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1.
Digestion ; 102(2): 161-169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31505493

RESUMO

BACKGROUND/AIMS: Delayed bleeding is among the adverse events associated with therapeutic gastrointestinal endoscopy. The aim of this study was to evaluate risk factors for delayed bleeding after gastrointestinal endoscopic resection in patients receiving oral anticoagulants as well as to compare the rates of occurrence of delayed bleeding between the oral anticoagulants used. METHODS: We retrospectively analyzed a total of 772 patients receiving anticoagulants. Of these, 389 and 383 patients were receiving direct oral anticoagulants (DOACs) and warfarin, respectively. Therapeutic endoscopic procedures performed included endoscopic submucosal dissection (ESD), endoscopic mucosal resection, polypectomy, and cold polypectomy. RESULTS: Delayed bleeding occurred in 90 patients (11.7%) with no significant difference between the DOAC and warfarin groups (9.5 and 13.8%, respectively). Delayed bleeding occurred significantly more frequently with apixaban than with rivaroxaban (13.5 vs. 6.4%; p < 0.05). A multivariate analysis identified continued anticoagulant therapy (OR 2.29), anticoagulant withdrawal with heparin bridging therapy (HBT; OR 2.18), anticoagulant therapy combined with 1 antiplatelet drug (OR 1.72), and ESD (OR 3.87) as risk factors for delayed bleeding. CONCLUSION: This study identified continued anticoagulant therapy, anticoagulant withdrawal with HBT, anticoagulant therapy combined with 1 antiplatelet drug, and ESD as risk factors for delayed bleeding after therapeutic endoscopy in patients receiving oral anticoagulants. Delayed bleeding rates were not significantly different between those receiving DOACs and warfarin. It was also suggested that the occurrence of delayed bleeding may vary between different DOACs and that oral anticoagulant withdrawal should be minimized during therapeutic gastrointestinal endoscopy, given the thromboembolic risk involved.


Assuntos
Anticoagulantes , Ressecção Endoscópica de Mucosa , Administração Oral , Anticoagulantes/efeitos adversos , Endoscopia Gastrointestinal , Humanos , Estudos Retrospectivos , Fatores de Risco
2.
Medicine (Baltimore) ; 97(30): e11654, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045318

RESUMO

Intraoperative cholangiography involving the excretion of fluorescent indocyanine green (ICG) into the bile is used to determine biliary anatomy in laparoscopic cholecystectomy (LC). This study aimed to evaluate the features of intraoperative ICG cholangiography, in LC with cholecystitis, and compared the delineation of the cystic duct (CD) between ICG cholangiography and magnetic resonance cholangiopancreatography (MRCP).Participants comprised 65 patients undergoing LC using ICG cholangiography.Fifty-eight patients (89.2%) were diagnosed with gallbladder stones and 32 (49.2%) with acute cholecystitis. ICG cholangiography identified CD in 54 patients (83.1%) and did not identify CD in 11 patients (16.9%). The mean value of the fluorescence intensity in the identified CD group by ICG cholangiography was 87.6 ±â€Š31.5 arbitrary unit and that in the not identified CD group by ICG cholangiography was 24.4 ±â€Š10.1 arbitrary unit (P < .001). Compared with the patients in the identified CD group, those in the not identified CD group had higher incidence of acute cholecystitis (P < .001), and higher conversion rates (P = .003). A correlation between the delineation of CD by ICG cholangiography and MRCP was analyzed, and it revealed a correlation between each other (P = .002)Inflammation had harmful effects with regard to the passing of CD. If we can identify CD or common bile duct with ICG cholangiography, we may be able to perform LC with confidence, even in the presence of severe inflammation.


Assuntos
Colangiografia/métodos , Colecistectomia Laparoscópica/métodos , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Corantes , Verde de Indocianina , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Ducto Colédoco/diagnóstico por imagem , Ducto Cístico/diagnóstico por imagem , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Surg Case Rep ; 3(1): 66, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28493096

RESUMO

BACKGROUND: Malignant mesothelioma commonly arises from the pleura, but can also arise from the peritoneum, pericardium, and tunica vaginalis testis. However, malignant mesothelioma of the liver is extremely rare and coexistence with malignant mesothelioma of the greater omentum has not been described in the literature. In this case report, we present a case of multiple malignant mesothelioma of the liver and greater omentum. CASE PRESENTATION: A 36-year-old woman was admitted to our hospital for the evaluation of an elastic hard mass in the right upper abdomen. Abdominal contrast computed tomography showed a cystic mass measuring 13 × 14 × 11 cm in the right liver lobe with enhanced mural nodule. Abnormal accumulation was identified in the liver and lower abdominal area on 18F-fluorodeoxyglucose positron emission tomography. The patient underwent hepatectomy of the posterior segment and partial resection of the omentum. The final pathological diagnosis was low-grade multiple malignant epithelioid mesothelioma based on characteristic immunohistochemical findings. As of 6 months postoperatively, the patient has shown no disease recurrence. CONCLUSIONS: We present the first case of a 36-year-old woman with multiple malignant mesothelioma of the liver and greater omentum.

