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Recent clinical studies have reported that microsatellite instability (MSI) colorectal cancers show a high sensitivity to 5-FU, but these reports are contradictory to findings from in vitro analyses. In this study, we analyzed the relationship between MSI phenotypes and the expression of 5-FU metabolic enzymes in human colorectal cancer specimens. MSI phenotypes in 174 sporadic colorectal carcinomas were determined and grouped into the following three categories based on the Bethesda guidelines: high-frequency MSI (MSI-H), low-frequency MSI (MSI-L), and stable microsatellite (MSS). The expressions of dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) in tumor specimens were measured by enzymelinked immunosorbent assays. The ratio of TP to DPD expression (TP/DPD ratio) was calculated for each tumor. These three factors were compared with regard to MSI phenotypes by non-parametric and logistic regression analyses using cut-off values at their medians. MSI-L tumors were excluded from statistical analyses. Thirteen tumors were classified as MSI-H, 8 tumors as MSI-L, and 153 tumors as MSS. DPD expression did not differ between MSI-H tumors and MSS tumors. TP expression and the TP/DPD ratio were significantly higher in MSI-H tumors than in MSS tumors [TP, 160.1± 104.0 vs 97.3 ± 53.7 (Units/mg protein) (P=0.009); TP/DPD ratio, 3.04 ± 1.62 vs 2.07 ± 1.08, (P=0.016)]. These differences were also significant in multivariate analysis. In conclusion, these data suggest that 5-FU catabolic activity in cancer tissue does not differ between MSI-Hand MSS tumors. However, 5-FU anabolic activity in cancer tissue is higher in MSI-H than in MSS colorectal carcinomas.

Recent clinical studies have reported that microsatellite instability (MSI) colorectal cancers show a high sensitivity to 5-FU, but these reports are contradictory to findings from in vitro analyses. In this study, we analyzed the relationship between MSI phenotypes and the expression of 5-FU metabolic enzymes in human colorectal cancer specimens. MSI phenotypes in 174 sporadic colorectal carcinomas were determined and grouped into the following three categories based on the Bethesda guidelines: high-frequency MSI (MSI-H), low-frequency MSI (MSI-L), and stable microsatellite (MSS). The expressions of dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) in tumor specimens were measured by enzymelinked immunosorbent assays. The ratio of TP to DPD expression (TP/DPD ratio) was calculated for each tumor. These three factors were compared with regard to MSI phenotypes by non-parametric and logistic regression analyses using cut-off values at their medians. MSI-L tumors were excluded from statistical analyses. Thirteen tumors were classified as MSI-H, 8 tumors as MSI-L, and 153 tumors as MSS. DPD expression did not differ between MSI-H tumors and MSS tumors. TP expression and the TP/DPD ratio were significantly higher in MSI-H tumors than in MSS tumors [TP, 160.1± 104.0 vs 97.3 ± 53.7 (Units/mg protein) (P=0.009); TP/DPD ratio, 3.04 ± 1.62 vs 2.07 ± 1.08, (P=0.016)]. These differences were also significant in multivariate analysis. In conclusion, these data suggest that 5-FU catabolic activity in cancer tissue does not differ between MSI-H and MSS tumors. However, 5-FU anabolic activity in cancer tissue is higher in MSI-H than in MSS colorectal carcinomas., Acta medica Nagasakiensia, 58(1), pp.1-7; 2013

The aim of this study was to clarify a correlation between acute inflammatory response to surgery and different laparotomy lengths in patients who underwent colorectal cancer resection via a single minimal laparotomy. Between April 2005 and May 2008, 131 consecutive patients (59 women, 72 men), who were scheduled to undergo elective surgery for resection of primary colorectal cancer using a single minimal skin incision, were enrolled in this study to investigate the correlation between postoperative acute inflammatory responses (as measured by serum C-reactive protein (CRP) levels and white blood cell count (WBC)) and different laparotomy lengths. According to the length of laparotomy, the patients were grouped into 3 categories, "small-incision" ( 7 cm), "medium-incision" (>7 and 14 cm), and "large-incision" (>14 cm) for comparison. Statistical analyses were conducted using the Kruskal-Wallis test with multiple comparison post-hoc and chi-square tests. The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P =0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( 7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection., Acta Medica Nagasakiensia, 56(1), pp.13-18; 2011

A rare case of cecal volvulus that was preoperatively diagnosed and surgically treated is herein reported. An 85-year-old woman was admitted to our hospital because of abdominal pain and distension concomitant with nausea and vomiting. She had no past history of laparotomy. Her abdomen showed distention with muscle rigidity and positivity for Blumberg's sign. Plain abdominal X-ray showed a markedly air-distended bowel segment in the right lower abdomen associated with dilated small intestine. An abdominal computed tomography showed extremely dilated bowel in the right lower abdomen that resembled a "coffee bean" in appearance. However, there was no evidence of air-distention in the descending colon. A colonoscopy did not show any bowel obstruction of the left side colon. We diagnosed a cecal volvulus associated with intestinal strangulation. An emergency laparotomy was thus performed. During the laparotomy, the ileocecal region, which was unfixed at the retroperitoneum, was found to be twisted clockwise 360°around the mesentery with the terminal ileum, thus resulting in a diagnosis of cecal volvulus. Since the colonic wall demonstrated vascular compromise and patchy gangrene, we therefore conducted an ileocecal resection without detorsion and reperfusion, followed by primary anastomosis. The patient recovered with minor complication. This case demonstrates the need for clinicians to consider cecal volvulus as a possible cause of acute abdomen. Abdominal computed tomography studies in such patients may enable early diagnosis. Resection without detorsion and reperfusion is the favored option for gangrenous bowel., Acta medica Nagasakiensia, 53(3), pp.73-76 ; 2009

