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Sunaga T.,Hachioji Digestive Disease Hospital | Sunaga T.,Showa University | Suzuki S.,Hachioji Digestive Hospital | Kogo M.,Showa University | And 6 more authors.
European Journal of Cancer Care | Year: 2014

Neutropenia during chemotherapy has been reported to be a predictor of better survival in patients with several types of cancer, although there are no reports on stage III colorectal cancer (CRC). The purpose of this study was to examine the association between neutropenia and prognosis in stage III CRC patients receiving adjuvant chemotherapy consisting of oral uracil and tegafur (UFT) plus leucovorin (LV). We retrospectively analysed 123 patients with stage III CRC who received UFT/LV as adjuvant chemotherapy. The end-point was disease-free survival (DFS). Survival curves of the two categories (neutropenia absent vs. present) were estimated using the Kaplan-Meier method and compared by the log-rank test. We estimated the hazard ratio (HR) for DFS according to neutropenia after adjustment for covariates by multivariate analyses using Cox's regression analysis. A total of 33 (26.8%) patients experienced neutropenia. Patients without neutropenia showed a significantly lower DFS than those with neutropenia (3-year DFS 57.3% vs. 81.2%, P = 0.0213). By multivariate analysis, neutropenia and histological type were independent prognostic factors, with HR of 0.410 (neutropenia absent vs. present, P = 0.045) and 4.793 (well to moderately differentiated vs. poorly differentiated, P = 0.004) respectively. We demonstrated that neutropenia occurring during adjuvant chemotherapy consisting of UFT/LV may be a prognostic factor of recurrence in stage III CRC patients. © 2013 John Wiley & Sons Ltd. Source

Narita T.,Tokyo Womens Medical University | Seshimo A.,Tokyo Womens Medical University | Suzuki M.,Hachioji Digestive Disease Hospital | Murata J.,Asakadai Central General Hospital | Kameoka S.,Tokyo Womens Medical University
Hepato-Gastroenterology | Year: 2013

Background: The incidence of HER2 expression in gastric cancer varies among previous studies. Furthermore, serum HER2 levels have not been well studied in patients with gastric cancer. Methodology: Cancerous gastric tissue was analyzed by immunohistochemistry (IHC) to give an IHC score (IHCO, 1+, 2+ or 3) for HER2 expression. Fluorescence in situ hybridization (FISH) was performed to examine HER2 gene expression in IHC2+ cases. Levels of HER2 in serum collected before surgery were determined by chemiluminescent enzyme immunoassay. Results: Subjects were 105 gastric cancer patients who underwent surgical resection. Tissue expression of HER2 was positive (IHC3+, or IHC2+ plus FISH+) in 6.7% of patients (7/105). All HER2-positive tumors were highly differentiated. Mean serum HER2 level was 8.7±2.1 ng/dl in patients with primary gastric cancer. The mean serum HER2 level in the highly differentiated cancer group was 9.2±2.1 ng/dl, which was significantly higher than that (8.1±1.9 ng/dl) in the poorly differentiated group. Conclusion: Tissue expression of HER2 was found in 6.7% of examined Japanese gastric cancer patients, and all HER2-positive tumors were highly differentiated. Serum HER2 levels were significantly higher in patients with highly differentiated cancer, in good agreement with the higher tissue expression of HER2 in highly differentiated cancer. © H.G.E. Update Medical Publishing S.A. Source

Ohashi H.,Yamanashi Hospital of Social Insurance | Saida S.,Hachioji Digestive Disease Hospital | Ozawa T.,Yamanashi Hospital of Social Insurance
Journal of Japanese Society of Gastroenterology | Year: 2012

A health check up in a 31-year-old man revealed free air under the diaphragm by a chest X-ray. The CT showed marked cystic emphysema along the small intestinal wall, as well as thickening and stenosis of the pyloric wall of stomach. Therefore, we suspected pneumatosis cystoides intestinalis (PCI) with stenosis of the pylorus. Since no perforation of the intestinal tract was diagnosed, it was preserved. Upper G.I. endoscopy showed H2 stage gastric ulcer in the posterior wall of the antrum. Eventually, a diagnosis of PCI with gastric ulcer and stenosis of the pylorus was, which we preserved. We report this rare case here. Source

