Language：Japanese   Publisher：(株)へるす出版  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(株)へるす出版  

researchmap

Language：Japanese   Publisher：(一財)日本消化器病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Extrahepatic portal vein obstruction (EHPVO) is a rare disease. Most EHPVO patients are usually referred to a gastroenterologist for intestinal bleeding and hypersplenic thrombocytopenia; however, hypercoagulative diseases may be occult in these patients and require anticoagulation. The purpose of this study was to elucidate the clinical characteristics of EHPVO. We conducted a retrospective analysis of the hospital database, evaluating the medical records of 15 patients (7 males, 8 females, mean age of onset 42.0 years, range 5-74 years). Thirteen of 15 EHPVO patients (86.7%) had intestinal varices. These included 10 esophageal (66.7%), 12 gastric (80.0%), and 6 ectopic varices (40.0%). Nine (60.0%) of 15 had a history of intestinal bleeding. Regarding comorbidities, 5 of 15 (33.3%) suffered from vascular diseases, including acute myocardial infarction, cerebral infarction, pulmonary embolism, Budd-Chiari syndrome, and mesenteric vein thrombosis. The former 3 vascular commodities manifested at less than 32 years of age. Four patients (26.7%) with JAK2V617F mutation were diagnosed as myeloproliferative neoplasm (MPN). 72.3% of EHPVO patients without MPN experienced thrombocytopenic state. No EHPVO patients with MPN experienced thrombo-leukocytopenia. The elevation of white blood cell and platelet counts, and decrease of protein S were seen in EHPVO with MPN, compared with EHPVO without MPN. EHPVO is frequently associated with underlying hypercoagulative factors, causing a dilemma between thrombotic complications and portal hypertensive bleeding. Most EHPVO patients experience an evident thrombocytopenic state due to severe hypersplenism; however, hypersplenic hematologic changes are eliminated in EHPVO with MPN. MPN should be suspected in EHPVO patients negative for thrombo-leukocytopenia.

DOI： 10.5582/irdr.2023.01106

PubMed

researchmap

Language：Japanese   Publisher：日本手術医学会  

(緒言)外科医は,多職種との関わりも多いが,主戦場は手術室とも言える。特に器械出し看護師(Scrub nurse:SN)は,戦友と言っても過言ではない。これまでの自分の経験と私見を交え,匠のSNについて述べる。(本文)SNとは,手術中に外科医と共に,命を掛けて手術に臨んでいる患者の近くにいる存在で,手術を成功させるために不可欠であり,患者生命の一端を握る責任のある存在である。自分の海外施設見学の経験から,見学者の自分よりも前のめりで術野を観察し,的確に外科医の指示に従うSNを見てきた。確かに"Skillful"なSNではあったが,国ごとの地域差を感じた。自分の考える匠のSNとは,同じく"匠"を目指す外科医と共に,お互いにリスペクトし合い,協力しながら,成長していく過程の延長に存在する。現在,手術に必要な手作り器具の作成,手術シミュレーション,研究会発表などを共に行いながら,互いに"匠"を目指し,奮闘中である。(結語)匠のSNとは,理想であり,目標でもある。それは,外科医が多職種と協力し合って共に育てるものかもしれない。お互いのレベル・モチベーションのアップやコミュニケーションの強化などが必須であり,その点においても本学会の役割は大きいものと考える。(著者抄録)

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Various energy devices are available for resection of the liver parenchyma during laparoscopic liver resection (LLR). We have historically performed liver resections using the Cavitron Ultrasonic Surgical Aspirator (CUSA). More recently, we have used new bipolar forceps (BiSect; Erbe Elektromedizin GmbH, Tübingen, Germany) to perform clamp-crush dissection with good results. The BiSect is a reusable bipolar forceps with a laparoscopic dissecting forceps tip and both an incision mode and coagulation mode. We evaluated the perioperative clinical course of patients who underwent LLR using the clamp-crush method with the BiSect compared with the CUSA. METHODS: This single-center case control study involved patients with liver metastasis from colorectal cancer who underwent LLR using either the BiSect or CUSA at our hospital from January 2019 to December 2022. We performed the LLR using CUSA from January 2019 to early October 2020. After introduction of the Bisect in late October 2020, we used Bisect for the LLR.Before surgery, the three-dimensional liver was constructed based on computed tomography images, and a preoperative simulation was performed. We evaluated the results of LLR using the BiSect versus the CUSA and assessed the short-term results of LLR. RESULTS: During the study period, we performed partial liver resection using the BiSect in 26 patients and the CUSA in 16 patients. In the BiSect group, the median bleeding volume was 55 mL, the median operation time was 227 minutes, and the median postoperative length of hospital stay was 9 days. In the CUSA group, the median bleeding volume was 87 mL, the median operation time was 305 minutes, and the median postoperative length of hospital stay was 10 days. There were no statistically significant differences in the clinical course including bile leakage, bile duct stenosis, and post operative hospital stay between the two groups. CONCLUSIONS: Compared with LLR using the CUSA, the clamp-crush method using the BiSect in LLR is a safe and useful liver transection technique. Further study should be conducted to clarify whether BiSect is safe and useful in LLR for patients with other tumor types and patients who undergo other procedures.

DOI： 10.1272/jnms.JNMS.2024_91-112

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The spleen is a lymphatic organ that manages immune surveillance of the blood, produces blood cells, and helps filter the blood, remove old blood cells, and fight infection. The normal splenic weight is approximately 65-265 g. This study evaluated spleen volume and segmental volume. METHODS: 121 patients who underwent enhanced CT at our center were analyzed. The spleen was divided into upper, middle, and lower segments according to arterial flow area, and the volume of each segment was measured. Patients were classified into two groups as those with and without liver cirrhosis, and differences in the distribution of the segments in these groups was evaluated. RESULTS: The mean upper, middle, and lower spleen segmental volume ratios were 35.4%, 37.0%, and 27.6%, respectively. In the liver cirrhosis group, the segmental splenic volume ratios for the upper, middle, and lower segments were 34.5%, 38.5%, and 28.0%, respectively, indicating that these ratios remain similar regardless of liver cirrhosis status. CONCLUSION: The present findings on segmental spleen volume are useful for estimating infarction volume in cases of partial splenic arterial embolization.

DOI： 10.1272/jnms.JNMS.2024_91-108

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本医科大学医学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本創傷治癒学会  

researchmap

Language：English   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：日本手術医学会  

researchmap

Language：Japanese   Publisher：日本手術医学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(株)医学書院  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for diagnosing and treating biliopancreatic disease. Because ERCP-related perforation can result in death, therapeutic decisions are important. The aim of this study was to determine the cause of ERCP-related perforation and suggest appropriate management. METHODS: Between January 1999 and August 2022, 7,896 ERCPs were performed in our hospital. We experienced 15 cases (0.18%) of ERCP-related perforation and conducted a retrospective review. RESULTS: Of the 15 patients, 6 were female and 9 were male, and the mean age was 77.1 years. According to Stapfer's classification, the 15 cases of ERCP-related perforation comprised 3 type I (duodenum), 3 type II (periampullary), 9 type III (distal bile duct or pancreatic duct), and no type IV cases. Fourteen of 15 (92.6%) were diagnosed during ERCP. The main cause of perforation was scope-induced damage, endoscopic sphincterotomy, and instrumentation penetration in type I, II, and III cases, respectively. Four patients with severe abdominal pain and extraluminal fluid collection underwent emergency surgery for repair and drainage. One type III patient with distal bile duct cancer underwent pancreaticoduodenectomy on day 6. Three type III patients with only retroperitoneal gas on computed tomography (CT) performed immediately after ERCP had no symptoms and needed no additional treatment. Seven of the 15 patents were treated by endoscopic nasobiliary drainage (n=5) or CT-guided drainage (n=2). There were no deaths, and all patients were discharged after treatment. CONCLUSIONS: Early diagnosis and appropriate treatment are important in managing ERCP-related perforation.

DOI： 10.1272/jnms.JNMS.2023_90-305

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publisher：(一社)日本癌学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Extrahepatic portal vein obstruction (EHPVO) is a very rare disease-causing portal hypertension. Myeloproliferative neoplasm (MPN) including essential thrombocythemia (ET) is reported as a risk factor for EHPVO due to underlying persistent thrombophilia.A Japanese woman in her 40s was referred to our hospital with a one-month history of gastric variceal bleeding due to EHPVO. Laboratory investigation demonstrated thrombocytosis despite portal hypertension. She had a mutation of clonal marker JAK2V617F with EHPVO, which prompted us to consult a hematologist. Bone marrow biopsy revealed megakaryocyte lineage proliferation, leading to a diagnosis of ET.Esophagogastroduodenoscopy indicated esophagogastric varices (LsF2CbRC2, Lg-cF1RC1). Abdominal Computed Tomography and angiography revealed splenomegaly and portal vein thrombosis with cavernous transformation. These radiologic findings suggested EHPVO.The patient had a history of ruptured esophagogastric varices and required prophylaxis against further variceal bleeding prior to anti-thrombotic therapy for EHPVO with ET. We performed laparoscopic Hassab's operation followed by endoscopic variceal ligation (EVL) and hematological cytoreduction therapy.Laparoscopic Hassab's operation and three bi-monthly EVL improved the esophagogastric varix (LmF0RC0, Lg-f F0RC0) at 6 months after surgery. Platelet count decreased to 60.1 x104 /uL by cytoreduction therapy. She was very healthy at 7 months after surgery.Patients with EHPVO are traditionally referred to the gastroenterologist for abdominal pain, intestinal bleeding, or refractory ascites; however, hypercoagulative disease may be occult in such patients and require the attention of a hematologist. When encountering the patients with splanchnic thrombosis caused by EHPVO, the gastroenterologists should screen for hematological disease, including MPN.

