H Sugiura

Hakodate Municipal Hospital, Hokodate, Hokkaidō, Japan

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Publications (27)34.34 Total impact

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    ABSTRACT: This retrospective study was undertaken to assess the changes in the clinical status of patients with generalized myasthenia gravis (MG) treated with extended thymectomy and to identify prognostic variables that may be of significance in optimizing patient selection. We reviewed the clinical outcomes of 17 patients who underwent extended thymectomy for MG. Main factors influencing the outcome are changes in clinical stage and medication requirement before and after thymectomy, age, sex, duration of disease, stage of disease, antibody status, histological characteristics of the thymus, and duration of follow-up. There was remission in 4 patients (23.5%), improvement in 9 patients (53%), and no change in 4 patients (23.5%). Patients in Osserman stage IIB and with a higher rate of decrease in acetylcholine receptor (AchR) antibody ratio showed a greater degree of postoperative improvement. Age of the patient, sex, presence or absence of thymoma, and time elapsed between diagnosis and operations were not found to be significant prognostic factors. The present study demonstrated that extended thymectomy for MG is an effective therapy with no great morbidity or mortality. Patients in preoperative stage IIB and with higher rate of change in the AchR antibody titer showed the greatest degree of postoperative improvement.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 07/2006; 12(3):203-6. · 0.47 Impact Factor
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    ABSTRACT: We report a male patient aged 45 years, who in 1993 had been diagnosed as having middle bile duct cancer and had received a pancreatoduodenectomy. Histopathology showed a nodular tumor with the main lesion in the middle bile duct and superficial spreading in both proximal and distal directions (which was not observed macroscopically), and residual tumor in the epithelium of the cut edge near the liver. The patient underwent follow-up without postoperative adjuvant therapy. In 2002, 9 years after the operation, the patient developed jaundice and was diagnosed with recurrence of bile duct cancer in the anastomotic site, based on cholangiographic results. He underwent resection of the right hepatic and caudate lobes and the anastomotic region of the bile duct and jejunum. Pathological findings showed an invasive tumor in the anastomotic region, with continuous intraepithelial spread in the direction of the bile duct, which suggested that the residual tumor in the epithelium had grown to become an invasive cancer. In this patient, the recurrence required 9 years after resection. This case provides evidence for the clinical course that might be anticipated for a patient with a residual tumor in the epithelium of the bile duct stump and subsequent superficial spreading bile duct cancer.
    Journal of Hepato-Biliary-Pancreatic Surgery 02/2006; 13(5):458-62. · 1.60 Impact Factor
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    ABSTRACT: Effective treatment has not yet been established for intestinal pseudo-obstruction, a rare complication of malignant pheochromocytoma. We report the case of a 41-year-old man who presented with malignant pheochromocytoma associated with pseudo-obstruction of the colon. His serum catecholamine level was markedly elevated, and his large intestine was distended with gas and lodged stool. Laxatives and enemas were not effective in relieving his symptoms. We subsequently performed an ileostomy, after which the patient had good bowel movement and was able to resume oral food intake.
    Journal of Gastroenterology 02/2003; 38(2):175-80. · 3.79 Impact Factor
  • Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 03/2002; 99(2):157-60.
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    ABSTRACT: A 28-year-old woman developed repeated neck swelling and remission over a 4-month period. Benign mediastinal teratomas also extended along her cervical region. It was not a teratoma which primarily developed in the neck. In this case, rich pancreatic tissue was histologically observed. The mechanism of the particular extension of the tumor considered to be: (1) an encasement by anatomical structures and the right-sided hard wall of the tumor, and (2) pancreatic tissue which developed cystic formation.
