Risk factors for developing colorectal cancer in Japanese patients with ulcerative colitis: a retrospective observational study-CAPITAL (Cohort and Practice for IBD total management in Kyoto-Shiga Links) study I.

BACKGROUND AND AIMS: Patients with ulcerative colitis (UC) are at risk for developing colorectal cancer (CRC), despite the development of new therapeutic agents. Stratification of the individual UC-patient's risk would be helpful to validate the risk factors for CRC. The aim of this study was to evaluate the risk factors for the development of CRC in a large cohort of patients with UC. METHODS: Data were obtained from 12 hospitals in the Kyoto-Shiga region during 2003-2013. We performed a retrospective cohort study of 2137 patients with UC. RESULTS: In total, 60 lesions of CRC were detected in 43 (2.0%) of 2137 patients. 30 of the 43 patients were male. The median age was 53 years. The median duration of disease was 13 years, and 67.4% of these patients had a disease duration >10 years. Of the 43 patients, 34 (79.1%) had extensive colitis. Primary sclerosing cholangitis was detected in 2 patients (4.7%). The median corticosteroids (CS) dose was 6.4 g, and 4 patients were treated with a total of more than 10 g of CS. 18 of these patients underwent more than 1 year CS treatment. Of all 60 CRC lesions, 43 (71.7%) were located in the distal colon and 35 (58.3%) were of the superficial type. Moreover, the stage of CRC was stage 0 or I in 55.8% of the 43 patients with CRC. Multivariate analysis suggested that extensive colitis could be a risk factor for the development of advanced CRC in patients with UC. CONCLUSIONS: Our findings indicated that male, extensive colitis, long-term duration of UC and family history of CRC, but not concomitant primary sclerosing cholangitis, are important factors for predicting CRC in Japanese patients with UC. Moreover, long-standing extensive colitis might contribute to the progression of CRC. Further studies are required to establish CRC surveillance in Japanese patients with UC.

[Case of ulcerative colitis associated with drug-induced hypersensitivity syndrome (DIHS) by salazosulfapyridine].

We experienced a case of drug-induced hypersensitivity syndrome (DIHS) for salazosulfapyridine (SASP). After we started administration of SASP in a 26-year old man with ulcerative colitis (UC), he had symptoms resembling infectious mononucleosis, high fever, skin eruption, cervical lymphadenopathy, elevate white blood cell count with atypical lymphocyte, and liver dysfunction. We diagnosed the illness as drug-induced hypersensitivity syndrome (DIHS) due to SASP. We halted SASP and started administration of methylprednisolone and prednisolone but his condition deteriorated. We changed to administration of betamethasone and he recovered. In cases of DIHS accompanied by UC, we should administer drugs carefully and recognize serious complications.

A case of scirrhous gastric cancer with peritonitis carcinomatosa controlled by TS-1 + paclitaxel for 36 mo after diagnosis.

A 34-year-old female complaining of abdominal fullness was diagnosed as scirrhous gastric cancer (type 4') with peritonitis carcinomatosa in July 2002. A combined chemotherapy regimen was selected to control massive ascites; TS-1 80 mg/m(2) was given orally on d 1-14, 22-35, and paclitaxel 50 mg/m(2) was administered intravenously on d 1, 8, 22 and 29. After 2 courses of this regimen, the primary tumor was markedly reduced, and ascites completely vanished. Alopecia (grade 1, since d 30), leukocytopenia (grade 2, on d 34) and anemia (grade 2, on d 34) were the only adverse events throughout the following courses. The chemotherapy was effective for 28 mo, and then it was discontinued upon the patientos own request, and she survived for 36 mo after diagnosis.

Leukocytapheresis therapy modulates circulating t cell subsets in patients with ulcerative colitis.

