Language：English   Publishing type：Research paper (scientific journal)   Publisher：Mary Ann Liebert Inc  

Introduction: A modified pull-through (PT) distinguished by complete full-thickness removal of the posterior rectal cuff, initially developed as an open procedure in 1980, has been performed with laparoscopic assistance since 1997. Postoperative bowel dysfunction improved when the anatomic landmark for PT surgery was revised from the dentate line (DL) to the anorectal (or Herrmann's) line (ARL) in 2007. A 40-year (1980-2019) review of 153 consecutive rectal/rectosigmoid type Hirschsprung's disease (HD) patients is presented. Methods: Data for postoperative bowel dysfunction and Hirschsprung-associated enterocolitis (HAEC) classified according to the American Pediatric Surgical Association (APSA) scale were obtained retrospectively. Results: PT was open (n = 43) and laparoscopic (n = 110). Dissection was DL (n = 57) and ARL (n = 96). Over 40 years, 5/153 patients (3.3%) had postoperative obstructive symptoms (POS), and 10/153 patients (6.5%) had 13 episodes of postoperative HAEC; APSA grades were: I (n = 4); II (n = 8); and III: (n = 1) presenting with explosive diarrhea (10/13; 76.9%), fever (10/13; 76.9%), abdominal distension (9/13; 69.2%), or bloody stools/shock (1/13 with grade III; 7.7%). The grade III case had histologically-proven transitional zone PT. Postoperative HAEC developed in 3/5 (60.0%) POS+ patients and 7/148 (4.7%) POS- patients (P = .002). Symptom duration and treatment were not correlated with APSA grades. Conclusions: Complete full-thickness posterior rectal cuff excision and using the ARL reduced postoperative HAEC significantly in this series. Despite being anatomically distinct, the DL is inadequate as a precise landmark for PT surgery because it lacks functional relevance. The APSA scale could benefit from timely review to improve its clinical and prognostic value.

DOI： 10.1089/lap.2021.0340

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Other Link： https://www.liebertpub.com/doi/pdf/10.1089/lap.2021.0340

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Eosinophilic gastroenteritis (EGE) causes acute abdomen, which is not diagnosed preoperatively and sometimes requires emergency surgery. Here we report a case of EGE, in which laparoscopy was performed to reveal the cause of recurrent abdominal pain, and a mass lesion was detected. Moreover, we finally diagnosed subserosal layer type of EGE based on the pathological results.

DOI： 10.1016/j.epsc.2021.101799

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

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The preoperative diagnosis of cecal volvulus (CV) is rare and difficult and emergent laparotomy is frequently performed. Here, we report a case of CV that was diagnosed by preoperative computed tomography in a patient with an intellectual disability. In addition, we demonstrate that elective laparoscopic cecopexy can be performed following conservative treatment, such as the use of an ileus tube per anus.

DOI： 10.1272/jnms.JNMS.2019_86-308

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

Anomalous congenital band (ACB) is rare and difficult to identify preoperatively. Here we report a pediatric ACB case that was preoperatively suspected using computed tomography and was difficult to differentiate from omphalomesenteric duct anomaly. ACB should be considered in the differential diagnosis of acute abdomen.

DOI： 10.1272/jnms.84.304

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Although the Nuss procedure for pectus excavatum has been widely employed, a variety of complications have been reported. The most dangerous complication is cardiac injury from the insertion of the introducer. To eliminate these complications, we present a sternum elevating technique using a Kent retractor and a lifting hook.

DOI： 10.1007/s00383-015-3764-2

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

Objective: The aim of this study was to examine the effects of a newly established neonatal intensive care unit (NICU) on clinical work practice and educational activity at Nippon Medical School Musashikosugi Hospital. Methods: This retrospective study analyzed the clinical records of all neonates admitted to the NICU from December 2010 through November 2013. Anthropometric data, clinical status, problems, and outcomes of patients and the related obstetrical history were extracted and analyzed. Results: Of the 568 neonatal admissions, about half were related to preterm birth (49%) and low birth weight (55%). Forty-eight percent of patients were born via caesarean delivery. Maternal hypertension, diabetes, and thyroid disease were found in 8%, 5%, and 2% of cases, respectively. Mechanical ventilatory support was provided for 20% of patients. Neonates from multiple pregnancy and with significant congenital anomalies accounted for 17% and 10% of all patients, respectively. Five patients died during hospitalization. In addition training was provided in the NICU for an average of 10 residents and 20 medical students per year. Conclusion: Since the NICU was established, closer cooperation beyond the framework of a single department has come to be needed. In addition, NICUs in teaching hospitals are expected to provide opportunities for medical students and residents to observe and participate in multidisciplinary medical care.

DOI： 10.1272/jnms.81.328

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Other Link： http://search.jamas.or.jp/link/ui/2015260978

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The effectiveness of pull-through for Hirschsprung's disease is dependent on accurate identification of normoganglionic bowel in intraoperative biopsy specimens. We report 2 cases of patchy innervation of pull-through bowel in children with Hirschsprung's disease only identified by circumferential biopsying. Case 1 was an 8-month-old boy. During laparoscopy-assisted transanal endorectal pull-through, extra biopsies of bowel were taken circumferentially, 2 cm proximal to the level of normoganglionosis confirmed by laparoscopic colon biopsies. Aganglionosis was found at 3 o'clock, suggesting that bowel innervation at this level was patchy. Circumferential biopsies were performed a further 2cm proximally, and all sites were normoganglionic. This level was used for pull-through with excellent outcome. Case 2 was a 27-day-old boy. Similarly, extra biopsies were taken circumferentially, 2cm proximal to the level of "normoganglionosis" as indicated by conventional biopsying. Normoganglionosis was found only at 3 o'clock, while all other sites were hypoganglionic. A further series of circumferential biopsies was performed 2 cm proximally and hypoganglionosis was still identified, but only at 6 o'clock. Circumferential biopsies were repeated another 2cm proximally, and all sites were normoganglionic. We recommend circumferential biopsies be performed routinely to prevent bowel with patchy innervation from being used for pull-through and possibly causing postoperative bowel dysmotility in a subgroup of Hirschsprung's disease patients. © H.G.E. Update Medical Publishing S.A.