    Surgery Today 02/2002; 32(2):159-62. · 0.96 Impact Factor
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    ABSTRACT: This report describes a case of secondary pneumothorax caused by a radiographically occult lung metastasis from parapharyngeal synovial sarcoma, a relatively rare tumor known to be highly metastatic to the lung. Although chest X-ray and thoracic computed tomography scan failed to detect the metastatic nodule in the right lung, the surgically resected specimen proved to be a 3-mm lung metastasis. To our knowledge, only eight cases of lung metastases from synovial sarcoma causing pneumothorax have ever been reported. In most of these cases, the lung metastases were detected by radiographical examinations. However, in this patient, the metastatic lesion was not detected during examination. It is speculated that secondary pneumothorax caused by synovial sarcoma may occur during the early stages of lung metastasis. Therefore, if pneumothorax occurs in a patient with a synovial sarcoma, the possibility of lung metastasis should be carefully considered, even if it is undetectable on radiological examinations.
    Surgery Today 02/2002; 32(3):267-9. · 0.96 Impact Factor
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    ABSTRACT: A 63-year-old man was admitted to our hospital for treatment of hypogammaglobulinemia with thymoma (Good's syndrome). Tests for immunological function showed an abnormality in humoral immunity with decreases in the proportion of cells bearing B-cell markers in the peripheral blood and bone marrow. The patient was found to have Campylobacter fetus sepsis caused by the hypogammaglobulinemia due to humoral immunodeficiency, and he was given gamma-globulin supplement. Thymectomy was performed due to enlargement of the thymoma after 4 years of follow-up and the pathological diagnosis was thymoma of the non-encapsulated, epithelial spindle cell type. Although there was no recurrence of thymoma, the hypogammaglobulinemia remained unchanged and the patient continued to suffer from repeated infections. Thus, we describe the case of a patient with Good's syndrome associated with independent humoral immunodeficiency in whom the effect of thymectomy for hypogammaglobulinemia was negative. In this respect, thymectomy was only beneficial when the thymoma proliferated and seemed to be more threatening than the hypogammaglobulinemia for the patient.
    Surgery Today 02/2002; 32(3):264-6. · 0.96 Impact Factor
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    ABSTRACT: The authors reviewed their experience with resected IPMT (intraductal papillary-mucinous tumor) of the pancreas to clarify the characteristics and prognosis of this neoplasm. Between 1983 and 1998, 30 consecutive patients with IPMT underwent operations at our institution. Their clinicopathological features and postoperative long-term outcomes were analyzed retrospectively. There were 22 males and 8 females, with a mean age of 64 years. Operations performed were duodenum-preserving pancreatic head resection in 12 patients, distal pancreatectomy in 8, segmental pancreatectomy in 6, conventional pancreaticoduodenectomy in 4. Malignancy was found in 10 of 30 (33%). Factors significantly associated with malignancy were tumor size or presence in main pancreatic duct. In 30 resected patients after a mean follow-up of 60 months, tumor recurrence had occurred in 2 cases of invasive carcinoma that infiltrated into the extrapancreatic organ. The overall actuarial 5-year and 10-year survival was 83% and 62%, respectively. IPMT has a favorable prognosis after adequate resection. Despite slow growth, IPMT has an obvious malignant potential and a poor prognosis when invasive carcinoma has developed. Early recognition and pancreatectomy is the mainstay of treatment for IPMT.
    Hepato-gastroenterology 01/2002; 49(43):263-7. · 0.77 Impact Factor
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    ABSTRACT: Background: Stable oxygenation and sufficient collapse of the lung are essential for video-assisted thoracic surgery (VATS). We performed the lobe-selective lung collapse technique with VATS for patients who had deteriorated lung function. Methods and Results: Case 1: A 75-year-old man who had undergone thoracoplasty showed spontaneous pneumothoraces in the contralateral side. Bullae were stapled successfully under complete isolation and collapse of diseased lobe. Case 2: A 57-year-old woman who had undergone left lower lobectomy for lung cancer presented with another lung cancer in the right lower lobe. The right lower lobe bronchus was closed selectively, and basal segmentectomy was performed. Case 3: A 60-year-old woman who had lost left lung function presented with right-side spontaneous pneumothoraces. The right upper lobe was collapsed selectively, and bullectomy was performed. Conclusion: Lobe-selective bronchial blockade may be beneficial when VATS is performed for selected patients with deteriorated lung function.