DOI： 10.1272/jnms.JNMS.2024_91-601

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The spleen is part of the lymphatic system and is one of the least understood organs of the human body. It is involved in the production of blood cells and helps filter the blood, remove old blood cells, and fight infection. Partial splenic artery embolization (PSE) is widely used to treat pancytopenia and portal hypertension. The efficacy of PSE for improving thrombocytopenia has been well demonstrated. In this study, we evaluated the splenic infarction ratio and platelet increase ratio after PSE. METHODS: Forty-five consecutive patients underwent PSE from January 2014 to August 2022. We retrospectively evaluated the splenic infarction volume and ratio after PSE and analyzed the relationship between the splenic infarction ratio and platelet increase ratio after PSE. RESULTS: The platelet increase ratio was correlated with the splenic infarction ratio after PSE. The cutoff value for the splenic infarction ratio with a two-fold platelet increase was 63.0%. CONCLUSION: We suggest performance of PSE in patients with a splenic infarction ratio of 63% to double the expected platelet count.

DOI： 10.1177/03000605231190967

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本膵臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

A Japanese man in his 20s was referred to our hospital with a two-month history of abdominal fullness and leg edema. Abdominal computed tomography revealing massive ascites and ostial blockage of the main hepatic veins, and angiographic evaluation demonstrating obstruction of the main hepatic veins yielded a diagnosis of Budd-Chiari syndrome (BCS). Diuretic agents were prescribed for the ascites but failed to provide relief. The patient was referred to our department for further evaluation and treatment. Angiography showed ostial obstruction of the main hepatic veins, with most of the portal hepatic flow draining from an inferior right hepatic vein (IRHV) into the inferior vena cava (IVC) thorough an intrahepatic portal venous and venovenous shunt. Access between the main hepatic veins and IVC was impossible, but cannulation between the IRHV and IVC was achieved. Because of the venovenous connection between the main hepatic vein and the IRHV, metallic stents were placed into two IRHVs to decrease congestion in the hepatic venous outflow. After stent placement followed by balloon expansion, the gradient pressure between the hepatic vein and IVC improved remarkably. The ascites and lower leg edema improved postoperatively, and long-term stent patency (6 years) was achieved.

DOI： 10.1272/jnms.JNMS.2023_90-603

PubMed

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本病理学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(公社)東京都医師会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

As liver disease progresses, intrahepatic vascular resistance increases (backward flow theory of portal hypertension) and collateral veins develop. Adequate portal hypertension is required to maintain portal flow into the liver through an increase in blood flow into the portal venous system (forward flow theory of portal hypertension). The splenic artery resistance index is significantly and selectively elevated in cirrhotic patients. In portal hypertension, a local hyperdynamic state occurs around the spleen. Splenomegaly is associated with a poor prognosis in cirrhosis and is caused by spleen congestion and by enlargement and hyperactivation of splenic lymphoid tissue. Hypersplenism can lead to thrombocytopenia caused by increased sequestering and breakdown of platelets in the spleen. The close relationship between the spleen and liver is reflected in the concept of the hepatosplenic axis. The spleen is a regulatory organ that maintains portal flow into the liver and is the key organ in the forward flow theory of portal hypertension. This review summarizes the literature on the role of the spleen in portal hypertension.

DOI： 10.1272/jnms.JNMS.2023_90-104

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本消化器病学会-関東支部  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本胆道学会  

症例は76歳男性で心窩部痛を主訴に近医を受診した.上部消化管内視鏡検査を施行したところ,前庭部大彎に粘膜下腫瘍様の隆起性病変を認めた.採血上炎症反応高値であり,CT,MRI上では胆嚢底部に不整な壁肥厚を認め肝実質との境界が不明瞭であり隣接する胃壁の肥厚を認めた.胆嚢癌の可能性を否定できず開腹手術の方針とした.胆嚢周囲は大網,横行結腸,胃が一塊になっていた.瘻孔形成部と思われる部位は強固に癒着していた.胆嚢床切除術を先行し再度瘻孔部の剥離を試みたが剥離は困難であったため幽門側胃切除術も施行した.術中迅速診断で明らかな悪性所見は認めなかったためBillroth II法で再建し手術終了とした.病理診断は黄色肉芽腫性胆嚢炎であった.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02149&link_issn=&doc_id=20221109380004&doc_link_id=%2Fdw1tando%2F2022%2F003604%2F004%2F0524-0530%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw1tando%2F2022%2F003604%2F004%2F0524-0530%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本消化器病学会-関東支部  

researchmap

Language：Japanese   Publisher：(一社)日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本消化器病学会-関東支部  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Liver cancer, including hepatocellular carcinoma (HCC), is the fifth most common cause of cancer deaths in Japan. The main treatment options for HCC are surgical resection, liver transplantation, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and systemic chemotherapy. Here, recent medical treatments for HCC, including surgery, percutaneous ablation, transcatheter arterial chemoembolization/transcatheter arterial embolization, and drug therapy, are reviewed with a focus on Japan.

DOI： 10.1272/jnms.JNMS.2022_89-224

PubMed

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities. They arise from aberrant bile duct cells that develop during embryonic development. With the development of diagnostic modalities such as ultrasonography (US), CT, and MRI, simple hepatic cysts are frequently detected in clinical examinations. US is the most useful and noninvasive tool for diagnosis of simple hepatic cysts and can usually differentiate simple hepatic cysts from abscesses, hemangiomas, and malignancies. Cysts with irregular walls, septations, calcifications, or daughter cysts on US should be evaluated with enhanced CT or MRI, to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts. Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension, and dietary symptoms such as nausea, vomiting, a feeling of fullness, and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels. Asymptomatic simple hepatic cysts do not require treatment. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration because of its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence. Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and selection of a reliable treatment.

DOI： 10.1272/jnms.JNMS.2022_89-115

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

当科では2014年10月〜2021年12月まで184例の腹腔鏡下肝切除術を施行してきた。部分切除や外側区域切除から開始し,著者が2016年に日本内視鏡外科学会技術認定(肝)を取得した後から高難度手術を行うなど,step by stepで適応も広げて来た。安全性を最優先させて来たつもりであるが,そのなかでも致死的となりうる術中合併症も経験してきた。その経験,対処法を共有することが今後の腹腔鏡下肝切除術(Lap-H)の普及と安全性の担保になると考えたため当科での経験を報告する。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

食道胃静脈瘤に対する治療は、EISやEVLなどの内視鏡的治療やB-RTOなどのIVRが主流となっているが、それらの保存的治療に難渋する症例に対して、我々はHassab手術(脾摘および胃上部、食道下部の血行郭清)を施行し有効性を示してきた。最近では、低侵襲な腹腔鏡下でHassab手術や胃小彎の血行郭清を省略したModified Hassab手術を施行している。当科で行っている腹腔鏡下Hassab手術のポイントについて解説する。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

食道胃静脈瘤に対する治療は、EISやEVLなどの内視鏡的治療やB-RTOなどのIVRが主流となっているが、それらの保存的治療に難渋する症例に対して、我々はHassab手術(脾摘および胃上部、食道下部の血行郭清)を施行し有効性を示してきた。最近では、低侵襲な腹腔鏡下でHassab手術や胃小彎の血行郭清を省略したModified Hassab手術を施行している。当科で行っている腹腔鏡下Hassab手術のポイントについて解説する。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科感染症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(株)日本メディカルセンター  

＜文献概要＞門脈圧亢進症では,門脈系の血管抵抗の増大や流入血流量の増加による門脈圧の上昇により,門脈系がうっ血状態となる.脾臓に血液のうっ滞が起こり脾腫が出現し汎血球減少が生じた病態が脾機能亢進症である.脾機能亢進症の治療には部分的脾動脈塞栓術(PSE)と脾臓摘出術がある.PSEは脾臓機能が温存され,IVR(interventional radiology)にて低侵襲に治療することが可能である.脾臓摘出術は制御不能な脾機能亢進症や内視鏡治療が不可能な食道・胃静脈瘤症例が良い適応となる.脾臓の温存の是非に関してはいまだ結論に至らず,患者の状態や各施設の特色から患者にとって最適な治療法を選択することが肝要である.

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes. METHODS: There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin). RESULTS: From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. CONCLUSIONS: We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.

DOI： 10.1272/jnms.JNMS.2021_88-408

PubMed

researchmap

Language：Japanese   Publisher：金原出版(株)  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

症例は85歳の女性で,局所進行膵頭部癌(上腸間膜動脈,門脈浸潤)に対し,化学放射線療法後に亜全胃温存膵頭十二指腸切除術,門脈合併切除再建術を施行した.術後経過は良好であったが3ヵ月目に下血と貧血を認めた.CTで肝外門脈閉塞(extrahepatic portal vein obstruction;以下,EHOと略記)と肝管空腸吻合部周囲に増生した側副血行路を認めた.ダブルバルーン小腸内視鏡検査で静脈瘤を肝管空腸吻合部に認め,同部からの出血と診断した.門脈圧減圧による出血予防を目的に部分的脾動脈塞栓術(partial splenic embolization;以下,PSEと略記)を施行した.その後は出血を認めていない.EHOにより生じる異所性静脈瘤出血は診断・治療の困難な致命的な合併症であるが治療法は確立していない.PSEは肝管空腸吻合部静脈瘤出血に対し一考すべき治療法である.(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01117&link_issn=&doc_id=20210901310004&doc_link_id=10.5833%2Fjjgs.2020.0049&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2020.0049&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：金原出版(株)  

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00620&link_issn=&doc_id=20210816130013&doc_link_id=10.18888%2Fop.0000002382&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002382&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

Language：Japanese   Publisher：(有)科学評論社  

researchmap

Language：Japanese   Publisher：(有)科学評論社  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT. METHODS: A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period. RESULTS: The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group. CONCLUSION: A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.

