Kashiwara Municipal Hospital

Ōsaka, Japan

Kashiwara Municipal Hospital

Ōsaka, Japan

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Nakao S.,Kashiwara Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We report a case of a 60-year-old woman with abdominal distension who was treated with self-expandable metal stent (SEMS) placement in the proximal transverse colon. She was found to have severe bowel obstruction due to advanced transverse colon cancer on plain computed tomography (CT) and colonoscopy. We performed colonic stenting safely, and the symptom promptly improved. Defecation and flatus were observed on the same day of stenting, and the patient was able to start drinking and eating on the next day. Enhanced abdominal CT revealed multiple liver metastasis, peritoneal dissemination, ascites, and cystic ovarian tumor. After treatment with 1 course of 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6), the patient was discharged on day 14 after admission. The rapidly enlarging ovarian tumors and primary colonic lesion with SEMS were surgically removed after treatment with mFOLFOX6 for 4 months in an outpatient basis. The patient has been alive with a good quality of life (QOL) and being treated with bevacizumab plus mFOLFOX6/Leucovorin, 5-fluorouracil, and irinotecan( FOLFIRI) for 6 months. SEMS placement could be safe and effective for the treatment of obstruction of the right colon, and could maintain a good QOL in patients.


Nakata B.,Kashiwara Municipal Hospital | Ishikawa T.,Kashiwara Municipal Hospital | Amano R.,Osaka City University | Kimura K.,Osaka City University | Hirakawa K.,Osaka City University
International Journal of Surgery | Year: 2013

Purpose: The goal of this study was to review published literature regarding the impact of preoperative diabetes mellitus (DM) in patients undergoing pancreatectomy. Methods: Ovid Medline® of a biomedical database was used on subjective literature research. Results: The prevalence of preoperative DM was 30.9-54.9% in patients with pancreatic cancer and was 5.3-10.8% in patients with chronic pancreatitis. There were few reports that described the relationship between preoperative DM status and postoperative morbidity/mortality, or long-term survival after pancreatectomy. The incidence of pancreatic fistula of Grade B and C [defined by International Study Group on Pancreatic Fistula Definition (ISGPF)] was similar when comparing patients with and without preoperative DM. Furthermore, the incidence of death and various morbidities (e.g., infections, cardiovascular complications, clinically significant level of acute renal failure after pancreatectomy, and delayed gastric emptying after pancreaticoduodenectomy) were not significantly different when comparing patients with and without preoperative DM. It is unclear whether preoperative DM has an impact on long-term survival after pancreatectomy, and the difficulty in assessing this parameter may be due to different definitions of DM, different surgical methods, and different comorbidities when comparing different studies. Conclusions: The occurrence rates of postoperative mortality and morbidities including pancreatic fistula and renal failure of moderate to severe degrees were almost same between patients with and without preoperative DM. The influence of preoperative DM on long term survival after pancreatectomy should be elucidated by future studies under accurate and consistent definitions of DM. © 2013 Surgical Associates Ltd.


Nakao S.,Kashiwara Municipal Hospital | Nakata B.,Kashiwara Municipal Hospital | Tendo M.,Kashiwara Municipal Hospital | Kuroda K.,Kashiwara Municipal Hospital | And 4 more authors.
BMC Surgery | Year: 2015

Background: Patient with α-Fetoprotein (AFP)-producing gastric cancer usually has a short survival time due to frequent hepatic and lymph node metastases. Gastric cancer with portal vein tumor thrombus (PVTT) is rare and has an extremely poor prognosis. Case presentation: A 63-year-old man was found to have a huge Type 3 gastric cancer with a PVTT and a highly elevated serum AFP level. Chemotherapy with S-1 plus cisplatin was given to this patient with unresectable gastric cancer for 4 months. The serum AFP level decreased from 6,160 ng/mL to 60.7 ng/mL with chemotherapy. Since the PVTT disappeared after the chemotherapy, the patient underwent total gastrectomy. Histological findings of the primary tumor after chemotherapy showed poorly differentiated adenocarcinoma without hepatoid cells and viable tumor cells remaining in less than 1/3 of the neoplastic area of mucosa and one lymph node. The cancerous cells were immunohistochemically stained by anti-AFP antibody. The patient has survived for 48 month without recurrence. Conclusions: AFP-producing gastric cancer with a PVTT has an extremely poor prognosis, but long-term survival was achieved for this dismal condition by salvage surgery after chemotherapy. © 2015 Nakao et al.; licensee BioMed Central.


