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1.
BMC Cancer ; 23(1): 492, 2023 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-37259045

RESUMO

BACKGROUND: Patients presenting with inoperable colon cancer at first onset (ICF) or at time of relapse (ICR) are considered in unrecoverable. The therapeutic goal for unrecoverable cancer is to prolong overall survival (OS) and maintain a high quality of life (QOL). As data on objective indicators of QOL in cancer patients, such as length of hospitalisation (LOH), outpatient consultation times (OCT), and hospital-free survival (HFS), is limited, this study compared ICF and ICR with respect to OS and QOL over the entire clinical course. METHODS: We retrospectively evaluated 90 inoperable colon cancer patients with chemotherapy and compared ICF and ICR in terms of OS, LOH, OCT, and HFS. RESULTS: Patients with ICF had a worse OS than those with ICR. In patients with ICF and ICR, OS and LOH were not correlated but OS and OCT and OS and HFS were strongly correlated. In patients with ICF and ICR, OCT and HFS accounted for approximately 8% and 90% of their OS, respectively. CONCLUSIONS: The LOH, OCT, and HFS are important factors for evaluating objective QOL of patients with inoperable colon cancer and should be considered when making treatment decisions.


Assuntos
Neoplasias do Colo , Qualidade de Vida , Humanos , Estudos Retrospectivos , Recidiva Local de Neoplasia , Neoplasias do Colo/tratamento farmacológico , Hospitalização
2.
Jpn J Clin Oncol ; 52(12): 1375-1388, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36007230

RESUMO

BACKGROUND: Cigarette smoking, alcohol drinking and obesity are known to be risk factors for colorectal cancer. These factors may affect survival after diagnosis, but evidence has been inconsistent. We investigated subsite-specific associations between prediagnosis smoking, alcohol drinking and body mass index and survival in colorectal cancer. METHODS: Subjects were 1300 patients (colon 778; rectum 502; concurrent 20) with histologically confirmed colorectal cancer diagnosed during 1997-2013 at a single institution in Japan. Histories of smoking and alcohol drinking, height and prediagnosis weight were assessed using a self-administered questionnaire. Using Cox proportional hazards model, hazard ratios and 95% confidence intervals of mortality were estimated. RESULTS: During a median follow-up period of 6.7 years, 479 deaths were documented. Ever-smoking was associated with an increased risk of all-cause death among patients with colon cancer (hazard ratio: 1.47; 95% confidence interval: 1.07-2.02 compared with never-smoking). According to colon subsite, this increased risk was clear in patients with proximal colon cancer (hazard ratio: 2.09; 95% confidence interval: 1.28-3.40). There was no association between smoking and rectal cancer survival. Alcohol drinking was not associated with survival for either colon or rectal cancer. Among patients with rectal cancer, higher body mass index was associated with a lower risk of all-cause (Ptrend = 0.0006) and disease-specific death (Ptrend = 0.02). For colon cancer, lower body mass index tended to be associated with a higher risk of all-cause death (Ptrend = 0.05). CONCLUSIONS: The results indicate that lifestyles identified as risk factors for colorectal cancer may impact differently on patient survival according to anatomic subsite.


Assuntos
Fumar Cigarros , Neoplasias do Colo , Neoplasias Colorretais , Neoplasias Retais , Humanos , Índice de Massa Corporal , Estudos Prospectivos , Japão/epidemiologia , Fatores de Risco
3.
Dig Dis Sci ; 67(1): 263-272, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33495918