DOI： 10.1007/s00423-021-02125-9

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本消化器病学会-関東支部  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：医学図書出版(株)  

食道胃静脈瘤の治療法には、内視鏡的治療、IVR、手術療法、薬物療法などがある。近年は内視鏡的治療が中心となっているが、難治例には他の治療法も選択される。食道胃静脈瘤は、門脈圧亢進により発達する側副血行路の一つで、亢進した門脈圧を減圧するdrainage veinの役割を担うため、治療により合併症が生じる場合もある。各疾患の血行動態を把握し一つの治療法に固執せず、その血行動態に即した治療法を選択することが重要である。(著者抄録)

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The Pringle maneuver is often used in liver surgery to minimize bleeding during liver transection. Many authors have demonstrated that intermittent use of the Pringle maneuver is safe and effective when performed appropriately. However, some studies have reported that the Pringle maneuver is a significant risk factor for portal vein thrombosis. In this study, we evaluated the effectiveness of portal vein flow after the Pringle maneuver and the impact that massaging the hepatoduodenal ligament after the Pringle maneuver has on portal vein flow. MATERIALS AND METHODS: Patients treated with the Pringle maneuver for hepatectomies performed to treat hepatic disease at our hospital between August 2014 and March 2019 were included in the study (N = 101). We divided these patients into two groups, a massage group and nonmassage group. We measured portal vein blood flow with ultrasonography before and after clamping of the hepatoduodenal ligament. We also evaluated laboratory data after the hepatectomy. RESULTS: Portal vein flow was significantly lower after the Pringle maneuver than before clamping of the hepatoduodenal ligament. The portal vein flow after the Pringle maneuver was improved following massage of the hepatoduodenal ligament. After hepatectomy, serum prothrombin time was significantly higher and serum C-reactive protein was significantly lower in the massage group than in the nonmassage group. CONCLUSION: Massaging the hepatoduodenal ligament after the Pringle maneuver is recommended in order to quickly recover portal vein flow during hepatectomy and to improve coagulability.

DOI： 10.1007/s00268-020-05570-7

PubMed

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本膵臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We report a case of metastatic pancreatic-head mucinous carcinoma (with multiple lymph node and bone metastases) and review the relevant literature. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for diagnosis, and a satisfactory outcome was achieved after systemic chemotherapy with FOLFIRINOX followed by resection of the primary lesion as conversion surgery. The patient was a 55-year-old man. Hematological findings included elevated serum tumor marker levels: CEA 12.7 ng/mL, DUPAN-2 400 U/mL. Findings from several imaging modalities and EUS-FNA confirmed a clinicopathological diagnosis of metastatic pancreatic mucinous carcinoma with multiple bone and lymph node metastases. Five courses of modified FOIFIRINOX (m-FFX) were given as systemic chemotherapy, which had an antitumor effect. Subtotal stomach-preserving pancreaticoduodenectomy and extensive lymph-node dissection were thus performed. Histopathological analysis showed invasive ductal carcinoma, muc (pT3, pN1b, cM1). After surgery, the clinical course was notable for the absence of complications. Tegafur/gimeracil/oteracil (S-1) was started as maintenance adjuvant chemotherapy postoperatively, and no disease progression has been observed at 10 months after surgery.

DOI： 10.1272/jnms.JNMS.2019_86-502

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We modified and administered capecitabine + epirubicin + cyclophosphamide combination therapy (CEX) as neoadjuvant chemotherapy (NAC) for HER-2-negative breast cancer and retrospectively analyzed its effectiveness and tolerability at our center. METHODS: The inclusion criteria were presence of breast cancer negative for HER-2 and positive lymph node metastasis, or negative lymph node metastasis when tumor diameter was 20 mm or greater without distant metastasis. Additional inclusion criteria were a performance status of 0 or 1, an EF >60%, and an age of 75 years or less. Clinical outcomes were evaluated after 4 courses of epirubicin 80 mg/m2, cyclophosphamide 500 mg/m2 (administered every 3 weeks), and capecitabine 1,500 mg/m2 (administered for 2 weeks and withdrawn for 1 week). RESULTS: A clinical benefit was noted in all 18 patients who received CEX as neoadjuvant chemotherapy during the period from 2009 through 2013. The clinical response rate was 83.3% (15/18), and the clinical complete response rate was 50%. Aesthetic outcomes of breast-conserving surgery were positive in all patients. Among patients with satisfactory outcomes, 33.3% had a pathologic complete response (triple-negative: 6, luminal: 0) and 68.8% were n0 (triple-negative: 8, luminal: 3). All patients with a pathologic complete response are presently alive, free of recurrence, and currently undergoing follow-up. Adverse events were classified as grade 2 or lower in all patients. CONCLUSIONS: CEX therapy administered as neoadjuvant chemotherapy could be useful for individualized treatment. In particular, this regimen was effective for triple-negative breast cancer.

DOI： 10.1272/jnms.JNMS.2020_87-204

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications were initially based solely on tumor location, size, and type. Use of LH has spread rapidly worldwide because it reduces incision size. This review systematically assesses the current status of LH. As compared with OH, LH is significantly less complicated, requires shorter hospital stays, and results in less blood loss. The long-term survival rates of LH and OH are comparable. Development of new techniques and instruments will improve the conversion rate and reduce complications. Furthermore, development of surgical navigation will improve LH safety and efficacy. Laparoscopic major hepatectomy for HCC remains a challenging procedure and should only be performed by experienced surgeons. In the near future, a training system for young surgeons will become mandatory for standardization of LH, and LH will likely become better standardized and have broader applications.

DOI： 10.1272/jnms.JNMS.2019_86-411

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The common metastatic sites of renal cell cancer (RCC) are the lung, bone, liver, brain, adrenal glands, and contralateral kidney. Metastasis to the gallbladder is rare, and cystic duct metastasis from RCC has been reported in only one metachronous case. This is the first report of a case of synchronous cystic duct metastasis from RCC. CASE REPORT: A 72-year-old woman presenting with hematuria had a history of Cushing disease approximately 10 years previously. Enhanced computed tomography of the abdomen showed a mass measuring 5.8 × 3.0 cm in the left kidney, which was strongly enhanced in the early phase and washed out in the late phase. A mass measuring 2 cm in diameter was seen in the left adrenal gland, and a 1.0-cm mass was noted in the right adrenal gland. Multiple tiny masses were detected in the cystic duct. Left renal cell carcinoma, cystic duct metastasis, and bilateral adrenal gland metastases were diagnosed. Because the metastatic tumor was close to the common bile duct, we performed left nephrectomy, bilateral adrenalectomy, cholecystectomy, resection of the extrahepatic bile duct, and hepaticojejunostomy. Pathological findings showed that the renal tumor was clear cell carcinoma, as were the bilateral adrenal tumors and cystic duct tumor. The patient died 30 months after the operation.

DOI： 10.1272/jnms.JNMS.2018_86-405

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

症例は71歳,男性.直腸癌に対し低位前方切除術を施行.術後に急性腎不全,心不全,誤嚥性肺炎,腹腔内膿瘍を併発したが保存的加療にて改善した.術後15ヵ月頃から下腹部膨満感が出現し,左下腹部のドレーン挿入部周囲の皮下気腫,および腹部単純CT検査で腹腔内にfree airを認めた.症状および炎症所見が軽度であったため腹腔穿刺・吸引を行い経過観察としていたが,症状が増悪したため精査を行った.下部消化管内視鏡検査で盲端部(S状結腸)に2mm大の穿孔部を認めたため,クリップによる閉鎖を施行した.経口摂食開始後,腹腔内の気体の微増と軽度の腹部膨満感を認めたが保存的に加療した.完全閉鎖は得られなかったが腸管内容の腹腔内への流出は認めなかったため外来で経過観察とした.穿孔後約1年経過したが全身状態は良好で現在通院加療中である.直腸切除術15ヵ月後の端側吻合盲端部に微小穿孔を認めた症例を経験したため報告する.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01066&link_issn=&doc_id=20190828040022&doc_link_id=130007893354&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007893354&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 59-year-old woman who complained of melena and lightheadedness visited the outpatient clinic at our hospital.According to her blood test result, she had anemia, and her tumor marker levels were high.Enhanced computed tomography(CT) findings showed small intestinal cancer with multiple liver metastases.Partial resection of the small bowel for the small intestinal cancer was performed.Following the administration of fourth-line outpatient chemotherapy containing S-1 plus irinotecan( IRIS)and IRIS plus bevacizumab(IRIS plus Bev), S-1 plus oxaliplatin plus Bev(SOX plus Bev), and weekly paclitaxel (wPAC), she survived with good condition for 19 months after the surgery.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は59歳、女性。下血、ふらつきを主訴に当科を受診となった。高度貧血と腫瘍マーカーの上昇を認め、腹部造影CTにて多発肝転移を伴う小腸癌と診断した。小腸部分切除術を施行した。病理組織診断は高分化型腺癌であった。術後からS-1+irinotecan(IRIS)併用療法、IRIS+bevacizumab(IRIS+Bev)併用療法、S-1+oxaliplatin+Bev(SOX+Bev)併用療法、weekly paclitaxel(wPAC)療法とfourth-lineまで化学療法を施行し得たが、1年7ヵ月後に原病死となった。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20190604480025&doc_link_id=%2Fab8gtkrc%2F2019%2F004605%2F026%2F0949-0952%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004605%2F026%2F0949-0952%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension. Interventional radiology (IVR) is generally selected as the first-line therapeutic option. Surgical treatment for IAPF is required in refractory cases of IVR. As the treatment success rate with IVR is high, cases requiring surgical treatment are extremely rare. CASE PRESENTATION: A 54-year-old man was admitted to another hospital complaining of hematemesis due to rupture of the esophageal varices. A computed tomography revealed ascites and arterioportal fistula in the left lobe of the liver. Transcatheter arterial embolization (TAE) was performed to occlude the fistula; however, it could not reach complete occlusion. Thereafter, there were a total of four hematemeses, and six endoscopic variceal ligations were required. The second TAE also failed to reach complete occlusion. He was transferred to our hospital for further treatment. Because liver function was low due to frequent hematemeses and there was also uncontrollable ascites, it was confirmed that hepatectomy could not be performed safely at this time. Therefore, we ligated the left portal branch and ligated and dissected the left gastric vein to decrease portal vein pressure. However, on the 5th day after surgery, the esophageal varices reruptured. As the disappearance of ascites was observed in the postoperative course and the general condition also improved, left hepatectomy was performed to remove IAPF. There was no recurrence of portal hypertension for 1 year and 3 months since hepatectomy. CONCLUSIONS: This case was difficult to treat with IVR and required surgical treatment. Our experience in the present case suggests that hepatectomy to remove arterioportal fistula was considered effective for improving portal hypertension due to IAPF. However, careful treatment selection according to the patient's overall condition and clinical course is necessary for IAPF presenting with severe portal hypertension.

