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Tanida K, Takeuchi S, Miyagawa S, Ikeda M, Katada N, Nagai T, Lee R, Phuphaibul R, Niles J, Li Y, Su I, Lee P. Comparison of daytime sleepiness among early adolescents in six Asia Pacific regions. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kojima K, Yamashita K, Ushiku H, Katoh H, Ishii S, Tanaka T, Yokoi K, Suzuki M, Ooizumi Y, Igarashi K, Hosoda K, Moriya H, Mieno H, Katada N, Tanabe S, Watanabe M. The clinical significance of cysteine dioxygenase type 1 methylation in Barrett esophagus adenocarcinoma. Dis Esophagus 2017; 30:1-9. [PMID: 28184414 DOI: 10.1093/dote/dow001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Methylation of cysteine dioxygenase type 1 (CDO1) gene, a tumor suppressor gene, has been studied in various cancers; however, there is no information regarding Barrett esophagus cancer. In this study, the clinical significance of CDO1 methylation in Barrett esophagus adenocarcinoma (BEA) was clarified. CDO1 gene promoter methylation was analyzed for DNA from the patient's specimens using quantitative methylation-specific polymerase chain reaction. Thirty-eight BEA patients who underwent resection were identified between 2000 and 2014. Hypermethylation of CDO1 gene was demonstrated to be frequently recognized even at early stage in BEA by quantitative methylation-specific polymerase chain reaction. In BEA, there is a robust prognostic difference between stage I and stage II/III/IV with regard to 5-year relapse-free survival (P = 0.0016) and 5-year overall survival (P = 0.0024), and the tumor size separated by 7 cm was also a prognostic factor. There was significant difference in CDO1 gene methylation according to the tumor size (P = 0.036). BEA patients with CDO1 gene methylation were shown marginally significantly poorer prognosis (P = 0.054) than otherwise patients. In conclusion, higher CDO1 gene methylation was seen in BEA at earlier stage than in squamous cell carcinoma, and it may account for aggressive phenotype of BEA.
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Affiliation(s)
- K Kojima
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - K Yamashita
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - H Ushiku
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - H Katoh
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - S Ishii
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - T Tanaka
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - K Yokoi
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - M Suzuki
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Y Ooizumi
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - K Igarashi
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - K Hosoda
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - H Moriya
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - H Mieno
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - N Katada
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - S Tanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - M Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Yamashita K, Ushiku H, Katada N, Hosoda K, Moriya H, Mieno H, Kikuchi S, Hoshi K, Watanabe M. Reduced preoperative serum albumin and absence of peritoneal dissemination may be predictive factors for long-term survival with advanced gastric cancer with positive cytology test. Eur J Surg Oncol 2015; 41:1324-32. [PMID: 26251341 DOI: 10.1016/j.ejso.2015.05.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 12/17/2014] [Revised: 05/09/2015] [Accepted: 05/31/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Peritoneal lavage cytology cancer-positive (CY1) is a critical prognostic factor and is taken as representing stage IV in gastric cancer. There is no consensus treatment strategy for CY1-gastric cancer, and the detailed clinicopathological features remain obscure. PATIENTS AND METHODS Among 790 gastric cancer patients between 2005 and 2009, 52 cases of CY1 were identified (6.6%). A multivariate prognostic model was applied to the univariate prognostic factors to identify independent prognostic factors and factors associated with long-term survival in CY1-gastric cancer. RESULTS (1) Five-year overall survival (OS) was 17.6% in CY1-gastric cancer as compared with 93.9% in CYX and 77.7% in CY0 (77.7%), where tumors with pT2 or beyond were included in 11% of CYX, 73% of CY0, and 98% of CY1 cases. (2) On univariate analysis, factors associated with a negative prognosis were the presence of peritoneal dissemination (p = 0.029) and high preoperative serum albumin (p = 0.011) in CY1-gastric cancer. The multivariate Cox proportional hazards and logistic regression model using propensity score identified preoperative albumin as a critical independent prognostic indicator. (3) Long-term survivors were identified and, were often characterized by long-term postoperative adjuvant treatment. CONCLUSION Reduced preoperative serum albumin and absence of peritoneal dissemination may be predictive factors for long-term survival in patients with advanced gastric cancer with positive cytology test. Long-term postoperative adjuvant therapy might improve survival of patients with CY1.
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Affiliation(s)
- K Yamashita
- Department of Surgery, Kitasato University School of Medicine, Japan.
| | - H Ushiku
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - N Katada
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - K Hosoda
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - H Moriya
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - H Mieno
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - S Kikuchi
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - K Hoshi
- Department of Hygiene, Kitasato University School of Medicine, Japan
| | - M Watanabe
- Department of Surgery, Kitasato University School of Medicine, Japan
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Katada C, Muto M, Tanabe S, Higuchi K, Sasaki T, Azuma M, Ishido K, Katada N, Sakuramoto S, Yamashita K, Masaki T, Nakayama M, Okamoto M, Koizumi W. Factors associated with the presence of multiple Lugol-voiding lesions in patients with esophageal squamous-cell carcinoma. Dis Esophagus 2014; 27:457-62. [PMID: 23009284 DOI: 10.1111/j.1442-2050.2012.01429.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Indexed: 12/11/2022]
Abstract
Multicentric squamous dysplasia of the esophagus is characterized by multiple Lugol-voiding lesions (LVLs) on Lugol chromoendoscopy. Multiple LVLs are associated with a very high risk of multiple cancers arising in the esophagus as well as the head and neck. To gain insight into the pathogenesis of multiple LVLs of the esophageal mucosa, we studied risk factors for the development of such lesions in 76 patients who had a current or previous diagnosis of esophageal squamous cell carcinoma. All patients underwent Lugol chromoendoscopy of the esophageal mucosa. The history of tobacco and alcohol use was documented. Polymorphisms of the aldehyde dehydrogenase type 2 (ALDH2) gene were identified by polymerase chain reaction using sequence-specific primers. Clinical factors related to multiple LVLs were analyzed. All patients with multiple LVLs were drinkers. On univariate analysis, male sex (odds ratio [OR] 15, 95% confidence interval [CI] 1.84-122.45: P = 0.011), presence of the ALDH2-2 allele (OR 4.5, 95% CI 1.55-13.24: P = 0.006), and smoking index ≥1000 (OR 2.6, 95% CI 1.02-6.6: P = 0.045) were associated with multiple LVLs. On multivariate analysis, male sex (OR 10.02, 95% CI 1.13-88.44: P = 0.038) and presence of the ALDH2-2 allele (OR 4.56, 95% CI 1.4-14.82: P = 0.012) were associated with multiple LVLs. Among drinkers, a daily alcohol intake of ≥100 g pure ethanol with the ALDH2-2 allele (OR 17.5, 95% CI 1.97-155.59: P = 0.01) and a daily alcohol intake of <100 g pure ethanol with the ALDH2-2 allele (OR 8.85, 95% CI 1.68-46.69: P = 0.01) more strongly correlated with multiple LVLs than did a daily alcohol intake of <100 g pure ethanol without the ALDH2-2 allele, whereas a daily alcohol intake of ≥100 g pure ethanol without the ALDH2-2 allele (OR 4.0, 95% CI 0.54-29.81: P = 0.18) did not. In conclusion, male sex and the ALDH2-2 allele are associated with an increased risk for multiple LVLs of the esophageal mucosa in patients with esophageal squamous cell carcinoma. Among drinkers with the ALDH2-2 allele, the risk of multiple LVLs increased in parallel to the daily alcohol intake.
