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Featured researches published by Tairo Ryotokuji.


Diseases of The Esophagus | 2010

Doxorubicin, cisplatin, and fluorouracil combination therapy for metastatic esophageal squamous cell carcinoma

M. Honda; A. Miura; Y. Izumi; T. Kato; Tairo Ryotokuji; K. Monma; J. Fujiwara; H. Egashira; T. Nemoto

The chemotherapy regimen currently used for treating esophageal and gastric carcinoma has been either epirubicin, cisplatin, and fluorouracil (5-FU) or docetaxel, cisplatin, and 5-FU. Here, we report the efficacy and toxicity of doxorubicin, cisplatin, and 5-FU for only esophageal squamous cell carcinoma (ESCC). Between January 2000 and October 2008, a total of 41 ESCC patients with a distant metastasis were enrolled. The most common sites of metastasis were liver (26, 63.4%), lung (9, 22.0%), and bone (8, 19.5%). Doxorubicin was administered on day 1 at 30 mg/m(2) , cisplatin on days 1-5 at 14 mg/m(2)/day, and 5-FU on days 1-5 at 700 mg/m(2)/day. The median number of cycles was 2.0 (range 1-8). The dose intensities of doxorubicin, cisplatin, and 5-FU were 92.9, 92.4, and 92.5%, respectively. The overall response rate was 43.9%; one showed complete response, 17 showed partial response, 13 showed a stable disease, and 10 showed progressive disease (PD). The median survival time was 306 days (95% CI = 74-935) and the 1-year survival rate was 37.6%. Grade 3 neutropenia was seen in seven patients and grade 4 in one patient. Grade 3 fatigue, anorexia, mucositis, and diarrhea were observed in three, two, two, and one patient, respectively. This regimen is effective as a first-line therapy for ESCC with distant metastasis.


PLOS ONE | 2015

Relationships between Micro-Vascular and Iodine-Staining Patterns in the Vicinity of the Tumor Front of Superficial Esophageal Squamous Carcinoma

Shunsuke Ohta; Kenro Kawada; Jirawat Swangsri; Naoto Fujiwara; Katsumasa Saito; Hisashi Fujiwara; Tairo Ryotokuji; Takuya Okada; Yutaka Miyawaki; Yutaka Tohkairin; Yasuaki Nakajima; Youichi Kumagai; Kagami Nagai; Takashi Ito; Yoshinobu Eishi; Tatsuyuki Kawano

OBJECTIVE The aim of the present study was to clarify differences between micro-vascular and iodine-staining patterns in the vicinity of the tumor fronts of superficial esophageal squamous cell carcinomas (ESCCs). METHODS Ten consecutive patients with ESCCs who were treated by endoscopic submucosal dissection (ESD) were enrolled. At the edge of the iodine-unstained area, we observed 183 sites in total using image-enhanced magnifying endoscopy. We classified the micro-vascular and iodine-staining patterns into three types: Type A, in which the line of vascular change matched the border of the iodine-unstained area; Type B, in which the border of the iodine-unstained area extended beyond the line of vascular change; Type C, in which the line of vascular change extended beyond the border of the iodine-unstained area. Then, by examining histopathological sections, we compared the diameter of intra-papillary capillary loops (IPCLs) in cancerous areas and normal squamous epithelium. RESULTS We investigated 160 sites that the adequate quality of pictures were obtained. There was no case in which the line of vascular change completely matched the whole circumference of the border of an iodine-unstained area. Among the 160 sites, type A was recognized at 76 sites (47.5%), type B at 79 sites (49.4%), and type C at 5 sites (3.1%). Histological examination showed that the mean diameter of the IPCLs in normal squamous epithelium was 16.2±3.7 μm, whereas that of IPCLs in cancerous lesions was 21.0±4.4 μm. CONCLUSIONS The development of iodine-unstained areas tends to precede any changes in the vascularity of the esophageal surface epithelium.


Archive | 2015

Observation of the Pharynx to the Cervical Esophagus Using Transnasal Endoscopy with Blue Laser Imaging

Kenro Kawada; Tatsuyuki Kawano; Taro Sugimoto; ToshihiroMatsui; Masafumi Okuda; Taichi Ogo; Yuuichiro Kume; YutakaNakajima; Katsumasa Saito; Naoto Fujiwara; Tairo Ryotokuji; YutakaMiyawaki; Yutaka Tokairin; Yasuaki Nakajima; Kagami Nagai; Takashi Ito

