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1.
Obstetrics & Gynecology Science ; : 226-233, 2021.
Article Dans Anglais | WPRIM | ID: wpr-902952

Résumé

Objective@#This study aimed to investigate the prognosis of patients with intermediate-risk cervical cancer and to evaluate the necessity of adjuvant therapy. @*Methods@#We conducted a retrospective chart review of patients with stage IB–II cervical cancer who underwent type III radical hysterectomy with pelvic lymphadenectomy between 2008 and 2017. In our institution, radical hysterectomy is performed as an open surgery and not as a minimally invasive surgery, and adjuvant therapy is not administered to patients with intermediate-risk cervical cancer. The intermediate-risk group included patients with 2 or more of the following factors: tumor size >4 cm, stromal invasion >1/2, and lymphovascular stromal invasion. Intermediaterisk patients with squamous cell carcinoma were included in the I-SCC group, whereas those with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma were included in the I-Adeno group. @*Results@#There were 34 and 18 patients in the I-SCC and I-Adeno groups, respectively. The 5-year recurrence-free survival (RFS) and overall survival rates in the I-SCC group were 90.5% (95% confidence interval [CI], 85.3–95.7%) and 100% (95% CI, 100%), respectively, whereas those in the I-Adeno group were 54.9% (95% CI, 42.0–67.9%) and 76.1% (95% CI, 63.7–88.4%), respectively. Multivariate analysis revealed that endocervical adenocarcinoma, usual type, or adenosquamous carcinoma, and tumor size >4 cm had worse RFS. @*Conclusion@#The I-SCC group had good prognosis without adjuvant therapy; therefore, adjuvant therapy may be omitted in these patients. In contrast, the I-Adeno group had poor prognosis without adjuvant therapy; therefore, adjuvant therapy should be considered in their treatment.

2.
Obstetrics & Gynecology Science ; : 226-233, 2021.
Article Dans Anglais | WPRIM | ID: wpr-895248

Résumé

Objective@#This study aimed to investigate the prognosis of patients with intermediate-risk cervical cancer and to evaluate the necessity of adjuvant therapy. @*Methods@#We conducted a retrospective chart review of patients with stage IB–II cervical cancer who underwent type III radical hysterectomy with pelvic lymphadenectomy between 2008 and 2017. In our institution, radical hysterectomy is performed as an open surgery and not as a minimally invasive surgery, and adjuvant therapy is not administered to patients with intermediate-risk cervical cancer. The intermediate-risk group included patients with 2 or more of the following factors: tumor size >4 cm, stromal invasion >1/2, and lymphovascular stromal invasion. Intermediaterisk patients with squamous cell carcinoma were included in the I-SCC group, whereas those with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma were included in the I-Adeno group. @*Results@#There were 34 and 18 patients in the I-SCC and I-Adeno groups, respectively. The 5-year recurrence-free survival (RFS) and overall survival rates in the I-SCC group were 90.5% (95% confidence interval [CI], 85.3–95.7%) and 100% (95% CI, 100%), respectively, whereas those in the I-Adeno group were 54.9% (95% CI, 42.0–67.9%) and 76.1% (95% CI, 63.7–88.4%), respectively. Multivariate analysis revealed that endocervical adenocarcinoma, usual type, or adenosquamous carcinoma, and tumor size >4 cm had worse RFS. @*Conclusion@#The I-SCC group had good prognosis without adjuvant therapy; therefore, adjuvant therapy may be omitted in these patients. In contrast, the I-Adeno group had poor prognosis without adjuvant therapy; therefore, adjuvant therapy should be considered in their treatment.

