M Miyazaki

IIzuka Hospital, Иидзука, Fukuoka, Japan

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Publications (26)84.57 Total impact

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    ABSTRACT: To clarify the clinical significance of sivelestat sodium (SIV) administration, we surveyed the status of 40 patients treated with SIV for respiratory dysfunction following surgery. The subjects were patients who received SIV administration due to systemic inflammatory response syndrome (SIRS) and respiratory dysfunction (PaO(2)/F(I)O(2) ratio ≤300 mmHg) after surgery at the Department of Surgery and Science, Kyushu University, and related facilities between April and December 2008. The most frequent underlying condition was perforation of the digestive tract, followed by cancer of the upper digestive organs. The main causes of SIRS were surgical stress and infection. The mean P/F ratio at the initiation of SIV administration was 185.5 ± 72.0 mmHg. The ratio increased, and the number of SIRS-related factors decreased with time after SIV administration. Sivelestat sodium was administered within 24 h after the onset of respiratory dysfunction in 87.5% of the patients, and the survival rate at 28 days after the initiation of SIV administration was 90.0%. Our findings suggest that multidisciplinary postoperative management, including the administration of SIV, during the early phase after the onset of respiratory dysfunction leads to improvements in respiratory function and survival.
    Surgery Today 11/2010; 40(11):1034-9. · 0.96 Impact Factor
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    ABSTRACT: Matrix metalloproteinase 7 (MMP-7) may play a key role in the progression of various human malignant tumors. Nuclear beta-catenin enhances the activating expression of MMP-7 genes by binding with the T-cell factor/lymphoid enhancer factor family of transcription factors. We immunohistochemically examined the expression of MMP-7 and beta-catenin to better understand the significance of these factors in the progression of esophageal squamous cell carcinoma. The entire coding region of beta-catenin exon 3 was also analyzed by direct sequencing in all cases. We found that MMP-7 was expressed in 7 (20.6%) of 34 esophageal squamous cell carcinomas. There was a significant relationship between MMP-7 expression and tumor invasion into adjacent structures (P < 0.05). Aberrant nuclear expression of beta-catenin was found in 12 of 34 (35.3%) esophageal cancers and correlated with MMP-7 expression, the statistical difference being (P < 0.05). None of the 34 esophageal cancers examined carried mutations in beta-catenin exon 3. MMP-7 expression correlates with penetrating tumor progression in esophageal cancer. Nuclear translocation of beta-catenin, without mutations in beta-catenin exon 3, is associated with MMP-7 expression.
    Digestive Diseases and Sciences 01/2003; 47(12):2738-42. · 2.26 Impact Factor
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    ABSTRACT: Solitary splenic metastasis from esophageal cancer is so rare that such an occurrence in our Japanese patient should be reported. In a 58-year-old Japanese man we detected a solitary splenic tumor by abdominal computed tomography done 6 months after he had undergone an esophagectomy. Transarterial embolization of the splenic artery was without effect. A splenectomy was then done and histological examination of the resected specimen revealed squamous cell carcinoma derived from the esophageal carcinoma.
    Hepato-gastroenterology 01/2003; 50(53):1336-7. · 0.77 Impact Factor
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    ABSTRACT: Squamous epithelial dysplasia is frequently encountered in the cancerous esophagus. However, its biological and clinical significance have not yet been fully elucidated. Investigations in squamous cell dysplasia of the esophagus have been performed to date in our department. We consider dysplasia to be the earliest malignancy of the esophagus based on such biologic features as the histopathologic findings, the proliferative activity, and the altered expression of cancer-associated genes. It is essential to detect and treat these early lesions endoscopically. Hopefully the findings of further studies of dysplasia can help to elucidate the mechanism of carcinogenesis in esophageal squamous cell carcinoma.
    Surgery 02/2002; 131(1 Suppl):S22-7. · 3.37 Impact Factor
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    ABSTRACT: To clarify mechanisms involved in the carcinogenesis of multiple oesophageal squamous cell carcinoma, the expression of p53 protein in 46 lesions surgically excised from 13 Japanese patients was investigated immunohistochemically and the relation of p53 protein accumulation to the patient's history of alcohol consumption and cigarette smoking was analyzed. p53 protein accumulation was observed in 13 main lesions, that is in 6 (85.7%) of 7 subjects with a history of heavy drinking and smoking, but only in 1 (16.7%) of 6 with no such history (Fisher's exact test, p = 0.025). As regards the 46 lesions, p53 protein accumulation was evident in 22 (88.0%) of 25 lesions of the high-risk patients, but in 7 (33.3%) of 21 lesions of the other subjects (Fisher's exact test, p < 0.001). p53 protein accumulation was similarly recognized in all oesophageal lesions in 5 of 7 high-risk patients. Thus, use of both alcohol and cigarettes is clearly associated with a high frequency of p53 protein accumulation in multiple oesophageal squamous cell carcinoma present at the same time. These findings are considered to support the concept of field carcinogenesis of the oesophagus.
