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The Number of Positive Tumor Marker Status Is Beneficial for the Selection of Therapeutic Modalities in Patients with Hepatocellular Carcinoma

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 165-168页

作者： Toru Beppu Shigeki Nakagawa Hidetoshi Nitta Hirohisa Okabe Takayoshi Kaida Katsunori Imai Hiromitsu Hayashi Yuki Koga Kunitaka Kuramoto Daisuke Hashimoto Yo-ichi Yamashita Akira Chikamoto Takatoshi Ishiko Hideo Baba department of Surgery Yamaga City Medical Center Kumamoto Japan department of gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto Japan department of gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto Japan

Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and des-c-carboxy prothrombin are well-known and useful tumor markers for *** positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local *** the normal ranges reported have differed by institution,the positivity of tumor markers is consistent and can easily be *** and Wakayama's group clearly demonstrated the following:1) Regardless of the degree of tumor stage,a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR;2) For RFA alone,HCC patients with double-and triple-positive status,having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes;3) For HCC patients with lesions ≤5 cm in Child-Pugh grade A,HR is preferred over RFA;4) Microvascular invasion rates increased even in the double-positive patients,while poorly differentiated HCC was frequently observed only in the triple-positive patients;and 5) RFA with chemoembolization,anatomical liver resection,and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor ***,the impacts of these therapies still need to be evaluated in prospective comparative studies.

关键词： Triple-positive tumor markers Double-positive tumor markers Hepatocellular carcinoma Hepatic resection Radiofrequency ablation Alpha-fetoprotein Des-γ-carboxy prothrombin Lens culinaris agglutinin reactive fraction of alpha-fetoprotein

Consensus of primary care in acute pancreatitis in Japan

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World Journal of Gastroenterology 2006年第21期12卷 3314-3323页

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as thediagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

关键词： Fluid resuscitation Protease inhibitor treatment Antibiotic treatment Continuous regional arterial infusion Contrast-enhanced computed tomography

Wilson disease:Histopathological correlations with treatment on follow-up liver biopsies

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World Journal of Gastroenterology 2010年第12期16卷 1487-1494页

作者： Sandy Cope-Yokoyama Milton J Finegold Giacomo Carlo Sturniolo Kyoungmi Kim Claudia Mescoli Massimo Rugge Valentina Medici department of Pathology University of Texas Southwestern Medical Center and Children's Medical Center department of Pathology Baylor College of Medicine and Texas Children's Hospital department of Surgical and gastroenterological Sciences University of Padua Division of Biostatistics Department of Public Health ScienceUniversity of California DavisOne Shields Avenue Davis department of Diagnostic Medical Sciences and Special Therapies Pathology UnitUniversity of Padua Division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of California Davis Medical Center

AIM:To investigate the progression of hepatic histopathology in serial liver biopsies from Wilson disease(WD)***:We report a group of 12 WD patients treated with zinc and/or penicillamine who underwent multiple follow-up liver ***,clinical and laboratory data were gathered and all patients underwent an initial biopsy and at least one repeat ***:Time to repeat biopsy ranged from 2 to 12 *** patients(non-progressors)showed stable hepatic histology or *** one case,we observed improvement of fibrosis from stage 2 to *** patients(progressors)had worsening of *** was no significant correlation between the histological findings and serum aminotransferases or copper me-tabolism *** hepatic copper concentration reached normal levels in only two patients:one from the non-progressors and one from the progressors *** estimated rate of progression of hepatic fibrosis in the entire group was 0 units per year in the time frame between the first and the second liver biopsy(4 years),and 0.25 between the second and the third(3 years).In the progressors group,the rate of progression of liver fibrosis was estimated at 0.11 fibrosis units per year between the first and second biopsy and,0.6 fibrosis units between the second and third ***:The inability of clinical tools to detect fibrosis progression in WD suggests that a liver biopsy with hepatic copper quantification every 3 years should be considered.