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Affiliation(s)
- C Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
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Kato T, Inagaki K, Sawai Y, Kanayama H, Katada N, Itoh M. Comparison of Efficacy of Pitavastatin and Colestimide in Japanese Patients with Diabetes Mellitus Complicated by Hyperlipidemia and Metabolic Syndrome. Exp Clin Endocrinol Diabetes 2011; 119:554-8. [DOI: 10.1055/s-0031-1273770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Katada C, Tanabe S, Koizumi W, Higuchi K, Sasaki T, Azuma M, Katada N, Masaki T, Nakayama M, Okamoto M, Muto M. Narrow band imaging for detecting superficial squamous cell carcinoma of the head and neck in patients with esophageal squamous cell carcinoma. Endoscopy 2010; 42:185-90. [PMID: 20195988 DOI: 10.1055/s-0029-1243963] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [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: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Narrow band imaging combined with magnifying endoscopy (NBI-ME) is useful for the detection of superficial squamous cell carcinoma (SCC) within the oropharynx, hypopharynx, and oral cavity. The risk of a second primary SCC of the head and neck is very high in patients with esophageal SCC. This prospective study evaluated the detection rate of superficial SCC within the head and neck region (superficial SCCHN) with NBI-ME in patients with esophageal SCC. PATIENTS AND METHODS Between March 2006 and February 2008, 112 patients with a current or previous diagnosis of esophageal SCC were enrolled. All patients underwent endoscopic screening of the head and neck by NBI-ME. The primary end point was the detection rate for superficial SCCHN. Secondary end points were to compare demographic characteristics between patients with and without superficial SCCHN and to assess the clinical course of patients with superficial SCCHN. RESULTS The detection rate for superficial SCCHN was 13 % (15/112). The prevalence of multiple Lugol-voiding lesions, observed endoscopically throughout the esophageal mucosa after application of Lugol dye solution, was significantly higher in patients with superficial SCCHN than in those without (100 % vs. 24 %, P < 0.0001). Minimally invasive curative treatment with organ preservation was feasible without severe complications in patients with superficial SCCHN after curative treatment of esophageal SCC. CONCLUSIONS In patients with esophageal SCC, NBI-ME is useful for detecting superficial SCCHN, thereby facilitating minimally invasive treatment.
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Affiliation(s)
- C Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara 228-8555, Japan.
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Kato T, Sawai Y, Kanayama H, Taguchi H, Terabayashi T, Taki F, Yamada K, Yamazaki Y, Hayakawa N, Suzuki A, Oda N, Katada N, Itoh M. Comparative Study of Low-dose Pioglitazone or Metformin Treatment in Japanese Diabetic Patients with Metabolic Syndrome. Exp Clin Endocrinol Diabetes 2009; 117:593-9. [DOI: 10.1055/s-0029-1202792] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yamashita K, Sakuramoto S, Katada N, Futawatari N, Moriya H, Hirai K, Kikuchi S, Watanabe M. Diffuse type advanced gastric cancer showing dismal prognosis is characterized by deeper invasion and emerging peritoneal cancer cell: the latest comparative study to intestinal advanced gastric cancer. Hepatogastroenterology 2009; 56:276-281. [PMID: 19453074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS Diffuse type advanced gastric cancer (D-AGC) is highly malignant disorder with dismal prognosis, however the causative attribution explaining such malignancy remains fully unexplained as compared to intestinal type AGC (I-AGC). METHODOLOGY We examined the archive of 232 AGC with cytology test (CY) but no distant metastasis, who underwent gastrectomy in Kitasato University Hospital in order to reveal the prognostic significance of D-AGC in a multivariate approach. RESULTS D-AGC occupied 68% (157/232) among AGC, and showed poorer prognosis than I-AGC (p = 0.024). Multivariate prognostic analysis revealed that independent prognostic factors for AGC are CY (p < 0.0001), pN (p = 0.0068), pT (p = 0.015), and age (p = 0.012), and that histology was eliminated, suggesting that histology itself does not represent high malignancy within the identical stage. D-AGC was significantly associated with younger age (p = 0.018), female preponderance (p = 0.006), advanced pT (p = 0.0002), advanced pN (p = 0.016), and positive CY factors (p = 0.032), among which negative prognostic factors were pT, pN, and CY factors. Multivariate logistic regression analysis elucidated that both pT (serosal exposure, p = 0.013) and CY (p = 0.034) factors were finally remnant independent predictors for D-AGC among the 3 univariate negative prognostic factors, but that pN was not. Intriguingly, age could be an independent prognostic factor only in D-AGC. CONCLUSION Our research revealed for the first time that more dismal prognosis of D-AGC than I-AGC could be explained by propensity of deeper invasion and emerging peritoneal cancer cell, and histology itself did not have a prognostic value, hence indicating that present staging system works properly even in D-AGC as well as I-AGC. We must identify its molecular mechanism of both invasion and emerging peritoneal disease of D-AGC in order to improve the prognosis.
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Affiliation(s)
- K Yamashita
- Department of Surgery, Kitasato University Hospital, Kitasato 1-15-1, Sagamihara 228-8555, Kanagawa, Japan
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9
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Nozawa M, Watanabe T, Katada N, Minami H, Yamamoto A. Residents' awareness and behaviour regarding typhoon evacuation advice in Hyogo Prefecture, Japan. Int Nurs Rev 2008; 55:20-6. [DOI: 10.1111/j.1466-7657.2007.00589.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Shiga A, Katada N, Niwa M. A theoretical study on Brønsted acidity of WO3 clusters supported on metal oxide supports by “paired interacting orbitals” (PIO) analysis. Catal Today 2006. [DOI: 10.1016/j.cattod.2005.10.059] [Citation(s) in RCA: 4] [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: 11/28/2022]
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Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, Watanabe M. Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc 2005; 20:55-60. [PMID: 16283580 DOI: 10.1007/s00464-005-0126-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [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: 03/03/2005] [Accepted: 07/19/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting its safety and usefulness is scant, and no study has compared the outcomes of various procedures for LADG. We examined the surgical outcomes of LADG performed using different methods for lymph node dissection. METHODS Between September 1998 and January 2005, we performed LADG in 111 patients with early gastric cancer. In the 55 patients treated initially, group 2 lymph node dissection was performed through a small, 7-cm-long incision (minilaparotomy). In 43 of these patients, hand-assisted laparoscopic surgery (HALS) was done. In the 56 patients treated more recently, lymph node dissection was performed laparoscopically. In 31 of these patients, the celiac branches of the vagus nerve were preserved. Clinical outcomes of these procedures were compared. RESULTS In the first 55 patients, HALS significantly shortened the operation time (277 vs 243 min, p < 0.05). In the latter 56 patients, LADG with preservation of the celiac branches of the vagus nerve was associated with a longer operation time (283 vs 228 min, p < 0.01) and higher blood loss (150 vs 92 g, p < 0.05) than with LADG without celiac branch preservation. There were no differences among the various operative procedures in postoperative course, including the length of the postoperative hospital stay or the rate of complications. CONCLUSIONS LADG is a safe and technically feasible procedure for the treatment of early gastric cancer. Laparoscopic lymph node dissection provided a good visual field and was easier to perform and required less time when the celiac branches of the vagus nerve were not preserved, with no negative effect on outcome.
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Affiliation(s)
- S Sakuramoto
- Department of Surgery, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan
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Abstract
Treatment of gastro-oesophageal reflux disease (GERD) with lifestyle changes to avoid the conditions that make the symptoms worse and medication to lower the acid content of the refluxed material are generally very effective therapies. However, some individuals do not benefit enough from these approaches, and surgical intervention is warranted. Laparoscopic surgery is the procedure of choice among surgeons performing operations for reflux disease. This surgical technique allows for shorter hospitalization, fewer post surgical complications and less pain than open surgery while maintaining a high success rate. Data from Japan confirms that laparoscopic fundoplication is a safe and effective technique for controlling both typical and atypical symptoms of GERD. Recently, several endoscopic or luminally delivered techniques have been developed as an alternative to laparoscopic surgery. These new surgical options, currently under evaluation in Japan, may offer a valuable alternative to patients who are not responsive to, or who do not wish to persist with lifelong medical therapy for GERD.
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Affiliation(s)
- N Katada
- Department of Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa 228-8555, Japan.
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Klingler PJ, Seelig MH, Floch NR, Branton SA, Freund MC, Katada N, Hinder RA. Aberrant left hepatic artery in laparoscopic antireflux procedures. Surg Endosc 2004; 18:807-11. [PMID: 15054654 DOI: 10.1007/s00464-003-8280-0] [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: 10/10/2002] [Accepted: 07/10/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aberrant left hepatic artery (ALHA) is an anatomic variation that may present an obstacle in laparoscopic antireflux procedures. Based on our experience, we addressed the following questions: How frequent is ALHA? When or why is it divided? What is the outcome in patients after division of the ALHA? METHODS From a prospective collected database of 720 patients undergoing laparoscopic antireflux surgery, we collected the following information: presence of an ALHA, clinical data, diagnostic workup, operative reports, laboratory data, and follow-up data. RESULTS In 57 patients (7.9%) (37 men and 20 women; mean age, 51 +/- 15.7 years), an ALHA was reported. Hiatal dissection was impaired in 17 patients (29.8%), requiring division of the ALHA. In three patients (5.3%), the artery was injured during dissection; in one case (1.8%), it was divided because of ongoing bleeding. Ten of the divided ALHA (55.5%) were either of intermediate size or large. Mean operating time was 2.2 +/- 0.8 h; mean blood loss was 63 +/- 49 ml. Postoperative morbidity was 5.3% and mortality was 0%. None of the patients with divided hepatic arteries had postoperative symptoms related to impaired liver function. Postoperatively, two patients (11.7%) had transient elevated liver enzymes. At a mean follow-up of 28.5 +/- 12.8 months, no specific complaints could be identified. CONCLUSIONS ALHA is not an uncommon finding in laparoscopic antireflux surgery and may be found in > or =8% of patients. Division may be required due to impaired view of the operating field or bleeding. Patients do not experience clinical complaints after division, but liver enzymes may be temporarily elevated.
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Affiliation(s)
- P J Klingler
- Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA
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Katada N, Akazawa S, Niwa M. Improvement of Selectivity in Specific Adsorption by the Addition of Acetic Acid during the CVD of Silicon Alkoxide to Form a Silica Overlayer with a Molecular Sieving Property. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/cvde.200306278] [Citation(s) in RCA: 3] [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: 11/11/2022]
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Kikuchi S, Katada N, Sakuramoto S, Koabayashi N, Shimao H, Sakakibara Y, Kakita A. Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer. Hepatogastroenterology 2004. [PMID: 14571827 DOI: 10.1016/s0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS The aim of the present study was to analyze factors associated with pN3-stage tumors, as classified according to the TNM Classification of Malignant Tumors, in patients who undergo curative resection for advanced gastric cancer. METHODOLOGY A total of 391 patients with advanced gastric cancer (247 males and 144 females; average age, 59.2 years) were enrolled in the present study. The numbers of dissected regional lymph nodes and positive nodes were assessed, and node stage was determined according to TNM. Patient survival and factors associated with pN3-stage tumors were then analyzed. RESULTS The 5-year survival rate was 82.9% for the 132 N0 patients, 66.4% for the 154 N1 patients, 41.1% for the 64 N2 patients and 21.1% for the 41 N3 patients. A significant difference was found between some of the curves (N0 and N1, p = 0.0012; N1 and N2, p = 0.0007; N2 and N3, p = 0.0055). In logistic regression analysis, independent factors associated with advanced gastric cancers with a pN3-stage tumor were tumor diameter (> 6 cm vs. < or = 6 cm, p = 0.0037), number of dissected nodes (> 30 vs. < or = 30, p = 0.0143), depth of invasion (T3 or T4 vs. T2, p = 0.0028) and microscopic type (undifferentiated vs. differentiated, p = 0.0147). CONCLUSIONS The results of the present study suggest that tumor diameter (> 6 cm), depth of invasion (T3 or T4) and microscopic type (undifferentiated type) are the most reliable indicators of pN3-stage tumors in patients who undergo curative resection for advanced gastric cancer.
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Affiliation(s)
- S Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan
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Kikuchi S, Katada N, Sakuramoto S, Koabayashi N, Shimao H, Sakakibara Y, Kakita A. Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer. Hepatogastroenterology 2003; 50:1723-6. [PMID: 14571827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND/AIMS The aim of the present study was to analyze factors associated with pN3-stage tumors, as classified according to the TNM Classification of Malignant Tumors, in patients who undergo curative resection for advanced gastric cancer. METHODOLOGY A total of 391 patients with advanced gastric cancer (247 males and 144 females; average age, 59.2 years) were enrolled in the present study. The numbers of dissected regional lymph nodes and positive nodes were assessed, and node stage was determined according to TNM. Patient survival and factors associated with pN3-stage tumors were then analyzed. RESULTS The 5-year survival rate was 82.9% for the 132 N0 patients, 66.4% for the 154 N1 patients, 41.1% for the 64 N2 patients and 21.1% for the 41 N3 patients. A significant difference was found between some of the curves (N0 and N1, p = 0.0012; N1 and N2, p = 0.0007; N2 and N3, p = 0.0055). In logistic regression analysis, independent factors associated with advanced gastric cancers with a pN3-stage tumor were tumor diameter (> 6 cm vs. < or = 6 cm, p = 0.0037), number of dissected nodes (> 30 vs. < or = 30, p = 0.0143), depth of invasion (T3 or T4 vs. T2, p = 0.0028) and microscopic type (undifferentiated vs. differentiated, p = 0.0147). CONCLUSIONS The results of the present study suggest that tumor diameter (> 6 cm), depth of invasion (T3 or T4) and microscopic type (undifferentiated type) are the most reliable indicators of pN3-stage tumors in patients who undergo curative resection for advanced gastric cancer.