RESUMO

BACKGROUND: In Crohn's disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied. AIMS: We aimed to assess this postoperative activity using capsule endoscopy (CE) and analyze the association between treatment optimization based on CE findings and the long-term course. METHODS: In patients who underwent intestinal resection, we performed CE and assessed the endoscopic activity using the Lewis score within 3 months postoperatively (1st CE) and during follow-up. Postoperative treatments were adjusted according to clinical symptoms or CE findings (severity of 1st CE or worsening of follow-up CEs). Hospitalization, repeat surgery, or endoscopic dilation defined the primary outcome. RESULTS: Among the CE group (N = 48), 85.7% (1st CE) and 79.2% (2nd CE) exhibited endoscopic activities indicating residual or recurrent lesions. Postoperative treatments were adjusted according to clinical symptoms in the non-CE group (N = 57) and clinical symptoms or CE findings in the CE group. Compared to the non-CE group, the CE group had significantly fewer primary outcomes. Patients with treatment adjustments based on CE findings had even lower primary outcome rate. Multivariate analysis identified the CE group as an independent protective factor (hazard ratio = 0.45, 95% confidence interval = 0.20-0.96). Treatment adjustments based on CE findings showed a stronger protective effect (0.30, 0.10-0.75). CONCLUSIONS: Postoperative repeated CE enabled us to assess residual and recurrent lesions accurately before clinical symptoms appeared. The regular assessment of endoscopic activity and subsequent treatment optimization have the potential for improving postoperative course.


Assuntos
Endoscopia por Cápsula/métodos , Doença de Crohn , Procedimentos Cirúrgicos do Sistema Digestório , Trato Gastrointestinal , Efeitos Adversos de Longa Duração , Complicações Pós-Operatórias , Adulto , Doença de Crohn/epidemiologia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/cirurgia , Humanos , Japão/epidemiologia , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/terapia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidade do Paciente , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prevenção Secundária/métodos , Tempo
4.
Nihon Shokakibyo Gakkai Zasshi ; 119(10): 961-968, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36216547

RESUMO

In this study, a 76-year-old man initially diagnosed with branch-duct pancreatic intraductal papillary mucinous tumor is presented. During follow-up, stenosis was discovered in the main pancreatic duct of the tail. A nodular lesion was found in the pancreatic duct consistent with the stenosis. Distal pancreatectomy was performed since it was suspected to be malignant. Histopathology revealed polymorphic mononuclear cells proliferated with osteoclast-like giant cells in the nodule. The patient was finally diagnosed with anaplastic pancreatic cancer with osteoclast-like giant cells, a relatively rare tumor. It is reported herein with a review of the literature.


Assuntos
Adenocarcinoma Mucinoso , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Constrição Patológica , Seguimentos , Células Gigantes/patologia , Humanos , Masculino , Osteoclastos/patologia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas
5.
Nihon Shokakibyo Gakkai Zasshi ; 117(12): 1087-1092, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33298674

RESUMO

An 83-year-old man was detected to have solitary abdominal lymphadenopathy, and pathological findings revealed squamous cell carcinoma. Endoscopic examination revealed a depressive lesion in the middle thoracic esophagus. Endoscopic submucosal dissection was performed. Pathological findings revealed invasion to the lamina propria mucosae, negative vascular invasion, and surgical margins. At 8 months after metastatic lymphadenectomy, no recurrence was observed.


Assuntos
Neoplasias Esofágicas , Artéria Esplênica , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/cirurgia , Humanos , Metástase Linfática , Masculino , Mucosa , Recidiva Local de Neoplasia
6.
Dig Dis Sci ; 63(3): 768-774, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29380174

RESUMO

BACKGROUND: In order to optimize postoperative therapy in patients with Crohn's disease (CD), it is important to detect endoscopic recurrence preceding clinical recurrence. However, we have little knowledge about how high the rate of residual lesions is and whether these lesions have an influence on postoperative course or not. AIMS: To assess residual lesions in small bowel immediately after surgery. METHODS: Capsule endoscopy (CE) was performed immediately after surgery (< 3 months), and endoscopic activity was assessed using the Lewis score (LS) composed of the highest tertile score (in first, second, and third tertile) and the stenosis score (in whole small intestine). The relationship between these residual lesions and postoperative clinical recurrence was prospectively evaluated. RESULTS: After assessing patency using a patency capsule, CE was performed in 25 patients. The mean LS was 751.3, and 84.0% (21/25) had endoscopic activity. These lesions were detected by preoperative examinations in 0% and by a serosal side view during surgery in 16.0%. Regarding the cumulative clinical recurrence rate according to endoscopic severity (normal, mild, and moderate-to-severe) immediately after surgery, no significant difference was found. However, comparing groups divided according to the highest tertile score, the cumulative clinical recurrence rate was significantly higher in the group with the highest third tertile score. Furthermore, patients with ulcers in the third tertile had a significantly higher recurrence rate. CONCLUSIONS: Many cases with CD had endoscopic activity immediately after "curative" surgery. These residual lesions, especially in the distal small intestine, were associated with postoperative clinical recurrence.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/etiologia , Intestino Delgado , Adulto , Estudos de Coortes , Doença de Crohn/cirurgia , Feminino , Humanos , Masculino , Recidiva , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Int J Colorectal Dis ; 32(10): 1407-1413, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28735411