关键词： Wilson disease Copper Liver biopsy Histopathology

TELOMERASE ACTIVITY IN COLORECTAL CARCINOMA AND ITS CORRELATION WITH EXPRESSION OF C-MYC

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Chinese Journal of Cancer Research 2005年第4期17卷 246-249页

作者：刘剑仑葛莲英张贵年 department of gastroenterological & Breast Surgery department of Endoscope Affiliated Cancer Hospital of Guangxi Medical University department of Gastrointestinal Surgery Guangxi Zhuang Autonomous Region Hospital

Objective： To study the role of telomerase activity and c-myc in pathogenesis and progression of colorectal carcinoma, and to investigate the possible regulatory mechanism of telomerase activation. Methods： A modified telomeric repeat amplification protocol （TRAP） and immunohistochemical staining was used to detect telomerase activity and the expression of c-myc in tissue samples from colorectal carcinoma, paracarcinomatousl tissues, normal mucosa, and adenomatoid polyp. Results： The positive rates of telomerase activity and c-myc expression were 83.33% and 80.00% in colorectal carcinoma, 13.33% and 23.33% in paracarcinomatousl tissues, 13.33% and 20.00% in normal mucosa, and 10.00% and 45.00% in adenomatoid polyp respectively, they were significantly higher in colorectal carcinoma than in paracarcinomatousl tissues, normal mucosa, and adenomatoid polyp （P〈0.05）. The rates of telomerase activity and c-myc expression were much higher in colorectal carcinoma with lymph nodes metastases than that without lymph nodes metastases. The expression of c-myc was found being significantly higher in the telomerase positive colorectal carcinoma than in the telomerase negative group （P〈0.05）. Conclusion： The activation of telornerase and abnormal expression of c-myc might play an important role in the process of carcinogenesis and progression of colorectal carcinoma. The over-expression of c-myc may be related to telomerase activation and up-regulation in colorectal carcinoma.

关键词： Colorectal carcinoma Telomerase activity c-myc

Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants

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World Journal of Gastroenterology 2023年第19期29卷 2916-2931页

作者： Mitsushige Sugimoto Masaki Murata Takashi Kawai department of gastroenterological Endoscopy Tokyo Medical University HospitalTokyo 160-0023Japan department of Gastroenterology National Hospital Organization Kyoto Medical CenterKyoto 612-8555Japan

Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal *** rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD *** fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving ***,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical *** that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.

关键词： Direct oral anticoagulants Gastrointestinal tumors Endoscopic submucosal dissection Delayed bleeding Adverse events Anticoagulants

Evaluation of the biliary tract in patients with functional biliary symptoms

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World Journal of Gastroenterology 2006年第18期12卷 2839-2845页

作者： Peter Funch-Jensen Asbjφrn Mohr Drewes László Madácsy Surgical gastroenterological department L Aarhus University HospitalAarhusDenmark Center for Visceral Biomechanics and Pain Department of GastroenterologyAalborg Sygehus and Center of Sensory Motor Interaction (SMI)University of AalborgDenmark First department of Internal medicine and OMCH Endoscopy Unit Fejér Megyei Szent Gyrgy HospitalSzékesfehérvárHungary

The aim of this paper was to describe functional biliary syndromes and methods for evaluation of the biliary tract in these patients. Functional biliary symptoms can be defined as biliary symptoms without demonstrable organic substrate. Two main syndromes exist： Gallbladder dysfunction and sphincter of Oddi dysfunction. The most important investigative tools are cholescintigraphy and endoscopic sphincter of Oddi manometry. In gallbladder dysfunction a scintigraphic gallbladder ejection fraction below 35% can select patients who will benefit from cholecystectomy. Endoscopic sphincter of Oddi manometry is considered the gold standard in sphincter of Oddi dysfunction but recent development in scintigraphic methods is about to change this. Thus, calculation of hilum-to-duodenum transit time and duodenal appearance time on cholescintigraphy have proven useful in these patients. In conclusion, ambient methods can diagnose functional biliary syndromes. However, there are still a number of issues where further knowledge is needed. Probably the next step forward will be in the area of sensory testing and impedance planimetric methods.