DOI： 10.1186/s40792-019-0623-8

PubMed

researchmap

Language：Japanese   Publisher：日本医科大学医学会  

症例は69歳女性で、子宮癌肉腫術後、腹腔内再発および盲腸癌を認め、回盲部切除術、小腸部分切除術、腫瘍摘出術を施行されていた。今回、腹部CT検査にて多発肝腫瘍を指摘され、精査加療目的にて入院となった。画像所見から子宮癌肉腫の肝転移と診断し、他に再発部位は画像上認められなかったため肝切除術を施行した。S7の腫瘍が最も大きく、S7グリソンに近接していたため、S7グリソンを切離する必要があった。そのほかの腫瘍は肝表面に認めているため腫瘍核出術を行う方針とした。術後経過は良好で、術後15日目に退院となった。3ヵ月後、腹部CTおよびPET検査にて骨盤内に再発所見を認め、術後経過良好で退院ののち、化学療法を行ったが、腫瘍の縮小は得らなかった。緩和病棟を持つ病院に転院し、肝切除術41ヵ月後に永眠された。

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J04260&link_issn=&doc_id=20190320310005&doc_link_id=%2Fcw1nimed%2F2019%2F001501%2F006%2F0032-0037%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2019%2F001501%2F006%2F0032-0037%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

Endoscopic variceal ligation (EVL) is being used increasingly to treat esophageal varices because of its safety and simplicity and because no sclerosant is required. However, early recurrence of esophageal varices after this procedure has been reported. We compared the efficacy and long-term results of EVL performed in three treatments using a total of 16 O-rings at two different intervals, namely, biweekly (once every 2 weeks: the conventional interval) and bimonthly (once every 2 months). In all patients except two (both in the biweekly group), the esophageal varices were completely eradicated. Overall rates of both variceal recurrence and additional treatment were higher in the biweekly group than in the bimonthly group (P &lt
0.001). EVL performed bimonthly in three treatment sessions for esophageal varices yielded better results than the same treatment performed biweekly. Treatment at the longer interval yielded a higher total eradication rate, lower recurrence rate, and lower rate of required additional treatment. Repeat treatment of EVL is useful
therefore, three treatment sessions should be considered as one course. Bimonthly EVL (three times in 4 months) might become a standard treatment for esophageal varices.

DOI： 10.1007/978-981-10-7425-7_27

Scopus

researchmap

Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

A number of surgical procedures have been developed for the management of esophagogastric varices. They can be broadry classified into shunting and nonshunting procedures. There are two types of shunting procedure, namely nonselective and selective. Nonselective shunts, such as portacaval or mesocaval shunts, effectively reduce the incidence of variceal bleeding, but they carry a high risk of postoperative encephalopathy as a result of hyperammonemia. Selective shunts such as the distal splenorenal shunt (DSRS) or left gastric venous caval shunt were developed to preserve portal blood flow through the liver and reduce esophagogastric variceal pressure. The DSRS effectively prevents rebleeding, but it still carries a risk of postoperative encephalopathy. In order to prevent both postoperative encephalopathy and bleeding, we have improved the DSRS procedure by additionally performing splenopancreatic disconnection and gastric transection. In conclusion, endoscopic treatments have been developed recently and are performed widely performed for esophagogastric varices
however, surgery in the form of DSRS is also useful for managing esophagogastric varices in patients with idiopathic portal hypertension in the absence of severe liver pathologies.

DOI： 10.1007/978-981-10-7425-7_44

Scopus

researchmap

Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

Transportal obliteration is a technique used in portal hypertension to embolize the collateral veins of the portal system. It is used to treat refractory esophagogastric varices, ectopic varices, or portal-systemic encephalopathy. After insertion of a 5-French long sheath introducer into the portal vein, a catheter is inserted directly into the vein, and the portal circulation is visualized by portography. A balloon catheter is inserted selectively into the inflow site of the veins feeding the varices. Sclerosant is injected to obliterate the feeding vein or veins, and steel coils are used to complete the obliteration. However, the rate of complete disappearance of varices is not high after transportal obliteration alone. Transportal obliteration combined with endoscopic treatment or balloon-occluded retrograde transvenous obliteration, or both, is useful for treating uncontrolled bleeding from varices. The most frequent complication of percutaneous transhepatic obliteration is intraperitoneal bleeding. Severe coagulopathy is a contraindication for both percutaneous transhepatic obliteration and transileocolic vein obliteration, and ascites is a contraindication for percutaneous transhepatic obliteration. The presence of collateral veins decreases portal venous pressure. Obliteration of these veins by transportal obliteration thus increases portal congestion and portal pressure, especially in patients with cirrhosis. Partial splenic embolization has been performed incrementally to reduce portal venous pressure to the level it was before obliteration of the collateral veins. Transportal obliteration in combination with endoscopic treatment or with other forms of interventional radiology is useful for treating refractory esophagogastric varices, ectopic varices, or portal-systemic encephalopathy.

DOI： 10.1007/978-981-10-7425-7_40

Scopus

researchmap

Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

Various complications, such as esophagogastric varices, ectopic varices, ascites, and hepatic encephalopathy, can occur in portal hypertension. Bleeding from esophagogastric or ectopic varices is the most critical complication of portal hypertension. In 1980, general rules for recording endoscopic findings of esophageal varices were initially proposed in Japan. Revised rules were proposed as “General Rules for Recording Endoscopic Findings of Esophagogastric Varices (1991)" and “General Rules for Recording Endoscopic Findings of Esophagogastric Varices (2010).” The revised rules are simpler and more straightforward than the former rules. In 2013, “General Rules for Study of Portal Hypertension” was proposed by the Japan Society for Portal Hypertension. These rules have widely been used in Japan and other countries. Here, we review future prospects in the treatment of portal hypertension.

DOI： 10.1007/978-981-10-7425-7_61

Scopus

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

61歳男性。C型肝硬変、アルコール性肝硬変、慢性腎不全にて近医を通院中、透析中に羽ばたき振戦を伴う意識障害が出現し、前医へ救急搬送された。前医では脾腎シャントに伴うシャント型肝性脳症と診断され、内服治療が行われるも抵抗性が強く、肝性脳症を繰り返すため当科へ紹介となった。各検査により、巨大側副血行路を有するシャント型肝性脳症と診断されたが、患者が透析症例で腹水コントロールに難渋すること、短絡路の最大径が5cmで血管内治療が不可能であったことから、外科的に短絡路を保存して脾静脈結紮切離(分流術)を施行することとなった。その結果、術後は肝性脳症は速やかに改善し、患者は目下、職場復帰している。

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03767&link_issn=&doc_id=20190215320005&doc_link_id=10.11423%2Fjsph.24.242&url=https%3A%2F%2Fdoi.org%2F10.11423%2Fjsph.24.242&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

At present the only method available to confirm microscopic infiltration of cancer into ductal margins during surgery, is intraoperative histological examination. In the present study, the status of the surgical margins and postoperative course were evaluated to determine any correlation between remnant carcinoma and postoperative survival. All consecutive patients who underwent resection for biliary tract cancer between January 2004 and May 2012 were identified from a database. Positive margin cases were divided into two groups, invasive carcinoma and carcinoma in situ (CIS). Immunohistochemical staining targeting Ki67 and p53 for positive margins was performed. Cases of major vessel invasion were significantly increased in the positive group compared with the negative group. The recurrence rate was significantly lower in the CIS group compared with the invasive group. The survival rate was significantly increased in the CIS group compared with the invasive group. The expression levels of p53 and Ki67 were significantly increased in the invasive group compared with the CIS group. No statistical correlations were observed between the expression of p53 or Ki67 and the survival or recurrence of disease. In the positive group, resected margin status was the principal factor associated with recurrence-free survival according to Cox-regression analysis. In conclusion, the status of the resected margins in the positive group was the most important factor for postoperative survival and recurrence in cholangiocarcinoma, not immunohistochemical staining targeting Ki67 and p53.

DOI： 10.3892/ol.2018.9479

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Recently, some reports have revealed a relationship between post-hepatectomy prognosis in hepatocellular carcinoma (HCC) and hepatic fibrosis markers. We evaluated the relationship between these markers of hepatic fibrosis, clinicopathological findings, and prognosis. METHODS: Three hundred and sixty patients underwent hepatectomy for HCC in the Nippon Medical School Hospital between 1993 and 2013. We divided these patients into two groups: normal serum hyaluronic acid (HA) levels and abnormal levels. We also divided patients into groups with normal serum type IV collagen levels and abnormal levels. RESULTS: The overall survival rate and recurrence-free survival rate of the normal group were significantly higher than those of the abnormal group. In the normal hyaluronic acid group, serum albumin and prothrombin time were significantly higher than in the abnormal group, and age, hepatitis C virus antibody (HCV)-Ab positivity, Child-Pugh grade B, liver cirrhosis, indocyanine green retention rate at 15 min (ICGR15), type IV collagen level, and type IV collagen 7s level were significantly lower than those in the abnormal group. In the normal type IV collagen group, HCV-Ab positivity, liver cirrhosis, ICGR15, HA level, and type IV collagen 7s level were significantly lower than those in the abnormal group, and the serum albumin level was significantly higher than that in the abnormal group. Multivariate analysis independently revealed the significant effect of serum type IV collagen on the overall survival rate as well as the significant effect of serum HA on the recurrence-free survival rate in patients who underwent hepatectomy for HCC. CONCLUSIONS: Preoperative examinations of serum hyaluronic acid levels and type IV collagen levels are imperative for hepatic resection for HCC because these markers are significantly associated with liver function and prognosis.

