記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00268-020-05570-7

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その他リンク： http://link.springer.com/article/10.1007/s00268-020-05570-7/fulltext.html

記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2019_86-411

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

Endoscopic retrograde cholangiopancreatography(ERCP)は肝胆膵疾患の診断と治療に不可欠な手技となり、ERCPを応用したさまざまな手技が活用されている。一方、ERCPの偶発症はときに重篤化し致命的な転帰となるため慎重を要す手技である。ERCPの偶発症のなかでも後腹膜穿孔は死亡率が高く、その診断、治療方針、予防が重要である。ERCP関連後腹膜穿孔の主な原因は、乳頭部穿孔ではESTの過長切開や不適切な切開方向、胆管穿孔では砕石処置具の挿入、膵管穿孔ではカテーテル操作、十二指腸穿孔ではファイバーの挿入による損傷である。後腹膜穿孔を疑う際にはファイバーを抜去する前に保存的加療を考慮して胆道ドレナージをできる限り挿入し、ERCP直後にCT検査を行い後腹膜液体貯留の程度を確認する。CTで後腹膜に液体貯留を認め、かつ発熱や疼痛のある症例は緊急手術を行う。後腹膜気腫のみ、もしくは少量の液体貯留のみで無症状の症例は保存的加療を行い経時的に疼痛や液体貯留をフォローし、腹部所見および画像所見の悪化がある際は緊急手術を考慮する。十二指腸をファイバーで完全に貫いて後腹膜穿孔をきたした症例は当初より緊急手術を考慮する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Spandidos Publications  

DOI： 10.3892/ol.2018.9479

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2018_85-34

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. METHODS: Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. RESULTS: Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. CONCLUSIONS: We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

DOI： 10.1007/s00464-017-5643-5

PubMed

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記述言語：日本語   出版者・発行元：金原出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00620&link_issn=&doc_id=20171206140005&doc_link_id=10.18888%2Fop.0000000504&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000000504&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1111/ases.12317

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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出版者・発行元：International College of Surgeons  

DOI： 10.9738/intsurg-d-15-00015.1

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)南江堂  

食道・胃静脈瘤に対する手術療法には,直達手術とシャント手術がある.ほかに脾摘術,脾肺固着術,肝移植,Budd-Chiari症候群に対する静脈再建術やバイパス手術などもある.手術療法は長年にわたる門脈血行動態研究に基づき理論的に工夫・改良され,長期成績は良好となった.現在では侵襲面から保存的療法の難治例に対する最終手段となっているが,難治例はより複雑な血行動態となっており,外科医は門脈血行動態のより深い理解が必要である.(著者抄録)

DOI： 10.15106/J00393.2016089685

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00393&link_issn=&doc_id=20160113090003&doc_link_id=issn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

ERCPは胆膵疾患の診断に不可欠な手技となり,ERCPを応用したさまざまな手技が活用されている一方,ERCPの偶発症は重篤化しやすく慎重を要す手技である。ERCP合併症の中でも後腹膜穿孔は死亡率が高く,その診断と対処が重要である。1999年1月から2015年5月までのERCP自験例4,076例のうちERCPの後腹膜穿孔を10例(0.25%)に認め,その原因と対応を検討した。穿孔部位は,乳頭部3例,胆管3例,膵管2例,十二指腸2例であり,原因は,乳頭部穿孔ではEST,胆管穿孔では砕石処置具の挿入,膵管穿孔ではカテーテル操作,十二指腸穿孔では内視鏡の挿入による損傷であった。後腹膜穿孔を疑う際にはENBDや胃管で減圧しCTで後腹膜穿孔の重症度を確認する。CTで後腹膜に液体貯留を認め,かつ発熱や疼痛のある症例は緊急手術を行う。後腹膜気腫のみ,もしくは少量の液体貯留のみで無症状の症例は保存的加療を行い経時的に疼痛や液体貯留をフォローし,所見の悪化がある際は緊急手術を考慮する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02824&link_issn=&doc_id=20160226430008&doc_link_id=10.11231%2Fjaem.36.79&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.36.79&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/hepr.12498

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.83.172

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Definitive assessment of laparoscopic skill improvement after virtual reality simulator training is best obtained during an actual operation. However, this is impossible in medical students. Therefore, we developed an alternative assessment technique using an augmented reality simulator. METHODS: Nineteen medical students completed a 6-week training program using a virtual reality simulator (LapSim). The pretest and post-test were performed using an object-positioning module and cholecystectomy on an augmented reality simulator(ProMIS). The mean performance measures between pre- and post-training on the LapSim were compared with a paired t-test. RESULTS: In the object-positioning module, the execution time of the task (P < 0.001), left and right instrument path length (P = 0.001), and left and right instrument economy of movement (P < 0.001) were significantly shorter after than before the LapSim training. With respect to improvement in laparoscopic cholecystectomy using a gallbladder model, the execution time to identify, clip, and cut the cystic duct and cystic artery as well as the execution time to dissect the gallbladder away from the liver bed were both significantly shorter after than before the LapSim training (P = 0.01). CONCLUSIONS: Our training curriculum using a virtual reality simulator improved the operative skills of medical students as objectively evaluated by assessment using an augmented reality simulator instead of an actual operation. We hope that these findings help to establish an effective training program for medical students.

DOI： 10.1111/ases.12209

PubMed

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Tension-free hernia repair with a mesh plug causes relatively low postoperative pain and allows an earlier return to work, as well as a low recurrence rate. Occasionally, however, hernioplasty can result in complications including mesh migration and invasion of intra-abdominal organs. This report describes the case of a 57-year-old man who had undergone a right inguinal hernioplasty 13 years previously. Recovery was uneventful until he experienced inflammation of the groin, and required open drainage three times for a refractory abscess in his right groin. Additional colonoscopy and x-ray examinations with contrast medium clearly demonstrated a mesh plug that had migrated and penetrated the cecum, forming a colocutaneous fistula. The mesh was successfully removed under general anesthesia, and the inflammation in the groin resolved.

DOI： 10.1272/jnms.82.246

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その他リンク： http://search.jamas.or.jp/link/ui/2016232641

記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本膵・胆管合流異常研究会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(株)オプトロニクス社  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

症例は71歳、男性。近医で施行された腹部超音波検査にて肝S7に径50mm大の腫瘍を指摘され、当院紹介となった。腫瘍マーカーはAFP、PIVKA-IIが高値であり、腹部CT、MRI、経動脈性血管造影CTで肝S7、S3に腫瘤を認めた。肝S3の腫瘤の造影効果は典型的ではなかったが、腫瘍マーカーの上昇およびB型肝炎ウイルスの既往感染の背景を考慮し、多発肝細胞癌と診断。肝S7亜区域切除術+肝S3部分切除術を施行した。病理組織学的検査で肝S7の腫瘍は数層からなる索状構造を形成しており、中分化型肝細胞癌と診断した。肝S3の腫瘍は、肝内胆管癌と細胆管細胞癌が混在しており、細胆管細胞癌成分を伴った肝内胆管癌と診断した。胆管癌であり部分切除では不十分と判断し、肝外側区域切除術およびリンパ節郭清を追加施行した。肝細胞癌と細胆管細胞癌成分を伴った肝内胆管癌の同時性重複癌の切除報告例は少なく、稀少性からも貴重な症例と思われたので、文献的考察を加え報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00263&link_issn=&doc_id=20140226060003&doc_link_id=10.2957%2Fkanzo.55.106&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.55.106&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.81.354

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

膵神経内分泌腫瘍(neuroendocrine tumor:NET)術後19年目の肝転移再発が疑われた1切除例を経験した。症例は58歳、男性。19年前に当院にて膵頭部腫瘍に対して膵頭十二指腸切除術施行。膵島細胞癌(2010年WHO分類ではNET G2)と診断された。再発なく経過し、以後、近医にてフォローアップされていた。1年前に腹部CT検査にて肝S6に多血性の径10mm大の腫瘍を指摘され、増大傾向を呈したため当院紹介となった。腹部造影CT検査にて肝S6に径20mm大の遅延相まで造影効果の持続する腫瘤を認めた。増大傾向であり、用手補助腹腔鏡下肝S6部分切除術を施行した。病理組織学的検査で類円形の核を有する細胞がロゼット状に増生している所見を呈し、免疫染色にてクロモグラニンA、シナプトフィジンが陽性であり、神経内分泌腫瘍と診断した。肝原発NETとの鑑別は困難であるが、本症例は膵内分泌腫瘍の肝転移再発と推測された。膵NET術後10年以上経過してからの再発症例は稀であるため、文献的考察を加え報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00263&link_issn=&doc_id=20130531150003&doc_link_id=10.2957%2Fkanzo.54.326&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.54.326&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.80.250

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.80.252

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

<italic>Introduction</italic>. Leiomyosarcomas of vascular origin are particularly rare tumors occurring mainly in the inferior vena cava (IVC). They are malignant, slow-growing tumors with a poor prognosis. This paper reports on a rare case of surgical resection of an IVC leiomyosarcoma mimicking a hepatic tumor.<italic>Case Presentation</italic>. A 65-year-old Japanese male was admitted for evaluation of an abdominal tumor. Enhanced computed tomography of the abdomen revealed a slightly enhanced heterogeneous tumor, 18 mm in diameter, between the Spiegel lobe of the liver and the IVC in early-phase images, with no enhancement or washout in late-phase images. We diagnosed this tumor as either a hepatic tumor in the Spiegel lobe or a retroperitoneal tumor such as leiomyosarcoma or liposarcoma and performed a laparotomy. On the basis of surgical findings, we extirpated the tumor by performing a wedge resection of the wall of the IVC and suturing the primary IVC wall. Pathological findings led to a further diagnosis of the tumor as a leiomyosarcoma originating in the IVC. Thirty-seven months after the operation, multiple liver and lung metastases were detected, and the patient died from multiple organic failures.<italic>Conclusion</italic>. We experienced a rare case of a leiomyosarcoma of IVC mimicking hepatic tumor.