The aim of this study was to elucidate the molecular mechanisms responsible for the therapeutic effects of leukocytapheresis (LCAP). We investigated the alterations in circulating T cell subsets after LCAP therapy in ulcerative colitis (UC) patients. Eighteen patients with UC were enrolled. Fourteen patients were responders, and four patients were non-responders. Peripheral venous blood was obtained within 5 min before and 5 min after LCAP therapy. Flow cytometric analysis for T cell markers and intracellular interferon (IFN)-gamma (Th1) and interleukin (IL)-4 (Th2) was then performed. The average numbers of lymphocytes, T and B cells were significantly decreased after LCAP therapy, respectively (P < 0.01). The numbers of CD4+ and CD8+ T cells were also significantly decreased, respectively (P < 0.01), but the CD4+/CD8+ ratio was not changed. The number of CD45RO+ CD4+ memory T cells was significantly decreased. The number of CD25+ CD4+ T cells tended to decrease after LCAP therapy (not significant). However, the ratio of CD25+ CD4+-cells/CD25- CD4+-cells was significantly increased (P < 0.05). The number of IFN-gamma-positive (Th1) cells was significantly decreased after LCAP therapy, but there was no significant change in the number of IL-4-positive (Th2) cells. The Th1/Th2 ratio was significantly decreased after LCAP therapy. Some of the immuno-suppressive effects of LCAP therapy may be associated with a modulation of circulating T cell subsets.

Evaluation of transcatheter arterial embolization therapy on hepatocellular carcinomas using contrast-enhanced harmonic power Doppler sonography: comparison with CT, power Doppler sonography, and dynamic MRI.

PURPOSE: The aim of this study was to assess and compare the sensitivity of power Doppler sonography, contrast-enhanced sonography, plain computed tomography (CT), and dynamic magnetic resonance imaging (MRI) for detecting hepatocellular carcinoma (HCC) nodules incompletely treated with transcatheter arterial embolization (TAE). METHODS: A total of 63 unresectable HCC nodules were examined in this study. The HCCs were treated with TAE. All patients underwent plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI 1 week after TAE. The sensitivity of each modality to incompletely treated HCC nodules was compared. Detection of the residual viable HCC on angiography or tumor biopsy was regarded as the gold standard for the diagnosis of incomplete treatment. RESULTS: Twenty-four nodules (38%) were diagnosed as incompletely treated. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these incompletely treated nodules were 42% (10/24), 46% (11/24), 88% (21/24), and 79% (19/24), respectively. Eighty percent (19 nodules) of the 24 incompletely treated nodules were located within a depth of less than 8 cm. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these superficial incompletely treated nodules were 37% (7/19), 53% (10/19), 100% (19/19), and 74% (14/19), respectively. In contrast, the sensitivities of each modality to deeply located nodules were 60% (3/5), 20% (1/5), 40% (2/5), and 100% (5/5), respectively. CONCLUSION: Plain CT and power Doppler sonography had a low sensitivity to HCC nodules incompletely treated with TAE. Except for those that were deeply located, contrast-enhanced harmonic sonography showed the highest sensitivity in detecting incompletely treated HCC nodules.

[A case of advanced gastric cancer attaining histological CR of paraaortic lymph node after TS-1/CDDP neoadjuvant chemotherapy].

A 60-year-old male complaining of anemic symptoms went through examinations and was diagnosed with gastric cancer (cardia, type 3', cT2, cN3, cH0, cP0, cM0, cStage IV). Further inspection showed multiple lymph node metastases, including, No. 1, 3, 7, 11, and 16 (paraaortic LNs). Poor prognosis was predicted, yet we tried neoadjuvant chemotherapy (NAC) expecting down staging of the tumor. With the efficacy and safety previously proven, we chose TS-1 + CDDP as NAC regimen. TS-1 (tegafur gimestat otastat potassium, = 80 mg/m2) was administered orally for 21 days, followed by CDDP (cisplatin, = 60 mg/m2) i.v. on day 9. One course was completed without any significant adverse effects. The tumor itself showed PR-MR to the chemotherapy, but all the lymph nodes were expected to attain PR from CT findings. Total gastrectomy, lymph node dissection (D3) with Roux-en-Y reconstruction was performed, and histological re-evaluation was made. Macroscopically, the stomach seemed to be penetrated into serosa by the tumor, i.e., se invasion was suggested, yet histologically no cancerous cells were detected within mp and ss layer. Many of the lymph nodes were replaced with fibrosis, some with normal lymph node structure remained. Definitely no malignant cells were detected throughout all the lymph node specimens (Grade 3). Because pathological CR of paraaortic lymph nodes has never been reported previously, this case shows TS-1 + CDDP as a promising NAC regimen for advanced gastric cancer, in a sense that tumors once diagnosed as inoperable would still have the possibility of CR.