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ABSTRACT: Evidence-based guidelines for the prevention of surgical site infection (SSI) have been published by the U.S. Centers for Disease Control and Prevention (CDC). According to these guidelines, a wound should usually be covered with a sterile dressing for 24 to 48 h when a surgical incision is closed primarily. However, it is not recommended that an incision be covered by a dressing beyond 48 h. In this study, patients were stratified into two groups for analysis: patients whose surgical wound was sterilized and whose gauze was changed once daily until postoperative day 7 (7POD; group A); and patients whose surgical wound was sterilized and whose gauze was changed once daily until 2POD (group B). We evaluated the incidence of SSI, nursing hours and cost implications. The results showed that there was no significant difference in SSI occurrence between the two groups (group A, 10% vs. group B, 7.3%). By contrast, the average nursing time differed by 2.8 min (group A, 3.8 min vs. group B, 0.9 min). The material costs per patient were also reduced by $14.70 (group A, $61.80 vs. group B, $47.10). In conclusion, we applied our knowledge of the evidence-based CDC guidelines to determine whether 48-h wound management can be made easier, more uniform and more cost-effective compared to conventional wound management. The results of the present study showed that surgical wound management methods can be more convenient and inexpensive.
Oncology letters 07/2012; 4(1):97-100. · 0.11 Impact Factor
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ABSTRACT: The urinary trypsin inhibitor (UTI) is responsible for most of the antitryptic activity in urine and is excreted in increased amounts in urine under certain pathological conditions such as cancer and bacterial infections. Our aim in this study was to better understand the mechanisms responsible for the increase in UTI excretion on surgical stress and thus to better appreciate the information provided by inflammatory mediators. Thirty-one consecutive patients who underwent radical esophagectomy for esophageal cancer were investigated in this study. We determined serum UTI and polymorphonuclear cell elastase (PMNE), urine UTI and evaluated the effectiveness of preoperative administration of methylprednisolone on the postoperative clinical course and adverse inflammatory reactions. The results revealed that urine UTI and serum PMNE levels in the steroid group were significantly lower than those in the non-steroid group. In addition, UTI levels correlated positively with serum levels of aminotransferases. More importantly, the maximum level of urine UTI in patients without complications was lower than that in patients with complications. These results suggest that urine UTI provides useful information concerning postoperative clinical course, and that preoperative administration of methylprednisolone may contribute to decrease postoperative complications following esophagectomy.
Experimental and therapeutic medicine 07/2012; 4(1):84-88.
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ABSTRACT: A 64-year-old man visited our hospital complaining of abdominal discomfort. A 2-cm-long 0-IIc+IIa esophageal superficial
carcinoma was detected in the middle third of the thoracic esophagus with endoscopy and esophagography. Computed tomography
(CT) did not detect any metastasis. The patient underwent video-assisted thoracic surgery of the esophagus (VATS-E). Anastomotic
leakage and a thoracic abscess were detected 16days after the operation. Repeated thoracic drainages and conservative therapy
with enteral nutrition were continued for approximately 1month, but an esophago-mediastinal fistula and small mediastinal
cavity remained. Additional drainage using interventional radiology (IVR) reduced the size of the cavity, but could not cure
the esophago-mediastinal fistula, 68days after the operation. The occurrence of an esophago-respiratory fistula followed
by a thoracic abscess is a very serious and frequently fatal complication. We performed endoscopic clipping and filling with
fibrin glue and succeeded in closing the fistula. Oral intake was started after training in swallowing, and the patient was
discharged from hospital 172days after the operation. One year after the operation he has no sign of a recurrence of the
tumor or fistula. We demonstrated a case in which an esophago-mediastinal fistula was successfully repaired by endoscopic
clipping with fibrin glue after an operation.
KeywordsEsophago-mediastinal fistula–Clipping–Esophagectomy
Esophagus 04/2012; 8(2):113-117. · 0.66 Impact Factor
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Ichiro Akagi,
Masao Miyashita,
Hiroshi Makino,
Tsutomu Nomura,
Keiichi Okawa,
Nobutoshi Hagiwara,
Junji Ueda,
Takeshi Yamada,
Tetsuya Shimizu, Ken Takahashi,
Kimiyoshi Yokoi,
Eiji Uchida
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ABSTRACT: We report a case of esophageal squamous cell carcinoma (ESCC) directly invading the liver and causing a pyogenic liver abscess. The patient was a 66-year-old man who presented with dysphagia. Esophagography, endoscopic study, and computed tomography (CT) showed a mass lesion in the lower third of the esophagus. A high fever developed on hospital day 17 and another CT scan revealed a liver abscess, 50 × 45 mm, in the left lateral lobe of the liver. Although imaging demonstrated a liver abscess continuous with the tumor, we performed percutaneous transhepatic drainage, followed thereafter by distal esophagectomy and total gastrectomy with a left lateral segmental resection of the liver. The pathological findings confirmed a diagnosis of ESCC with direct invasion (T4N1M0, stage IVa in the TNM classification). The patient had an uneventful postoperative recovery. Microscopic examination of the resected specimen revealed the expansive growth of tumor cells into the hepatocellular tissues. To our knowledge, this is the first report of the direct invasion of esophageal cancer to the liver causing a pyogenic liver abscess; however, it should be borne in mind when a patient with esophageal cancer becomes febrile.