A minilaparotomy approach (? 7 cm) for colorectal cancer resection is feasible and safe. Such minilaparotomy generally employs a small vertical incision. A low transverse abdominal incision (a K?stner incision) has been shown to be associated with cosmetic advantage, less postoperative pain, and fewer wound-complications than the midline incision. We report three cases (75-year-old female, 64-year-old male, and 74-year-old female) who underwent anterior resection of rectal cancer via a minilaparotomy approach employing the K?stner incision. No hand-port or laparoscope was used. The median body mass index was 18.9 (range, 18.3-19.3) kg/m2. The rectal tumors were located in the rectosigmoid and the upper rectum. There were no intraoperative complications. The median operating time and operative blood loss were 160 (range, 159-162) min and 80 (range, 30-90) ml, respectively. All tumors were curatively resected. The patients quickly returned to normal function without morbidity or mortality. No patients developed wound-related complications. During a median follow-up period of 27.4 (range, 26.8-29.0) months, all patients are alive without tumor recurrence. In addition, neither incisional hernia nor nerve damage developed. We conclude that the minilaparotomy approach employing a K?stner incision is a less invasive and an attractive method with a cosmetic advantage for rectal cancer resection in selected patients., Acta medica Nagasakiensia, 53(2), pp.51-54 ; 2007

Smaller incisions may be the major reason for reduced invasiveness of laparotomy. The aim of this study was to clarify the feasibility and safety of a minimal skin incision for colorectal cancer resection. Between April 2005 and February 2008, 122 consecutive patients (56 women, 66 men) were enrolled in this prospective study and scheduled to undergo resection for colorectal cancer using a single minimal skin incision. All of the operations were performed by a single surgeon. The patients were grouped into "small-incision" (?7 cm), "medium-incision" (>7 and ?14 cm), and "large-incision" (>14 cm) for comparison. The small-incision, medium-incision, and large-incision groups included 64 (52.5%), 38 (31.1%) and 20 (16.4%) patients, respectively. The median length of laparotomy incision in the small-incision and medium-incision groups (102 patients) was 7 (interquartile range 7-10) cm. There was no operative mortality. The group with larger length of skin incision had longer operation time, greater operative blood loss, higher rate of postoperative complications and longer postoperative stay. Failure of the small-incision was significantly associated with tumor location (splenic flexure/rectum) and tumor characteristics (adhesion/invasion of tumor into adjacent organs, and/or tumor diameter ?6.0 cm). This experience suggests that the majority of colorectal cancer resection can be safely accomplished via a median length of skin incision of 7 (interquartile range 7-10) cm., Acta medica Nagasakiensia, 53(2), pp.33-36 ; 2007

To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p, Acta medica Nagasakiensia. 2004, 49(3), p.87-91

The purpose of this study was to elucidate the factors that influence the clinical evaluation of the depth of tumor invasion in patients with T1 (tumor invasion of mucosa or submucosa) gastric cancer. The depth of tumor invasion was determined in 593 patients with gastric cancer. Patients were divided into two groups based on the agreement between clinical and pathological evaluation of depth of tumor invasion. Of 320 patients with clinical T1 gastric cancer, consistent diagnoses were made in 308 (96.2%) patients (consistent diagnosis group) while inconsistent diagnoses were made in 12 (3.8%) patients (inconsistent diagnosis group). In the clinical T1 gastric cancer, multivariate logistic regression analysis revealed that the disagreement between the clinical and pathological evaluation of the depth of tumor invasion was independently related to two variables; tumor location (upper stomach) and maximum tumor diameter (?30 mm). For clinical T1 gastric cancer with ?30 mm in maximum tumor diameter located in the upper stomach, caution should be exercised when selecting therapy., Acta medica Nagasakiensia. 2004, 49(3), p.93-97

To clarify the relationship with development of colorectal cancer, we investigated chromosomal aberrations in 715 specimens of the colorectal neoplasm by cytogenetic analysis. A gain of chromosome 17 was observed in the transitional epithelium around non-polypoid carcinomas, although the normal epithelium exhibited diploidy. Most tubular adenomas were diploid, however, loss of chromosome 11 and gain of chromosome 17 were increased in adenomas in association with an increased villous component. DNA aneuploidy, aneusomy and p53 deletion were predominantly observed in carcinomas, even in early cancers. Alterations of chromosomes 11 and 18 reflected different tumor morphologies in the early carcinomas. Gains of chromosomes 11, 17 and 18, and deletion of chromosomes 11 and 17p and p53 became more frequent following an increase in the depth of invasion. Aneusomy of chromosome 11 was a risk factor for patient survival after operation. Gains of chromosome 20 and 20q13.2 were associated with liver metastasis. Aneusomy and translocations of chromosome 17 and the p53 locus were predominantly observed in patients with multiple cancers and hereditary non-polyposis colorectal cancer. Our results indicate that in the process of development of colorectal carcinomas, specific chromosomal aberrations might be related to each step of development, or an alternative pathway of de novo carcinogenesis., Acta medica Nagasakiensia. 2004, 49(1-2), p.25-32

Bile duct cystadenocarcinomas are rare cystic neoplasms of the liver. A 70-year-old woman with a cystadenocarcinoma with the invasion to the stomach as a submucosal tumor is presented. There were unrepresentative findings in a pre-operative examination, and it was difficult to distinguish whether this cystic tumor was malignant or benign. The tumor in the stomach was diagnosed as submucosal prior to operation, but was revealed as an invasive tumor from a bile duct cystadenocarcinoma in a left lobe of the liver during surgery. As it metastasized to the stomach and spread intraductally, a left lobectomy was performed. The operation was noncurative but the patient has been alive for 19 months since., Acta medica Nagasakiensia. 2004, 49(1-2), p.59-62

