Tatsuro Kamakura

Estimation of risk of major complications after hepatic resection

To identify the risk factors predicting major postoperative complications from among preoperative and intraoperative variables, an extensive retrospective analysis of 209 patients who underwent hepatic resections was performed using multivariate logistic regression. The major complications were defined as liver failure, intractable ascites and pleural effusion, intraperitoneal infection, intra-abdominal hemorrhage requiring reoperation, major bile leakage, and gastrointestinal tract bleeding. First, detailed pre- and intraoperative data including medical history, laboratory data, portion and extent of hepatectomy, operative time, and amount of blood loss were univariately analyzed. Next, any significant variables were multivariately analyzed using the logistic regression method. Diabetes, increased intraoperative blood loss, resection of segment 8, and an increased serum blood urea nitrogen level were independent and significant variables predicting major postoperative complications. A higher level of serum cholesterol and a procedure involving a portion of left lateral segment were found to decrease the risk. Both more careful operative procedures and intensive management of DM and renal dysfunction in the perioperative period could result in a better quality of life after hepatic resection.

The association between transfusion and cancer‐free survival after curative resection for hepatocellular carcinoma

Background. In cases of surgery for hepatocellular carcinoma (HCC), postoperative intrahepatic recurrence is the main obstacle to long‐term survival of patients. The association between perioperative transfusion and recurrence‐free survival was studied in 126 patients with HCC who underwent hepatic resection between 1985 and 1990 and in whom complete follow‐up information was available until 1992.

A simple classification of lymph node level in gastric carcinoma

BACKGROUND Because insufficient lymph node examination can cause erroneous listing of earlier-nodal-stage gastric carcinoma (stage migration phenomenon), surgical results must be evaluated based on a highly accurate examination of the dissected lymph nodes. To establish a simple and useful classification of lymph node level, we analyzed the frequency and distribution of lymph node metastasis by using curatively treated node-positive gastric carcinoma. PATIENTS AND METHODS Various clinicopathologic data were analyzed with reference to the degree of lymph node metastasis by using 240 patients with curatively resected node-positive gastric carcinoma. The cases were divided into the following three groups: 142 with positive level I (perigastric) nodes, 71 with positive level II (intermediate) nodes, and 27 with positive level III (distant) nodes, irrespective of the location of tumors. RESULTS The level of lymph node metastasis clearly correlated with the survival of patients, with the 5-year survival rates for level I, II, and III cases being 67%, 35%, and 26%, respectively (P < 0.01). The degree of lymph node metastasis was determined by the number of positive nodes (P < 0.01), the depth of invasion (P < 0.01), the size of tumors (P < 0.01), and the location of tumors (P < 0.05). CONCLUSION This simple classification of lymph node level (level I, II, and III) is useful for the evaluation and prediction of surgical results in gastric carcinoma.

Prognostic Value of Combination Assays for CEA and CA 19–9 in Gastric Cancer

Preoperative serum CEA and CA 19-9 levels in 158 patients with gastric cancer were analyzed with respect to prognostic factors, using univariate and multivariate analysis. The incidence of high preoperative levels of both CEA and CA 19-9 was 10.1% (16/158). 13.9% (22/158) showed high CEA levels and normal CA 19-9 levels, whereas the reverse was true in 16.5% (26/158). Neither marker showed a high level in 59.5% (94/158). The multivariate analysis showed that in addition to tumor stage, the depth of invasion, liver metastasis and peritoneal dissemination, combination assays of preoperative serum CEA and CA 19-9 levels were an independent prognostic factor. Combination assays of preoperative serum CEA and CA 19-9 will allow us to conduct a more careful postoperative follow-up of high-risk patients, and also help determine the optimum adjuvant chemotherapy.

Modulation of coagulation and fibrinolysis in hepatic resection: a randomized prospective control study using antithrombin III concentrates.

A randomized prospective control trial for determining the efficacy of antithrombin III concentrates in hepatic resection was performed using 24 patients with hepatocellular carcinoma. Thirteen patients were given antithrombin III concentrates (1,500 IU) immediately before operation, during hepatectomy and immediately after operation. Coagulant and fibrinolytic profiles were determined by molecular markers such as thrombin-antithrombin III complex and plasmin-alpha 2plasmin inhibitor complex. During hepatic resection, both hypercoagulability and mainly primary hyperfibrinolysis occurred. Regarding the effectiveness of antithrombin III concentrates, in the antithrombin III treatment group, only a significant lower incidence of positive soluble fibrin monomer complex at postoperative days 1 and 5 was found among all the parameters studied. Therefore, no definite evidence of clinical usefulness of the perioperative administration of antithrombin III concentrates in hepatic resection was proved.

