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Kobayashi N.,Yokohama City University | Sugimori K.,Gastroenterological Center | Shimamura T.,Yokohama City University | Hosono K.,Yokohama City University | And 8 more authors.
Pancreatology | Year: 2012

Background: The preoperative diagnosis of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be very difficult, since low-risk and high-risk lesions can be difficult to differentiate even after cytological analysis. The purpose of this study was to evaluate the preoperative diagnostic value of endoscopic ultrasonography (EUS) in differentiating low-risk and high-risk IPMNs. Methods: We retrospectively identified 36 patients who underwent preoperative EUS for branch duct IPMNs. The pathological diagnosis after surgical resection was low-grade dysplasia (n = 26), moderate dysplasia (n = 1), high-grade dysplasia or carcinoma in situ (n = 5), and invasive carcinoma (n = 4). We divided the patients into two groups: low risk (low-grade dysplasia or moderate dysplasia) and high risk (high-grade dysplasia or carcinoma). We focused on the diameter of the cystic dilated branch duct, the main pancreatic duct, and the mural nodule as measured using the EUS findings. Results: The cystic dilated branch duct diameter (31.5 mm vs. 41.9 mm, P = 0.0225) was significantly correlated with low-risk and high-risk IPMNs, but the main pancreatic duct diameter (5.37 mm vs. 5.44 mm, P = 0.9418) was not significantly correlated with the low-risk and high-risk IPMNs. The mural nodule diameter of the papillary protrusions (4.3 mmvs. 16.4 mm, P < 0.0001) and the width diameter of the mural nodule (5.7 mmvs. 23.2 mm, P < 0.0001) were significantly correlated with low-risk and highrisk IPMNs. Conclusions: The mural nodule of papillary protrusions diameter and width diameter observed using EUS was a reliable preoperative diagnostic finding capable of distinguishing low-risk and high-risk IPMNs. Copyright © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. Source


Akiyoshi T.,Gastroenterological Center | Kobunai T.,Teikyo University | Watanabe T.,Teikyo University | Watanabe T.,University of Tokyo
Surgery Today | Year: 2012

Preoperative radiotherapy or chemoradiotherapy (CRT) has become a standard treatment for patients with locally advanced rectal cancer. However, there is a wide spectrum of responses to preoperative CRT, ranging from none to complete. There has been intense interest in the identification of molecular biomarkers to predict the response to preoperative CRT, in order to spare potentially non-responsive patients from unnecessary treatment. However, no specific molecular biomarkers have yet been definitively proven to be predictive of the response to CRT. Instead of focusing on specific factors, microarray-based gene expression profiling technology enables the simultaneous analysis of large numbers of genes, and might therefore have immense potential for predicting the response to preoperative CRT. We herein review published studies using a microarray-based analysis to identify gene expression profiles associated with the response of rectal cancer to radiation or CRT. Although some studies have reported gene expression signatures capable of high predictive accuracy, the compositions of these signatures have differed considerably, with little gene overlap. However, considering the promising data regarding gene profiling in breast cancer, the microarray analysis could still have potential to improve the management of locally advanced rectal cancer. Increasing the number of patients analyzed for more accurate prediction and the extensive validation of predictive classifiers in prospective clinical trials are necessary before such profiling can be incorporated into future clinical practice. © 2012 Springer. Source


Kagaya A.,Chiba University | Shimada H.,Toho University | Shiratori T.,Chiba University | Kuboshima M.,Chiba University | And 12 more authors.
Proteome Science | Year: 2011

Background: Diagnosis of esophageal squamous cell carcinoma (SCC) may improve with early diagnosis. Currently it is difficult to diagnose SCC in the early stage because there is a limited number of tumor markers available.Results: Fifty-two esophageal SCC SEREX antigens were identified by SEREX (serological identification of antigens by recombinant cDNA expression cloning) using a cDNA phage library and sera of patients with esophageal SCC. Sequence analysis revealed that three of these antigens were similar in amino acid sequences, and they were designated as ECSA (esophageal carcinoma SEREX antigen)-1, -2 and -3. The ECSA family was also similar to an EST clone, hepatocellular carcinoma-associated antigen 25a (HCA25a). Serum antibody levels to ECSA-1, -2 and -3 were significantly higher in patients with esophageal SCC than in healthy donors. Based on the conserved amino acid sequences, three peptides were synthesized and used for enzyme-linked immunosorbent assays (ELISA). The serum antibody levels against one of these peptides were significantly higher in patients with esophageal SCC. This peptide sequence was also conserved in FAM119A, GOSR1 and BBS5, suggesting that these are also ECSA family members. Reverse transcription followed by quantitative PCR analysis showed that the mRNA expression levels of ECSA-1, -2 and -3 and FAM119A but not of HCA25a, GOSR1 and BBS5 were frequently elevated in esophageal SCC tissues.Conclusions: We have identified a new gene family designated ECSA. Serum antibodies against the conserved domain of the ECSA family may be a promising tumor marker for esophageal SCC. © 2011 Kagaya et al; licensee BioMed Central Ltd. Source


Osuga T.,Sapporo Medical University | Sato Y.,Sapporo Medical University | Ishikawa K.,Sapporo Medical University | Onuma H.,Sapporo Medical University | And 6 more authors.
Gastroenterological Endoscopy | Year: 2015

A 70-year-old man was referred to our hospital to treat a polyp in the duodenal bulb. Endoscopic examination showed that the polyp was composed of Yamada type IV lesions with thick stems and a head that was reddish. Magnifying endoscopy revealed a small opening and gastric epithelial metaplasia in the head of the polyp. We performed polypectomy for therapeutic diagnosis. Histologically, the lesion was a duodenal Brunner's gland hamartoma with abundant mature adipose tissue and gastric metaplasia. Brunner's gland hamartoma is composed of hyperplastic Brunner's glands mixed with elements such as adipose tissue, and is often accompanied by gastric epithelial metaplasia. Because diagnosis by biopsy is not possible, preoperative diagnosis of the disease is difficult. However, magnifying endoscopy enabled us to detect some characteristic findings of the disease, such as a small opening and gastric epithelial metaplasia. As a result, preoperative diagnosis might be possible by magnifying endoscopy. This case suggested that magnifying endoscopy is useful for the diagnosis of Brunner's gland hamartoma. © 2015, Japan Gastroenterological Endoscopy Society. All rights reserved. Source


Jiang X.,Gastroenterological Center | Jiang X.,Nanjing Southeast University | Hiki N.,Gastroenterological Center | Nunobe S.,Gastroenterological Center | And 4 more authors.
Gastric Cancer | Year: 2011

Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil™ system. The reconstruction method was Roux-en-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association. Source

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