DOI： 10.1272/jnms.JNMS.2018_85-34

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Cutaneous metastasis of an internal malignancy is uncommon and is estimated to occur in 0.7-9% of patients with internal cancer including autopsy cases. We would like to report a case of long survival of sigmoid colon adenocarcinoma diagnosed as an instance of facial cutaneous metastasis. A 68-year-old male was admitted to our hospital for a tumor mass on the left side of his cheek. In his past history, acute myocardial infarction had occurred 2 years earlier. He also had chronic renal failure and chronic obstructive pulmonary disease. Histologic findings from the biopsy sample of this facial lesion were moderately differentiated adenocarcinoma. Colonoscopy revealed a tumor 20 mm × 30 mm in diameter in the sigmoid colon. Histologic findings of the biopsy sample of this tumor also indicated moderately differentiated adenocarcinoma. The patient was diagnosed with sigmoid colon cancer with cutaneous metastasis to the face. We performed a sigmoidectomy with lymph node dissection and resection of the facial cutaneous metastasis. After being discharged, low dose chemotherapy was performed in consideration of the patient's renal function. Although long-term management of his general condition was provided, the patient died 37 months after surgery because of chronic heart failure.

DOI： 10.1007/s12328-017-0767-7

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPANDIDOS PUBL LTD  

The prognosis of hepatocellular carcinoma (HCC) is unfavorable following complete tumor resection. The aim of the present study was to identify a molecule able to predict HCC prognosis through comprehensive protein profiling and to elucidate its clinicopathological significance. Comprehensive protein profiling of HCC was performed by liquid chromatography-tandem mass spectrometry. Through the bioinformatic analysis of proteins expressed differentially in HCC and non-HCC tissues, protein disulfide-isomerase A3 (PDIA3) was identified as a candidate for the prediction of prognosis. PDIA3 expression was subsequently examined in 86 cases of HCC by immunostaining and associations between PDIA3 expression levels and clinicopathological characteristics were evaluated. The Ki-67 index and apoptotic cell death of carcinoma cells were examined by immunostaining and terminal deoxynucleotidyl transferase dUTP nick-end labeling assay in 24 cases. The results demonstrated that PDIA3 was expressed in all 86 HCC cases; 56 HCC cases (65%) exhibited high expression of PDIA3 and 30 (35%) exhibited low expression. The disease-free and overall survival times of HCC patients with high PDIA3 expression were significantly shorter than in HCC patients with low expression. Furthermore, increased expression of PDIA3 was associated with an elevated Ki-67 index, indicating increased cancer cell proliferation and a reduction in apoptotic cell death. Taken together, these results suggest that PDIA3 expression is associated with tumor proliferation and decreased apoptosis in HCC, and that increased expression of PDIA3 predicts poor prognosis. PDIA3 may therefore be a key molecule in the development of novel targeting therapies for patients with HCC.

DOI： 10.3892/ol.2016.5304

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Chronic pain and discomfort is a notable complication after inguinal hernia repair. This study assesses the incidence and degree of chronic pain and discomfort after primary inguinal hernia repair performed in our hospital and aims to clarify its relationship to the type of mesh placement. MATERIALS AND METHODS: A retrospective analysis was conducted of 334 patients (378 lesions) who underwent primary inguinal hernia using the Lichtenstein (onlay mesh), Ultrapro Plug (UPP; onlay plus plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (TAPP; underlay mesh) procedure. Postoperative pain was assessed using a numerical rating scale at postoperative 2-3 wk, 3 mo, and 6 mo. Postoperative discomfort was assessed 6 mo afterward. RESULTS: Questionnaire responses were received for 378 lesions (100%) after 2-3 wk, 229 (60.6%) after 3 mo, and 249 (65.9%) after 6 mo. The majority of chronic pain experienced was mild, and no patient suffered from severe pain. The level of pain tended to be less for the TAPP procedure than for other methods. Discomfort at rest was significantly less for TAPP versus Ultrapro Plug (P < 0.01), and discomfort with movement was significantly less for TAPP versus modified Kugel (P < 0.05). CONCLUSIONS: Onlay mesh appears to be a risk factor in chronic pain and discomfort. The lower level of chronic pain and discomfort with underlay mesh placement is considered to result from the reduced risk of nerve damage in this procedure than in the onlay mesh placement procedure.

DOI： 10.1016/j.jss.2016.08.027

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Portal vein thrombosis (PVT) is a rare complication of liver transplantation which can lead to graft failure and patient death. Treatment can be difficult, especially in cases of PVT from the intrahepatic portal vein to the proximal jejunal veins. A 55-year-old woman had undergone living-donor liver transplantation with splenectomy for end-stage liver cirrhosis due to hepatitis C with hepatocellular carcinoma. Ten months after transplantation, massive ascites and slight abdominal pain developed, and computed tomography revealed a PVT between the intrahepatic portal vein and the superior mesenteric vein. Repeated interventional radiology procedures were used in combination with thrombolysis, thrombectomy, and metallic stent replacement to obtain favorable portal flow to the graft. Five years after being treated, the patient is well, with favorable portal flow having been confirmed. In conclusion, repeated and assiduous interventional radiological treatment combined with thrombolytic therapy, thrombectomy, and metallic stent replacement could be important for severe PVT.

DOI： 10.1272/jnms.83.206

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English  

researchmap

Language：English  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report the first documented case of pancreatic metastasis from a gastrointestinal stromal tumor of the stomach. A 42-year-old Japanese man presented with severe abdominal discomfort. Computed tomography of the abdomen showed a huge heterogeneous mass consisting of cystic and solid components in the left upper abdomen. F-18-Fluorodeoxyglucose positron-emission tomography revealed high tracer uptake in the abdominal mass. After total gastrectomy with lymphnodectomy was performed, a hard mass was palpated in the pancreatic tail. The pancreatic tumor was also resected under the therapeutic strategy. Histological examinations of the resected gastric and pancreatic specimens revealed that both tumors consisted of uniform spindle cells with a fascicular growth pattern and were immunohistochemically positive for CD34 and CD117/KIT. Gene sequencing analysis of DNA from each tumor revealed an identical deletion of 21 nucleotides in exon 11 of the gene KIT. On the basis of these results, we concluded that the pancreatic tumor was a metastatic tumor from the gastrointestinal stromal tumor of the stomach.

DOI： 10.1272/jnms.83.133

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A clear operative view of the middle and lower mediastinum is possible in prone position during video-assisted thorocoscopic surgery of esophagus (VATS-E), but the working space in the upper mediastinum is limited and lymph node dissection along the left recurrent laryngeal nerve (RLN) is difficult in this position. METHODS: Esophagectomy and lymph node dissection are performed for pneumothorax by maintaining CO2 insufflation in the prone position. Working space in the left upper mediastinal area for lymph node dissection around RLN is limited in this position. To create space, the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose. Lymph node dissection is performed after stripping the residual esophagus. RESULTS: We could obtain a clear operative field in the upper left mediastinum by stripping the residual esophagus in the prone position, enabling safe and straightforward lymph node dissection along the left RLN. The rate of permanent RLN paralysis was 1.2%. CONCLUSIONS: Lymph node dissection along the left RLN after esophageal stripping is possible in the prone position during VATS-E.

DOI： 10.21037/jovs.2016.11.01

PubMed

researchmap

DOI： 10.1272/jnms.83.93

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

DOI： 10.14309/00000434-201510001-01628

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

Epithelial splicing regulatory protein 1 (ESRP1) binds the FGFR-2 auxiliary cis-element ISE/ISS-3, located in the intron between exon IIIb and IIIc, and primarily promotes FGFR-2 IIIb expression. Here we assessed the role of ESRP1 in pancreatic ductal adenocarcinoma (PDAC). Immunohistochemical analysis was performed using anti-ESRP1, FGFR-2 IIIb and FGFR-2 IIIc antibodies in 123 PDAC cases. ESRP1 expression vector and small interference RNA (siRNA) targeting ESRP1 were transfected into human PDAC cells, and cell growth, migration and invasion were analyzed. In vivo heterotopic and orthotopic implantations using ESRP1 overexpression clones were performed and effects on pancreatic tumor volumes and hepatic and pulmonary metastases determined. ESRP1 immunoreactivity was strong in the nuclei of cancer cells in well-to-moderately differentiated PDACs but weak in poorly differentiated cancers. Well-to-moderately differentiated cancers also exhibited high FGFR-2 IIIb and low FGFR-2 IIIc expression, whereas this ratio was reversed in the poorly differentiated cancers. Increased ESRP1 expression was associated with longer survival in comparison with low ESRP1 expression, and PANC-1 cells engineered to express ESRP1 exhibited increased FGFR-2 IIIb expression and decreased migration and invasion in vitro, whereas ESRP1 siRNA-transfected KLM-1 cells exhibited increased FGFR-2 IIIc expression and increased cell growth, migration and invasion. In vivo, ESRP1-overexpressing clones formed significantly fewer liver metastases as compared with control clones. ESRP1 regulates the expression pattern of FGFR-2 isoforms, attenuates cell growth, migration, invasion and metastasis, and is a favorable prognostic factor in PDAC. Therefore, devising mechanisms to upregulate ESRP1 may exert a beneficial therapeutic effect in PDAC.

DOI： 10.1038/onc.2013.392

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Pancreatic ductal adenocarcinoma (PDAC) is associated with a high incidence of hepatic metastases, as well as occasional pulmonary metastases. To delineate the potential role of cancer stem cells (CSCs) in PDAC metastasis, human PDAC cells were injected into the spleen of mice. The characteristics and expression of markers associated with CSC and epithelial mesenchymal transition (EMT) of metastatic cells that developed in the liver and Lung were then compared with parental cells. The metastatic cells were polygonal, and larger than parental cells. Metastatic cells also exhibited decreased proliferation and increased adhesion to extracellular matrices, as well as enhanced migration and invasion in vitro and increased metastatic capacity in vivo. The CSC markers ALDH1A1, ABCG2, and nestin were expressed at high levels in metastatic cells and exhibited changes consistent with EMT (eg, decreased E-cadherin expression). Moreover, metastatic cells readily formed spheres in culture and exhibited an increased side population by flow analysis. Nestin and ABCG2 were also expressed at high levels in metastatic Lesions from PDAC patients, and silencing nestin with shRNA in PDAC cells derived from lung metastases resulted in a marked decreasein the capacity of the cells to form spheres and to yield pulmonary or hepatic metastases. Thus, the metastatic potential of human PDAC cells correlates with CSCs and with EMT characteristics and is dependent on nestin expression.

