Shuichiro Uchiyama

Miyazaki University, Миядзаки, Miyazaki, Japan

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Publications (45)186.26 Total impact

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    ABSTRACT: Purpose: To investigate the clinicopathological features and postoperative survival of patients with mucinous colorectal carcinoma (MC) and to identify the factors related to long-term survival. Methods: Twenty-three patients who had undergone resection for MC at Miyazaki University Hospital from 1991 to 2006 were followed up for at least 5 years or until death. The effects of the clinicopathological variables on the 5-year cancer-specific survival were assessed by the univariate analyses. These patients' clinicopathological data were compared with those of 403 non-mucinous carcinoma (NMC) patients (102 well-differentiated adenocarcinomas, 301 moderately differentiated adenocarcinomas). Results: The 5-year cancer-specific survival rate was significantly worse in MC (56.2 %) than in NMC (73.8 %; p = 0.008) cases. Univariate analyses showed the T factor, lymph node metastases, liver metastases, metastases to the distant peritoneum, remote metastases and curative resection to be significant factors predicting the survival. However, there were no significant differences in the postoperative survival in patients with stage II-IV disease. The rates of metastases to the distant peritoneum, M1, T4, a tumor size ≥5 cm and non-curative resection were higher in MC than in NMC patients. Conclusions: Patients with MC had advanced stage cancer, especially with metastases to the distant peritoneum, more frequently than did the patients with NMC. To improve the survival of these patients, it is therefore important to detect MC at an early stage and to perform curative resection.
    Surgery Today 06/2014; 45(3). DOI:10.1007/s00595-014-0943-z · 1.53 Impact Factor
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    ABSTRACT: An 84-year-old woman with sigmoid colon cancer underwent sigmoidectomy with lymph node dissection at the age of 72. Final diagnosis was well differentiated adenocarcinoma, pSE, ly2, v1, pN1 (3/19), sH0, sP0, sM0, fStage IIIa. Computed tomography (CT) scan 19 months later detected a liver metastasis in S6, and S6 subsegmentectomy was performed. Although there was no cancer recurrence after hepatectomy for more than 5 years, follow-up was continued through laboratory examinations including CEA. Just over 11 years after sigmoidectomy, the serum CEA level was markedly elevated, and abdominal CT scan showed a 7-cm liver tumor with some calcifications and peripheral bile duct dilatation in the lateral segment. We considered this tumor to be an intrahepatic cholangiocarcinoma with hepatolithiasis, not a metastatic liver tumor. Lateral segmentectomy was performed, and pathological examinations showed well- to moderately-differentiated adenocarcinoma with necrosis and hyalinization. Furthermore, immunohistochemical examinations revealed CK7-/CK20+, as in previous findings, and we diagnosed this as liver metastasis from sigmoid colon cancer. We report a rare case of liver metastasis that developed 19 months and 135 months after curative resection of the primary sigmoid colon cancer.
    Nippon Shokaki Geka Gakkai zasshi 01/2014; 47(1):26-33. DOI:10.5833/jjgs.2013.0074
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    ABSTRACT: Although fecal diversion is reported to improve the quality of life (QOL) of the patients with active perianal disease, the effect of the concomitant abdominal surgery was not well studied. The aim of this study was to investigate factors that impair postoperative QOL of patients with Crohn's disease. A SF-36v2 questionnaire was mailed to patients who underwent abdominal operation between January 2001 and February 2007. Patients were also asked about the medical therapy they were receiving. Data from 50 patients were analyzed. Univariate analyses revealed that patients with active perianal disease had lower scores for role physical, bodily pain and social functioning than did patients without it. Social functioning and role emotional scores were lower in patients older than 40 years than in those younger. The physical component summary score was significantly affected in patients with active perianal disease. Fecal diversion had no effect on QOL after abdominal surgery for Crohn's disease. Multivariate analysis showed that the physical component summary score was significantly lower in patients with active perianal disease than in patients without it. Active perianal disease is an important factor that impairs QOL in patients who have undergone surgery for intestinal Crohn's disease.
    Hepato-gastroenterology 09/2012; 59(118):1814-8. DOI:10.5754/hge10440 · 0.93 Impact Factor
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    ABSTRACT: To assess the role of positron emission tomography-computed tomography (PET-CT) and multidetector-row CT (MD-CT) in detecting the primary lesion and lymph node metastasis in patients with colorectal cancers. A collective total of 80 lesions resected from 77 patients were examined pathologically. We analyzed the significance of the standardized uptake value (SUV) and its relationship with the clinicopathologic findings of primary lesions and lymph node metastasis. The detectability of primary lesions and lymph node metastases on PET-CT images was compared with that on MD-CT images. The detectability of primary lesions was better on PET-CT images than on MD-CT images (p = 0.0023). We observed no significant differences in the SUV with respect to staging, tumor grade, lymphatic or vessel invasion, and macroscopic type; however, primary tumor size analysis revealed that tumors larger than 3 cm had a higher SUV than those smaller than 3 cm. The sensitivity of PET-CT for detecting lymph node metastasis was lower than that of MD-CT, but the specificity of PET-CT was higher than that of MD-CT. The SUV of primary cancers tends to increase in proportion to tumor size. Although the value of PET-CT in detecting lymph node metastasis is limited, PET -positive lymph nodes can be considered metastatic.
    Surgery Today 06/2012; 42(10):956-61. DOI:10.1007/s00595-012-0225-6 · 1.53 Impact Factor
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    ABSTRACT: Abstract This study aimed to investigate whether the initial indication for surgery or type of surgery (strictureplasty or resection) performed determines recurrence patterns in patients with Crohn disease. Recurrence patterns of 41 patients (31 patients: only resection and anastomosis of the intestine, and 10 patients: strictureplasty with/without resection and anastomosis) who underwent operation for recurrent Crohn disease (June 2002-December 2010) were evaluated. Strictureplasty for nonperforating disease was performed at 17 sites, and reoperation was required at 11 sites (10 sites for nonperforating disease and 1 site for perforating disease). There was a significant difference in the recurrence pattern in patients who underwent resection and anastomosis (P < 0.01) and in patients who underwent strictureplasty with resection and anastomosis (P < 0.05) between sites at which resection and anastomosis was performed for nonperforating and for perforating disease. Initial indication for surgery, but not the type of surgery, appeared to determine recurrence patterns.
    International surgery 04/2012; 97(2):120-128. DOI:10.9738/CC95.1 · 0.47 Impact Factor
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    David A Morrow · Eugene Braunwald · Marc P Bonaca · Sebastian F Ameriso · Anthony J Dalby · Mary Polly Fish · Keith A A Fox · Leslie J Lipka · Xuan Liu · José Carlos Nicolau · [...] · Frey A · Short L · Stein B · McGee R · Schneider D · Chadwick L · Puleo P · Tarsi D · Singh N · Logwood D. ·
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    ABSTRACT: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 number, NCT00526474.).
    New England Journal of Medicine 03/2012; 366(15):1404-13. DOI:10.1056/NEJMoa1200933 · 55.87 Impact Factor