DOI： 10.1155/2013/235698

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その他リンク： http://downloads.hindawi.com/journals/crim/2013/235698.xml

掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

Cystic echinococcosis (CE) is a rare afferent infectious disease in Japan. This paper reports a case of a hepatic cyst being diagnosed after surgical resection. A 40-year-old Syrian male was admitted for evaluation of a hepatic cyst. Serum antibodies of echinococcosis were negative. Enhanced computed tomography of the abdomen revealed a large cystic lesion, 9 cm in diameter, in the left lateral sector of the liver, which had many honeycomb-like septa and calcified lesions. Magnetic resonance imaging of this lesion revealed high intensity in the T2 weighted image. We preoperatively diagnosed this lesion as cystadenocarcinoma or CE and performed a left hepatectomy. Pathological examination revealed the presence of protoscolices in the fluid of the cysts and led to a diagnosis of this lesion as CE. In conclusion, on seeing patients with huge hepatic cysts who come from an epidemic area, we should consider hepatic CE.

DOI： 10.1155/2013/271256

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その他リンク： http://downloads.hindawi.com/journals/crim/2013/271256.xml

記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

肝胆膵領域におけるステンティング療法について胆管ステントと膵管ステントに分けて述べる。胆管ステントでは、切除不能悪性胆道狭窄に対しては、金属ステント(Expandable metallic Stent:EMS)、悪性胆道狭窄術前および良性胆道狭窄に対しては、Plastic stentが適応である。胆管(肝管)消化管吻合部の減圧および狭窄防止目的として、内ステント(internal stent)や外ステント(external stent)が留置される。膵管ステントでは、良性疾患に対する膵液ドレナージ目的として、主にPlastic stentが使用される。膵消化管吻合部の減圧および狭窄防止目的には、節付き膵管チューブをexternal stentとして使用しているが、internal stentを留置する施設やstentを使用しない施設もある。さまざまなステントが開発され、目的に応じて留置するステントの種類も異なってくる。各ステントには長所短所があるため、各ステントの特性を把握し使用することが肝要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00001&link_issn=&doc_id=20121203400007&doc_link_id=%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBL GRP CO LTD  

Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced computed tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically. (C) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i23.3027

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Update Medical Publishing  

DOI： 10.5754/hge12000

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.79.19

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.246

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/manms.7.110

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JALC/00371971190?from=CiNii

掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.317

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.194

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.30

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.312

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

The response rate of Irinotecan for gastric cancer is reported to be 18.4%. The rate is improved by combination with 5-FU. However, it remains unclear whether or not the effect of the two drugs is synergy or antagonistic. The purpose of this study is to clarify whether the effect of Irinotecan and 5-FU in gastric cancer is synergy or antagonistic. We performed study using 13 specimens removed surgically and 2 specimen collected from ascites. We performed the Collagen Gel Droplet Embedded Culture Drug Sensitivity Test (CD-DST) with 3 assumptions. In the first assumption, we let 5-FU come in contact with a tumor at a level of 1 μg/mL for 24 hours. The second assumption was SN-38 at a level of 30 μg/mL for 24 hours and the 3rd assumption was SN-38 at a level of 30 μg/mL and 5-FU at a level of 1 μg/mL for 24 hours. If the combination index was more than 1, the combination therapy was judged as synergic
if less than 1, it was considered antagonistic. Results: The inhibition rate of combination therapy was significantly higher than that of monotherapy. The inhibition rate of combination therapy was significantly correlate with that of monotherapy (Irinotecan
r=0.704, p=0.003, 5-FU
r=0.746, p=0.001). The combination index was antagonistic in only 6 of 15 cases. However, it was synergic in all well-differentiated adenocarcinomas (4/4). Discussion: We conclude that combination therapy is antagonistic in most cases of gastric cancer in vitro. However, it may be synergic in well-differentiated adenocarcinomas.

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: We evaluated the results of shunting and nonshunting procedures for the treatment of esophagogastric varices in patients with idiopathic portal hypertension (IPH).
Methodology: Between 1981 and 2008, surgery was performed in 9 patients with IPH. Three patients were bleeding before operation, and the other 6 were treated prophylactically. Patients were divided into 2 groups, a shunting group (4 underwent distal splenorenal shunt) and a nonshunting group (3 underwent esophageal transection and 2 underwent Hassab&apos;s procedure).
Results: Esophagogastric varices were completely eradicated in 3 (75.0%) patients in the shunting group and 4 patients (80.0%) in the nonshunting group. Additional endoscopic treatment (one session) was performed in 2 patients with incompletely eradicated varices. There was no recurrence in the shunting group. In the nonshunting group, esophagogastric varices recurred in all 4 patients with completely eradicated varices. All recurrent esophageal varices were completely eradicated. Postoperative platelet counts (x10(4)/mu L) were significantly lower in the shunting group (10.0+/-2.6) than in the nonshunting group (42.0+/-14.0) (p=0.0029). The increase in the platelet count after operation was significantly lower in the shunting group (1.7+/-0.2 times) than in the nonshunting group (5.8+/-2.9 times) (p=0.0267). No patient received anticoagulants postoperatively. Portal venous thrombus did not develop in the shunting group, but appeared in 4 patients (80.0%) in the nonshunting group. No patient had loss of shunt selectivity or portal-systemic encephalopathy. One patient in the nonshunting group died of cerebral hemorrhage; all others are alive.
Conclusions: Shunting procedure, distal splenorenal shunt, was suggested to be useful for the management of esophagogastric varices in patients with IPH.

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(株)アークメディア  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver.
Methodology: In this prospective, randomized, controlled trial, 38 patients were assessed for eligibility. Fourteen patients were excluded because they had received intraoperative blood transfusions or incomplete resections. The 24 eligible patients (20 with malignant liver tumors and 4 with benign liver tumors) were randomly assigned to receive perioperative ON with BCAA (11 patients, BCAA group) or a usual diet (13 patients, control group). The BCAA group received a BCAA supplement twice daily plus a usual diet for 14 days before operation and on days 1 to 7 after operation. The control group received a usual diet alone. The primary end point was the improvement in postoperative biochemical measurements.
Results: Two of the 11 patients in the BCAA group developed postoperative complications, as compared with 3 of the 13 patients in the control group (18.2% vs. 23.1%, p=0.7686). Serum levels of alanine aminotransferase, aspartate aminotransferase, and ammonia did not differ significantly between the BCAA group and control group; however, peak values were lower in the BCAA group. There was no difference between the groups in serum hemoglobin levels after operation. Among patients with hepatitis, serum erythropoietin (EPO) levels on POD 3, 5, and 7 were slightly but not significantly higher in the BCAA group than in the control group. Among patients with non-hepatitis, serum EPO levels on POD 3, 5, and 7 were significantly higher in the BCAA group than in the control group (p=0.0174, p=0.0141, and p=0.0328, respectively).
Conclusion: Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis.