3.
Journal of Gynecologic Oncology ; : e7-2019.
Article Dans Anglais | WPRIM | ID: wpr-719308

Résumé

OBJECTIVE: Gynecologists occasionally encounter synchronous endometrial and ovarian endometrioid carcinoma (SEO-EC) patients who show favorable prognosis than locally advanced or metastatic disease patients. This study aimed to elucidate prognostic factors of SEO-EC and identify patients who have a sufficiently low risk of recurrence without receiving adjuvant chemotherapy. METHODS: We retrospectively reviewed 46 patients with pathologically confirmed SEO-EC who underwent surgery at the National Cancer Center Hospital between 1997 and 2016. Immunohistochemical evaluation of DNA mismatch repair (MMR) protein expression were performed for both endometrial and ovarian tumors. Patient outcomes were analyzed according to clinicopathologic factors. RESULTS: From the multivariate analysis, cervical stromal invasion indicated a worse prognosis for progression-free survival (hazard ratio [HR]=6.85; 95% confidence interval [CI]=1.50–31.1) and overall survival (HR=6.95; 95% CI=1.15–41.8). Lymph node metastasis and peritoneal dissemination did not significantly affect survival. MMR deficiency was observed in 13 patients (28.3%), with both endometrial and ovarian tumors showing the same MMR expression status. MMR deficiency was not significantly associated with survival. Of 23 patients with lesions confined to only the uterine body and adnexa, only 2 had recurrence in the group receiving adjuvant therapy, while none of the 10 patients who did not receive adjuvant therapy had recurrence. CONCLUSION: SEO-EC patients with tumors localized to the uterine body and adnexa lesions had a low risk for recurrence and may not require adjuvant therapy. SEO-EC may have prognostic factors different from those of endometrial and ovarian cancer.


Sujets)
Humains , Carcinome endométrioïde , Traitement médicamenteux adjuvant , Survie sans rechute , Réparation de mésappariement de l'ADN , Immunohistochimie , Noeuds lymphatiques , Analyse multifactorielle , Métastase tumorale , Tumeurs primitives multiples , Tumeurs de l'ovaire , Pronostic , Récidive , Études rétrospectives
4.
Journal of Gynecologic Oncology ; : e81-2019.
Article Dans Anglais | WPRIM | ID: wpr-764544

Résumé

OBJECTIVE: To treat advanced ovarian cancer, interval debulking surgery (IDS) is performed after 3 cycles each of neoadjuvant chemotherapy (NAC) and postoperative chemotherapy (IDS group). If we expect that complete resection cannot be achieved by IDS, debulking surgery is performed after administering additional 3 cycles of chemotherapy without postoperative chemotherapy (Add-C group). We evaluated the survival outcomes of the Add-C group and determined their serum cancer antigen 125 (CA125) levels to predict complete surgery. METHODS: A retrospective chart review of all stage III and IV ovarian, fallopian tube, and peritoneal cancer patients treated with NAC in 2007–2016 was conducted. RESULTS: About 117 patients comprised the IDS group and 26 comprised the Add-C group. Univariate and multivariate analyses revealed that Add-C group had an equivalent effect on progression-free survival (PFS; p=0.09) and overall survival (OS; p=0.94) compared with the IDS group. Multivariate analysis revealed that patients who developed residual disease after surgery had worse PFS (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.45–3.28) and OS (HR=2.33; 95% CI=1.43–3.79), and those who received <6 cycles of chemotherapy had worse PFS (HR=5.30; 95% CI=2.56–10.99) and OS (HR=3.05; 95% CI=1.46–6.38). The preoperative serum CA125 cutoff level was 30 U/mL based on Youden index method. CONCLUSIONS: Administering 3 additional cycles of chemotherapy followed by debulking surgery exhibited equivalent effects on survival as IDS followed by 3 cycles of postoperative chemotherapy. Preoperative serum CA125 levels of ≤30 U/mL may be a useful predictor of achieving complete surgery.


Sujets)
Femelle , Humains , Antigènes CA-125 , Interventions chirurgicales de cytoréduction , Survie sans rechute , Traitement médicamenteux , Trompes utérines , Méthodes , Analyse multifactorielle , Traitement néoadjuvant , Tumeurs de l'ovaire , Études rétrospectives
5.
Intestinal Research ; : 484-488, 2018.
Article Dans Anglais | WPRIM | ID: wpr-715871

Résumé

Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings.


