查看更多>>摘要：Background/Aims: This study was conducted to assess the usefulness of multi-slice CT (MDCT] and diffusion weighted MR images (DWI-MRI) for diagnosis of metastatic lymph nodes (LNs) in biliary carcinomas. Methodology: Eighteen patients with biliary carcinomas (total 121 LNs) underwent surgical resection were included. In MDCT, the following criteria were measured: the maximum diameter, the enhanced value and the long and short axis (L/S) ratio. In DWI-MRI, the apparent diffusion coefficients (ADCs) were measured from ADC maps. Results: In ROC analysis, the maximum diameter has the highest diagnostic power with area under curves of 0.903. And when the maximum diameter 8 mm and L/S ratio is less than 2, the accuracy was improved with a sensitivity of 81%, positive predictive value (PPV) of 45%. In DWI-MRI, ADCs values of metastatic LNs significantly lower than that of non-metastatic LNs (mean: 1.65 vs. 2.11 x10-3mm2/s). When the ADC value of 1.8 x10-3 was used as a cut-off value, the best results were obtained with sensitivity of 75%, PPV of 82%. Conclusions: Using MDCT, diagnosis of LNs metastasis should be more than 8mm diameter and less than 2 of L/S ratio. In addition, DWI-MRI is more useful modality for diagnosis of LNs metastasis.
查看更多>>摘要：Background/Aims: It is difficult to diagnose cholangiocarcinoma in the early stages because most patients present with jaundice, which is generally thought to be the most important symptom at diagnosis. Despite improvements to surgical instruments and techniques, these rates are not quite satisfactory. Intraductal ultrasound (IDUS) is easy to handle due to the wire-guided, thin-caliber, and high-frequency probe. The purpose of the present study was to assess the efficacy of IDUS as a diagnostic tool for patients with early distal cholangiocarcinoma. Methodology: We enrolled 23 with early distal cholangiocarcinoma. The cholangiography and IDUS findings were retrospectively analyzed. The morphology of the tumors detected by IDUS was also classified including localized wall thickening, polypoid lesion, and sessile tumor. Results: The morphologies on IDUS were as follows: five (21.7%) localized wall thickenings, five (21.7%) polypoid lesions, and 13 (56.5%) sessile tumors. Conclusions: Since forceps biopsy complemented by IDUS can substantially improve the diagnostic rate, pathological investigations should be performed simultaneously after detection by IDUS. We believe that noninvasive modalities should be followed by IDUS and used as a decisive approach to distinguish between benign and malignant status.
查看更多>>摘要：Background/Aims; To identify predictive factors for NSAIDs-related GI toxicity and to clarify whether cox-2 selective inhibitors can prevent it or not. Methodology; We have surveyed all patients received esophagogastroduodenoscopy examined at our hospital between January 2008 and September 2011. We performed the following retrospective analyses of the clinical records of the 253 patients prescribed NSAIDs. The severity of gastro duodenal mucosal lesions was evaluated using the modified gastro duodenal LANZA score. The following scores for response were used: 0=no lesions (LANZA score 0); l=erosion and redness (LANZA score 1-3); 2=ulcer (LANZA score 4). Pre dictors evaluated were factors potentially related to pathogenesis of NSAIDs related GI toxicity. Ordered logistic regression analysis was performed to identify predictive factors for NSAIDs related ulcer. Results; A multivariate logistic regression identified number of risk factors (odds ratio (OR) =6.82, confidence interval (Cl) =5.31-8.76; P =0.01), concomitant use of anticancer drugs (OR =2.17, Cl =1.02-4.62; P =0.04) were found to be significant factors. Conclusions; Number of risk factors and concomitant use of anticancer drugs were shown to be predictive factors for NSAID-related GI toxicity. Use of celecoxib or proton pump inhibitor was not identified as a protective factor.