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.77.269

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.77.328

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：10  

DOI： 10.1111/j.1872-034X.2009.00549.x

PubMed

CiNii Books

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：33  

DOI： 10.3748/wjg.15.4201

PubMed

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出版者・発行元：94-95  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   出版者・発行元：3  

Balloon-occluded retrograde transvenous obliteration (B-RTO) has been used successfully to treat gastric varices in adults. However, only a few case reports of B-RTO in children have been published. We describe a child who had gastric varices with extrahepatic portal venous obstruction (EHO). A 12-year-old boy presented to the pediatric clinic with anemia and tarry stools. He was referred to our department to receive additional treatment for gastric varices. Endoscopy revealed spurting bleeding from gastric varices, and emergent endoscopic injection sclerotherapy was performed. Angiography showed cavernous transformation of the portal vein, hepatofugal flow of the left gastric vein, gastric varices, and gastrorenal shunt. The gastric varices were not eradicated adequately with endoscopic sclerotherapy because of excessive regurgitant blood flow against the portal venous pressure. B-RTO combined with partial splenic embolization (PSE) was therefore performed. The gastric varices were completely eradicated with no complications. This is, to our knowledge, the first report describing the use of B-RTO combined with PSE in a child with EHO who had gastric fundal varices. B-RTO combined with PSE is not excessively invasive and is effective and safe for children. This procedure is therefore recommended for the treatment of gastric varices in children.<br>

DOI： 10.1272/jnms.76.173

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

We compared two types of stents in patients who underwent surgery for hepatic hilar malignancies.
Twenty-one patients with hepatic hilar malignancies who underwent hepatectomy were randomly assigned to one of two groups. A 5-Fr silicon drain with an internal lumen and side holes was used for the hepaticojejunostomy in one group (intraluminal stent group), and a 10-Fr silicon drain with channels along the sides was used in the other (channel stent group).
Leakage developed in four patients (36.4%) in the intraluminal stent group versus two (20.0%) in the channel stent group. Cholangitis developed in three patients with leakage (27.3%) in the intraluminal stent group versus no patient in the channel stent group. After operation, the times required for the serum alkaline phosphatase and total bilirubin levels to return to the normal range were significantly shorter in the channel stent group (5.3 +/- 2.9, 3.8 +/- 2.2 days) than in the intraluminal stent group (17.0 +/- 5.8, 9.4 +/- 5.7 days) (P &lt; 0.0001, P = 0.0093).
A 10-Fr silicon drain with channels is superior to a 5-Fr silicon drain with an internal lumen for internal biliary stenting of hepaticojejunostomy in patients with hepatic hilar malignancies.

DOI： 10.1111/j.1440-1746.2009.05827.x

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出版者・発行元：91-92  

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

A 56-year-old woman visited our hospital because of high fever and right hypochondralgia. Abdominal computed tomography showed a liver cyst 10 cm in diameter and dilatation of the intrahepatic bile duct. Percutaneous transhepatic drainage of the cyst guided by ultrasonography disclosed that the cyst contained a brown milky fluid, and cystography showed biliary communication. Thus, the cyst was diagnosed as an infectious hepatic cyst with biliary communication. Treatments for liver cysts include aspiration therapy, alcoholic sclerotherapy, laparoscopic fenestration, fenestration by laparotomy, cystojejunostomy, cystectomy, and hepatectomy. Because a simple liver cyst is benign, treatments should be low-risk and minimally invasive; thus, we performed laparoscopic fenestration. Fenestration should not be performed if the case is complicated by infection or biliary communication. Although cystography showed biliary communication, the cyst was not visualized with endoscopic retrograde cholangiography, and we concluded that the biliary communication was small. Operation time was 95 minutes, and blood loss was 10 g. Pathological findings of the liver cyst were consistent with a simple cyst. The postoperative course was good, and the patient left the hospital 10 days after the operation. Eighteen months have passed since the operation, and no recurrent cysts have been detected with computed tomography. This is the second report of liver cyst with biliary communication successfully treated with laparoscopic deroofing. Laparoscopic fenestration is a useful method for treating simple benign liver cysts because of its minimal invasiveness and may be useful in cases with small biliary communication.<br>

DOI： 10.1272/jnms.76.103

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Primary hepatic gastrinoma is very rare, with fewer than 20 cases reported. We describe a 44-year-old woman in whom primary hepatic gastrinoma was strongly suspected clinically. The patient was referred to our hospital because of intractable diarrhea. She had elevated serum levels of alanine aminotransferase, aspartate aminotransferase, and fasting gastrin. A calcium provocative test showed a marked elevated serum gastrin level (17,000 pg/ml). Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed a tumor in the right lobe of the liver, measuring 38x33 mm. No other tumor was detected in the pancreas, duodenum, or local lymph nodes on preoperative radiological imaging or endoscopic ultrasonography. The hepatic tumor was resected. Total intraoperative ultra-sonography and intraoperative exploratory palpation of the duodenum, pancreas, and lymph nodes showed no evidence of an extrahepatic tumor. Pathological findings and immunohistochemical studies revealed a neuroendocrine tumor with increased production of gastrin. Postoperatively, the serum gastrin level returned to normal.

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記述言語：英語   出版者・発行元：5  

Bile duct invasion is rare in patients with hepatocellular carcinoma (HCC). We show the usefulness of selective transcatheter hepatic arterial embolization (TAE) followed by microwave coagulation therapy (MCT) in a case of HCC with portal and biliary tumor thrombi that ruptured into the biliary system. A 70-year-old man with HCC was admitted because of melena and postprandial abdominal pain. Four years earlier, he had undergone posterior segmentectomy of the liver for HCC. Portal venous thrombus was detected on computed tomography (CT) 3 months earlier. On admission laboratory tests revealed the following values: serum alkaline phosphatase, 760 IU/L; total serum bilirubin, 11.9 mg/dL; direct bilirubin, 9.8 mg/dL; serum hemoglobin, 7.7 g/dL; alpha-fetoprotein 103.9 ng/mL; and PIVKA-2, 52,655 mAU/mL. Serum examinations were positive for anti-hepatitis C virus antibody but negative for hepatitis B surface antigens. Ultrasonography revealed a hypoechoic mass in the right branch of the bile duct at the hepatic hilum. Doppler ultrasonography showed blood flow in the mass. CT showed diffuse tumor involvement throughout the liver parenchyma and the presence of a high-density substance in the right intrahepatic bile duct. The diagnosis was hemobilia secondary to HCC in the right hepatic lobe. The symptoms recurred, and emergency TAE was performed 5 days after the onset of hemobilia. The symptoms subsided, and liver function improved. Endoscopic retrograde cholangiography revealed obstruction of the right intrahepatic bile duct. Surgery was performed 15 days after TAE, and MCT of the right hepatic hilum was performed. After MCT, CT revealed necrosis of the right hepatic hilum. Seven months after TAE, the patient died of liver failure with no recurrence of hemobilia.<br>

DOI： 10.1272/jnms.75.284

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：英語   出版者・発行元：5  

Spontaneous intracystic hemorrhage rarely occurs in nonparasitic hepatic cysts. We describe a patient with spontaneous intracystic hemorrhage of a large simple hepatic cyst that mimicked a malignancy. A 59-year-old man presented with right abdominal discomfort. The patient's medical history included a simple hepatic cyst that had been detected 7 years earlier but was left untreated. Three weeks before presentation, right upper abdominal pain occurred but resolved spontaneously. The serum CA19-9 concentration was 48.3 U/mL (normal<37 U/mL). Ultrasonography revealed a large cystic mass, containing many hyperechoic structures and occupying nearly the entire right hepatic lobe. Computed tomography demonstrated a homogenous low-density area, 20 cm in diameter, in the right hepatic lobe. Magnetic resonance imaging revealed a heterogeneous hypointense lesion measuring 20 cm in diameter. The lesions showed linear hyperintense areas on T1-weighted sequences and mosaic heterogeneous hyperintensity on T2-weighted sequences. We suspected a hemorrhagic simple hepatic cyst, hydatid cyst, or hemorrhagic cystadenocarcinoma. Right hepatectomy was performed, and the enlarged right lobe was removed. The mass was soft, sponge-like, and contained fluid, but was not elevated. Pathologic examination of the surgical specimen confirmed the presence of a hemorrhagic benign hepatic cyst.<br>

DOI： 10.1272/jnms.75.302

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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出版者・発行元：86-87  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：3  

Background: Refractory hepatic encephalopathy (HE) frequently develops in patients with cirrhosis and portal-systemic shunt. Recently, patients with refractory HE associated with portal-systemic shunt have been treated with interventional radiology. We describe a promising new treatment for portal-systemic shunt, ligation of the patent paraumbilical vein (PUV) after partial splenic embolization, in patients with refractory HE. Patients: Four patients with cirrhosis (3 women and 1 man
mean age. 56 years) and refractory HE due to a patent PUV were studied. Patency of the PUV had recurred in 1 patient after primary occlusion by interventional radiological procedures. The Child-Pugh class was B in 2 patients and C in 2. Before the present treatment, all patients had been hospitalized at least 3 times because of recurrent HE. Surgical Procedure: Partial splenic embolization was performed in all patients to decrease portal venous pressure before surgery. Surgical ligation of the patent PUV was performed under epidural anesthesia. The patent PUV was carefully skeletonized and doubly ligated. Esophageal varices were evaluated with upper gastrointestinal endoscopy before and after surgery. Result: The mean follow-up duration was 15.8 months. After ligation, there were no clinically significant complications. Esophageal varices were unchanged. The serum ammonia level was higher before surgery (162.3 ± 56.4 μg/dL, mean ± SD) than after surgery (41.8 ± 20.2 μg/dL
p=0.0299). No patient had symptoms of HE. Conclusion: Ligation of the patent PUV is an effective treatment for patients with refractory HE.

