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Safety of hepatectomy for elderly patients with hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第41期20卷 15028-15036页

作者： Koichi Oishi Toshiyuki Itamoto Toshihiko Kohashi Yasuhiro Matsugu Hideki Nakahara Mikiya Kitamoto department of Gastroenterological Surgery Hiroshima Prefectural Hospital Faculty of medicine Hiroshima University department of Hepatology Hiroshima Prefectural Hospital

The number of elderly patients with hepatocellular carcinoma(HCC) has been *** of elderly HCC patients are a higher proportion of females,a lower rate of positive hepatitis B surface antigen,and a higher rate of positive hepatitis C *** patient selection is vital for performing hepatectomy safely in elderly HCC *** strategy should be decided by not only considering tumor stage and hepatic functional reserve,but also physiological status,including comorbid *** assessment tools have been applied to predict the risk of *** reported mortality and morbidity rates after hepatectomy in elderly HCC patients ranged from 0% to 42.9% and from 9% to 51%,*** survival rate after hepatectomy in elderly HCC patients at 5 years ranged from 26% to 75.9%.Both short-term and long-term results after hepatectomy for strictly selected elderly HCC patients are almost the same as those for younger ***,considering physiological characteristics and the high prevalence of comorbid disease in elderly patients,it is important to assess patients more meticulously and to select them strictly if scheduled to undergo major hepatectomy.

关键词： Hepatocellular carcinoma Hepatectomy Elderly

Gastric adenocarcinoma of the fundic gland(chief cell-predominant type): A review of endoscopic and clinicopathological features

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World Journal of Gastroenterology 2016年第48期22卷 10523-10531页

作者： Masaki Miyazawa Mitsuru Matsuda Masaaki Yano Yasumasa Hara Fumitaka Arihara Yosuke Horita Koichiro Matsuda Akito Sakai Yatsugi Noda department of Internal medicine Toyama Prefectural Central Hospital

Gastric adenocarcinoma of the fundic gland(chief cellpredominant type, GA-FG-CCP) is a rare variant of welldifferentiated adenocarcinoma, and has been proposed to be a novel disease entity. GA-FG-CCP originates from the gastric mucosa of the fundic gland region without chronic gastritis or intestinal metaplasia. The majority of GA-FG-CCPs exhibit either a submucosal tumor-like superficial elevated shape or a flat shape on macroscopic examination. Narrow-band imaging with endoscopic magnification may reveal a regular or an irregular microvascular pattern, depending on the degree of tumor exposure to the mucosal surface. Pathological analysis of GA-FG-CCPs is characterized by a high frequency of submucosal invasion, rare occurrences of lymphatic and venous invasion, and low-grade malignancy. Detection of diffuse positivity for pepsinogen-I by immunohistochemistry is specific for GA-FG-CCP. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP. Nearly all GA-FG-CCPs are treated by endoscopic resection due to their small tumor size and low risk of recurrence or metastasis.

关键词： Narrow-band imaging Pepsinogen-I Fundic gland Gastric adenocarcinoma Chief cell

Hypermethylation of tumor suppressor and tumor-related genes in neoplastic and non-neoplastic gastric epithelia

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World Journal of Gastrointestinal Oncology 2009年第1期1卷 41-46页

作者： Gen Tamura department of Pathology and Laboratory medicine Yamagata Prefectural Central Hospital

A number of tumor suppressor and tumor-related genes exhibit promoter hypermethylation with resultant gene silencing in human *** frequencies of methylation differ among genes and genomic regions within CpG islands in different tissue *** initially occurs at the edge of CpG islands and spreads to the transcription start site before ultimately shutting down gene *** the degree of methylation was quantitatively evaluated in neoplastic and non-neoplastic gastric epithelia using DNA microarray analysis,highlevel methylation around the transcription start site appeared to be a tumor-specific phenomenon,although multiple tumor suppressor genes became increasingly methylated with patient age in non-neoplastic gastric *** analysis of DNA methylation is a promising method for both cancer diagnosis and risk assessment.

关键词： Hypermethylation DNA microarray Tumor suppressor gene Gastric cancer

Influence of NUDT15 variants on hematological pictures of patients with inflammatory bowel disease treated with thiopurines

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World Journal of Gastroenterology 2018年第4期24卷 511-518页

作者： Yuichiro Kojima Yosuke Hirotsu Wataru Omata Makoto Sugimori Shinya Takaoka Hiroshi Ashizawa Keiko Nakagomi Dai Yoshimura Kenji Hosoda Yoji Suzuki Hitoshi Mochizuki Masao Omata department of Gastroenterology Yamanashi Prefectural Central Hospital Genome Analysis Center Yamanashi Prefectural Central Hospital department of Dermatologic Oncology National Cancer Institute Division of Gastroenterology Department of Medicine Yokohama City University Graduate School of Medicine department of Gastroenterology Genome Analysis Center Yamanashi Prefectural Central Hospital