To clarify the relationship between resected (RSV) or remnant hepatic volume (RMV) in major hepatectomy, and standard liver volume (SLV) and its clinical significance, the RSV/SLV, RMV/SLV and the volume of regeneration (RGV)/RMV were examined in 41 patients including 19 with chronic hepatitis and 5 with obstructive jaundice who underwent lobectomy or extended lobectomy. The hepatic function was maintained in all patients. SLV was calculated by the body-surface area using Urata's formula. RGV was calculated by subtracting the RMV from the remnant liver volume at day 28 after hemi-hepatectomy. Measurement of the hepatic volume was performed by computed tomography. The means of RSV, RMV, RGV and SLV were 591 ﾂｱ 173, 459 ﾂｱ 119, 667 ﾂｱ 129 and 1128 ﾂｱ 129cm3, respectively. The means of RSV/SLV, RMV/SLV and RGV/RMV were 0.52 ﾂｱ 0.14, 0.41 ﾂｱ 0.12 and 1.54 ﾂｱ 0.47, respectively. RGV was inversely correlated with RMV/SLV (p, Acta medica Nagasakiensia. 2003, 48(3-4), p.125-128

The aim of this study was to clarify whether or not preoperative serum levels of sialyl Lewisa (CA19-9), sialyl LewisX (SLX), and sialyl Tn (STN) antigens are predictors for diffuse type gastric cancer. Eighty-two patients with diffuse type and 96 patients with intestinal type cancers were studied. Univariate logistic regression analysis showed that the following factors were significantly associated with diffuse type cancer: high levels of serum STN, young age (, Acta medica Nagasakiensia. 2003, 48(3-4), p.129-133

To clarify the clinical usefulness of measuring branched chain amino acids and tyrosine ratio (BTR), which is correlated with Fischer's ratio, we examined the serum BTR level in 33 patients with liver diseases. Serum levels of branched-chain amino acids (BCAAs) and tyrosine were measured by the new enzymatic method, which costs inexpensive and is immediate compared to measuring Fischer's ratio. BTR was calculated as ratio of concentration of BCAA to tyrosine. BTR was correlated with levels of albumin, transaminase and cholinesterase and was lower in patients with chronic viral hepatitis, Child B cirrhosis and portal hypertension. In 19 patients who underwent hepatic resection included 8 for major hepatectomy, resected volume, blood loss, operation time and background of liver diseases were not associated with changes of BTR after hepatectomy. In patients with prolonged jaundice, postoperative BTR level was significantly lower between day I and 7 after hepatectomy. We concluded that serum BTR level was correlated with poor liver function and monitoring of BTR levels after hepatectomy may be useful to evaluate degree of hepatic damage after liver surgery., Acta medica Nagasakiensia. 2003, 48(1-2), p.29-33

Management of a rectovaginal fistula (RVF) following low circular-stapled colorectal anastomosis is difficult and often unsatisfactory. We report herein the case of a 66- year-old woman who developed a RVF following low anterior resection using the double-stapling technique for rectal cancer. The RVF spontaneously closed with nonoperative treatment that included simple observation without dietary restrictions. The spontaneous closure occurred within approximately 25 days. Minimally symptomatic patients may be candidates for nonoperative treatment., Acta medica Nagasakiensia. 2003, 48(1-2), p.81-84

This study was designed to provide an immunohistochemical analysis of tumor biological factors in 28 patients who underwent hepatectomy for cholangiocellular carcinoma (CCC). Analyzed factors were microvessel counts (stained by CD34) and proliferating cell nuclear antigen (PCNA). PCNA L.I. was correlated with serum level of CA19-9, which was correlated with a higher recurrence rate and shorter patient survivals. Microvessel counts were negatively correlated with tumor size. Furthermore, the microvessel count in CCC with mass-forming (MF) plus periductal infiltrating (PI) type associated with poorer survivals, was significantly lower compared to that of CCC with MF type or PI type. Neither microvessel counts nor PCNA L.I. were associated with any other clinicopathologic factors or cancer recurrence. The five-year overall and cancer-free survival rates were 26% and 13%, respectively. Patients with MF plus PI type, poorer differentiated carcinoma, stage 4A and higher CA19-9 level had shorter cancer-free and overall survivals after hepatectomy (p, Acta medica Nagasakiensia. 2003, 48(1-2), p.23-27

From 1991 to 2001, we performed 5 re-operations with limited posterior sagittal anorectoplasty (PSARP) for low imperforate anus in girls who had anteriorly located anus after primary surgery. Four girls were diagnosed with anocutaneous fistula and one girl with anovestivular fistula. Primary operations were one cutback anoplasty and four anal transplantation. None of them underwent colostomies before re-operation with the limited PSARP. The sphincter muscle was cut through a median perineal skin incision and then the rectum was placed at the center of the complex muscles. This limited PSARP could give good anal function and satisfactory cosmetic appearance, Acta medica Nagasakiensia. 2003, 48(1-2), p.51-54

Angiogenic factors play a major role in tumor growth and metastasis. Vascular endothelial growth factor (VEGF)- D is a ligand for VEGF receptor-3 (VEGFR-3/Flt-4), which mainly expressed on the lymphatic endothelium. Recent experimental studies have shown that VEGF-D induces tumor lymphangiogenesis and promote metastatic spread of tumor cells via lymphatic vessels. However, the contribution of VEGFD to lymph node metastasis in human colorectal cancer is less understood. We therefore examined VEGF-D and VEGFR-3 expression in patients with colorectal cancer. Sections of formalin-fixed and paraffin-embedded specimens from 76 colorectal cancers were immunohistochemically stained for VEGF-D and VEGFR-3. Staining for VEGF-D was positive in the cytoplasm of tumor cells in 43 of 76 examined tumors (56.6%). Staining for VEGFR-3 was positive in endothelial cells in 38 (50.0%) tumors. Univariate analysis showed that both VEGF-D and VEGFR-3 expressions correlated significantly with lymph node metastasis, histological type and depth of tumor invasion. However, logistic regression analysis indicated that VEGF-D expression, but not that of VEGFR-3, was an independent predictor for lymph node metastasis. Our data suggest that VEGF-D plays an important role in lymph node metastasis in colorectal cancer., Acta medica Nagasakiensia. 2002, 47(3-4), p.155-160