DOI： 10.1272/jnms.75.152

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：3  

We present a case report of a posttransplant patient who had hepatotoxicity due to both tacrolimus and cyclosporine and cholestatic jaundice due to tacrolimus. The patient did not show sustained improvement in enzyme and bilirubin abnormalities after an initial change from tacrolimus to cyclosporine or with a change back to tacrolimus, but he ultimately showed improvement when the blood concentration of tacrolimus was lowered. A 56-year-old man with subacute fulminant hepatitis induced by acarbose was admitted to our hospital for living donor liver transplantation. The liver graft consisted of the left lobe from his ABO-identical son. The early posttransplant course was uneventful. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin improved initially, but the ALT and AST levels later increased. A liver biopsy suggested a presumptive diagnosis of drug reaction. All drugs were discontinued, the immunosuppressive agent was changed from tacrolimus to cyclosporine. After initial improvement, the ALT and AST levels increased again. Assuming a reaction to cyclosporine, we decreased the concentration of cyclosporine in the blood. The enzyme levels improved temporarily but again began to rise. We changed the immunosuppressive agent to tacrolimus, which resulted in improvements in the ALT and AST levels: however, the total bilirubin level increased. We interpreted this increase as tacrolimus-induced cholestasis
in response, we decreased the blood concentration of tacrolimus to between 3 and 5 ng/dL and added 1.000 mg of mycophenolate mofetil to the drug regimen. The patient recovered without further complications. Repeated liver biopsies throughout the hospital course suggested that the mild mononuclear cell infiltration observed in a few triads had not been caused by acute rejection but had possibly been drug-induced.

DOI： 10.1272/jnms.75.187

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Dihydropyrimidine dehydrogenase is the initial and rate-limiting enzyme in the catabolism of 5-fluorouracil. The aim of this study was to determine the levels of messenger RNA for 5-fluorouracil-related metabolic enzymes in cirrhotic liver and to assess the correlation between these mRNA levels and clinicopathological features.
Methodology: The study material consisted of 33 liver samples. The levels of mRNA for the 5-fluorouracil-related metabolic enzymes were quantified by real-time reverse transcription polymerase chain reaction combined with laser-captured microdissection.
Results: The Dihydropyrimidine dehydrogenase mRNA level in patients with grade B liver damage was significantly lower than that in patients with grade A liver damage (p=0.009). The Dihydropyrimidine dehydrogenase and orotate phosphoribosyl transferase mRNA level in a1 samples was higher than that in a2 and a3 samples (p=0.01 and 0.013, respectively). Statistically significant correlations were found between the hyaluronic acid and the thymidylate phosphorylase mRNA level (p=0.0001), and the T-BIL and the dihydropyrimidine dehydrogenase mRNA level (p=0.01).
Conclusions: The level of Dihydropyrimidine dehydrogenase mRNA may be affected by the clinicopathological status of patients with cirrhosis.

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出版者・発行元：19  

DOI： 10.3748/wjg.14.3000

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Background/Purpose. According to the General rules for the clinical and pathological study of primary liver cancer, compiled by the Liver Cancer Study Group of Japan, ruptured hepatocellular carcinoma (HCC) is classified as stage 4, even if the tumor is small and solitary. We examined the long-term results of elective hepatectomy for the treatment of ruptured HCC.
Methods. A first hepatectomy was performed without operative death in 193 patients with HCC. Ten patients had ruptured HCC ( ruptured group) and 183 patients had nonruptured HCC ( nonruptured group). The extension of HCC was macroscopically classified as stage 1 in 23 patients, stage 2 in 71, stage 3 in 53, and stage 4 in 46.
Results. Cumulative survival rates in the ruptured group at 1, 5, and 10 years were 90.0%, 67.5%, and 20.3%, respectively. The cumulative survival rate was lower in patients with stage 4 disease in the nonruptured group than that in patients in the ruptured group ( P &lt; 0.05). Cumulative survival rates did not differ significantly between patients in the ruptured group and those with stage 2 or stage 3 disease.
Conclusions. Survival rates after elective hepatectomy in patients with ruptured HCC are good, even if the disease is classified as stage 4.

DOI： 10.1007/s00534-007-1239-0

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記述言語：英語   出版者・発行元：3  

DOI： 10.1111/j.1872-034X.2007.00302.x

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CiNii Books

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出版者・発行元：1  

DOI： 10.1272/jnms.75.36

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

A 41-year-old man was referred to our hospital for treatment of a large pancreatic pseudocyst. On admission an abdominal computed tomography scan showed an 8-cm pseudocyst in the tail of the pancreas. On the 28^th hospital day hypotension suddenly developed, and the patient became unconscious. An enhanced computed tomography scan showed hemorrhage in the pseudocyst. Celiac angiography confirmed bleeding from the splenic artery to the cyst. Transcatheter arterial emobilization was performed. We inserted a catheter in the splenic artery, which was then packed with metallic coils. The hemorrhage of the pseudocyst was stopped, but the pseudocyst did not decrease in size during the next 6 weeks. Therefore, we considered the presence of a communication between the cysts and the main pancreatic duct. A pancreatic duct stent was then placed via the papilla of Vater, and the pancreatic pseudocyst was eliminated.<br>

DOI： 10.1272/manms.4.41

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その他リンク： https://jlc.jst.go.jp/DN/JALC/00310716431?from=CiNii

記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Biliary cystadenocarcinomas are rare cystic tumors arising from the biliary epithelium. Symptoms vary and are sometimes absent. Most lesions are found incidentally during diagnostic radiologic procedures or surgical exploration for unrelated conditions. We describe an 80-year-old man with anemia due to intracystic bleeding. A computed tomographic scan showed a low-density hepatic lesion with thick, irregular walls and septa. Left lobectomy with cholecystectomy was performed. Histological examination revealed that the surgical specimen was a biliary cystadenocarcinoma. The concentrations of both carcinoembryonic antigen and CA19-9 were high in the cyst contents. The patient died of pneumonia 1 year 4 months after the operation, without the recurrence of cystadenocarcinoma.<br>

DOI： 10.1272/jnms.75.293

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記述言語：英語   出版者・発行元：3  

DOI： 10.1007/s00595-007-3604-7

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Hepatic vein (HV stenosis after liver transplantation is a rare but life-threatening complication that leads to graft loss. The incidence of HV stenosis after living-donor liver transplantation (LDLT) and split liver transplantation is not so rare, and is reported to range from 2 to 8.6%. Recently, the minimal invasiveness of radiologic interventions and the innovative techniques have led to their widespread adoption for the treatment of various complications after liver transplantation. We report a five-year-old boy with ITV stenosis post-LDLT with only scarcity of clinical information including edema with hypoalbuminemia and elevated hyaluronic acid value. Doppler ultrasonography was effective to suggest stenosis, and angiography confirmed its diagnosis. The stenosis was successfully treated with balloon dilatation using interventional radiologic technique through the jugular vein. In conclusion, we suggest that if liver transplanted patients manifest ascites or/and edema with hypoalbuminemia and elevated hyaluronic acid in sera, ITV stenosis should be suspected even if the other laboratory values are normal.

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: 5-fluorouracil (5-FU)-related metabolic enzymes, including dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS), thymidylate phosphorylase (TP), and orotate phosphoribosyl transferase (OPRT) are initial, rate-limiting enzymes in the metabolism of 5-FU. The therapeutic implications of these enzymes in hepatocellular carcinoma (HCC) remain poorly understood. We used a newly developed laser-captured microdissection technique combined with RNA extraction to examine the mRNA levels of 5-FU-related metabolic enzymes in HCC and adjacent liver tissue. METHODOLOGY: The study material comprised 43 paired specimens of HCC and adjacent liver tissue. The mRNA levels of 5-FU-related metabolic enzymes were quantified by real-time reverse-transcriptase polymerase chain reaction combined with laser-captured microdissection. RESULTS: The DPD mRNA level in HCC (4.31 +/- 4.21) was lower than that in adjacent liver (6.53 +/- 2.93) (p < 0.001). The TS mRNA level in HCC (3.55 +/- 2.54) was higher than that in adjacent liver (1.90 +/- 0.11) p < 0.001). The TP and the OPRT mRNA levels did not differ significantly between HCC and adjacent liver. The TS mRNA level of HCC with portal invasion (4.47 +/- 2.76) was higher than that of HCC without portal invasion (2.71 +/- 1.96) (p = 0.015). The DPD mRNA level of HCC with septum formation (4.89 +/- 4.82) was significantly higher than that of HCC without septum formation (2.12 +/- 0.61) (p < 0.027). The OPRT mRNA level of poorly differentiated HCC (1.18 +/- 0.49) was lower than that of moderately or well-differentiated HCC (2.42 +/- 1.82) (p = 0.037). CONCLUSIONS: The DPD mRNA level was lower and the TS mRNA level was higher in HCC than in adjacent liver. Our results will hopefully stimulate further investigations designed to optimize the use of 5-FU in patients with HCC.