    Oncology 02/2002; 62(2):175-9. · 2.17 Impact Factor
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    ABSTRACT: Chemoradiotherapy (CR) and hyperthermochemoradiotherapy (HCR) have been performed on numerous patients with esophageal cancer. These neoadjuvant therapies for esophageal cancer are done widely. The purpose of this study is to demonstrate the recent advances in surgical and oncological treatment. From 1967 to 2000, 847 patients who underwent an esophagectomy were classified into 4 groups according to the date of operation. Group 1 consisted of 110 patients who underwent an esophagectomy in the first 10-year period (1967-1976), group 2 consisted of 194 patients who had operations from 1977 to 1986, group 3 comprised 400 patients who had operations from 1987 to 1996, and group 4 comprised 143 patients who had operations from 1997 to 2000. From 1967 to 2000, 322 patients with neoadjuvant therapy and esophagectomy were classified into 6 groups according to the kinds of anticancer drugs that were administered. Group A received regimen A, using BLM (5 mg iv) 6 times as the chemotherapeutic drug in the early period (1965-1990); group B received regimen B, using cis-diaminedichloroplatinum (CDDP) (40 mg/m2) 3 times as the chemotherapeutic drug in the second period (1990-1997); and group C received regimen C, using CDDP (40 mg/m2) and 5FU (250 mg/m2) daily in the most recent period (1997-2000). The HCR group was also divided into the following 3 groups: Group D, who received regimen A and hyperthermia 6 times in the early period; group E, who received regimen B and hyperthermia 6 times in the next period; and group F, who received regimen C and hyperthermia 6 times in the most recent period. The local response and the long-term results were investigated. A complete removal of the primary tumor was achieved in 29%, 39%, 62%, and 68% of the patients in groups 1, 2, 3, and 4, respectively. The 30-day operative mortality rates were 11%, 4%, 1%, and 0% in groups 1, 2, 3, and 4, respectively. The 5-year survival rates for all patients in groups 1, 2, and 3 were 16.7%, 19.2%, and 44.4%, respectively. The cases in which CR or HCR was evaluated to be effective numbered 44 (48.4%) in group A, 22 (73.3%) in group B, 8 (66.7%) in group C, 79 (63.7%) in group D, 36 (73.5%) in group E, and 12 (75.0%) in group F. Our clinical results thus showed CDDP to have a greater effect than BLM, while HCR was shown to have a greater effect than CR. Preoperative therapy, especially using CDDP and hyperthermia, has improved thanks to recent advances in the treatment of esophageal cancer.
    Surgery 02/2002; 131(1 Suppl):S28-34. · 3.37 Impact Factor
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    ABSTRACT: The unique pathologic features of esophageal tumors in patients with esophageal cancer includes the presence of multiple occurrence within the esophagus. The aim of this study is to clarify the molecular mechanism of carcinogenesis of multiple esophageal squamous cell carcinomas in the Japanese. We studied the relationship between the incidence of patients with multiple carcinomas and the coexistence of dysplasia lesions with p53 protein accumulation, alcohol consumption, and cigarette smoking. Among 76 cancer lesions and 60 cases of dysplasia, p53 accumulation was studied by means of immunohistochemical analysis. The incidence of patients with multiple carcinomas in the high-risk group was 33%, and the incidence of patients with a coexistence of dysplasia in the high-risk group was 67%. The incidence of patients with multiple carcinomas or the coexistence of dysplasia in the high-risk group was much higher than that of the middle-risk and low-risk groups (P <.0001 and P =.04, respectively). The average number of abnormal epitheliums, such as cancer and dysplasia, in the high-risk group was 3.2 +/- 2.1. The average number of abnormal epitheliums was much higher than that of the other groups (P =.02). For carcinoma lesions, the incidence of lesions with a positive p53 protein accumulation in the high-risk group was 91%. Regarding dysplasia lesions, the incidence of lesions with a positive p53 protein accumulation in the high-risk group was 80%. The incidence of both cancer and dysplasia lesions with a positive p53 protein accumulation in the high-risk group was higher than that of the other groups. The pattern of p53 accumulation in dysplasia in the high-risk group was closely similar to that in cancer of the high-risk group. These findings support the concept of field carcinogenesis of the esophagus.
