Motoi Koyama

Effects of long-term treatment with α-glucosidase inhibitor on the peripheral nerve function and structure in Goto-Kakizaki rats : a genetic model for type 2 diabetes

Continuous hyperglycemia is implicated in the pathogenesis of chronic diabetic complications. It is not well known, however, how and to what extent the development of neuropathy is inhibited by blood glucose control in subjects with Type 2 diabetes. We investigated therefore the effects of an α‐glucosidase inhibitor (voglibose; Vg) on neuropathic changes in diabetic Goto‐Kakizaki (GK) rats, a genetic model for Type 2 diabetes.

Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers: Japanese experience with lateral node dissection.

Surgical practices for treatment of rectal cancer in Japan have changed from extended dissection along perivascular or parietal plane to pelvic autonomic nerve-preserving procedures without compromising radicality of surgical resection. Previous surgical results suggested the significant advantages of extended surgery in survival and local recurrence rate of Dukes B and C patients. More than 15 percent of patients with cancer in the lower rectum have extramesorectal spread to lateral pelvic nodes that can be removed by lateral dissection for local control and cure. Initially the total nerve-preserving procedure has been introduced for a complete preservation of para-aortic and intrapelvic nervous system in patients with early-stage cancer not requiring para-aortic and lateral lymph-node dissection. However, the concept of aggressive surgery for advanced rectal cancer has led to various types of pelvic autonomic nerve-preserving procedures, in which extended lymph-node dissection plus nerve-preserving technique with resection of one or more autonomic nervous segments has been performed. During two decades, total pelvic autonomic nerve-preserving procedure with lateral lymph-node dissection has been used increasingly for Dukes C lesion without increased local recurrence. The overall status of pelvic autonomic nerve-preserving procedures according to clinical experiences in Japan is reviewed in the context of cadaveric anatomic findings, Japanese vs. Western techniques and concepts, and our own clinical data.

P53 protein expression in pancreatic tumors and its relationship to clinicopathological factors and prognosis.

We examined the expression of p53 protein by immunohistochemical method in a series of pancreatic tumors and evaluated its relationships to the clinicopathological factors and prognosis. The study involved 108 cases of pancreatic tumors (79 ductal carcinomas, 1 acinar cell carcinoma, 14 endocrine tumors, 6 solid cystic tumors, 8 benign ductal tumors) and 8 chronic pancreatitides. Thirty‐nine cases of pancreatic ductal carcinoma (49.4%) were positive for p53 protein. Analysis of the Cox hazards model identified p53 positivity and stage at the initial operation as an independent prognostic factor. Patients with p53 positive ductal carcinomas had a greater risk of death compared to p53 negative cases (P < 0.05). There was, however, no statistically significant correlation between p53 protein expression and other clinicopathological factors. Cases of stage III and IVb with positive p53 showed a bleak prognosis compared to p53 negative cases (P < 0.05). Our results suggest that p53 expression is common in invasive pancreatic ductal carcinomas and may have a prognostic value.

Rectal adenocarcinoid with lymph node metastasis

We describe a case of a rare variant of a rectal carcinoid tumor that showed mucous gland differentiation accompanied by a lymph node metastasis with a histological appearance similar to that of the primary site. The tumor consisted of a typical argyrophilic carcinoid component and of goblet cell glands. The carcinoid component was positive for neuron‐specific enolase, chromogranin A and synaptophysin. The goblet cells stained positively with periodic acid‐Schiff (PAS) and alcian blue, and expressed carcinoembryonic antigen, but were negative for neuroendocrine markers. This case suggests that carcinoid tumor can differentiate towards mucus glands, which can also be found in the metastatic site.

Risk Factors for the Development of Desmoid Tumor After Colectomy in Patients with Familial Adenomatous Polyposis: Multicenter Retrospective Cohort Study in Japan.