查看更多>>摘要：We evaluated the bypass operation as palliation for unresectable esophageal cancer. In this study, patients were divided into 2 groups. Group A included 19 patients with good progress, defined as sufficient oral ingestion for more than 2 months. The other 10 patients were in Group B and had poor progress. Oral ingestion was impossible postoperatively in 2 of 29 cases. Al though there is a difference of a grade, other patients could have improvement of quality of life. Patients with no preoperative therapy and patients whose nutrient state was maintained comparatively well had a good adaptation after bypass surgery. We concluded that if the surgeon chooses the patients carefully, bypass is a very useful operative method.
查看更多>>摘要：Background/Aims: This study was designed to investigate the effect of bevacizumab plus chemotherapy such as pemetrexed and carboplatin followed by maintenance bevacizumab in patients with advanced, nonsquamous nonsmall cell lung cancer. Methodology: Previously untreated patients with advanced, nonsquamous nonsmall cell lung cancer received bevacizumab 15 mg/kg, pemetrexed 500 mg/m2 and carboplatin at an area under the concentration-time curve of 6 intravenously on day 1 every 21 days. Responding or stable patients who completed 6 cycles then received bevacizumab maintenance every 21 days until disease progression. In total, 32 patients were entered on the study. Results: No complete responses were observed, and 16 patients (50%) had a partial response. Sixteen patients (50%) displayed disease stability. The progression-free survival was 11.92?12 months, and the overall survival was 12.52?56 months. Treatment-related grade adverse events were obsearved gastrointestinal reaction (68%), rash (2%), Pectoral-gia (1%), headache (1%), rlopecia (1%), renal function (1%), liver function (1%), and diarrhea (1%). Conclusions: Combined pemetrexed, and carboplatin followed by maintenance bevacizumab was well tolerated and displayed remarkable effect in patients with advanced, nonsquamous nonsmall cell lung cancer.
查看更多>>摘要：Background/Aims: Circulating hepatocellular carcinoma cells (CHCCs] may be detected by reverse transcription-polymerase chain reaction (RT-PCR). We investigated the relationship between CHCCs and hepatoma patients' survival period after different managements. Methodology: Peripheral blood (5ml) samples were obtained from 93 patients with hepatocellular carcinoma (HCC), and from 33 control subjects (9 with liver cirrhosis after hepatitis B, 14 with chronic hepatitis B, 10 with healthy people) between January 1st, 2009 and December 31, 2012. To detect CHCCs in peripheral blood, alpha-fetoprotein (AFP) messenger RNA (mRNA) was amplified from total RNA extracted from whole blood by RT-PCR. Results: AFPmRNA was detected in 49 blood samples from the HCC patients (49/93, 53.0%). In contrast, there were no clinical control subjects whose samples showed detectable AFPmRNA. The presence of AFPmRNA in blood seemed to be correlated with the tumor stage (by TNM classification) of HCC, the serum AFP value, and the presence of intrahepatic metastasis, portal vein thrombosis, tumor diameter and/or distant metastasis. Conclusions: The presence of AFPmRNA in peripheral blood may be an indicator of CHCCs, which might predict hematogenous spreading metastasis in patients with HCC and may be as a bad prognostic factor for HCC patients.
查看更多>>摘要：Background/Aims: We analyzed the effects of the Kampo medicine "Dai-kenchu-to (DKT) on clinical aspects in colorectal surgery. Methodology: Total 122 patients who underwent colorectal cancer surgery were divided into a DKT group (n=53) and a non-DKT group (n=69). The differences of postoperative course and anti-inflammatory responses between those two groups were analyzed. Results: The 53 out of 59 patients could completely take DKT. In the postoperative course, significant difference was observed in the first flatus day. In the anti-inflammatory effects, differences were observed in the heart rate (HR) of the 3rd POD. In the change between 1st POD and 3rd POD, HR in the DKT group was well controlled compared to the non-DKT group. In the patients who had over 37.5H of body temperature in 1st POD (n=53), inflammatory response of the DKT group was reduced compared to the non-DKT group. Conclusions: The DKT might have the favorable influences on postoperative bowel movement and systemic inflammatory reaction, and induce the better postoperative course.