    Surgery 01/2002; 131(1 Suppl):S7-S13. · 3.37 Impact Factor
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    ABSTRACT: The expression of panendothelial markers (eg, CD34, CD31, and factor VIII) is not always observed in angiogenic vessels, and such markers are not useful for measuring angiogenesis. In contrast, CD105 is preferentially expressed in angiogenic vessels and thus may be valuable for measuring angiogenesis. We hypothesized that microvessel quantification by means of CD105 might be useful for measuring angiogenesis in the colorectal adenoma-carcinoma sequence. We immunohistochemically investigated 54 cases of colorectal adenomas and 20 cases of carcinomas using monoclonal antibodies CD34 and CD105, and microvessel density (MVD) was counted at x200 magnification. Microvessels positive for CD34 were distributed almost uniformly in adenomas. In contrast, microvessels positive for CD105 were preferentially observed in the surface area of adenomas. In carcinomas, CD34 stained only a proportion of blood vessels that were positive for CD105. No significant difference of MVD for CD34 was observed in the colorectal adenoma-carcinoma sequence. In contrast, an increment of MVD for CD105 from low-grade to high-grade dysplasia (P <.0001) and that from high-grade dysplasia to carcinomas (P <.05) was statistically significant. Assessing neovascularization with CD105 in the process of colorectal cancer development may thus be a valuable marker for predicting the risk of colorectal cancer development.
    Surgery 01/2002; 131(1 Suppl):S109-13. · 3.37 Impact Factor
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    ABSTRACT: To the authors' knowledge, the significance of allogenic blood transfusion in the prognosis of patients with esophageal carcinoma remains controversial. The objective of the current study was to elucidate the correlation, if any, between intraoperative allogenic blood transfusion and prognosis in patients with esophageal carcinoma. Two hundred fifty-nine patients with esophageal carcinoma who had undergone esophagectomy and reconstruction were studied. The clinicopathologic data and survival were compared between the 87 patients (33.6%) who received an intraoperative allogenic blood transfusion and the 172 patients (66.4%) who did not. Multivariate analysis demonstrated that the factors that appeared to independently determine prognosis in patients with esophageal carcinoma were the depth of the tumor (P = 0.0001), lymph node metastasis (P < 0.0001), lymphatic invasion (P = 0.0002), venous invasion (P = 0.0008), and the occurrence of postoperative complications (P = 0.034). Intraoperative allogenic blood transfusion was not found to be an independent prognostic indicator. In the current study, an advanced stage of disease at the time of surgery, which resulted in the need for blood transfusion and the occurrence of postoperative complications, appeared to worsen the prognosis in patients with esophageal carcinoma.
    Cancer 10/2001; 92(7):1913-8. · 5.20 Impact Factor
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    ABSTRACT: BACKGROUND To the authors' knowledge, the significance of allogenic blood transfusion in the prognosis of patients with esophageal carcinoma remains controversial. The objective of the current study was to elucidate the correlation, if any, between intraoperative allogenic blood transfusion and prognosis in patients with esophageal carcinoma.METHODS Two hundred fifty-nine patients with esophageal carcinoma who had undergone esophagectomy and reconstruction were studied. The clinicopathologic data and survival were compared between the 87 patients (33.6%) who received an intraoperative allogenic blood transfusion and the 172 patients (66.4%) who did not.RESULTS Multivariate analysis demonstrated that the factors that appeared to independently determine prognosis in patients with esophageal carcinoma were the depth of the tumor (P = 0.0001), lymph node metastasis (P < 0.0001), lymphatic invasion (P = 0.0002), venous invasion (P = 0.0008), and the occurrence of postoperative complications (P = 0.034). Intraoperative allogenic blood transfusion was not found to be an independent prognostic indicator.CONCLUSIONS In the current study, an advanced stage of disease at the time of surgery, which resulted in the need for blood transfusion and the occurrence of postoperative complications, appeared to worsen the prognosis in patients with esophageal carcinoma. Cancer 2001;92:1913–8. © 2001 American Cancer Society.