Background In 2014, the new transnasal endoscopy with Blue laser Imaging (BLI) has been developed. Aim We present the usefulness of the observation of from the pharynx to the cervical esophagus using transnasal endoscopy with BLI. Patients and Methods This study was conducted between June 2014 and October 2014. During this period, 70 consecutive patients (60 men, 10 women; mean age 67.9 years old) with esophageal or head and neck cancer underwent endoscopic screening at the orophar‐ ynx and hypopharynx by transnasal endoscopy with BLI system We performed this endoscopic observation from oral cavity to pharynx before inserting into the cervical esophagus.The visibility of subsites of the hypopharynx and the orifice of the esophagus was evaluated. The extent of the view of hypopharyngeal opening was classified into 3 categories (excellent, good, poor). Then, the diagnostic accuracy of transnasal endoscopy with BLI system was estimated. Our screening is as follows. First, the patient is asked to bow their head deeply in the left lateral position. We put a hand on the back of the patient’s head and push it forward. The patient is then asked to lift the chin as far as possible. In order to inspect the oral cavity, we insert an endoscope without a mouthpiece. After observation of the oral cavity, the endoscope was inserted through the nose. When the tip of the endoscope reached caudal to the uvula, the patient opened his mouth wide, stuck his tongue forward as much as possible and made a vocal sound like “ayyy”. The endoscopist caused the endoscope to U-turn and observed the oropharynx, in particular the radix linguae (Intra© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. oropharyngeal U-turn method). For examination of the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed (Trumpet maneuver). Results 8 elderly cases were excluded because they could not perform the adequate ballooning. Finally, 62 cases were investigated. The ballooning the pyriform sinus and posterior wall not only allows accurate assessment of the stretched pharyngeal mucosa but also gives a view of postcricoid subsite and the orifice of the esophagus. The wide endoscopic view of the pharynx was obtained in a series of the procedures (excellent=53/62, 85.4%; good=7/52, 4.5%; and poor=2/62, 7.6%). Among 70 patients, 6 superficial lesions (8.6%) at the oropharynx(n=1) and hypopharynx (n=5) were discovered with BLI system. Mucosal redness, a pale thickened mucosa, white deposits or loss of a normal vascular pattern, well demarcated areas covered with scattered dots are important characteristics to diagnose superficial carcinoma. Conclusion The more progress achieved in transnasal endoscopy rapidly in the last few years, it can improve for observing the blind area using trans-oral endoscopy, therefore the trans-nasal endoscope will be a standard tool for the screening of the upper gastrointestinal tract in the near future.


Asia Pacific Journal of Clinical Nutrition | 2015

A Prospective Study of Nutritional Supplementation for Preventing Oral Mucositis in Cancer Patients Receiving Chemotherapy

Takuya Okada; Yasuaki Nakajima; Tetsuro Nishikage; Tairo Ryotokuji; Yutaka Miyawaki; Akihiro Hoshino; Yutaka Tokairin; Kenro Kawada; Kagami Nagai; Tatsuyuki Kawano

BACKGROUND AND OBJECTIVES Patients undergoing chemotherapy often develop distressing adverse effects such as oral mucositis and diarrhea. Nutritional support with elemental diet is effective against various gastrointestinal complications and may exert protective effects against adverse effects induced by chemotherapy. To evaluate the influence of elemental diet on chemotherapy-induced oral mucositis and diarrhea, we conducted a randomized control trial in patients with esophageal cancer undergoing chemotherapy. METHODS AND STUDY DESIGN Twenty esophageal cancer patients receiving chemotherapy with 5-fluorouracil plus cisplatin were assigned randomly to one of the following two groups: (1) receiving elemental diet with Elental (one pack per day) for 14 days and (2) not receiving Elental during chemotherapy. The severity of oral mucositis and diarrhea was graded using clinical examination by doctors and a standard questionnaireon days 1-14. RESULTS Based on the analysis of the standard questionnaire, the distribution of the maximum severity of oral mucositis showed a statistically significant reduction in the Elental group (p=0.020), while clinical examination showed insignificant reduction but shift toward lower grade. In the Elental group, the incidence of oral mucositis (grade >=2) reduced consistently and the median grade was lower at all-time points. Regarding diarrhea, no difference was observed between the two groups based on the analysis of the standard questionnaire and clinical examination results. CONCLUSIONS This study illustrates the effectiveness of oral elemental diet in preventing oral mucositis during chemotherapy. This is a preliminary report and further study with larger patients groups should be devoted to optimization of efficacy.


Laryngoscope Investigative Otolaryngology | 2018

Detection of Second Primary Malignancies of the Esophagus and Hypophraynx in Oral Squamous Cell Carcinoma Patients: Detection of second primary malignancies

Toshihiro Matsui; Takuya Okada; Kenro Kawada; Masahumi Okuda; Taichi Ogo; Yutaka Nakajima; Yuichiro Kume; Tairo Ryotokuji; Akihiro Hoshino; Yutaka Tokairin; Yasuyuki Michi; Hiroyuki Harada; Yasuaki Nakajima; Tatsuyuki Kawano

To assess the usefulness of modified esophagogastroduodenoscopy (EGD) for the detection of second primary malignancies of the esophagus or hypopharynx in patients with oral squamous cell carcinoma and determine the association between the oral lesion subsite and esophageal or hypopharyngeal lesion occurrence.