RESUMO

PURPOSE: To avoid frequent surgery in patients with Crohn's disease, it is important to identify the risk factors for postoperative recurrence or repeat surgery. However, there have so far been few studies on this topic from Asian countries. In addition, the recent development of anti-tumor necrosis factor (TNF) therapy may have changed the risk factors. We aimed to identify the factors associated with postoperative recurrence and repeat surgery. METHODS: The postoperative courses of 168 patients were reviewed. We analyzed the cumulative postoperative recurrence and repeat surgery rates and identified the factors affecting these rates. RESULTS: Postoperative recurrence was observed in 70 patients, and the 1-, 3-, and 5-year cumulative recurrence rates were 17.1, 40.1, and 54.9%, respectively. The recurrence rate was significantly higher in patients with anal lesions and lower in patients newly treated with anti-TNF agents following surgery. In a multivariate analysis, the new introduction of anti-TNF agents was identified as an independent suppressor (hazard ratio 0.50, 95% confidence interval 0.28-0.88). Twenty-four patients underwent repeat surgery, and the 1-, 3-, and 5-year cumulative repeat surgery rates were 4.6, 11.2, and 18.7%, respectively. The surgery rate was significantly higher in patients with penetrating-type disease. In a multivariate analysis, penetrating-type disease (6.98, 2.37-23.35), anal lesions (4.40, 1.14-30.53), and first-time surgery (5.28, 1.17-17.93) were identified as independent risk factors. CONCLUSIONS: Anti-TNF agents have the potential to prevent postoperative recurrence. The new introduction, dose escalation, or switching of anti-TNF agents is recommended in patients with some risk factors.


Assuntos
Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Canal Anal , Doença de Crohn/patologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto Jovem
8.
Nihon Shokakibyo Gakkai Zasshi ; 114(9): 1639-1648, 2017.
Artigo em Japonês | MEDLINE | ID: mdl-28883293

RESUMO

BACKGROUNDS AND AIMS: Peripherally inserted central catheters (PICC) have been widely used as a blood access route for total parenteral nutrition (TPN) in recent years. However, there have been few reports that evaluated the usefulness of PICC for patients with inflammatory bowel disease (IBD). In this study, we compared the clinical courses in patients with IBD who received TPN during their hospitalization by conventional central venous catheters (CVC) and PICC. PATIENTS AND METHODS: A total of 137 IBD patients were enrolled. The CVC group and the PICC group included 56 and 81 patients, respectively. The clinical courses in both groups were compared retrospectively. RESULTS: As a complication of the puncture, pneumothorax occurred in two patients (3.6%) in the CVC group, but in none (0%) in the PICC group. The PICC group had significantly higher rates of achieving the scheduled TPN without removing the catheter, lower rates of catheter-related blood stream infection (CRBSI) and longer periods without CRBSI than the CVC group. CONCLUSION: PICC might be more useful than CVC in terms of safety and the ability to deliver scheduled TPN for IBD patients.