Hirata K.,Osaka City University | Nakata B.,Osaka City University | Nakata B.,Kashiwara Municipal Hospital | Amano R.,Osaka City University | And 3 more authors.
Journal of Gastrointestinal Surgery | Year: 2014

Introduction: This study aimed to determine risk factors for exacerbation of diabetes mellitus (DM) after pancreatectomy. Methods: Medical records of 167 patients with benign and malignant pancreaticobiliary diseases who underwent pancreaticoduodenectomy or distal pancreatectomy were retrospectively analyzed. DM was diagnosed by diabetic history or American Diabetes Association criteria. Worsened and improved DM after pancreatectomy was defined when treatment intensity or insulin/oral antidiabetic drug dosage increased or decreased, respectively, postoperatively. Long-standing DM was defined as a duration of >2 years. Results: In 76 preoperative diabetic patients, worsened and improved DM was observed postoperatively in 46 (60.5 %) and 9 (11.8 %) patients, respectively. In 91 preoperative nondiabetic patients, 22 (24.2 %) developed new-onset DM after pancreatectomy. Multivariate logistic analysis of the preoperative diabetic patients demonstrated long-standing DM and malignancy as independent predictors for postoperative worsened DM. No patients with long-standing DM or insulin treatment experienced improved DM after pancreatectomy. Multivariate logistic analysis of the preoperative nondiabetic patients showed body mass index of ≥25 and hard pancreatic texture as independent risk factors for new-onset postoperative DM. Conclusions: These results may enable preoperative evaluation of risk factors for worsened or new-onset DM after pancreatectomy and may help plan intensive care for patients at a high risk of postoperative worsened DM. © 2014, The Society for Surgery of the Alimentary Tract.


PubMed | Kashiwara Municipal Hospital and Osaka City University
Type: Journal Article | Journal: World journal of surgical oncology | Year: 2017

The first-line treatment for resectable pancreatic cancer (RPC) is surgical resection. However, our patients have often experienced early recurrence after curative resection for RPC, with desperately poor prognosis. Some reports indicated that minimally distant metastasis not detected at operation might cause early recurrence. The present study aimed to identify preoperative clinicopathological features of early recurrence after curative resection of RPC.Ninety RPC patients who underwent curative resection between 2000 and 2014 at our institution were retrospectively analyzed.Of the 90 patients, 32 had recurrence within 1year. Univariate analysis demonstrated that preoperative serum carbohydrate antigen (CA19-9) 529U/mL (P=0.0011), preoperative serum s-pancreas-1 antigen (SPan-1) 37U/mL (P=0.0038), and histological grades G2-G4 (P=0.0158) were significantly associated with recurrence within 1year after curative resection. Multivariate analysis demonstrated that preoperative serum CA19-9529U/mL (P=0.0477) and histological grade G2-G4 (P=0.0129) were independent predictors of recurrence within 1year. Recurrent cases within 1year postoperatively had significantly more distant metastasis than cases with no recurrence within 1 year (P<0.001).Preoperative serum CA19-9529U/mL and histological grades G2-G4 were independent predictive factors for recurrence within 1year after pancreatectomy for RPC. Furthermore, recurrent cases within 1year had more frequent distant metastasis than cases with no recurrence within 1year. These results suggest that RPC patients with preoperative serum CA19-9529U/mL should receive preoperative therapy rather than surgery.


PubMed | Kashiwara Municipal Hospital, Eastern Virginia Medical School, Osaka City University and Osaka City General Medical Center
Type: | Journal: BMC cancer | Year: 2016

Anaplastic pancreatic cancer (APC) cell lines have been scarcely established.The morphology, gene expressions, karyotyping and epithelial-mesenchymal transition markers of newly established APC cell lines OCUP-A1 and OCUP-A2 were analyzed. Their abilities of proliferation under normoxia and hypoxia, migration and invasion were compared to 4 commercially available pancreatic ductal adenocarcinoma (PDA) cell lines. Their induction of angiogenesis, stem-like cell population and subcutaneous tumor growth in nude mice were estimated, comparing 2 PDA cell lines examined here.OCUP-A1 and OCUP-A2 cells continuously grew with spindle and polygonal shapes, respectively. Gene analysis revealed 9 gene mutations including KRAS and TP53. Karyotyping clarified numerical structural abnormalities in both cells. Loss of E-cadherin and expression of vimentin in both cell lines were observed. The doubling time of both cell lines was approximately 20 h. Proliferation, migration and invasion abilities were not notable compared to other PDA cell lines. However stem-like cell population of both cell lines was superior to a part of PDA cell lines. Moreover OCUP-A1 showed stronger hypoxia tolerance and induction of angiogenesis than other PDA cell lines. The tumorigenicity in vivo of OCUP-A2 was stronger than conventional PDA cell lines.The OCUP-A1 and OCUP-A2 cell lines of rare malignancies might be useful for investigating the biology of pancreatic cancer.