Surgery Today 09/2011; 41(9):1247-51. · 1.22 Impact Factor
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Ichiro Akagi,
Masao Miyashita,
Hiroshi Makino,
Tsutomu Nomura,
Nobutoshi Hagiwara, Ken Takahashi,
Kazumitsu Cho,
Takuya Mishima,
Osamu Ishibashi,
Toshikazu Ushijima,
Toshihiro Takizawa,
Takashi Tajiri
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ABSTRACT: The genomic region containing PIK3CA was found to be amplified in esophageal squamous cell carcinoma (ESCC) tissue. PIK3CA at 3q26, which encodes the p110alpha catalytic subunit of phosphatidylinositol (PI) 3-kinase, is a unique intracellular signal transducer characterized by its lipid substrate specificity. In order to characterize PIK3CA in ESCC, we investigated hot-spot mutations in exons 1, 9 and 20, the copy number gain, the expression levels of mRNA and protein. Analysis in exon 9 of the PIK3CA gene revealed mutation in 7.7% (4 of 52) of ESCC samples. No mutation was detected in either exon 1 or exon 20. Copy number amplifications of PIK3CA were found in 12 of the 45 patients (26.7%). PIK3CA mRNAs were examined in 37 ESCC patients as determined by quantitative RT-PCR and the mean mRNA level of PIK3CA in ESCC tissues was 2.61-fold higher compared with that in corresponding non-tumorous esophageal epithelia (P<0.001). Immunohistochemically, positive immunoreaction for PIK3CA was detectable in 33 of 66 (50.0%) ESCC cases, while it was not detectable in the remaining 33 cases. Furthermore, comparing the cases with negative staining with those with positive staining for PIK3CA, the presence of node metastasis was significantly correlated with those with positive staining (P<0.05). This study is the first report providing comprehensive analysis of PIK3CA expression in ESCC. These results indicate that PIK3CA may play a crucial role in the development of ESCC and serve as an indicator for lymph node metastasis.
International Journal of Oncology 03/2009; 34(3):767-75. · 2.40 Impact Factor
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ABSTRACT: The Akt-Mdm2 pathway plays an important role in carcinogenesis in a variety of malignant tumors. However, the Akt-Mdm2 pathway in esophageal squamous cell carcinoma (ESCC) has not been fully studied. We investigated the proteins and mRNA expression of Akt and Mdm2 to elucidate the roles of these proteins in ESCC. We also examined the effect of Akt knockdown on Mdm2 expression in ESCC cells. ESCC tissue samples were obtained from 23 individuals who underwent surgical resection with no preoperative treatment. Akt1-3 and Mdm2 gene and protein expression were analyzed. The effect of siRNA-mediated Akt knockdown on Mdm2 expression was also studied, using ESCC cell lines. Akt1 and Mdm2 immunoreactivity was detected in 77.8 and 66.7% of tumor specimen from ESCC patients, respectively. Akt1 and Mdm2 mRNA expressions were correlated and significantly elevated in tumor tissue (p<0.0001 and p<0.05, respectively). The siRNA-targeted reduction of each Akt isoform reduced Mdm2 protein expression. The overexpression of Akt1 and Mdm2 may be related to esophageal carcinogenesis. Furthermore, Akt expression regulates Mdm2 expression, which may in turn regulate the function of wild-type p53. These results may provide the basis for future preventative or clinical therapies for esophageal cancer.
Experimental and Molecular Pathology 12/2008; 87(1):42-7. · 2.42 Impact Factor
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ABSTRACT: Earlier studies have identified the minimal overlapping region of amplification at 3q26 in esophageal squamous cell carcinoma (ESCC) by comparative genomic hybridization (CGH) analysis. These include PIK3CA which encodes the p110alpha catalytic subunit of phosphatidylinositol (PI) 3-kinase, a telomerase RNA component (TERC), a squamous cell carcinoma-related oncogene (SCCRO), ecotropic viral integration site-1 (EVI-1), and a Ski-related novel oncogene (SnoN). In the present study, we investigated the mRNA levels of four candidate genes (TERC, SCCRO, EVI-1, and SnoN) to determine whether genes other than PIK3CA are targets for amplification at 3q26 in ESCC. And also, we examined SnoN expression in ESCC samples.