Activation of poly(ADP-ribose) polymerase-1 (PARP-1) and its subsequent cleavage are early markers of apoptosis. PARP-1 is associated with DNA repair and so chromosome stability, cell cycle regulation, as well as tumorigenesis. To investigate the role of PARP-1 expression in colorectal carcinoma and its metastasis of liver, we compared the expression of PARP-1 in primary colorectal cancers with (n=15) and without liver metastasis (n=17) using a semi-quantitative reverse transcription - polymerase chain reaction. We also examined the expressions of poly(ADP-ribose) (PAR) and p53 in these tumors by immunohistochemistry. A significantly higher PARP-1 mRNA expression was noted in tumors with liver metastasis than those without liver metastasis (p, Acta medica Nagasakiensia. 2002, 47(3-4), p.111-115

The serum hyaluronic acid (HA) levels are associated with liver regeneration after hepatectomy. In the present study, the HA concentrations were examined to evaluate the relationship with changes of hepatic volume after right portal vein embolization (PVE). The HA level of serum samples from 10 patients who underwent PVE before hepatectomy of the right lobe was measured, and the results were compared to the changed volume of embolized right lobe and unembolized left lobe of the liver. The mean serum HA level in patients with chronic viral liver disease (CVLD) (202+/-118 ng/ml) was significantly greater than in those without CVLD (70+/-24 ng/ml) (p, Acta medica Nagasakiensia. 2002, 47(1-2), p.43-46

Sialyl Lewisa (CA19-9) and sialyl LewisX antigens (CSLEXI) may play a role in tumor metastasis by serving as functional ligands in the cell adhesion system. To determine their prognostic value, we examined preoperative serum levels of CA19-9, CSLEXI, and carcinoembryonic antigen (CEA) in 64 female patients with primary breast cancer who underwent radical mastectomy. The patients were divided into two groups, termed the low- and high-antigen groups based on a value selected as a diagnostic cut-off. Correlation between the serum antigen levels, various established clinicopathologic factors, and prognosis were studied by univariate and multivariate analysis. The high- CEA group was at a more advanced stage (including T factor, N factor, M factor, and Stage) than the low-CEA group. Patients with high serum levels of CEA had shorter disease- specific intervals than those with low serum levels (P, Acta medica Nagasakiensia. 2002, 47(1-2), p.37-41

Platelet-derived endothelial cell growth factor (PD-ECGF) is one of the angiogenic factors. PD-ECGF expression is elevated in colorectal carcinoma, but its prognostic value does not reach a consensus. The aim of this study is to clarify the prognostic value of the PD-ECGF expression in colorectal carcinomas. PD-ECGF expression was measured by enzyme- linked immunosorbent assay in frozen materials from 71 colorectal cancer patients who had recived curative resection. Patients were divided into high expression and low expression groups based on cut-off value. Correlations among PD-ECGF expression, clinicopathologic features, and disease-free interval were studied by univariate and multivariate analysis. To evaluate the origin of PD-ECGF, serial sections of 71 tumors were stained for PD-ECGF and CD68. PD-ECGF expression in normal mucosa was 34.4 ﾂｱ 15.5 (Units/mg protein) and the cut-off value was 65.4 (mean+2SD). There were no significant correlations between clinicopathological features and PD-ECGF expression. The disease-free interval for high PD-ECGF expression group was significantly longer than that of low expression group (P=0.006). A multivariate Cox's regression analysis revealed a high PD-ECGF expression as an independent factor for better outcome. In immunohistochemical study, almost all tumor cells were negative for PD-ECGF, but stromal macrophages were predominantly positive for PD-ECGF. In conclusion, the PD-ECGF expression measured in this study was derived from stromal macrophages. High PD-ECGF expression was a predictor for favorable outcome after curative resection for colorectal cancer., Acta medica Nagasakiensia. 2002, 47(1-2), p.47-52

Aims: Outcome in minilaparotomy and laparoscopic-assisted approaches to colon cancer resection was compared retrospectively. Methods: The 'minilaparotomy approach', defined as a complete resection performed through a skin incision of 7cm or shorter ('moving window method'), was achieved in 47 patients with colon cancers (Tis/T1/T2/T3/T4) between 1997 and 1998 (minilaparotomy group). A laparoscopic-assisted approach was used in 30 patients with colon cancers (Tis/T1) between 1994 and 1996 (laparoscopic-assisted group). Results: Age, gender, prior laparotomy, tumor location, weight, height, body mass index, operation time, blood loss, and type of colectomies and anastomosis were similar in both groups. Median incision lengths in the minilaparotomy group were longer than in the laparoscopic-assisted group (7.0 versus 6.0cm). Maximal tumor diameter, number of lymph nodes removed, and proximal and distal margins in the minilaparotomy group were larger than in the laparoscopicassisted group. The minilaparotomy group had more advanced staged tumors; however, times until initial walking, flatus, fluid and solid food, time with urinary catheter, analgesic usage, postoperative hospital stay, and postoperative complication frequencies were similar. In neither group was there tumor recurrence at the laparotomy wound or port sites. Conclusion: Minilaparotomy and laparoscopic-assisted approaches to colon cancer resection were similar in terms of early return of function and discharge., Acta medica Nagasakiensia. 2001, 46(3-4), p.25-32

