Takuji Naka

Postoperative delirium following gastrointestinal surgery in elderly patients

Postoperative delirium is a common complication which can interfere with the surgical treatment and recovery of elderly patients, and is likely to prolong their hospitalization. Unfortunately, there is as yet no completely effective pre- and/or post operative technique of patient care to reduce or prevent postoperative delirium. In this study, 36 patients aged over 70 years undergoing gastrointestinal operations were assessed to examine the relationships between the preoperative cognitive state, the postoperative sleep cycle, and the occurrence of postoperative delirium. All patients were evaluated preoperatively using the revised version of Hasegawas dementia scale (HDS-R). We correlated those test results and assessed the sleep-wakefulness disturbance postoperatively, to obtain a clinical DMS-III diagnosis of postoperative delirium. The incidence of postoperative delirium was 17% (6/36). The patients who developed postoperative delirium demonstrated preoperative cognitive impairment, and had a short sleep period during the night and a long sleep period during the day. Postoperatively, these results suggest that HDS-R is a useful method of evaluating preoperative cognition in elderly patients. Considering that sleep deficiency is likely to predispose elderly patients to postoperative delirium, techniques to prevent sleep deprivation may be of considerable value in minimizing the incidence of postoperative delirium.

Gastrointestinal Stromal Tumor of the Stomach: Report of a Case

Abstract We report herein the case of a 70-year-old woman found to have a gastrointestinal stromal tumor (GIST) of the stomach. Preoperative X-ray and endoscopic examination revealed a hemispheric submucosal tumor with central depression in the anterior wall of the gastric fornix. The tumor, which was 3 cm in diameter, was resected by a laparoscopy-assisted procedure. Histologic examination revealed that it was composed of spindle-shaped cells with elongated nuclei, and few mitoses. Most of the tumor cells showed immunoreactivity for vimentin and CD34, but not for α-smooth muscle actin, desmin, or S-100 protein. The PCNA index was 40.5%. Thus, the GIST did not show differentiation toward smooth muscle or neural cells. A gastrectomy was not performed because the small size of the tumor, and the paucity of the mitoses indicated that it was benign. Nevertheless, careful and long-term follow-up is needed to monitor for signs of possible local recurrence or distant metastases.

Unusual case of tacrolimus vascular toxicity after deceased donor renal transplantation

We report a case of tacrolimus vascular toxicity found on a protocol biopsy shortly after a deceased donor renal transplantation. The patient was immunologically high‐risk and acute antibody‐mediated rejection during post‐transplant dialysis phase was suspected on the protocol biopsy. Although the patient was stable after treatment of rejection, a further examination showed a very rare but specific side‐effect of tacrolimus. It is sometimes difficult to make a differential diagnosis during postoperative dialysis period among AMR, primary non‐functioning, drug toxicity, infection or just prolonged recovery from the damage of a long agonal phase on the non‐heart beating donor. Although the possibilities of coexistence of rejection or other causes such as infection have not been completely excluded, it is important to be aware of this unusual side effect of tacrolimus.

Biopsy findings on a stable recipient after secondary donor specific antibody (DSA) positive and ABO incompatible kidney transplantation

Using desensitization protocol, we performed a secondary donor specific antibody (DSA) positive and ABO incompatible kidney transplantation. One‐hour biopsy showed no C4d deposition. The protocol biopsy after 2 weeks showed diffuse C4d deposition with peritubulitis. After 12 weeks, however, the protocol biopsy showed disappearance of tubulitis in spite of remaining C4d deposition. The recipient was in stable condition with excellent graft function despite high titer of the DSA. Monitoring of protocol biopsy is critical while antibody titer and the interpretation of the histological findings correlating with clinical markers must be considered.

Abstract 1759: Immunohistochemical detection of human telomerase reverse transcriptase in human cholangiocarcinoma and risk condition.

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC Background/Aims: Telomerase activation plays a critical role in several human carcinogenesis through the maintenance of telomeres. The catalytic subunit of telomerase is human telomerase reverse transcriptase (hTERT), whose expression is the critical determinant of telomerase activity. Studies on hTERT in human cholangiocarcinoma (ChC) are rare, and there are no immunohistochemical studies on the correlations with its expressions and ChC patients clinicopathological parameters. Methods : HTERT Immunoreactivity was measured in cancerous parenchyma of 28 archival cases of human cholangiocarcinoma (ChC) compared with hyperplastic small biliary ducts in surrounding non-neoplastic liver. And hTERT immunoreactivity was also assessed in both large and small hyperplastic biliary ducts (HBDs) in 9 archival cases of primary sclerosing cholangitis (PSC), which is risk condition for human cholangiocarcinogenesis. Measurements of intrahepatic biliary duct sizes and quantitative microdensitometry measurements of immunostaining intensities were determined using a color video image analysis system. Micro-optical density values related to a standard optical density curve were generated for each set of measurements, using arbitrary units of immunostaining intensity ranging from 0 (nondetectable) to 255 (highest intensity). Results : HTERT immunoreactivity was presented in nuclei of ChC and PSC cells. Mean micro-optical density values for hTERT in tumorous cells were almost 8-fold greater than that measured in small HBDs in surrounding non-tumorous liver within the same tissue sections. Although there was no significantly difference of tumor differentiation in hTERT expression, its expression was stronger in tubular type than in papillary type and in tubulopapillary type. In PSC cases, hTERT expression was significantly stronger in large HBDs (>500μm cross-sectional diameter) than in small HBDs (<500μm cross-sectional diameter). Conclusion : Our findings suggest that hTRET protein in human ChC may emerge at a early stage in the progression of the malignant process. The results also suggest hTERT as potentially important targets relevant to chemoprevention or adjunct therapy of ChC. Citation Format: Kanenori Endo, Shunichi Tsujitani, Miwa Yoshimoto, Jyoji Watanabe, Naruo Tokuyasu, Teruhisa Sakamoto, Takuji Naka, Yasuaki Hirooka, Masahide Ikeguchi. Immunohistochemical detection of human telomerase reverse transcriptase in human cholangiocarcinoma and risk condition. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1759. doi:10.1158/1538-7445.AM2013-1759

Measurement of Protein Expression of p53, p21(WAF1), and Rb in Patients with Surgically Treated Hepatocellular Carcinoma by Using Catalyzed Signal-Amplification System.

Hepatocellular carcinoma (HCC) is one of the most common human malignancies in the world and it is especially prevalent in Asia and Africa (1). Some tumors are suitable for resection, however, there is a very high rate of recurrence (2). Infection with hepatitis B or C virus, alcoholic cirrhosis, and ingestion of aflatoxin B1-contaminated food are important risk factors for HCC (3,4), but the exact molecular mechanism of tumorigenesis is still unclear.