Itsuo Fujita

Nippon Medical School, Tokyo, Tokyo-to, Japan

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Publications (31)39.2 Total impact

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    ABSTRACT: Superior mesenteric artery (SMA) syndrome is an uncommon disease resulting from compression and partial obstruction of the third portion of the duodenum from the SMA. A 77-year-old man, who did not have a history of surgery, experienced repeated vomiting and developed abdominal distension. Abdominal CT showed a narrowed third portion of the duodenum, with a distended stomach and proximal duodenum. The patient was diagnosed as having SMA syndrome and was initially treated conservatively, but his condition did not improve. Single-incision laparoscopy-assisted duodenojejunostomy was performed. The patient recovered well and was discharged from hospital on postoperative day 8. Laparoscopic treatment is feasible for the treatment of SMA syndrome given its safety and minimal invasiveness. This is a report of the first case of single-incision laparoscopy-assisted duodenojejunostomy. This procedure is safer and less invasive than a conventional laparoscopic approach in a patient with SMA syndrome. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
    Asian Journal of Endoscopic Surgery 02/2015; 8(1):67-70. DOI:10.1111/ases.12140
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    ABSTRACT: This study investigated gastric tube cancer (GTC) to clarify the clinicopathological characteristics in different generations. We analyzed 165 cases with metachronous GTC; 9 cases from our institution and 156 from reported Japanese cases. Cases were divided into 3 groups to provide a detailed analysis of age-specific variations. GTC most commonly occurred in the lower gastric tube, and the most common histological type was tubular adenocarcinoma (70%). There were no age-related variations in the site and histological type of GTC. The incidence rate of endoscopic detection increased from 2003 to 74% in 2012, and the incidence of early GTC detection also significantly increased in this period. The rate of endoscopic treatment before 2003 was approximately 20%, and it doubled over the 10-year course of the study. The recent progress made in the diagnosis and treatment of GTC may have contributed to an improvement in its prognosis.
    Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2014; 111(3):512-20.
  • Journal of Nippon Medical School 01/2013; 80(4):250-1. · 0.59 Impact Factor
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    ABSTRACT: We report a case of advanced stomach cancer metastatic to the spermatic cord 1 year after curative distal gastrectomy. The patient underwent distal gastrectomy with D2 lymph node dissection. There was no metastasis to the liver or peritoneum, and cytologic examination of the peritoneal lavage fluid was negative for cancer cells (CY0). Histological examination revealed a moderately differentiated tubular adenocarcinoma that had penetrated the serosa (T4a). Postoperative staging was T4aN1M0, stage IIIA, according to the Japanese gastric carcinoma classification scale. One year after the operation, the patient was readmitted with right groin pain. Percutaneous fine needle aspiration biopsy of the inguinal tumor revealed a tubular adenocarcinoma. Extirpation of the inguinal tumor with wedge resection of the right iliac-femoral vein was performed. Pathological examination revealed a moderately differentiated tubular adenocarcinoma that had diffusely infiltrated the connective tissue surrounding the spermatic cord. Immunohistochemical studies showed the tumor cells were reactive for CK7 but not for CK20. These findings were consistent with the diagnosis of a spermatic cord tumor metastatic from a known gastric primary cancer. Laparoscopic exploration showed invagination of the peritoneum with small nodules from the median umbilical fold to the lateral umbilical fold and a markedly decreased distance between the folds. Pathological examination in this area revealed a tubular structure consisting of mesothelial cells within the cancer tissue which was associated with dense fibrosis, suggesting that the invagination of the peritoneum had been caused by minimal peritoneal metastasis.