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Background/Purpose. Delayed gastric emptying (DGE) sometimes occurs after left hepatectomy with lymphadenectomy. We performed fixation of the greater omentum to the peritoneum to prevent DGE and other complications in patients undergoing left hepatectomy with lymphadenectomy for cholangiocarcinoma.
Methods. Patients undergoing left hepatectomy with lymphadenectomy for cholangiocarcinoma were divided into a fixation group (n = 9) and a nonfixation group (n = 10). In the fixation group, the greater omentum was sutured to the peritoneum 3cm from the greater curvature of the stomach to prevent contact between the stomach and the cut surface of the liver.
Results. Mean age, sex, disease, and hepatectomy procedures were similar in the two groups. DGE developed in six patients in the nonfixation group (60.0%) versus no patients in the fixation group (P = 0.011). The total number of complications was higher in the nonfixation group (16 complications) than in the fixation group (3 complications; P = 0.003). Overall morbidity was higher in the nonfixation group (60.0%) than in the fixation group (22.2%). Postoperative hospitalization was longer in the nonfixation group (67.4 days) than in the fixation group (20.2 days; P = 0.0041).
Conclusions. Fixation of the greater omentum to the peritoneum decreases the occurrence of DGE and other complications after left hepatectomy with lymphadenectomy for cholangiocarcinoma.

DOI： 10.1007/s00534-006-1201-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：3  

We report a case of splenic abscess that was successfully treated with percutaneous ultrasound-guided drainage and without splenectomy. A 40-year-old woman was admitted to Nippon Medical School Hospital because of pyrexia and left upper quadrant pain, which had persisted despite antibiotic treatment. On admission, computed tomography demonstrated a low-density area in the spleen, which had been been seen on computed tomography 3 months earlier. Ultrasonography demonstrated a hypoechoic area in the spleen. Initial laboratory tests revealed a serum C-reactive protein concentration of 19.7 mg/dl and a white blood cell count of 15.800 /μl. The serum glucose concentration was 267 mg/dl, and the glycolated hemoglobin value was 7.7%. A splenic abscess was diagnosed and was treated with percutaneous drainage. Milky yellow fluid was obtained, and the patient's left upper quadrant abdominal pain and pyrexia resolved. A culture of the drainage fluid yielded Escherichia coli. The drainage catheter was removed 12 days after insertion. The patient was discharged 6 days later. The splenic abscess has not recurred during 3 months of follow-up. Our results suggest that ultrasound-guided percutaneous drainage is a safe and effective alternative to surgery for the treatment of splenic abscess and allows preservation of the spleen.

DOI： 10.1272/jnms.74.257

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記述言語：英語   出版者・発行元：W J G PRESS  

Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow-up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients' quality of life. Recently, we have performed EVL at 2-mo (bimonthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment. (c) 2007 The WJC: Press. All rights reserved.

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

C型慢性肝炎に対するインターフェロン(以下、IFN)治療後にHCV-RNAの持続的陰性化とALT値の正常化が得られる著効例からの肝細胞癌(以下、HCC)の発生率は少ないとされる。患者は65歳の男性で、C型慢性肝炎に対してIFN-βによる治療により著効を得た。IFN著効12年後の肝S7の破裂HCCに対し、動脈塞栓術による止血後にS7亜区域切除を施行した。切除標本では、IFN開始時、新犬山分類のF3/A2であった線維化と壊死、炎症所見が切除時にはF0/A0まで改善していた。また、極めて多くのMib-1陽性細胞を有する低分化型肝細胞癌であった。IFN長期著効例であっても発癌の可能性を十分に考慮した経過観察が必要であると考えられた。(著者抄録)

DOI： 10.2957/kanzo.48.48

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00263&link_issn=&doc_id=20070308230002&doc_link_id=10.2957%2Fkanzo.48.48&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.48.48&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

A case of hepatocellular carcinoma (HCC) causing a major arterioportal (A-P) shunt is reported. The patient exhibited massive ascites and tested positive for hepatitis B surface antigen. An abdominal computed tomography (CT) examination showed a low-density lesion in the left lobe of the liver and an A-P shunt, but no tumor stain was visible. Upper gastrointestinal endoscopy revealed severe esophageal varices. Because the tumor marker level was abnormally high, an HCC causing an A-P shunt in a cirrhotic liver background with severe esophageal varices as a result of portal hypertension was diagnosed. We performed endoscopic variceal ligation to treat the severe esophageal varices and interventional radiology treatment for the A-P shunt and HCC, but the patients condition was unchanged. Because the patients liver function gradually improved, surgical treatment was selected. The patient underwent left hepatectomy. Pathological examination revealed a poorly differentiated HCC in a cirrhotic liver background. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation.The patient subsequently underwent transcatheter arterial embolization therapy for recurrent HCC in the right lobe of the liver, but the esophageal varices disappeared.<br>

DOI： 10.1272/jnms.74.314

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Background: Malignant ascites may produce a cluster of symptoms that include abdominal distention, early satiety, respiratory embarrassment, impaired mobility, and lethargy, and relief of these symptoms is often difficult to achieve. We report on the placement of peritoneovenous shunts (PVSs) in a group of patients with malignant ascites, with particular reference to the effectiveness and complications of the procedure.<br> Patients and Method: PVSs were inserted in 9 patients with malignant ascites after obtaining their informed consent. The patients were 6 men and 3 women with a median age of 59 years. All had previously been treated with vigorous diuretic therapy or repeated paracentesis or both. Shunt insertion was carried out via a percutaneous approach under local anesthesia.<br> Results: The procedure was well tolerated by all patients. The abdominal distention resolved in all patients, and urine volume increased significantly, demonstrating that the PVS did not affect renal function. The platelet count was reduced, and prothrombin time was prolonged. Two patients had the complication of shunt occlusion, and both patients underwent shunt replacement. There were no lethal complications. Median survival time after PVS placement was 21 days (range, 10∼90 days), and the shunt was functioning at the time of death with good control of ascites in all patients.<br> Conclusions: Malignant ascites produces troublesome symptoms for patients, who may live for some time. Placement of a PVS is a well-tolerated, relatively minor surgical procedure that can provide excellent control of ascites in most patients selected. The selection of optimal patients requires further study.<br>

DOI： 10.1272/jnms.74.355

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Background: The aim of this study was to investigate the advantages of laparoscopic hepatectomy over open surgery for liver tumors.<br> Patients and Method: A retrospective study was performed of 10 patients with liver tumors (9 with hepatocellular carcinoma and 1 with focal nodular hyperplasia) at our hospital. Five patients who had received laparoscopic hepatectomy (Lap-Hx group) were compared with 5 patients who had undergone open hepatectomy (O-Hx group) in the same period. The operative procedure was partial hepatectomy and cholecystectomy in both groups. For liver excision, a microwave coagulation device and an ultrasonically activated scalpel were used.<br> Results: Mean patient age was 55.6 ± 13.9 years in the Lap-Hx group and 51.8 ± 14.1 years in the O-Hx group. Four patients in the Lap-Hx group had hepatocellular carcinoma with liver cirrhosis and 1 patient had focal nodular hyperplasia. All patients in the O-Hx group had hepatocellular carcinoma and 4 patients had associated liver cirrhosis. The mean tumor size was 2.6 ± 1.5 cm in the Lap-Hx group and 3.0 ± 1.8 cm in the O-Hx group. The two groups did not thus differ significantly in the preoperative background factors. Blood loss and duration of the postoperative hospital stay were significantly less in the Lap-Hx than in the O-Hx groups(213 ± 82 vs 247 ± 97 min; 154 ± 128 vs 648 ± 468 ml, p=0.05: and 10.4 ± 2.3 vs 18.0 ± 5.1 days, p=0.017), but operating time did not differ significantly.<br> Conclusions: Laparoscopic hepatectomy has the advantages of reducing the amount of operative blood loss because of the magnified view afforded by the laparoscope and shortening the hospital stay. The procedure is therefore recommended for patients with appropriate liver tumors, in particular, hepatocellular carcinoma in the cirrhotic liver.<br>

DOI： 10.1272/jnms.74.158

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W J G PRESS  

AIM: To elucidate the biological effects of transforming growth factor-beta 1 (TGF-beta 1) on intrahepatic cholangiocarcinoma (ICC).
METHODS: We investigated the effects of TGF-beta 1 on human ICC cell lines (HuCCT1, MEC, and HuH-28) by monitoring the influence of TGF-beta 1 on tumor growth and interleukin-6 (IL-6) expression in ICC cells.
RESULTS: All three human ICC cell lines produced TGF-beta 1 and demonstrated accelerated growth in the presence of TGF-beta 1 with no apoptotic effect. Studies on HUCCT1 revealed a TGF-beta 1-induced stimulation of the expression of TGF-beta 1, as well as a decrease in TGF-beta 1 mRNA expression induced by neutralizing anti-TGF-beta 1 antibody. These results indicate that TGF-beta 1 stimulates the production and function of TGF-beta 1 in an autocrine fashion. Further, IL-6 secretion was observed in all three cell lines and exhibited an inhibitory response to neutralizing anti-TGF-beta 1 antibody. Experiments using HUCCT1 revealed a TGF-beta 1-induced acceleration of IL-6 protein expression and mRNA levels. These findings demonstrate a functional interaction between TGF-beta 1 and IL-6. All three cell lines proliferated in the presence of IL-6. In contrast, TGF-beta 1 induced no growth effect in HuCCT1 in the presence of small interfering RNA against a specific cell surface receptor of IL-6 and signal transducer and activator of transcription-3.
CONCLUSION: ICC cells produce TGF-beta 1 and confer a TGF-beta 1-induced growth effect in an autocrine fashion. TGF-beta 1 activates IL-6 production, and the functional interaction between TGF-beta 1 and IL-6 contributes to ICC cell growth by TGF-beta 1. (c) 2006 The WJG Press. All rights reserved.