DOI： 10.5754/hge11238

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

Background: Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration.
Case Report: A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months.
Conclusion: To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.

DOI： 10.5761/atcs.cr.12.01907

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Aim To determine if follow-up by consultant pediatric surgeons (CPS) affects morbidity due to incarceration (INC) in children with indirect inguinal hernia (IH).
Methods We educate parents so they can identify possible INC and advise them to attend our emergency department anytime for immediate review by on-call CPS.
Results We reviewed 3,493 cases of IH by grouping them according to age at diagnosis: neonatal (G1; n = 96), 2-3 months (G2; n = 331), 4-6 months (G3; n = 118), 7-12 months (G4; n = 193), and over 12 months (G5; n = 2,755). Data per group were: mean gestational age (weeks): 32.1, 38.0, 36.4, 37.4, 38.7; mean birth weight (g): 1,645, 2,736, 2,471, 2,769, 2,930; mean age at elective hernia repair (HR) (months): 11.3, 4.9, 10.1, 12.9, 56.5; mean weight at elective HR (kg): 6.8, 6.4, 7.3, 9.1, 17.4; mean duration from diagnosis to elective HR (months): 10.9, 3.1, 6.3, 3.6, 3.0; mean follow-up: 6.7 years. Overall, INC occurred in 203/3,493 during follow-up. Incidence per group was: G1: 4/96, G2: 62/331, G3: 6/118, G4: 47/193, G5: 84/2,755. All INC were reduced manually without complications. HR complications occurred in 7/3,493 (0.2%).
Conclusions With CPS follow-up, INC can be managed without morbidity, allowing elective HR to be performed later with fewer complications.

DOI： 10.1007/s00383-011-3005-2

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A 13-month-old boy accidentally ingested a 5 cm dressmaker's pin. On presentation, the pin was in the duodenum and there was a right inguinal hernia. After 17 days, the pin failed to progress. At surgery, the sac contained appendix perforated by the pin. This is the first case in the literature.

DOI： 10.4103/0189-6725.93312

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Language：Japanese   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_590_2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Background/Purpose: Snodgrass tubularized incised plate urethroplasty (SUP) is versatile and has good cosmesis. However, postoperative meatal/neourethral stenosis (M/N-S) is common enough for some surgeons to add a dorsal inlay graft (DIG) harvested from the inner prepuce and sutured to cover the longitudinal midline incision of the urethral plate. This is the first formal assessment of the effectiveness of DIG for preventing M/N-S.
Methods: We reviewed the medical records of 100 consecutive SUP cases performed by a single surgeon between 2003 and 2010 comparing SUP + DIG (S + D group, n = 50) with SUP - DIG (S - D group, n = 50). Mean follow-up was 3.6 years. Data were analyzed statistically using the chi(2), 2-way ANOVA, and Mann-Whitney tests, with P < .05 considered significant.
Results: Severity of hypospadias and type of SUP were similar. Mean age at SUP was 3.3 years in S + D and 3.6 years in S-D (P = NS). There were 4 complications in the S + D group: urethrocutaneous fistula (n = 3) and neourethral stenosis without diverticulum (n = 1). There were 15 complications in the S-D group : meatal stenosis (n = 2), neourethral stenosis with or without diverticulum (n = 6), urethrocutaneous fistula (n = 7) (P < .01). M/N-S was significantly less in the S + D group (1 vs 8; P < .05).
Conclusions: We strongly recommend that DIG be performed routinely during SUP. (C) 2011 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2011.09.033

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We report our experience of laparoscopic repair of choledochal cyst (CC).
We reviewed 10 CC patients (mean age 3.3 years) who had lap CC repair. Eight patients had minimally dilated/fusiform type CC (fusiform CC) and presented with pancreatitis, and two had cystic type CC (cystic CC). Using conventional trocar placement (right upper quadrant, left paraumbilical, left upper quadrant; laparoscope in the umbilicus), the CC was isolated and transected at mid level. An additional 3.9 mm trocar in the left epigastrium was used to introduce a fine ureteroscope. Its tip was inserted into the common channel through the distal CC to remove protein plugs (PP) under laparoscopic guidance. To perform intralaparoscopic endoscopy of the intrahepatic ducts, a trocar placed in the left lower quadrant was used. Two extra trocars (3 and 5 mm) were added for hepatico-jejunostomy anastomosis (HJA); one lateral right subcostal, and one between the right subcostal and right upper quadrant trocars, respectively. HJA was performed using interrupted 5/0 absorbable sutures with the right upper quadrant trocar as a needle holder in the right hand, 5 mm for the laparoscope, and 3 mm subcostal trocar as a needle receiver in the left hand. Both the right and left edge sutures were exteriorized and used as traction sutures during anastomosis of the anterior wall.
Seven of eight fusiform CC patients had PP (massive in 3, moderate in 3, little in 1) in the common channel successfully removed with normal saline washouts through the side channel of the ureteroscope. Eight of ten CC patients had debris (moderate in 4, little in 4) in the intrahepatic ducts. Two complications were encountered; pancreatitis that resolved with conservative management and duodenal obstruction due to inadequate Roux-en-Y limb fixation that was treated by laparoscopic intervention. All are well after a mean follow-up of 12 months with cosmetically attractive wounds.
Although three additional trocars are required, we recommend our HJA technique and intraoperative common channel endoscopy during laparoscopic repair of CC.

