1.A Review of Surgical Treatment Cases of Gastric Cancer in the Elderly in a Rural Area of Japan.
Noboru SASAKI ; Sigenobu KADO ; Masaharu KAWAGUCHI ; Kazuto FURUKAWA ; Tatsuya NAKAO ; Shuji KOHATA ; Masafumi SUESHIRO
Journal of the Japanese Association of Rural Medicine 1991;40(1):25-30
A total of 478 resected gastric cancer cases were studied. The male-female ratio was 1.6, -294 males and 184 females. The patients were divided into two groups, namely, the elderly group (patients aged 70 and over) and the non-elderly group (patients aged 69 and below). In the elderly group males were predominant over females. The number of elderly patients accounted for 34.1% of the total number of stomach cancer cases. This percentage is higher than the national average. In the elderly group, cases detected by stomach health screening or health diagnosis tests were a few, but many cases were in stage IV. The number of inoperable cases was somewhat high, radical gastrectomy was performed on a few of the patients, and the resection rate was somewhat low. A tendency was observed for multiple cancer focuses ; in regard to the regions of occupation or spreading and tissue type, the upper region was less likely and the lower region was more likely to be affected, the anterior wall and the circle were likely to be affected. A tendency was observed for the localization of highly differentiated tissue in the patients. Although no difference was observed in the direct surgical mortality rate, the 5 year survival rate was unfavorable, suggesting the patients might have died due to other diseases. In the elderly group, those who suffered from diseases and preoperative complications comprised 92% of the total, and abnormalities during preoperative examinations were detected in 96% of these patients. Postoperative complications developed in 42%. Postoperatively, psychological problems must be taken into consideration. In elderly patients who are operable, although it is desirable to actively perform surgery aiming at radical operations, it is thought necessary to cope carefully with resection of the stomach. If a radical operation is performed after carefully evaluating preoperative risks and with adequate preparations, it is thought possible for elderly patients to achieve favorable therapeutic results and improvement in their QOL differing little from non-elderly patients.
2.Study on Resected Cases of Colon/Rectum Cancer in a Rural Area Adjacent to Hiroshima City.
Noboru SASAKI ; Sigenobu KADO ; Masaharu KAWAGUCHI ; Kazuto FURUKAWA ; Tatsuya NAKAO ; Shuji KOHATA ; Masafumi SUESHIRO
Journal of the Japanese Association of Rural Medicine 1991;40(1):31-35
Study was made on total of 304 cases of cancer of the large intestine resected during the period of 12 years from 1978 to 1989.
Colon cancer accounted for 56.8% of the total and rectal cancer 43.2%. There were no sexual differences. Those people aged 50 and older represented 86.0% of the total number of the cases. By age group, those in their 60s topped the list with 27.3%, followed by those in 70s with 24.4%. Almost all the cases (95.1%) were of the patients who had visited the hospital, having noticed symptoms themselves. A very few cases were detected among the people without subjective symptoms when they received group medical Checkups.
By region, 39.4% of the colon cancer cases were found in S, followed by A. In the cases of rectum cancer, Rb accounted for 50.7%. Of the total caces, 74.5% had cancer on the left side of the large intestine.
Resection rate was 91.5%. The rate of resection leading to cure was 71.8%. Broken down by histological staging, stage I came to 11.7%; stage II, 30.9%; stage III, 21.8%; stage IV, 11.7%; stage V, 23.8%.
The 5-year-survival rete averaged 57.1%. In pre-surgery tests, the positive rate of CEA was as low as 46.6%. The positive rate for early cancer was extremely low. Measurement of CEA levels as an auxiliary diagnosis, therefore, did not prove itself to be useful in searching for cancer.
3.A Study of Surgical Treatment of Gastric Cancer in the Elderly. Comparative Investigation between Patients Aged Seventies and Eighty and above.
Noboru Sasaki ; Shigenobu Kado ; Masaharu Kawaguchi ; Shuji Kohata ; Masafumi Sueshiro ; Yoshikata Eguchi ; Tatsuo Nishino
Journal of the Japanese Association of Rural Medicine 1992;40(5):1030-1035
A clinical study was made on a total of 478 stomach cancer cases that had been subjected to surgery during the 12-year period from 1978 to 1989. Of the total, 34.1% were accounted for by the patients aged 70 years and above. Those old patients were divided into the two groups-those in their 70s and those in their 80s and above. The clinical cases of the two aged groups were studied in comparison with the cases of the patients aged 69 and below (65.9%). The number of early stomach cancer cases was smallest in the 70s age group. However, in this age group, advanced cancer was largest in number, metastases to lymph nodes, peritonea, and the liver were observed in many cases, and the curative resection rate was low. In the age group of 80 and above, either early cancer or advanced cancer was large in number. Apparently moderation was exercised in performing surgerical operations on the persons of advanced age. It was found that R2 lymph node dissection had been confined to 68.4% of the patients aged 80 and above, but that the curative resection rate was highest with 84.2% probably because limited lymph node metastasis. In this age group, a majority of cancers occurred at the antral region. A tendency was observed that cancer occurs less at the lesser curvature and on the posterior wall of the stomach and much more freqently at the greater curvature and on the anterior wall. Histologically, the tumor cells were mostly of a highly differentiated, localized type. Although high risk is involved in surgery in the elderly patients, many cases of stomach cancer are operable. So, it would be worth physicians' intention to risk operations while taking precautions against postoperative complications, with a view to improving the cure rate and helping the patients to upgrade the quality of life in their remining years.
4.The Role of Oxidative Stress in the Pathogenesis of Diabetic Vascular Complications.
Shuji SASAKI ; Toyoshi INOGUCHI
Diabetes & Metabolism Journal 2012;36(4):255-261
Oxidative stress has been paid increasing attention to as an important causative factor for diabetic vascular complications. Among possible various sources, accumulating evidence has indicated that NAD(P)H oxidase may be the most important source for reactive oxygen species production in diabetic vascular tissues. The mechanisms underlying activation and up-regulation of NAD(P)H oxidase has been supposed to be mediated by high glucose-induced protein kinase C (PKC) activation. In this review article, activation of local renin-angiotensin II system induced by chymase activation is also shown to amplify such a PKC-dependent activation of NAD(P)H oxidase. Additionally, human evidence showing the beneficial effect of antioxidants on diabetic vascular complications. Bilirubin has been recognized as a strong endogenous antioxidant. Here markedly lower prevalence of vascular complications is shown in diabetic patients with Gilbert syndrome, a congenital hyperbilirubinemia, as well as reduced markers of oxidative stress and inflammation. Lastly, statin, angiotensin II receptor blocker, chymase inhibitor, bilirubin and biliverdin, PKC beta isoform inhibitor, and glucagon-like peptide-1 analog, are shown to serve as antioxidants and have some beneficial effect on diabetic vascular complications, via inhibiting PKC-NAD(P)H oxidase activation, supporting the notion that this mechanism may be an effective therapeutic target for preventing diabetic vascular complications.
Angiotensin II
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Antioxidants
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Bilirubin
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Biliverdine
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Chymases
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Diabetic Angiopathies
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Gilbert Disease
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Glucagon-Like Peptide 1
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Humans
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Hydroxymethylglutaryl-CoA Reductase Inhibitors
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Hyperbilirubinemia
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Inflammation
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NADPH Oxidase
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Oxidative Stress
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Oxidoreductases
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Prevalence
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Protein Kinase C
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Reactive Oxygen Species
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Receptors, Angiotensin
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Up-Regulation