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：W J G PRESS  

Bleeding from gastric varices has been successfully treated by endoscopic modalities. Once the bleeding from the gastric varices is stabilized, endoscopic treatment and/or interventional radiology should be performed to eradicate varices completely. Partial splenic artery embolization is a supplemental treatment to prolong the obliteration of the veins feeding and/or draining the varices. The overall incidence of bleeding from gastric varices is lower than that from esophageal varices. No studies to date have definitively characterized the causal factors behind bleeding from gastric varices. The initial episodes of bleeding from esophageal varices or gastric varices without prior treatment may be at least partly triggered by a violation of the mucosal barrier overlying varices. This is especially likely in the case of varices of the fundus. In view of the high rate of hemostasis achieved among bleeding gastric varices, treatment should be administered in selective cases. Among untreated cases, steps to prevent gastric mucosal injury confer very important protection against gastric variceal bleeding. (C) 2006 The WJG Press. All rights reserved.

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本癌学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：英語   出版者・発行元：3  

We report our second case of fracture of a SMART self-expandable metallic stent (Cordis Endovascular, Warren, NJ) placed to treat biliary obstruction due to an unresectable common bile duct carcinoma. An 82-year-old man presented with jaundice. Computed tomography and ultrasonography on admission demonstrated a mass in the lower common bile duct. The mass was identified as a common bile duct obstruction. A SMART stent was inserted. Ten months after stent insertion, two additional SMART stents were inserted to relieve obstructive jaundice due to occlusion of the first stent. Fourteen months after insertion of the first stent, endoscopic examination revealed stenosis of the duodenum due to invasion of the common bile duct carcinoma, prompting us to perform a gastrojejunostomy 1 month later. Three months after gastrojejunostomy, the patient presented with obstructive jaundice and cholangitis. A fracture of one of the stents was then discovered on plain X-ray films and percutaneous transhepatic cholangiography. Two SMART stents were inserted simultaneously. In conclusion, we report the fracture of a SMART stent placed for common bile duct carcinoma. Fracture should be considered as a possible complication after metallic stent insertion.<br>

DOI： 10.1272/jnms.73.164

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC), the number of cases of incidental gallbladder carcinoma (GBC) has increased; however, management of incidental GBC is a difficult issue in the absence of established guidelines. The present study aims to evaluate the treatment of patients with incidental GBC diagnosed with LC. We performed a 14-year review of 10 patients with GBC discovered with LC. From April 1991 through March 2004, we performed LC for 1,195 patients at Nippon Medical School Main Hospital. Of these patients, 10 (0.83%) were found to have GBC. Seven patients were women and 3 were men, with a mean age of 61.4 years. Four patients had mucosal tumors (pT1a), 5 had subserosal tumors (pT2), and 1 had a serosal lesion (pT3). Eight of the 10 patients underwent radical surgery. Two patients with pT1a tumors underwent no additional surgery. All 4 patients with pT1a tumors are alive without recurrence. One patient with a pT2 tumor with metastases to the liver and pericholedochal lymph nodes found with additional resection died of recurrence of metastasis to the liver and lung 70 months after LC. One patient with a pT2 tumor died of primary lung cancer 35 months after LC. The remaining 3 patients with pT2 tumors are alive without recurrence 51 to 128 months after surgery. One patient with a pT3 tumor is alive with no recurrence for 9 months. For stage Tis or T1a tumors, LC is sufficient. Patients with T1b tumors should undergo liver-bed resection and lymphadenectomy, and patients with >pT2 tumors should undergo systematic liver resection with lymphadenectomy. Even when incidental GBC diagnosed with LC is advanced, adequate additional surgery may improve the prognosis.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W J G PRESS  

We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage (RTBD) tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative management, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation. (C) 2006 The WJG Press. All rights reserved.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W J G PRESS  

AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies.
METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure. RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min, The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered.
CONCLUSIONS: One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient's quality of life. (c) 2006 The WJG Press. All rights reserved.

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The effectiveness of intraoperative adjuvant therapy for satellite lesions of non-resectable hepatocellular carcinoma (HCC) was investigated.
Methodology: We randomly assigned 30 eligible patients with advanced-stage HCC with multiple intrahepatic lesions who underwent reduction hepatectomy in conjunction with either intraoperative adjuvant therapy (hepatectomy plus microwave coagulonecrotic therapy or radiofrequency ablation) or postoperative adjuvant therapy (transcatheter arterial embolization). The cumulative survival rates were obtained for both groups using the Kaplan-Meier method and compared using the log-rank test. To evaluate whether the intraoperative adjuvant therapy significantly influenced the prognosis, we reviewed changes in clinical factors by multiple regression analysis using the Cox's proportional hazard model. A p value of less than 0.05 was considered statistically significant.
Results: The 3- and 5-year cumulative survival rates in patients who underwent intraoperative adjuvant therapy were 35.7% and 7.7%, while those in patients who underwent postoperative adjuvant therapy were 35.0% and 0%, respectively. The difference was not statistically significant. The level of alpha-fetoprotein, maximum tumor size, number of tumors, and clinical stage were found to be independent factors affecting survival after diagnosis. Intraoperative adjuvant therapy was not an independent prognostic factor.
Conclusions: The survival rates did not differ between the patients who underwent intraoperative adjuvant therapy and postoperative adjuvant therapy for satellite lesions of non-resectable HCC.

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

A number of factors can lead to the life-threatening liver dysfunction in the aftermath of an extended hepatectomy. Prominent among them is the high portal pressure induced by the concentrated flow of the entire stream of portal blood toward the small remnant liver. Twelve beagle dogs were randomly divided into group A (n = 6, 70% hepatectomy) and group B (n = 6, 70% hepatectomy after jejunectomy). Three dogs in each group were euthanized at 1 or 4 weeks after the operation and examined to evaluate hemodynamic changes, liver functions, and liver histology. One hour after the hepatectomy, the animals in group B exhibited a significantly lower portal pressure (P = 0.002) and significantly higher hepatic arterial flow (P = 0.004) than the animals in group A. As more time passed, the total hepatic flow and hepatic tissue flow both rose up to levels significantly higher than those in group A (P = 0.037 and P = 0.025, respectively). The alkaline phosphatase, total protein, albumin, and antithrombin III were all significantly better in group B than in group A on the 1st post-operative day. Liver specimens biopsied at 1 h after the hepatectomy showed significantly more swelling of the hepatocytes in group A than in group B. In addition, an immunohistochemical study using the TUNEL method for liver biopsy on the seventh post-operative day revealed numerous positive cells in group A but few in,group B. Our results suggest that the portal pressure control by the enterectomy can forestall dysfunction of the remnant liver after extended hepatectomy, especially during the early post-operative period. (c) 2006 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2005.08.019

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

A 58-year-old man with a chief complaint of epigastralgia was admitted to our hospital. Physical examination disclosed a large, firm mass in the right hypochondrium. Abdominal computed tomography comfirmed thickening of the gallbladder wall and a 15 × 8 cm mass occupying almost all of the right lobe and medial segment of the liver. With a preoperative diagnosis of malignant gallbladder tumor infiltrating the liver, right hepatic trisegmentectomy was performed. Histopathologic examination showed atypical cells with small round to oval nuclei and sparse eosinophilic cytoplasm, proliferating in a solid and focal nesting pattern. Near this small cell proliferation was a focus of tubular adenocarinoma that showed a zone of transition from the small cell neuroendcrine pattern. The small cells demonstrated immunohistochemical reactivity for chromogranin A. Electron microscopy disclosed neurosecretory granules 150 nm in diameter, representing dense round core vesicles, confirming a neuroendocrine cell linage. The patient was diagnosed with neuroendocrine cell carcinoma combined with adenocarcinoma of the gallbladder. Tumor recurrence became evident 3 months after surgery, and he died 4 months after surgery.<br>

