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Concurrent chemoradiotherapy for cervical cancer： background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups

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Chinese Journal of Cancer Research 2016年第2期28卷 221-227页

作者： Yukiharu Todo Hidemichi Watari division of Gynecologic Oncology National Hospital Organization Hokkaido Cancer Center Sapporo 003-0804 Japan Department of Obstetrics and Gynecology Hokkaido University School of Medicine Sapporo 060-8648 Japan

Concurrent chemoradiotherapy （CCRT） is regarded as the standard treatment for locally advanced uterine cervical cancer （LACC）, including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics （FIGO） staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage Ⅲ-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin （CDDP）, surgery following CCRT, adjuvant chemotherapy （CT） following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease.

关键词： Concurrent chemoradiotherapy (CCRT) locally advanced cervical cancer (LACC) adjuvant chemotherapy (CT)

Gastric cancer surgery for patients with liver cirrhosis

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World Journal of Gastrointestinal Surgery 2009年第1期1卷 49-55页

作者： Yoshiyuki Ikeda Tatsuo Kanda Shin-ichi Kosugi Kazuhito Yajima Atsushi Matsuki Tsutomu Suzuki Katsuyoshi Hatakeyama division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Department of Nursing School of Health SciencesNiigata University

AIM:To elucidate the influence of liver cirrhosis(LC) on the prognosis of patients with gastric cancer(GC).METHODS:Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007,25 patients(21 men and 4 women with a median age of 67 years;range 54-77 years) with LC were enrolled in this *** the Child-Pugh classification,15 patients were evaluated as grade A and 10 patients as grade *** grade C patient underwent gastrectomy in this *** outcomes,including postoperative morbidity and survival,were retrospectively analyzed based on medical records and surgical f ***:There was no significant difference in operative blood loss and perioperative blood transfusion between the two *** most common postoperative complication was intractable ascites,which was the single postoperative morbidity noted more frequently in grade B patients(40.0%) than in grade A patients(6.7%) with statistical signif icance(P = 0.041).Operative mortality due to hepatic failure was seen in one grade A *** patients had hepatocellular carcinoma(HCC) at presentation and two patients developed HCC after *** 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC(P = 0.230).GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3%(P = 0.010).Four patients with early GC died of uncontrolled HCC,of which two were synchronous and two ***:The risk of postoperative intractable ascites is high,particularly in grade B *** detection and complete control of HCC is vital to improve a patient's prognosis.

关键词： Gastric cancer Liver dysfunction Surgery

Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine

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World Journal of Gastroenterology 2014年第21期20卷 6671-6674页

作者： Shinjini Kundu Shari Rogal Abdulkader Alam David J Levinthal Medical Scientist Training Program University of Pittsburgh School of MedicinePittsburghPA 15261United States division of Gastroenterology Hepatologyand NutritionDepartment of MedicineUniversity of Pittsburgh Medical CenterPittsburghPA 15213United States Department of Psychiatry Stony Brook University HospitalStony BrookNY 11794United States

We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management. This patient had no prior history of gastrointestinal symptoms. However, in the aftermath of a viral illness, she developed two months of intractable nausea, vomiting, and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances. A solid-phase gastric emptying scan had confirmed delayed emptying, confirming gastroparesis. Unfortunately, conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms. At our institution, the patient experienced a cessation of vomiting, reported a significant reduction in nausea, and tolerated oral intake shortly after taking mirtazapine. Based on mirtazapine’s primary action as a serotonin (5-HT) 1a receptor agonist, we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms. This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting. We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.

关键词： Nausea Vomiting Gastroparesis Symptoms Mirtazapine Anti-emetics

Fecal stream diversion and mucosal cytokine levels in collagenous colitis:A case report

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World Journal of Gastroenterology 2015年第19期21卷 6065-6071页

作者： Niki Daferera Ashok Kumar Kumawat Elisabeth Hultgren-Honquist Simone Ignatova Magnus Strom Andreas Münch division of Gastroenterology and Hepatology Department of Clinical and Experimental MedicineFaculty of Health SciencesLinkoping University School of Health and Medical Sciences Orebro University Department of Pathology Linkoping University

