Katsunori Tauchi

Upregulation of thromboxane synthase in human colorectal carcinoma and the cancer cell proliferation by thromboxane A2

Tumor growth of colorectal cancers accompanies upregulation of cyclooxygenase‐2, which catalyzes a conversion step from arachidonic acid to prostaglandin H2 (PGH2). Here, we compared the expression levels of thromboxane synthase (TXS), which catalyzes the conversion of PGH2 to thromboxane A2 (TXA2), between human colorectal cancer tissue and its accompanying normal mucosa. It was found that TXS protein was consistently upregulated in the cancer tissues from different patients. TXS was also highly expressed in human colonic cancer cell lines. Depletion of TXS protein by the antisense oligonucleotide inhibited proliferation of the cancer cells. This inhibition was rescued by the direct addition of a stable analogue of TXA2. The present results suggest that overexpression of TXS and subsequent excess production of TXA2 in the cancer cells may be involved in the tumor growth of human colorectum.

Histological complete response in advanced gastric cancer after 2 weeks of S-1 administration as neoadjuvant chemotherapy

Single-agent or combined chemotherapy with the novel oral fluoropyrimidine anticancer drug, S-1 (TS-1), has been reported to be useful for the treatment of advanced gastric cancer. Here, we report a patient with advanced gastric cancer achieving a complete response (CR) after 2 weeks of administration of S-1 as neoadjuvant chemotherapy. A 78-year-old woman with epigastric pain was diagnosed as having advanced gastric cancer. S-1 was administered orally, at a dose of 50 mg twice a day every day for 2 weeks, followed by a 2-week drug-free period. No obvious adverse reactions occurred. Subsequently, the patient underwent distal partial gastrectomy with D2 lymph node dissection. Pathological examination indicated no remnant signet-ring cells in the excised specimen, no lymph node metastasis, and unnatural fibrosis in one of the No. 3 lymph nodes. The neoadjuvant chemotherapy induced a CR according to the Japanese classification of gastric carcinoma.

Phase IIb, Randomized, Double-Blind, Placebo-Controlled Study of Naldemedine for the Treatment of Opioid-Induced Constipation in Patients With Cancer

Purpose This randomized, double-blind, multicenter study aimed to determine the dose of naldemedine, a peripherally-acting μ-opioid receptor antagonist, for future trials by comparing the efficacy and safety of three doses of naldemedine versus placebo in patients with cancer and opioid-induced constipation. Methods Patients ≥ 18 years old with cancer, an Eastern Cooperative Oncology Group performance status ≤ 2, who had been receiving a stable regimen of opioid analgesics for ≥ 2 weeks, had at least one constipation symptom despite laxative use, and no more than five spontaneous bowel movements (SBMs) during the past 14 days, were randomly assigned (1:1:1:1) to oral, once-daily naldemedine 0.1, 0.2, or 0.4 mg, or placebo, for 14 days. The primary end point was change in SBM frequency per week from baseline during the treatment period. Secondary end points included SBM responder rates, change from baseline in the frequency of SBM without straining, and complete SBM. Safety was also assessed. Results Of 227 patients who were randomly assigned, 225 were assessed for efficacy (naldemedine 0.1 mg, n = 55; 0.2 mg, n = 58; 0.4 mg, n = 56; placebo, n = 56) and 226 for safety. Change in SBM frequency (primary end point) was higher with all naldemedine doses versus placebo ( P < .05 for all comparisons), as were SBM responder rates and change in complete SBM frequency. Change in SBM frequency without straining was significantly improved with naldemedine 0.2 and 0.4 (but not 0.1) mg versus placebo (at least P < .05). Treatment-emergent adverse events were more common with naldemedine (0.1 mg: 66.1%; 0.2 mg: 67.2%; 0.4 mg: 78.6%) than placebo (51.8%); the most common treatment-emergent adverse event was diarrhea. Conclusion Fourteen-day treatment with naldemedine significantly improved opioid-induced constipation in patients with cancer and was generally well tolerated. Naldemedine 0.2 mg was selected for phase III studies.

Primary Abscess of the Omentum : Report of a Case

We report a case of a primary abscess of the omentum without any obvious etiology. A 62-year-old man was referred to our clinic with lower abdominal pain, and computed tomography showed an intra-abdominal abscess in the left pelvic area. Laparotomy revealed that the abscess adhered to the urinary bladder and abdominal wall, but no perforation of the alimentary tract was identified and there was no foreign body in the abscess cavity. A culture of the abscess fluid grew Clostridium perfringens. The patient was discharged on the 16th hospital day after an uneventful postoperative course without any complications.

Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density

Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 × 1024×pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 ± 44.4 in metastatic and 62.9 ± 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 ± 38.4 in DSA-N(+) cases and was 57.8 ± 21.9 in DSA-N(−) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.

