Kyouji Ogoshi

Health-related quality of life varies with personality types: a comparison among cancer patients, non-cancer patients and healthy individuals in a Japanese population

In an attempt to examine differential effects of personality on health-related quality of life (HRQoL) without regard to disease type, we used the HRQoL-20, a general questionnaire (Japanese original scale) we developed (comprising 20 questions related to physiological, psychological or social HRQoL) and the Eysenck Personality Questionnaire (EPQ), which measures personality traits of extraversion (E), neuroticism (N) and psychoticism (P). The subjects (399 males and 429 females), stomach cancer patients, non-cancer patients (who had received acupuncture or moxibustion treatment) and healthy controls, were classified into three personality types. The results indicated that the HRQoL score of the tolerable/tolerant type (high E, low N and high P scorers) was greater than the intolerable/intolerant type (low E, high N and low P scorers) and also the unclassified type (neither of above scorers). The HRQoL correlated positively with the E and P scales and negatively with the N scale, in the case of all subjects, with the exception of N in male cancer patients and E in male non-cancer patients. The results supported the hypothesis that the HRQoL varies with personality variables, in that each patient, in different treatment settings, strives for the situation that is congruent with his/her personality to attain a better HRQoL.

Immunotherapy and combined assay of serum levels of carcinoembryonic antigen and acute-phase reactants.

Abstract Our previous studies have revealed that gastric and esophageal cancer patients with abnormal sialic acid levels had a better response than those with normal levels if they received polysaccharide K (PSK), a nonspecific immunomodulator. Serum levels of carcinoembryonic antigen (CEA) and acute-phase reactants (APR) such as immunosuppressive acidic protein, acid-soluble glycoproteins, α1-antichymotrypsin, and sialic acid were analyzed in 872 gastric cancer patients who had undergone resection from March 1979 to September 1993 at the Department of Surgery of Tokai University. The patients were categorized into four groups according to the preoperative serum levels: group A had normal levels of both CEA and APR, group B had abnormal CEA and normal APR levels, group C had a normal CEA level and normal levels of one or more APR, and group D had abnormal levels of both CEA and of one or more APR. Patients in group D who received PSK showed significantly better survival than those without PSK (29.3% versus 6.9%; log-rank test, P = 0.0015; Breslow test, P = 0.0042). CEA-positive patients receiving PSK therapy exhibited a significantly better survival rate than those without PSK (38.1% versus 18.6%; log-rank test, P = 0.0136; Breslow test, P = 0.0125). Cox’s regression analysis showed that PSK therapy was significantly related to survival in group D, but not in the other groups. We conclude that the combined assay of tumor-associated factors (such as CEA) and various nonspecific reactants to the presence of cancer (such as immunosuppressive acidic protein, α1-antichymotrypsin, acid-soluble glycoproteins and sialic acid) provides a good set of preoperative indicators on which to base the selection of treatment for individual gastric cancer patients.

Clinicopathological Study of Cholelithiasis following Gastric Cancer Surgery

The purpose of this study was to compare liver function tests preoperatively and postoperatively in 2 cohorts of patients, those that developed gallstones after gastrectomy for cancer and those that did not develop gallstones. The cohorts were taken from 698 consecutive patients who underwent curative gastrectomy for gastric cancer between April 1980 and March 1995. In comparison with 698 patients, the gallstone group was characterized by the findings that the incidence of cholelithiasis was significantly higher in totally-gastrectomized patients and patients with upper stomach cancer. Comparison of the perioperative status revealed a significantly higher rate of complications in the gallstone patients. Analysis of the changes in liver function showed significantly higher values of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase at time points of 1 and 3 months after surgery in the gallstone patients. The results suggest that the postoperative development of liver dysfunction and complications is associated with the formation of gallstones.

Endoscopy‐assisted anastomosis: a modified technique for laparoscopic side‐to‐side esophagojejunostomy following a total gastrectomy

Introduction: Esophagojejunostomy with a circular stapling device is sometimes difficult to perform in a laparoscopic setting. On the other hand, a side‐to‐side anastomosis with a linear stapling device is technically challenging.

Technique of the double-channel ESD method performed with an EEMR tube

Endoscopic submucosal dissection (ESD) recently has been aggressively performed to treat superficial esophageal cancer; however, it is difficult to secure a good field of view for mucosal dissection, and the technique requires considerable skill. We have developed a double-channel ESD method using an endoscopic esophageal mucosal resection (EEMR) tube that makes it possible to perform the submucosal dissection with a good field of view while applying countertraction. Countertraction is achieved by maneuvering a fine grasping forceps inserted through the side channel of the EEMR tube, and the field of view of the submucosal dissection layer can be easily exposed. This technique can be performed while constantly observing the submucosal dissection layer with a stable field of view, and it is also easy to handle the blood vessels. Moreover, there is no disturbance of the field of view by the dissected mucosa.

Predicting the recurrence/metastasis of stage I and II breast cancer without lymph node metastasis.

This study compared prediction of the recurrence of breast cancer by detection of occult neoplastic cells (ONCs) in lymph nodes or by using the criteria for a high risk of recurrence and metastasis of gastric/large bowel cancer. The subjects were 45 patients with stage II and III node-positive breast cancer. Prediction of recurrence by detection of ONCs showed a sensitivity of 78.6% (11/14), a false-negative rate of 21.4% (3/14), a specificity of 96.4% (30/31), a false-positive rate of 3.2% (1/31), and an accuracy of 87.7% in patients with stage II and III node-positive cancer. Prediction of recurrence based on positivity for at least 2 of the high-risk criteria showed a sensitivity of 92.9% (13/14), a false-negative rate of 7.1% (1/14), a specificity of 87.1% (27/31), a false-positive rate of 12.9% (4/31), and an accuracy of 90.0% in patients with stage II and III node-positive cancer. These results suggest that ONCs plus the high-risk criteria are useful for predicting recurrence/metastasis of stage II and III node-positive breast cancer during the early postoperative period with a high sensitivity and accuracy.