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Tokunaga Y.,Kyoto Japan Post Hospital | Sasaki H.,Osaka North Japan Post Hospital
International Surgery

Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced.We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications. Source

Tokunaga Y.,Osaka North Japan Post Hospital | Ohnishi T.,Clinical Laboratory | Sasaki H.,Osaka North Japan Post Hospital
Japanese Journal of Cancer and Chemotherapy

In colorectal cancer (CRC), 5-fluorouracil (5-FU) has been a basic chemotherapeutic agent. Orotate phosphoribosyltransferase (OPRT) and thymidine Phosphorylase (TP) are essential enzymes for activation of 5-FU. Dihydropyrimidine dehydrogenase (DPD) is an enzyme for degradation. The feasibility of individualized chemotherapy was studied using the enzyme expression and drug sensitivity test. Methods: The study included 160 surgical patients (stage II to IV). OPRT, TP, and DPD expressions, assessed with immunohistochemistry, were evaluated in relation to clinicopathological features and patient survival. We assessed 5-FU sensitivity using the collagen gel droplet. Embedded culture-drug sensitivity test (CD-DST). The area under the concentration curve (AUC) and growth inhibition curve (IR) were combined in the AUC-IR curve, according to which the individual AUCIR50 was calculated. Durations to achieve AUCIR50 were calculated using AUC24hr values in UFT and S-1. Results: TP and DPD expression were positively associated with CRC progression and related with poor prognosis, although OPRT expression was negatively associated with CRC progression and related with better prognosis. Patient survival was best in patients with OPRT (+) DPD (-), and worst in those with OPRT (-) DPD (+). Individual AUC IR50 ranged from less than 100μg·hr/mL to more than 10, 000μg·hr/mL. In the chemotherapy with UFT, 55% of patients achieved AUCIR50 within 6 months, 13% of patients achieved it 6 to 12 months, another 13% of patients in 12 to 24 months, and the other 19% after 24 months of chemotherapy. In the chemotherapy with S-1, 31% of patients achieved AUC IR50 within 1 course, 15% in 1 to 2 courses, another 23% in 2 to 6 courses and the other 31% of patients achieved AUCIR50 after 6 courses. Conclusions: The present results suggest that patients' prognosis may be improved with selection of an anti-cancer drug based on the 5-FU metabolizing enzyme expressions and prognostic factors. CD-DST may predict the duration of chemotherapy. Source

The liver is the most common site for recurrent metastases from bile duct cancer (BDC) in the ampullary area. However, the optimal chemotherapy regimen for recurrent hepatic metastases has not yet been established. An oral combined fluoropyrimidine drug, S-1 (tegafur, gimeracil and oteracil), has recently been introduced alone or in combination with gemcitabine for BDC. A 67-year-old man underwent a pancreaticoduodenectomy (PD) for early stage distal BDCin the ampullary area. A small hepatic metastasis developed 8 months after the PD. Combined chemotherapy of S-1 (80 mg/m2) and gemcitabine (1000 mg/m2) was started after radiofrequency ablation (RFA) of the hepatic tumor. Although complete response was achieved and maintained for 4 months with chemotherapy, there was regrowth of the tumor. We performed hepatic segmentectomy for radical treatment. Fourteen months after the hepatectomy, metastasis developed again in the remnant liver. Bevacizumab was added to the combination chemotherapy with S-1 and gemcitabine, since the cancer seemed resistant to the chemotherapy alone. The patient has been well managed for 3 years by a multidisciplinary treatment with surgery, RFA and the combination chemo-therapy on an outpatient basis. This case indicates that distal BDCeven in an early stage has a more malignant potential than anticipated. The multidisciplinary treatment including surgery, RFA and combination chemotherapy of S-1, gemcitabine and bevacizumab was effective for BDCwith hepatic metastasis. This chemotherapy is feasible on an outpatient basis and may be one of the treatment options for metastatic BDC. Source

Shitara K.,Aichi Cancer Center Hospital | Morita S.,Yokohama City University | Fujitani K.,The Surgical Center | Kadowaki S.,Saitama Cancer Center Hospital | And 13 more authors.
Gastric Cancer

Background It is unclear whether S-1 plus cisplatin is effective for patients with recurrent gastric cancer after adjuvant S-1 chemotherapy. Methods We retrospectively evaluated the efficacy of S-1 plus cisplatin in patients whose gastric cancer recurred after adjuvant S-1 chemotherapy. Results In the 52 patients evaluated, the median duration of adjuvant S-1 chemotherapy was 8.1 months, and the median recurrence-free interval (RFI) since the last administration of adjuvant S-1 was 6.4 months. Among the 36 patients with measurable lesions, 7 achieved a complete or partial response, and 13 were evaluated as having stable disease, for an overall response rate of 19.4% and a disease control rate of 55.6%. For all patients, the median progression-free survival (PFS) was 4.8 months, and the median overall survival (OS) was 12.2 months. Compared with patients with an RFI of\6 months (n = 25), patients with an RFI of C6 months (n = 27) had a significantly higher response rate (5.0 vs. 37.5%, respectively), longer PFS (2.3 vs. 6.2 months, respectively), and longer overall survival (7.3 vs. 16.6 months, respectively). According to a multivariate Cox model including performance status (PS) and reason for discontinuation of adjuvant S-1, an RFI of 6 months was still significantly associated with PFS and OS. Conclusions S-1 plus cisplatin is effective for patients with gastric cancer that recurs after adjuvant S-1 chemotherapy, especially for those with an RFI of C6 months. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association. Source

Tokunaga Y.,Osaka North Japan Post Hospital | Sasaki H.,Osaka North Japan Post Hospital

Background/Aims: In colorectal cancer (CRC), 5-fluorouracil (5-FU) has been a basic chemotherapeutic agent. Antitumor effects of 5-FU and its derivatives are likely due to inter-individual difference in the drug sensitivity. Methodology: We evaluated the 5-FU sensitivity of cancer cells from CRC patients using the collagen gel droplet embedded culture-drug sensitivity test (CD-DST) under multiple drug concentration and contact durations. The area under the concentration curve (AUC) and growth inhibition curve (IR) were combined in the AUC-IR curve. Using the AUC-IR curve, the individual AUCIR50 was calculated. Furthermore, using the AUC values of 5-FU during 24 hours with chemotherapy with UFT and S-1, the durations to achieve the AUCIR50 were calculated in chemotherapy with UFT or S-1 for individual patient. Results: The value of individual AUCIR50 ranged widely from less than 100μg hr/ml to more than 1000μg hr/ml. Approximately 13% of patients demonstrated a relatively low 5-FU sensitivity. Durations of chemotherapy to achieve the AUCIR50 differed widely depending on the AUC IR50 of individual patient. Relapse free survival was significantly better in the patients who have achieved individual AUCIR50 than those who have not achieved the AUCIR50. Conclusions: The present results suggest that the antitumor effects of 5-FU and its derivatives differ widely depending on inter-individual difference of sensitivity, and that individual AUCIR50 may be useful to predict the optimal duration of chemotherapy. © H.G.E. Update Medical Publishing S.A. Source

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