Ikeda T, Akahoshi T, Kawanaka H
… +14 more, Uchiyama H, Yamashita Y, Morita M, Oki E, Saeki H, Sugimachi K, Ikegami T, Yoshizumi T, Soejima Y, Shirabe K, Mimori K, Watanabe M, Hashizume M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693678
BACKGROUND: Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible duri...BACKGROUND: Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. PURPOSE: The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. METHODS: Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs: monopolar high-frequency electric cautery attached AI (MCI) (n = 6), bipolar high-frequency electric cautery attached AI (BCI) (n = 6), bipolar tissue sealing system (LigaSure) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEX ENDOPATH) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location (s) of the first disruption (s). The dissected tissues were examined histologically. RESULTS: Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P < 0.001). While thermal denaturation of the liver parenchyma occurred at approximately 2-3 mm of depth when bipolar high-frequency electric cautery was used for dissection, it reached up to more than 10 mm with monopolar high-frequency electric cautery. All of the first disruption points of stapling were at stapling line. CONCLUSIONS: Electrosurgical devices with an automatic irrigation function are useful devices to dissect the liver parenchyma.
Iguchi T, Shirabe K, Inoue K
… +14 more, Ito S, Ohga T, Nozoe T, Ezaki T, Yoshizumi T, Uchiyama H, Soejima Y, Ikegami T, Yamashita Y, Kawanaka H, Ikeda T, Saeki H, Morita M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693677
Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause t...Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate.
Adachi E, Harimoto N, Yamashita Y
… +10 more, Sakaguchi Y, Toh Y, Okamura T, Nishiyama K, Saeki H, Uchiyama H, Morita M, Kawanaka H, Ikeda T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693676
BACKGROUND: Pancreatic fistula is major source of postoperative morbidity or mortality. Soft pancreas has been considered to be one of the most important risk factors for pancreatic fistula. The purpose of the study is t...BACKGROUND: Pancreatic fistula is major source of postoperative morbidity or mortality. Soft pancreas has been considered to be one of the most important risk factors for pancreatic fistula. The purpose of the study is to clarify the relationship among extravasation of pancreatic secretions from the pancreatic stump, the pancreatic texture and clinical pancreatic fistula after pancreaticoduodenectomy. METHODS: For nineteen patients who were treated between July 2007 and August 2008, we performed intraoperative pancreatic leakage test to confirm the extravasation of pancreatic secretions from the pancreatic stump. Degree of fibrosis at the cut surface of the pancreas was reviewed blindly. RESULTS: Serum pancreatic amylase increased on first postoperative day (POD) and returned to preoperative level on 3POD. These change were inversely correlated with fibrosis (P < 0.001), namely the amylase level in patients with normal to mild fibrotic pancreas showed marked increase on 1POD, but not in those with moderate to severe fibrotic pancreas. Positive pancreatic leakage test was recognized in five patients (26.3%), four of 9 patients with soft pancreas (44.4%) and one of 10 with hard pancreas (10.0%). In soft pancreas, all four cases showing positive leakage test developed pancreatic fistula after pancreaticoduodenectomy, while one positive case in hard pancreas did not develop pancreatic fistula. CONCLUSION: The extravasation of pancreatic secretions from the pancreatic stump occurred frequently in soft pancreas, which might result in postoperative pancreatic fistula. Therefore we should take care in treating branched duct as well as main pancreatic duct at the pancreatic stump of soft pancreas.
Akahoshi T, Kawanaka H, Tomikawa M
… +6 more, Saeki H, Uchiyama H, Ikeda T, Shirabe K, Hashizume M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693675
BACKGROUND: Transient esophageal ulceration is a common finding after sclerotherapy of varices. These ulcers sometimes cause pain, ulcer bleeding, and stricture formation. Gastroesophageal reflux (GER) after Endoscopic i...BACKGROUND: Transient esophageal ulceration is a common finding after sclerotherapy of varices. These ulcers sometimes cause pain, ulcer bleeding, and stricture formation. Gastroesophageal reflux (GER) after Endoscopic injection sclerotherapy (EIS) is a known cause of worsening ulcer formation. Therefore, an efficient drug for GER is desirable to improve the quality of life of patients with esophageal varices. METHODS: We randomized 18 Japanese cirrhotic patients who had risky esophageal varices. The patients were randomly allocated into two groups, and during EIS sessions, one group was administered proton pump inhibitor(PPI) (Rabeprazole 20 mg a person once a day), while the other received histamine H2 receptor antagonist (H2-blocker) (famotidine 20 mg a person, twice a day). Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. Ulcer formation was evaluated using an endoscopic examination. The subjective and objective symptoms were also compared between the two groups. RESULTS: All patients in the H2-blocker group showed an increased percentage of time with pH < 4.0 after EIS sessions, but no patients in the PPI group showed an increased such symptoms. The H2-blocker group also experienced a significantly higher number of days of heartburn and dysphasia than did the PPI group (p = 0.017, p = 0.042). The rate of ulcer improvement was found to be faster in Rabeprazole group than in H2 blocker group (p = 0.008). CONCLUSION: These results suggest that Rabeprazole treatment prevents EIS-associated gastroesophageal reflux and promotes ulcer healing. Rabeprazole also improve the subjective symptoms following EIS.