Sujets)
Enfant , Femelle , Humains , Grossesse , Études de cohortes , Rectocolite hémorragique , Maladies inflammatoires intestinales , Mères , Parturition , Phénotype , Premier trimestre de grossesse , Qualité de vie , Récidive , Stéroïdes , Tacrolimus , Ulcère
6.
Japanese Journal of Cardiovascular Surgery ; : 122-125, 2017.
Article Dans Japonais | WPRIM | ID: wpr-379312

Résumé

<p>A 76-year-old woman required aortic valve replacement due to severe aortic stenosis. She had a huge thyroid cancer, which invaded the innominate and left internal jugular veins. We planned a two-stage operation : the first involved aortic valve replacement ; and the second involved operation of the thyroid cancer. To avoid median sternotomy, we adopted the right parasternal approach. A 7-cm right parasternal skin incision was made. The third and fourth costal cartilages were cut and bent into the right thoracic cavity, without removal of the ribs. The postoperative course was uneventful, and second operation was performed via the median sternotomy approach on postoperative day 53. The right parasternal approach can be used as an alternative when sternotomy is unsuitable in cases of aortic valve replacement.</p>

7.
Japanese Journal of Cardiovascular Surgery ; : 320-322, 2012.
Article Dans Japonais | WPRIM | ID: wpr-362974

Résumé

We report a case of redo aortic valve replacement by right minithoracotomy approach for aortic stenosis after coronary artery bypass grafting (CABG). An 81-year-old man was followed-up once a year for 9 years after CABG. He complained of increasing respiratory distress, showed narrowing of the aortic valve area, elevation of the aortic valve pressure gradient, and tricuspid valve regurgitation by echocardiography. He was admitted for surgery. We considered minimally invasive operation would be better for him and performed aortic valve replacement (Carpentier-Edwards Perimaunt valve 19 mm) by a right minithoracotomy approach because graft injury could occur by median sternotomy after CABG, and he had the risks of advanced age, low activities of daily living, and mild dementia. His postoperative course was uneventful. On echocardiography performed at postoperative days 9, the ejection fraction recovered to 75% from 53% before surgery and the mean aortic valve pressure gradient was 8 mmHg. He was discharged on postoperative day 12. Right minithoracotomy approach with port access is a good option for redo operation for aortic valve stenosis after CABG.

8.
Asian Journal of Andrology ; (6): 561-568, 2008.
Article Dans Anglais | WPRIM | ID: wpr-359929

Résumé

<p><b>AIM</b>To show whether molecular motor dynein on a microtubule track, molecular motor myosin Va, motor recruiter myosin Va, VIIa-Rab27a/b interacting protein (MyRIP), and vesicle receptor Rab27b on an F-actin track were present during human and monkey spermiogenesis involving intramanchette transport (IMT).</p><p><b>METHODS</b>Spermiogenic cells were obtained from three men with obstructive azoospermia and normal adult cynomolgus monkey (Macaca fascicularis). Immunocytochemical detection and reverse transcription-polymerase chain reaction (RT-PCR) analysis of the proteins were carried out. Samples were analyzed by light microscope.</p><p><b>RESULTS</b>Using RT-PCR, we found that dynein, myosin Va, MyRIP and Rab27b were expressed in monkey testis. These proteins were localized to the manchette, as shown by immunofluorescence, particularly during human and monkey spermiogenesis.</p><p><b>CONCLUSION</b>We speculate that during primate spermiogenesis, those proteins that compose microtubule-based and actin-based vesicle transport systems are actually present in the manchette and might possibly be involved in intramanchette transport.</p>