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

A 62-year-old woman was admitted to our hospital because of bloody stool. Colonoscopy revealed stenosis by a type 2 tumor of the recto-sigmoid colon. A biopsy specimen contained moderately differentiated adenocarcinoma. Thoraco-abdominal computed tomography (CT) showed liver metastasis (S7, 10 mm) and enlargement of Virchows lymph node (17 mm) and several para-aortic lymph nodes (15 mm on average). Because of oozing from the tumor and severe stenosis of the recto-sigmoid colon, we performed laparoscopic-assisted high anterior resection of the primary lesion. After surgery, 3 courses of mFOLFOX6, 20 courses of mFOLFOX6 plus bevacizumab, and 5 courses of infusional 5-FU plus Leucovorin plus bevacizumab were administered. Thoraco-abdominal CT demonstrated complete response to the 1 year 2 months of chemotherapy. The patient has been alive without relapse for 2 years after surgery.


PubMed | Kashiwara Municipal Hospital, Naniwa Ikuno Hospital and Osaka City University
Type: Journal Article | Journal: Scandinavian journal of gastroenterology | Year: 2016

Gastroesophageal reflux disease (GERD) and psychological stress are associated with sleep disturbances. The aim of the present study was to examine the prevalence of sleep disturbances, anxiety, and depression by GERD subtypes and to identify factors associated with sleep disturbances in general population.A total of 2002 Japanese subjects, who underwent annual health checkups, were enrolled and asked to fill out a questionnaire, including the frequency scale for the symptoms of GERD (FSSG), Athens Insomnia Scale (AIS), Rome III questionnaire, and Hospital Anxiety and Depression Scale (HADS). GERD was divided into asymptomatic erosive reflux disease (a-ERD), symptomatic ERD (s-ERD), and non-erosive reflux disease (NERD), according to the presence or absence of esophageal mucosal injury on endoscopy, and the FSSG scores. Sleep disturbances were diagnosed in subjects with AIS score 6.Prevalence of sleep disturbances was significantly higher in GERD subjects than in controls (35.9 and 14.7%, respectively), especially, in the NERD group (45.1%). Sleep duration was significantly shorter in the s-ERD group compared with other groups. Subjects in the NERD and s-ERD groups showed higher HADS scores, resulting in higher incidences of anxiety and depression than those in the control and a-ERD groups. Reflux symptoms, anxiety, depression, and coexisting functional dyspepsia, but not the presence of esophageal mucosal injury, were associated with an increased odds ratio for sleep disturbances.There were significant positive associations among reflux symptoms, psychological stress, and sleep disturbance in Japanese adults. Further studies investigating the efficacy of therapy are needed.


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

We report a case of a villous tumor of the rectum with electrolyte depletion syndrome (EDS). A 76-year-old woman developed general fatigue, and on investigation, we found a large laterally spreading tumor of the rectum using bowel enema and colon fiber. Pathologically, the biopsy specimen was graded Group 4. We intended to perform a laparoscopy-assisted low anterior resection in the patient. However, the operation was interrupted by a short-run type of ventricular premature contraction (VPC) due to EDS-induced hypokalemia. After treating the hypokalemia, low anterior resection or laparotomy was performed. The tumor was 19 13 cm in size and occupied the circumference of the rectum. Histological examination revealed well differentiated tubular adenocarcinomas with tubulovillous adenoma. Pathological staging was pTis, pN0, M0, stage 0 according to the Japanese Classification of Colorectal Carcinoma (8th edition). It is now 6 months after the operation and hypokalemia has not recurred in the patient.


PubMed | Kashiwara Municipal Hospital and Osaka City University
Type: Journal Article | Journal: International journal of surgery (London, England) | Year: 2016

In Japan, the majority of early gastric cancers (EGCs) are now treated with endoscopic submucosal dissection (ESD). Patients with non-curative lesions treated by ESD are advised to undergo additional surgical resection (ASR) based on guidelines from the Japan Gastroenterological Endoscopy Society (JGES) and Japanese Gastric Cancer Association (JGCA). However, many studies have demonstrated that residual cancer and lymph node metastasis are only rarely found in ASR specimens. Here we retrospectively analyzed the conditions that could enable the avoidance of unnecessary ASR.The ESD data for 114 absolute indication lesions and 26 lesions of expanded indication lesions were analyzed. The indications and the curability were evaluated according to the JGES/JGCA guidelines.The rates of non-curative resection and ASR were significantly higher in the expanded indication group compared to the absolute indication group (26.9% and 19.2% vs. 7.9% and 0.9%, respectively). ASR was performed for six patients. Three of their ARS specimens contained neither residual cancer nor lymph node metastasis, and the pathological findings of the preceding ESD specimens deviated slightly from the curative criteria defined by the guidelines. The conditions of the lesions that did not meet the curative criteria were as follows: (1) sm1 invasion of undifferentiated-type lesion <10mm dia., (2) 21-25mm dia. mucosal undifferentiated-type lesion, or (3) peacemeal resection with a horizontal margin positive for the mucosal differentiated-type.These data suggest that a close follow-up without ASR might be appropriate for patients in the above-mentioned three categories after non-curative ESD for EGC.

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