Assuntos
Doenças Inflamatórias Intestinais/terapia , Nutrição Parenteral Total , Adulto , Cateterismo Periférico , Feminino , Humanos , Masculino , Estudos Retrospectivos
9.
Sci Rep ; 14(1): 9661, 2024 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-38671142

RESUMO

It has been postulated that being breastfed in infancy affects not only health status in childhood but also disease risk in adulthood. To investigate the association of being breastfed with the risks of adult colorectal cancer and benign tumor, we conducted a case-control study including 1190 colorectal cancer and 1585 benign tumor cases and 5301 controls, admitted to a single hospital in Miyagi Prefecture, Japan, between 1997 and 2013. History of having been breastfed was assessed using a self-administered questionnaire, and odds ratios (ORs) were estimated using unconditional logistic regression. There was no association between being breastfed and colorectal cancer risk (breastfed versus formula-only fed, OR = 1.21; 95% CI 0.87-1.67). There was also no association with the risk of benign tumor (OR = 1.04). On the other hand, analyses stratified by sex and birth year found heterogeneous associations. Women born after 1950 who had been breastfed tended to have increased risks of colorectal cancer (OR = 1.58) and benign tumor (OR = 1.51) relative to those who had been formula-only fed, although not statistically significant. In men born after 1950, being breastfed was associated with a significantly decreased risk of benign tumor (OR = 0.57; 95% CI 0.33-0.98).


Assuntos
Aleitamento Materno , Neoplasias Colorretais , Humanos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Aleitamento Materno/estatística & dados numéricos , Feminino , Masculino , Japão/epidemiologia , Pessoa de Meia-Idade , Estudos de Casos e Controles , Adulto , Fatores de Risco , Idoso , Lactente , Razão de Chances , População do Leste Asiático
10.
Dig Dis Sci ; 58(7): 1985-90, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23504354

RESUMO

BACKGROUND AND AIMS: To prospectively evaluate the role of contrast-enhanced computed tomography (CE-CT) in the detection of colonic diverticular bleeding (CDB). PATIENTS AND METHODS: Consecutive patients who presented with hematochezia and were clinically suspected of CDB were prospectively enrolled. Those who could undergo both CE-CT and total colonoscopy, and who were finally diagnosed as CDB, were included in the analysis. RESULTS: Fifty-two cases were finally included in the analysis. The detection rate of CDB by CT was 15.4 % (8/52). Univariate analysis showed that the interval from the latest episode of hematochezia to the performance of CT and the presence of a past history of CDB were contributing factors for detection. The interval was 1.6 ± 4.6 h (mean ± SD) in patients detected by CT, and 3.4 ± 3.2 h in those without detection. The detection rate of CDB by total colonoscopy was 38.5 % (20/52). The overall detection rate was 46.2 % (24/52), which was superior to what CT or colonoscopy alone achieved. CONCLUSIONS: CE-CT may play a complementary role to colonoscopy in patients with suspected CDB, but is not recommended for all cases due to its low detection rate. Patients who can be examined within 2 h of last hematochezia would be candidates for urgent CT.


Assuntos
Doenças do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Divertículo do Colo/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/complicações , Colonoscopia , Meios de Contraste , Divertículo do Colo/complicações , Feminino , Humanos , Iopamidol , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos
11.
Dig Endosc ; 24(5): 309-14, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22925281

RESUMO

AIM: Endoscopic diagnosis of the lateral extension of Barrett's cancer under the squamous epithelium (BCUS) is sometimes difficult because the cancer is unobservable in the esophageal lumen. The aim of the present study was to clarify the endoscopic features of the extension of BCUS and verify the usefulness of the acetic acid-spraying method (AAS) for diagnosis. METHODS: A total of 25 patients with Barrett's cancer who had undergone endoscopic resection were included in this study. Histological examination of patients' resected specimens was performed to identify the presence of BCUS. Then, the endoscopic images of the BCUS cases were reviewed to summarize the findings and to evaluate the feasibility of diagnosing the extent of BCUS with each imaging technique. RESULTS: Of the 25 patients, 10 (40%) had BCUS. With white-light imaging, subtle reddish change was observed in the area of BCUS in 80% of the patients, and a flat elevated lesion was recognized in 30%. With narrow band imaging, slight brownish change was observed in the area of BCUS in 86% of the patients. Slight white changes were visualized in all cases with AAS. The extension of BCUS was correctly diagnosed by white-light imaging, narrow band imaging and AAS in 50%, 43% and 100% of the cases, respectively. Histology verified the opening of cancerous glands, which extended under the squamous epithelium, into the esophagus in the area showing slight white changes by AAS. CONCLUSION: AAS can be useful for diagnosing the extension of BCUS.