BackgroundDesmoid tumor (DT) is the primary cause of death in patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy. This study aimed to identify risk factors for DT in a Japanese population.MethodsClinical data for 319 patients with FAP undergoing first colectomy from 2000 to 2012 were reviewed retrospectively.ResultsTwo hundred seventy-seven FAP patients were included in this study. Thirty-nine (14.1 %) patients developed DT. Occurrence sites were the intraperitoneal region in 25 (64.1 %) cases, intraperitoneal region and abdominal wall in three (7.7 %), and abdominal wall in nine (23.1 %). The mean period from surgery to DT development was 26.3 months (range 4–120 months). Gender (female vs. male, p = 0.03), age at surgery (>30 vs. ≤30 years, p = 0.02), purpose of surgery (prophylactic vs. cancer excision, p = 0.01), and surgical procedure (proctocolectomy [ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), total proctocolectomy (TPC)] vs. total colectomy [ileorectal anastomosis, partial colectomy]; p = 0.03) significantly influenced the estimated cumulative risk of developing DT at 5 years after surgery. Conversely, approach (laparoscopic vs. open, p = 0.17) had no significant effect on the increased risk of DT occurrence. In multivariate analysis, female gender, with a hazard ratio of 2.2 (p = 0.02,) and proctocolectomy (IAA, IACA, TPC), with a hazard ratio of 2.2 (p = 0.03), were independent risk factors for DT incidence after colectomy.ConclusionsFemale gender and proctocolectomy (IAA, IACA, TPC) were independent risk factors for developing DT after colectomy in patients with FAP.

Long-term Outcome after Total Colectomy with Ileorectal Anastomosis for Familial Adenomatous Polyposis

目的: 家族性大腸腺腫症 (FAP) に対する予防的手術の術式として, 結腸全摘回腸直腸吻合術 (IRA), 回腸肛門吻合術 (IAA), 回腸肛門管吻合術 (IACA) が選択される. 今回, IRAの長期的な術後経過から, 手術術式と治療方針について検討を加えた. 対象: 1970年から2002年までのFAP初回手術例は72例で, 1990年までの予防的あるいは治癒手術例は42例であった. このうち直腸病変が非密生型であること, 下部直腸に癌の合併がないこと, 術後定期的追跡調査ができることを前提にIRAを29例に施行した. 結果: IRA初回手術29例の性別は男性16例, 女性13例で, 平均年齢は28.9歳であった. 平均19.7年の術後観察期間において, 残存直腸からの発癌が8例 (27.6%) で認められた. その内訳は, 男性3例, 女性5例であり, 初回手術時の平均年齢は30.3歳であった. 初回手術時の癌合併は4例で認められ, 密生型が4例, 非密生型が4例であった. APC遺伝子変異は検索した7例全例 (codon 348-785: 1例, codon 658-1283: 3例, codon 1099-1700: 3例) で認めた. 初回手術から残存直腸発癌までの平均期間は15.0年 (1.3～30年) であり, 再手術は, IACA2例, 腹会陰式直腸切断術2例, 局所切除1例, IAA 3例を施行した. 1年に1～2回の定期的検査を継続していたが, 5例がmp以深の進行癌であり, 2例は残存直腸の発癌のため死の転帰をとった. 結語: 手術時には直腸病変が非密生型であっても, その時点で病態が完成しているわけではなく, 予防的手術の術式としては, 原則としてIAAもしくはIACAを選択すべきことが確認できた.

Emergent Surgical Treatment of Five Cases with Massive Lower Gastrointestinal Bleeding in Crohn's Disease

大量下血により緊急手術を施行したCrohn病の5例を経験したので報告する. 内訳は男性4例, 女性1例. 手術時の平均年齢は25.8歳, 病型別では小腸型2例, 小腸大腸型2例, 大腸型1例であった. 緊急手術時の下血量は平均3,100mlで, 血圧を維持するために必要とした輸血量は平均2,040mlであり, 2症例でショック状態を呈した. 術前検査および術中所見で出血点が同定できなかった1症例で, 術中大腸内視鏡検査を施行した. 切除範囲は出血点を含む主要病変部の小範囲切除とした. 切除標本所見では地図状～不整形の深い潰瘍底からの出血が特徴的であり, 組織学的にUL-II～IVの潰瘍および裂溝形成が認められた. 潰瘍底近傍に中等度の動脈がみられ, 潰瘍底血管の破綻が大量下血の原因であった. 若い年代に発症した下血症例で, 内視鏡的に地図状～不整形の深い潰瘍形成が認められる場合は, 大量下血を引き起こす危険性があることを念頭に, 治療にあたるべきである.