AIM The single nucleotide polymorphism(SNP) c.415C>T in exon 3 of NUDT15 affects thiopurine-induced leukopenia in Asian patients with Crohn's disease. Meanwhile, three additional genetic variants of NUDT15 were reported in patients with acute lymphoblastic leukemia. We evaluated the effects of these additional genetic variants of NUDT15 in patients with inflammatory bowel disease(IBD) treated with *** Ninety-six Japanese patients with IBD were enrolled. Genotyping for the NUDT15 and TPMT genes was performed using Custom Taq Man SNP genotyping assays or Sanger sequencing. The changes in white blood cell(WBC) count, mean corpuscular volume(MCV), platelet count, hemoglobin, CRP, amylase, albumin, AST, ALT, and ESR were *** Genetic variants of exon 1 and exon 3 of NUDT15 were identified in 24 of 96 patients(25.0%). C.52G > A and c.36_37 insG GAGTC in exon 1 were found in three patients each. All three patients with c.36_37 insG GAGTC in exon 1 were heterozygotes of ***139 Cys in exon 3. Eighteen patients had ***139 Cys in exon 3 alone. The WBC count gradually decreased after initiation of thiopurine treatment in the mutated cases(n = 24), and was significantly lower at 6, 8, 10, and 16 wk(P = 0.0271, 0.0037, 0.0051, and 0.0185, respectively). The WBC counts were also evaluated in patients with and without prednisolone treatment. In the patients with prednisolone treatment, the WBC count tended to show a greater decrease in the mutated cases, with significant differences at 8 and 10 wk(P = 0.012 and 0.029, respectively). In the patients without prednisolone treatment, the WBC count was significantly lower at 2, 4, 8, and 14 wk in mutated cases(P = 0.0196, 0.0182, 0.0237 and 0.0241, respectively). MCV increased after starting thiopurine treatment in the mutated cases, and was significantly higher at 10 wk(P = 0.0085). Platelet count, hemoglobin, CRP, amylase, albumin, AST, ALT and ESR did not differ significantly between the wildtype and

关键词： Inflammatory bowel disease NUDT15 Leukopenia Mean corpuscular volume Japanese

Helicobacter heilmannii sensu stricto-related gastric ulcers:A case report

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World Journal of Gastroenterology 2014年第12期20卷 3376-3382页

作者： Takehisa Matsumoto Masatomo Kawakubo Taiji Akamatsu Naohiko Koide Naoko Ogiwara Seiko Kubota Mitsutoshi Sugano Yoshiyuki Kawakami Tsutomu Katsuyama Hiroyoshi Ota departments of Laboratory medicine Shinshu University Hospital Endoscopy Center Suzaka HospitalNagano Prefectural Hospital Organization department of Surgery Nagano Prefectural Kiso Hospital department of Health and Medical Sciences Shinshu University Graduate School of Medicine Maruko Central hospital

A spiral bacterium (SH9), morphologically different from Helicobacter pylori (H. pylori), was found in a 62-year-old woman’s gastric mucosa. Gastroscopic examination revealed multiple gastric ulcers near the pyloric ring; mapping gastric biopsy showed mild mononuclear infiltration with large lymphoid follicles in the antrum, without corpus atrophy. Urea breath test and H. pylori culture were negative, but Giemsa staining of biopsies revealed tightly coiled bacteria that immunostained with anti-H. pylori antibody. Sequencing of SH9 16S rRNA and the partial urease A and B subunit genes showed that the former sequence had highest similarity (99%; 1302/1315 bp) to Helicobacter heilmannii (H. heilmannii) sensu stricto (H. heilmannii s.s.) BC1 obtained from a bobcat, while the latter sequence confirmed highest similarity (98.3%; 1467/1493 bp) to H. heilmannii s.s. HU2 obtained from a human. The patient was diagnosed with multiple gastric ulcers associated with H. heilmannii s.s. infection. After triple therapy (amoxicillin, clarithromycin, and lansoprazole) with regimen for eradicating H. pylori, gastroscopy showed ulcer improvement and no H. heilmannii s.s. upon biopsy.

关键词： Helicobacter heilmannii sensu stricto, “ Helicobacter heilmannii” type 2, Gastric ulcers, Urease gene, Non-Helicobacter pylori helicobacters

Surgery for gastric cancer patients of age 85 and older: Multicenter survey

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World Journal of Gastroenterology 2017年第7期23卷 1215-1223页

作者： Hirotaka Konishi Daisuke Ichikawa Hiroshi Itoh Kenichiro Fukuda Naoki Kakihara Manabu Takemura Kaori Okugawa Kiyoshi Uchiyama Masashi Nakata Hiroshi Nishi Toshiyuki Kosuga Shuhei Komatsu Kazuma Okamoto Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of Medicine department of Surgery North Medical CenterKyoto Prefectural University of Medicine department of Surgery Saiseikai Shigaken Hospital department of Surgery Japanese Red Cross Kyoto Daini Hospital department of Surgery Osaka General Hospital of West Japan Railway Company department of Surgery Omihachiman Community Medical Center department of Surgery Kyoto Okamoto Memorial Hospital department of Surgery Kyoto Yamashiro General Medical Center department of Surgery Saiseikai Kyoto Hospital

To investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter *** opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were ***-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P = 0.01), particularly in cStage II patients (P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P = 0.07).CONCLUSIONNon-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.