DOI： 10.1007/s00383-010-2846-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARY ANN LIEBERT INC  

Aim: Laparoscopic Kasai portoenterostomy (LKPE) is generally regarded to have a poorer outcome than open Kasai portoenterostomy for the surgical treatment of uncorrectable biliary atresia. We will describe our LKPE as the only center using laparoscopy to perform Kasai portoenterostomy in Japan.
Techniques: For our LKPE, a 5-mm trocar is placed in the epigastrium in addition to conventional trocar placement. A Ligasure device is inserted through this additional trocar to seal portal vein branches at the porta hepatis draining into the caudate lobe, instead of hook diathermy that is used universally elsewhere because there is an unacceptably high risk for lateral thermal injury to microbile ducts. We minimize porta hepatic microbile duct injury during anastomosis between the Roux-en-Y jejunum and the liver parenchyma around the transected biliary remnant by not suturing where the original right and left bile ducts were present and making sutures deliberately shallow but deep enough to prevent leakage. Our anastomosis is more central to the porta hepatis, like the original Kasai, compared with "extensive lateral dissection" commonly performed elsewhere in Japan. The length of the Roux-en-Y jejunal limb should be individualized, not predetermined to be 30, 40, or 50 cm as is common practice; the jejuno-jejunostomy should fit naturally into the splenic flexure, otherwise the redundant limb may become tortuous as the patient grows, causing bile stasis and possible cholangitis.
Conclusions: Our LKPE can be performed safely and successfully with encouraging outcome.

DOI： 10.1089/lap.2010.0162

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Aim: The anorectal angle (AA) influences defecation after pull-through (PT) for imperforate anus (IA). We compared postoperative AA and continence after Georgeson's laparoscopy-assisted colon PT (GPT) and Pena's posterior sagittal anorectoplasty (PSARP) for high/intermediate-type IA.
Methods: We reviewed 33 high/intermediate-type IA cases (20 GPTs and 13 PSARPs) prospectively. All had colostomy initially as neonates. Anorectal angle was measured as the angle between the rectum and the anal canal on barium enema. A fecal continence evaluation questionnaire (FCEQ) consisting of 5 parameters (frequency of defecation, staining/soiling, perianal erosion, anal shape, and requirement for medication; maximum score = 10) was evaluated in 28 cases (15 GPTs and 13 PSARPs) followed up for more than 3 years.
Results: Mean age at PT was similar (6.6 months for GPT and 6.3 months for PSARP; P = not significant). There was no significant difference in mean AA. The FCEQ scores for GPT were generally higher throughout the study and significantly better from 3 years postoperatively (P < .05).
Conclusions: We are the first to confirm that effective AA similar to PSARP can be achieved after GPT, although FCEQ would suggest that GPT has less detrimental functional impact. (C) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2010.08.041

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Introduction: We routinely perform intraoperative endoscopy (IOE) of the intrahepatic bile duct (IHBD) and intrapancreatic bile duct (IPBD) with a pediatric cystoscope during excision of choledochal cyst (CC). Here we compare extended long-term follow-up patients with a series of recent cases.
Methods: We compared 25 CC patients treated over the past 5 years (group 1) with 69 CC patients treated between 1986 and 1998 and followed up for more than 10 years (group 2), focusing on stone formation.
Results: In group 1 (mean follow-up, 2.6 years) IOE identified IHBD debris in 7 (28%) of 25 and IPBD protein plugs in 9 (36%) of 25. In group 2 (mean follow-up, 14.6 years) IOE identified IHBD debris in 11 (16%) of 69 and IPBD protein plugs in 17 (25%) of 69. There was no relation between type of CC and incidence of IHBD debris or IPBD protein plugs. The incidence of postoperative stones to date is 0% in group 1 and 2.9% in group 2, rates far lower than those reported in the literature.
Conclusions: We attribute our lower incidence of stones directly to IOE and recommend that it be performed routinely during cyst excision. It is simple, is effective, and improves outcome. (C) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2009.10.083

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

We reviewed our clinical experience of using a computer-powered right angle linear cutter (CPRALC) for Collis-Nissen fundoplication (CNF) in three children with gastroesophageal reflux (GER) or failed Nissen associated with short esophagus. Case 1 was a 13-month-old female with persistent GER after type-C esophageal atresia repair. Case 2 was a 2-year-old female with dysphagia secondary to fundic wrap migration after laparoscopic Nissen. Case 3 was a 3-year-old male with post type-C esophageal atresia repair, dysphagia secondary to fundic wrap migration after open Nissen. All had short esophagus confirmed pre- or intra-operatively. After the esophagus was mobilized, Collis vertical gastroplasty was performed using CPRALC parallel to the lesser curve to elongate the esophagus. Nissen fundoplication was performed loosely around the neo-esophagus. There were no intra- or post-operative complications, although case 3 still has mild dysphagia, requiring dilatation. This is the first report of CNF performed using CPRALC in children. It would appear to be safe and effective for treating children with GER or failed Nissen associated with short esophagus.