Esophagus | 2018

Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum

Yutaka Tokairin; Yasuaki Nakajima; Kenro Kawada; Akihiro Hoshino; Takuya Okada; Tairo Ryotokuji; Masafumi Okuda; Yuichiro Kume; Yudai Kawamura; Kazuya Yamaguchi; Kagami Nagai; Keiichi Akita; Yusuke Kinugasa

BackgroundThe structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues.MethodsSemi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues.ResultsThe “visceral sheath” and “vascular sheath,” as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the “visceral sheath” on the right side of the upper mediastinum was unclear in comparison to the left side. The “visceral sheath” (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the “visceral sheath” in all cadavers, the left recurrent nerve lymph nodes were located inside the “visceral sheath” in cadaver 1 and between the “visceral sheath” and “vascular sheath” in cadaver 3.ConclusionThe “visceral sheath” around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.


Acta Oto-Laryngologica Case Reports | 2018

Asymptomatic marginal zone lymphoma of mucosa-associated lymphoid tissue in the hypopharynx, detected with esophagogastroduodenoscopy

Takuya Okada; Kenro Kawada; Taro Sugimoto; Takashi Ito; Kazuya Yamaguchi; Yudai Kawamura; Masafumi Okuda; Yuichiro Kume; Tairo Ryotokuji; Akihiro Hoshino; Yutaka Tokairin; Yasuaki Nakajima

Abstract Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of lymphoma that commonly originates in the gastrointestinal (GI) tract, and in rare instances may also occur in the head and neck region. In this report, we present a case of early stage, primary asymptomatic MALT lymphoma of the hypopharynx as detected by esophagogastroduodenoscopy (EGD). A 73-year-old man underwent EGD for an examination of the upper GI tract. At the left pyriform sinus, a swollen irregular mucosa was detected. Biopsy specimens confirmed histologically prominent proliferation of lymphocytes in the epithelium. Immunohistochemical analysis showed that the neoplastic lymphocytes were positive for CD20 and negative for CD3. Based on the other imaging studies, we diagnosed the lesion as a localized MALT lymphoma of the hypopharynx at Stage IA. In total, 46 Gy of radiotherapy was administered to the lesion. In the subsequent 5 years after the treatment, there have been no signs of recurrence.


Esophagus | 2013

A case of lymph node metastasis after endoscopic mucosal resection of esophageal cancer invading the muscularis mucosa

Tatsuto Nishigori; Akinori Miura; Tsuyoshi Kato; Tairo Ryotokuji; Yosuke Izumi; Hideto Egashira; Junko Fujiwara; Kumiko Monma; Yoko Tateishi; Tetsuo Nemoto; Misao Yoshida

A 70-year-old man was diagnosed with a thoracic esophageal squamous cell carcinoma invading the muscularis mucosa without lymph node or distant metastases in June 2003. Endoscopic mucosal resection was conducted. Histological examination showed squamous cell carcinoma invading the deep mucosal layer without lymphatic permeation. In April 2006, a chest CT scan revealed a metastasis to the right recurrent laryngeal nerve chain (106recR) lymph node, and chemoradiotherapy and chemotherapies were performed but were not very effective. He died of esophagobronchial fistula in October 2007. We reexamined this case in detail, and a deeper cut of the block revealed positive lymph vessel invasion and droplet infiltrations. We were initially unable to identify lymphatic permeation but specific findings were determined, such as high degrees of cellular atypia, downward extension of irregular epithelial processes, and irregular margins of cancer alveoli. Extreme caution is required for treating patients with these morphological changes.


Journal of medical and dental sciences | 2013

Changes in the microvascular structure of mucosal squamous cell carcinoma of the esophagus and their significance in tumor progression.

Jirawat Swangsri; Yutaka Nakajima; Kenro Kawada; Yutaka Tokairin; Toshiya Suzuki; Yutaka Miyawaki; Akihiro Hoshino; Takuya Okada; Ota S; Tairo Ryotokuji; Naoto Fujiwara; Tetsuro Nishikage; Kagami Nagai; Hiroshi Kawachi; Tatsuyuki Kawano


Open Journal of Gastroenterology | 2015

Case of a Superficial Hypopharyngeal Cancer at the Pharyngoesophageal Junction Which Is Detected by Transnasal Endoscopy Using Trumpet Maneuver

Kenro Kawada; Tatsuyuki Kawano; Taro Sugimoto; Toshihiro Matsui; Masafumi Okuda; Taichi Ogo; Yuuichiro Kume; Yutaka Nakajima; Katsumasa Saito; Naoto Fujiwara; Tairo Ryotokuji; Yutaka Miyawaki; Yutaka Tokairin; Yasuaki Nakajima; Kagami Nagai; Takashi Ito

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Kenro Kawada

Tokyo Medical and Dental University

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Takuya Okada

Tokyo Medical and Dental University

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Yutaka Tokairin

Tokyo Medical and Dental University

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Yasuaki Nakajima

Tokyo Medical and Dental University

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Kagami Nagai

Tokyo Medical and Dental University

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Tatsuyuki Kawano

Tokyo Medical and Dental University

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Akihiro Hoshino

Tokyo Medical and Dental University

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Naoto Fujiwara

Tokyo Medical and Dental University

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Yutaka Miyawaki

Tokyo Medical and Dental University

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Katsumasa Saito

Tokyo Medical and Dental University

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