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We have previously demonstrated tumor-specific alpha1,2fucosylation, which is associated with resistance of tumor cells to anticancer treatment in human colorectal tumor tissues. By using the YB-2 monoclonal antibody, the resulting products have been identified as Y, Le(b), and H type 2 antigens in colorectal tumor tissues.Immunohistochemical analyses of colorectal cancer tissues (74 specimens) were performed with a newly established mouse monoclonal antibody, YB-3 specifically recognizing H disaccharide (Fucalpha1,2Galbeta) structures, and anti-A, anti-B, YB-2, and anti-sialyl Lewis X (SLX) antibodies, together with the analyses of glycosyltransferases involved in the synthesis of ABH antigens in the same tissues.The YB-3 antibody enabled us to detect colorectal tumors, particularly tumors in the distal large intestine and the rectum, with high sensitivity (74.3%) and specificity (100%). From immunohistochemical and enzymatic analyses of colorectal tissues, we found that once alpha1,2fucosylation had proceeded in tumor tissues, blood group A or B antigen was also synthesized in approximately half of the tissues of A or B blood type, but not in their normal tissues. A correlation of survival rate with immunostaining of tissues was found only by YB-3 antibody and not by anti-A, anti-B, or anti-SLX antibody.As a predictor of postoperative prognosis of patients with colorectal cancer, immunodetection of alpha1,2fucosylated antigens with the YB-3 antibody seemed to be superior to blood groups A, B, or SLX antigen in colorectal tumor tissues.

Colorectal surgery presents a high risk of surgical site infections (SSI). SSI and prolonged hospital stay were associated with being aged 75 years or older. We investigated the efficacy of sulbactam sodium/ampicillin sodium (SBT/ABPC), which is a combination drug of ampicillin and beta-lactamase inhibitor, as a prophylactic drug against SSI in elderly patients undergoing colorectal surgery.From July 2003 to November 2005, a total of 181 patients underwent colorectal surgery. Of these patients, 43 who were older than 75 years were compared with 138 who were younger. Patients were given SBT/ABPC as follows: Before anesthetic induction at surgery, 1.5 g of SBT/ABPC was administrated by intravenous drip infusion, and further doses were continued at 12-hour intervals for 2 days. We assessed SSI, postoperative stay, type of surgery, duration of operation, and amount of bleeding.The result was that SSI was found in none of the patients. There was no significant difference in rate of SSI and postoperative hospital stay between the two groups. Adverse reactions due to SBT/ABPC such as apparent skin symptoms or gastrointestinal symptoms were not observed.SBT/ABPC for elderly patients would be effective to prevent SSI in colorectal operations and could be used safely.

Hepatic arterial infusion (HAI) chemotherapy has a number of limitations, including a low rate of complete response and frequent extrahepatic recurrence, in colorectal cancer (CRC) patients with unresectable hepatic metastases. A clinical trial was planned to assess the safety and efficacy of combination chemotherapy of HAI and oral administration of UFT and leucovorin (UZEL) in CRC patients with unresectable liver metastases.Sixteen CRC patients with unresectable liver metastases were treated with concurrent HAI and systemic oral UFT/UZEL. Eligible patients were previously untreated (except for adjuvant therapy) CRC patients with unresectable liver metastases, with WHO performance statuses of 0 to 2. On an outpatient basis, the patients received a treatment regimen consisting of 5-fluorouracil at 1000 mg/m2 and l-Leucovorin at 50 mg/m2 for 5 hours on days 1, 8, 15, and 22 by hepatic arterial infusion plus oral UFT (300 mg/m2) and UZEL (75 mg/body) on days 2-7, 9-14, and 23-28 followed by withdrawal for one week. The cycles were repeated every 5 weeks until disease progression.A total of 103 cycles of HAI with the UFT/UZEL regimen were administered (median, 5 cycles; range, 6 to 9 cycles). The response rate was 87.5% (14 partial responses and 2 stable diseases). The median progression-free survival rate was 9.2 months, and the median survival time was 22 months. No treatment-related grade 3 or 4 adverse events were observed.This novel locoregional HAI with an oral UFT/UZEL systemic chemotherapeutic regimen is feasible in an outpatient setting and should be considered as first-line chemotherapy for CRC patients with unresectable liver metastases.

