Fumie Ikezawa

Tohoku University, Sendai-shi, Miyagi, Japan

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Publications (27)60.92 Total impact

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    ABSTRACT: Although surgery is commonly used to treat parastomal hernia, it is very difficult and has shown poor results. Recently, repair with prosthetic materials has been thought to be a more promising method. The Sugarbaker technique with e-PTFE mesh (Dualmesh(®)) performed via open surgery was adopted for seven patients with parastomal hernia. Two of them were recurrent cases. Three of the patients experienced incarceration of the intestine and recovered conservatively before surgery. The median age of the patients at the parastomal hernia repair was 77.6 years old (range 37.7-84.7). The median operative time was 211 min (range 147-256). The median hernia size was 28 cm(2) (range 7.5-60 cm(2)). The median amount of blood loss during the operation was 158 g (range 0-370 g). Surgical site infection was not observed. The postoperative median hospital stay was 17 days (range 13-40) and the median follow-up was 2.4 years (range 1.0-3.7). During the follow-up period, we did not observe recurrence or readmission. The surgical results were satisfactory with minimal morbidity and no recurrences. The Sugarbaker technique for parastomal repair using e-PTFE mesh may be suitable as a standard method for treating parastomal hernia.
    No preview · Article · Feb 2015 · Surgery Today
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    ABSTRACT: An 88-year-old man presented to a physician complaining of bloody stool and consulted Tohoku Rosai Hospital under a diagnosis of ulcerative colitis (UC). He was diagnosed as moderate, left-sided colitis. Steroid treatment was resistive and not effective, and subsequently the UC lesion extended to total colitis. Finally, he underwent subtotal colectomy on the 20th hospital day. He was discharged from our hospital on the 28th postoperative day. Six months later, he underwent a second operation for resection of the residual rectum. Among a total of eight operated cases over 75 years old, including the present case, the present case was the oldest. In very elderly patients with UC, the prognosis is poor due to the high risk of systemic infection and cardiopulmonary complications. It is essential to decide the surgical indication as soon as medical treatment fails.
    Preview · Article · Jan 2015 · Nippon Daicho Komonbyo Gakkai Zasshi
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    ABSTRACT: Purpose: To evaluate the foregut and hindgut hypotheses for metabolic surgery in obese rats with diabetes. Methods: Otsuka Long-Evans Tokushima fatty rats were divided into a sham operation group, a partial duodeno-jejunal bypass (P-DJB) group, and a complete DJB (C-DJB) group. P-DJB is a model to test foregut hypothesis, whereas C-DJB is a model to test both hypotheses. We performed oral glucose tolerance tests (OGTT) on all groups at baseline, and then 4 and 8 weeks postoperatively. The rats were killed thereafter and the plasma levels of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) were measured. A separate sub-group of C-DJB rats underwent OGTT after treatment with the GLP-1 antagonist, the PYY antagonist, or saline. Results: Marked improvement of the blood glucose control during the OGTT was noted 8 weeks after C-DJB, but not 8 weeks after P-DJB or the sham operation. The serum GLP-1 and PYY levels were higher in the C-DJB group than in the other two groups. Pretreatment with the GLP-1 antagonist increased the blood glucose levels 30 min after the OGTT in the C-DJB rats. Conclusions: Improvement in glucose metabolism after DJB was associated with the inflow of bile and pancreatic juice into the ileum, supporting validity of the hindgut hypothesis. GLP-1 appears to play a role in this improvement.
    No preview · Article · Jun 2013 · Surgery Today

  • No preview · Article · Jun 2013 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology

  • No preview · Article · Mar 2013 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology

  • No preview · Article · Jan 2013 · Nippon Daicho Komonbyo Gakkai Zasshi
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    ABSTRACT: [Case] 50-year-old male who had undergone left nephrectomy for renal cell carcinoma 5 years before was receiving oral administration of sunitinib because of lung metastasis and bone metastasis. He was introduced to our hospital because of perianal discharge for 2 months and severe perianal pain for 2 week. Pus with a bad odor was discharged from a secondary opening of the anal fistula. Swelling, tenderness and crepitus was widely observed around the perianal region, scrotum and left inguinal region. Abdominal CT showed extensive pus collection and emphysema around this region. So he underwent a fistulotomy and wide skin incision and debridement of necrotic tissue with the diagnosis of Fournier's gangrene. The postoperative course was uneventful. [Discussion] Although diabetes mellitus was the most well known risk factor of Fournier's gangrene, patients with malignancies are also reported to be at great risk. As for sunitinib, there has been no report of a case with Fournier's gangrene during sunitinib therapy. However, the possibility that myelosuppression and/or the anti-angiogenic effect of sunitinib promoted the development of Fournier's gangrene cannot be denied in our case. It is important to take the possibility of Fournier's gangrene into consideration when the patients receiving sunitinib therapy complain of anal pain.
    No preview · Article · Jan 2013 · Nippon Daicho Komonbyo Gakkai Zasshi

  • No preview · Article · Jan 2013
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    ABSTRACT: Ileal interposition (IT), in which the distal ileum is transposed isoperistaltically into the proximal jejunum, is considered as a procedure for metabolic or antidiabetes surgery. Our aim was to study the effects of IT on glycemic control, fat metabolism, and hormonal changes in obese rats with spontaneous diabetes. Animals were divided into either an IT or a sham (SH) group. They underwent an oral glucose tolerance test (OGTT) before and 4 and 8 weeks after the operation. All animals were killed 10 weeks after operation for analyses of tissue weight (liver, pancreas, epididymal fat, brown fat), immunoblotting of uncoupling protein-1 (UCP1) protein in brown adipose tissue (BAT), and fasting plasma levels of glucose, insulin, glucagon-like peptide (GLP)-1, peptide YY (PYY), glucose-dependent insulinotropic polypeptide (GIP), and leptin. Body weight increased postoperatively in both groups compared with preoperative weight, but it did not differ between the 2 groups. Eight weeks postoperatively, integrated blood glucose levels during the OGTT were decreased in IT compared with SH (P < .05). Fasting plasma levels of insulin, GLP-1, and GIP did not differ between the 2 groups, but PYY levels were higher in the IT animals (P < .01). The weight of epididymal and BATs, homeostasis model assessment insulin resistance, and fasting plasma leptin levels were decreased in the IT group (P < .05). Expression of UCP1 was higher in IT than SH animals (P < .05). These results suggest that IT improves glucose and lipid metabolism by decreasing insulin resistance and epididymal fat, and increased expression of UCP1 in BAT might be among the mechanisms responsible.
    No preview · Article · Feb 2012 · Surgery
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    ABSTRACT: Parenteral nutrition (PN) is indispensable for meeting caloric and substrate needs of patients who cannot receive adequate amounts of enteral nutrition; however, PN impairs hepatic immunity. We examined the effects of ω-3 and -6 polyunsaturated fatty acids, added individually to fat-free PN, on hepatic immunity in a murine model. We focused on serum liver enzymes, cytokine production, histopathology, and the outcomes after intraportal bacterial challenge. Male Institute of Cancer Research mice were randomized into 4 groups; ad libitum chow (CHOW), fat-free PN (FF-PN), PN + fish oil (FO-PN), or PN + safflower oil (SO-PN). After the mice had been fed for 5 days, hepatic mononuclear cells (MNCs) were isolated. The number of MNCs was counted and cytokine production (tumor necrosis factor [TNF]-α and interleukin [IL]-10) by hepatic MNCs in response to lipopolysaccharide (LPS) was measured. Blood samples were analyzed for hepatobiliary biochemical parameters. Moreover, 1.0 × 10(7) pseudomonas aeruginosa were delivered by intraportal injection. Survival and histology were examined. Hepatic MNC numbers were significantly less in the FO-PN and FF-PN than in the CHOW group, whereas the SO-PN group showed moderate recovery of hepatic MNC numbers. The CHOW, FO-PN, and SO-PN groups showed LPS dose-dependent increases in TNF-α levels. These increases were blunted in the FF-PN group. IL-10 levels were increased LPS dose-dependently in the CHOW and FO-PN groups, but no marked changes were observed with LPS stimulation in the SO-PN and FF-PN groups. Plasma levels of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were significantly greater in the FF-PN than in the FO- and SO-PN and CHOW groups. The FO-PN group showed significantly improved survival compared with the SO-PN and FF-PN groups, showing essentially no morphologic hepatic abnormalities. Addition of fish oil to PN was advantageous in terms of reversing PN-induced deterioration of hepatic immunity, as reflected by altered cytokine production. Fish oil administration was also useful for preventing PN-induced hepatobiliary dysfunction. These changes seem to result in better survival and to protect against severe tissue damage after intraportal bacterial challenge. This therapy may have the potential to ameliorate PN-induced impairment of host immunity and thereby decrease morbidity and mortality.
    No preview · Article · Jan 2012 · Surgery
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    ABSTRACT: Our aim was to study the effect of the viscosity of enteral nutrient solutions on upper gut motility and gut hormone secretion. We used 5 beagle dogs equipped with strain gauge force transducers to measure upper gastrointestinal motility. Upper gut motility and gut hormone secretion were compared across 6 experimental conditions; control (oral solid meal), liquid-120, liquid-5 (liquid enteral nutrients administered for 120 and 5 min, respectively), low, middle, and high viscosity conditions. The magnitude of receptive relaxation was decreased in the liquid-120 compared to control, but this decrease was reversed with the increase of viscosity. The duration of the postprandial contractions in the proximal jejunum was decreased in the liquid-5 compared to the control, but this decrease was reversed in the middle and high viscosity conditions (p < 0.05). Rapid increase in plasma concentrations of gastric inhibitory polypeptide observed in the liquid-5 compared to the control was reversed in the low, middle, and high viscosity conditions. Although patterns of upper gut motility and gut hormone secretion after liquid enteral nutrients were considerably altered compared to those after solid meal ingestion, increasing the viscosity of liquid enteral nutrients reversed those altered patterns.
    No preview · Article · Jan 2011 · Hepato-gastroenterology