    Journal of Nippon Medical School 01/2013; 80(4):318-23. · 0.59 Impact Factor
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    ABSTRACT: Objective: The aim of this study was to assess the feasibility and safety of adjuvant chemotherapy with S-1 followed by docetaxel. Patients and Method: Twenty-eight patients with advanced gastric cancer underwent gastrectomy without preoperative chemotherapy. These patients were divided into 3 groups on the basis of cytologic results of peritoneal lavage (CY) and the presence of local peritoneal metastatic nodules (P): CY1-P0, CY0-P1, and CY1-P1. Oral S-1 (80 mg/m(2)/day) was administered for 3 consecutive weeks, followed by intravenous docetaxel (35 mg/m(2)) on days 29 and 43 (1 cycle). This cycle was repeated every 8 weeks. The primary endpoint was the ability to complete 6 cycles of S-1 followed by docetaxel. The secondary endpoints were safety, progression-free survival, mean survival time (MST), and overall survival (OS). Results: The subjects were 18 men and 10 women (39 to 78 years old, median age, 64 years). The extent of peritoneal metastasis was CY1-P0 in 8 patients, CY0-P1 in 14 patients, and CY1-P1 in 6 patients. Both hematologic and nonhematologic toxicities were generally mild. The completion rate of the planned 6 cycles of the protocol was 71.4% (20 of 28 patients). Median progression-free survival was 22.9 months, and the 2-year survival rate was 78.6%. The overall MST was 34.3 months, and the MST by group was 34.5 for CY1-P0, 34.3 for CY0-P1, and 19.3 months for CY1-P1. The OS in the CY1-P0 and CY0-P1 groups was significantly longer than that in the CY1-P1 group (P<0.05). Conclusion: Adjuvant chemotherapy with S-1 followed by docetaxel is safe and well tolerated and has the potential to improve OS in patients with a status of CY1P0 following relatively curative resection.
    Journal of Nippon Medical School 01/2013; 80(5):378-83. DOI:10.1272/jnms.80.378 · 0.59 Impact Factor
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    ABSTRACT: A 56-year-old man was hospitalized for treatment of severe acute abdominal pain. Chest X-ray and abdominal CT showed the presence of free air intra-abdominally. A clinical diagnosis of acute generalized peritonitis due to gastro-duodenal perforation was made and emergency surgery was performed. At the time of surgery, a 3 cm-diameter perforation was identified on the anterior wall of the duodenal bulb, and treatment effected by omental patch. On the 12th day post-operatively, endoscopy confirmed that no leakage was present at the previously-perforated site in the duodenum. On day 17, food debris appeared unexpectedly at the surgical site due to wound dehiscence. Abdominal enhanced CT showed the presence of free air from the front of the duodenal bulb extending through the intra-abdominal space to the skin wound. Whilst fasting combined with a course of antibiotics, treatment for the site of leakage was performed. Using regular clips and nylon yarns under endoscopy, the hole was reefed and leakage of contrast medium significantly abated. Subsequently inflammation reduced dramatically. The patient’s condition discernibly improved and finally resolved without the need for invasive surgery.
    01/2013; 82(1):154-155. DOI:10.11641/pde.82.1_154
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    ABSTRACT: The indications for endoscopic treatment have expanded in recent years, and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection (ESD), even if they measure over 20 mm in size. However, ESD requires complex maneuvers, which entails a long operation time, and is often accompanied by complications such as bleeding and perforation. Many technical developments have been implemented to overcome these complications. The scope, cutting device, hemostasis device, and other supportive devices have been improved. However, even with these innovations, ESD remains a potentially complex procedure. One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection. Recently, countertraction devices have been developed. In this paper, we introduce countertraction techniques and devices mainly for gastric cancer.
