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Purpose The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients. Design Retrospective review of medical records. Subjects and setting The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014. Methods Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis. Results Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002). Conclusions Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

Platelet-derived growth factors (PDGFs) are known to be associated with tumor growth and angiogenesis through their activation of the receptor tyrosine kinases, PDGF receptors alpha and beta. Several studies revealed the participation of the PDGF family in colorectal cancer (CRC). However, the role of platelet derived growth factor-C (PDGFC) in CRC is less well studied. This study aimed to determine the correlation between PDGFC expression and the prognosis of patients with CRCs. Tumor samples were obtained from patients with CRC who underwent surgical resection between 2002 and 2006. The mRNA expression of PDGFC was investigated by quantitative reverse transcription-polymerase chain reaction in 85 patients with stage I-IV CRC. PDGFC protein expression was analyzed by immunohistochemistry, and the relationship between PDGFC protein expression and clinicopathologic features was investigated in 245 patients with stage I-III CRC. PDGFC mRNA expression in cancer tissues was significantly higher in patients with distant metastases than in those without metastases (P = 0.016). PDGFC protein overexpression was associated with significantly worse overall and relapse-free survival (P P - 6.081, P

Various guidelines suggest indications for performing additional colectomy with en bloc removal of regional lymph nodes after endoscopic resection for T1 colon cancer. The aim of this study was to evaluate the pathologic outcomes of patients with surgical treatment after endoscopic resection for T1 colorectal cancer. We used data from 275 patients who had undergone curative resection for T1 colorectal cancer at a single institution between 1991 and 2009. We evaluated the rationale for additional surgical treatment after endoscopic resection performed on 68 of the 275 patients and the association between various clinicopathologic features and lymph node metastasis. The 5-year overall survival rate was 96.3 %. Reasons for additional surgical treatment included an endoscopic specimen with a pathologically positive margin (n = 20), lymphovascular invasion (n = 25), and submucosal invasion depth of ≥1,000 μm (n = 23). When endoscopists failed to find macroscopic cancer residue during endoscopic resection, no pathologically residual cancer was found in the resected specimens. Histologic grade was an independent risk factor for lymph node metastasis (p = 0.028). In the absence of lymphovascular invasion, patients with well-differentiated T1 colorectal cancer did not have nodal involvement. Although the outcomes of patients with additional surgical treatment after endoscopic resection for T1 colorectal cancer were satisfactory, excessive and unnecessary treatments may have been performed. Additional surgical treatment after endoscopic resection for T1 colorectal cancer might be unnecessary for patients with well-differentiated adenocarcinoma and no lymphovascular invasion.

Background/Aims: Increasing negative lymph node count has been reported to be associated with better outcomes in patients with colon cancer. The present study aimed to clarify the clinical significance of the lymph node ratio (LNR) and location of lymph node metastasis (LNM) in patients with stage III right colon cancer. Methods: We enrolled 820 patients who had undergone curative resection due to colon cancer at a single institution between 1991 and 2005. Among them, 197 underwent curative resection for T2–T4 right colon cancer. We evaluated the oncological outcomes according to LNR (quartiles) and distribution of LNM (n1 = LNM adjacent to the colon or along the vascular arcades of the marginal arteries; n2 = LNM along the major vessels; n3 = LNM near the roots of the major vessels). Results: The rates of LNM in T2, T3 and T4 right colon cancer were 11.1, 38.6 and 58.0%, respectively (p < 0.0001). Recurrence rates were 27.3, 37.5 and 57.1% in patients with n1, n2 and n3 LNM, respectively (p < 0.0001). LNR (p < 0.0001) and distribution of LNM (p = 0.046) were independent risk factors for recurrence in patients with stage III right colon cancer. Conclusions: Some patients with extensive LNM benefited from lymph node dissection with high ligation. Those with T3–T4 right colon cancer are suitable candidates for lymph node dissection with high ligation. Adding the concept of LNR and location of LNM to conventional TNM staging could improve the accuracy of evaluating nodal status.