DOI： 10.1007/s00383-009-2455-2

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

DOI： 10.1272/jnms.76.173

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Gastric outlet obstruction due to ulceration is extremely rare in childhood. We report a case of gastric outlet obstruction possibly secondary to peptic ulceration and our surgical management. Our approach, without vagotomy or antrectomy, would appear to be a safe and effective. © 2009 Okawada et al
licensee BioMed Central Ltd.

DOI： 10.1186/1757-1626-2-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Purpose: The aim of the study was to report a new technique for repairing hypospadias with severe chordee (HSC).
Methods: Our new technique involves making a long, wide, U-shaped incision on the ventral penis from the coronal sulcus to very distal to the meatus and dissecting to create a flap (U-flap). During dissection, the urethra is divided just proximal to the meatus. After release of chordee, the U-flap is returned to the ventral penile shaft and sutured in place. A buttonhole made distally in the U-flap is anastomosed to the cut end of the urethra to create a neomeatus. Snodgrass urethroplasty is performed 6 to 18 months later. We have treated 11 patients with FISC (mean age, 22.3 months) using this technique.
Results: Postoperatively, all U-flaps were viable. The neomeatus appeared to be more proximal because the penis was straighter. Urethroplasty using the central part of the U-flap was uncomplicated by sear tissue and successful in all cases. After a mean follow-up of 15.7 months, all patients have satisfactory penises without stenosis or diverticulum, although 1 had fistula.
Conclusion: Our U-flap technique allows the ventral penis to be preserved intact without scarring for second-stage urethroplasty and as a result is Well suited for treating HSC. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2008.08.055

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SINGAPORE PTE LTD  

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) placement is associated with considerable complications. We added laparoscopic monitoring to improve outcome.
METHODS: Thirty-four patients who had laparoscopy-assisted PEG (LAP-PEG) were reviewed. A 5 mm supraumbilical trocar and two S mm working ports were required for LAP-PEG. A needle was placed percutaneously into the stomach under laparoscopic and gastroscopic control. A wire was placed through the needle, encircled with a snare, and the PEG completed. The anterior wall of the stomach was then anchored to the abdominal wall.
RESULTS: Thirty-one subjects had cerebral palsy. Age at LAP-PEG ranged from S months to 25 years (mean, 8.1 years). Weight ranged from 4.7 kg to 25.9 kg (mean, 12.2 kg). In 23 patients, LAP-PEG was performed with laparoscopic Nissen fundoplication. in 11 patients, it was performed for reasons such as gastric volvulus and nutritional supplementation. Mean operating time was 67 minutes, and all procedures were performed safely without intra- or postoperative complications.
CONCLUSION: LAP-PEG is our method of choice for gastrostomy because it allows the first and last parts of a conventional PEG procedure to be well controlled and safe instead of being blind. [Asian J Surg 2008,31(4):204-6]

DOI： 10.1016/S1015-9584(08)60087-1

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We report a case of a choledochal cyst (CC) associated with accessory hepatic duct (AHD) and review the literature, focusing on biliary reconstruction. CC is only rarely associated with AHD. Intra-operative endoscopy is invaluable for confirming anatomical relations and highly recommended for routine use. Reconstructive surgery is feasible for AHD in CC cases.

DOI： 10.1007/s00383-008-2213-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：84  

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

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Hepatic portoduodenostomy with interposition of the ileocecoappendix (HPI) can be used for the surgical treatment of biliary atresia (BA). The purpose of this study was to evaluate the long-term outcome of patients with HPI. The records of nine patients who had HPI performed for BA were reviewed. Mean age at portoenterostomy was 68.1 days (range 26-113 days). At the end of 2006, seven of the nine subjects were alive, although two required liver transplantation (LT). The two deaths occurred 94 days and 2 years after HPI due to varicella infection and variceal bleeding, respectively. Length of follow-up for the seven survivors ranged from 17 to 19 years (mean 18 years). Three subjects achieved normal liver function after HPI and have remained jaundice-free to date. Another three who were initially jaundice-free required Roux-en-Y jejunostomy (RYJ) to the ileocecum for severe obstructive cholestasis 6 months, 3 years, and 19 years after HPI secondary to stones in the cecum. RYJ was successful in these three cases, and liver function returned to normal within a few months. Two of these three have continued to have almost normal liver function, but one required LT 5 years after RYJ. The remaining case had LT because of liver dysfunction 14 months after HPI. There is a high risk for stone formation and obstruction with the HPI procedure because bile can stagnate in the ileocecum.

DOI： 10.1007/s00383-007-1975-x

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This study was undertaken to compare magnetic resonance angiography (MRA) and gastrointestinal tract endoscopy (ENDO) for detecting varices in postoperative biliary atresia (BA) patients. Thirty-four BA patients were divided into groups according to age and liver function; group 1: 1-4 years old; group 2: 5-9 years old; group 3: over 10 years old; group A: normal liver function; and group B: moderate liver dysfunction. All subjects had MRA and ENDO. ENDO showed esophageal or gastric varices in 16 of 34 subjects. MRA depicted gastroesophageal vessels in 12 of 16 cases with varices on ENDO (sensitivity: 75%). Two subjects appeared to have varices on MRA that could not be confirmed on ENDO. Sixteen subjects had no varices on ENDO and normal MRA (specificity: 88.9%). Sensitivities and specificities of MRA for detecting varices were 20 (1/5) and 100% (6/6) in group 1 (n = 11), 100 (6/6) and 66.7% (4/6) in group 2 (n = 12), 100 (5/5) and 100% (6/6) in group 3 (n = 11), 100 (8/8) and 100% (9/9) in group A (n = 17), 50 (4/8) and 77.8% (7/9) in group B (n = 17), respectively. From these findings, MRA was not accurate in BA patients less than 10 years old or with moderate liver dysfunction. Therefore, periodic endoscopic examination is recommended for the accurate assessment and follow-up of varices in postoperative BA patients.