DOI： 10.1272/jnms.73.101

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

A 59-year-old man with myelodysplastic syndrome who was hospitalized for evaluation of fever and generalized fatigue had elevated levels of C-reactive protein and pancytopenia. A search for a site of infection and empiric treatment with antibiotics were unsuccessful. Over 5 to 6 weeks right upper quadrant pain and rebound tenderness developed. Sonographic Murphys sign was present. Computed tomography showed thickening of the gallbladder wall, and repeated ultrasonography demonstrated changes consistent with cholecystitis. Open cholecystectomy was performed as an emergency procedure. Macroscopically the resected gallbladder showed an edematous and thickened wall. Histopathologic examination revealed transmural infiltration by atypical mononuclear cells with distinct nuclei. The cells showed immunohistochemical staining for CD15, indicating myeloid lineage. By 10 days after surgery, counts of leukocytes and leukoblasts had markedly increased, reaching 36,700/μL and 76.0%, respectively. The blast crisis was thought to indicate progression from myelodysplastic syndrome to leukemia. The patient died of progressive disease 12 days after surgery. We have described a rare case of acute cholecystitis caused by infiltration of immature myeloid cells to the gallbladder. An acute abdomen complicating hematologic disorders is life-threatening and requires prompt and appropriate treatment.<br>

DOI： 10.1272/jnms.73.97

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：4  

We report a rare case of bleeding ileal varices successfully treated with emergency enterectomy. A 72-year old woman with hepatic cirrhosis due to hepatitis C was admitted to our hospital because of anemia and hematochezia. An endoscopic examination showed no evidence of bleeding in the upper and lower gastrointestinal tracts. Angiographic studies of portal hemodynamics revealed extravasation from the ileal varices and total occlusion of the portal vein due to portal thrombus. This made it difficult to remove the ileal varices using interventional radiology. Therefore, the patient underwent emergency enterectomy for the ileal varices. No further gastrointestinal bleeding occurred during the 1-year follow-up.

DOI： 10.1272/jnms.73.221

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：2  

Background: We retrospectively identified the prognostic factors in cases of synchronous liver metastases from colorectal cancer and established a clinical strategy at our institution. Methods: One hundred eight patients with hepatic metastases from colorectal cancer underwent a first radical hepatic resection. Of these, 67 were diagnosed with hepatic synchronous metastases from colorectal primaries (S group) and 41 were diagnosed with metachronous metastases (M group). Hepatic lesions were diagnosed concurrently with the primary lesions in 45 of the 67 patients in the S group. Of these 45 patients, 37 underwent synchronous hepatectomy (SH group) and 8 underwent metachronous hepatectomy (MH group). Results: The overall 3-, 5- and 10-year survival rates were 51.4%, 41.6%, and 30.9%, respectively. There were no significant differences between the S and M groups in overall survival. Univariate analysis of the S group revealed significant differences in survival based on tumor factor, pathological lymph node metastases of the primary tumor, and the tumor-free margin. There were no significant differences between the SH and MH groups in overall survival. Conclusions: Patients with synchronous liver metastases from colorectal cancer should undergo radical resection of the primary lesion and simultaneous hepatectomy with an adequate tumor-free margin as a standard surgical course.

DOI： 10.1272/jnms.73.82

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Background: This study assessed the safety and utility of preoperative splenic artery embolization before laparoscopic splenectomy in children.
Methods: Five young girls with a mean age of 13.2 years underwent laparoscopic splenectomies at the authors' institution from August 1998 to April 2003. Three of the patients had idiopathic thrombocytopenic purpura, and two had hereditary spherocytosis. Preoperative splenic artery embolization was performed the day before the surgery in all cases. The laparoscopic splenectomy was performed using traditional laparoscopic procedures and standard laparoscopic instruments with the patient in the right semilateral position.
Results: The mean spleen weight was 252.6 g, and the mean length was 11.6 cm. All the patients reported postembolic pain, but not to a level unmanageable by intravascular narcotics. There were no severe complications in the splenic artery embolization. The laparoscopic splenectomies were completed in a mean of 211 min, with a mean estimated blood loss of 9 ml. None of the operations required conversion to traditional open laparotomy, and none of the patients died or experienced operative complications.
Conclusions: The authors concluded that splenic artery embolization is safe and useful as an adjuvant procedure performed before elective laparoscopic splenectomy in children.

DOI： 10.1007/s00464-004-2210-7

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1111/j.1572-0241.2005.41864.x

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study is to prove the hemodynamic change in distribution of splenic venous flow in the liver, especially in the cirrhotic liver, and to reveal and evaluate a participation of splenic venous flow in regeneration or enlargement of the hepatic lobe.
Methodology: We studied the distribution of splenic venous flow in the liver of patients with normal liver (NL group, n=15), chronic hepatitis (CH group, n=8), and liver cirrhosis (LC group, n=13) with the technique of scintiphotosplenoportography after percutaneous intrasplenic injection of Techi-netium-99m-diethylenetriaminepentaacetic acidgalactosyl-human serum albumin. The index of splenic venous flow volume per unit hepatocytes (V-unit) was calculated in each hepatic lobe. To com-pare V value of the left lobe (VLunit) with that of the right lobe (VRunit), predominant index of the left lobe L/R index) was defined as L/R index = VLunit/ VRunit.
Results: The median (interquartile range) of L/R index of the LC group; 1.22 (1.06-1.70) was significantly higher than that of the NL group; 0.83 (0.66-0.92), p &lt; 0.001 and the CH group; 0.79 (0.69-0.92), P &lt; 0.001.
Conclusions: L/R index reflects the change of portal hemodynamics in cirrhotic liver and is useful for discrimination between noncirrhosis and cirrhosis. These results suggest that in the liver exposed to continuous damages, splenic venous blood promotes liver fibrosis in the right lobe and eventually flows more into the left lobe with milder fibrosis.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: We performed a randomized trial to evaluate whether fixation of the greater omentum to the peritoneum prevents delayed gastric emptying and other complications after left-sided hepatectomy.
Methodology: Patients undergoing left lateral segmentectomy or left hepatectomy were randomly assigned to a fixation group (n=24) and a non-fixation group (n = 25). In the fixation group, the greater omentum was sutured to the peritoneum to prevent the stomach from contacting the cut surface of the liver.
Results: Delayed gastric emptying developed in 4 of the patients in the non-fixation group (16%) versus none of the patients in the fixation group. According to univariate analysis, fixation. significantly lowered the risk of delayed gastric emptying (p &lt; 0.05). The overall morbidity was higher in the non-fixation group (20.0%) than in the fixation patients (8.3%) without significance.
Conclusions: Fixation of the greater omentum to the peritoneum decreased the occurrence of delayed gastric emptying following left-sided hepatectomy.

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：4  

We describe a patient with a ruptured and rapidly enlarging secondary tumor of the liver metastasized from an α-fetoprotein (AFP)-producing gastric cancer. The ruptured liver metastasis was successfully treated by transarterial embolization (TAE) followed by hepatic resection. A 65-year-old woman was admitted to our hospital with residual gastric cancer. No liver metastasis was detected by preoperative computed tomography (CT), or ultrasonography, and total gastrectomy was performed. Microscopically, the tumor was a poorly differentiated adenocarcinoma invading no deeper than the subserosa, with positive staining for AFP and positive staining for Ki67 in approximately 80% of the tumor cells. Severe venous and lymphatic involvements were evident. The serum AFP level was 100 ng/ ml at 3 weeks after the total gastrectomy, but decreased to 16 ng/ml by the end of postoperative month 3. At 6 months, the patient was referred and readmitted to our hospital with sudden severe pain in the upper abdomen. She was admitted in a state of shock with laboratory findings of anemia. A liver tumor surrounded by effusion was detected in segment 8 and diagnosed as a ruptured liver metastasis. Emergency arteriography revealed a large hypervascular tumor, and a TAE performed promptly thereafter was successful in improving the blood pressure. A second TAE was performed 2 months after first TAE due to a dramatic elevation of serum AFP to 180,000 ng/ml. The second TAE decreased the patient's serum AFP to 2,200 ng/ml, but the level remained in the abnormal range. A right hepatectomy was performed after confirming the absence of other detectable metastatic tumors. The resected specimen contained a well-defined tumor, measuring 6 x 6 cm that appeared almost necrotic under microscope. Over the 6 years since the hepatectomy, no recurrence has appeared and serum AFP has remained within the normal range.

DOI： 10.1272/jnms.72.236

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：3  

We report a case of double cancer of the liver and esophagus, an extremely rare condition that can be very difficult to treat. A tumorous lesion was pointed out in segment 6 of the liver of a 69-year-old man under treatment for liver cirrhosis. Abdominal computed tomography and angiography revealed a hepatocellular carcinoma. The patient underwent transcatheter arterial embolization and partial resection of segments 5 and 6. Fourteen months later, a small elevated lesion was detected in the esophagus during an endoscopic examination. The patient was treated by endoscopic mucosal resection and radiation therapy at a total dose of 50 Gy. Histological examination revealed a squamous cell carcinoma with cancer cells confined within the epithelium of the esophagus. Over the 6 years since the hepatectomy, there have been no signs of recurrence. We report a successful curative resection in an extremely rare form of double cancer with a poor prognosis.