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Affiliation(s)
- S Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan
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Kikuchi S, Katada N, Sakuramoto S, Kobayashi N, Shimao H, Sakakibara Y, Sato K, Kakita A. Limited effectiveness of extended lymph-node dissection for node-negative patients with proximal gastric cancer. Anticancer Res 2001; 21:1359-62. [PMID: 11396213] [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: 02/20/2023]
Abstract
BACKGROUND The optimal surgical treatment with respect to the extent of lymph-node dissection for node-negative patients with gastric cancer remains to be established. MATERIALS AND METHODS A total of 101 node-negative patients with proximal gastric cancer (62 males and 39 females; age range 33 to 79 years; mean 58.0 years), who had undergone curative total gastrectomy, were retrospectively evaluated to determine whether any correlation existed between survival and the extent of lymph-node dissection (D1, limited; D2, extended lymph-node dissection). RESULTS The 10-year survival rates of patients with T1 (n = 59), T2 (n = 31) or T3 tumors (n = 11) were 100%, 90.0% and 46.7%, respectively. Significant differences in survival were found between patients with T1 and T2 tumors (p = 0.018), T2 and T3 tumors (p = 0.003), and T1 and T3 tumors (p < 0.0001). Despite the fact that only 9 patients with a T1 tumor underwent a D2 lymph-node dissection, all other patients had an excellent prognosis. On the other hand, the 10-year survival rates of patients with T2 or T3 tumors who underwent a D1 or D2 lymph-node dissection were 83.3% and 76.8%, respectively, representing no significant difference between the two procedures for advanced stage cases (p = 0.590). Multivariate analysis showed that depth of invasion was the only statistically significant prognostic factor (p < 0.0001; relative risk, 19.018). CONCLUSIONS Conventional radical prophylactic D2 lymph-node dissection does not improve the survival of node-negative patients with proximal gastric cancer when compared to limited D1 dissection.
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Affiliation(s)
- S Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Sagamihara-shi, Kanagawa 228, Japan
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18
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Sasaki Y, Hoshino H, Nishimura D, Seki Y, Morita K, Katada N, Kato K. [A long-term survival case of gastric carcinoid with multiple liver metastasis]. Nihon Shokakibyo Gakkai Zasshi 2001; 98:290-4. [PMID: 11280906] [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: 02/19/2023]
Affiliation(s)
- Y Sasaki
- Department of Internal Medicine, Kamo Hospital, Aichi
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19
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Kitamura M, Hoshino H, Katada N, Nishimura D, Shimizu F, Sasaki Y, Sano H, Kato K. [An autopsy case of alpha-fetoprotein-producing carcinoma of the pancreas]. Nihon Naika Gakkai Zasshi 2000; 89:2345-6. [PMID: 11142820 DOI: 10.2169/naika.89.2345] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M Kitamura
- Department of Internal Medicine, Kamo Hospital, Toyota
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20
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Kikuchi S, Hirai T, Katada N, Kobayashi N, Shimao H, Sakakibara Y, Hiki Y, Kakita A. Marginal ulcer on the jejunum after proximal gastrectomy by jejunal interposition. Hepatogastroenterology 2000; 47:1579-80. [PMID: 11149005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Marginal ulcer after proximal gastrectomy has never been previously reported, despite that this procedure preserves the fundic gland area of the stomach, which secretes gastric acid. In this report, we describe a patient who developed a marginal ulcer on the oral side of the gastrojejunal anastomosis after proximal gastrectomy by jejunal interposition. This case serves as a reminder that gastric acid secretion of the remnant stomach must be carefully monitored after proximal gastrectomy in gastric cancer surgery.
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Affiliation(s)
- S Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan
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Abstract
The purpose of this review is to outline the laparoscopic-endoscopic procedures that we perform for early gastric cancer. These procedures were applied to 29 patients. Preoperative work-up included gastric endoscopy, barium X-ray examination, endoscopic ultrasonography, and histological examination, and surgery was performed in patients diagnosed as having mucosal gastric cancer for which endoscopic mucosal resection (EMR) was difficult. Laparoscopic wedge resection of the stomach using the lesion-lifting method, by which a wedge resection is made while pulling up the full-thickness gastric wall, was carried out in the 16 patients with lesions of the anterior wall, lesser curvature, and greater curvature of the stomach. On pathological examination of resected specimens, the surgical margin and lymphatic or venous invasion were negative in all these patients. The histological depth of the lesions was m (mucosal cancer) in 15 patients and sm1 (slight cancer infiltration into the submucosal layer) in one. This one patient later underwent gastrectomy but no lymph node metastases were found. Oral nutrition was resumed for a mean (+/- SD) of 2.9 +/- 0.8 days after operation, and the duration of hospitalization after operation was 12.3 +/- 3.4 days. The 13 patients with lesions of the posterior wall of the stomach and near the cardia or the pylorus received laparoscopic intragastric mucosal resection. Laparotomy was required in 1 of these patients due to intraoperative hemorrhage. The surgical margins were negative in all 12 patients in whom laparoscopic intragastric mucosal resection was successful. Lymphatic or venous invasion was positive in 2, both of whom had sm1 cancer lesions of both of these patients were located in the cardiac region, total gastrectomy was avoided, and careful observation is continued. Oral nutrition was resumed 4.0 +/- 1.6 days after operation, and the duration of hospitalization after operation was 12.0 +/- 3.5 days. In addition, no postoperative complication was noted after either procedure, and all patients have been recurrence free for a follow-up period of 460 months. Selected properly, these laparoscopic endoscopic procedures are considered to be curative and minimally invasive treatments for early gastric cancer.
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Affiliation(s)
- Y Hiki
- Abteilung für Chirurgie, East-Hospital, Kitasato Universität, Tokyo, Japan.
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22
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Kikuchi S, Sato M, Katada N, Sakuramoto S, Kobayashi N, Shimao H, Sakakibara Y, Kakita A. Surgical outcome of node-positive early gastric cancer with particular reference to nodal status. Anticancer Res 2000; 20:3695-700. [PMID: 11268441] [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: 02/19/2023]
Abstract
BACKGROUND The risk of recurrence according to nodal status in patients with node-positive early gastric cancer (EGC) remains unclear and no appropriate treatment approaches have yet been established for such patients. MATERIALS AND METHODS The surgical outcome of gastrectomy in combination with lymphadenectomy was examined in a total of 100 patients (54 males and 46 females, ranging in age from 25 to 84 years; average 56.6 years) with EGC and metastasis to lymph nodes. The outcome was assessed with particular reference to the extent of lymph node metastasis. RESULTS The 5 and 10-year overall survival rates were 93.5 and 89.8%, respectively. Significant differences in survival were detected when anatomical distribution of lymph node metastasis (p < 0.0001), number of positive nodes (p = 0.0004) and tumor size (p = 0.0085) were examined. In particular, in 73 patients for whom the metastasis was limited to a perigastric node, prognosis was excellent and no recurrence was observed during the follow-up period. On the other hand, 27 patients with metastasis to a lymph node beyond the perigastric region were defined as comprising a high risk group for recurrence among node-positive EGC patients due to their poor prognosis (10-year survival rate, 58.5%). CONCLUSION The results of the present study have suggested that radical gastrectomy combined with lymphadenectomy is essential to achieve complete remission in patients with lymph node metastasis restricted to perigastric nodes. For patients with a high risk of recurrence in EGC, whose condition is complicated by lymph node metastasis beyond the perigastric region, care should be taken to prevent recurrence by conducting long-term follow-up even after radical surgery. In order to improve survival, an appropriate protocol for post-operative adjuvant therapy may be needed for patients such as those with advanced gastric cancer.
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Affiliation(s)
- S Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan
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Abstract
BACKGROUND Patent ductus venosus is extremely rare with only 14 cases reported in the world literature. We present a case of patent ductus venosus. METHODS AND RESULTS A 29-year-old male was admitted with melaena stool caused by gastric haemorrhagic ulcers. Laboratory data disclosed severe anaemia; however, liver function tests were normal. Serum ammonia was also within the normal range. Serological viral markers for hepatitis B or C were all negative. The abdominal ultrasonography and computed tomography indicated a 12 mm diameter shunt located in the left lobe of the liver, which connected the portal vein with the left hepatic vein. After treatment for gastric ulcers, percutaneous transhepatic portography was performed and an enormous shunt connecting the umbilical portion of the portal vein with the left hepatic vein was revealed. CONCLUSIONS Histological findings of the liver biopsy showed that portal venules could not be observed in the portal areas and that no fibrosis or inflammatory cell infiltration were shown. Because of the anatomical position of the shunt, the case was diagnosed as patent ductus venosus.
