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Gastrointestinal stromal tumor presenting with prominent calcification

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World Journal of Gastroenterology 2012年第39期18卷 5645-5648页

作者： Naoki Izawa takeshi sawada Ryuichi Abiko Daisuke Kumon Mami Hirakawa Mika Kobayashi Nobuyuki Obinata Masahito Nomoto Tadateru Maehata Shun-ichi Yamauchi Takefumi Kouro Takashi Tsuda Satoshi Kitajima Hiroshi Yasuda Keiichi Tanaka Ichiro Tanaka Masahiro Hoshikawa Masayuki Takagi Fumio Itoh Division of Gastroenterology and Hepatology St.Marianna University School of MedicineKawasaki 216-8511Japan Division of Gastroenterological and General Surgery St.Marianna University School of MedicineKawasaki 216-8511Japan Department of Pathology St.Marianna University School of MedicineKawasak 216-8511Japan

We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcifica-tion at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray. Computed tomography demonstrated that the tumor was growing from the upper gastric body, with calcification in the peripheral ring area. A laparoscopic partial gastrectomy was performed, and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria. Microscopic examination revealed spindle- shaped tumor cells with calcification and hemorrhage. Additionally, positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST. There are a few case reports of heavily calcified GIST, although solitary or punctate calcification of primary GIST has been reported in several case series. Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs. In contrast, appearance of calcification after administration of imatinib mesylate, which may be one indicator of disease response, is possibly caused by a different mechanism.

关键词：胃肠道钙化间质肿瘤生长突出有丝分裂指数肿瘤细胞 CD34

Dynamic Lower-Limb Alignment Focusing on Gait Stability

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Open Journal of Therapy and Rehabilitation 2022年第4期10卷 179-188页

作者： Kan Imai takeshi Onishi Koshiro sawada Department of Orthopaedics Kyoto Prefectural Rehabilitation Hospital for Mentally and Physically Disabled Kyoto Japan Department of Orthopaedics Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan Department of Consultation and Assessment Section Kyoto Prefectural General Family Support Center Kyoto Japan Department of Rehabilitation Medicine Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan Department of Multidisciplinary Promote for Physical Activity University Hospital Kyoto Prefectural University of Medicine Kyoto Japan

Introduction: Prosthetic limbs must be developed with proper alignment to facilitate safe and efficient gait patterns. This study aimed to identify factors impacting clinically proper gait patterns by objectively evaluating them in persons with lower-limb amputations who use prosthetic limbs. Materials and Methods: This non-experimental descriptive study assessed 58 persons with amputation who used prosthetic limbs. The mechanical axis angle (MAA) of the lower limb during the heel contact, midstance, and toe-off phases and the angle between the tube and floor during the midstance phase were measured using coronal plane gait images. We also investigated whether the MAA and tube angle during the midstance phase have a multimodal distribution. In case of multimodal distributions, we tested for significant between-group differences in patient characteristics. Results: The MAA and tube angle in the coronal plane during the midstance phase had a bimodal distribution (mean 0°). There was a significant difference in the duration of prosthetic limb use between the MAA < 0° and ≥0° groups during the midstance phase. Deviations in the lower limb MAA between the heel contact and midstance phases were 3.3° ± 2.2° and 3.1° ± 2.3° for persons with lower limb amputations in the MAA Conclusions: In this study, prosthetic alignment during the midstance phase had a bimodal distribution. In both groups, deviations in the lower limb MAA were aligned to be approximately 3°.

关键词： Prosthetic Limbs Alignment Gait Below-the-Knee Amputation

Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis:A retrospective casecontrol study

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World Journal of Gastroenterology 2022年第10期28卷 1055-1066页

作者： Yuichi Kida takeshi Yamamura Keiko Maeda Tsunaki sawada Eri Ishikawa Yasuyuki Mizutani Naomi Kakushima Kazuhiro Furukawa Takuya Ishikawa Eizaburo Ohno Hiroki Kawashima Masanao Nakamura Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 466-8550AichiJapan Department of Endoscopy Nagoya University HospitalNagoya 466-8560AichiJapan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with *** This study was conducted as a single-center,retrospective case-control ***-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern *** results were compared with the pathological diagnoses to evaluate the diagnostic ***-and intra-observer agreements were *** In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive *** the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high *** interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,*** intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and

关键词： Diagnostic performance Japan Narrow-Band Imaging Expert Team classification Pit pattern classification Sporadic neoplasms Ulcerative colitis Ulcerative colitis-associated neoplasms

Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching

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World Journal of Gastroenterology 2021年第47期27卷 8182-8193页

作者： Masashi Saito takeshi Yamamura Masanao Nakamura Keiko Maeda Tsunaki sawada Eri Ishikawa Yasuyuki Mizutani Takuya Ishikawa Naomi Kakushima Kazuhiro Furukawa Eizaburo Ohno Hiroki Kawashima Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 4668550Japan Department of Endoscopy Nagoya University HospitalNagoya 4668550Japan

BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by *** clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so *** were few reports that observed the course over long periods of time after CP in clinical *** To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score *** We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy *** divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was *** propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical *** After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the *** mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the *** events did not occur in either *** Local recurrence after CP was

关键词： Cold polypectomy Colorectal polyp Hot polypectomy Local recurrence Safety Propensity score matching

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

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World Journal of Gastroenterology 2020年第10期26卷 1056-1066页

作者： Ryo Nishio Hiroki Kawashima Masanao Nakamura Eizaburo Ohno Takuya Ishikawa takeshi Yamamura Keiko Maeda Tsunaki sawada Hiroyuki Tanaka Daisuke Sakai Ryoji Miyahara Masatoshi Ishigami Yoshiki Hirooka Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineAichi PrefectureNagoya 4668550Japan Department of Endoscopy Nagoya University HospitalAichi PrefectureNagoya 4668550Japan Department of Liver Biliary Tract and Pancreas DiseasesFujita Health University HospitalAichi PrefectureToyoake 4701192Japan

BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these *** There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success *** median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO *** incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.