Distant metastasis is the major cause of death in colorectal cancer (CRC) patients. To identify genes influencing the prognosis of patients with CRC, we compared gene expression in primary tumors with and without distant metastasis using an oligonucleotide microarray. We also examined the expression of the candidate gene in 100 CRC patients by quantitative real-time reverse transcription PCR and studied the relationship between its expression and the prognosis of patients with CRC. As a result, we identified MUC12 as a candidate gene involved in metastasis processes by microarray analysis. Quantitative real-time reverse transcription PCR showed that MUC12 expression was significantly lower in cancer tissues than in adjacent normal tissues (p < 0.001). In Stages II and III CRC, patients with low expression showed worse disease-free survival (p = 0.020). Multivariate analysis disclosed that MUC12 expression status was an independent prognostic factor in Stages II and III CRC (relative risk, 8.236; 95% confidence interval, 1.702-39.849 p = 0.009). Our study revealed the prognostic value of MUC12 expression in CRC patients. Moreover, our result suggests MUC12 expression is a possible candidate gene for assessing postoperative adjuvant therapy for CRC patients.

Background: This study aimed to validate an easy to use practical classification of peritoneal metastasis arising from colorectal cancer. Patients and Methods: Data from 2,134 consecutive patients who underwent resection for colorectal cancer at a single institution were reviewed. Peritoneal metastasis was classified depending on extent into three groups (P1–P3). The macroscopic radical resection rates and survival of patients with colorectal cancer complicated with peritoneal metastasis were analyzed. Results: Of the 2,134 patients, 116 (5.4%) had peritoneal metastasis. Among them, 20 (17.2%) underwent macroscopic radical resection. Tumor location on the right side was associated with more extensive peritoneal metastasis (p = 0.010). Male gender (p = 0.0027), liver metastasis (p = 0.0021), and P3 peritoneal metastasis were independent risk factors for noncurative resection. The Cox proportional hazards model showed that gender (p = 0.031), operation period (p = 0.031), and macroscopic radical resection for colorectal cancer and peritoneal metastasis (p = 0.031) were independent prognostic factors. Conclusions: Being female with left colon cancer complicated with P1 or P2 peritoneal metastasis is a good indicator for macroscopic radical resection if liver metastasis is absent. The present classification helped to determine surgical indication for patients with colorectal cancer complicated with synchronous peritoneal metastasis in routine clinical practice.

盲腸癌による穿通で広範な腹壁膿瘍を呈し，癌による穿通部以外にも複数の箇所で腹壁膿瘍と腸管に交通を認めた症例を経験したので報告する．症例は74歳の男性で，食思不振・腹痛で当院を受診された．腹部CTにて広範な腹壁膿瘍を認めるとともに，盲腸壁の肥厚を認めた．大腸癌による腹壁膿瘍が疑われたが，まず膿瘍ドレナージを施行し，全身状態の改善を図った．後日，結腸右半切除術を施行した．腹壁膿瘍が非常に広範であったこと，また入院時より患者の全身状態が不良なこともあり腹壁は合併切除しなかった．病理組織学的検索では盲腸の中分化腺癌で，pSI，pN2，ly2，v2，fStage IIIbであった．腹壁膿瘍を治療する場合，その原因として大腸癌も念頭におく必要があると考えられた．また，その診断にはCTが有用である一方，膿瘍ドレナージにおける細胞診の有用性は低いと考えられた．

The PI3K-AKT pathway is activated in a variety of human cancers, resulting in disturbance of cell growth, proliferation and survival. Among the factors affecting the pathway, the K-Ras mutation and PIK3CA mutation are the most common oncogenic alterations in colorectal cancer. We hypothesized that these two mutations are important in activation of the PI3K pathway and colorectal carcinogenesis. In this study, we aimed to examine the influence of PIK3CA mutation and K-Ras mutation on AKT activation, and to clarify whether PIK3CA mutation, K-Ras mutation and p-AKT expression may be used as parameters for predicting prognosis in colorectal cancer. Tissue samples from 158 colorectal cancer patients who underwent surgical resection were examined. The sequences of exon 1 of K-Ras and exons 9 and 20 of PIK3CA were determined by direct sequencing using genomic DNA extracted from paraffin-embedded blocks. Activation status of AKT was evaluated by immunohistochemical staining using phospho-specific AKT antibody (Ser473). Correlation between these factors and clinicopathologic findings/patient survival were examined. As a result, PIK3CA mutation was significantly associated with shorter relapse-free survival (RFS) in stage II/III patients (p = 0.0216) and shorter disease-specific survival in all patients (p = 0.0357). In the multivariate analysis, PIK3CA mutation was the only independent and significant prognostic factor for RFS in stage II/III patients (p = 0.0433, HR 2.478). This study revealed the prognostic value of PIK3CA mutation in colorectal cancer patients. Patients with PIK3CA mutation should be followed up carefully. Moreover, our result suggests that inhibition of PIK3CA mutant may be a new molecular target therapy.