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Affiliation(s)
- K Nagano
- Department of Internal Medicine, Kamo Hospital, Toyota, Aichi, Japan
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24
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Abstract
The esophageal epithelial damage caused by duodenoesophageal reflux was examined by assessing histology, free radicals, and apoptosis in rats with an end-to-side esophagoduodenostomy (reflux group) or sham operation. Rats were sacrificed at 1, 6, or 12 weeks after surgery. Reflux-associated hyperplasia was noted in the reflux group at 6 and 12 weeks. The reflux group manifested glutathione (GSH) overproduction at one and six weeks. Apoptotic cells were detected by the terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end-labeling method. Significantly increased numbers of apoptotic cells were seen on the epithelial surface in the reflux group at 6 and 12 weeks. Duodenoesophageal reflux causes esophageal injury with hyperplasia. Early GSH overproduction indicated that reflux esophagitis may be partly mediated by free radicals. Increased apoptosis may counteract increased proliferation and may be a protective mechanism against increased genotoxic events.
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Affiliation(s)
- N Katada
- Department of Surgery, Kitasato University, Sagamihara, Japan
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25
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Mabuchi T, Katada N, Nishimura D, Hoshino H, Shimizu F, Suzuki R, Sano H, Kato K. [Chronic pancreatitis, acute pancreatitis]. Nihon Rinsho 1998; 56:2896-901. [PMID: 9847617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
MRCP has been recognized as a safe and noninvasive diagnostic method. In the present study we evaluated the usefulness of MRCP in diagnosis of chronic and acute pancreatitis. Two-dimensional fast asymmetric spin-echo (FASE) MRCP was performed in 40 patients with chronic pancreatitis and 13 with acute pancreatitis. In 29 patients (72.5%) with chronic pancreatitis and 9 (66.7%) with acute pancreatitis, main pancreatic duct (MPD) was visualized entirely. MRCP could demonstrate the characteristic findings of chronic pancreatitis such as dilatation and irregularity of MPD in most cases. In acute pancreatitis, MRCP indicated that MPD was normal in diameter, but irregular in configuration compared with that of the control group. MRCP may facilitate the diagnosis of chronic and acute pancreatitis.
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Ida Y, Satoh Y, Katsumata M, Nagasao M, Hirai Y, Kajimoto T, Katada N, Yasuda M, Yamamoto T. Two novel oleanolic acid saponins having a sialyl Lewis X mimetic structure from Achyranthes fauriei root. Bioorg Med Chem Lett 1998; 8:2555-8. [PMID: 9873579 DOI: 10.1016/s0960-894x(98)00457-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 11/18/2022]
Abstract
Two novel triterpene glycosides, achyranthosides E and F, were isolated as methyl esters from the root of Achyranthes fauriei, an antiinflammatory medicinal plant. Their structures were characterized as oleanolic acid glucuronides having unique substituents composed of C6H9O5 and C9H15O7, respectively, at the C-3 position of glucuronic acid. These compounds are active components which can inhibit the excess recruiting of neutrophiles to injured tissues 1,000 times more potently than sialyl Lewis X.
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Affiliation(s)
- Y Ida
- School of Pharamaceutical Sciences, Showa University, Tokyo, Japan.
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27
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Abstract
We report two cirrhotic patients with gastric antral vascular ectasia (GAVE) in whom chronic blood loss presented a major problem. Case 1, a 69-year-old man, had alcoholic liver cirrhosis, and case 2, a 75-year-old woman, had liver cirrhosis associated with hepatitis C virus. The patients required repeated blood transfusions but still exhibited persistent anemia. On upper gastrointestinal endoscopy, both patients showed esophageal varices without stigmata of bleeding or red color signs and presented with a characteristic antral appearance so distinctive as to be diagnostic; diffuse erythemas consisting of ectatic and tortuous capillaries throughout the antrum. Endoscopic electrocoagulation treatment with a monopolar probe was effective for controlling blood loss from GAVE. The patients tolerated the procedure well and there were no resultant complications. Several sessions of the treatment resulted in eradication of almost all the vascular lesions, negative fecal occult blood test results, and marked alleviation of their anemia without further treatment. Endoscopic electrocoagulation is suggested to be a safe, non-invasive, and effective treatment for blood loss from GAVE, especially in patients with liver cirrhosis in whom surgery carries an increased risk.
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Affiliation(s)
- M Yamada
- Department of Internal Medicine, Koseiren Kamo Hospital, Toyota, Japan
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28
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Perdikis G, Lund RJ, Hinder RA, McGinn TR, Filipi CJ, Katada N, Cina R, Hinder PR, Lanspa SJ. Esophageal manometry and 24-hour pH testing in the management of gastroesophageal reflux patients. Am J Surg 1997; 174:634-7; discussion 637-8. [PMID: 9409588 DOI: 10.1016/s0002-9610(97)00181-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 02/05/2023]
Abstract
BACKGROUND With rising interest in gastroesophageal reflux disease, an evaluation of the importance of manometry (M) and 24-hour pH testing (pH) for decisions regarding these patients is appropriate. METHODS Two gastroenterologists and two surgeons were presented with history and physical examination, endoscopy, histology, and esophagram data ("DATA") from 100 patients and asked to make a treatment decision. After some time, either pH or M was added to DATA, and a further decision requested. Finally, DATA plus pH plus M was presented, and a decision was requested. Decisions were evaluated for changes in medical therapy, changes between medical and surgical therapy, and changes in type of surgery offered. RESULTS Overall, 43% (173 of 400) of decisions were altered by the addition of both M and pH to DATA, with 28.5% (114 of 400) of decisions changed from medical therapy to surgery or vice versa by the addition of both tests to DATA. The addition of M alone changed decisions more often than pH alone especially with regard to the type of surgery offered (P <0.05). CONCLUSIONS Together, M and pH alter clinical decisions and often alter the decision regarding surgery. Both tests appear important, but M more frequently alters overall management decisions and the type of surgery offered. Despite the need for cost containment, these clinical tools are essential to important decisions regarding the care of patients with gastroesophageal reflux disease.
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Affiliation(s)
- G Perdikis
- Department of Surgery, Creighton University, Omaha, Nebraska, USA
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29
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Horii M, Takatani Y, Mori E, Andoh H, Ohta K, Okaya K, Katada N, Katsuta H, Kawamura S, Doi Y, Nakanishi M, Minami Y. [Ethical problems in nursing: recognition and professional conduct, as a nurse, regarding HIV infection of patients due to blood products]. Nihon Kango Kagakkaishi 1997; 17:69-75. [PMID: 10426078 DOI: 10.5630/jans1981.17.4_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
A 72-year-old woman was admitted for recurrent episodes of encephalopathy. Laboratory data showed mild liver dysfunction and hyperammonemia, while she had neither anemia nor splenomegaly. The dilated inferior mesenteric vein (IMV) was opacified retrogradely from the superior mesenteric vein by superior mesenteric arteriography, and IMV was found to connect with the inferior vena cava (IVC) through a torturous shunt. No obstruction of the extrahepatic portal vein or hepatic vein was observed by arteriography. Histological evaluation of the liver biopsy indicated remarkable fatty change without cirrhosis. Finally, we diagnosed this case as extrahepatic portosystemic venous shunt without portal hypertension.