关键词： Biliary tract diseases Double-balloon enteroscopy Endoscopic retrograde cholangiopancreatography Hepatectomy Liver transplantation Risk management

Utility of linked color imaging for endoscopic diagnosis of early gastric cancer

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World Journal of Gastroenterology 2019年第10期25卷 1248-1257页

作者： Toshihisa Fujiyoshi Ryoji Miyahara Kohei Funasaka Kazuhiro Furukawa Tsunaki sawada Keiko Maeda takeshi Yamamura Takuya Ishikawa Eizaburo Ohno Masanao Nakamura Hiroki Kawashima Masato Nakaguro Masahiro Nakatochi Yoshiki Hirooka Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Department of Endoscopy Nagoya University Hospital Department of Pathology and Laboratory Medicine Nagoya University Hospital Division of Data Science Data Coordinating CenterDepartment of Advanced MedicineNagoya University Hospital

BACKGROUND Linked color imaging(LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal *** To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological *** Endoscopic images were obtained for 39 patients(43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging(WLI) and LCI. Color values in Commission Internationale de l'Eclairage(CIE)1976 L*a*b* color space were used to calculate the color difference(ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection,blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images(WLI and LCI) and pathological *** LCI was superior for lesion recognition(P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI(29.4 vs 18.6, P <0.0001). Blood vessel density was significantly higher in cancer lesions(5.96% vs4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%.CONCLUSION LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.

关键词： Linked color imaging Early gastric cancer Endoscopic submucosal dissection Vessel density Color difference

Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

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World Journal of Gastroenterology 2020年第42期26卷 6669-6678页

作者： Yoshiki Niwa Masanao Nakamura Hiroki Kawashima takeshi Yamamura Keiko Maeda Tsunaki sawada Yasuyuki Mizutani Eri Ishikawa Takuya Ishikawa Naomi Kakushima Kazuhiro Furukawa Eizaburo Ohno Takashi Honda Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 466-8560Japan Department of Endoscopy Nagoya University HospitalNagoya 466-8560Japan

BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal *** accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely *** To determine the accuracy of carbon dioxide insufflation enterography(CDE)at the branch for selecting the correct route during *** We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November *** selection via two methods(visual observation and CDE)was performed in each *** determined the correct rate of route selection using *** Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal *** therapeutic target region was reached in 50 *** mean procedure times from the teeth to the target(total insertion time),from the teeth to the branch,and from the branch to the target,and the mean total examination time were 15.2,5.0,8.2,and 60.3 min,*** rate of correct route selection using visual observation and CDE were 36/52(69.2%)and 48/52(92.3%),respectively(P=0.002).The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33(87.8%),and the rate in patients with a gastrojejunal anastomosis was 19/19(100%).CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

关键词： Retrograde cholangiopancreatography Double-balloon endoscopy Carbon dioxide insufflation Anastomosis Accuracy Prospective study

Clinical characteristics of gastrointestinal immune-related adverse events of immune checkpoint inhibitors and their association with survival

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World Journal of Gastroenterology 2021年第41期27卷 7190-7206页

作者： Kentaro Yamada Tsunaki sawada Masanao Nakamura takeshi Yamamura Keiko Maeda Eri Ishikawa Tadashi Iida Yasuyuki Mizutani Naomi Kakushima Takuya Ishikawa Kazuhiro Furukawa Eizaburo Ohno Takashi Honda Hiroki Kawashima Masatoshi Ishigami Satoshi Furune Tetsunari Hase Kenji Yokota Osamu Maeda Naozumi Hashimoto Masashi Akiyama Yuichi Ando Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Endoscopy Nagoya University HospitalNagoya City 4668560AichiJapan Department of Clinical Oncology and Chemotherapy Nagoya University HospitalNagoya City 4668560AichiJapan Department of Respiratory Medicine Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Dermatology Nagoya University Graduate School of MedicineNagoya City 4668560AichiJapan Department of Gastroenterology and Hepatology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan

BACKGROUND Despite the popularity of immune checkpoint inhibitors(ICIs)in the treatment of advanced cancer,patients often develop gastrointestinal(GI)and non-GI immune-related adverse events(irAEs).The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous *** necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI *** To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with *** In this single-center,retrospective,observational study,we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August *** analyzed the clinical characteristics of patients who received ICI *** also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer(LC)and malignant melanoma(MM).Kaplan-Meier analysis was used to compare the median overall survival(OS).Multivariate Cox proportional hazards models were used to identify prognostic factors.A P value<0.05 was considered statistically *** GI-irAEs occurred in 34 of 605 patients(5.6%)treated with an anti-programmed cell death-1/programmed death-ligand 1(anti-PD-1/PD-L1)antibody alone and in nine of 56 patients(16.1%)treated with an anti-cytotoxic T-lymphocyte antigen 4(CTLA-4)antibody alone or a combination of anti-PD-1 and anti-CTLA-4 *** cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies(P<0.05).In 130 patients with MM,OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs(P=0.035).In contrast,in 209 patients with non-small cell LC,there was no significant difference in OS between the *** multivariate analyses showed that a performance status of 2-3(ha

关键词： Colitis Cytotoxic T-lymphocyte antigen 4 Diarrhea Drug-related side effects and adverse reactions Immune checkpoint inhibitors Prognosis