DOI： 10.1007/s00383-007-1973-z

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

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

Background/Aims: 5-fluorouracil (5-FU)-related metabolic enzymes, including dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS), thymidylate phosphorylase (TP), and orotate phosphoribosyl. transferase (OPRT) are initial, rate-limiting enzymes in the metabolism of 5-FU. The therapeutic implications of these enzymes in hepatocellular carcinoma (HCC) remain poorly understood. We used a newly developed laser-captured microdissection technique combined with RNA extraction to examine the mRNA levels of 5-FU-related metabolic enzymes in HCC and adjacent liver tissue.
Methodology: The study material comprised 43 paired specimens of HCC and adjacent liver tissue. The mRNA levels of 5-FU-related metabolic enzymes were quantified by real-time reverse-transcriptase polymerase chain reaction combined with laser-captured microdissection.
Results: The DPD mRNA level in HCC (4.31 +/- 4.21) was lower than that in adjacent liver (6.53 +/- 2.93) (P<0.001). The TS mRNA level in HCC (3.55 +/- 2.54) was higher than that in adjacent liver (1.90 +/- 0.11) (P<0.001). The TP and the OPRT mRNA levels did not differ significantly between HCC and adjacent liver. The TS mRNA level of HCC with portal invasion (4.47 +/- 2.76) was higher than that of HCC without portal invasion (2.71 +/- 1.96) (p=0.015). The DP1) mRNA level of HCC with septum formation (4.89 +/- 4.82) was significantly higher than that of HCC without septum formation (2.12 +/- 0.61) (p< 0.027). The OPRT mRNA level of poorly differentiated HCC (1.18 +/- 0.49) was lower than that of moderately or well-differentiated HCC (2.42 +/- 1.82) (p=0.037).
Conclusions: The DPD mRNA level was lower and the TS mRNA level was higher in HCC than in adjacent liver. Our results will hopefully stimulate further investigations designed to optimize the use of 5FU in patients with HCC.

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

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

DOI： 10.1007/s00464-004-2210-7

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

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

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Endoscopic variceal ligation (EVL) is a safe and simple procedure now being used on a widening scale. Yet most patients who undergo endoscopic treatment for esophageal varices eventually require additional treatment for recurrent varices. In this study, we investigated and compared the efficacy and long-term results of EVL performed in three treatments with a total of sixteen O-rings at two different intervals; bi-weekly (once every 2 wk: the conventional interval) and bi-monthly (once every 2 months). A total of 63 patients with esophageal varices were randomly assigned to groups receiving bi-weekly or bi-monthly EVL treatment. Optimal medical therapy was assessed by one medical doctor who was unaware of the patients' treatment assignments. Three parameters of treatment outcome were evaluated: the rate of recurrence, rate of additional treatment, and overall survival. The overall rates of variceal recurrence and additional treatment were both higher in the bi-weekly group than in the bi-monthly group (p < 0.001). In conclusion, EVL performed for the treatment of esophageal varices at bi-monthly intervals brought about better results than the same treatment performed at bi-weekly intervals. The treatments intercalated by the longer interval obtained a higher total eradication rate, lower recurrence rate, and lower rate of additional treatment.

DOI： 10.1111/j.1572-0241.2005.41864.x

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We describe two patients with abdominal incisional hernias, which occurred after appendectomy and replacement of an artificial blood vessel. Both were treated by operative hernial repair with the Composix Kugel Patch (C.R. Bard Inc.), a composite mesh that combines polypropylene mesh and expanded polytetrafluoroethylene (Gore-Tex). The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall; even when in direct contact with the intestinal tract it is minimally adherent to the intestinal tract. The mesh expands readily and is easily fixed to the abdominal wall because it has a shape-memory ring. The long-term results of operative repair with this mesh have not yet been reported, but it is hoped that the aforementioned characteristics will yield favorable outcomes.

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

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

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

DOI： 10.1272/jnms.72.121

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

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We describe successful resection of rapidly enlarging liver metastases from an alpha-fetoprotein-producing gastric cancer, as these usually carry a dismal prognosis. A 68-year-old woman underwent distal gastrectomy for an alpha-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 alpha-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 alpha-fetoprotein increased to 2,190 ng/mL, and at 5 months liver tumors were detected by ultrasonography and computed tomography. Serum alpha-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 5 x 4 cm and 2 x 2 cm, while that of segment 5 contained a similar-appearing tumor measuring 2 x 2 cm. The resected tumors had the same histologic appearance as the previously removed gastric cancer. The tumor cells were immunohistochemically reactive for alpha-fetoprotein. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. Serum alpha-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 alpha-fetoprotein has remained within the normal range.

DOI： 10.1272/jnms.72.66

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：6  

Adenocarcinoma is the most common malignant neoplasm of the gallbladder, but squamous cell carcinoma (SCC) is rare with an incidence of 1.4 approximately 3.3%. We present a recent case of a 63-year-old man complaining of abdominal distention. Preoperative US and CT revealed a large tumor of the gallbladder infiltrating the liver and transverse colon. Cholecystectomy, subsegmental resection of the liver, lymph node dissection, and partial resection of the transverse colon were performed. The resected specimen was histologically diagnosed as SCC without nodal metastases.