Galectin-3, a beta-galactoside-binding protein, has been associated with various biological processes, such as cell adhesion, recognition, proliferation, differentiation and apoptosis. The aim of this study was to determine the relationship of galectin-3 expression to clinicopathological findings in patients with colorectal cancer. Furthermore, the correlation between the expression of galectin-3 and beta-catenin, and the Ki-67 labeling index were investigated.Immunohistochemical assessment of galectin-3, beta-catenin and Ki-67 expression was performed on samples from 108 patients with colorectal cancer. The expression of galectin-3 was classified at the tumor surface and the invasive front, and its relationship with clinicopathological factors was considered from a statistical viewpoint.There was significant liver metastasis when the expression of galectin-3 was lower at the invasive front of a tumor compared to its surface (p = 0.04). There were also significant correlations between beta-catenin expression at the tumor surface and liver metastasis and tumor stage (p = 0.03, p = 0.04 respectively).The reduction of galectin-3 expression is associated with the invasion and metastasis of colorectal cancer. A possible involvement of galectin-3 expression in tumor invasion, metastasis and proliferation in patients with colorectal cancer is suggested.

Entero-related fistulae are often intractable. Recently, growth factors were generally in sight with the development of regenerative medicine. Basic fibroblast growth factor (bFGF) possesses potent angiogenic activity. In Japan, recombinant bFGF, also known as Trafermin, has been administered for intractable skin ulcer for its strong effect on tissue granulation. Here, we report the effect of bFGF for entero-related fistulae. Two intractable cases were treated by applying bFGF in the fistulae after performing the enterostomy. Case 1: Postoperative intractable vesicorectal fistula was treated by bFGF. 82 days later, fistula was closed. Case 2: Colonic perforation due to ischemic colitis was treated. 37 days after treatment, fistula was closed. In conclusion, in the treatment of the intractable entero-related fistulae, Trafermin was useful for healing the fistulae.

A clinical trial has been planned to assess the safety and efficacy of oral administration of UFT and leucovorin (UZEL) in elderly patients with advanced colorectal cancer (CRC).Twenty-six patients with advanced CRC who were over 70 years and considered ineligible for combination chemotherapy received oral UFT 300 mg/day and UZEL 75mg/day were administered orally for 28 days followed by a 7-day rest period. Treatment was repeated every 5 weeks until disease progression.A total of 106 cycles of UFT/UZEL were administered (median, four cycles; range, one to twelve cycles). UFT/UZEL was well tolerated. The response rate was 11% (3 partial responses, 16 stable diseases, and 7 progressive diseases). The median progression-free survival rate was 3.9 months and the median survival time was 9.8 months. Treatment-related grade 3 and 4 adverse events were not observed.Oral regimen consisting of UFT/ UZEL is effective and well tolerated in elderly patients with advanced CRC who are considered ineligible for combination chemotherapy.

A phase I clinical trial has been planned to determine the recommended dose and to assess the safety and efficacy of combination chemotherapy of S-1 with cisplatin and irinotecan (SCI regimen) as a second-line treatment in 5-fluorouracil (5-FU) resistant colorectal cancer (CRC).Patients with unresectable recurrent or metastatic CRC were enrolled in this study for second-line treatment. On an outpatient basis, the patients received a treatment SCI regimen comprising S-1 oral administration for 28 days followed by withdrawal for 2 weeks, plus cisplatin and irinotecan were administered on days 1, 8, 15 and 22 by intravenous injection. These courses were repeated every 6 weeks. Starting doses were 70 mg/m2 S-1, 6 mg/m2 Cisplatin, and 60 mg/m2 Irinotecan.A total of 29 patients was enrolled. Dose-limiting toxicities were fatigue, nausea, and leucopenia. Twenty-three patients at recommended dose were evaluable for treatment response. The response rate was 21.7% (5 partial responses, 13 stable diseases, and 5 progressive diseases). The median progression-free survival rate was 4.3 months; the median survival time was 9.6 months.The SCI regimen is feasible in an outpatient setting and should be considered as second-line chemotherapy for patients with 5-FU resistant CRC.

We report a case of a paraesophageal hernia, which was successfully treated with laparoscopic surgery after a natural history of eight years. Eight years before surgery only the fundus of the stomach was included in the hernia sac. At surgery, although the gastroesophageal junction and fundus were found in their normal positions, the distal half of the stomach and the omentum were pulled into the thorax, which demonstrated an organoaxial gastric volvulus. As the omentum tightly adhered to the top of the hernia sac and there was no tight adhesion between the stomach and hernia sac, the omentum could serve as the lead point for the gastric volvulus. This patient was successfully treated with laparoscopic surgery and is presently in good condition without any recurrence of the hernia.