    06/2012; 4(6):231-5. DOI:10.4253/wjge.v4.i6.231
  • 01/2012; 80(2):98-99. DOI:10.11641/pde.80.2_98
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    ABSTRACT: To evaluate the efficacy of S-1 for Stage IV gastric cancer, we retrospectively examined 124 patients with Stage IV gastric cancer. We classified patients into two groups based on the presence or absence of S-1 administration: the S-1 therapy group (n= 56) and the non-S-1 therapy group (n=68). Basically, patients received S-1 orally at 40 mg per square meter of body surface area twice daily for 4 weeks, followed by 2 weeks without chemotherapy. When side effects appeared, we tried dose reduction or cut short the administering period according to the dose modification criteria. Major patient characteristics were as follows: gender (male/female: 76/48), and age (median[range]: 63[24-83]). The median S-1 dosage was about 5 courses, and the median of the S-1 total dosage was 10. 08 g, based on the amount of tegafur. The relative dose intensity (RDI) was well maintained (average: 74. 9%). The survival rate in the S-1 therapy group was significantly higher than in the non-S-1 therapy group. The median survival time (MST) was 308 days in the S-1 group and 157 days in the non-S-1 group. In the S-1 therapy group, the MST was 629 days for those receiving 10 g or more, while that of those receiving less than 10 g was 209 days. The MST of patients administered 10 g or more was significantly longer than that of those receiving less than 10 g (p<0. 0001). Therefore, we consider that S-1 therapy improves survival in patients with Stage IV gastric cancer.
    Gan to kagaku ryoho. Cancer & chemotherapy 10/2011; 38(10):1619-22.
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    ABSTRACT: Exposure to nitroso compounds and the activity of cytochrome P450 2E1 (CYP2E1), an activation enzyme for these carcinogens, are important factors in gastric carcinogenesis. Here, we investigated the potential correlation between genetic variation in CYP2E1 and its enzyme expression as detected with immunohistochemical (IHC) staining and cancer susceptibility in unoperated and remnant stomach. Expression of CYP2E1 in the stomach (n=117) was detected with IHC staining using a polyclonal anti-CYP2E1 antibody. Interindividual variation in CYP2E1 enzyme activity was then compared with genetic polymorphisms in the transcriptional flanking region of the CYP2E1 gene by restriction fragment length polymorphism (RFLP) detection using the Rsa I restriction enzyme. Genetic polymorphisms of Rsa I RFLP in CYP2E1 were investigated in 499 patients with gastric cancer (466 unoperated stomachs and 33 remnant stomachs) and 553 control patients with benign gastroduodenal diseases. Mucosal IHC staining for CYP2E1 was stronger in areas of intestinal metaplasia, particularly in endocrine cells, which stained consistently and strongly. Expression of CYP2E1 enzyme in areas of IHC staining were confirmed with Western blot analysis and showed a significant association between the degree of staining and the CYP2E1 genotype (p<0.01) in cancer tissues and in the foveolar epithelium of normal gastric mucosa. No association between specific CYP2E1 genotype and gastric cancer risk in the unoperated stomach was found in either the large study or the age- and gender-matched case-control study. However, the frequency of rare alleles (C1/C2 or C2/C2) was significantly higher in patients with cancer in the remnant stomach following gastrectomy than in controls subjects without cancer (odds ratio=2.8, 95% confidence interval=1.3-5.8) or those with primary gastric cancer (odds ratio=2.6, 95% confidence interval=1.3-5.5). CYP2E1 genetic polymorphisms might correlate with CYP2E1 enzyme expression levels in normal and cancerous gastric tissues. These polymorphisms do not influence the development of primary stomach cancer but may do so in specific conditions, such as the remnant stomach after gastrectomy.
    Journal of Nippon Medical School 01/2011; 78(4):224-34. DOI:10.1272/jnms.78.224 · 0.59 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the effect of vagotomy on body weight changes after gastric banding. Rats were divided into a sham-operated group (n = 10), a vagotomy alone group (n = 10), a gastric banding alone group (n = 10) and a gastric banding + vagotomy group (n = 10). All groups were given a liquid diet for 5 days after surgery and then given free access to chow. Their body weight was measured through postoperative day (POD) 14, and caloric intake and nitrogen balance were measured until POD 7. The increase in body weight in the banding + vagotomy group between POD 0 and POD 14 was not significant (12.5 +/- 16.8 g; p = 0.48), and it was less than in the banding alone group (52.8 +/- 3.8 g; p = 0.031). Cumulative caloric intake from POD 5 to POD 7 was less in the banding + vagotomy group than in the banding alone group (158.6 +/- 26.3 vs. 223.9 +/- 8.3 kcal; p = 0.030). Daily nitrogen balance from POD 5 to POD 7 in the banding + vagotomy group was less than in the banding group (337 +/- 77 vs. 540 +/- 42 mg; p = 0.033). Vagotomy suppressed body weight gain in the rat model of gastric banding.