  • No preview · Article · Jan 2011 · Gastroenterology
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    ABSTRACT: A 53-year-old man whose pruritus ani was diagnosed by a dermatologist as Paget's disease and referred for further confirmation was found in total colonoscopy to have a tumor of the anal canal. Biopsies of the erythematous perianal skin lesion and the anal canal tumor showed anal canal adenocarcinoma with pagetoid spread, necessitating abdominoperineal resection with wide excision of the perianal skin. Pathology results showed that poorly differentiated and signetring cell adenocarcinoma in the anal canal invaded the muscularis propria and Paget cells occupied the perianal epidermis. Immunohistochemical staining was positive for cytokeratin (CK) 20, but negative for CK7 and gross cystic disease fluid protein 15 (GCDFP-15). The definitive diagnosis was anal canal adenocarcinoma with pagetoid spread. Although 42 cases, including ours, of rectal and anal adenocarcinoma with pagetoid spread have been reported, the prognosis remains unknown, making it essential to closely observe perianal skin changes and to biopsy skin lesions.
    No preview · Article · May 2010 · Nippon Shokaki Geka Gakkai zasshi
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    ABSTRACT: A 75-year-old male who with type 3 gastric cardia cancer with multiple liver metastases was initially treated with S-1 in July of 2005. After 4 courses of the treatment, the liver metastases became undetectable on abdominal CT scan, with reduction in size of the primary tumor of the stomach. After 7 months of S-1 treatment, however, the progression of the primary lesion was endoscopically detected, and irinotecan was administered, demonstrating primary tumor regression. When re-growth of the primary tumor was observed, 3 courses of paclitaxel treatment showed little effect and was replaced by docetaxel treatment for 5 months, which had a grade 3 adverse effect. The next 10 courses of 5-FU combined with methotrexate were applied for one year until the primary tumor showed enlargement. Then 12 courses of CDDP with S-1 were administered until now, and the size of the primary carcinoma is under control. The patient is being followed on an outpatient basis without any surgical treatment, while the liver metastases have not relapsed on abdominal imaging.
    No preview · Article · May 2010 · Gan to kagaku ryoho. Cancer & chemotherapy
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    ABSTRACT: The aim of the present study was to investigate the effects of diversion of biliary and pancreatic juices on upper gut motility and hormone secretion. We used dogs equipped with strain gauge force transducers to measure upper gut motility. Dogs were divided into 5 groups: control, sham operation, biliary diversion (BD), pancreatic juice diversion (PJD), and biliopancreatic juice diversion (BPD). Postprandial plasma concentrations of insulin, gastric inhibitory polypeptide (GIP), and peptide YY (PYY) were also measured. Occurrence and migration velocity of the migrating motor complex in the jejunum in the interdigestive state were decreased in the BD and BPD groups compared with the other 3 groups (P < .05). In the BD and BPD groups, areas of postprandial contractile curves in the upper gut were decreased, and the duration of the postprandial contractions in the proximal jejunum, which a previous study showed to correlate with gastric emptying, were less compared with the other 3 groups (P < .05). Plasma insulin levels did not differ among the 5 groups. Plasma concentrations of GIP suppressed in the PJD and BPD groups (P < .05), whereas plasma PYY level was increased in the BD group (P < .05). Bile diversion seems to inhibit interdigestive and postprandial upper gut contractions in association with an increase of plasma PYY. Pancreatic juice was considered to play a role in the secretion of GIP.
    No preview · Article · Apr 2010 · Surgery