Hatori T.,Tokyo Womens Medical University | Imaizumi T.,Tokai University | Harada N.,Hachioji Digestive Disease Hospital | Fukuda A.,Tokyo Womens Medical University | And 3 more authors.
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2010

Background/purpose: We developed the Imaizumi modification of the Beger procedure, a duodenum-preserving pancreatic head resection. The Imaizumi modification allows for removal of more of the subtotal pancreatic head than in the conventional Beger procedure, including the intrapancreatic bile duct, for chronic pancreatitis with common bile duct stenosis. A retrospective study was performed to evaluate the efficacy of the Imaizumi modification compared to a pylorus-preserving pancreaticoduodenectomy (PPPD), based on the early and late postoperative results. Methods: A group of 14 patients who underwent the Beger procedure with the Imaizumi modification to treat chronic pancreatitis from November 1997 to December 2005 was investigated retrospectively. This group was compared to a group of 21 patients who underwent PPPD from November 1997 to December 2003. The median follow-up period was 3.6 years (range 3.1-5.7 years) for the Imaizumi modification group and 4.0 years (range 3.0-8.3 years) for the PPPD group. Results: A pancreatic fistula formed in 7% of the Imaizumi modification patients (PPPD 5%), pain relief was achieved in 92% (PPPD 94%), complete professional rehabilitation was achieved in 71% (PPPD 67%), insulin-dependent diabetes mellitus was present in 43 versus 36% before the procedure (PPPD 62 versus 38% before the procedure), and body weight improved in 79% (PPPD 48%). No significant differences were found between the two groups for the early postoperative complications and the late postoperative outcome 3 years after the procedure. However, the Imaizumi modification group exhibited an encouraging tendency to have a lower rate of new-onset exocrine and endocrine insufficiency than the PPPD group. Conclusions: Our Imaizumi modification of the Beger procedure, including intrapancreatic bile duct resection, represents a useful alternative for the treatment of chronic pancreatitis with an inflammatory mass and bile duct stenosis in the pancreatic head. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009. Source

Suzuki S.,Hachioji Digestive Disease Hospital | Kaji S.,Hachioji Digestive Disease Hospital | Koike N.,Hachioji Digestive Disease Hospital | Harada N.,Hachioji Digestive Disease Hospital | And 4 more authors.
Journal of the Pancreas | Year: 2010

Context: We report the imaging features of pancreatic schwannomas, a rare benign type of pancreatic tumor. Case report: A 66-year-old woman was admitted to our hospital with a pancreatic tumor indicated in medical examinations. Computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) revealed a solid and cystic tumor, 3 cm in diameter, within the body of the pancreas. Contrast-enhanced CT, MRI and ultrasonography showed partial enhancement in the solid component. Endoscopic retrograde cholangiopancreatography (ERCP) and angiography showed no abnormal findings. A distal pancreatectomy together with a splenectomy and lymph node dissection were performed with a tentative diagnosis of mucinous cystic neoplasm of the pancreas. The cut surface of the resected pancreas showed a well-demarcated, pale yellow, solid tumor within the pancreas parenchyma. Histopathological examination of the tumor revealed proliferation of the spindle cells showing interlacing and palisading patterns. Immunohistochemically, these spindle cells were positive for S-100 protein and vimentin, and negative for alpha-smooth muscle actin, CD34, and cytokeratin. Thus the tumor was diagnosed as a pancreatic schwannoma. Conclusion: CT and US can detect pancreatic schwannomas as solid and cystic masses, and MRI shows a relatively characteristic feature. Imaging procedures such as CT, MRI and US are able to differentiate a pancreatic tumor, such as a pancreatic schwannoma. Source

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