Fifty-nine representative cases with ESCC were selected from our archives. We performed quantitative RT-PCR of four candidate genes (TERC, SCCRO, EVI-1, and SnoN) and immunohistochemistry for SnoN. Finally, we correlated these findings with the clinicopathological characteristics to determine their interrelationship.
Among the four genes we tested, only SnoN mRNA was consistently overexpressed in primary ESCC, compared with those in corresponding nontumorous esophageal epithelia (P < 0.001). Immunoreactive SnoN was detectable in 31 of 59 (52.5%) esophageal squamous cell carcinoma specimens. The levels of SnoN expression were found to correlate with the depth of invasion and recurrence (P < 0.05). Furthermore, patients with positive staining for SnoN displayed more unfavorable outcomes than patients with negative staining (P < 0.05).
SnoN is likely to be the target of the amplification at 3q26 in ESCC and plays an important role in the development of ESCC, influencing disease-specific survival.
Annals of Surgical Oncology 07/2008; 15(10):2965-75. · 4.17 Impact Factor
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Hiroshi Makino,
Masao Miyashita,
Tsutomu Nomura,
Miwako Katsuta,
Moto Kashiwabara, Ken Takahashi,
Kiyohiko Yamashita,
Munenaga Nakamizo,
Kazuhiko Yokoshima,
Munehiko Onda,
Zenya Naito,
Takashi Tajiri
Digestive Diseases and Sciences 10/2007; 52(9):2195-200. · 2.12 Impact Factor
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ABSTRACT: Recently, endoscopic mucosal resection (EMR) has become the first choice of treatment for superficial esophageal cancer without metastasis. However, EMR is not safe for all patients. Argon plasma coagulation (APC) is a noncontact electrocoagulation technique that creates tissue damage. The risk of bleeding may be lower with APC than with EMR. Therefore, we selected APC for the treatment of patients with superficial esophageal cancer who could not undergo EMR. The aim of the present study was to describe these cases and analyze the results of this treatment.
Ten patients with superficial esophageal cancer underwent APC at our institution from February 2001 through January 2002. None of the patients could undergo EMR because of complications. Ablation was performed using an APC probe (ERBE APC probe; ERBE Elektromedizin, Tübingen, Germany), a high-frequency electrosurgical generator (ERBE ICC200), and an argon delivery unit (ERBE APC 300). All patients had uneventful recoveries.
No incidents of bleeding from the ablated lesion or infection occurred. Oral intake was resumed on the day after treatment. The mean duration of the procedure was 20 minutes (range, 10 to 40 minutes). Disease recurred in two patients. Two patients died of laryngeal cancer and liver failure, respectively.
APC is a safe and easy to perform procedure, but the effect of therapy is inferior to that of EMR in terms of the complete resection of the lesion. In conclusion, APC should be limited to cases of superficial esophageal cancer without metastasis in which EMR has been deemed difficult.
Journal of Nippon Medical School 05/2007; 74(2):163-7.
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Masao Miyashita,
Hiroshi Makino,
Miwako Katsuta,
Tsutomu Nomura,
Seiichi Shinji,
Moto Kashiwabara, Ken Takahashi,
Mitsuhiro Kudo,
Toshiyuki Ishiwata,
Zenya Naito,
Takashi Tajiri
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ABSTRACT: Cyclo-oxygenase (COX)-2 is not usually detectable in normal tissues but is induced in inflammation and carcinogenesis. The level of COX-2 is elevated in cancer tissues of the colon, bladder, and skin. In the esophagus, squamous cell carcinoma and adenocarcinoma are known to express COX-2. The purpose of this study was to clarify the association of COX-2 expression with clinicopathological factors of squamous cell carcinoma. The immunohistochemical expression of COX-2 was examined in 48 surgical specimens of esophageal squamous cell carcinoma. Although COX-2 over-expression was more frequently observed in tumors invading the submucosa (T1b, 76.4%), muscularis propria (T2, 57.1%), adventitia, or adjacent organs (T3 approximately 4, 83.3%), even 33.3% of mucosal cancers, such as T1a, showed COX-2 over-expression. COX-2 over-expression was present in 82.3% of lymph node-negative patients but in only 54.8% of lymph node positive patients. There was no difference in COX-2 over-expression between the earlier stages (0 and I, 60%) and more advanced stages (II approximately IV, 69.6%). COX-2 over-expression did not correlate with survival during 3 years of follow-up. These findings suggest that COX-2 is associated with the phenotype of the esophageal squamous cell carcinoma cells, including superficial cancer cells, and may be related to tumor growth in esophageal squamous cell carcinoma.