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2012; 73(4):821-826. DOI:10.3919/jjsa.73.821
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    ABSTRACT: To investigate the efficacy of infliximab for complicated perianal Crohn's disease with special reference to maintenance therapy. Between June 2002 and April 2009, 20 patients (15 men and 5 women, aged 31.4±2.9 years old (mean ± standard error)) with complicated fistulizing anal Crohn's disease underwent seton placement. For the induction therapy, intravenous infusion of infliximab was given 3 times after surgical treatment. Thereafter, infliximab was given every 8 weeks as maintenance therapy. Patients were followed-up for 31.8±4.2 months after the first infliximab infusion. The number of the infliximab treatments given was 13.6±2.5. After induction therapy, complete response (CR) was observed in 8 patients (40%), partial response (PR) in 9 and progress disease (PD) in 3. With (n=17) or without (n=3) maintenance therapy following the induction therapy, CR was observed in 15 of 20 patients (75%). Of the 17 patients who received maintenance therapy, CR was of observed in 13 patients, of whom 7 patients showed PR or PD before maintenance therapy. Seton drainage and infliximab therapy is effective in the patients with fistulizing perianal Crohn's disease. Maintenance infliximab therapy might be effective in patients with perianal Crohn's disease.
    Hepato-gastroenterology 08/2011; 58(109):1189-92. DOI:10.5754/hge09586 · 0.93 Impact Factor
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    ABSTRACT: Only two cases of rectal giant inflammatory polyposis with ulcerative colitis have been reported in the English literature and both concern children. This is the first report of a case of localized giant inflammatory polyposis of the rectum in an adult with indeterminate colitis. A 71-year-old man underwent sigmoidectomy due to stenosis of the sigmoid colon. Final histological diagnosis was indeterminate colitis. Three years following the first operation, a rectal tumor with giant polyposis was observed, and abdominoperineal resection was performed. Macroscopic and microscopic examination indicated a localized giant inflammatory polyposis of the rectum. KeywordsIndeterminate colitis–Localized giant inflammatory polyposis–Filiform disease
    Clinical Journal of Gastroenterology 04/2011; 4(2):95-98. DOI:10.1007/s12328-011-0213-1
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    ABSTRACT: Meckel diverticulum is one of the causes of gastrointestinal bleeding; however, preoperative conclusive diagnosis is very difficult even with the use of various radiologic modalities. The development of double-balloon enteroscopy enables us to diagnose various bleeding source, including Meckel diverticulum, in the small intestine. We herein report a case of bleeding Meckel diverticulum, diagnosed by double-balloon enteroscopy and treated successfully by laparoscopic surgery, and review of the literature.
    Surgical laparoscopy, endoscopy & percutaneous techniques 08/2010; 20(4):278-80. DOI:10.1097/SLE.0b013e3181f2f4a8 · 1.14 Impact Factor
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    ABSTRACT: A 57-year-old woman was diagnosed as having rectal cancer. A barium enema study showed the apple-core sign at the rectosigmoid colon, and colonoscopy revealed an encircled ulcerated tumor. A laparoscope-assisted resection of the rectum was planned; however, the rectal cancer directly invaded the uterus body. The operation was converted to open surgery. An elastic hard tumor suspected of being peritoneal dissemination at the peritoneal reflection was detected and excised together with the rectum below the peritoneal reflection. A histological examination of this tumor revealed that cystic glands lined by nonmucinous columnar epithelial cells were seen on the serosal side and were embedded in the proper muscle of the rectum. This tumorous lesion was diagnosed as endometriosis.
    Surgery Today 07/2010; 40(7):672-5. DOI:10.1007/s00595-009-4119-1 · 1.53 Impact Factor
  • Masayuki Hotokezaka · Takuto Ikeda · Shuichiro Uchiyama · Kazuo Chijiiwa ·

    Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)61494-1 · 16.72 Impact Factor
  • Masayuki Hotokezaka · Takuto Ikeda · Shuichiro Uchiyama · Kazuo Chijiiwa ·

    Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)61480-1 · 16.72 Impact Factor
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    ABSTRACT: Side-to-side strictureplasty is a useful procedure for preserving the bowel in patients with Crohn's disease. However, bowel resection is required in some patients, and diseased proximal bowel and disease-free distal bowel exist after resection. We performed a modified new technique called side-to-side-to-end strictureplasty. Four patients with Crohn's disease underwent this procedure. After resection of the diseased bowel that was not suitable for strictureplasty, side-to-side strictureplasty was performed with use of the proximal diseased loop. Thereafter, the distal end of the side-to-side stricture was anastomosed to the distal disease-free bowel in a side-to-side-to-end manner. The length of the small intestine requiring surgical intervention was 69.8 +/- 26.4 (mean +/- standard deviation) cm, and the length of the small intestine necessitating resection was 31.8 +/- 12.6 cm. Side-to-side stricture was performed by use of 48.8 +/- 20.2 cm of the diseased proximal bowel, which was anastomosed to the disease-free distal bowel. Intra-abdominal abscess, which was not associated with this procedure, was observed in one patient, but was treated by drainage. The recoveries of all four patients were uneventful, without recurrence, after a follow-up of 21.5 +/- 16.2 months. Side-to-side-to-end strictureplasty may be a useful procedure when diseased proximal bowel and disease-free distal bowel are present after bowel resection in patients with Crohn's disease.
    Diseases of the Colon & Rectum 11/2009; 52(11):1882-6. DOI:10.1007/DCR.0b013e3181b11487 · 3.75 Impact Factor
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    ABSTRACT: A 41-year-old man without clinical symptoms was referred for treatment of an enlarging retroperitoneal tumor. Enhanced computed tomography showed a well-defined and heterogeneously enhanced tumor, 4cm in size, in the dorsal portion of the pancreas. A low-density nodule was detected in the left adrenal gland, 10mm in diameter. Retroperitoneal sarcoma and nonfunctional left adrenal tumor were suspected, and surgical treatment was performed. During excision of the retroperitoneal tumor, blood pressure was extremely elevated when the tumor was compressed. Blood pressure normalized after excision of the tumor; thus, a diagnosis of paraganglioma was favored over that of retroperitoneal sarcoma. The left adrenal gland was resected together with the adrenal tumor. Microscopically, the tumor cells of the retroperitoneum had round to oval nuclei, and abundant granular amphophilic cytoplasm proliferated in nest-like fashion. Extra-adrenal retroperitoneal paraganglioma was considered, and the adrenal tumor was diagnosed as cortical adenoma. In patients with retroperitoneal tumor, even in the absence of clinical symptoms, we should keep in mind the possibility of extra-adrenal paraganglioma.
    Clinical Journal of Gastroenterology 02/2009; 3(1):13-17. DOI:10.1007/s12328-009-0118-4
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    Shuichiro Uchiyama · Kazuo Chijiiwa ·