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Affiliation(s)
- Y Nishimoto
- Department of Internal Medicine, Kamo Hospital, Toyota, Aichi
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31
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Katada N, Hinder RA, Smyrk TC, Hirabayashi N, Perdikis G, Lund RJ, Woodward T, Klingler PJ. Apoptosis is inhibited early in the dysplasia-carcinoma sequence of Barrett esophagus. Arch Surg 1997; 132:728-33. [PMID: 9230856 DOI: 10.1001/archsurg.1997.01430310042007] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the alteration of apoptosis in the esophageal epithelium during the esophagitis-Barrett esophagus-adenocarcinoma sequence. DESIGN Archival tissue samples of 85 lesions in 58 cases were used. The lesions represented 7 groups: normal esophagus (n = 10), reflux esophagitis (n = 12), Barrett metaplasia (n = 21), Barrett low-grade dysplasia (n = 17), Barrett high-grade dysplasia (n = 5), well- or moderately differentiated adenocarcinoma (n = 10), and poorly differentiated adenocarcinoma (n = 10). Apoptotic cells with fragmented DNA were detected by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP)-biotin nick end labeling (TUNEL) method. Monoclonal antibodies against bcl-2 protein were applied using the avidin-biotin complex immunoperoxidase method. RESULTS The esophagitis group showed many apoptotic cells on the epithelial surface; in the other groups, few apoptotic cells were seen. Weak bcl-2 expression was seen in the basal cells in normal subjects and those with esophagitis. There was overexpression of bcl-2 in 72% of Barrett metaplasia, 100% of Barrett low-grade dysplasia, 25% of Barrett high-grade dysplasia, 40% of well- or moderately differentiated adenocarcinoma, and 20% of poorly differentiated adenocarcinoma. CONCLUSIONS Increased apoptosis in reflux esophagitis may be a protective mechanism counteracting increased proliferation. Inhibition of apoptosis by overexpression of bcl-2 protein occurs early in the dysplasia-carcinoma sequence of Barrett esophagus. The resulting prolongation of cell survival may promote neoplastic progression. Despite the absence of apoptosis, bcl-2 was not widely overexpressed in Barrett high-grade dysplasia and adenocarcinoma, suggesting that cells acquire other ways of avoiding apoptosis as malignancy appears.
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Affiliation(s)
- N Katada
- Department of Surgery, Creighton University, Omaha, Neb, USA
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Lund RJ, Wetcher GJ, Raiser F, Glaser K, Perdikis G, Gadenstätter M, Katada N, Filipi CJ, Hinder RA. Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1997; 1:301-8; discussion 308. [PMID: 9834362 DOI: 10.1016/s1091-255x(97)80049-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [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: 01/31/2023]
Abstract
Impaired esophageal body motility is a complication of chronic gastroesophageal reflux disease (GERD). In patients with this disease, a 360-degree fundoplication may result in severe postoperative dysphagia. Forty-six patients with GERD who had a weak lower esophageal sphincter pressure and a positive acid reflux score associated with impaired esophageal body peristalsis in the distal esophagus (amplitude <30 mm Hg and >10% simultaneous or interrupted waves) were selected to undergo laparoscopic Toupet fundoplication. They were compared with 16 similar patients with poor esophageal body function who underwent Nissen fundoplication. The patients who underwent Toupet fundoplication had less dysphagia than those who had the Nissen procedure (9% vs.44%; P=0.0041). Twenty-four-hour ambulatory pH monitoring and esophageal manometry were repeated in 31 Toupet patients 6 months after surgery. Percentage of time of esophageal exposure to pH <4.0, DeMeester reflux score, lower esophageal pressure, intra-abdominal length, vector volume, and distal esophageal amplitude all improved significantly after surgery. Ninety-one percent of patients were free of reflux symptoms. The laparoscopic Toupet fundoplication provides an effective antireflux barrier according to manometric, pH, and symptom criteria. It avoids potential postoperative dysphagia in patients with weak esophageal peristalsis and results in improved esophageal body function 6 months after surgery.
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Affiliation(s)
- R J Lund
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb, USA
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Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PJ. Laparoscopic paraesophageal hernia repair. Arch Surg 1997; 132:586-9; discussion 590-1. [PMID: 9197849 DOI: 10.1001/archsurg.1997.01430300028005] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Paraesophageal hernias require surgery to avoid potentially serious complications. OBJECTIVE To evaluate paraesophageal hernia repair using the laparoscopic approach. DESIGN Case series. SETTING University hospital and foregut testing laboratory. SUBJECTS Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram, endoscopy, esophageal manometry, and 24-hour pH monitoring. OUTCOME MEASURES Operative complications, postoperative morbidity, follow-up symptoms (53 patients; mean, 18 months; range, 2-54 months) and barium esophagogram (46 patients). RESULTS Fifty-six patients (86%) had a type III hernia and 9 (14%) had a type II hernia. Twenty (65%) of 31 patients who underwent pH monitoring had a positive 24-hour pH score, and 24 (56%) of 43 patients who underwent manometry had an incompetent lower esophageal sphincter. Four patients had a gastric volvulus and 21 patients had more than 50% of their stomach in the chest. All patients underwent hernia reduction, crural repair, and fundoplication (64 Nissen procedures and 1 Toupet procedure). The average duration of surgery was 2 hours. There were 2 conversions: gastric perforation and a difficult dissection because of a large fibrotic sac. Other complications, all managed intraoperatively, were 2 gastric perforations and bleeding in 6 patients. Average length of hospital stay was 2 days (range, 1-23 days). Early re-operation was required in 3 patients: slipped Nissen; small-bowel obstruction due to trocar-site hernia; and organo-axial rotation with gastroduodenal obstruction. Four patients required esophageal dilatation after surgery. Forty-nine of 53 patients available for long-term follow-up were satisfied with the results of surgery. Time to full recovery was 3 weeks (range, 1 week to 2 months). Seven of 46 patients experienced small type I hernias observed on routine follow-up esophagograms. CONCLUSIONS Most paraesophageal hernias are type III. A concomitant antireflux procedure is recommended. Paraesophageal hernias can be managed successfully by the laparoscopic route with good outcome.
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Affiliation(s)
- G Perdikis
- Department of Surgery, Mayo Clinic, Jacksonville, Fla, USA
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Katsuta H, Minami Y, Andoh H, Ohta K, Okaya K, Katada N, Takatani Y, Nakanishi M, Horii M, Mori E. [A survey on research ethics committee in Japanese baccalaureate programs in nursing]. Nihon Kango Kagakkaishi 1997; 17:79-84. [PMID: 10426088 DOI: 10.5630/jans1981.17.2_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Affiliation(s)
- P J McBride
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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36
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McBride PJ, Hinder RA, Filipi C, Raiser F, Katada N, Lund RJ. Surgical treatment of spastic conditions of the esophagus. Int Surg 1997; 82:113-8. [PMID: 9331834] [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: 02/05/2023] Open
Abstract
Primary esophageal motility disorders include achalasia, diffuse and segmental esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter. Failed medical therapy frequently precedes the presentation of these patients for surgical intervention. Both laparoscopic and thoracoscopic techniques have been developed to successfully treat these spastic disorders of the esophagus. Laparoscopic and thoracoscopic operative techniques are described.
