[Examination of stent treatment and bypass surgery for unresectable advanced gastric cancer].

This study was conducted to analyze the outcomes of endoscopic stent placement (n=9) and bypass surgery (n=9) with regard to perioperative complications and dietary intake conditions in patients with unresectable advanced gastric cancer with stenosis. Regarding perioperative complications, 1 patient in the stent group experienced a stent failure and 1 patient in the bypass group developed an adhesive ileus. Dietary intake began from the first day in the stent group and from the fourth day in the bypass group, and it was continued for 55 and 113 days, respectively.

A case of esophageal cancer with multiple lymph node metastases which responded to neoadjuvant chemotherapy (DCF therapy).

It is difficult to perform radical surgery for esophageal cancer with multiple lymph node metastases. Therefore, effective neoadjuvant adjuvant treatment is necessary to achieve successful radical resection. The use of neoadjuvant chemotherapy of docetaxel, cisplatin (CDOP) and 5-fluorouracil (5-FU) (DCF) in an advanced case is reported.

The efficacy of endoscopic submucosal dissection compared with modified endoscopic aspiration mucosectomy by assessing the short-term therapeutic results for differentiated mucosal gastric cancer.

Background: We developed a modified method of endoscopic aspiration mucosectomy (m-EAM) which includes the pre-cutting of the peripheral mucosa before aspiration, and which has been employed in this department since 1998. An endoscopic submucosal dissection (ESD), which enables the resection of a larger area of the lesion using newly-developed surgical devices, has also been employed here since March 2003. This study was performed to investigate the efficacy of ESD at the present time by assessing the short-term therapeutic results for the procedure in patients with a preoperative diagnosis of early-stage differentiated gastric mucosal cancer, by tumor diameter, as well as by comparing these results with those obtained previously with m-EAM.

[The significance of Onodera's prognostic nutritional index for the treatment of gastrointestinal cancer].

Background: We evaluated the role of the prognostic nutritional index reported by Onodera (Onodera's PNI) in patients with gastrointestinal cancer regarding the occurrence of postoperative complications.

Method: Subjects were 324 patients (42 with esophageal cancer, 107 with gastric cancer, and 175 with colon cancer). We classified them into the high risk group (< or = 40) and the non-high risk group (> 40) according to Onodera's PNI.

Neoadjuvant chemotherapy (FAP) for advanced esophageal cancer.

This study was performed to assess the usefulness and safety of neoadjuvant chemotherapy utilizing the FAP regimen consisting of 5-fluorouracil, cisplatin and adriamycin for the treatment of highly advanced esophageal cancer. Twenty-seven patients with Stage III or more advanced esophageal cancer were enrolled in the study. The patients generally received two cycles of FAP.

[A short-term outcome of endoscopic submucosal dissection (ESD) for early gastric cancer].

In this study, we investigated a short-term outcome of 56 cases of ESD for early gastric cancer performed in our department concerning the tumor diameter within or over 20 mm. Seventeen lesions were larger than 21 mm (large group), and 39 lesions were within 20 mm (indication group). There was no significant difference in the background factors between the two groups.

Surgical treatment of intractable cutaneous fistula with osteomyelitis in the neck developed after esophagectomy.

A case of intractable cutaneous fistula in an esophagogastrostomized region complicated by osteomyelitis is reported. A three-stage operation was performed, and gratifying results were obtained. The patient was a 74-year-old man who received a subtotal esophagectomy and a cervical esophagogastrostomy through a retrosternal approach for advanced esophageal cancer.

Surgical treatment for superficial esophageal cancer with liver cirrhosis and esophageal varices: report of a case.

Surgical treatment of esophageal cancer is substantially invasive and often entails some postoperative complications. Perioperative management for patients with liver cirrhosis involves great difficulties. Recently, we conducted an esophagectomy for the treatment of superficial esophageal cancer in a 52-year-old male patient with liver cirrhosis and esophageal varices, with gratifying results.

Modification of the procedure for esophageal reconstruction after resection of esophageal cancer.

Background/aims: Reconstruction after esophagectomy is still associated with the highest risk of anastomotic leakage among all of the gastrointestinal anastomoses. In 1994, the reconstruction phase of our procedure was modified aiming to reduce the risk of anastomotic leakage. We evaluated usefulness of our modified procedure.

Clinical usefulness of the angiotensin II receptor antagonist losartan in patients with portal hypertensive gastropathy.

Background/aims: An elevated portal vein pressure is an important factor in the onset of portal hypertensive gastropathy associated with liver cirrhosis, and propranolol or vasopressin (drugs with a portal hypotensive effect) are used to treat this problem. It has been reported that angiotensin II receptor antagonists, which were developed as antihypertensive agents, also have a portal hypotensive effect, but their usefulness for portal hypertensive gastropathy is unclear. In this study, the angiotensin II receptor antagonist losartan was administered to 16 portal hypertensive gastropathy patients, and its clinical usefulness was examined.

Scopolamine raises cardiac demand in the elderly during gastrointestinal endoscopy.