    Cancer 09/2001; 92(7):1913 - 1918. · 5.20 Impact Factor
  • Journal of Surgical Oncology 08/2001; 77(3):213-6. · 2.64 Impact Factor
  • Journal of Surgical Oncology 07/2001; 77(3):213 - 216. · 2.64 Impact Factor
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    ABSTRACT: BACKGROUND While there are reports that CYFRA 21-1 is a useful tumor marker, to our knowledge the clinical utility of this marker to detect recurrences for squamous cell carcinoma of the esophagus has not been addressed.METHODS By immunoradiometric assay, human serum levels of CYFRA 21-1, SCC antigen and CEA were measured in esophageal squamous cell carcinoma patients prior to their initial treatment. Monthly follow-ups of these tumor markers was done after surgery.RESULTSThe diagnostic sensitivity of CYFRA 21-1 was 43.9% (18 of 41), a value superior to that for SCC antigen (26.8%) and CEA (17.0%) (P < 0.05). The positive rates of CYFRA 21-1 increased with progression of the disease, 22.2% of pTNM Stage 0-IIA and 77.8% of pTNM Stage IIB/III (P = 0.013), whereas SCC antigen and CEA rates were not related to pTNM stage. Among 13 patients with clinical evidence of a recurrence, 76.9% (10 of 13) exhibited an increase in CYFRA 21-1, and this increase was evident before clinical detection of the recurrence in 9 of these 13 patients (69.2%). Consequently, postoperative elevations of serum CYFRA 21-1 levels were indicative of a tumor recurrence 1–13 months before acquisition of clinical and radiological data.CONCLUSIONS The assay of CYFRA 21-1 is useful not only for diagnosis but also for close monitoring of patients with esophageal squamous cell carcinoma. Cancer 2000;89:1413–7. © 2000 American Cancer Society.
    Cancer 11/2000; 89(7):1413 - 1417. · 5.20 Impact Factor
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    ABSTRACT: Vascular endothelial growth factor-C (VEGF-C) functions specifically to induce lymphangiogenesis. We examined the relationship between expression of VEGF-C and clinicopathological features in patients with colorectal cancer. The expression of VEGF-C in the 99 primary tumours and 18 metastatic lymph nodes from colorectal cancer patients was examined immunohistochemically. To verify VEGF-C mRNA expression, reverse transcriptase-polymerase chain reaction (RT-PCR) was carried out. The expression of VEGF-C correlated with lymphatic involvement, lymph nodes metastasis, and depth of invasion. On the other hand, correlations were nil with regard to gender of the patients, histologic type, venous involvement, and liver metastasis. The expression of VEGF-C in metastatic lymph nodes was fairly consistent with this expression in the primary tumour. Survival time was shorter for VEGF-C positive groups than for VEGF-C negative ones, but with no statistically significant difference. RT-PCR findings revealed that the expression of VEGF-C mRNA correlated mostly with that of VEGF-C protein expression. VEGF-C may play an important role in lymphatic spread of colorectal cancer.
    British Journal of Cancer 11/2000; 83(7):887-91. · 5.08 Impact Factor
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    ABSTRACT: The significance of the small distal tubular adenoma detected by sigmoidoscopy as a predictor of proximal neoplasm remains controversial. The aim of this study was to examine the prevalence of proximal neoplasms in patients with and without distal neoplasms. This is a retrospective study of 3131 asymptomatic middle-aged men who underwent total colonoscopy. For 812 men with colorectal neoplasms characteristics of the identified neoplasms were determined. The prevalence of proximal neoplasms in patients with small distal tubular adenoma was 20% (92 of 461), whereas the prevalence of proximal neoplasms in patients without distal neoplasms was 11.5% (301 of 2620). The prevalence of advanced proximal neoplasms in patients with small distal tubular adenoma and without distal neoplasm was 1.3% and 0.8%, respectively. In the 29 patients with advanced proximal neoplasms, only 6 (21%) had a small distal tubular adenoma. The presence of small distal tubular adenomas may provide a clue to the presence of small proximal tubular adenomas. However, the majority of advanced proximal neoplasms (79%) do not have a synchronous small distal tubular adenoma. (Gastrointest Endosc 2000;52:358-61).