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Affiliation(s)
- P J McBride
- Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA
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37
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Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N. Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc Percutan Tech 1997; 7:17-21. [PMID: 9116940] [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: 02/04/2023]
Abstract
Laparoscopic Nissen fundoplication was first performed in 1991. With the increasing number of these procedures being performed it is appropriate to review the published short-term results. A retrospective review of reports on this subject was performed. There were a total of 2453 patients available for review. Twenty-five of 2453 (1.0%) patients had an esophageal or gastric perforation and 28 of 2453 (1.1%) patients required transfusion for bleeding. Forty-nine of 2453 (2%) patients developed a pneumothorax. Two of 2453 (0.1%) patients required a splenectomy. Conversion to the open procedure was necessary in 5.8% (143 of 2453) of patients. The laparoscopic approach is associated with minimal postoperative morbidity. Four of 2453 (0.2%) needed further early surgery for persistent bleeding, 11 of 2453 (0.4%) for a missed perforation, 22 of 2453 (0.9%) for crural disruption, paraesophageal herniation, or gastric volvulus. Four of 2453 (0.2%) patients died of either a missed duodenal perforation, a missed esophageal perforation, ischemic bowel with mesenteric thrombosis, or myocardial infarction. Early postoperative dysphagia occurred in 500 of 2453 (20.3%) patients. Late postoperative dysphagia occurred in 114 of 2068 (5.5%), with the need for dilatation in 72 of 2068 (3.5%). Endoscopy was required for food impaction in 11 of 2068 (0.5%) and re-operation for dysphagia occurred in 18 of 2068 (0.9%). Fifty-seven of 1658 (3.4%) patients developed reflux symptoms and 11 of 1658 (0.7%) required revisional surgery. Satisfaction rates ranged from 87 to 100%. In the short term, laparoscopic fundoplication can be performed with less morbidity and mortality than the open procedure. It is superior to medical therapy. Long-term follow-up is awaited.
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Affiliation(s)
- G Perdikis
- Dept. of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA
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38
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Abstract
BACKGROUND This study defines the entity of the hypertensive lower esophageal sphincter (HLES) and its treatment, including surgical implications. METHODS Esophageal manometry was performed on 1,300 patients. Of these, 53 (4%) had HLES with resting pressure > 26.5 mm Hg, defined as the upper limit of normal resting LES pressure. Thirty-two of these patients had 24-hour esophageal pH studies. The response to treatment was assessed. RESULTS Fourteen patients (26%) with HLES had achalasia. Of the remaining 39 (74%), 25 had an isolated HLES with normal esophageal body motility, 5 had a nonspecific esophageal motility disorders (NEMD), 4 were post-Nissen fundoplication, 3 had a nutcracker esophagus, and 2 had diffuse esophageal spasm (DES). Nineteen percent of HLES patients had gastroesophageal reflux on pH studies. Eighty-two percent of HLES patients responded well to symptom-directed medical therapy. Two patients with esophageal body dysmotility responded well to an esophageal myotomy with a partial fundoplication. CONCLUSIONS Patients with the HLES form a heterogeneous group. Gastroesophageal reflux in HLES patients is not uncommon. Patients with HLES respond well to medical therapy. Carefully selected patients require surgery.
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Affiliation(s)
- N Katada
- Department of Surgery, Creighton University, Omaha, Nebraska, USA
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39
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Nakajima M, Hoshino H, Hayashi E, Nagano K, Nishimura D, Katada N, Sano H, Okamoto K, Kato K. Pseudoaneurysm of the cystic artery associated with upper gastrointestinal bleeding. J Gastroenterol 1996; 31:750-4. [PMID: 8887048 DOI: 10.1007/bf02347630] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [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: 02/04/2023]
Abstract
Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.
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Affiliation(s)
- M Nakajima
- Department of Internal Medicine, Koseiren Kamo Hospital, Aichi, Japan
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40
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Toyoda H, Fukuda Y, Koyama Y, Nishimura D, Hoshino H, Katada N, Kato K, Hayakawa T. Case report: multiple systemic lymph node metastases from a small hepatocellular carcinoma. J Gastroenterol Hepatol 1996; 11:959-62. [PMID: 8912135 DOI: 10.1111/j.1440-1746.1996.tb01854.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [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: 02/03/2023]
Abstract
Extrahepatic lymph node metastases from hepatocellular carcinoma (HCC) are usually observed in patients with advanced and poorly differentiated HCC. We encountered a patient with multiple, systemic lymph node metastases from a small HCC (18 mm in diameter), which was nodular and had a capsule at the time of resection (a partial hepatectomy of the postero-inferior subsegment of the right lobe of the liver). Widespread lymphadenopathy resembling malignant lymphoma developed 2 months after surgery. A biopsy specimen from a supraclavicular lymph node revealed metastatic HCC. The patient died 2.5 months after the detection of the lymphadenopathy. Lymph node metastases can occur in small HCC less than 2 cm in diameter and may adversely affect the long-term prognosis of patients with these curatively resectable small HCC.
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Affiliation(s)
- H Toyoda
- Second Department of Internal Medicine, Nagoya University School of Medicine, Japan
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41
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Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJ, McBride PJ, Katada N, Neary PJ. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg 1996; 131:593-7; discussion 597-8. [PMID: 8645064 DOI: 10.1001/archsurg.1996.01430180019003] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Myotomy offers the best known cure for achalasia and can now be performed via minimal-access surgery. OBJECTIVE To examine the questions of surgical approach for Heller myotomy and choice of fundoplication in the setting of minimal-access surgery. DESIGN Thirty-nine patients with achalasia underwent Heller myotomy via either thoracoscopy or laparoscopy, with either a Dor or a Toupet fundoplication (Heller-Dor and Heller-Toupet procedures, respectively). Manometry, pH analysis, and clinical course were evaluated 3 to 9 months after surgery. Clinical course was reviewed at 11 to 46 months after surgery. SETTING University hospitals. PATIENTS Diagnosis of achalasia was based on history and physical examination, contrast radiography, stationary manometry, and 24-hour pH analysis. All patients participated in the clinical evaluations. Twenty-two patients consented to postoperative manometry and 18 to postoperative pH analysis. INTERVENTIONS Thoracoscopic Heller-Dor procedures (n = 4), laparoscopic Heller-Dor procedures (n = 6), and laparoscopic Heller-Toupet procedures (n = 29). MAIN OUTCOME MEASURES Hospital stay and recovery time were compared between thoracoscopic and laparoscopic groups. Decrease in the lower esophageal sphincter pressure, 24-hour esophageal pH, postoperative symptoms, and overall satisfaction were compared between the Dor and Toupet groups. RESULTS Only 1 patient was dissatisfied with the experience. Patients undergoing thoracoscopy had a longer convalescence. No postoperative reflux was identified, although some patients complained of heartburnlike symptoms. Dysphagia and heartburn were more prevalent among patients with Dor fundoplication than among patients with Toupet fundoplication. CONCLUSIONS Minimal-access myotomy is an excellent intervention for achalasia. The preferred approach is via laparoscopy. Our experience has led us to favor the Toupet over the Dor fundoplication after myotomy.