DOI： 10.1272/jnms.71.417

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

63歳男.心窩部痛,心窩部腫脹を自覚したことを契機に近医にて超音波検査により胆嚢内腫瘍が疑われた.紹介入院にて精査を行い,白血球増加,CRP上昇を認め,肝逸脱酵素と胆道系逸脱酵素の上昇を認めたが,腫瘍マーカーは陰性であった.腹部CT検査および腹部エコーと腹部血管造影検査により,胆嚢癌と診断し,胆嚢摘出術,肝亜区域切除および横行結腸部分切除を施行した.病理組織学的に角化を伴う高分化型扁平上皮癌と診断された.術後15日で退院したが,残肝再発により死亡した

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

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

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

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：3  

We report a case of hepatocellular carcinoma with situs inversus totalis treated by hepatectomy. A 70-year-old asymptomatic female with hepatocellular carcinomas in segments 5, 6 and 8 underwent transarterial embolization in the department of medicine. However, hepatocellular carcinoma in segment 8 relapsed, and she was referred to the department of surgery. Laboratory tests revealed elevation of serum PIVKA2 level (4,690 ng/mL). Angiography revealed tumor stain in segment 8, 3 cm in diameter. No aberrant vessels were detected on angiography. The operator stood on the patient's left, and partial hepatectomy could be performed safety after careful examination of the anatomy. Although aberrant vessels are detected in many patients with situs inversus totalis, operations can be performed safely on them with sufficient understanding of the anatomy.

DOI： 10.1272/jnms.71.209

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A 74-year-old woman with advanced carcinoma of the gall bladder underwent anterior and medial segmentectomies, extrahepatic bile duct resection, lymph node dissection, and hepaticojejunostomy with retrograde transhepatic biliary drainage. On the sixteenth postoperative day, bleeding was noted through the biliary drain, but it stopped spontaneously. Two days later, the biliary drain showed bleeding again. Ultrasonography revealed mild dilatation of the intrahepatic bile duct. Cholangiography via the drain disclosed a defect in the jejunal limb. Emergency angiography revealed an aneurysm, 2 cm in diameter, in the posterior branch of the right hepatic artery. Contrast medium demonstrated extravasation into the jejunal limb. The pseudoaneurysm was embolized with coils. No further hemorrhage was noted, and the patient was discharged 30 days after operation.

DOI： 10.1272/jnms.71.213

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

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

70歳女.69歳時に肝細胞癌と診断され,肝動脈塞栓術が施行された.HCV抗体陽性でPIVKA IIは高値を示し,肝予備能の低下を認めた.X線検査では右胸心を認め,左横隔膜は右より高く腫瘍による突出を認めた.腹部CTでは内臓逆位を認め,左横隔膜下S8に前回の肝動脈塞栓術によるリピオドール集積と近傍に腫瘤性病変を認めた.造影早期相では高濃度域として造影された.横隔膜に高度の癒着を認め,横隔膜を合併切除した.切除標本は単結節型腫瘍が存在し,病理では高分化型肝細胞癌で一部に壊死を認めた.左胸水が原因と思われる発熱が第15病日まで持続し,保存的治療にて回復した.第30病日に退院し,現在,無再発で生存中である

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74歳女.胆嚢腫瘍と診断され,入院となった.胆嚢底部に隆起性病変が認められ,造影CTでは不均一に濃染され肝臓との境界は不明瞭であった.手術を施行し,胆嚢底部に腫瘍を認め,腹腔側への漿膜浸潤は認められなかった.肝への直接浸潤とS4,S5に数個の転移を認めた.術中迅速診断にて,12,13aリンパ節への転移は認められなかった.肝中央2区域切除,胆管切除,リンパ節郭清,肝管空腸吻合を施行した.術後10日目より軽度の発熱と胆道系酵素の上昇を認め,抗生物質を変更し対処した.挙上空腸脚内出血が疑われ,緊急で血管造影を施行した.肝動脈後区域枝に仮性動脈瘤を認めた.塞栓後,出血は認められず,全身状態は改善して,術後30日目に退院となった

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

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BACKGROUND/AIMS: The characteristics of recurrent esophageal varices after endoscopic variceal ligation (EVL) plus endoscopic injection sclerotherapy (EIS) versus EVL alone, including the number of additional treatments and patterns of recurrence have been compared. METHODOLOGY: Thirty-four patients with cirrhosis and esophageal varices were treated by EVL alone (EVL group), and 46 patients were treated by EVL followed by extravariceal injection sclerotherapy (EVL+extraEIS group). RESULTS: Fewer treatment sessions were needed (p<0.005), and more O-rings were required (p<0.0001) in the EVL group than in the EVL+extraEIS group. The 1- and 3-year cumulative recurrence rates were higher in the EVL group (81.3% and 93.8%) than in the EVL+extraEIS group (62.8% and 91.5%) (p<0.05). Endoscopic examination at first recurrence showed varices of a more severe form (p<0.001), but less frequently having the red color sign (p<0.0001), and intramucosal venous dilatation (p<0.0001) in the EVL group than in the EVL+extraEIS group. The number of rehospitalizations for additional treatment was lower (p<0.0001) and more patients could be managed with only endoscopic treatment for recurrent varices in the EVL group than in the EVL+extraEIS group (p<0.05). CONCLUSIONS: Even if the overall rate of variceal recurrence was higher, fewer treatment sessions were needed, and the number of rehospitalizations for these additional treatments was lower in the EVL group than in the EVL+extraEIS group. Multiple sessions of EVL are an effective strategy for the treatment of esophageal varices.