Assuntos
Ácido Acético , Esôfago de Barrett/patologia , Neoplasias Esofágicas/patologia , Esôfago/patologia , Mucosa Intestinal/patologia , Lesões Pré-Cancerosas , Idoso , Diagnóstico Diferencial , Epitélio/patologia , Esofagoscopia/métodos , Feminino , Seguimentos , Humanos , Indicadores e Reagentes/farmacologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
12.
J Colloid Interface Sci ; 392: 256-265, 2013 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-23141704

RESUMO

We have developed an effective organo-modification method at the organic solvent/distilled water interface of natural aluminosilicate clay surfaces. We also investigated the molecular arrangement of organo-modified aluminosilicate with high surface coverage in Langmuir-Blodgett films (LB) by performing out-of-plane and in-plane X-ray diffraction (XRD) measurements. In addition, the surface morphology of mixed monolayers of organo-modified aluminosilicate and several biodegradable polymers (e.g., poly(L-lactide), PLLA) was also characterized by atomic force microscopy (AFM). The in-plane XRD results of multilayers of organo-modified aluminosilicate formed by the LB method indicate the formation of a two-dimensional lattice of hydrocarbons on the aluminosilicate surface. These hydrocarbons of organo-modified reagents packed hexagonal or orthorhombic in films. Based on our experimental findings, the LB technique enabled the formation of a densely packed organo-modified aluminosilicate monolayer at the water surface. Furthermore, for mixed monolayer systems comprising an organo-modified clay with high surface coverage and biodegradable polymers, a miscible surface was observed by AFM on a mesoscopic scale, whereas those with low surface coverage formed phase-separated structures.


Assuntos
Silicatos de Alumínio/química , Hidrocarbonetos/química , Estrutura Molecular , Tamanho da Partícula , Polímeros/química , Propriedades de Superfície
13.
Intern Med ; 52(12): 1311-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23774539

RESUMO

OBJECTIVE: The purpose of this study was to review cases of early gastric cancer associated with Endocrine cell micronests (ECM) and investigate the incidence and characteristics of these lesions. METHODS: A total of 482 patients who had undergone endoscopic or surgical resection for gastric epithelial neoplasms from April 2008 to March 2010 were enrolled in this study. After detection of ECM in the lamina propria mucosa by histological examination of the resected specimens with hematoxilin-eosin staining, immunostaining was also performed. Clinical manifestation and endoscopic findings, as well as histological findings, were examined. RESULTS: Among the 482 patients, 5 (1.0%) had ECM. The histological type of gastric epithelial cancers associated with ECM was tubular adenocarcinoma and carcinoma in situ (Tis) in the WHO classification in all 5 cases. ECM were round to oval or trabecular and located within the area of the early gastric cancer in all the 5 cases. The background gastric mucosa was Type A gastritis in 2 patients and ordinary atrophic gastritis in 2 patients. In the other case, it was difficult to determine the type of gastritis. CONCLUSION: ECM developed not only from the background of Type A gastritis but also from ordinary atrophic gastritis. ECM coexistent with gastric cancer were present in 1.0% of resectable gastric epithelial neoplasms.


Assuntos
Adenocarcinoma/patologia , Tumor Carcinoide/patologia , Células Endócrinas/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/complicações , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/complicações , Carcinoma in Situ/complicações , Carcinoma in Situ/patologia , Feminino , Mucosa Gástrica/patologia , Gastrite/complicações , Gastrite/patologia , Gastrite Atrófica/complicações , Gastrite Atrófica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Gástricas/complicações
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