Background: Unfortunate complications in some patients who undergo minimally-invasive resections for colorectal cancer using a minilaparotomy are the development of postoperative wound infection or tumor recurrence at in the minilaparotomy site. These complications are potentially avoidable. In an effort to prevent these problems, we designed an easy-to-use device named the Lap-Protector TM. The purpose of this study was to evaluate the efficacy of the Lap-Protector TM in preventing bacterial infection and tumor recurrence at minilaparotomy incision sites. Patients and Methods: Ninety-eight colon cancer patients who underwent minimally-invasive resections using minilaparotomy (minilaparotomy or laparoscopic-assisted approach) with the assistance of the Lap-Protector TM between January 1999 and August 2000 were compared with 87 patients treated without this device between January 1997 and December 1998. Postoperative wound infection and tumor recurrence rates at the minilaparotomy site were retrospectively analyzed. Results: Patient characteristics (age, sex, body mass index, and frequency of diabetes mellitus), tumor location, operative procedures, and pathological parameters were similar between the two groups. Four patients (4.6%) in the control group developed postoperative wound infections versus none in the Lap-Protector TM group (P=0.047). With a median follow-up of 8.3 (range, 1.3 to 19.3) and 29.7 (range, 8.4 to 54.4) months in the Lap-Protector TM group and control group, respectively, neither group has recorded a tumor recurrence at the minilaparotomy site. Conclusion: The Lap-Protector TM appears to prevent wound infection after minimally-invasive resections for colon cancer using a minilaparotomy. Longer follow-up to evaluate tumor recurrence rates at the minilaparotomy site is necessary., Acta medica Nagasakiensia. 2001, 46(1-2), p.55-60

Aqua oxidation water is a new disinfectant with a bactericidal activity based on high oxidation-reduction potential and acidity. We compared the effectiveness of aqua oxidation water and povidone iodine against the surgical site infection (SSI). The bacteriological effect against several organisms and the efficacy of both disinfectants were almost similar. However, the duration of treatment with aqua oxidation water was shorter than that with the povidone iodine in healed wounds (p, Acta medica Nagasakiensia. 2001, 46(1-2), p.33-37

Background- Two distinct morphologic types of colorectal cancer have been described in recent studies: polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). Materials and Methods- We investigated possible biological and clinical differences between 37 PG-type and 156 NPGtype cancers using both univariate and multivariate analyses (logistic and Cox regression models). Results- Unlike NPG-type cancers, PG-type cancers had a high proportion of well-differentiated adenocarcinoma cells, a high likelihood of being early colorectal cancers (carcinoma in situ and cancer invades submucosa), and a low frequency of lymph node metastasis. On average, such PG-type cancers also carried a better prognosis than NPG-type cancers (P=0.01). In particular, PG-type cancer patients with stage IV tumors had a better prognosis than NPG-type cancer patients (P=0.02). In fact, after performing a Cox regression analysis, we found that colorectal cancer growth type is an independent prognostic variable, separate from histologic type or stage. Conclusions- PG-type colorectal cancer is less aggressive and has a favorable prognosis compared to NPG-type cancer., Acta medica Nagasakiensia. 2000, 45(1-2), p.51-59

Aims: We examined the preoperative serum levels of sialyl Lewisa (CA19-9) and carcinoembryonic antigen (CEA) in 262 colorectal cancer patients, in order to clarify whether or not the prognostic value of CA19-9 after curative surgery is superior to that of CEA. Patients and Methods: The patients were divided into two groups: low or high antigen groups (higher or lower than a selected diagnostic-based cut-off value). For evaluation of the prognostic value of CA19-9 and CEA, the disease-free interval was studied. Results: The disease-free interval of patients with a high serum levels of CA19-9 or CEA was significantly shorter than for those patients with a low serum level of the particular antigen (P, Acta medica Nagasakiensia. 2000, 45(1-2), p.47-50

PURPOSE: The purpose of this study was to investigate the effects of omental pedicle graft (OPG) wrapping to limit leakage from compromised double-stapled anastomoses after anterior resection for rectal cancer. PATIENTS AND METHODS: Between 1994 and 1997, a prospective study was conducted on 80 consecutive patients who had undergone double-stapled anastomoses after anterior resection for rectal cancer. Decisions to perform OPG were made intraoperatively because of compromised doublestapled anastomoses. RESULTS: Twenty-one patients (26%) received OPG to protect anastomosis, the remainder of patients had no OPG. Ten of the 21 patients underwent OPG for stapler-related operative complications, 5 for rectal carcinoma with stenosis, 3 for obstructive colitis or diverticulitis in the sigmoid colon, and 6 for very low anterior resection with coloanal anastomosis after total mesorectal excision. Three of 21 patients had more than one indication for OPG. The two types of patients were comparable with respect to patient characteristics and operative procedures, although tumor diameter in the OPG patients was significantly larger than in the non-OPG patients. Anastomotic leakage was noted in 1 non-OPG patient (2%) but in none of the OPG patient. There were no statistically significant differences between the two types of patients with regard to postoperative course and anastomotic or other postoperative complications. CONCLUSION: We conclude that OPG wrapping provides an effective protection for a compromised anastomosis of anterior resection in selected patients with rectal cancer, Acta medica Nagasakiensia. 1999, 44(1-2), p.40-46