  • No preview · Article · Jan 2009 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: Although parenteral nutrition (PN) prevents progressive malnutrition, lack of enteral nutrition (EN) during PN leads to gut associated lymphoid tissue (GALT) atrophy and dysfunction. Administering a small amount of EN with PN reportedly prevents increases in intestinal permeability. However, its effects on GALT remain unclear. We analyzed the minimum amount of EN required to preserve gut immunity during PN. Male Institute of Cancer Research mice underwent jugular vein catheter insertion and tube gastrostomy. They were randomized into four groups to receive isocaloric and isonitrogenous nutritional support with variable EN to PN ratios (EN 0, EN 33, EN 66, and EN 100). EN was provided with a complex enteral diet. After 5 days of feeding, the mice were killed and whole small intestines were harvested. GALT lymphocytes were isolated and counted. Their phenotypes were analyzed by flow cytometry. IgA levels of small intestinal washings were analyzed with enzyme-linked immunosorbent assay. Body weight changes did not differ between any two of the groups. Peyer's patch lymphocyte numbers increased in proportion to EN amount, whereas lamina propria lymphocyte numbers were significantly higher in the EN 100 than in the EN 0 group, with no marked increases in the EN 33 and EN 66 groups. Small intestinal IgA levels increased EN amount-dependently and reached a plateau at EN 66. A small amount of EN partially reverses PN-induced GALT changes, suggesting beneficial but limited effects on gut mucosal immunity.
    No preview · Article · Sep 2008 · The Journal of trauma
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    ABSTRACT: Lack of enteral nutrition reduces gut-associated lymphoid tissue (GALT) mass and function, a mechanism underlying the increased morbidity of infectious complications in severely injured or critically ill patients. Strategies to restore parenteral nutrition (PN)-induced changes of GALT mass and function have been pursued. However, the influences of adding fish oil to PN on gut immunity remain to be clarified. Male Institute of Cancer Research (ICR) mice (n = 50) were randomized to 4 groups: ad libitum chow (chow), fat free PN (fat (-)-PN), PN + fish oil (FO-PN), and PN + safflower oil (SO-PN). The PN groups were given isocaloric and isonitrogenous PN solutions. The FO- and SO-PN groups received 20% of total calories from fat emulsions. After 5 days of feeding, lymphocytes from Peyer's patches (PPs), the intraepithelial space (IE), and the lamina propria (LP) of the entire small intestine were isolated. GALT lymphocyte numbers and phenotypes (CD4+, CD8+, alphabetaTCR+, gammadeltaTCR+, B220+ cells) were determined. Immunoglobulin A (IgA) levels of small intestinal washings were also measured by enzyme-linked immunosorbent assay. Another set of mice (n = 24) was used to determine plasma fatty acid compositions after feeding. Lymphocyte numbers from PPs and the LP and intestinal IgA levels were significantly lower in the PN groups than in the chow group, with no significant differences between any 2 PN groups. The FO- and SO-PN groups showed moderate recovery of IE cell numbers compared with the fat (-)-PN group. Omega-3 and omega-6 fatty acid levels were increased with fish and safflower oil additions, respectively, compared with the fat (-)-PN group. Adding fish oil to PN does not exacerbate PN-induced GALT changes but rather partially reverses these changes, with increased plasma omega-3 fatty acid levels.
    No preview · Article · Sep 2007 · Journal of Parenteral and Enteral Nutrition
