Kumamoto-shi, Japan
Kumamoto-shi, Japan

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Hashimoto D.,Kumamoto University | Chikamoto A.,Kumamoto University | Miyanari N.,National Hospital Organization Kumamoto Medical Center | Ohara C.,Kumamoto Saishunso National Hospital | And 4 more authors.
Journal of Surgical Research | Year: 2015

Background Thrombomodulin is a thrombin receptor on the endothelial cell surface that plays an important role in the regulation of intravascular coagulation. The purpose of this study was to evaluate the efficacy and safety of treatment with recombinant human soluble thrombomodulin (rhTM) for patients with septic-disseminated intravascular coagulation (DIC) associated with gastroenterological surgery. Materials and methods From April 2011-September 2013, 201 patients with DIC associated with gastroenterological surgery were treated in 16 institutions in Kumamoto, Japan. The patients were diagnosed according to the Japanese Association for Acute Medicine DIC scoring system. The clinical course, mortality rate at 28 d, and adverse events were evaluated retrospectively. Results Forty-five patients were excluded because they did not meet the Japanese Association for Acute Medicine DIC criteria or had an insufficient duration of drug administration. Thus, 156 patients were analyzed. Of these patients, 107 received rhTM at the discretion of the attending surgeon and 49 did not. The most common reason for surgery in both groups was peritonitis due to perforation of the colon. Within 7 d, the platelet count, prothrombin time-international normalized ratio, DIC score, neutrophil count, and C-reactive protein level significantly improved in the rhTM group compared with those in the control. Treatment with rhTM was significantly associated with reduced inhospital mortality at 28 d. The incidence of adverse events did not differ between the two groups. Conclusions Therapy with rhTM may be associated with reduced inhospital mortality in patients with septic DIC associated with gastroenterological surgery without increasing adverse events. © 2015 Elsevier Inc. All rights reserved.


PubMed | Kumamoto University, Red Cross, National Hospital Organization Kumamoto Medical Center, Kumamoto Rosai Hospital and Arao Municipal Hospital
Type: Controlled Clinical Trial | Journal: Journal of gynecologic oncology | Year: 2015

The aim of this study was to determine the efficacy and toxicity of oral administration of tegafur-uracil (UFT) at a high dose, 600 mg/day, based on the tegafur dose, against uterine cervical cancer.This study consisted of a retrospective analysis. From April 1986 to March 1997, 309 patients with uterine cervical cancer were registered. Oral UFT was administered to 162 patients for maintenance therapy after an initial treatment (the UFT group). The other 147 patients were not treated with UFT (the control group). The survival rate was calculated for both groups and statistically analyzed using the log-rank test. Adverse events were compared between the UFT and control groups.In the UFT group, 103 patients (63.6%) received UFT for 90 days. The drug dose was 600 mg/day for 137 patients (84.6%) and 300 to 400 mg/day for the remainder. The overall survival rate was significantly higher in the UFT group than in the control group (p<0.05). The prognosis was particularly favorable in stage III cases, in cases of squamous cell carcinoma, and in cases that were treated by radiotherapy. The most frequent side effects were nausea/vomiting (12.2%), appetite loss (10.1%), and leukopenia/neutropenia (5.8%).High-dose oral UFT maintenance treatment prolonged the disease-free survival and overall survival of patients with uterine cervical cancer, particularly of those with advanced disease.


Iwanaga T.,Arao Municipal Hospital | Yamamoto S.,Arao Municipal Hospital | Tsukamoto Y.,Arao Municipal Hospital | Hamaguchi H.,Arao Municipal Hospital | And 2 more authors.
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

We report the case of a 68-year-old woman who underwent laparoscopic gastrectomy for a gastric gastrointestinal stromal tumor (GIST) after neoadjuvant chemotherapy with imatinib mesylate. After conducting gastroscopy because of weight loss and anemia, we identified a submucosal tumor in the cardia. A GIST of 8 cm in diameter invaded the pancreatic tail and excluded the splenic vein. We administered imatinib 400 mg/day as neoadjuvant chemotherapy. We performed laparoscopic partial gastrectomy 5 months after the initiation of chemotherapy. According to the histopathological diagnosis, the surgical margin was positive. As an additional excision, we performed laparoscopic proximal gastrectomy. Without postoperative complications, it passes smoothly as of 5 months after surgery.


Maruyama R.,Omuta Tenryo Hospital | Matsumura F.,Omuta Tenryo Hospital | Shibata Y.,Omuta Tenryo Hospital | Takahashi H.,Omuta Tenryo Hospital | And 5 more authors.
General Thoracic and Cardiovascular Surgery | Year: 2016

We herein present a rare case of ALK-positive pulmonary pleomorphic carcinoma in an octogenarian patient. A computed tomography scan of the thorax indicated a pulmonary nodule in the right upper lobe of an asymptomatic 87-year-old female. The surgical resection revealed that the disease was pleomorphic carcinoma with pathological T2aN0M0, stage IB. EML4-ALK was evaluated using immunohistochemistry and fluorescence in situ hybridization, and EGFR mutations were analyzed using the Cycleave method. While there were no EGFR mutations detected, she was positive for the ALK rearrangement. This is the first report of ALK rearrangement in an octogenarian patient with pleomorphic carcinoma of the lung. © 2014, The Japanese Association for Thoracic Surgery.