Malignant fibrous histiocytoma (MFH) of the retroperitoneum is relatively rare in Japan. MFHs often recurs even if the tumor is resected completely. We describe a case with recurrent MFH of the retroperitoneum. A 49-year-old male was-admitted to our hospital for a palpable mass in the right lower abdomen. Ultrasonography and computed tomography demonstrated a solid mass with cystic compartment in the lower pole of the right kidney. The tumor was resected completely, and histological examination showed it was MFH, storiform-pleomorphic type. Thirty-three months later, a local recurrence developed and a second operation was performed. The resected tumor was 4.5 ﾃ・3.9 ﾃ・3.1 cm in size and histological diagnosis was recurrent MFH. We also examined the cytological characteristics of the tumor, using DNA flow cytometric quantification and fluorescence in situ hybridization (FISH) with a set of 14 chromosomespecific DNA probes. DNA contents showed a DNA diploid pattern, however, FISH analysis showed various aberrations of chromosome number such as +1, +2, +7, +8, -10, +11, +12, -16, -17, -18, and +20. These results suggested that chromosomal aberrations may reflect a higher biologic aggressiveness of recurrent MFH., Acta medica Nagasakiensia. 1998, 43(3-4), p.88-91

Between September 1992 and July 1996, 2 patients with type I early gastric cancer, 3 with type IIa, and 14 with type IIc, totaling 19 patients underwent laparoscopic partial gastrectomy (gastric wedge resections in 17 and Billroth II distal gastric resection in 2). There were 12 men and 7 women. Mean age was 65.4 years ranging from 44 to 86. Gastric lesions were located on the anterior wall in 7, posterior wall in 8 and lesser curvature in 4. In 15 of 19 patients, we performed laparoscopic surgery by a lesion lifting method using plastic T-fasteners. Average operative time was 164.8±49.6 min (range 85-252) in all, 153.7±46.7 min for the lesion lifting method, and 227 ± 33 min for diatal gastrectomy. Average blood loss was 44.1 ± 57.3 ml, 30.9 ± 43.7 ml, and 97 ± 61 ml, respectively. Mean hospital stay after surgery was 13.6 ± 6.8 (6-30) days. There was no mortality and no postoperative complications. The average size of tumors in type I, IIa and lie was 30 mm, 17.3 mm and 20 mm, respectively. In histologic examination, 16 cases were differentiated carcinoma and the remaining 3 cases were signet cell carcinoma. One of 4 cases diagnosed as SM cancer preoperatively was m (mucosal) cancer, two were sm (submucosal), and one was mp (muscularis propria) cancer histologically, but no one was involved in regional lymph nodes. These results indicate that laparoscopic partial gastrectomy will play an increasing role in the treatment of early gastric cancer without lymph node involvement as well as benign gastric tumors., Acta medica Nagasakiensia. 1996, 41(3-4), p.57-65

The prognostic significance of carcinoembryonic antigen (CEA) values in the drainage vein of the tumor (portal blood levels of CEA) of colorectal cancer patients were evaluated by examining the correlation with the peripheral blood levels of CEA and histopathologic findings of the tumor. 1) Portal blood levels of CEA were significantly increased by the operative procedure. Mean values of CEA in portal blood were higher than those in peripheral blood. Portal blood CEA was correlated with Dukes' staging, and revealed higher positive rates than CEA in peripheral blood in each stage. Elevated CEA levels were noted in those who had cancer infiltration extending through the proper muscle layer. There was a close correlation between portal CEA and CEA content in cancerous tissue (ng/g, wet weight) (p, Acta medica Nagasakiensia. 1996, 41(3-4), p.52-56

To determine the clinical features and problems presented by a pancreatic pseudocyst, eighteen patients managed at our hospitals since 1980 were reviewed. Males predominated with a ratio of 16: 2, and the average age was 36.2 years. Pseudocyst was located in the pancreatic head in 6, in the body in 6, in the tail in 5 and multiple pseudocysts in one case. The cause of pancreatic pseudocyst was chronic pancreatitis in 9 (including 8 patients with histories of alcoholism), acute pancreatitis in 2 and trauma in 7 patients, respectively. Three patients were associated with pancreatic calculi. Rupture of pseudocyst occurred in one patient with multiple cysts. Autopsy showed acute pancreatic necrosis and penetration to the stomach and duodenum. The indications for surgery were principally cyst-related symptoms(infection, hemorrhage, enlargement and compression of adjacent organs) and differential diagnosis from malignancy. Most of the patients underwent internal drainage ; 9 cystojejunostomy, 2 cystogastrostomy). Three patients underwent cystojejunostomy with longitudinal pancreaticojejunostomy for chronic pancreatitis. Massive hemorrhage after cystogastrostomy occurred in one patient with infected pseudocysts, which required removal of the cysts. Postoperative outcome of the 17 surgical patients was excellent in 16 patients. Only one patient died of pancreatitis associated with alcohol abuse, resulting in a 5.9% mortality. This study suggests that adequate internal drainage by pancreaticojejunostomy to treat the underlying pancreatic disease is most important to obtain an excellent prognosis in patients with pseudocysts., Acta medica Nagasakiensia. 1995, 40(1-4), p.18-21

In order to more fully understand the morphological characteristics of villous tumors of the colorectum, the vascular patterns of six colorectal resection specimens were microangiographically studied. Grossly, villous adenomas were of two main types: pedunculated polyps and carpet-like lesions. Pedunculated villous adenomas had many large stalk vessels in a broad short pedicle, representing a large blood supply to the tumor. The carpet-like lesions were composed of continuous clusters of polyps with stalk vessels and the flat elevated lesions among polyps and at the periphery showed similar vascular patterns to the mucosa of normal colon. In lesions with cancer invasive to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to at least a Dukes B lesion. The above findings could represent very important additional information for endoscopic treatment or local excision for the prevention of hemorrhagic complicatios or incomplete removal of tumor., Acta medica Nagasakiensia. 1994, 39(1-3), p.172-175

