Hofu Institute of Gastroenterology

Hōfu, Japan

Hofu Institute of Gastroenterology

Hōfu, Japan
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Yamada T.,Hofu Institute of Gastroenterology | Miura O.,Hofu Institute of Gastroenterology | Kawano T.,Hofu Institute of Gastroenterology | Matsuzaki K.,Hofu Institute of Gastroenterology | Yamamoto M.,Tokyo Women's Medical University
Japanese Journal of Gastroenterological Surgery | Year: 2011

We report a case of mucinous adenocarcinoma of the duodenum in a 79-year-old woman. The patient was admitted to our hospital because of anemia. Upper gastrointestinal endoscopy and a barium meal showed an irregular ulcerative lesion in the anterior wall of the duodenal bulb. Biopsy yielded a diagnosis of well differentiated adenocarcinoma. After the preoperative examination, we performed pancrea-toduodenectomy. Pathological findings revealed mucinous adenocarcinoma. Mucin stain for MUC5AC and MUC6 were both positive, but MUC2 was negative. We therefore diagnosed gastric-type adenocarcinoma. We reviewed 10 Japanese cases of mucinous adenocarcinoma of the duodenum and analyzed the clinicopathologic features. © 2011 The Japanese Society of Gastroenterological Surgery.


PubMed | Tokyo Women's Medical University and Hofu Institute of Gastroenterology
Type: Journal Article | Journal: Journal of surgical case reports | Year: 2016

A 69-year-old man, who had undergone pylorus-preserving pancreaticoduodenectomy (PD) (Imanaga procedure) for duodenum papilla cancer 13 years prior, had a history of repeated hospitalization due to cholangitis since the third year after surgery and liver abscess at the 10th year after surgery. Gastrointestinal series indicated no stenosis after the cholangiojejunostomy. However, reflux of contrast media into the bile duct and persistence of food residues were observed. We considered the cholangitis to be caused by reflux and persistence of food residues into the bile duct. So, we performed the tract conversion surgery, Imanaga procedure to Child method. The postoperative course was good even after re-initiating dietary intake. He was discharged on the 19th day after surgery. He has not experienced recurrent cholangitis for 18 months. For patients with post-PD recurrent cholangitis caused by reflux of food residues like ours, surgical treatment should be considered because tract conversion may be an effective solution.


Sentani K.,Hiroshima University | Oue N.,Hiroshima University | Noguchi T.,Oita University | Sakamoto N.,Hiroshima University | And 2 more authors.
Pathology International | Year: 2010

We previously reported that Reg IV is associated with neuroendocrine (NE) differentiation in gastric cancers. The aim was to examine which NE hormone products are related to Reg IV-positive NE cells and their roles in gastric cancers. In the present study, we performed immunohistochemical analysis in a tissue microarray (TMA) of a consecutive series of 630 cases with ten different antibodies, including chromogranin A, synaptophysin and neural cell adhesion molecule (NCAM) as NE differentiation markers, and gastrin, serotonin, calcitonin, gastrin-releasing peptide (GRP), pancreatic polypeptide (PP), somatostatin and glucagon as NE hormones. In 630 cases, we identified 205 (33%) with NE differentiation and 147 (23%) positive for Reg IV. Reg IV-positive cases showed NE differentiation more frequently than Reg IV-negative cases (P < 0.0001). In 205 cases with NE differentiation, Reg IV-positive cases expressed serotonin (P = 0.0032) and somatostatin (P = 0.036) more frequently than Reg IV-negative cases. Double immunofluorescence staining revealed co-expression of Reg IV with gastrin, serotonin and PP. These results indicate that Reg IV might be a mediating factor of several NE hormones. © 2010 Japanese Society of Pathology.