Sujets)
Adulte , Animaux , Humains , Mâle , Actines , Métabolisme , Transport biologique , Physiologie , Dynéines , Métabolisme , Macaca fascicularis , Microtubules , Métabolisme , Chaînes lourdes de myosine , Métabolisme , Myosine de type V , Métabolisme , Myosines , Métabolisme , Spermatides , Biologie cellulaire , Métabolisme , Spermatogenèse , Physiologie , Testicule , Biologie cellulaire , Métabolisme , Vésicules de transport , Physiologie , Protéines du transport vésiculaire , Métabolisme , Protéines G rab , Métabolisme
9.
Japanese Journal of Cardiovascular Surgery ; : 33-35, 2001.
Article Dans Japonais | WPRIM | ID: wpr-366637

Résumé

Abnormalities of the skeleton and joint as well as ophthalmic symptoms and cardiovascular abnormalities are found in Marfan's syndrome, one of the connective tissue diseases associated with autosomal dominant inheritance. A 34-year-old man was operated on for Stanford type A acute aortic dissection that developed 13 years after sternal turnover surgery for funnel chest. After approaching by median incision made on the sternum, composite graft replacement and aortic arch replacement were performed. After surgery, the sternum at the site of reflections became unsteady, causing flail chest, which required internal fixation with an artificial respirator for 15 days. A patient with Marfan's syndrome may undergo cardiovascular operation twice or more throughout his lifetime. Where a longitudinal incision is made on the sternum after operation on the funnel chest, care should be exercised even if it is a long time after surgery. In this sense, minimal invasive surgery with a steel bar inserted percutaneously, a surgical technique that has come to be used recently, should be useful.

10.
Japanese Journal of Cardiovascular Surgery ; : 271-274, 1999.
Article Dans Japonais | WPRIM | ID: wpr-366503

Résumé

A 22-year-old woman was admitted to our hospital with high fever and lumbar pain. Echocardiography revealed mitral regurgitation due to prolapse of the anterior mitral leaflet. On admission, her white blood cell count was high and results for C-reactive protein were positive. The blood culture was positive for hemolytic streptococcus. After the white blood cell count and C-reactive protein level were normalized, and the blood culture had become negative following treatment by multiple antibiotics, she underwent valvular surgery. Because the infectious lesion was limited to the mitral leaflet and chordae, mitral valvuloplasty was performed with a satisfactory postoperative result. The operative technique consisted of resection of the infected valvular tissue, implantation of artificial chordae with e-PTFE, and suture annuloplasty. To conclude, mitral valvuloplasty should be the operative method of choice in patients with infective endocarditis, especially in young women with the potential of future pregnancy and labor.

11.
Japanese Journal of Cardiovascular Surgery ; : 113-116, 1999.
Article Dans Japonais | WPRIM | ID: wpr-366464

Résumé

A 53-year-old woman was admitted with cardiac failure due to aortic regurgitation (AR) and pseudocoarctation of the aorta associated with Takayasu's aortitis. It was revealed that her hypertension of upper extremities was based on Takayasu's aortitis at her 37-year-old age. But at that time there was no sign of inflammation, only drug therapy for hypertension had been employed. She started to complaint of dyspnea on exertion and palpitation when 47 years old, ultrasonic echocardiography and cardiac catheterization revealed that her symptoms were based on pseudocoarctation and AR. Despite of drug therapy, her symptoms progressed and reached NYHA class III. Detailed examination showed progressed AR and occurrence of mitral regurgitation (MR). Surgical treatment, ascending aorto-terminal aortic bypass, aortic valve replacement (AVR), and mitral valvuloplasty was performed at the age of 53 years old. In instituting the extracorporeal circulation, an arterial cannula was placed in the graft that anastomosed to the terminal aorta, in addition to the arterial cannula to the ascending aorta, to prevent low perfusion of the organs distal to the pseudocoarctation. The postoperative course was uneventful. Special attention should be paid to prevent low perfusion of the organs in such case with presence of pressure gradient in the aorta.

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