To clarify the features and problems presented by a peripheral cholangiocarcinoma (CCC), seven patients with hepatectomy from the First Department of Surgery, Nagasaki University School of Medicine (6 patients), and from Department of Surgery, National Ureshino Hospital (one patient) were reviewed. Men predominate with ratio of 5:2, and an average age was 65.4 years. Tumor location was left lateral segment in 4 patients, right lobe, middle lobe and posterior segment in one, respectively. Three patients were associated with hepatolithiasis. Underlying liver disease was found in 4 patients (57%); cirrhosis in 3 patients, and chronic hepatitis in one. Initial symptoms were abdominal pain, fever and palpable abdominal mass. In imaging modalities available, the detection rates of tumor were 100% in CT and 67% in US and angiography, respectively. Combination of MRI and CT clearly showed tumor characteristics. The serum CEA was slightly elevated in 5 patients (83%), but serum CA19-9 rose strikingly in 3 patients. Most tumors showed an infiltrating growth along intrahepatic bile duct, with a portal vein thrombus and/or satellite tumors frequently. In 3 patients, early recurrence with intrahepatic metastasis occured within the first 6 months. The patient of poorly differentiated adenocarcinoma containing a squamous or signet ring cell carinoma showed an extremely poor prognosis. This study suggests that early detection of small CCC and an extended resection are the most important factors for the survival of patient., Acta medica Nagasakiensia. 1993, 38(2-4), p.237-241

To select the sensitive anticancer agents for the treatment of patients with carcinoma, chemosensitivity should be timely assessed from biopsy specimen for patients with gastric carcinoma. Histogram of DNA analysis from biopsy specimens revealed the disappearance of GZM accumulation in reflection of effects of anticancer drugs prior to the appearance of clinical signs. In conclusion, DNA analysis from biopsy specimens is of great value in assessing the efficacy of anticancer drugs in the course of drug treatment and also in knowing the drug sensitivity to the tumor timely., Acta medica Nagasakiensia. 1993, 38(2-4), p.222-225

Five hundred and nine patients who underwent surgery for colorectal cancer during 1970-1988 at the First Department of Surgery, Nagasaki University School of Medicine, were studied retrospectively to compare the clinicopathological features in 65 cases older than 75 years of age and 409 ranged from 40 to 75 years of age. Older patients revealed a high frequency of right-sided tumors including the transverse colon (32.3%). The older patient group presented with a fewer Dukes stage D in 3.1% of cases compared with 16.4% of the middle age group with low incidences of hepatic metastasis (p, Acta Medica Nagasakiensia. 1992, 37(1-4), p.32-36

The remedial operation for the control of sympotoms was carried out in 6 cases with severe dumping syndrome. Three male cases and 3 female cases were treated, and its age at the initial gastrectomy ranged from 24 to 64 years old, and 5 cases with gastric ulcer and 1case with gastric cancer were observed as primary diseases. As the initial operative procedures, distal subtotal gastrectomy in 5 cases, distal hemigastrectomy in one case and Billroth II type anastomosis in 5 cases with gastric ulcer were performed, and 1case with gastric cancer was reconstructed by Billroth I type anastomosis. Dumping symptom developed from 3 weeks to 1 month after gastrectomy in all cases except 1, and body weight loss due to labor disturbance and malnutrition was observed. They have been suffering from the syndrome for 3 to 27 years, and remarkable rapid transit of gastric contents was observed on both roentgenograph and gastric scintigram before surgery. As reoperation, the jejunum was interposed reversibly from 5 to 9cm between the gastric remnant and duodenum. Re-surgery was necessitated in 1 case, while improvement of symptoms was observed in remaining cases, and reduction of the emptying time of gastric contents was observed by imaging diagnosis., Acta Medica Nagasakiensia. 1992, 37(1-4), p.120-126

Clinicopathologic features in 35 patients below the age of 40 years with colorectal carcinoma were reviewed and compared with those of a control group containing 409 patients ranging from 40 to 74 years of age. All cases in this series were experienced at the First Department of Surgery, Nagasaki University School of Medicine, during the 18 years from 1970 to 1988. 1) Young patients accounted for 6.7% of all cases with colorectal cancer, and this group included more female patients than in the elderly control group. 2) The young patient group presented with advanced lesions (Dukes' stage C) in 54.3% of cases compared with 35.6% of the old patient group with significantly high incidences of lymph node involvement. There were no significant differences in the hepatic metastasis and peritoneal dissemination among two groups. 3) Mucinous carcinoma and vascular invasion were frequently found on histologic examination in the young group, which suggested the highly malignant potentiality, but no significant difference in DNA ploidy pattern was observed between the young and the control group. 4) Curative resection rates were 71.4% in young and 68.1% in elderly patients. Overall 5-year survival was 56.9%. Five-year survival in 25 patients undergoing potentially curative resection increased to 74.4% with the similar rates of the control group. Improved 5-year survival following potentially curative resection stresses the need for early diagnosis and treatment., Acta medica Nagasakiensia. 1991, 36(1-4), p.6-11

The Carcinoembryonic antigen (CEA), CA19-9 and Tissue Polypeptide Antigen (TPA) levels in portal blood in colorectal cancer patients were studied in correlation with the peripheral blood levels and histopathologic findings in order to know serum levels increased. 1) Portal blood CEA, CA19-9 and TPA increased by operative maneuver. 2) Mean values of these markers in portal blood were higher than those in peripheral blood. 3) Portal blood CEA was correlated with Dukes' staging, and revealed higher positive rates than CEA in peripheral blood in each stage. Portal CA19-9 changed within normal value and strikingly rose in Dukes' D stage. Portal TPA tends to be higher in all stages and correlated with grades, but the value in Dukes' D were lower than that of peripheral blood. 5) Moderately differentiated adenocarcinoma revealed the highest level of portal CEA (P, Acta medica Nagasakiensia. 1991, 36(1-4), p.185-190