Background The potential of expression profiling using microarray analysis as a tool to predict the prognosis for different types of cancer has been realized. This study aimed to identify a novel biomarker for colorectal cancer (CRC). Methods The expression profiles of cancer cells in 152 patients with stage I-III CRC were examined using microarray analysis. High expression in CRC cells, especially in patients with distant recurrences, was a prerequisite to select candidate genes. Thus, we identified seventeen candidate genes, and selected Traf2- and Nck-interacting kinase (TNIK), which was known to be associated with progression in CRC through Wnt signaling pathways. We analyzed the protein expression of TNIK using immunohistochemistry (IHC) and investigated the relationship between protein expression and patient characteristics in 220 stage I-III CRC patients. Results Relapse-free survival was significantly worse in the TNIK high expression group than in the TNIK low expression group in stage II (p = 0.028) and stage III (p = 0.006) patients. In multivariate analysis, high TNIK expression was identified as a significant independent risk factor of distant recurrence in stage III patients. Conclusion This study is the first to demonstrate the prognostic significance of intratumoral TNIK protein expression in clinical tissue samples of CRC, in that high expression of TNIK protein in primary tumors was associated with distant recurrence in stage II and III CRC patients. This TNIK IHC study might contribute to practical decision-making in the treatment of these patients. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1783-y) contains supplementary material, which is available to authorized users.

Several lines of experimental evidence indicated that over-expression of vascular endothelial growth factor-C and cyclooxygenase-2 genes promotes angiogenesis and lymphangiogenesis, both of which are essential for the growth and spreading of tumor cells. This study was designed to evaluate the coexpression of vascular endothelial growth factor-C and cyclooxygenase-2 in human colorectal carcinoma to determine their relationships and correlations with lymph node metastasis and prognosis.Tissue samples of primary tumors and metastatic lymph nodes from 150 patients undergoing intentionally curative surgical resections for colorectal adenocarcinoma were immunohistochemically examined for vascular endothelial growth factor-C, cyclooxygenase-2, and CD34 expressions. Then, we analyzed their relationships and correlations with clinicopathologic findings and patients' survival time.The positivity rate of vascular endothelial growth factor-C and cyclooxygenase-2 in the primary tumor was 68 and 72.7 percent, respectively, and in the metastatic lymph nodes was 93.3 and 80 percent, respectively. A significant correlation was found between the expression scores of vascular endothelial growth factor-C and cyclooxygenase-2 (P0.0001), and both also were correlated to microvessels density and several clinicopathologic parameters, including primary tumor size, lymph node metastasis, lymphatic invasion, and TNM stage. Patients with vascular endothelial growth factor-C-positive and/or cyclooxygenase-2-positive tumors had a significant shorter survival time than those with negative tumors did. However, in a multivariate analysis, only cyclooxygenase-2 expression was recognized as an independent prognostic factor (P = 0.0412; relative risk ratio, 3.067; 95 percent confidence interval, 1.046-8.994).These data show that in human colorectal carcinoma, vascular endothelial growth factor-C and cyclooxygenase-2 are coexpressed and significantly associated with lymph node metastasis and prognosis.

An anastomotic leak is one of the major complications following colorectal surgery. Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy. The over-the-scope-clipping (OTSC) system was originally developed to treat intestinal perforation or to close the tissue after natural orifice transluminal endoscopic surgery. Two cases of successful management of an anastomotic leak after colorectal surgery using the OTSC system are reported. One patient avoided a temporary ileostomy. In the other, hospitalization was shortened by the use of the OTSC system. The OTSC system can be a potential option in the management of anastomotic leaks after colorectal surgery.