    Surgical Endoscopy 01/2002; 16(2):327-330. · 3.43 Impact Factor
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    ABSTRACT: We report a case of a 62-year-old woman with primary leiomyosarcoma of the chest wall which was successfully resected under the video-assisted thoracoscopic approach. The disease was found during the treatment for a malignant melanoma of the left heel. On the preoperative CT images, the lesion was suspected to be a metastasis of the malignant melanoma. The thoracoscopic surgery revealed that the tumor originated from the parietal pleura, and it was resected with a 5-mm margin of normal pleura. Histopathologically, the tumor was diagnosed as low-grade leiomyosarcoma. Since no residual tumor cells were proven in the resected margins histologically, further resection was not performed. At present, she is alive and well with no sign of recurrence of leiomyosarcoma two years and one month after operation. Thoracoscopic surgery is worth trying for accurate diagnosis of and effective treatment for a chest lesion without apparent invasion of the chest wall on the preoperative CT images.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 01/2002; 7(6):368-70. · 0.47 Impact Factor
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    ABSTRACT: In this study we analyzed 33 cases which underwent complete surgical resection to assess the role of surgery in the treatment of patients with N 2 NSCLC. The 3 year survival rate was 33.3% and the median survival time was 26.1 months. The survival curve for patients with T 3 factor was statistically worse than those with T 1 or T 2 factor. Further, the survival curve for patients with p 2 or p 3 factor was significantly lower than than that for those classified as p 0. Patients classified with p 2 or p 3 had a survival rate under 2 years. Only one patient diagnosed as T 3 achieved 3 year survival. This patient had a pm1 tumor with p 0 factor. We thereby recommend that surgery should only be performed for those N 2 NSCLC patients diagnosed as T 1 or T 2 with a classification of p1 or less.
    Kyobu geka. The Japanese journal of thoracic surgery 02/2001; 54(1):80-5.
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    ABSTRACT: We report herein the rare case of a 33-year-old man found to have a multiple endocrine neoplasia type 1 (MEN1)-associated carcinoid tumor in the thymus. A chest roentgenogram demonstrated an asymptomatic anterior mediastinal mass, 7 cm in diameter, and ultrasound-guided percutaneous Tru-Cut biopsy revealed a carcinoid tumor of the thymus. An extended thymectomy was performed through a median sternotomy and pathological examination confirmed the diagnosis of a thymic carcinoid tumor, which was mainly encapsulated with locally invasive growth into the pleura. Despite the absence of a family history of MEN1, he was treated for two pancreatic islet cell tumors, hyperparathyroidism, an adrenal tumor, and a retroperitoneal lipoma. MEN1 mutations were detected both in blood samples and pancreatic tumor tissues. He is now well without any evidence of tumor recurrence 27 months after the operation for the thymic carcinoid. MEN1 mutations were screened by direct nucleotide sequencing of all protein-coding regions of exons 2-10 of the MEN1 gene. Heterozygous germline mutation was detected in the blood sample analyses. Moreover, fresh-frozen pancreatic tumor tissues showed a loss of heterozygosity in the MEN1 region.
    Surgery Today 02/2001; 31(5):428-32. · 0.96 Impact Factor
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    ABSTRACT: Multiple genetic alterations are involved in the development of pancreatic neoplasm. Here we investigated the incidence of p53, ras, bcl-2 and c-erbB-2 gene alterations in intraductal papillary-mucinous tumors and invasive ductal adenocarcinoma of the pancreas by immunohistochemical method to identify and analyze their relationship in terms of these genetic alterations. Fifty-four pancreatic lesions, including 18 benign (hyperplasia (3) and intraductal papillary adenoma (15)), and 16 malignant (carcinoma in situ (2) and intraductal papillary adenocarcinoma (14)) cases of intraductal papillary-mucinous tumor; and 20 cases of invasive ductal adenocarcinoma, were immunostained by avidin-biotin peroxidase conjugate method. p53 and rasp21 expressions were significantly greater in malignant intraductal (P < 0.01, P < 0.05) and invasive ductal (P < 0.01, P < 0.01) tumors than in benign intraductal papillary-mucinous tumors; while bcl-2 and c-erbB-2 expressions were significantly greater in invasive ductal adenocarcinoma than both benign (P < 0.01, P < 0.05) and malignant (P < 0.05, P < 0.05) intraductal papillary-mucinous tumors. Different groups of genetic alterations are involved in different phases of pancreatic tumorigenesis. p53 and ras gene alterations occur at an early stage during the development of intraductal papillary-mucinous tumor, while additional alterations of bcl-2 and c-erbB-2 occur during the development of invasive ductal adenocarcinoma of the pancreas.
    Hepato-gastroenterology 01/2001; 48(39):879-83. · 0.77 Impact Factor
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    ABSTRACT: We report a case of biliary cystadenocarcinoma of the liver with superficial spread to the extrahepatic bile duct. Preoperative endoscopic retrograde cholangiography revealed communication between a 4.5-cm cyst in segment 4 of the liver and the bile duct. From the findings obtained by peroral cholangioscopy and intraoperative cholangioscopy, the granular mucosa in the bile duct was diagnosed as superficially spreading cancer. The right posterior segmental bile duct and the right anterior segmental bile duct were resected at the point where the spread of cancer was no longer traceable and left lobectomy plus caudate lobectomy was carried out. This achieved radical resection, leaving the resected margin of the bile duct free from cancer. Histopathologically, well-differentiated papillary adenocarcinoma was found on the inner surface of the cyst, and the cancer had superficially spread from the cyst to the extrahepatic bile duct via the 2.5-mm diameter communication between the cyst and bile duct. The cancer was limited only to the mucosal layer all over the lesion. When performing radical surgery for biliary cystadenocarcinoma, it is recommended that cholangioscopy be performed to examine whether the cancer has superficial spread to the extrahepatic bile duct or not. Bile duct resection should be carried out, depending on the extent of the superficial spread, so that the resected margin of the bile duct is free from cancer.
    Hepato-gastroenterology 01/2001; 48(39):647-9. · 0.77 Impact Factor
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    ABSTRACT: Among the intrahepatic cystic diseases except Caroli's disease, only biliary cystadenoma/cystadenocarcinoma may communicate with the bile duct. We present a case of biliary cystadenocarcinoma in which drip infusion cholangiographic-computed tomography demonstrated communication between an intrahepatic cyst and the biliary system preoperatively. Drip infusion cholangiographic-computed tomography, a simple and noninvasive examination, is useful for differentiating biliary cystadenoma/cystadenocarcinoma from other intrahepatic cystic lesions.
    Hepato-gastroenterology 01/2001; 48(40):1005-6. · 0.77 Impact Factor
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    ABSTRACT: A 73-year-old male patient presenting with synchronous triple cancer of the hypopharynx, esophagus and stomach is herein reported. To pursue safety by reducing surgical stress and better postoperative quality of life, we preserved the stomach by treating the gastric cancer by endoscopic mucosal resection and subsequently used the stomach for making an elongated stomach roll during the esophageal reconstruction. Postoperatively, no complications occurred and the patient has been on oral feeding for 23 months with no recurrence of primary cancer.