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    ABSTRACT: To clarify the influence of nutritional route on hepatic immunity in a murine model. Parenteral nutrition is disadvantageous for preventing infectious complications in critically ill and/or severely injured patients as compared with enteral nutrition. To date, lack of enteral nutrition has been demonstrated to impair mucosal immunity, gut barrier function, and the peritoneal defense system. However, influences of nutritional route on hepatic immunity, another important defense system against infection, have not been well studied. Male ICR mice were randomized to 3 groups: ad libitum chow (chow), intravenous (IV)-TPN and intragastric (IG)-TPN groups. The TPN groups were given isocaloric and isonitrogenous TPN solutions. After the mice had been fed for 5 days, hepatic mononuclear cells (MNCs) were isolated. Hepatic MNC numbers and functions (cytokine production, intracellular signaling, and LPS receptor expression) were determined. Moreover, 1.0 x 10 Pseudomonas aeruginosa were delivered by intraportal injection. Survival and histology were examined. Hepatic MNC numbers were significantly lower in the IV-TPN group than in the chow and IG-TPN groups, without subpopulation changes. As compared with enterally fed mice, cytokine production (TNF-alpha, IFN-gamma, and IL-10) by hepatic MNCs in response to LPS was impaired in parenterally fed mice in association with blunted phosphorylation of ERK1/2, a MAPK. Hepatic MNCs from IV-TPN mice showed decreased expressions of CD14 and TLR4/MD2, as compared with enterally fed mice. Survival times were reduced in the IV-TPN group as compared with the chow and IG-TPN groups. Preservation of hepatic immunity with enteral feeding is important for prevention of infectious complications in severely injured and/or critically ill patients.
    Preview · Article · May 2007 · Annals of Surgery
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    ABSTRACT: Long-term antibiotic administration is sometimes necessary to control bacterial infections during the perioperative period. However, antibiotic administration may alter gut bacterial flora, possibly impairing gut mucosal immunity. We hypothesized that 1 week of subcutaneous (SC) antibiotic injections would affect Peyer's patch (PP) lymphocyte numbers and phenotypes, as well as mucosal immunoglobulin A (IgA) levels. Sixty-one male Institute of Cancer Research mice were randomized to CMZ (cefmetazole 100 mg/kg, administered SC twice a day), IPM (imipenem/cilastatin 50 mg/kg x 2), and control (saline 0.1 mL x 2) groups. After 7 days of treatment, the mice were killed and their small intestines removed. Bacterial numbers in the small intestine were determined using sheep blood agar plates under aerobic conditions (n = 21). PP lymphocytes were isolated to determine cell numbers and phenotypes (CD4, CD8, alphabetaTCR, gammadeltaTCR, B220; n = 40). IgA levels in the small intestinal and bronchoalveolar washings were also measured with ELISA. Antibiotic administration decreased both bacterial number and the PP cell yield compared with the control group. There were no significant differences in either phenotype percentages or IgA levels at any mucosal sites among the 3 groups. Long-term antibiotic treatment reduces PP cell numbers while decreasing bacterial numbers in the small intestine. It may be important to recognize changes in gut mucosal immunity during long-term antibiotic administration.
    No preview · Article · Sep 2006 · Journal of Parenteral and Enteral Nutrition