PubMed | Arao Municipal Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

We report the case of a 68-year-old woman who underwent laparoscopic gastrectomy for a gastric gastrointestinal stromal tumor (GIST) after neoadjuvant chemotherapy with imatinib mesylate. After conducting gastroscopy because of weight loss and anemia, we identified a submucosal tumor in the cardia. A GIST of 8 cm in diameter invaded the pancreatic tail and excluded the splenic vein. We administered imatinib 400 mg/day as neoadjuvant chemotherapy. We performed laparoscopic partial gastrectomy 5 months after the initiation of chemotherapy. According to the histopathological diagnosis, the surgical margin was positive. As an additional excision, we performed laparoscopic proximal gastrectomy. Without postoperative complications, it passes smoothly as of 5 months after surgery.


PubMed | Arao Municipal Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

The patient was a 65-year-old woman who underwent segmental mastectomy for left breast cancer 5 years ago. The pathological diagnosis ofthe tumor was noninvasive ductal carcinoma, TisN0M0 and Stage 0. Postoperative radiation therapy was performed, but chemotherapy and hormone therapy were not administered. The patient presented with redness of the residual left breast. Skin biopsy showed lymphatic invasion of adenocarcinoma, and the patient was diagnosed with inflammatory carcinoma ofthe breast. After 4 cycles ofAC followed by 4 cycles ofdocetaxel, the mass was diminished and the redness disappeared. Total mastectomy with wide skin resection and axillary lymph node dissection was performed. The pathological diagnosis revealed scirrhous carcinoma ofthe left residual breast(T3N0, Stage II B, s, f, g, margin[-], ly0, v0, ER[+], PgR[+], HER2[1+]). She received treatment with an aromatase inhibitor, and 2 years after the operation is alive with no recurrence.


PubMed | Arao Municipal Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

A 67-year-old woman presented with a 3 cm palpable mass in the lower lateral quadrant of her right breast. Mammography and ultrasonography showed a mass with an irregular border. Using fine needle aspiration biopsy and cytology, we detected malignant cells with keratosis, and made a diagnosis of squamous cell carcinoma(SCC). We performed total mastectomy with axillary lymph node dissection. Histologically, the tumor was identified as SCC with keratinization and a component of scirrhous adenocarcinoma; estrogen and progesterone receptor expression were not elevated. The tumor tested negative for HER2. The patient did not receive any adjuvant chemotherapy and is alive with no recurrence 13 years after surgery.


PubMed | Arao Municipal Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

A 64-year-old man underwent laparoscopic surgery for rectal cancer and lateral lymph node dissection. The histopathological findings indicated adenocarcinoma (moderate>well), pA, pN3(4/25No 263 1/1), pM0, Stage IIIb. After the surgery, he received 12 courses of adjuvant chemotherapy with modified 5-fluorouracil Leucovorin oxaliplatin (mFOLFOX6). Liver metastasis( S8)was present, and open hepatectomy was performed 1 year after the first surgery. Three months after the second surgery, the carcinoembryonic antigen (CEA) level increased and chemotherapy TS-1 was started. However, the CEA level continued to increase, and positron emission tomography-computed tomography revealed peritoneal dissemination, and multiple lymph node, bone, and local metastases(in the liver and rectum). Accordingly, 11 courses of chemotherapy with 5- fluorouracil Leucovorin irinotecan (FOLFIRI) and bevacizumab was administered. The patient recently experienced anal bleeding during each bowel evacuation, which developed owing to the recurrence of the cancer in the anus. To improve his quality of life, the anal tumor was excised 2 years 6 months after the first surgery. Chemotherapy with FOLFIRI and bevacizumab was restarted. The CEA level stopped increasing. We think that the anal surgery did not affect our patients prognosis but helped improve his quality of life.


Thoracoscopic esophagectomy was performed in the prone position under artificial pneumothorax and did not affect the surgical area during lung ventilation; tracheal mobility was also improved. Lymphadenectomy around the left recurrent laryngeal nerve was performed by separating the left main bronchus and trachea between the esophagus and pericardium before detaching the dorsal side of the esophagus.


PubMed | Arao Municipal Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

We report a 44-year-old male patient who was diagnosed with scirrhous gastric cancer with peritoneal dissemination using laparoscopy. The patient underwent a non-curative resection with laparoscopic distal subtotal gastrectomy. In addition, we placed a port into the patients abdomen for intraperitoneal chemotherapy administration. Postoperatively, we administered capecitabine (per os)+ paclitaxel (intraperitoneally) and, after 2 cycles, the oral anticancer agent 5-FU was given. The patient died of peritonitis carcinomatosa 25 months after the operation. The combined therapies contributed to improve the quality of life, specifically oral ingestion, for 2 years.

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