Non-Hodgkin's Lymphoma of the Ascending Colon in a Patient with Becker Muscular Dystrophy: Report of a Case

Abstract We herein present the findings of a 10-year-old boy with non-Hodgkins lymphoma of the ascending colon which caused intussusception and intestinal bleeding. He had a history of Becker muscular dystrophy. However, he had neither hypertrophic calves nor cardiomyopathy, and his serum creatine kinase (CK) level always exceeded 2 000 IU/l. Preoperatively, a laboratory examination revealed high serum levels of CK (2 038 IU/l), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH), and the blood hemoglobin level was 7.0 g/dl. A barium enema examination revealed an intussusception in his ascending colon, which was found to be a highly vascular tumor on Doppler ultrasound scans. A right hemicolectomy was performed. Macroscopically, the 5 × 6 × 8-cm solid tumor of the ascending colon resembled a submucosal tumor and had two ulcerous lesions at the tip. The tumor was histologically diagnosed to be a diffuse large B-cell lymphoma of the ascending colon. General examinations revealed no involvement of lymphoma postoperatively. At 13 months after surgery, the CK (3 786 IU/l), AST (110 IU/l), ALT (138 IU/l), and LDH (420 IU/l) levels are still high, and the patient is doing well without any signs of recurrence.

Pancreatic nonfunctioning neuroendocrine tumor with the main pancreatic duct obstruction presenting as excessive hyperglycemia: a case report and review of the literature.

We present the case of a 65-year-old man with a pancreatic nonfunctioning neuroendocrine tumor causing main pancreatic duct obstruction that presented as excessive hyperglycemia. We considered the tumor elicited worsening of diabetes in this case, and we performed review of the relevant literature.

RESULTS OF THE INTRODUCTION OF CLINICAL PATH TO SURGERY FOR BREAST CANCER

当院では医療の標準化・業務の効率化・医療の質の向上・入院日数の短縮を目的として全科的にクリニカルパスを導入し,その有効性について検討したので報告する.対象は乳癌症例で, 2000年4月から2001年3月までの導入前14症例と2001年4月から2002年3月までの導入後25症例とした.医療の標準化を徹底するため,従来の漫然とした医療行為は削除され,早期離床・早期退院を促すことが可能になった.入院オーダーを疾患毎に統一してオーダリングシステムからパス表を作成し,必要な医療行為をもれなく確実に行い,患者に対してはパス表を用いて入院後の治療内容と経過の説明を行いインフォームドコンセントの充実を計った.パス導入後は在院日数は短縮し,総医療費は減少したが1日あたり医療費は増加した.更に病床利用率は一時的に下がったものの回転率は上昇し全身麻酔手術件数も増加し収益にも有効であった.現在の厳しい医療業界においてパス導入は有効と考えられた.

Gastric Leiomyoblastoma Showing Exogastric Pedunculated Development.

症例は69歳の女性. 肝嚢胞, 脂肪肝の経過観察目的で行った腹部CTで, 胃体上部大彎の胃壁外に4cm大の充実性腫瘍を指摘された. 胃内視鏡検査ならびに超音波内視鏡検査にて胃固有筋層と連続する平滑筋腫と診断した. さらに, 入院時の胃内視鏡検査で認められた胃壁圧排所見が, 術直前の再検査で消失していたことから有茎性の腫瘍であると判断し, 手術は腹腔鏡下に胃楔状切除を行った. 術後病理組織学的に胃平滑筋芽細胞腫, 免疫組織学的には狭義のstromal tumorに該当する腫瘍と診断された. 術後2年再発なく生存中である. 本腫瘍は約30%が胃壁外性に発育するとされている. 術前診断率が低く, 特に有茎性に発育することはまれであり, その術前診断, 術式および悪性度診断の問題点を中心に文献的考察を加えて報告した.

A Case Report of Roux-operation for Postgastrectomy Dumping Syndrome.

症例は57歳の男性. 20歳時に十二指腸潰瘍にて広範囲胃切除, Billroth I法再建術をうけた. 術後間もなくより食後約20分での全身の熱感, 発汗, 動悸を自覚しており, 44歳時には内服治療を受けるも軽快せず, 当科受診した. 入院後, 抗セロトニン剤, 体液性アミン拮抗剤, 抗キニン剤, 漢方薬などの薬物治療を試みたが効果なく, Billroth I法からRoux-en-Y法への転換手術を施行した. 術後, 愁訴は消失. 術後23病日のシンチグラフィー, 24病日の透視では術前と比較し胃内容の小腸への流出が遅延しており, 手術の効果を示していた. また, 75gブドウ糖負荷試験では, 負荷15分後のセロトニン値の変動が術後には消失しており, ダンピング症候群とセロトニンの関与が示唆された. 術後2年を経過した現在も症状の再発は認めていない. Roux-en-Y手術は難治性ダンピング症候群に対し, 考慮すべき治療法と考えられた.