    Journal of Gastrointestinal Surgery 02/2009; 13(2). DOI:10.1007/s11605-008-0770-x · 2.80 Impact Factor
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    ABSTRACT: An 80-year-old woman who had undergone both a cholecystectomy and an appendectomy presented with intermittent abdominal pain. Computed tomography (CT) revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant. The hernia orifice was adjacent to the left side of the superior mesenteric artery and vein. An upper gastrointestinal series also revealed a cluster of jejunal loops, suggesting the possibility of an internal hernia. Laparoscopic surgery was performed. The hernia orifice was found to be caused by abnormal adhesion between the transverse mesocolon and the jejunum mesentery. An adhesiotomy reduced the jejunum entrapped in the hernia. The hernia space was a large mesocolic fossa composed of transverse mesocolon and mesentery, continuing to the splenic flexure. The hernia was classified as a variant of paraduodenal hernia.
    Surgery Today 02/2009; 39(6):533-5. DOI:10.1007/s00595-008-3875-7 · 1.53 Impact Factor

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2009; 70(10):3146-3150. DOI:10.3919/jjsa.70.3146
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    ABSTRACT: To clarify the characteristics of hepatocellular carcinoma (HCC) with bile duct invasion, we retrospectively analyzed clinical features and surgical outcome of HCC with bile duct invasion (b(+) group, n = 15) compared to those without bile duct invasion (b(-) group, n = 256). In the b(+) group, four patients (27%) showed obstructive jaundice, and a diagnosis of bile duct invasion was obtained preoperatively in seven patients (47%). The levels of serum bilirubin and carbohydrate antigen 19-9 were significantly higher in the b(+) group. Macroscopically, confluent multinodular type and infiltrative type were predominant in the b(+) group (P = 0.002). Microscopically, capsule infiltration (P = 0.040) and intrahepatic metastasis (P = 0.013) were predominant in the b(+) group. Portal vein invasion was associated significantly with the b(+) group (P = 0.004); however, the frequency of hepatic vein invasion was similar (P = 0.096). The median survival after resection was significantly shorter in the b(+) group than in the b(-) group (11.4 vs. 56.1 months, P = 0.002), and eight of 11 intrahepatic recurrences in the b(+) group occurred within 3 months after surgery. HCC with bile duct invasion has an infiltrative nature and a high risk of intrahepatic recurrence, resulting in poor prognosis.
    Journal of Gastrointestinal Surgery 12/2008; 13(3):492-7. DOI:10.1007/s11605-008-0751-0 · 2.80 Impact Factor
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    ABSTRACT: We report two resected cases of gastric granular cell tumors. Case 1 : A 40-year-old man admitted after gastroscopy showed a submucosal tumor 1.5cm in diameter with a molar-like appearance at the greater curvature of the gastric fundus. Biopsy showed a granular cell tumor necessitating laparoscopic partial resection of the stomach. Case 2 : A 42-year-old woman admitted for epigastralgia was found in gastroscopy to have a submucosal tumor 1.5cm in diameter on the lesser curvature of the lower stomach. Histological diagnosis was not accurate and a carcinoid tumor could not be ruled out, so we partially resected the stomach. Both resected specimens were microscopically located in the submucosal layer. Tumor cells were arranged in small clusters with long, abundant granular eosinophilic cytoplasm strongly positive for PAS and S-100 protein. Both cases were pathologically diagnosed as granular cell tumors. Such gastric tumors are rare, with only 32 cases reported in Japan.
    Nippon Shokaki Geka Gakkai zasshi 11/2008; 41(11):1916-1920. DOI:10.5833/jjgs.41.1916