Background/aims: We measured changes in cardiopulmonary function of elderly patients during upper gastrointestinal endoscopy to examine the effects of antispasmodics.

Methodology: This study was conducted on 174 subjects older than 60 years (101 male and 73 female, mean age 71.0).

Platelet factor 4 gene transfection into tumor cells inhibits angiogenesis, tumor growth and metastasis.

Tumor growth and metastasis depend on angiogenesis, which is triggered by a chemical signal from the tumor cells to resting endothelial cells which then enter into a phase of rapid growth. Platelet Factor 4 (PF4) inhibits endothelial proliferation in vitro and angiogenesis in vivo. PF4 also inhibits tumor growth, however, as with other angiogenesis inhibitors, sustained tumor growth inhibition requires prolonged exposure to the recombinant protein.

Expression of twist and wnt in human breast cancer.

Twist, a transcription factor of the basic helix-loop-helix class, has been suggested to have oncogenic properties. We reported Twist expression was regulated by Wnt/beta-catenin signaling and that both Wnt-1 and Twist could contribute to mammary tumorigenesis. The aim of this study was to demonstrate the expression of Twist, Wnt-1 and Wnt-2 in human breast cancer tissue.

[A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP combination therapy].

A 53-year-old man had consulted another physician regarding his epigastralgia and anorexia. Since gastric cancer was detected, he was referred to our department. An upper gastrointestinal endoscopy revealed a type-2 gastric cancer at the upper portion of the lesser curvature of the stomach, and an abdominal CT scan showed marked swelling of periaortic lymph nodes.

Clinical experience of transjugular intrahepatic portosystemic shunt (TIPS) and its effects on systemic hemodynamics.

We performed TIPS (transjugular intrahepatic portosystemic shunt) in patients with intractable esophageal varices accompanied by repeated hematemesis or with refractory ascites for the purpose of portal venous decompression, and successfully obtained complete elimination of esophageal varices or a marked decrease in ascites. While TIPS caused no particular variations in mean blood pressure or heart rate, cardiac output increased markedly on the 2nd and 3rd postoperative days before declining on the 5th postoperative day. Along with this, right atrial pressure, pulmonary arterial pressure and pulmonary capillary wedge pressure also increased transiently.

Perforated duodenal ulcer at seven years after heart-renal transplantation: a case report.

We experienced a rare case of perforated duodenal ulcer that occurred at seven years after heart-kidney transplantation. This patient is reported here together with a discussion of the etiology, the selection of treatment, and perioperative management. The patient was a 46-year-old man who presented with precordial pain.

Thymidine phosphorylase expression in gastric carcinoma as a marker for metastasis.

Background: Thymidine phosphorylase (dThdPase) is identical to platelet-derived endothelial cell growth factor (PD-ECCF) and has a function of angiogenesis in vitro and in several types of human carcinoma tissues. We have reported that expression of dThdPase was an independent prognostic factor in 116 gastric carcinomas by immunohistochemical analysis.

Materials And Methods: In the present study, we updated the analysis of recurrence in 116 patients with gastric carcinomas to find how dThdPase plays an important role in progression of gastric carcinoma.

Mutation analysis of copper-transporting P-type adenosine triphosphatase (ATP7B) in human solid carcinomas.

A major obstacle in the treatment of human solid carcinomas is the intrinsic/acquired resistance to cisplatin-based chemotherapy. Copper-transporting P-type adenosine triphosphatase (ATP7B) has been reported to be associated with cisplatin resistance in vitro. ATP7B is overexpressed in human solid carcinomas such as breast, gastric and oral squamous cell carcinomas.

Expression of copper-transporting P-type adenosine triphosphatase in human esophageal carcinoma.

A major obstacle in the treatment of esophageal carcinoma is the intrinsic/acquired resistance to cisplatin-based chemotherapy. Copper-transporting P-type adenosine triphosphatase (ATP7B) has been reported to be associated with cisplatin resistance in vitro. However, the clinical significance of this transporter has not previously been addressed.

Copper-transporting P-type adenosine triphosphatase (ATP7B) is expressed in human gastric carcinoma.

This study describes the first report that a copper-transporting P-type adenosine triphosphatase, ATP7B, is expressed in human gastric carcinomas. Herein, we investigated the hypothesis that ATP7B, which was shown to be associated with cisplatin resistance in vitro, is expressed in certain gastric carcinomas. To test this hypothesis, ATP7B expression level was examined in 51 gastric carcinomas by immunohistochemistry.

Modification of endoscopic aspiration mucosectomy (EAM) for early gastric cancer: EAM with pre-cutting.

Background/aims: We have performed endoscopic aspiration mucosectomy for early gastric cancer since June 1993. In order to increase the complete resection rate, it is necessary to place the cancer in the center of the resection field. To facilitate complete resection, a circular incision to guide aspiration mucosectomy was made with a cutting knife (pre-cutting) before endoscopic aspiration mucosectomy, a procedure that we call endoscopic aspiration mucosectomy, with pre-cutting.