Journal of Nippon Medical School 01/2007; 73(6):308-13.
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ABSTRACT: We report a case of perforation of the esophagus associated with mediastinitis and pneumomediastinum during endoscopic treatment. The patient was successfully treated by means of nonsurgical computed tomography-guided mediastinal drainage. Esophagoscopy demonstrated a scar on the 14th day at the perforation site. This nonsurgical treatment with computed tomography-guided mediastinal drainage is proposed as a less invasive treatment for iatrogenic perforation of the esophagus.
Journal of Nippon Medical School 01/2007; 73(6):337-40.
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Nobutoshi Hagiwara,
Leah E Mechanic,
Glenwood E Trivers,
Helen L Cawley,
Masataka Taga,
Elise D Bowman,
Kensuke Kumamoto,
Peijun He,
Mark Bernard,
Saira Doja,
Masao Miyashita,
Takashi Tajiri,
Koji Sasajima,
Tsutomu Nomura,
Hiroshi Makino, Ken Takahashi,
S Perwez Hussain,
Curtis C Harris
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ABSTRACT: In lung tumors, the p53 tumor suppressor gene is commonly mutated with a characteristic mutation spectrum. The amount of and alterations in plasma DNA, such as mutations in p53, were associated with several cancers. Few studies used quantitative methods of high sensitivity. Previously, we observed p53 mutations in the noncancerous tissue that differed from those in lung tumors using the highly sensitive p53 mutation load assay. Based on our observation of an increased p53 mutation load in nontumorous lung tissue in smokers, we hypothesized that plasma DNA may contain mutant p53 indicative of tobacco smoke exposure and will be an effective biomarker of lung cancer or smoking exposure. We modified the p53 mutation load assay to detect mutations at p53 codons 248 and 249, common mutations in lung cancer, in plasma DNA samples with a sensitivity of 1:5,000. The assay was applied to a set of lung cancer cases (n = 39), hospital controls (n = 21), and population controls (n = 20) from a larger study. Controls were selected to consist of equal numbers of both ever and never smokers. The p53 mutation load (mutated p53 copies per total number of p53 copies) was associated with smoking (P = 0.06), but not with lung cancer (P = 0.59). Most of the individuals with p53 mutations observed in plasma DNA were ever smokers and the p53 mutation load was higher in those who smoked for longer durations (P = 0.04). In summary, we were able to detect p53 mutations in plasma DNA from healthy individuals and our data suggest that p53 mutations in plasma DNA may be a marker of carcinogen exposure from tobacco smoke.
Cancer Research 09/2006; 66(16):8309-17. · 7.86 Impact Factor
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ABSTRACT: We report a case of double cancer of the liver and esophagus, an extremely rare condition that can be very difficult to treat. A tumorous lesion was pointed out in segment 6 of the liver of a 69-year-old man under treatment for liver cirrhosis. Abdominal computed tomography and angiography revealed a hepatocellular carcinoma. The patient underwent transcatheter arterial embolization and partial resection of segments 5 and 6. Fourteen months later, a small elevated lesion was detected in the esophagus during an endoscopic examination. The patient was treated by endoscopic mucosal resection and radiation therapy at a total dose of 50 Gy. Histological examination revealed a squamous cell carcinoma with cancer cells confined within the epithelium of the esophagus. Over the 6 years since the hepatectomy, there have been no signs of recurrence. We report a successful curative resection in an extremely rare form of double cancer with a poor prognosis.
Journal of Nippon Medical School 07/2005; 72(3):187-90.
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ABSTRACT: Spontaneous perforation of a duodenal diverticulum is a rare but serious complication with significant mortality rates. Just over 100 cases have been reported in the world literature. One case of perforated duodenal diverticulum treated by simple closure is reported. An elderly female was admitted to our hospital with an acute abdomen. Computed tomography of the abdomen showed retroperitoneal air around the duodenum and right kidney. Laparotomy with a Kocher maneuver disclosed a perforated diverticulum in the second portion of the duodenum. Although diverticulectomy is the most common treatment, simple closure of the perforated duodenal diverticulum with drainage was performed to avoid injury to the distal common bile duct and ampulla of Vater, which were close to the diverticulum. The patient has fully recovered and has been asymptomatic with no signs of recurrence for 25 months.
Journal of Nippon Medical School 10/2004; 71(5):337-9.