4.
Ann Gastroenterol Surg ; 1(2): 136-142, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29863136

RESUMO

Objectives of the present study were to identify predictors of the recurrence of intrahepatic cholangiocarcinoma (ICC), and to evaluate the survival benefit of adjuvant chemotherapy and surgical treatment for ICC recurrence. A multi-institutional retrospective study was carried out in 356 patients with ICC who underwent curative surgery at one of 14 institutions belonging to the Kyushu Study Group of Liver Surgery. A total of 214 patients (60%) had recurrence. Predictors of ICC recurrence were as follows: positive for pathological intrahepatic metastasis (im), positive for lymph node metastasis (n), positive for pathological lymphatic infiltration (ly), pathological bile duct invasion (b), and tumor size ≥4.4 cm. Adjuvant chemotherapy was given to 120 patients (34%) and, in the patients with im or tumor size ≥4.4 cm, adjuvant chemotherapy showed a survival benefit. Only 37 patients (17%) underwent surgical treatment for ICC recurrence. The surgical treatment resulted in a good 5-year survival rate (44%), which is similar to the rate obtained by the first operation for primary ICC. Prognosis of patients with primary im after the second operation was significantly worse (5-year survival 18%) compared to patients without primary im. Primary im+ should be considered a contraindication for surgical treatment for ICC recurrence.

5.
Mol Clin Oncol ; 4(3): 393-398, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26998290

RESUMO

The present study aimed to study the efficacy of aprepitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately emetogenic chemotherapy (MEC) for colorectal cancer (CRC), and comprised a multicenter, phase II, open-label, randomized, parallel comparative study conducted as part of the Kagoshima aprepitant study for colon cancer in Japan. Patients with advanced or recurrent CRC were treated with standard MEC regimens (FOLFOX, XELOX or FOLFIRI) and received either standard chemotherapy [5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) + dexamethasone] or aprepitant regimen chemotherapy (5-HT3 RA + reduced-dose dexamethasone + aprepitant). The primary endpoint of the present study was the proportion of patients who achieved a complete response (CR) during the overall, acute, and delayed phases of the first planned chemotherapy cycle. Secondary endpoints were complete protection, the proportions of patients without emetic episodes or nausea, patients with no more than moderate nausea during the overall, acute and delayed phases, and the time to treatment failure. The CR rates in the overall, acute and delayed phases were similar in the aprepitant and the standard-regimen groups. Additionally, there were no significant differences in secondary endpoints between the two groups. In summary, aprepitant in combination with 5-HT3 RA and reduced-dose corticosteroids was well tolerated and effective in preventing CINV associated with moderately emetogenic antitumor agents in Japanese patients with CRC.

6.
Anticancer Res ; 24(2C): 1045-8, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15154620

RESUMO

One of the major obstacles in the treatment of hepatocellular carcinoma (HCC) is the intrinsic/acquired resistance to cisplatin-based chemotherapy. Copper-transporting P-type adenosine triphosphate (ATP7B) has been reported to be associated with cisplatin resistance in vitro. However, the expression of ATP7B has not previously been addressed in human liver and HCC. Our purpose was to investigate ATP7B expression in human liver and hepatocellular carcinoma and its clinical significance. We retrospectively examined the expression of ATP7B in primary hepatocellular carcinoma. Immunohistochemical analysis of ATP7B was performed using a monoclonal antibody against ATP7B in 19 surgically removed hepatocellular carcinomas. A variable degree of cytoplasmic staining of tumor cells was observed in 21.1% (4/19) of the analyzed carcinomas. ATP7B expression was not observed in normal hepatic cells. Strong expression of ATP7B was observed in all the analyzed bile ducts. These findings suggest that overexpression of ATP7B in hepatocellular carcinoma might be associated with unfavorable clinical outcome in patients treated with cisplatin-based chemotherapy. Further, ATP7B is expressed in bile duct epithelial cells, where it may mediate copper secretion into bile fluid.


Assuntos
Adenosina Trifosfatases/biossíntese , Carcinoma Hepatocelular/enzimologia , Proteínas de Transporte de Cátions/biossíntese , Neoplasias Hepáticas/enzimologia , Adenosina Trifosfatases/imunologia , Anticorpos Monoclonais/imunologia , Especificidade de Anticorpos , Ductos Biliares/enzimologia , Carcinoma Hepatocelular/tratamento farmacológico , Proteínas de Transporte de Cátions/imunologia , Cisplatino/farmacologia , ATPases Transportadoras de Cobre , Grânulos Citoplasmáticos/enzimologia , Resistencia a Medicamentos Antineoplásicos , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/tratamento farmacológico , Estudos Retrospectivos
7.
Gan To Kagaku Ryoho ; 29(11): 1981-3, 2002 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-12465400

RESUMO

We report a patient with hepatocellular carcinoma (HCC) with intraperitoneal lymph node metastases in whom UFT (uracil + tegafur) was markedly effective. The patient was a 70-year-old woman with chronic hepatitis C, who developed HCC mainly infiltrating the medial segment of the liver. Arterial infusion chemotherapy and embolization were performed, and radiofrequency ablation was also conducted. Despite these interventions, the serum alpha-fetoprotein level continued to increase, and reached a level as high as 208,000 ng/ml by the second month of treatment. Abdominal computed tomography (CT) revealed no recurrence in the liver, but multiple metastases to intraperitoneal lymph nodes were identified. UFT-E treatment was initiated at the dose of 400 mg/day. A subsequent abdominal CT revealed complete disappearance of the intraperitoneal lymph node metastases 2 months after the start of UFT treatment. The serum alpha-fetoprotein level returned to normal 4 months after the start of UFT treatment. We consider that the patient described here is a good example to illustrate the remarkable effectiveness of UFT in the treatment of metastatic HCC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/secundário , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Linfonodos/patologia , Administração Oral , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Feminino , Humanos , Metástase Linfática , Peritônio , Tegafur/administração & dosagem , Uracila/administração & dosagem
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