In this case report, we examined the levels of cytokines expressed before and during fecal stream diversion and after intestinal continuity was restored in a patient with collagenous colitis. We report the case of a46-year-old woman with chronic, active collagenous colitis who either failed to achieve clinical remission or experienced adverse effects with the following drugs:loperamide, cholestyramine, budesonide, methotrexate and adalimumab. Due to the intractable nature of the disease and because the patient was having up to 15 watery bowel movements per day, she underwent a temporary ileostomy. Colonic biopsies were analyzed for mucosal cytokine protein levels before and during fecal stream diversion and after intestinal continuity was restored. Mucosal protein levels of interleukin(IL)-1β,IL-2, IL-6, IL-12, IL-17 A, IL-23, TNF, IFN-γ, IL-4, IL-5,IL-10 and IL-13 were all higher during active disease and decreased to non-detectable or considerably lower levels during fecal stream diversion. One month after the restoration of bowel continuity, when the patient experienced a relapse of symptoms, IL-2, IL-23 and IL-21 levels were again increased. Our results indicate that fecal stream diversion in this patient suppressed the levels of all cytokines analyzed in colonic biopsies. With the recurrence of clinical symptoms and histological changes after bowel reconstruction,the levels of primarily proinflammatory cytokines increased. Our findings support the hypothesis that a luminal factor triggers the inflammation observed in collagenous colitis.

关键词： Microscopic colitis Collagenous colitis Luminex Mucosal cytokines Fecal stream diversion

Genetic analysis is helpful for the diagnosis of small bowel ulceration

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World Journal of Gastroenterology 2018年第28期24卷 3198-3200页

作者： Junji Umeno Takayuki Matsumoto Atsushi Hirano Yuta Fuyuno Motohiro Esaki Department of Medicine and Clinical Science Graduate School of Medical SciencesKyushu UniversityFukuokaFukuoka 812-8582Japan division of Gastroenterology Department of Internal MedicineFaculty of MedicineIwate Medical UniversityMoriokaIwate 020-8505Japan Department of Endoscopic Diagnostics and Therapeutics Saga University HospitalSaga 849-8501Japan

The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis(CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.

关键词： cryptogenic multifocal ulcerous stenosing enteritis chronic nonspecific multiple ulcers of the small intestine chronic enteropathy associated with SLCO2A1 gene Crohn’s disease

characteristics of intestinal pseudo-obstruction in patients with mitochondrial diseases

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World Journal of Gastroenterology 2012年第33期18卷 4557-4562页

作者： Yusuke Sekino Masahiko Inamori Eiji Yamada Hidenori Ohkubo Eiji Sakai Takuma Higurashi Hiroshi Iida Kunihiro Hosono Hiroki Endo Takashi Nonaka Hirokazu Takahashi Tomoko Koide Yasunobu Abe Eiji Gotoh Shigeru Koyano Yoshiyuki Kuroiwa Shin Maeda Atsushi Nakajima Gastroenterology division Yokohama City University School of Medicine Yokohama 236-0004 Japan Department of Medical Education Yokohama City University School of Medicine Yokohama 236-0004 Japan Department of Neurology Yokohama City University School of Medicine Yokohama 236-0004 Japan

AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were di-agnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined. RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO. CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.

关键词： Chronic intestinal pseudo-obstruction Criteria Mitochondrial disease Mitochondrial encephalopathy Lactic acidosis Stroke-like episodes Chronic progressive external ophthalmoplegia

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

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World Journal of Gastroenterology 2020年第37期26卷 5561-5596页

作者： Sasidharan Rajesh Tom George Cyriac Abby Philips Rizwan Ahamed Sandeep Kumbar Narain Mohan Meera Mohanan Philip Augustine division of Hepatobiliary Interventional Radiology Cochin Gastroenterology GroupErnakulam Medical CenterKochi 682028KeralaIndia The Liver Unit and Monarch Liver Lab Cochin Gastroenterology GroupErnakulam Medical CenterKochi 682028KeralaIndia Gastroenterology and Advanced GI Endoscopy Cochin Gastroenterology GroupErnakulam Medical CenterKochi 682028KeralaIndia Anesthesia and Critical Care Cochin Gastroenterology GroupErnakulam Medical CenterKochi 682028KeralaIndia

More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding,the transjugular intrahepatic portosystemic shunt(TIPS)procedure continues to remain a focus of intense clinical and biomedical *** the impressive reduction in portal pressure achieved by this intervention,coupled with its minimally invasive nature,TIPS has gained increasing acceptance in the treatment of complications of portal *** early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic ***,the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions,which was occasionally *** the incidence of shunt dysfunction has markedly reduced with the advent of covered stents,hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after *** has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after *** past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax,portal hypertensive gastropathy,ectopic varices,hepatorenal and hepatopulmonary syndromes,non-tumoral portal vein thrombosis and chylous *** has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and *** current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