The significance of methicillin-resistant Staphylococcus aureus infection in general surgery : a multivariate analysis of risk factors and preventive approaches

To investigate the characteristics, risk factors, and prevention of methicillin-resistant Staphylococcus aureus (MRSA), a total of 3,627 patients were studied. Among these, 1,336 patients with various infections were used in a risk factor analysis of MRSA to determine the relationship between the use of antibiotics and the incidence of MRSA. Only 3.0% of infections were attributed to MRSA, the esophagus and colorectal region being highly involved, as anastomotic or pelvic abscesses, while the lung had a lower incidence. Almost half the patients with MRSA infections (47.6%) had concomitant infections. A univariate analysis revealed the following significant factors: The coexistence of gastrointestinal or metastatic malignancy, sepsis, tracheostomy, and the prior use of antibiotics such as the β-lactam compounds or aminoglycosides. A multivariate analysis showed that gastrointestinal malignancy, sepsis, and the prior use of aminoglycosides, tetracycline, macrolides, and carbapenems were independently significant factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Moreover, preventive approaches such as patient isolation, strategically placed hand washing equipment, and the use of disposable gloves and contaminated waste bags, have been initiated, and the incidence of MRSA has decreased significantly since then. Thus, to control MRSA, the following steps should be taken: (1) constant and careful surveillance, (2) regular risk factor analyses, (3) the optimal administration of antibiotics, and (4) the education of all hospital staff.

Immunohistochemical expression of sialyl Tn and sialyl Lewisa antigens in stromal tissue correlates with peritoneal dissemination in Stage IV human gastric cancer

Immunohistochemical expression of sialyl Tn antigen (TKH2 and B72.3), sialyl Lewis(a) antigen (CA19-9) and CEA was examined in 52 cases with Stage IV gastric cancer, the objective being to examine whether or not these tumour-associated antigens show different expression between peritoneal dissemination and liver metastasis. Stromal type for TKH2, B72.3, CA19-9 and CEA were seen in 14 (50%), 13 (46%), 18 (64%) and nine (32%) cases with peritoneal dissemination, respectively, and in four (17%), three (13%), four (17%) and four (17%) cases with liver metastasis, respectively. The stromal type correlated to peritoneal dissemination in TKH2 (P < 0.05) B72.3 (P < 0.05) and CA19-9 (P < 0.05). In other clinicopathological factors, the stromal type for TKH2, B72.3 and CA19-9 correlated to the undifferentiated type. However, even in the undifferentiated type group, the stromal type correlated to peritoneal dissemination in TKH2 (P < 0.05), B72.3 (P < 0.05) and CA19-9 (P < 0.05). Based on these results, the spread of sialyl-rich tumour-associated antigens into the surrounding stroma in the undifferentiated type of gastric cancer may be associated with peritoneal dissemination.

The effect of a multiple literature database search: a numerical evaluation in the domain of Japanese life science

In literature database searching, we show that it is necessary to use plural databases for a more improved search. We also compare the results of a single database search with that of multiple database search in the domain of Japanese life sciences. We searched the MEDLINE and EMBASE using the same search terms. There were some differences in the results, owing to differences in the journals and recording methods. We herein show some of the differences in the journals contained in both databases. Furthermore, we show the differences in the number of papers derived from the same journal. Next, as an example of a practical search, we selected some universities in Japan, searched both databases regarding papers published from these universities and then merged the results by hand. According to our results, only 63% of all papers were common to both databases.

A random allocation system with the minimization method for multi-institutional clinical trials

This paper describes the random allocation system used to perform precise and rapid treatment assignments in multi-institutional clinical trials. This system is based on sophisticated randomization procedures, according to Pocock and Simons minimization method and Zelens method for institution balancing. The major advantage of randomized treatment assignments with this system is to balance treatment numbers for each level of various prognostic factors over the entire trial and at the same time balance the allocation of treatments within an institution. Therefore, the randomized treatment assignments by this system can prevent degrading of the statistical power of a particular treatment factor. This system is designed to run on a small-sized notebook computer and therefore can be set up beside a telephone for registration, without occupying a large space. At present, this system is conveniently being used in two clinical trials.

Poor prognosis of lowr quadrant breast carcinoma

Althoguh some lymphatic plexuses exist in lower audrants of the breast, there have been no investigations of whether or not carcinoma located in this region is a prognostic factor for breast cancer. Of 914 patients with carcinoma of the breast who underwent curative resection following chemo‐endocrine therapy between 1982 and 1985, 149 patients had disease of the lower quadrants. The recurrence‐free survival rate was lower in patients with the lower quadrants carcinoma than in those with carcinoma of other breast regions. MUltivariate analysis showed that a lower quadrant tumor location was a significant prognostic factor for recurrence, especially soft tissue and visceral recurrence. The worse prognosis of patients with lower quadrant carcinoma of the breast suggests the possible existence of residual or occult tumor cells after surgical resection.