关键词： Gastric cancer Elderly more than 85 Surgery Limited lymphadenectomy Multicenter survey

Management of gastric mucosa-associated lymphoid tissue lymphoma in patients with extra copies of the MALT1 gene

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World Journal of Gastroenterology 2017年第33期23卷 6155-6163页

作者： Masaya Iwamuro Ryuta Takenaka Masahiro Nakagawa Yuki Moritou Shunsuke Saito Shinichiro Hori Tomoki Inaba Yoshinari Kawai Tatsuya Toyokawa Takehiro Tanaka Tadashi Yoshino Hiroyuki Okada department of Gastroen-terology and Hepatology Okayama University Graduate School of MedicineDentistryand Pharmaceutical Sciences department of Internal medicine Tsuyama Chuo Hospital department of Internal medicine Hiroshima City Hospital department of Gastroenterology Mitoyo General Hospital department of Internal medicine Okayama Saiseikai General Hospital department of Gastroenterology Shikoku Cancer Center department of Gastroenterology Kagawa Prefectural Central Hospital department of Gastroenterology Onomichi Municipal Hospital department of Gastroenterology Fukuyama Medical Center department of Pathology Okayama University Hospital department of Pathology Okayama University Graduate School of MedicineDentistryand Pharmaceutical Sciences

AIM To identify the clinical features of gastric mucosaassociated lymphoid tissue(MALT) lymphoma with extra copies of *** This is a multi-centered,retrospective study. We reviewed 146 patients with MALT lymphoma in the stomach who underwent fluorescence in situ hybridization analysis for t(11;18) translocation. Patients were subdivided into patients without t(11;18) translocation or extra copies of MALT1(Group A,n = 88),patients with t(11;18) translocation(Group B,n = 27),and patients with extra copies of MALT1(Group C,n = 31). The clinical background,treatment,and outcomes of each group were *** Groups A and C showed slight female predominance,whereas Group B showed slight male predominance. Mean ages and clinical stages at lymphoma diagnosis were not different between groups. Complete response was obtained in 61 patients in Group A(69.3%),22 in Group B(81.5%),and 21 in Group C(67.7%). Helicobacter pylori(H. pylori) eradication alone resulted in complete remission in 44 patients in Group A and 13 in Group C. In Group B,14 patients underwent radiotherapy alone,which resulted in lymphoma disappearance. Although the difference was not statistically significant,event-free survival in Group C tended to be inferior to that in Group A(P = 0.10).CONCLUSION Patients with t(11;18) translocation should be treated differently from others. Patients with extra copies of MALT1 could be initially treated with H. pylori eradication,similar to patients without t(11;18) translocation or extra copies of MALT1.

关键词： Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue Gastric neoplasms Esophagogastroduodenoscopy t(11 18) translocation Trisomy 18

Predictive factors for body weight loss and its impact on quality of life following gastrectomy

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World Journal of Gastroenterology 2017年第26期23卷 4823-4830页

作者： Kazuaki Tanabe Masazumi Takahashi Takashi Urushihara Yoichi Nakamura Makoto Yamada Sang-Woong Lee Shinnosuke Tanaka Akira Miki Masami Ikeda Koji Nakada department of Gastroenterological Surgery Hiroshima University Hospital Division of Gastroenterological Surgery Yokohama Municipal Citizen’s Hospital department of Gastroenterological Breast and Transplant SurgeryHiroshima Prefectural Hospital department of Surgery Toho University Ohashi Medical Center department of Surgery Gifu Municipal Hospital department of general and Gastroentero-logical Surgery Osaka Medical College department of Gastroenterological Surgery Fukuoka University School of Medicine department of Surgery Kobe City Medical Center General Hospital department of Surgery Asama General Hospital department of Laboratory medicine the Jikei University School of Medicine

To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL). METHODSWe applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures. RESULTSA total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P 2, 0.028-0.080). CONCLUSIONWhile it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

关键词： Quality of life Gastrectomy Weight loss Postgastrectomy syndrome assessment scale-45

Treating inflammatory bowel disease by adsorptive leucocytapheresis:A desire to treat without drugs

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World Journal of Gastroenterology 2014年第29期20卷 9699-9715页

作者： Abbi R Saniabadi Tomotaka Tanaka Toshihide Ohmori Koji Sawada Takayuki Yamamoto Hiroyuki Hanai department of Pharmacology Hamamatsu University School of Medicine department of Gastroenterology Akitsu Prefectural Hospital Ohmori Gastrointestinal Clinic Ikoma general and Gastroenterological Clinic Inflammatory Bowel Disease Centre Yokkaichi Social Insurance Hospital Hamamatsu South hospital

Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early st

关键词： Inflammatory bowel disease Myeloid lineage leucocytes Adsorptive granulocytes/monocytes apheresis Corticosteroid sparing effect Complement activation fragments Treating inflammatory bowel disease without drugs