on secondary cardiac xenografts. Transplant Proc 2002; 34:2752-4. [PMID: 12431594 DOI: 10.1016/s0041-1345(02)03395-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Saito
- Department of Surgery, Division of Organ Transplantation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Abstract
Sixteen new thymol derivatives have been isolated from Eupatorium fortunei and their structures determined based on spectroscopic data. They were classified into three groups (i-iii) depending on the oxidation levels: (i) one oxygen function at the 9-position, (ii) two oxygen functions at the 8- and 9-positions, and (iii) three oxygen functions at the 8-, 9-, and 10-positions. The hydroxyl groups are acylated with tigloyl, angeloyl, acetyl, isobutyryl, 3-methyl-2-butenoyl, or 2-methylbutyryl moieties. The compounds having chiral centers showed no specific rotation and exist as racemic mixtures.
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Affiliation(s)
- M Tori
- Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Yamashiro-cho, Tokushima 770-8514, Japan.
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Su BN, Takaishi Y, Yabuuchi T, Kusumi T, Tori M, Takaoka S, Honda G, Ito M, Takeda Y, Kodzhimatov OK, Ashurmetov O. Sesquiterpenes and monoterpenes from the bark of Inula macrophylla. J Nat Prod 2001; 64:466-471. [PMID: 11325229 DOI: 10.1021/np000211h] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Eleven new sesquiterpenes (1--11) and two thymol derivatives (12, 13), along with 12 known sesquiterpenes and monoterpenes, were isolated from the bark of Inula macrophylla. Their structures were determined on the basis of spectral evidence (especially by HREIMS and 2D NMR) as well as chemical transformations. The structure of macrophyllic acid A (1) was confirmed by X-ray analysis, and the absolute configuration of 1 was determined on the basis of the appropriate chemical conversions and the application of a modified Mosher's method.
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Affiliation(s)
- B N Su
- Faculty of Pharmaceutical Sciences, University of Tokushima, Shomachi 1-78, Tokushima 770-8505, Japan
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