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

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

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

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

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

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An unusual case of a hepatobiliary cystadenoma caused severe abdominal pain and obstructive jaundice by rapid enlargement in a woman aged 73 years. Magnetic resonance imaging revealed a 12 cm cystic lesion in the left medial segment of the liver and dilatation of the intrahepatic bile ducts. The abdominal pain was worse 4 days later, when magnetic resonance imaging demonstrated enlargement of the cystic lesion, to 14 cm in diameter. Laboratory tests on admission revealed serum alkaline phosphatase, 1342 IU/L; gamma glutamic transpeptidase, 672 IU/L; total serum bilirubin, 7.4 mg/dL; direct bilirubin, 5.8 mg/dL; and carbohydrate antigen 19-9, 37U/mL. Serosanguineous fluid was obtained by emergency percutaneous transhepatic drainage of the cyst, which resolved the patient's abdominal pain. Culture and cytologic examination of the fluid were nondiagnostic. The discharged fluid through dramage tube turned brown, and the total serum bilirubin concentration gradually decreased. Cystography and endoscopic retrograde cholangiography demonstrated communication between the cyst and the intrahepatic bile ducts on the left side of the liver. The cyst was removed by left hepatectomy 14 days after it had been drained. Pathologic examination of the resected specimen confirmed the presence of a hepatobiliary cystadenoma. Although hepatobiliary cystadenoma is a rare benign cystic tumor of the liver, it can become malignant and should thus be excised.

DOI： 10.1007/BF02481290

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：6  

Living-related liver transplantation is widely accepted as a treatment for patients with end-stage liver disease, with survival rates of up to 80%. Liver transplant recipients are at risk for the same postoperative complications as any patient undergoing a major intraabdominal operation, in addition to several complications specific to this procedure. Maintenance immunosuppression relies principally on administration of tacrolimus and methylprednisolone. Nevertheless, approximately 36% of liver transplant recipients suffer acute rejection in the early posttransplant period and require bolus steroid therapy as a rescue agent. Vascular complications, including hepatic arterial thrombosis and portal vein thrombosis, are additional major problems. When they occur in the immediate postoperative period, they can produce fulminant hepatic necrosis requiring retransplantation, so intensive anticoagulation therapy is needed as prophylaxis against these vascular complications. If thrombosis of the hepatic artery or portal vein is diagnosed early in the postoperative course, emergency thrombectomy with reanastomosis should be attempted. Outflow obstruction by hepatic vein stenosis sometimes causes liver dysfunction, pleural effusion, and hepatosplenomegaly. Percutaneous transhepatic or transjugular approached hepatic vein dilatation is very useful in case of hepatic vein stenosis. Recipients are generally immunocompromised secondary to immunosuppressive therapy and their poor clinical condition and are at high risk for postoperative infection. Infection is a major cause of morbidity and the most common cause of death in liver transplant recipients. Antibiotic, antifungal, and antiviral agents are used empirically, and serologic examinations and bacterial investigations of blood, sputum, stool, urine, and discharge from drains should be performed as well as antibiotic sensitivity tests when necessary. Other complications related to the operation are intraabdominal bleeding, bile leakage, biliary anastomotic stenosis, and intestinal perforation. The postoperative course of liver transplant recipients with these complications depends on making an accurate diagnosis promptly and initiating appropriate management. Postoperative complications of living-related liver transplantation are protean, so it is very important to communicate with professionals in each specialized field to ensure optimal treatment.

DOI： 10.1272/jnms.70.522

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An unusual case involving an infected hepatic cyst in which the correct diagnosis was made without operation is reported. A 93-year-old woman presented with acute onset of right upper quadrant abdominal pain, mild left lower quadrant abdominal pain, diarrhea, and fever. On admission, computed tomography revealed a 15 cm solitary hepatic cyst in the anterior-superior segment of the liver with a thickened wall that enhanced with contrast media. Ultrasonography demonstrated a 15 cm anechoic lesion with a hypoechoic area in the dependent portion of the cyst and a thickened wall. The serum concentration of C-reactive protein was 24.3 mg/dL, and the white blood cell count was 13,800/microL. A diagnosis of infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. Milky yellow fluid was obtained and the patient's right upper quadrant abdominal pain resolved after drainage. Klebsiella pneumoniae was cultured from the drainage fluid. The patient was discharged 20 days after drainage. Infection has not recurred and the hepatic cyst has not enlarged after 18 months.

DOI： 10.1272/jnms.70.515

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

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Language：Japanese   Publisher：(株)日本医学館  

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

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

The case of a patient with hepatocellular carcinoma and thrombocytopenia secondary to liver cirrhosis who underwent successful hand-assisted laparoscopic hepatectomy after partial splenic embolization is described. A 67-year-old man with severe liver cirrhosis was admitted for treatment of hepatocellular carcinoma. His early phase of hepatic angiography showed two hypervascular tumors in segment 6. The patient's liver function was poor, with the indocyanine green retention at 15 min of 49.5%, a total serum bilirubin concentration of 2.0 mg/dl, an albumin concentration of 2.8 g/dl, and an hyaluronic acid concentration. of 649 ng/ml. The platelet count was 3.0 x 10(4)/mul secondary to hypersplenism. Partial splenic embolization decreased the splenic volume by 50% preoperatively. At 2 months later, the platelet count was 6.0 x 10(4)/mul, and hand-assisted laparoscopic partial hepatectomy was performed uneventfully. The patient's postoperative course was unremarkable, and he was discharged on postoperative day 12.