    Digestive surgery 01/2010; 27(4):302-6. DOI:10.1159/000288701 · 1.37 Impact Factor
  • Nippon Shokaki Geka Gakkai zasshi 01/2010; 43(7):765-769. DOI:10.5833/jjgs.43.765
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    ABSTRACT: A 40-year-old woman was referred to our Department of Surgery because of an abdominal wall mass. Sixteen years earlier, she had undergone surgical resection of an inguinal tumor that had been diagnosed as a hemangiosarcoma. Fourteen months after the initial resection, the tumor recurred locally, and complete resection was performed. Twenty-nine months later, computed tomography showed multiple metastatic tumors in the lung. All these tumors were resected during thoracoscopic surgery. Thirteen years after the patient's 3rd operation, a firm mass was detected in the left lower quadrant of the abdominal wall. Magnetic resonance image showed a well-defined mass with heterogeneous contrast enhancement within the rectus abdominis muscle. Positron emission tomography-computed tomography demonstrated no recurrent tumors other than this mass. Complete resection was performed. Microscopic examination showed that this tumor was composed of hypercellular spindle cells and staghorn-shaped blood vessels. The average number of mitotic figures was 28 per 10 high-power fields. Immunohistochemical examination of the tumor showed focal positivity for CD34. Therefore, the tumor was diagnosed as a metastatic hemangiopericytoma with malignant potential. Careful long-term follow-up is required because metastases can develop after an extended disease-free interval. Aggressive surgical treatment is recommended for distant metastases.
    Journal of Nippon Medical School 08/2009; 76(4):221-5. DOI:10.1272/jnms.76.221 · 0.59 Impact Factor
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    ABSTRACT: Prevention of blood glucose elevation and insulin resistance could be more pronounced in patients undergoing laparoscopic rather than open gastrectomy. Fifty-seven patients underwent distal gastrectomy by either laparoscopy (n = 36) or an open approach (n = 21). Blood glucose, serum insulin, and the daily insulin secretion rate (urinary C-peptide) were measured. Insulin resistance was evaluated using an adapted homeostasis model assessment of insulin resistance (HOMA-R). Blood glucose levels were lower in the laparoscopy group than in the open group on the operative day and on postoperative days (POD) 1 and 3 (P < .001, P = .001, and P = .024, respectively). Serum insulin levels were lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .045 and P = .027, respectively). HOMA-R was lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .024 and P = .009, respectively). Daily insulin secretion rates were lower in the laparoscopy group than in the open group on POD 1 (P = .023). Laparoscopic surgery prevents blood glucose elevation and improves insulin resistance compared with open surgery.
    Journal of Parenteral and Enteral Nutrition 08/2009; 33(6):686-90. DOI:10.1177/0148607109333003 · 3.14 Impact Factor
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    ABSTRACT: A 67-year-old woman was admitted to our hospital for surgical management of cancer of the ascending colon. On admission, she had cholangitis due to choledocholithiasis. Abdominal computed tomography, ultrasonography, and magnetic resonance showed cholelithiasis, choledocholithiasis, and multiple liver tumors. Colonoscope showed advanced cancer of the ascending colon. Because of acute obstructive suppurative cholangitis, endoscopic sphincterotomy was performed. During the procedure, periampullary retroperitoneal perforation was identified on radiologic examination. Because computed tomography had shown extravasation of contrast medium and widespread pneumoretroperitoneum, an emergency operation was performed 2 hours after perforation. After cholecystectomy and choledocholithotomy had been performed and all bile duct stones had been removed, periampullary perforation was readily identified close to the duodenal diverticula and easily repaired. The postoperative course was uneventful. This patient could resume oral feeding soon after the operation, and colonic surgery could be performed immediately thereafter. Therefore, early surgical management is a possible first choice of treatment in patients with remaining biliary disease after periampullary perforation.