关键词： Early transjugular portosystemic shunt Preemptive transjugular intrahepatic portosystemic shunt Portal hypertension Esophageal varices Gastric varices Refractory ascites

Recurrence of cholestatic liver disease after living donor liver transplantation

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World Journal of Gastroenterology 2008年第33期14卷 5105-5109页

作者： Sumihito Tamura Yasuhiko Sugawara Junichi Kaneko Junichi Togashi Yuichi Matsui Noriyo Yamashiki Norihiro Kokudo Masatoshi Makuuchi Artificial Organ and Transplantation division Department of Surgery Graduate School of Medicine University of Tokyo7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan Japanese Red Cross Medical Center 4-1-22 Hiroo Shibuya-ku Tokyo 150-8935 Japan

End-stage liver disease, due to cholestatic liver diseases with an autoimmune background such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), is considered a good indication for liver transplantation. Excellent overall patient and graft outcomes, based mostly on the experience from deceased donor liver transplantation (DDLT), have been reported. Due to the limited number of organ donations from deceased donors in most Asian countries, living donor liver transplantation (LDLT) is the mainstream treatment for end-stage liver disease, including that resulting from PBC and PSC. Although the initial experiences with LDLT for PBC and PSC seem satisfactory or comparable to that with DDLT, some aspects, including the timing of transplantation, the risk of recurrent disease, and its long-term clinical implications, require further evaluation. Whether or not the long-term outcomes of LDLT from a biologically related donor are equivalent to that of DDLT requiresfurther observations. The clinical course following LDLT may be affected by the genetic background shared between the recipient and the living related donor.

关键词： Liver transplantation Primary biliary cirrhosis Primary sclerosing cholangitis Living donor Recurrence

Continuous regional arterial infusion therapy with gabexate mesilate for severe acute pancreatitis

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World Journal of Gastroenterology 2008年第41期14卷 6382-6387页

作者： Yoshifumi Ino Yoshiyuki Arita Tetsuro Akashi Toshinari Kimura Hisato Igarashi Takamasa Oono Masayuki Furukawa Ken Kawabe Keiichiro Ogoshi Jiro Ouchi Toshihiko Miyahara Ryoichi Takayanagi Tetsuhide Ito Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University Department of Social Insurance Nakabaru Hospital Department of Gastroenterology Saiseikai Fukuoka General Hospital Department of Gastroenterology Fukuoka Higashi Medical Center division of Gastroenterology National Kyushu Cancer Center National Hospital Organization Kyushu Medical Center

AIM： To evaluate the efficacy of continuous regional arterial infusion therapy （CRAI） with gabexate mesilate and antibiotics for severe acute pancreatitis （SAP）. METHODS： We conducted a prospective study on patients who developed SAP with or without CRAI. Out of 18 patients fulfilled clinical diagnostic criteria for SAP in Japan, 9 patients underwent CRAI, while 9 patients underwent conventional systemic protease inhibitor and antibiotics therapy （non-CRAI）. CRAI was initiated within 72 h of the onset of pancreatitis. Gabexate mesilate （2400 mg/d） was continuously administered for 3 to 5 d. The clinical outcome including serum inflammation-related parameters were examined. RESULTS- The duration of abdominal pain in the CRAI group was 1.9 =1：0.26 d, whereas that in the non-CRAI group was 4.3 ±0.50. The duration of SIRS in the CRAI group was 2.2 ± 0.22 d, whereas that in the non- CRAI group was 3.2 ± 0.28. Abdominal pain and SIRS disappeared significantly in a short period of time after the initiation of CRAI using gabexate mesilate. The average length of hospitalization significantly differed between the CRAI and non-CRAI groups, 53.3 ± 7.9 d and 87.4± 13.9 d, respectively. During the first two weeks, levels of serum CRP and the IL6/IL10 ratio in the CRAI group tended to have a rapid decrease compared to those in the non-CRAI group. CONCLUSION： The present results suggest that CRAI using gabexate mesilate was effective against SAP.

关键词： Severe acute pancreatitis Arterial infusion Gabexate mesilate Antibiotics