DOI： 10.1016/j.ajpath.2013.11.014

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

A liver tumor metastatic from a sigmoid colon carcinoma was diagnosed in a 70-year-old man. Because hepatectomy was not indicated, the patient was treated with a combination of oxaliplatin, levofolinate, and fluorouracil (5-FU) (modified FOLFOX 6 regimen). After 15 cycles of chemotherapy, this regimen was considered to have been ineffective; therefore, treatment was started with the topoisomerase inhibitor irinotecan and an intravenous infusion of 5-FU and levofolinate (FOLFIRI). After receiving irinotecan and levofolinate, the patient had chills, a severe cough, and dyspnea. We diagnosed pulmonary edema as a side effect due to oxaliplatin, and the chemotherapeutic regimen was changed from FOLFIRI to FOLFOX plus bevacizumab. After the third cycle of oxaliplatin and levofolinate, pulmonary edema recurred, and a preshock state developed again. We suspected that either oxaliplatin or irinotecan had caused the pulmonary edema and, therefore, administered levofolinate, 200 mg/m(2); 5-FU, 400 mg/m(2); and bevacizumab, 330 mg/m(2); intravenously on day 1, followed by 5-FU, 2,400 mg/m(2), as a continuous intravenous infusion at 46 hours without either of oxaliplatin, levofolanate, and bevacizumab. After being treated with levofolinate again, the patient suddenly complained of severe dyspnea; this symptom confirmed that levofolinate had caused the pulmonary edema. To our knowledge, severe pulmonary edema caused by levofolinate has not been reported previously. This adverse effect was clinically significant because it led to the patient's death.

DOI： 10.1272/jnms.80.460

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科感染症学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：English   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Bleeding from gastric varices (GVs) is generally considered more severe than that from esophageal varices (EVs) but occurs less frequently. We review the risk factors for bleeding EVs and GVs. GVs were divided into 2 groups: cardiac varices (CVs, Lg-c) and fundal varices (FVs), i.e., varices involving the fundus alone (Lg-f) or varices involving both the cardia and fundus (Lg-cf). Elevated pressure in the portal vein is a risk factor for bleeding EVs. The portal pressure in patients with GVs and a gastrorenal shunt is lower than that in patients with EVs. The large size of varices is a risk factor for bleeding EVs. Red color signs are elevated red areas that are important for predicting the risk of variceal bleeding, and red wale markings, dilated venules oriented longitudinally on the mucosal surface, have been considered to be the sign with the highest risk. Red color signs are rare in FVs, possibly because of the pronounced thickness of the mucosal layer. Bleeding EVs are not associated with use of antiulcer drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Although, in patients with bleeding GVs, "occasional" use of an oral NSAID is an important step leading to variceal hemorrhage, especially from FVs, even if the mucosa is protected by antiulcer drugs. Constipation, vomiting, severe coughing, and excessive consumption of alcohol may precipitate rupture of EVs.

DOI： 10.1272/jnms.80.252

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a cystic intraductal papillary neoplasm of bile duct (IPNB) of adenocarcinoma treated with surgical resection. An 82-year-old man was admitted to our hospital because of distension of the right upper quadrant of the abdomen. On admission, a huge nontender mass was palpated in the right upper abdomen. Initial laboratory tests revealed the following serum values: aspartate aminotransferase, 123 IU/L; alanine aminotransferase, 113 IU/L; alkaline phosphatase, 376 IU/L; bilirubin, 1.6 mg/dL; alpha-fetoprotein, 7.4 ng/mL; CA19-9, 39.8 U/mL; carcinoembryonic antigen, 4.1 ng/mL; and Duke pancreatic monoclonal antigen type 2, 200 U/mL. Abdominal ultrasonography revealed an anechoic mass with an elevated papillary lesion in the right paramedian section. Computed tomography showed a low-density hepatic lesion, measuring 12 x 10 cm, with thick, irregular walls. A T2-weighted magnetic resonance scan showed mural nodules with signal intensity higher than that of the liver. The cystic lesion was suspected to be a cystic IPNB, but we could not determine whether it was a carcinoma. We performed extensive right paramedian sectionectomy and cholecystectomy. The resected multilocular tumor was filled with a yellow fluid, and the cut surface showed multiple, yellowish papillary nodules lining the cystic wall. On histologic examination, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. Papillary and micropapillary lesions exhibited cellular atypia: nuclear enlargement and hyperchromasia, mutilayering, and mitosis. Ovarian-like stroma was not detected. The tumor was diagnosed as an IPNB (carcinoma in situ lesion). These lesions had expanded into several intrabiliary ducts. No recurrence has been detected 2 year after operation.

DOI： 10.1272/jnms.80.234

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

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

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

Introduction. 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. Case Presentation. 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. Conclusion. We experienced a rare case of a leiomyosarcoma of IVC mimicking hepatic tumor. © 2013 Junji Ueda et al.

DOI： 10.1155/2013/235698

Scopus

PubMed

researchmap

Language：Japanese   Publisher：Japan Surgical Association  

We report a case of wide-ranged non-occlusive mesenteric ischemia (NOMI) associated with duodenal ischemia. A 79-year-old man underwent a stent graft replacement for thoracic aortic aneurysm. Three days after the procedure, he developed infectious enteritis associated with diarrhea and abdominal pain. Thirteen days after the procedure, abdominal distention and vomiting appeared and a computed tomography (CT) scan revealed paralytic ileus, hepatic-portal venous gas, and pneumatosis cystoideus intestinalis. Judging from the severity of the illness, we treated conservatively by decompression of the gastrointestinal tract. However, 8 hours thereafter, the patient developed shock and a CT scan demonstrated poor enhancement of the part of the small intestine. We performed an emergency laparotomy. <BR>The intraabdominal findings showed a wide range of ischemic bowel from the duodenum to the transverse colon and we resected the necrotic bowels. The patient could not recover from the shock state and died of multiple organ failure on the postoperative day 11. Pathological examination detected no thrombus in the mesenteric arteries. Therefore, the patient was diagnosed as NOMI. This patient is the fourth case of wide-ranged NOMI associated with duodenal ischemia in the literature search and it seems to have a poor prognosis.

DOI： 10.3919/jjsa.73.3145

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2013118295

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPANDIDOS PUBL LTD  

Cancer stem cells (CSCs) play pivotal roles in cancer growth, invasion, metastasis and recurrence. Several proteins have been reported as CSC markers for pancreatic ductal adenocarcinoma (PDAC). In the present study, we examined the correlation between pancreatic intraepithelial neoplasias (PanINs) and CSC markers including CD24, CD44, CD133, CXCR4, ESA and nestin using immunohistochemical analysis. Furthermore, we examined the roles and clinical significance of these CSC markers in PDAC. CD24-, CD44-, CXCR4-, ESA- and nestin-positive cells were detected in the following tissues, listed in order of increasing percentage: normal ducts &lt; low-grade PanINs &lt; high-grade PanINs &lt; PDACs. CD133 did not increase according to the malignancy grade. In PDAC, cells positive for each of the following CSC markers were detected, listed according to increasing percentage: nestin &lt; CD133 &lt; CD44 &lt; CD24 &lt; CXCR4 &lt; ESA. CXCR4 and ESA expression correlated with well-differentiated PDAC. Venous invasion was positively associated with CD133 and inversely associated with ESA. CSC marker expression levels detected in PDAC cell lines using flow cytometry showed lowest expression of CD133 and highest of CD44, differing from the results obtained using immunohistochemistry. In two PDAC subtypes, adenosquamous carcinoma and anaplastic carcinoma, ESA was expressed more abundantly in adenocarcinoma components, whereas CD44 and nestin showed high expression in anaplastic components. Together, these results suggest that most CSC markers correlate with pancreatic carcinogenesis through the PanIN-to-PDAC sequence. Each CSC marker was related in a different manner with proliferation, differentiation, invasiveness or tissue type of PDAC.

DOI： 10.3892/ijo.2012.1565

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Resectability of hepatic metastases which have developed from lung cancer is limited and only a few reports have been published. We report two cases of a surgical resection of liver metastases arising from lung cancer. A 77-year-old male underwent a lower left lobectomy to treat a primary large cell lung carcinoma. Eight months later, abdominal computed tomography revealed a slightly enhanced heterogeneous tumor measuring 50mm in diameter in the right liver, segment 8. We performed a hepatic anterior sectionectomy. The pathological findings were similar to those of the primary carcinoma. After six months, there was no evidence of a recurring lesion. A 65-year-old female underwent an upper right lobectomy to treat a primary adenocarcinoma. Twenty months later, abdominal computed tomography revealed a heterogeneous tumor measuring 20mm in diameter in the right liver, segment 7. We performed a hepatic posterior sectionectomy. The pathological findings were similar to those of the primary lung carcinoma. After twenty months, the patient died from an unresectable recurrent carcinoma in the lung and brain. No recurrence was detected in the liver. We recommend that surgical resection be considered for solitary metastatic liver tumors which develop from lung cancer.

DOI： 10.5754/hge12000

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科感染症学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：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

researchmap

Language：Japanese   Publisher：(NPO)日本食道学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1-2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2-0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery. Copyright © 2012 S. Karger AG, Basel.