DOI： 10.1007/s00464-003-4210-4

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

75歳男.C型慢性肝炎と高血圧のため近医に通院中,AFPが上昇し,超音波検査で肝腫瘍を指摘され,精査により肝細胞癌(HCC)と診断,肝動脈塞栓療法(TEA)施行された.その後のCTで腫瘍濃染像を認め,精査加療目的で入院となった.画像検査でS2に肝外に突出する腫瘍を認め,肝外側区域切除術を施行した.摘出した腫瘍は,高度の線維化を伴った硬化型と紡錘型細胞からなる肉腫様変化を伴った低分化型HCCであり,上皮マーカーのkeratin陽性と非上皮型マーカーのS-100 protein陽性像を認めた.術後現在,経過良好で再発の兆候は認めていない

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2003&ichushi_jid=J00263&link_issn=&doc_id=20031105180008&doc_link_id=10.2957%2Fkanzo.44.533&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.44.533&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

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

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

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Language：Japanese   Publisher：日本胆道学会  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：48  

Hepatocellular carcinoma rarely disseminates intraperitoneally. When it does, it usually is considered a terminal event. The successful treatment of complications of peritoneal metastases by surgical resection in a patient with hepatocellular carcinoma is reported. A 63-year-old man with hepatocellular carcinoma in the anterior segment underwent transarterial and portal embolization followed by extended radical hepatectomy. Five years and 8 months later, he presented with an ileus that was secondary to multiple peritoneal metastases that were resected to the extent possible. Eight months later, the patient presented with a second episode of ileus and underwent another operation that included bowel resection. However, pelvic tumors that were unresectable also were present. The patient survived for another 9 months before dying with peritoneal carcinomatosis. Although surgical treatment of peritoneal dissemination of hepatocellular carcinoma is not curative, surgery may improve survival and provide a good quality of life in selected cases.

PubMed

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

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

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

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

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

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

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Language：Japanese   Publisher：(公社)日本臨床細胞学会  

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

J-GLOBAL

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

J-GLOBAL

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

J-GLOBAL

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

消化器外科領域における消化管・腹腔内動脈性出血に対するIVR(Interventional Radiology)治療のなかで,術後出血,肝細胞癌破裂に対する治療成績を検討した.術後出血例では膵臓術後出血14例に対してIVRを10例,手術を4例に施行した.IVRの止血は4例(40%)に得られた.IVRにて止血不能の6例中5例はその後緊急手術で止血された.一方,肝細胞癌破裂18例中14例はIVRを施行し,全例止血された.IVR不能の4例は全例1ヵ月以内に死亡した.IVR施行14例中4例は手術適応外であったため,その後も塞栓術を行ったが,生存期間は11.5±2.4ヵ月であった.IVR止血後肝切除を行った症例10例の5年生存率は67.5%と良好であった.消化管・腹腔内動脈性出血に対するIVR治療は不可欠であるが,患者の全身状態,出血の状況などから個々の症例で手術とIVRを使い分ける柔軟さも重要である(著者抄録)

DOI： 10.11231/jaem1993.25.815

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2005&ichushi_jid=J02824&link_issn=&doc_id=20051221180010&doc_link_id=10.11231%2Fjaem1993.25.815&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem1993.25.815&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本胆道学会  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：一般社団法人日本消化器外科学会  

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J-GLOBAL

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

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

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Language：Japanese  

J-GLOBAL

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

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

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

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(株)南江堂  

75歳女.腹部膨満感が出現し,超音波で腹部右側に境界明瞭でほぼ均一な高エコーの腫瘤を認め,内部には一部低エコーの隔壁を認めた.CTでは右後腹膜腔に27×14×19cmの内部不均一なsoft tissue componentを認めた.MRIのT1強調像では等信号を呈し,同部分を中心に造影効果を認めた.右腎動脈造影で腎動脈起始部より頭側に分岐する主栄養血管が存在し,末梢に強い拡張蛇行と腫瘍濃染像を認めた.また右第1〜4腰動脈からも濃染像を認め,腎周囲組織原発が疑われた.脂肪腫または脂肪肉腫と診断し,手術を施行した.右腎,右副腎は腫瘍からの剥離が困難で,一塊に摘出した.また回盲部の腸間膜への浸潤を認め,合併切除した.腫瘍は30×20×10cm,2700gであった.HE染色で脂肪滴に圧排されたscallopingを認め,S-100免疫染色強陽性であった.高分化型の組織内には一部紡錘形異型細胞と染色されない部分が混在していた.術後経過良好で2年後も再発はない

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2004&ichushi_jid=J00393&link_issn=&doc_id=20041201090020&doc_link_id=issn%3D0016-593X%26volume%3D66%26issue%3D13%26spage%3D1709&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D66%26issue%3D13%26spage%3D1709&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese  

J-GLOBAL

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

J-GLOBAL

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

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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

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

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

劇症肝炎に対する肝移植までの治療戦略について検討を行った.12例,平均年齢33.0歳を対象にした.B型肝炎4例,不明8例,亜急性4例,急性8例であった.救命率は41.7%であり,内科的治療のみでは28%,移植症例は50%に改善していた.肝補助療法5日後の移植適応基準を満たした症例9例中,内科的治療のみでは全例死亡していたが,適応外の症例は全例救命されていた.また肝萎縮のない症例は早期により治療に反応し,内科的治療で改善される可能性が示された.保存的治療では救命できない症例に対する移植決定までの日数を短縮することで,救命率が改善され生存率も上がると思われた

DOI： 10.11231/jaem1993.24.581

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2004&ichushi_jid=J02824&link_issn=&doc_id=20040409170004&doc_link_id=10.11231%2Fjaem1993.24.581&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem1993.24.581&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

J-GLOBAL

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