关键词： Functional biliary pain Scintigraphy Manometry Pain Sphincter of Oddi Gallbladder

The impact of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)on liver tumors with unusual indications

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 477-480页

作者： Kensuke Yamamura Toru Beppu Tatsunori Miyata Shinichi Akahoshi Takatoshi Ishiko department of Surgery Yamaga City Medical CenterYamagaJapan department of gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamotoJapan

An associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been developed as a novel surgical technique for patients with insufficient future liver remnant volume even after portal vein embolization(PVE)±hepatic arterial or venous embolization or conventional two-stage hepatectomy(TSH)(1-5).ALPPS was thought to be a breakthrough but high-risk procedure;however,it recently became a safer technique after the developing phase(1-3).Conversion surgery is strongly recommended for patients with initially unresectable liver tumors that are deemed resectable by systemic chemotherapy or hepatic arterial chemotherapy/embolization(6,7).The primarily targeted diseases are colorectal liver metastases(CRLM)and hepatocellular carcinoma(HCC).ALPPS is indicated for patients undergoing not only primary surgery but also conversion surgery.

关键词： ALPPS chemotherapy hepatectomy

Efficacy and safety of dual therapy with daclatasvir and asunaprevir in elderly patients

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World Journal of Hepatology 2017年第11期9卷 544-550页

作者： Kazuo Tarao Katsuaki Tanaka Akito Nozaki Akira Sato Toshiya Ishii Hirokazu Komatsu Takaaki Ikeda Tatsuji Komatsu Shozo Matsushima Kenji Oshige Tarao’s gastroenterological Clinic gastroenterological Center Medical Center Yokohama City University Division of Gastroenterology Department of Internal Medicine St. Marianna University Yokohama City Seibu Hospital department of Gastroenterology Yokohama Municipal Citizen’s Hospital department of Gastroenterology Yokosuka General Hospital Uwamachi department of Clinical Research National Hospital Organization Yokohama Medical Center Yokohama National University Center for Health Service Sciences

To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus (HCV) patients multicentricity. METHODSInterferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded. Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients (≥ 75 years-old) and 141 non-elderly patients (24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter (not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases (12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued (6.4%, not significant). CONCLUSIONDual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.

关键词： Asunaprevir Chronic hepatitis Daclatasvir Dual oral therapy Elderly patients Hepatitis C virus infection Hepatitis C virus Liver cirrhosis

Conservative reconstruction using stents as salvage therapy for disruption of esophago-gastric anastomosis

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World Journal of Gastroenterology 2015年第28期21卷 8723-8729页

作者： Taro Oshikiri Yoshinobu Yamamoto Ikuya Miki Masahiro Tsuda Tetsu Nakamura Yasuhiro Fujino Masahiro Tominaga Yoshihiro Kakeji department of gastroenterological Surgery Hyogo Cancer Center department of gastroenterological Oncology Hyogo Cancer Center Division of Gastrointestinal Surgery Department of Surgery Graduate School of MedicineKobe University

Esophagectomy with extended lymphadenectomy and gastric conduit reconstruction is a radical procedure for the treatment of esophageal cancer that is associated with a high morbidity *** conduit necrosis is a fatal complication that occurs in 2%of ***,two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed;however,this procedure has a high morbidity *** describe a61-year-old man who underwent minimally invasive esophagectomy complicated by slowly progressive gastric conduit necrosis associated with complete neck drainage and a stable overall *** was a 2 cm gap in the *** there was no evidence of residual gastric conduit necrosis,a removable,covered self-expanding metal stent(SEMS)was inserted to bridge the *** stent was fixed to the patient's ear with silk thread through the lasso on its proximal end to prevent *** weeks after insertion,the stent was removed easily without any associated *** anastomotic defect was completely bridged with granulation tissue,showing progressive epithelialization without leakage or *** patient was discharged home in good general *** is the first report of the successful conservative management of esophago-gastric conduit anastomosis disruption with SEMS placement.

关键词： Esophagectomy Gastric conduit necrosis Disruption of anastomosis Self-expanding metal stent Hanarostent Conservative management