A case of gastritis cystica polyposa is presented. A 45-year-old woman developed gastritis cystica polyposa at the gastroduodenostomy anastomotic site four years after Billroth II gastrectomy for adenomatous polyp. There was no association of gastric cancer in the lesion., Acta medica Nagasakiensia. 1990, 35(1-4), p.29-32

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible., Acta medica Nagasakiensia. 1990, 35(1-4), p.157-163

Local recurrence in the pectoralis muscle after modified radical mastectomy for breast cancer is rare. We encountered a 53-year-old woman who developed a small nodule on her right antero-lateral chest wall after modified radical mastectomy. Excision biopsy of the mass lesion was performed, and pathological examination revealed a local recurrence in the pectoralis major muscle. Resection of the pectoralis major and minor muscles, subclavicular lymph nodes dissection and postoperative radiation therapy were performed. After operation, no local recurrence appeared, but the patient died of multiple liver and bone metastases two and a half years later., Acta medica Nagasakiensia. 1997, 42(3-4), p.58-60

Two patients with rectal cancer induced by irradiation for the treatment of uterine cancer were reported. Surgical outcome for radiation-induced cancer was satisfactory as far as the primary focus was well controlled. Definition of radiation-induced cancer also was discussed. It is the most important factor to be a long time interval of more than 10 years by detection of rectal cancer after irradiation and to reveal a histologic pattern concerning irradiation tissue damage., Acta medica Nagasakiensia. 1988, 33(1-4), p.83-86

A 60-year-old, Japanese woman, with congenital web-like tracheal stenosis surgically treated. Successful relief from tracheal stenosis was obstained. Detection in adulthood and chance of the treatment for congenital tracheal stenosis is very rare. As far as this case is concerned, delay in detection and treatment is discussed of congenital tracheal stenosis., Acta medica Nagasakiensia. 1985, 30(1-3), p.256-260

Acta Medica Nagasakiensia. 1987, 32(1-4), p.123-129

The six patients who underwent reoperation for recurrence of gastric cancer following surgery were clinically analysed, of whom one had lung metastasis and the other five local recurrences. The conditions of resectability are that carcinoma infiltration should be limited, the disease-free interval-after the first operation should be long and there are no blood-borne metastases into the lung and the liver. The surgical outcome for lung metastasis was pessimistic. It is emphasized that multidisciplinary therapy and early detection are indispensable for improving the surgical outcome in the treatment of recurrence of gastric cancer., Acta medica Nagasakiensia. 1988, 33(1-4), p.163-166

In order to evaluate the factors affecting the patient's survival, 32 patients of hepatic resection in which the liver had a sollitary hepatocellular carcinoma (HCC) smaller than 5 cm in size were studied. 1) Chronic liver diseases were associated in 96.9 % of patients. Minor resection was done in 30 patients, and right hepatectomy in two. 2) 87.5 % of all cases were diagnosed during periodic follow-up examination for the patients with chronic liver disease, mostly cirrhosis. For small HCC, ultrasonography (US) had the highest detection rate (90%) compared with CT (66.7%) and angiography (55.6%). Preoperative serum AFP values were abnormal in 73%. 3) Grossly, all tumors were nodular or expanding and none was diffuse. Encapsulation appeared to be complete as tumor grew. Portal vein tumor thrombus (12.5%) and/or satellite tumor (31.2%) were frequent in those with larger than 2 cm in diameter. 4) The mortality rate was 9.4% and the hospital mortality rate was 6.3 %. The survival rate of the group with small HCC was far better than that of the groups with HCC larger than 2 cm in size (p, Acta medica Nagasakiensia. 1988, 33(1-4), p.228-234

Acta Medica Nagasakiensia. 1986, 31(1-4), p.294-302

Acta Medica Nagasakiensia. 1986, 31(1-4), p.276-287

Of 105 patients of hepatocellular carcinoma (HCC) treated during 1970-1988, twelve patients had spontaneous rupture of carcinomatous nodules. 1) Of previous 6 cases, five were treated by conventional surgical procedures such as packing and suture, and all died. One case underwent right lobectomy following guaze pack and lived for 15 months. 2) The recent 6 cases underwent emergency transcatheter arterial embolization (TAE ) and two died of hepatic failure due to severe cirrhosis. The other 4 cases had successful control , of bleeding which allowed further treatment of HCC ; hepatectomy in 3 and repeated TAE in one. 3) All cases had precirrhosis or cirrhosis. Pathologically, ruptured tumors expansively growing with capsule invasion of cancer cells, and portal tumor thrombus were recognized in resected or autopsy specimens. DNA aneuploid HCC on flow cytometric DNA analysis were found in 4 out of 5 cases. In conclusion, hepatic resection following embolization, when possible, would seem to be rational treatment for spontaneous rupture of HCC, although the prognosis is still extremely poor despite successful control of bleeding., Acta medica Nagasakiensia. 1989, 34(2-4), p.203-208

An exceedingly rare case of perforated early gastric cancer is reported. A 47-year-old man developed a peritonitis due to perforation of early gastric cancer. Emergency operation was performed and followed by uneventful recovery. The histologic examination of the surgical specimen showed early gastric cancer (EGC) of type III, composed of signet ring cell carcinoma. Thirteen years after surgery, the patient died of a cerebrovascular accident with no evidence of tumor recurrence. The rarity of this complication in EGC is discussed and the Japanese literature reviewed., Acta medica Nagasakiensia. 1988, 33(1-4), p.185-188