DOI： 10.1159/000339691

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

DOI： 10.1158/1538-7445.AM2012-2412

Web of Science

researchmap

DOI： 10.1158/1538-7445.AM2012-412

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPANDIDOS PUBL LTD  

Keratinocyte growth factor (KGF), also known as fibroblast growth factor-7, and KGF receptor (KGFR) play important roles in the growth of epithelial cells and are overexpressed in a variety of malignant epithelial tumors, including pancreatic ductal adenocarcinoma (PDAC). We previously reported that co-expression of KGF and KGFR in PDAC is associated with venous invasion, enhanced vascular endothelial growth factor A expression and poor prognosis. Matrix metalloproteinase-9 (MMP-9) is known to participate in the degradation of type IV collagen, which is a primary component of extracellular matrices in the vascular basement membrane. In the present study, we examined the expression and roles of KGF, KGFR and MMP-9 in human PDAC cell lines and tissues. Quantitative real-time polymerase chain reaction analysis demonstrated the expression of MMP-9 mRNA in all eight PDAC cell lines. KGF, KGFR and MMP-9 were, respectively, expressed in 27 (43%), 23 (37%) and 35 (56%) of 63 patients. Each expression of KGF, KGFR or MMP-9 correlated positively with venous invasion. Furthermore, expression of KGF or MMP-9 correlated positively with liver metastasis. KGF-positive cases exhibited shorter survival than KGF-negative cases, while KGFR and MMP-9 expression were unrelated to prognosis. Administration of recombinant human KGF increased MMP-9 expression in PDAC cells, while transient transfection with short hairpin RNAs targeting KGF transcripts reduced MMP-9 expression in PDAC cells. Moreover, recombinant human KGF significantly enhanced migration and invasion of PDAC cells. These findings suggest that KGF and KGFR promote venous invasion via MMP-9 in PDAC, and closely correlate with liver metastasis. The KGF/KGFR pathway may be a critical therapeutic target for PDAC metastasis.

DOI： 10.3892/ijo.2011.1280

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Purpose No consensus has been reached on the use of prostheses in a potentially infected operating field. In this study, we evaluated the validity of a mesh prosthesis for the repair of incarcerated groin hernias with intestinal resection.
Methods Twenty-seven patients underwent operations for correction of incarcerated groin hernias with small intestinal resection at our hospital between January 2000 and March 2010. The patients were divided into two groups: those who underwent repair with a prosthetic mesh and those who underwent primary hernia repair. Patients with intestinal perforations, abscess formations, panperitonitis, and those who required colon resections were excluded. The length of the operation, blood loss, and incidences of surgical site infection, postoperative ileus, and recurrence were evaluated in each group.
Results Of the 27 patients studied, 10 (37%) underwent tension-free repair with a mesh, and 17 (63%) underwent primary hernia repair. Although the patients who underwent primary hernia repair were significantly older than the patients who underwent mesh repair (P = 0.015), no statistically significant differences in morbidity, including surgical site infection, or mortality, were identified.
Conclusion Strangulated inguinal hernias cannot be considered a contraindication to the use of a prosthetic mesh even in cases requiring small-intestinal resection.

DOI： 10.1007/s00595-011-0019-2

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：English   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Bleeding from esophageal varices (EVs) or gastric varices (GVs) is a catastrophic complication of chronic liver disease. In this paper, we review the management of bleeding EVs and GVs.
Diagnosis of EVs and GVs: The grading system for esophagogastric varices proposed by the Japan Society for Portal Hypertension classifies GVs into those involving the cardia (Lg-c). the fundus (Lg-f). and both the cardia and the fundus (Lg-cf). In this review, we divide GVs into 2 categories: Lg-c (cardiac varices: CVs) and Lg-cf or Lg-f (fundal varices: FVs). Treatment Modalities for EVs and GVs:
Treatment modalities for EVs and GVs include placement of a Sengstaken-Blakemore tube, pharmacologic therapy, surgery, interventional radiology, and endoscopic treatment.
Management of Bleeding EVs and GVs: In Japan, endoscopic treatment has recently become the therapy of choice for bleeding EVs or GVs. In other countries, especially the United States, vasoactive drugs and endoscopic treatment are routinely used to manage variceal hemorrhage.
Bleeding EVs: Endoscopic variceal ligation is useful for controlling bleeding from EVs. However, confirmation of ligation precisely at the site of bleeding is usually difficult in patients with massive variceal bleeding. The site of acute bleeding can generally be identified by means of water instillation and suction. Ligation is then performed at the bleeding point. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Transportal obliteration is useful for blocking variceal blood flow.
Bleeding GVs: Endoscopic injection sclerotherapy with a tissue adhesive, such as N-butyl-cyanoacrylate or isobutyl-2-cyanoacrylate, is effective for acute bleeding from GVs. However, bleeding from the CV injection site and rebleeding from the rupture point have been reported in patients receiving endoscopic injection sclerotherapy. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Balloon-occluded retrograde transvenous obliteration and transportal obliteration are useful for the treatment of uncontrolled bleeding from GVs.
Prevention of Recurrent Variceal Hemorrhage: Given the high recurrence rate, survivors of an acute variceal hemorrhage should receive treatment to prevent recurrence. Complete eradication of EVs or GVs and maintenance of low portal venous pressure are essential for preventing recurrence of variceal hemorrhage. (J Nippon Med Sch 2012; 79: 19-30)

DOI： 10.1272/jnms.79.19

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

DOI： 10.1155/2012/574768

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科感染症学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科感染症学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Hepatic angiomyolipoma is a rare hepatic mesenchymal tumor. We report a case of hepatic angiomyolipoma that was successfully resected along with a giant hemangioma. A 53-year-old Japanese woman was admitted to our hospital for further evaluation of a liver tumor in segment 4. The tumor was detected on positron emission tomography during a health check-up. Abdominal ultrasonography revealed a well-defined mass of mixed echogenicity, 1.5 cm in diameter, in segment 4, and a giant hemangioma of mixed echogenicity, 7 cm in diameter, in segment 7. On enhanced computed tomography, the tumor in segment 4 showed hyperattenuation in the early phase and hypoattenuation in the delayed phase. On magnetic resonance imaging, the tumor in segment 4 showed hypointensity on T1-weighted images. hyperintensity on T2-weighted images, and hyperintensity on diffusion-weighted images. On angiography. the tumor in segment 4 appeared as a circumscribed hypervascular mass in the early phase and a slightly hypovascular mass in the delayed phase. The imaging findings suggested a primary hepatocellular carcinoma. The patient consented to resection of the tumor in segment 4 along with the giant hemangioma in segment 7. These tumors were resected with tumor-free surgical margins by partial resection of segments 4 and 7 of the liver. The cut surface of the resected specimen of segment 4 showed a yellowish tumor consisting of mature adipose tissue. The histopathological diagnoses of the resected specimens were angiomyolipoma in segment 4 and cavernous hemangioma in segment 7. The tumor in segment 4 consisted of mature lipocytes with angiomatous and small lymphocytic components. but no mitotic figures. The tumor showed immunoreactivity to smooth muscle antigen and homatropine methylbromide 45 and no immunoreactivity to AE/E3. The postoperative course was uneventful, and the patient remains well 1 year after the operation. (J Nippon Med Sch 2011; 78: 317-321)

DOI： 10.1272/jnms.78.317

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

We report a case of esophageal squamous cell carcinoma (ESCC) directly invading the liver and causing a pyogenic liver abscess. The patient was a 66-year-old man who presented with dysphagia. Esophagography, endoscopic study, and computed tomography (CT) showed a mass lesion in the lower third of the esophagus. A high fever developed on hospital day 17 and another CT scan revealed a liver abscess, 50 x 45 mm, in the left lateral lobe of the liver. Although imaging demonstrated a liver abscess continuous with the tumor, we performed percutaneous transhepatic drainage, followed thereafter by distal esophagectomy and total gastrectomy with a left lateral segmental resection of the liver. The pathological findings confirmed a diagnosis of ESCC with direct invasion (T4N1M0, stage IVa in the TNM classification). The patient had an uneventful postoperative recovery. Microscopic examination of the resected specimen revealed the expansive growth of tumor cells into the hepatocellular tissues. To our knowledge, this is the first report of the direct invasion of esophageal cancer to the liver causing a pyogenic liver abscess; however, it should be borne in mind when a patient with esophageal cancer becomes febrile.

DOI： 10.1007/s00595-010-4455-1

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor. We report on a patient who underwent hepatectomy for malignant HEH associated with abdominal pain due to rapid progression. An 83-year-old man was admitted to Nippon Medical School Hospital because of acute, severe upper abdominal pain. Seven months before admission, a hepatic tumor, 3 cm in diameter, had been detected in the left lateral sector. The diagnosis was hepatic cavernous hemangioma. Abdominal ultrasonography revealed a heterogeneous hyperechoic tumor with a smooth border, 6 cm in diameter, in the left lateral sector (segment 3). Contrast-enhanced computed tomography of the abdomen showed that the tumor was enhanced from the early to the late phase. Abdominal angiography revealed a cotton wool-like appearance of the tumor. The diagnosis was hepatic cavernous hemangioma. A malignancy could not be ruled out because of the tumor&apos;s rapid growth, which had caused abdominal pain. Left hepatectomy was performed. Histopathological examination showed necrosis throughout the tumor. Slightly pleomorphic neoplastic cells with rounded, spindle-like nuclei and scant cytoplasm were sporadically found in vascular channels. Intracytoplasmic lumina occasionally contained red cells. Neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34. The Mib-1 index was high. The tumor was diagnosed as malignant HEH. The postsurgical course was uneventful, and the patient was discharged on postoperative day 11. After 3 months, multiple metastatic tumors appeared in right hepatic lobe. Transcatheter arterial chemoembolization was performed. (J Nippon Med Sch 2011; 78: 246-251)