The accurate preoperative diagnosis of depth of tumor invasion and nodal status in distal rectal cancer is important because neoadjuvant chemotherapy or lateral pelvic lymph node dissection is indicated for patients with T3-T4 tumor or nodal involvement. This study aimed to determine the optimal cutoff value for predicting lymph node metastasis in patients with distal rectal cancer using multidetector row computed tomography (MDCT).The study investigated 77 patients who had undergone surgery for distal rectal cancer at a single institution between 2008 and 2011. Diagnostic performance for depth of tumor invasion and mesorectal and lateral pelvic lymph node metastases was evaluated. The optimal cutoff value was determined by receiver operating characteristic curve analysis.For predicting mesorectal and lateral pelvic lymph node metastasis, MDCT had a sensitivity of 0.36 and 0.89 and a specificity of 0.78 and 0.97, respectively. The optimal cutoff values of major and minor axes lengths for predicting mesorectal lymph node metastasis were 6.5 mm and 5.7 mm, respectively. The areas under the curve (AUCs) were 0.82 and 0.88, respectively. For predicting lateral lymph node metastasis, the optimal cutoff values were 9 mm for the major axis and 6 mm for the minor axis. Both AUCs were 1.Using MDCT, the optimal cutoff value of minor axis length for predicting mesorectal and lateral pelvic lymph node metastases in patients with distal rectal cancer was 6 mm. The accuracy of MDCT was satisfactory for predicting lateral pelvic lymph node metastasis.

Background A number of patients undergo percutaneous endoscopic gastrostomy (PEG) under various conditions. Open colectomy is usually performed for colon cancer in patients with PEG because the safety of the laparoscopic approach for such patients has not been established. However, if the laparoscopic approach is possible in patients with PEG, it will be less invasive and more helpful in rehabilitation into society. Case presentation We describe the case of a 64-year-old male with a T1 adenocarcinoma of the ascending colon 2 years after surgery for nasal cancer and PEG for dysphagia. The patient did not have any distant metastases or malignant tumors on preoperative computed tomography and positron-emission tomography. He underwent laparoscopic-assisted colectomy (LAC) with lymph node dissection. No complications developed during or after the surgery. Conclusions LAC could be a potential option for the treatment of colon cancer in patients who have undergone PEG. To our knowledge, this is the first recorded case of an ascending colon cancer treated with LAC under the condition of gastrostoma.

The purpose of this study was to find a methylation-related gene that could become a biomarker or therapeutic target in colorectal carcinoma (CRC). We screened candidate genes suspected to be silenced by DNA methylation using cDNA microarray analysis. To investigate the clinical significance of one candidate gene (UNC5B), we analyzed the correlation between mRNA expression and clinicopathological features using clinical tissue samples. Moreover, methylation specific PCR analysis was performed to reveal whether the promoter region was methylated in CRC cell lines. We found 75 candidate genes that were potentially suppressed by DNA methylation in CRC. We focused on UNC5B, a possible tumor suppressor gene and regulator of apoptosis known to be inactivated in CRC. The mRNA expression analysis using tissue samples revealed that UNC5B mRNA was down-expressed in about 20% of CRC patients, and the patients with low-UNC5B-expression tumors showed a significantly higher recurrence rate after curative surgery. According to the univariate and multivariate analysis, low UNC5B expression was an independent risk factor for postoperative recurrence in stage I, II and III CRC patients. Furthermore, patients with low expression of UNC5B in tumors had significantly poorer prognosis than those with high expression of UNC5B. Although UNC5B mRNA expression was restored by the demethylation treatment in CRC cell lines, the promoter region of UNC5B was not methylated. UNC5B is a potential biomarker for the selection of patients with high risk of postoperative recurrence and worse prognosis in CRC.

The majority of human solid tumors exhibit aneuploidy caused by impairment of the mitotic checkpoint. Since the Mad2, BubR1 and Aurora kinase B (AURKB) proteins are involved in the mitotic checkpoint, we investigated Mad2, BubR1 and AURKB mRNA expression and its effect on clinicopathological parameters and prognosis in 100 consecutive patients who underwent surgical resection for gastric cancer. Mad2, BubR1 and AURKB mRNA expression levels in gastric cancer tissues and corresponding normal gastric mucosa were compared by real-time quantitative RT-PCR. The data were then correlated to clinicopathological parameters and prognosis. The expression of Mad2, BubR1 and AURKB mRNA was found to be significantly higher in cancer tissue compared to normal tissue. BubR1 and AURKB expression was significantly higher during the earlier stages of the disease. Patients with high BubR1 expression had improved relapse-free survival and overall survival compared to patients with low BubR1 expression. Multivariate analysis of stage II and III patients indicated that high expression of BubR1 and/or AURKB was associated with improved overall survival. We conclude that overexpression of BubR1 and AURKB is associated with a low risk of gastric cancer progression, and that overexpression of BubR1 and/or AURKB can therefore be used to identify gastric cancer patients with a favorable prognosis.

Purpose: This study aimed to identify a novel biomarker or a target of treatment for colorectal cancer (CRC). Experimental Design: The expression profiles of cancer cells in 104 patients with CRC were examined using laser microdissection and oligonucleotide microarray analysis. Overexpression in CRC cells, especially in patients with distant metastases, was a prerequisite to select candidate genes. The mRNA expression of candidate genes was investigated by quantitative reverse transcriptase PCR (RT-PCR) in 77 patients as a validation study. We analyzed the protein expression and localization of the candidate gene by immunohistochemical study and investigated the relationship between protein expression and clinicopathologic features in 274 CRC patients. Results: Using microarray analysis, we identified 6 candidate genes related to distant metastases in CRC patients. Among these genes, osteoprotegerin (OPG) is known to be associated with aggressiveness in several cancers through inhibition of apoptosis via neutralization of the function of TNF-related apoptosis-inducing ligand. The mRNA expression of OPG in cancer tissues was significantly higher in patients with distant metastases than those without metastases. Overexpression of OPG protein was associated with significantly worse overall survival and relapse-free survival. Moreover, overexpression of the OPG protein was an independent risk factor for CRC recurrence. Conclusion: Overexpression of OPG may be a predictive biomarker of CRC recurrence and a target for treatment of this disease. Clin Cancer Res; 17(8); 2444–50. ©2011 AACR.

Aberrant promoter hypermethylation (methylation) is an epigenetic change that silences the expression of crucial genes, thus inactivating the apoptotic pathway in various cancers. Inactivation of the apoptotic pathway has been considered to be associated with chemoresistance. The objective of the present study was to clarify the effect of the methylation of the apoptosis-related genes, Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP3) and death-associated protein kinase (DAPK), on the response to chemotherapy in metastatic or recurrent gastric cancers. Tumor samples were obtained from 80 gastric cancer patients who were treated with fluoropyrimidine-based chemotherapy for distant metastatic or recurrent disease, after surgical resection of the primary tumor. The methylation status of the apoptosis-related genes, BNIP3 and DAPK, was investigated by methylation-specific PCR. Methylation in BNIP3 was detected in 31 tumors (39%) and in DAPK in 33 tumors (41%). There was no correlation between the methylation status of BNIP3 and that of DAPK. The response rate was significantly lower in patients with methylation of DAPK, than in those without (21 vs. 49% p=0.012). Progression-free survival time (PFS) was shorter in patients with methylation of DAPK than in those without (p=0.007). The overall survival time (OS) was shorter in patients with methylation of BNIP3 than in those without (p=0.031). The response rate was significantly lower in patients with methylation of either DAPK or BNIP3, or both, than in those without methylation (p=0.003). PFS and OS were significantly shorter in patients with methylation of either or both of these genes than in those without (p=0.002, p=0.001). The methylation of BNIP3 and DAPK can predict lower response to chemotherapy and poor prognosis in gastric cancer.

Several new drugs that are targeted towards various angiogenic factors have shown considerable potential for controlling tumor proliferation and metastases. Expression levels of the targeted genes in primary tumors and metastases should be understood to maximize the use of such drugs. The present study aimed to clarify associations between mRNA levels of cyclooxygenase 2 (COX-2) and angiogenic factors [vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8)] in primary colorectal cancer and in corresponding liver metastasis. We also compared these gene expressions of primary colorectal cancer between patients with and without liver metastasis. In 31 pairs of formalin-fixed and paraffin-embedded primary and metastatic liver tumors as well as 27 specimens of consecutive stage II patients without recurrence, mRNA was quantified by real-time reverse transcription-polymerase chain reaction following the laser capture microdissection. We found a significantly positive correlation in IL-8 between primary tumors and matched liver metastases (p=0.034, rs=0.39) and in VEGF (p=0.0083, rs=0.48), but not in COX-2, which was associated with both VEGF (p=0.044, rs=0.37) and IL-8 (p=0.0004, rs=0.64) in primary colorectal cancers. Multiple regression analysis revealed that COX-2 was independently associated with IL-8 (p

Formation of an intratracheal granuloma is one of the sequelae in tracheotomy. We reported a man of intratracheal granuloma. The patient underwent an emergency tracheotomy in another hospital to secure his air way for unconsciousness caused by the traffic accident. Six weeks later, his tracheostoma was closed. After the closure of the tracheostoma, shortness of breath increased gradually. After six months, as his dyspnea became severe, he visited our hospital urgently. We removed the intratracheal granuloma through the new tracheostoma which was made by us. We cited a few factors as the cause of the intratracheal granuloma, that is, infection around the tracheostoma, mechanical irritation of the cannula and unskillful technique in the tracheotomy. It is concluded that we must pay much attention to surgical managements in tracheotomy in order to avoid complications and sequelae, even though the tracheotomy is in emergency.

A new method for assessing the selected hearing aids was developed and applied 53 patients with hearing impairment. Our previous paper showed that the average confusion distance which was introduced in this method was useful for estimating the hearing aids. We carried out a follow-up survey in order to measure the usefulness of this method after 3 or 4 years practical hearing aid use. There were 34 patients out of 53 from whom we could obtain adequate information about their hearing aids. They were asked to rate their satisfaction with the recommended instrument in five degrees. Fifteen of the 34 patients who had purchased the recommended hearing aid rated it very satisfactory; four rated the aid satisfactory; eight rated the aid helpful; six rated the aid sometimes helpful; and one rated the aid unsatisfactory. The Spearman's rank correlation coefficient between the change in the speech discrimination score with and without a hearing aid and the user's evaluation was 0.34. The Spearman's rank correlation coefficient between the change in the average confusion distance and user's evaluation was 0.41. The value 0.34 is not significant, but the value 0.41 is significant at the 1% level of significance. Therefore, we think that the average confusion distance should be taken into consideration as well as the speech discrimination score at least for predicting successful hearing aid use. Finally we feel that there is need for the inclusive system which is able to estimate both the speech mediated communication ability and user's satisfaction.

Stenosis of the tracheostoma after laryngectomy is a potentially serious condition. We performed revision surgery of the tracheostomal stenosis after laryngectomy for 10 patients in our clinic between May 1975 and March 1988. Ten patients consisted of 9 males and 1 female with ages ranged from 56 to 74 years. We classified our cases into three types; vertical slit type, concentric type and inferior shelf type. A vertical slit type of stenosis occurred in 9 cases and a concentric type of stenosis in one. We speculated that tracheostomal stenosis was created by an excessive scar tissue formed after postoperative infection, excessive skin around the stoma and supportless tracheal ring. There was one patient who had undergone preoperative radiotherapy. Finally, we reviewed several reconstruction methods of the stenosed tracheostoma and presented our own methods. We recommend a surgical revision for tracheostomal stenosis after laryngectomy when it occurred unfortunately.

Background: Angiogenesis is required for growth and metastasis of colorectal cancer (CRC), and several positive regulators of tumor angiogenesis have been identified. Cyclooxygenase-2 (COX-2), known to be elevated in several human cancers, regulates angiogenesis by inducing angiogenic factors. The aim of this study was to clarify the levels and evaluate the relationships of COX-2, vascular endothelial growth factor A and C, thymidine phosphorylase (TP) and microvascular density (MVD) in paired tissue specimens between primary CRC and corresponding metastatic liver cancer. Methods: Tissue samples from pairs of primary tumors and corresponding metastatic liver tumors from 44 patients with CRC were immunohistochemically evaluated for COX-2, VEGFA, VEGF-C, TP and MVD. Results: The primary and corresponding metastatic liver tumors tended to show concordant immunoreactivity for COX-2 (P ¼ 0.005, rs ¼ 0.428), VEGF-A (P ¼ 0.039, rs ¼ 0.314), TP (P ¼ 0.005, rs ¼ 0.422) and MVD (P ¼ 0.046, rs ¼ 0.304) by Spearman rank test. The rate of COX-2 immunoreactivity was higher in liver metastases than in primary tumors (P ¼ 0.002), while the rate of VEGF-A was higher in primary tumors than in liver metastases (P ¼ 0.0004). The incidence of TP immunoreactivity and the level of MVD did not differ between primary and metastatic liver tumors (P ¼ 0.247; P ¼ 0.229). Significant correlations were found between COX-2 immunoreactivity and VEGF-A immunoreactivity in metastatic liver tumors (P ¼ 0.033) as well as in primary tumors (P ¼ 0.008). Conclusion: The positive correlations between COX-2, VEGF-A, TP and MVD in primary CRC and liver metastasis as demonstretaed here will help to predict the angiogenic activity of liver metastasis by analyzing primary tumors, allowing for individualized cancer treatment options.

Many studies have shown that angiogenesis plays an important role in the process of cancer development and progression. Vascular endothelial growth factor (VEGF) has a potent angiogenic activity, and cyclooxygenase-2 (COX-2) supports angiogenesis by regulated production of angiogenic factors, including VEGF. The purpose of this study was to examine the expression of VEGF in combination with COX-2 and CD34, their correlation with various clinicopathological factors, and their prognostic significance in human gastric carcinoma.Specimens from 169 patients with different grade and stage gastric carcinoma were investigated by immunohistochemistry for COX-2 and VEGF expression. Tumor microvessel density was assessed with CD34 immunostaining. Correlations between the expression of VEGF, COX-2, CD34, and various clinicopathological factors were studied. The effect of these proteins on patient survival was determined.COX-2 and VEGF were positively expressed in 36.7% and 50.3% of the patients, respectively. Positive correlation was found between VEGF and COX-2 and between VEGF and CD34. VEGF expression was correlated with depth of invasion; metastatic lymph nodes; lymphatic and venous invasion; and tumor, node, metastasis system stage. Patients with positive staining for VEGF showed far lower disease-free (64.9% vs. 81.3%) and overall (58.3% vs. 76.9%) survival rates than VEGF-negative patients. In multivariate analysis, only tumor location, depth of invasion, and lymph node metastasis were shown to be independent prognostic factors.VEGF expression correlates with angiogenesis and tumor progression and is a valuable prognostic factor in patients with gastric carcinoma.

Colorectal cancer (CRC) is among the most common types of cancer in both men and women and is associated with high mortality, particularly at advanced stages. Markers for defining individual risk signatures in CRC patients are of great clinical value, as they may allow for targeted therapies to improve outcomes in CRC patients. Epigenetic alteration such as promoter hypermethylation of gene, as well as genetic abnormality such as gene mutation, occurs frequently during the pathogenesis of human cancers. Recent studies exhibit the increasing observations that both epigenetic and genetic changes combine to determine the phenotype of cancer. Thus, in the present study, we examined KRAS and PIK3CA mutations and the methylation status of BNIP3, SFRP1, and Dkk1, and analyzed the correlation between these molecular alterations and the clinicopathological features of CRC. We aimed to clarify whether a combination of genetic and epigenetic alterations can be used to classify CRC patients in relation to their clinicopathological features and outcomes. Tissue samples from 122 CRC patients who underwent surgical resection were examined. The methylation status of SFRP1 and Dkk1 and the sequences of exon 1 of KRAS gene and exons 9 and 20 of the PIK3CA gene were determined by methylation specific PCR and direct sequencing, respectively, using genomic DNA extracted from paraffin-embedded blocks. Correlation between these factors and clinicopathologic findings/patients survival were examined. As a result, there was a significant correlation between KRAS mutation and BNIP3 (p=0.0004) or Dkk1 (p=0.0009) methylation but not SFRP1 (p=0.114). Although SFRP1 and Dkk1 methylation showed no associations with disease specific survival (DSS) and other clinicopathological findings in CRC patients, BNIP3 was associated with poor DSS (p=0.0149). In CRC without both KRAS and PIK3CA mutation, patients with two or three methylated genes had poorer overall survival compared to those with no or one methylated genes (p=0.0017). To contrary, in the cases of at least one or more mutations, patients with two or three methylated genes tended to have better survival than patients with no methylation. Classifying CRC based on BNIP3, SFRP1, and Dkk1 methylation status and KRAS and PIK3CA mutation may be a clinically powerful predictor of patient outcome. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4565. doi:1538-7445.AM2012-4565

We reviewed 64 cases of peritonsillar abscess treated at our clinic between May, 1975 and March, 1988. The patients consisted of 42 males and 22 females, aged 3 to 68 years. The abscess was on the right side in 35 cases, on the left in 28 cases and bilateral in 1 case. Bacteriological study of the abscess revealed a high percentage of α-streptococcus and β-streptococcus in aerobic culture, and Bacteroides sp., Peptostreptococcus sp., and Peptococcus., in anerobic culture. All patients were treated with antibiotics. Removal of abscess by puncture was performed in 23 patients, and incision for drainage was perfomed in 41. Interval tonsillectomy was perfomed in 3 patients and immediate tonsillectomy was perfomed in 1 patient. Recurrent peritonsillar abscess was observed in one patient who had not undergone tonsillectomy. Puncture of abscess, incision for drainage and administration of antibiotics are essential in the treatment of peritonsillar abscess.