Matsuda M.,Hiroshima University | Sentani K.,Hiroshima University | Noguchi T.,Oita University | Hinoi T.,Hiroshima University | And 7 more authors.
Pathology International | Year: 2010

Claudin-18 plays a key role in constructing tight junctions, and altered claudin-18 expression has been documented in various human malignancies; however, little is known about the biological significance of claudin-18 in colorectal cancer (CRC). The aim of this study is to investigate the significance of claudin-18 expression in CRC and its association with clinicopathological factors. We performed clinicopathological analysis of claudin-18 expression in a total of 569 CRCs by immunohistochemistry. Moreover, we investigated the association between claudin-18 and various markers including gastric/intestinal phenotype (MUC5AC, MUC6, MUC2 and CD10), CDX2, claudin-3, claudin-4, p53 and Ki-67. Claudin-18 expression was detected in 21 of the 569 CRCs (4%) and was seen exclusively on the cell membrane. Positive expression of claudin-18 showed a significant correlation with positive expression of MUC5AC (P < 0.0001) and negative expression of CDX2 (P = 0.0013). The prognosis of patients with positive claudin-18 expression was significantly poorer than in negative cases (P = 0.0106). Multivariate analysis revealed that T grade, M grade and claudin-18 expression were independent predictors of survival in patients with CRC. We revealed that claudin-18 expression correlates with poor survival in patients with CRC and is associated with the gastric phenotype. © 2010 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.


Matsusaki K.,Hofu Institute of Gastroenterology | Ohta K.,International University of Health and Welfare | Yoshizawa A.,Kanamecho Hospital | Gyoda Y.,Kanamecho Hospital
International Journal of Clinical Oncology | Year: 2011

Background: We have actively carried out cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites. However, with conventional CART, the membrane becomes clogged after processing about 2 L of cancerous ascites fluid due to the fact that it is rich in cellular and mucous components; it is therefore difficult to process the entire volume of collected ascites. Methods: We developed KM-CART which includes a membrane cleaning function, and applied it in 73 cases of cancerous ascites, after its basic functions had been evaluated in 11 cases of refractory cancerous ascites. Results: On average, using KM-CART, 6.4 L (range 1.7-14.9 L) of ascites were filtrated and concentrated to 0.8 L (0.2-2.0 L) in 57 min (5-129 min); the membrane was cleaned an average of three times (range 0-10 times) and this enabled the processing of more ascites in a shorter period. In addition, the circuit and the handling were both markedly simple, and fever, which has been the most notable adverse effect with the conventional system, was not an issue. Conclusion: Since KM-CART was safe and is expected to improve the subjective symptoms and general condition of the patient, it is proposed that this novel system should actively be used not only for palliation but also as supplementary treatment for cancerous peritonitis. © 2011 Japan Society of Clinical Oncology.


Nishimura J.,Yamaguchi University | Nishikawa J.,Yamaguchi University | Hamabe K.,Yamaguchi University | Nakamura M.,Yamaguchi University | And 4 more authors.
Journal of Gastrointestinal Cancer | Year: 2014

Purpose: Cancer can develop in the operated stomach after partial gastrectomy and in the reconstructed gastric tube after surgery for esophageal cancer. It is considered that endoscopic therapy is more safe and suitable for the early gastric cancer developed in such stomach than operation. We investigated the efficacy of endoscopic submucosal dissection (ESD) for cancer of the operated stomach. Methods: Subjects were 669 gastric cancer patients who underwent ESD: 22 patients (23 lesions) had surgically altered gastric anatomy, whereas 647 patients (727 lesions) had normal gastric anatomy. In the altered gastric anatomy group, 13 patients, 6 patients, and 3 patients had previously undergone distal gastrectomy, gastric tube reconstruction, and proximal gastrectomy, respectively. Rates of complete en bloc resection and curative resection were compared between the two groups. Influence of an anastomotic site and/or a suture line on ESD outcomes was examined in the altered gastric anatomy group. Results: The rate of complete en bloc resection by ESD was 82.6 % (19/23 lesions) in the altered gastric anatomy group and 92.3 % (671/727 lesions) in the normal gastric anatomy group. The rate of curative resection and incident rates of complications were not significantly different between the groups. In the altered gastric anatomy group, the rate of complete en bloc resection was significantly lower when a lesion had spread across an anastomotic site and/or a suture line (P=0.0372). Furthermore, duration of ESD was significantly longer (P=0.0276), and resection efficiency was significantly lower (13 mm2/min, P=0.0283), when treating lesions with an anastomotic site and/or a suture line than when treating isolated lesions. Conclusions: Outcome of ESD for cancer of the operated stomach compares with that in normal stomach anatomy. Anastomotic site/suture line within a lesion influenced the ESD procedure. © 2013 Springer Science+Business Media.