    Journal of Nippon Medical School 11/2008; 75(5):298-301. DOI:10.1272/jnms.75.298 · 0.59 Impact Factor
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    ABSTRACT: Adjustable gastric banding is a surgical approach to weight reduction. In this study we created a gastric banding model in rats to better understand the mechanism of body weight loss. Male Sprague-Dawley rats weighing 260 to 280 g were subjected to gastric banding (band group) (n=8) or to a sham operation (control group) (n=8). Body weights were monitored for 14 days, and daily food and water intake and nitrogen balance were monitored for 7 days. Two rats in the band group died of malnutrition due to gastric stomal stenosis and obstruction caused by the gastric banding. Body weight gain during the 14 days after the operation was less in the band group than in the control group (p<0.01). Food intake during the 7 days after the operation was significantly less in the band group than in the control group (p<0.01), and water intake during the 7 days after the operation was significantly less in the band group than in the control group (p<0.01). Cumulative nitrogen balance was significantly less in the band group than in the control group (p<0.01). Gastric banding decreased the body weight gain of rats by decreasing the amount of food intake because of the creation of a small gastric pouch.
    Journal of Nippon Medical School 08/2008; 75(4):202-6. DOI:10.1272/jnms.75.202 · 0.59 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stages IA, IB, and II). We retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy (DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes dissected, and length of stay were investigated. Tumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 +/- 57 vs. 268 +/- 55), mean blood loss was significantly higher in the DG group (139 +/- 181 vs. 460 +/- 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 +/- 14 vs. 34 +/- 19, p = 0.012). Hospital stay was longer in the DG group (13.3 +/- 8.5 vs. 16.7 +/- 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and four (8%) of the DG. The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer.
    Journal of Gastrointestinal Surgery 08/2008; 12(10):1807-11. DOI:10.1007/s11605-008-0599-3 · 2.36 Impact Factor
  • Nihon Ika Daigaku Igakkai Zasshi 01/2007; 3(3):128-135. DOI:10.1272/manms.3.128
  • Nippon Shokaki Geka Gakkai zasshi 01/2007; 40(1):97-100. DOI:10.5833/jjgs.40.97
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    ABSTRACT: The purpose of this study was to clarify the safety and value of laparoscopic surgery for gastric cancer. This retrospective study involved 101 patients with gastric cancer treated with laparoscopic surgery at the Nippon Medical School Hospital from February 2001 through July 2005. The following variables were evaluated: age, sex, comorbid conditions, tumor size, location, gross type, histological type, depth of wall invasion, and presence or absence of lymph node metastasis. The surgical variables investigated included operating time, blood loss, postoperative complications, and length of postoperative stay. Mean tumor diameter was 24.1 +/- 18.4 mm, and most tumors were located in the lower third of the stomach. Endoscopic examination revealed that 98 of the tumors were early gastric cancers. The mean operation time was 255 +/- 74 min, and mean blood loss was 128 +/- 162 g. Local gastrectomy without lymphadenectomy was performed in 13 cases, and pylorus-preserving gastrectomy with perigastric lymphadenectomy was performed in 16 cases. Distal gastrectomy with systemic lymphadenectomy was performed in 56 cases. Proximal or total gastrectomy with lymph node dissection for tumors located in the upper half of the stomach was performed in 16 cases. The mean postoperative hospital stay was 13.3 +/- 7.6 days. No patients died during the admission. Postoperative surgical complications occurred in 10 patients (10%) and consisted of anastomotic bleeding in 3 patients, pneumohypoderma in 1 patient, and remote infection in 6 patients. The only medical complication was a stroke in 1 patient. We conclude that laparoscopy-assisted gastrectomy is a safe and useful operation for most early gastric cancers. If patients are selected properly, laparoscopy-assisted gastrectomy can be a curative and minimally invasive treatment for gastric cancer.
    Journal of Nippon Medical School 09/2006; 73(4):214-20. DOI:10.1272/jnms.73.214 · 0.59 Impact Factor