查看更多>>摘要：Background/Aims: Minimally invasive laparoscopy provides faster recovery, less pain, fewer complications, and better cosmesis than laparotomy. We aimed to evaluate outcomes of postoperative local anesthesia infiltration at the single-incision laparoscopic surgery (SILS) wound. Methodology: This prospective, non-randomized controlled study evaluated outcomes of 58 colorectal cancer cases receiving SILS from May 2010 to December 2010. Twenty-nine patients received postoperative infiltration of local anesthesia at the wound site; another 29 patients did not. Demographic, intra- and postoperative data were compared. Postoperative pain was assessed by visual analogue scale and analgesic usage. Results: Local an esthesia group included 16 males, 13 females (mean age, 62.0 ?5.1 years); no local anesthesia group included 14 males, 15 females (mean age, 58.1 ?2.7 years). There were no significant differences between groups at baseline (i.e., age, gender, disease stage, tumor location or size) except BM1 (25.2?.8 vs. 23.5?.4, p=0.041) was significantly higher. Postoperative pain scores were significantly lower in local anesthesia group than in no local anesthesia group (median VAS score 2.0, IQR 2.0-3.0 vs. VAS score 3.0, IQR 3.0-4.0, respectively, P=0.024). Conclusions: Our results provide further evidence of SILS safety. Local anesthesia infiltration at SILS wounds decreases postoperative wound pain and analgesic usage.
查看更多>>摘要：Background/Aims: Ostomy creation is a fundamental technique. However, little information is available concerning the procedure and the associated complications. We reviewed the relationship between the ostomy procedure and complications. Methodology: The records of patients who were diagnosed with ulcerative colitis and underwent ostomy creation between January 2007 and July 2012 were reviewed. Stoma complications, including muco-cuta-neous dehiscence, fistula and granulation were also reviewed. Results: The study included 176 patients who received interrupted sutures with removal of the stitches and 202 patients who received subcutaneous sutures without removal of the stitches. Among the patients with buried sutures, 108 received braided absorbable sutures and 94 received with mono filament absorbable sutures. The incidence of dehiscence was significantly higher with the interrupted sutures (43.2%) than with the buried sutures (31.2%), although the granulation and fistula rates were not significantly different. Among the patients with buried sutures, fistula (6.4%) and granulation (21.3%) rates were slightly increased with the mono filament sutures compared with the braided sutures, although the differences were not significant. Conclusions. Suture removal appeared to be an unnecessary manipulation at ostomy creation. Further study for all colorectal surgery is needed to investigate whether the incidence of fistula increases with buried sutures.
查看更多>>摘要：Background/Aims: Patients with ulcerative colitis suffer from long term impairment of quality of life, especially when subjected to repeated hospitalization. We aimed to identify factors that may predict future hospitalization. Methodology: We followed 139 consecutive patients with ulcerative colitis for average of 11.2 years (2.8 to 49.5 years) from the onset. Clinical and endoscopic stagings were determined by Japanese staging system, the extent of colitis by Montreal classification and endoscopic grading by Matts' grade. Results: Overall hospitalization rate was 37% at 5 years, 47% at 10 years and 60% at 20 years from the onset. Of 5 parameters including demographic and staging scores, univariate analysis revealed clinical severity at onset (p=0.003), total colonoscopic findings on severity (Matts grade, p=0.003), and total colonoscopic findings on sites of abnormality (p=0.012) were significantly correlated with hospitalization. By multivariate analysis, total colonoscopic findings on sites of abnormality was the only baseline character significantly related to the need of hospitalization (p=0.0007). In fact, 5/10/20 years hospitalization rates were only 18/26/33 percent for proctitis type, whereas those were 61/72/90 for total colitis type. Conclusions: The total colonoscopic finding on sites of abnormality at the onset is the only predictor of hospitalization in patients with ulcerative colitis.
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