DOI： 10.1272/jnms.72.187

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Increases in the serum extracellular matrix proteins (ECMPs) have been described in studies on cholestasis, therefore we investigated the serum levels of collagen IV, aminoterminal propeptide of type III procollagen, and hyaluronic acid prior to percutaneous transhepatic biliary drainage (PTBD) to evaluate its potential as a predictor for prolonged bilirubin clearance and clinical course in patients with malignant obstructive jaundice (MOJ).
Methodology: Serum levels of ECMPs were prospectively investigated in 42 patients with MOJ prior to PTBD. The study group was subdivided according to the bilirubin clearance, and was also subdivided according to the determined level of collagen IV (cut-off point of 260ng/mL).
Results: Serum collagen IV was identified as an independent risk factor for prolonged bilirubin clearance (P=0.006). Receiver-operating-characteristic curve analysis revealed that serum collagen IV had a diagnostic accuracy of 79% at the cut-off point of 260ng/mL. Furthermore, these results indicated that the level of collagen IV is a reliable marker of postoperative liver failure (P=0.029) and predictor of death from liver failure (P=0.02).
Conclusions: Elevated serum collagen IV is a feature of MOJ commonly associated with prolonged bilirubin clearance, and a useful indicator of clinical course, postoperative morbidity, and mortality in patients with MOJ.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration.
Methodology: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups.
Results: Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups.
Conclusions: The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Hemophagocytic syndrome (HPS) is a hypercytokinemia caused by activated T lymphocytes and macrophages in immunologically compromised patients. We report a 37-year-old female who was diagnosed with HPS after undergoing living-donor liver transplantation (LDLT) for fulminant liver failure of unknown etiology. After liver transplantation, recipients with pancytopenia should be tested for serum ferritin. When the serum ferritin is abnormal, the bone marrow should be biopsied to screen for HPS as soon as possible. If the condition is caught early and promptly treated, the outcome of this devastating condition might be improved. In addition, HPS should be ruled out in LDLT candidates with acute liver failure before their operations.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

We report successful outcome following transhepatic insertion of metal stents with a double-pigtail catheter in a patient with afferent loop syndrome caused by recurrent gastric carcinoma. A 77-year-old man was admitted with a 2-week history of fever, right upper quadrant pain, and jaundice. His past medical history included distal gastrectomy for treatment of gastric cancer two years previously. Abdominal computed tomography revealed marked dilation of the jejunal limb and intrabepatic bile duct. We diagnosed the patient with afferent loop syndrome resulting from recurrent cancer. Percutaneous transhepatic biliary drainage was performed, and a catheter was placed beyond the papilla of Vater. Approximately 1300ml, of turbid jejunal contents were removed. Symptoms resolved by one day after initiation of drainage. After 1 week, a sheath introducer was inserted beyond the point of stenosis, and two metal stents were placed. A double-pigtail catheter was inserted into the metal stents to prevent migration. Good stent placement was confirmed and the drainage catheter was removed.

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：2  

We describe an inflammatory tumor in the Spiegel lobe of the liver of an 81-year-old woman. The patient was referred to our hospital for evaluation of a fever of over 39°C and upper abdominal pain. Both conditions had persisted for five days in spite of antibiotic treatment. Initial laboratory tests revealed a serum C-reactive protein concentration of 20.9 mg/dL and white blood cell count of 15,500/μL. Abdominal ultrasound showed a hypoechoic lesion measuring 4 cm in diameter in the Spiegel lobe of the liver. A follow-up abdominal ultrasound revealed that the hypoechoic lesion was not decreased in size. Computed tomography showed a moderate-to-high-density area in the arterial phase and a low-density area in the Spiegel lobe on delayed phase. Magnetic resonance imaging showed a faint low-intensity lesion on T1-weighted imaging and moderate-to-high-intensity lesion on T2-weighted imaging in the Spiegel lobe. Angiography showed a slight hypervascularity in the area of the Spiegel lobe. Antibiotics and v-globulin were commenced soon after admission and the fever gradually improved. Ultrasound-guided liver biopsy revealed that the hepatic parenchyma was almost completely replaced by dense hyalinized fibrous tissue and inflammatory cells. These findings were construed to indicate a benign lesion, but the tumor remained unchanged. Malignant disease could not be completely ruled out. Segment 1 of the liver was resected. Macroscopic examination of the resected specimen revealed a gray, fibrotic, solid tumor. The border of the tumor was well-circumscribed but not encapsulated. Microscopically, the tumor showed a marked fibrotic background with infiltration by a mixed population of lymphocytes, plasma cells, histiocytes, and reactive, plump spindle cells. The postoperative course was uneventful. The patient has remained well in the 10 months since the resection without recurrence.

DOI： 10.1272/jnms.72.121

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING INC  

OBJECTIVES: To present long-term results of angiographic partial splenic artery embolization (PSE) as a supplemental treatment of portal-systemic encephalopathy.
METHODS: Twenty-five patients with portal-systemic encephalopathy were divided into two groups: 14 patients underwent transportal obliteration and/or balloon-occluded retrograde transvenous obliteration (BRTO) of portal-systemic shunts (PSS), followed by PSE (PSE(+) group), and 11 patients underwent only transportal obliteration and/or BRTO of PSS (PSE(-) group).
RESULTS: Portal venous pressures pretreatment was similar to posttreatment in the PSE(+) group, but lower than posttreatment in the PSE(-) group. Serum ammonia levels were higher at pretreatment than at 1 wk posttreatment in both groups, but the levels in the two groups were similar at pretreatment, 1 wk, 3 months, 3 yr, 4 yr, and 5 yr posttreatment. However, serum ammonia levels were lower in the PSE(+) group than in the PSE(-) group 6 months, 9 months, 1 yr, and 2 yr posttreatment. Grades of encephalopathy were higher at pretreatment than at 11 wk posttreatment in both groups, but the levels in the two groups were similar at pretreatment, 1 wk, 2 yr, 3 yr, 4 yr, and 5 yr posttreatment. However, grades of encephalopathy were lower in the PSE(+) group than in the PSE(-) group 3 months, 6 months, 9 months, and 1 yr posttreatment.
CONCLUSIONS: Obliteration of PSS followed by PSE benefit patients with portal-systemic encephalopathy.

DOI： 10.1111/j.1572-0241.2005.40559.x

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

A 73-year-old male with C type liver cirrhosis and poor liver function reserve was diagnosed with hepatocellular carcinoma (HCC)(Segment V, 2×2 cm in diameter) and underwent open microwave coagulation therapy (MCT). Ten months later, a movable hard mass about the size of a quail egg was palpable at the left supra-clavicular lymph node (LN)(Virchow's LN) and blood tests revealed an elevated serum α-fetoprotein (AFP) level of 26.7 ng/dl. Abdominal and chest CT showed no evidence of recurrence in liver or lung, and no metastases of abdominal LN. Barium and bone scintigraphy revealed no abnormal spots. The affected left supra-clavicular LN was extirpated. The tumor was confirmed to be an LN metastasis from HCC by histopathological examination. After the operation, the patient developed uncontrollable pleural effusion and ascites, and intrahepatic and abdominal LN metastases were visible on abdominal CT with great haste. He died 1.5 months after the LN was extirpated. We herein report a case of HCC treated by MCT which later resulted in a solitary Virchow's LN metastasis in the absence of any abdominal LN or recurrence in the liver or lung.<br>

DOI： 10.1272/jnms.72.245

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Calcifications within primary gastrointestinal tumors are rare. Gastrointestinal stromal tumor (GIST) is an unusual nonepithelial tumor that develops in the gastrointestinal tract. In this paper we describe a case of spurt bleeding from a calcificated GIST in the stomach successfully treated by partial gastric resection. A 77-year-old man was admitted for chest discomfort and loss of consciousness. Endoscopic examination revealed spurt bleeding from the top of the submucosal tumor. No other lesions or points of bleeding were found in the stomach. Emergency partial gastrectomy was performed, and the stomach was closed. The cut surface of the tumor had a firm, solid, whitish-gray parenchyma with patchy calcification. Microscopic observation revealed a profusion of spindle-shaped tumor cells with calcification growing from the gastric muscular propria to the submucosa. The cells exhibited low mitotic activity and no prominent signs of nuclear atypia. Immunohistochemical staining of the tumor demonstrated positive reactivity for CD34, KIT, and vimentin, but negative reactivity for α-smooth muscle actin, desmin, and S-100 protein. Tumor cells positive for Mib-1 were rare. The diagnosis of the tumor was established as GIST.<br>

DOI： 10.1272/jnms.72.304

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.72.66

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