    Gastrointestinal Endoscopy 10/2000; 52(3):358-61. · 5.21 Impact Factor
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    ABSTRACT: While there are reports that CYFRA 21-1 is a useful tumor marker, to our knowledge the clinical utility of this marker to detect recurrences for squamous cell carcinoma of the esophagus has not been addressed. By immunoradiometric assay, human serum levels of CYFRA 21-1, SCC antigen and CEA were measured in esophageal squamous cell carcinoma patients prior to their initial treatment. Monthly follow-ups of these tumor markers was done after surgery. The diagnostic sensitivity of CYFRA 21-1 was 43.9% (18 of 41), a value superior to that for SCC antigen (26.8%) and CEA (17.0%) (P < 0.05). The positive rates of CYFRA 21-1 increased with progression of the disease, 22.2% of pTNM Stage 0-IIA and 77.8% of pTNM Stage IIB/III (P = 0.013), whereas SCC antigen and CEA rates were not related to pTNM stage. Among 13 patients with clinical evidence of a recurrence, 76.9% (10 of 13) exhibited an increase in CYFRA 21-1, and this increase was evident before clinical detection of the recurrence in 9 of these 13 patients (69.2%). Consequently, postoperative elevations of serum CYFRA 21-1 levels were indicative of a tumor recurrence 1-13 months before acquisition of clinical and radiological data. The assay of CYFRA 21-1 is useful not only for diagnosis but also for close monitoring of patients with esophageal squamous cell carcinoma.
    Cancer 10/2000; 89(7):1413-7. · 5.20 Impact Factor
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    ABSTRACT: Human papillomavirus type 16/18 (HPV-16/18) is implicated in the pathogenesis of squamous cell carcinoma (SCC) of the cervix and esophagus. The arginine allele at codon 72 of p53 was found to be more susceptible to degradation by HPV E6 protein than is the proline allele in vivo, thus resulting in a high frequency of cervical SCC in individuals homozygous for arginine at the codon. There are controversial results from several clinical studies of cervical SCC. In the present study, encoding regions of p53 codon 72 and HPV-16/18 E6 were directly sequenced, using pairs of primary esophageal SCC tissue and corresponding normal mucosa, which were from 75 patients (Japanese, n = 38; Chinese, n = 37). The arginine allele alone was detected in 70.6% (12 of 17) of HPV-positive cases but only in 43.1% (25 of 58) of HPV-negative cases (P < 0.05). In contrast, such a significant correlation between p53 polymorphism and HPV infection was not evident in corresponding normal mucosae. Because our findings between tumor specimens and the normal mucosae differed, we suggest that the frequent loss of proline allele in HPV-associated carcinogenesis of the esophagus major plays some role. The particular type of p53 polymorphism may indicate a potential candidate for HPV-associated SCC.
    Cancer Research 06/2000; 60(11):2753-5. · 8.65 Impact Factor
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    ABSTRACT: A new endoscopic classification of gastroesophageal reflux disease (GERD) has been proposed, and the term mucosal break has been introduced to describe mucosal damage. This new classification was evaluated by endoscopists with different levels of experience. Fifty endoscopic photographs for each of 20 randomly selected patients with GERD were assessed retrospectively by three groups of seven endoscopists classified by experience: group 1 (100 to 500 procedures), group 2 (500 to 3000), and group 3 (more than 3000). The new classification was modified by adding grade 0 to describe healed mucosal breaks, so that there were five grades. All photographs were assessed twice at an interval of more than 1 week, and kappa statistics were used to determine observer variation. Interobserver variation within group 3 (kappa = 0.39, n = 21) and between groups 3 and 2 (kappa = 0.36, n = 49) was significantly different (p < 0.01) from that between groups 3 and 1 (kappa = 0.26, n = 49). Intraobserver variation in group 1 (kappa = 0.39, n = 7) was significantly different (p < 0.01) from that in group 2 (kappa = 0.51, n = 7) and group 3 (kappa = 0.54, n = 7). Observer variation depends on level of endoscopic experience. Only experienced endoscopists should use the new classification for grading of GERD.
    Gastrointestinal Endoscopy 06/1999; 49(6):700-4. · 5.21 Impact Factor
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    ABSTRACT: To ascertain how the clinicopathologic features of early gastric cancer detected by current diagnostic tools had changed clinical features, we compared 711 early gastric cancer patients with 933 advanced gastric cancer patients regarding age, sex, and tumor location. We found that the proportion of early gastric cancer cases did not change according to age. However, the proportion of early gastric cancer cases in the proximal part was significantly lower than that observed in the distal part (p < 0.01). We conclude that recent diagnostic improvements have rendered age no longer a major deterrent for early detection of gastric cancer. However, a careful examination of the proximal stomach is called for because it is so hard to detect small lesions in that area.
    Journal of Clinical Gastroenterology 07/1998; 27(1):60-2. · 3.20 Impact Factor
  • M Miyazaki, M Kusano, T Sekiguchi
    Nippon rinsho. Japanese journal of clinical medicine 05/1997; 55 Suppl 2:128-31.