DOI： 10.1272/jnms.78.246

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(株)医学書院  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report a case of xanthogranulomatous cholecystitis (XGC) that was diagnosed preoperatively by means of ultrasonography (US) with the contrast-enhancement agent Sonazoid after a false-positive result had been obtained with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). A 69-year-old woman was admitted because of right upper quadrant pain. Blood tests revealed a serum CA19-9 level of 749.8 IU/L. Computed tomography (CT). US, and magnetic resonance imaging of the abdomen showed abnormal thickening of the gallbladder wall but no stones. The border between the gallbladder and the liver was unclear. FDG-PET revealed a lesion with increased uptake of tracer in the gallbladder wall. The thickness of the lesion was similar to that on CT. We suspected gallbladder carcinoma with hepatic invasion. To confirm the tentative diagnosis, we performed US with the contrast-enhancement agent Sonazoid. The gallbladder wall was homogeneously enhanced in the early vascular phase and remained enhanced for 90 seconds. Enhancement of the gallbladder wall was smooth and regular. The border between the gallbladder and liver was clear and smooth. On the basis of these examinations, we diagnosed chronic cholecystitis (XGC suspected), not gallbladder carcinoma. At surgery, the gallbladder wall was observed to be extremely thick because of severe inflammation, and cholecystectomy was performed. XGC was diagnosed on intraoperative pathological examination. Histopathological examination showed XGC, severe proliferative fibrosis with formation of multiple yellow-brown intramural nodules, and foamy histiocytes without malignant cells. In conclusion, the present case of XGC was diagnosed preoperatively with contrast-enhanced US after a false-positive result had been obtained with FDG-PET. Contrast-enhanced US can thus play important roles in diagnosing gallbladder disease and selecting treatment. (J Nippon Med Sch 2011: 78: 194-198)

DOI： 10.1272/jnms.78.194

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

DOI： 10.1158/1538-7445.AM2011-1194

Web of Science

researchmap

DOI： 10.1158/1538-7445.AM2011-5240

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本肝臓学会  

researchmap

Language：Japanese   Publisher：(株)医学書院  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a 35-year-old man with hepatocellular carcinoma (HOC) that recurred in the diaphragm after right hepatic lobectomy. The patient had undergone right hepatic lobectomy for HOC with chronic hepatitis B virus infection 1 year previously. On pathological examination, the tumor measured 15 x 14.4 x 11 cm and was moderately well differentiated. The surgical margins were negative. After 1 year. computed tomography of the abdomen revealed a mass extending from the right side of the diaphragm to the retroperitoneal space. The mass was enhanced in the early phase and washed out in the late phase. Extrahepatic recurrence of HOC in the diaphragm was diagnosed. We performed tumor resection with partial resection of the right side of the diaphragm and wedge resection of the right lower lobe of the lung. The diaphragm was reconstructed with a sheet of artificial pericardium. The histopathological diagnosis was recurrence of HCC in the diaphragm with invasion of the right lung. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. He underwent chemotherapy with cisplatin and 5-fluorouracil. After 9 months, the patient died of unresectable recurrence of HCC in the brain. No recurrence was detected in the right subphrenic area. (J Nippon Med Sch 2011: 78: 30-33)

DOI： 10.1272/jnms.78.30

Web of Science

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 73-year-old man was admitted with bloody stool. Duodenoscopy showed a hemorrhagic ulceration in the duodenum on the side opposite to the papilla of Vater. Abdominal CT demonstrated a well-defined hypervascular mass, adjacent to the lesion of the duodenum. Although as duodenal GIST was diagnosed, histologic examination for frozen sections during the procedure revealed tubular adenocarcinoma of the duodenum and pancreaticoduodenal lymph node metastasis of neuroendocrine carcinoma He underwent a subtotal stomach-preserving pancreaticoduodenectomy. Clinicopathologically, the neuroendocrine carcinoma of the pancreaticoduodenal lymph node was considered to be metastasis from an unknown primary lesion.

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(株)医学書院  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We describe a 43-year-old woman who underwent laparoscopic distal pancreatectomy preserving the spleen and splenic vessels for the treatment of insulinoma in the pancreatic body. The patient experienced cold sweats on fasting, received diagnosis of insulinoma, and was referred to our hospital for laparoscopic surgery. Blood biochemistry studies showed low fasting blood glucose of 42 mg/dL, serial immunoreactive insulin of 15.2 μU/mL, and a Fajans index (immunoreactive insulin/blood glucose) of 0.36 (normal &lt
0.30). Contrast-enhanced early-phase computed tomography of the abdomen showed a circular, intensely stained, 1.6-cm-diameter tumor in the pancreatic body close to the main pancreatic duct. A solitary insulinoma of the pancreatic body was diagnosed on the basis of the result of hematologic studies, and diagnostic imaging results. Because of the location of the tumor, we elected to perform distal pancreatectomy preserving the spleen and splenic vessels, rather than enucleation. Insulin and blood glucose levels were monitored during surgery. Before removal of the tumor, insulin levels remained consistently high, never decreasing to less than 10 μU/mL. After surgery, insulin levels decreased rapidly, to less than 5 μU/mL within 30 minutes and subsequently remained at the new low level, leading us to conclude that the entire tumor had been removed. There were no postoperative complications, and the patient was discharged from the hospital on day 7. There was no major intraoperative bleeding other than at the resected surface. The patient was ambulatory soon after the procedure, and had a brief hospital stay therefore, the surgery was judged to have been highly useful in this case.

DOI： 10.1272/jnms.77.175

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We describe the spontaneous rupture of a simple hepatic cyst associated with a benign course. A 64-year-old woman was admitted for right upper quadrant pain. The patient denied a history of abdominal trauma. Abdominal computed tomography (CT) showed a huge solitary hepatic cyst (diameter, 10 cm) in the right lobe. Part of the cyst surface was irregular, and the interior was heterogeneous on ultrasonography. Fluid retention was detected under the liver capsule. Spontaneous rupture of a nonparasitic hepatic cyst was suspected. The patient was admitted to our hospital for further evaluation and treatment. Examination of the abdomen revealed right upper quadrant pain but no signs or symptoms of peritonitis. One week after admission, CT revealed that the volume of fluid retained under the liver capsule had decreased. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Serous, brown fluid was aspirated. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was given daily by intravenous injection for 7 days. The catheter was then removed. There has been no evidence of recurrence after 1 year.

DOI： 10.1272/jnms.77.181

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction. We describe a patient with a huge caudate lobe of the liver due to Budd-Chiari syndrome. A 49-year-old woman was referred to Nippon Medical School Hospital to receive treatment for enlarged gastric varices. She had been followed up for idiopathic portal hypertension with deformity of the liver for 7 years and had undergone surgery for pharyngeal carcinoma 5 years earlier. Upper gastrointestinal endoscopy revealed solitary gastric varices without esophageal varices. Abdominal computed tomography revealed obstructions and scars of the right, middle, and left hepatic veins. The caudate lobe was enlarged, and the portal vein was displaced ventrally, without thrombus. The drainage vein of the caudate lobe, the short hepatic vein on the left side of the inferior vena cava, was dilated. The portal vein and drainage vein of segment 6 were visualized and showed no atrophy. Venography revealed no obstruction of the inferior vena cava. Budd-Chiari syndrome with solitary gastric varices was diagnosed on the basis of these findings. We performed balloon-occluded retrograde transvenous obliteration and partial splenic embolization to treat the gastric varices. The posttreatment course was uneventful, and the patient was discharged 8 days after embolization. The gastric varices shrank.

DOI： 10.1272/jnms.77.328

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We describe a 71-year-old man with an inflammatory tumor arising in segment 5 of the liver. The patient was admitted because of acute pain in the right upper quadrant of the abdomen and fever. Initial laboratory tests revealed the following: serum alkaline phosphatase concentration, 634 IU/L
serum gamma glutamic transpeptidase concentration, 1,378 IU/L
serum C-reactive protein concentration, 0.89 mg/dL
and total bilirubin concentration, 8.9 mg/dL. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging showed a mass, 3 cm in diameter, in segment 5 of the liver. Magnetic resonance cholangiopancreatography showed a lesion of moderate-to-high signal intensity on T2-weighted images of segment 5. Endoscopic retrograde cholangiopancreatography revealed a common bile duct stone. The intrahepatic bile ducts of segment 5 could not be visualized after the use of contrast material. Endoscopic sphincterotomy was performed to remove the common bile duct stone. Antibiotics were administered soon after stone removal, and fever gradually resolved. Positron emission tomography revealed hot spots in segment 5 of the liver. Three weeks after discharge, the patient was readmitted with an acute pain in the right upper quadrant of the abdomen. Abdominal ultrasonography, CT, and magnetic resonance imaging showed enlargement of this area. Inflammatory changes of segment 5 due to cholangitis with intrahepatic bile duct stones was diagnosed. Because malignant disease could not be completely ruled out, segment 5 of the liver was resected. Macroscopic examination of the resected specimen revealed a gray, fibrotic, solid tumor associated with intrahepatic bile duct stones. Microscopic examination of the tumor showed proliferation of spindle-shaped myofibroblastic cells in a mixed myxoedematous, dense fibrotic stroma, associated with infiltration by various acute and chronic inflammatory cells. The postoperative course was uneventful, and the patient was discharged on postoperative day 16.

DOI： 10.1272/jnms.76.154

Scopus

PubMed

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

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

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We describe successful resection of rapidly enlarging liver metastases from an α-fetoprotein-producing gastric cancer, as these usually carry a dismal prognosis. A 68-year-old woman underwent distal gastrectomy for an α-fetoprotein-producing gastric cancer without liver metastasis. The tumor was a moderately differentiated tubular adenocarcinoma with invasion of the muscularis propria. Venous and lymphatic invasion were noted, as was metastasis to lymph nodes along the greater curvature. Serum α-fetoprotein was 331 ng/mL before gastrectomy, decreasing to 18.6 ng/mL by postoperative day 28. At 2 months after operation, computed tomography detected no metastasis, but at 4 months α-fetoprotein increased to 2,190 ng/mL, and at 5 months liver tumors were detected by ultrasonography and computed tomography. Serum α-fetoprotein increased to 5,673 ng/mL, and serum PIVKA2 concentration was 18 mAU/ml just before operation. Extended left hepatectomy was performed. The resected specimen of segment 4 contained two well-defined tumors, measuring 5x4 cm and 2x2 cm, while that of segment 5 contained a similar-appearing tumor measuring 2x2 cm. The resected tumors had the same histologic appearance as the previously removed gastric cancer. The tumor cells were immunohistochemically reactive for α-fetoprotein. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. Serum α-fetoprotein decreased to 20 ng/mL by postoperative day 15, and to 5 ng/mL by 2 months after operation. For 5 months since operation, no recurrence has become evident, and serum α-fetoprotein has remained within the normal range.

DOI： 10.1272/jnms.72.66

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap