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Ohkubo H.,Yokohama City University | Masaki T.,Kyorin University | Matsuhashi N.,Nippon Telegraph and Telephone | Kawahara H.,Jikei University School of Medicine | And 3 more authors.
Neurogastroenterology and Motility | Year: 2014

Background: Idiopathic megacolon (IMC) is an intractable motility disorder in which chronic symptoms of colonic dysmotility appear with no mechanical cause. Although a pathological analysis is essential to understand the mechanism of IMC, no study has compared the histopathologic findings between dilated and non-dilated loops in IMC cases, and little is known about the proportion of each disease subtype. Methods: Fifty-three full-thickness samples (dilated loops, n = 31; non-dilated loops, n = 22) from 31 IMC cases and 16 samples (dilated loops; n = 8, non-dilated loops; n = 8) from eight controls were collected. All the samples were stained with hematoxylin-eosin (HE), Hu C/D antibody, and CD117 antibody to assess degenerative myopathy, degenerative neuropathy, inflammatory neuropathy, hypoganglionosis, and mesenchymopathy according to the London Classification. Findings of the dilated and non-dilated loop samples were compared, and the proportions of each subtype were analyzed. Key Results: Based on a control study, <60 ganglion cells/cm was defined as hypoganglionosis in our series. Myopathy was observed in 11 patients (35.5%), neuropathy was in 19 patients (61.3%), and mesenchymopathy was in 10 patients (32.2%). An overlap between subtypes was observed in some cases. Surprisingly, the non-dilated loop samples exhibited very similar histopathologic abnormalities to those observed in the dilated loop samples in most cases. Conclusions & Inferences: Our study is the first to compare the histopathologic findings between dilated and non-dilated loops in IMC patients. Histopathologic abnormalities precede the clinical manifestation of IMC, and may consequently lead to gradual colonic dilatation; however, detailed mechanism including dilation triggering factor needs further elucidation. © 2014 John Wiley & Sons Ltd.

Kojima T.,Kojima Family Clinic | Matsui T.,Aichi Cancer Center Research Institute | Fujimitsu Y.,Aichi Cancer Center Research Institute | Kojima H.,Aichi Cancer Center Research Institute | And 8 more authors.
Annals of Cancer Research and Therapy | Year: 2011

Background: The early detection of colorectal cancer is important issue for improving the survival rate. Although fecal occult-blood testing and Carcinoembryonic antigen (CEA) in serum is widely used for noninvasive screen method, it has limited sensitivity. Methods: 142 patients with primary colorectal cancer who underwent surgery and 150 healthy volunteers were enrolled in this study. 37 of the tumors (26%) were Stage I, 34 (24%) were Stage II, 58 (41%) were Stage III, 12 (9%) were Stage IV. In each serum sample, CEA, p53 antibodies, and CEA-IgM complexes were measured. Results: The diagnostic sensitivity with CEA (cut-off: 5 ng/ml) and p53 antibodies (cut-off: 3.0 U/ml) was 48% (68/142), Stage I 16% (6/37), Stage II 56% (19/34), Stage III 53% (31/58), and Stage IV 92% (12/13), while false positive rate was 7% (10/150). Because the sensitivity of CEA-IgM (cut-off: 150 AU/ml) was low, three tests combination did not much increase the overall sensitivity. Conclusions: The sensitivity of CEA-IgM for detecting colon cancer was lower than expected from previous study. As for the specificity of p53-antibodies, because its sensitivity is preserved with cut-off at 3.0 U/ml, re-evaluation of present cutoff level (1.3 U/ml) seemed to be needed.

Watanabe M.,Tokyo Medical and Dental University | Hanai H.,Center for Gastroenterology | Nishino H.,Colo Proctology Center | Yokoyama T.,Yokoyama Hospital for Gastroenterological Diseases | And 2 more authors.
Inflammatory Bowel Diseases | Year: 2013

Background: Mesalazine preparations are widely used to treat mild to moderately severe ulcerative colitis (UC). We compared once-daily administration of oral mesalazine in patients with quiescent UC with the established 3-times-daily prescription, assessing the efficacy and safety of each method in maintaining remission for 52 weeks. Methods: This was a double-blind, double-dummy, randomized, multicenter noninferiority study in which 301 patients with quiescent UC were randomly assigned to treatment groups and administered prolonged-release oral mesalazine at doses of 1.5 to 2.25 g/d once daily (QD) or 3 times daily (TID) for 52 weeks. The primary endpoint was whether remission was maintained after 52 weeks of administration or until the time of discontinuation, as represented by the Ulcerative Colitis Disease Activity Index score. Results: The proportion of patients still in remission after 52 weeks of administration was 79.4% in the QD group and 71.6% in the TID group. The between-group difference was 7.8% (2-tailed 95% confidence interval [CI]: -2.2% to 17.8%), and the noninferiority of QD administration to TID administration was verified with a noninferiority margin of -10%. In the safety analysis, the incidence of adverse events in each group was 72.4% for the QD group and 76.5% for the TID group, showing no statistically significant difference between the 2 groups (P = 0.4305). Conclusions: This double-blind parallel-group comparison verified for the first time the noninferiority of QD administration of oral mesalazine 1.5 to 2.25 g/d to TID administration in terms of maintaining remission in patients with UC. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

Inagaki H.,Yokoyama Hospital for Gastroenterological Diseases | Yokoyama T.,Yokoyama Hospital for Gastroenterological Diseases | Kikuchi M.,Yokoyama Hospital for Gastroenterological Diseases | Yokoyama Y.,Yokoyama Hospital for Gastroenterological Diseases
Japanese Journal of Cancer and Chemotherapy | Year: 2010

A 71-year-old man, whose chief complaint was a faecal occult blood, had gastrointestinal endoscopy and gastric cancer was diagnosed. CT scan and intraoperative findings revealed metastatic liver tumors. We performed total gastrectomy with D2 lymph dissection, partial hepatic resections and microwave coagulation therapy. Small cell carcinoma of the stomach was diagnosed by histopathological findings. We used combination chemotherapy consisting of carboplatin, epirubicin, etoposide and 5-FU was performed. After one course, he suffered from leucopenia and agranulocytosis of grade 3, thrombocytopenia of grade 4, so we reduced the dose and performed 6 courses in total. The patient remains alive without recurrence 48 months after operation. We conclude that adjuvant chemotherapy was effective for small cell carcinoma of the stomach, which was to be considered to have a poor prognosis.

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