Goto A.,Yamaguchi University | Nishikawa J.,Yamaguchi University | Okamoto T.,Yamaguchi University | Hamabe K.,Yamaguchi University | And 6 more authors.
Hepato-Gastroenterology | Year: 2013

Background/Aims: The introduction of endoscopic submucosal dissection for the treatment of early gastric cancer has enabled en bloc resection of lesions that cannot be treated with conventional endoscopic mucosal resection. Despite expansion of indications for endoscopic treatment, a considerable number of patients still require additional treatment. The objective of this study was to summarize the outcomes of endoscopic submucosal dissection performed on patients with early gastric cancer and to identify factors associated with incomplete resection and non-curative resection. Methodology: This study examined 605 lesions in 533 patients with early gastric cancer who underwent endoscopic submucosal dissection. Evaluation of treatment outcome was based on the rates of complete resection and curative resection. Factors associated with incomplete resection and non-curative resection were retrospectively identified. Results: Of the 605 lesions, 562 (92.9%) and 510 (84.3%) were diagnosed as complete resection and curative resection, respectively. Factors identified as associated with incomplete resection were tumor size ≥30mm, location in the U region, undifferentiated carcinoma, sm2 invasion and ulceration. Factors identified as associated with non-curative resection were tumor size ≥30mm, location in the U region and ulceration. Conclusions: Incomplete and non-curative resection appears to be associated with preoperative diagnosis of lesions and technical difficulty. © H.G.E. Update Medical Publishing S.A.


Ikari N.,Hofu Institute of Gastroenterology | Miura O.,Hofu Institute of Gastroenterology | Takeo S.,Hofu Institute of Gastroenterology | Okamoto F.,Hofu Institute of Gastroenterology | And 4 more authors.
Journal of Japanese Society of Gastroenterology | Year: 2014

We report the case of a 64-year-old man who underwent resection on two occasions for recurrent renal cell carcinoma. He first underwent right nephrectomy for renal cell carcinoma, and 10 years later, he underwent pylorus-preserving pancreaticoduodenectomy for pancreatic metastasis. Microscopic extracapsular invasion without lymph node metastasis was observed at that time. Twelve years after the first surgery, he was diagnosed with stomach metastasis. Clinically, metastases to other organs was not observed, and endoscopic ultrasonography revealed no changes in the submucosal layer; endoscopic submucosal dissection was subsequently performed. Pathologically, the tumor was found to be localized in the mucosal layer. There has been no occurrence of metastases for 2 years and 6 months since the last surgery.


PubMed | Hofu Institute of Gastroenterology
Type: Case Reports | Journal: Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2014

We report the case of a 64-year-old man who underwent resection on two occasions for recurrent renal cell carcinoma. He first underwent right nephrectomy for renal cell carcinoma, and 10 years later, he underwent pylorus-preserving pancreaticoduodenectomy for pancreatic metastasis. Microscopic extracapsular invasion without lymph node metastasis was observed at that time. Twelve years after the first surgery, he was diagnosed with stomach metastasis. Clinically, metastases to other organs was not observed, and endoscopic ultrasonography revealed no changes in the submucosal layer; endoscopic submucosal dissection was subsequently performed. Pathologically, the tumor was found to be localized in the mucosal layer. There has been no occurrence of metastases for 2 years and 6 months since the last surgery.


PubMed | Hofu Institute of Gastroenterology
Type: Journal Article | Journal: International journal of clinical oncology | Year: 2011

We have actively carried out cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites. However, with conventional CART, the membrane becomes clogged after processing about 2L of cancerous ascites fluid due to the fact that it is rich in cellular and mucous components; it is therefore difficult to process the entire volume of collected ascites.We developed KM-CART which includes a membrane cleaning function, and applied it in 73 cases of cancerous ascites, after its basic functions had been evaluated in 11 cases of refractory cancerous ascites.On average, using KM-CART, 6.4L (range 1.7-14.9L) of ascites were filtrated and concentrated to 0.8L (0.2-2.0L) in 57min (5-129min); the membrane was cleaned an average of three times (range 0-10times) and this enabled the processing of more ascites in a shorter period. In addition, the circuit and the handling were both markedly simple, and fever, which has been the most notable adverse effect with the conventional system, was not an issue.Since KM-CART was safe and is expected to improve the subjective symptoms and general condition of the patient, it is proposed that this novel system should actively be used not only for palliation but also as supplementary treatment for cancerous peritonitis.

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