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Affiliation(s)
- F Raiser
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb, USA
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42
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Hoshino H, Katada N, Nishimura D, Imada J, Morita K, Yoshida N, Sano H, Okamoto K, Kato K. Case report: fibrolamellar hepatocellular carcinoma in a Japanese woman: a case report and review of Japanese cases. J Gastroenterol Hepatol 1996; 11:551-5. [PMID: 8792309 DOI: 10.1111/j.1440-1746.1996.tb01701.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/02/2023]
Abstract
Fibrolamellar hepatocellular carcinoma (FLHCC) is an entity distinct from ordinary hepatocellular carcinoma and is very rare in Oriental countries. We present here a Japanese case of FLHCC in a 25 year old woman, and review Japanese cases of FLHCC. The patient had mild abdominal pain when the hepatic tumour was revealed by ultrasonography. Hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody were negative and serum alpha-fetoprotein (AFP) was within the normal limit. Ultrasound-guided fine needle biopsy was performed and the tumour was histologically diagnosed as FLHCC. A right lobectomy of the liver was then performed. Macroscopically, the tumour (10 x 10 x 8 cm) was circumscribed, rather hard and yellowish white. Microscopically, neoplastic hepatocytes were polygonal and large with eosinophilic cytoplasm, which contained pale bodies. A number of fibrous stroma were arranged in thin parallel bands. Consequently, the case was diagnosed as FLHCC. In Japan, approximately 18,000 people die of ordinary hepatocellular carcinoma annually, while only nine cases (including the present case; six males, three females) of FLHCC in Japanese subjects have been reported previously. The mean age of the Japanese cases of FLHCC is 20.9 years old. One case with positive HBsAg, liver cirrhosis and high level of AFP was observed of nine cases. The nature of FLHCC in Japanese subjects may not be significantly different from that in Caucasians, except for male predominance.
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Affiliation(s)
- H Hoshino
- Department of Internal Medicine, Koseiren Kamo Hospital, Aichi, Japan
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43
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Imada J, Hoshino H, Nishimura D, Morita K, Yoshida N, Katada N, Sano H, Kato K, Mori N. Case report: multiple cancers: hepatocellular carcinoma and adenocarcinomas of the common bile duct and the gall-bladder in a woman with primary biliary cirrhosis. J Gastroenterol Hepatol 1996; 11:546-50. [PMID: 8792308 DOI: 10.1111/j.1440-1746.1996.tb01700.x] [Citation(s) in RCA: 5] [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: 02/02/2023]
Abstract
We present a case of primary biliary cirrhosis associated with simultaneous triple cancers: a hepatocellular carcinoma and adenocarcinomas of the common bile duct and gall-bladder. A 70 year old Japanese woman, who had been diagnosed with primary biliary cirrhosis (stage 2 by Scheuer) 15 years before, was admitted to Koseiren Kamo Hospital in a comatose state. Laboratory data were as follows: the ammonia level was high (164.0 micrograms/dL), the antimitochondrial antibody showed a 320-fold increase, a high level of alpha-fetoprotein was indicated (2677 ng/mL), hepatitis B surface antigen was negative and hepatitis C antibody by enzyme immunoassay was negative, although a test for the RNA of hepatitis C virus by polymerase chain reaction was positive (10(3.5) copies/50 microL). The patient's condition gradually worsened and the patient died of liver failure. Autopsy showed triple cancers in the liver (hepatocellular carcinoma; trabecular type, moderately differentiated), the common bile duct (well-differentiated papillary adenocarcinoma) and the gall-bladder (well-differentiated papillary adenocarcinoma) with primary biliary cirrhosis (stage 4). Primary biliary cirrhosis has been believed to be a low risk for the development of hepatocellular carcinoma, despite the high risk of extrahepatic malignancy. The simultaneous occurrence of triple cancers with primary biliary cirrhosis, to the best of our knowledge, has never been reported. The present case may provide additional evidence for a predisposition to malignancy in primary biliary cirrhosis.
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Affiliation(s)
- J Imada
- Department of Internal Medicine, Koseiren Kamo Hospital, Toyota, Japan
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44
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Katada N, Osaki F, Takaya Y, Suzuki M, Murata K, Iwai S, Kameya F, Higaki M. [Nursing care skills for pain alleviation]. Kango Kenkyu 1996; 29:5-21. [PMID: 9281982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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45
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Perdikis G, Hinder RA, Lund RJ, Katada N. Laparoscopic fundoplication: the alternative to long-term medical therapy for severe gastroesophageal reflux disease. Yale J Biol Med 1996; 69:283-8. [PMID: 9165697 PMCID: PMC2589005] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Gastroesophageal reflux disease is common. Fundoplication is very effective for those patients who fail medical therapy, particularly those with an incompetent lower esophageal sphincter. Open surgery is reported to achieve cure rates in excess of 90 percent. Laparoscopic fundoplication has been performed since 1991. The early experience with this procedure is reviewed. RESULTS 1992 cases were reported in the literature. The mortality rate was 0.1 percent. Operative complications occurred as follows: 0.9 percent esophagogastric perforation rate; 0.6 percent bleeding rate (requiring transfusion); and 0.6 percent pneumothorax rate. No splenectomies were reported. 4.8 percent of patients required conversion to the open procedure. As experience with the procedure is gained this conversion rate decreases. Recurrent reflux postoperatively is 3.4 percent, but follow-up is short (range: 0 to 36 months; mean: two years). Dysphagia requiring dilatation occurs in 3.5 percent of patients. Gas bloat occurs in 0 to 24 percent of patients. These results compare favorably with the published results of medical therapy and the open fundoplication. CONCLUSIONS The early experience with laparoscopic fundoplication appears promising and provides an attractive alternative to long-term medical therapy and to open surgery in appropriate patients. Long-term follow-up is awaited.
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Affiliation(s)
- G Perdikis
- Department of Surgery, Creighton University, Omaha, Nebraska, USA
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46
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Yamamoto A, Nakagomi S, Kobayashi Y, Kotake Y, Katsuhara Y, Endo T, Kabeyama K, Katada N. [Nursing skills for family care]. Kango Kenkyu 1996; 29:35-46. [PMID: 9281984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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47
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Katada N. [Qualitative analysis of nursing care skills]. Kango Kenkyu 1996; 29:2-4. [PMID: 9281981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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48
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Hinder RA, Raiser F, Katada N, McBride PJ, Perdikis G, Lund RJ. Results of Nissen fundoplication. A cost analysis. Surg Endosc 1995; 9:1328-32. [PMID: 8629222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R A Hinder
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
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49
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Tanaka Y, Katada N, Arita T, Ohuchi T. [We learned so many things from the great Hanshin earthquake]. Kango 1995; 47:164-84. [PMID: 8716779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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50
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Raiser F, Hinder RA, McBride PJ, Katada N, Filipi CJ. The technique of laparoscopic Nissen fundoplication. Chest Surg Clin N Am 1995; 5:437-48. [PMID: 7583030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients with severe GERD resistant to medical therapy are benefited greatly by laparoscopic fundoplication provided that there is careful preoperative patient selection and evaluation. Preoperative evaluation should include contrast esophagography, EGD with biopsies, stationary manometry, and 24-hour pH analysis. Significant esophageal shortening or severe dysplasia are contraindications to laparoscopic fundoplication. A short, loose Nissen fundoplication should be performed in patients with adequate esophageal body function, whereas patients with esophageal dysmotility should be offered a partial fundoplication such as the Toupet procedure. If these guidelines are followed, long-term good results can be expected, with minimal complications, and all of the advantages of the minimally invasive approach.
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Affiliation(s)
- F Raiser
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
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