    Hepato-gastroenterology 01/2001; 48(41):1372-4. · 0.77 Impact Factor
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    ABSTRACT: Thymic neuroendocrine carcinoma (carcinoid) is rare. Here we present four cases of this unusual neoplasm to provide more clinical, radiologic, and prognostic data. Four male patients with an average age of 44 years (range 27-63) were identified as having thymic neuroendocrine carcinoma and were reviewed retrospectively. One patient had Cushing's syndrome with elevated serum ACTH. Three others were asymptomatic with normal laboratory findings, one case was associated with MEN type 1. All underwent complete resection along with invaded adjacent structures. Local recurrence developed in two patients at 45 and 98 months after the initial excision. Both patients died at 90 and 105 months, respectively. The other two patients are alive and have been disease-free for 27 and 120 months, respectively. Thymic neuroendocrine carcinomas have a rather poor prognosis based on their tendency to recur and metastasize many years after the initial operation. Therefore, prolonged follow-up is essential for these tumors.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 11/2000; 6(5):304-8. · 0.47 Impact Factor
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    ABSTRACT: We report a case of a 61-year old woman with pulmonary atypical mycobacteriosis. Although she had been treated with chemotherapy, image findings gradually deteriorated. Chest X-ray and CT scan demonstrated that the advanced destruction with cavity formation and diffused shadow in the right lung. She underwent a right pneumonectomy under the video-assisted thoracic surgery (VATS) approach. The operation time was 4.9 hours, and the amount of intraoperative bleeding was 550 ml. The postoperative course was uneventful and the patient was discharged from hospital on 13th postoperative day. At present, two years after the operation, there is no progress of the pathogen into the other lung, and the patient is doing well with no postoperative complaint. Anatomically, pneumonectomy is a simple procedure, and in consideration of postoperative quality of life with alleviation of pain as well, VATS is worth trying in the cases where the status and nature of the disease are suitable for this technique.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 09/2000; 6(4):258-61. · 0.47 Impact Factor
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    ABSTRACT: Clinical features of small cell lung cancer were studied in 15 cases. The overall 5-year survival rate of the patients with limited small cell lung cancer was 11.4%. Surgery played substantial role for long-term survival in limited SCLC. The 4-year-survival rate of the patients in stage I was 50%, and that of those in stage II and IIIA was 50% and 37.5%, respectively. In the two survivors over four years in stage IIIA, all tumor was categorized as pT3 disease. The 4-year-survival rate of the patients treated with PE was 100%, and that of those treated with another chemotherapy was 10%, and that difference is statistically significant (p < 0.05). There was no significant difference in prognosis of patients in any other factors such as location (central or peripheral), histological subtype, curability or R number, pT factor, pN factor, p stage or with or without thoracic irradiation. Surgical resection for limited SCLC should be recommended in patients with stage I, II and T3N0M0 or T3N1M0 disease. For the patients in stage IIIA, particularly in N2M0 disease, who showed partial response or no change after chemotherapy, surgery should be considered because those patients might have nonsmall cell carcinoma components.
    Kyobu geka. The Japanese journal of thoracic surgery 01/2000; 52(13):1061-6; discussion 1066-8.
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    ABSTRACT: We aimed to determine whether the prognosis of non-small cell lung cancer (NSCLC), with lesions 2 cm or less in diameter, was better than that of Stage Ia lung cancer having a diameter of more than 2 cm. We reviewed 64 cases of NSCLC which were preoperatively diagnosed as TINOMO. The tumors were classified into 2 groups on the basis of a tumor diameter set at 2 cm. After comparison of background factors, we compared the prognoses of the groups and determined the prognostic factors in Stage IA NSCLC. No differences were observed in the survival rate between the 2 groups. Statistically significant factors for the survival period in Stage IA NSCLC were serum carcino-embryonic antigen (CEA), residual tumor condition and lymph node metastasis. Those cases where CEA was abnormal were all in Stage II or inllmore advanced stage. It is not justifiable to sub-classify Stage IA NSCLC on the basis of a tumor diameter of 2 cm. The present study revealed that the most important preoperative prognostic factor was serum CEA.
    Anticancer research 01/2000; 20(2B):1155-8. · 1.71 Impact Factor

Publication Stats

212 Citations
900 Views
34.34 Total Impact Points

Institutions

  • 2002
    • Hakodate Municipal Hospital
      Hokodate, Hokkaidō, Japan
  • 1999–2002
    • Hokkaido University
      • • Department of Cancer Preventive Medicine
      • • Department of Medicine II
      Sapporo, Hokkaidō, Japan
  • 1998–2002
    • Hokkaido University Hospital
      • Department of Surgical Pathology
      Sapporo, Hokkaidō, Japan