Ninomiya M, Ikeda T, Shirabe K
… +14 more, Kayashima H, Harimoto N, Iguchi T, Sugimachi K, Yamashita Y, Ikegami T, Saeki H, Oki E, Uchiyama H, Yoshizumi T, Soejima Y, Kawanaka H, Morita M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620644
Along with the expansion of living donor liver transplantation, whereby hepatic venous anastomosis is mandatory, the frequency of hepatic venous stenosis that need interventional treatment is increasing. Due to its anato...Along with the expansion of living donor liver transplantation, whereby hepatic venous anastomosis is mandatory, the frequency of hepatic venous stenosis that need interventional treatment is increasing. Due to its anatomical features, there are several pitfalls in the process of endovascular intervention for hepatic vein. Insufficient information of and around the hepatic vein may lead to miss-diagnosis of target lesion. Simulation by using three-dimensional computed tomography images was useful in planning the direction of X-ray projection and, as a consequence, contributed to safe endovascular treatment for hepatic venous stenosis.
Soejima Y, Shirabe K, Yoshizumi T
… +12 more, Uchiyama H, Ikegami T, Yamashita Y, Ikeda T, Kawanaka H, Sugimachi K, Mimori K, Watanabe M, Morita M, Oki E, Saeki H, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620643
Portal vein thrombosis (PVT) after liver transplantation is a relatively common but serious complication which could lead to portal hypertension or a direct graft loss. A "Rex" shunt created between the superior mesenter...Portal vein thrombosis (PVT) after liver transplantation is a relatively common but serious complication which could lead to portal hypertension or a direct graft loss. A "Rex" shunt created between the superior mesenteric vein (SMV) and the umbilical portion of the left portal vein can be a useful option to treat PVT after pediatric liver transplantation, however, its application to adult patients has not been reported so far because appropriate vein grafts are hardly available. Herein we present a case of PVT after left lobe living donor liver transplantation (LDLT) who underwent the procedure using the own inferior jugular vein and the gonadal vein as a shunt graft. The shunt was patent immediately after the procedure but was thrombosed 2 days after probably due to the insufficient inflow from the SMV and the absence of anticoagulation therapy, for which emergent thrombectomy and ligation of the significant hepatofugal collateral veins followed by full anti-coagulation therapy were performed. The shunt remains open at 8 month after the procedure with a normal anmonia level and liver function. In conclusion, the Rex shunt using recipient's autologous vein grafts is a feasible and valuable option for adult patients to treat PVT after LDLT.
Kusumoto T, Kimura Y, Sugiyama M
… +10 more, Ohta M, Tsutsumi N, Sakaguchi Y, Ikejiri K, Oki E, Saeki H, Morita M, Ikeda T, Furuta T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620642
BACKGROUND: Leptomeningeal carcinomatosis (LMC) is a rare complication of gastric cancer. Case 1. A 57-year-old female was diagnosed with gastric cancer and underwent distal gastrectomy with D2 lymph node dissection. Two...BACKGROUND: Leptomeningeal carcinomatosis (LMC) is a rare complication of gastric cancer. Case 1. A 57-year-old female was diagnosed with gastric cancer and underwent distal gastrectomy with D2 lymph node dissection. Two years later, the patient suffered from para-aortic lymph node metastases and provided chemotherapy. During the chemotherapy, the patient emergently visited our hospital with chief complaints of a severe headache and dizziness. The above symptoms promptly abated by meningeal drainage, with a high value of the cerebrospinal fluid (CSF) pressure. Despite the administration of subsequent chemotherapy, the patient's clinical state rapidly worsened, including gradual progression of both blindness and hearing loss. Case 2. A 42-year-old male was diagnosed with Stage IV gastric cancer due to both distant lymph node metastases and an ascites. Chemotherapy with S-1 plus docetaxel was initiated. Upon finishing the fifth course of treatment, the patient complained of a severe headache. The magnetic resonance imaging (MRI) findings were suggestive of LMC. Under suspicion of carcinomatous meningitis, the patient underwent both cerebrospinal drainage with a high pressure value of 180 mmH2O and a cytological examination with a diagnosis of Class V. Immediately following the cerebrospinal drainage, the patient's symptoms promptly diminished. Case 3. A 66-year-old female was diagnosed with gastric cancer and underwent total gastrectomy with D2 dissection. About a year later, the patient suffered from the peritoneal dissemination, and provided serial chemotherapy regimens for 13 months. Thereafter the patient suffered from mildly stiff shoulders followed by serial severe headaches, and meningeal drainage was performed. The CSF showed pleocytosis and the presence of neoplastic cells, leading a diagnosis of LMC. After the placement of an Ommaya reservoir, the intrathecal chemotherapy was performed. Within two weeks of treatment, the patient's condition improved significantly, and the cell counts in the CSF obtained from the Ommaya reservoir remained low for six months after the first diagnosis of LMC. CONCLUSIONS: Although gastric LMC-affected patients often exhibit a fatal clinical course, the administration of intrathecal chemotherapy may improve survival. Systemic chemotherapy may be also administered in a limited number of patients with a superior performance status. At present, each case requires the individual making treatment decisions. Further accumulation of clinical cases and improving the overall understanding of the pathogenesis of this disease is needed in order to advance in the treatment of gastric LMC.
Kinjo N, Yano H, Sugimachi K
… +12 more, Tanaka J, Tanaka K, Saeki H, Tsukamoto S, Mimori K, Kawanaka H, Ikebe M, Morita M, Ikeda T, Mu S, Higashi H, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620641
A 74-year-old noncirrhotic woman presented with abdominal distension and pain in the right hypochondrium. Contrast-enhanced computed tomography (CT) demonstrated multiple large simple liver cysts occupying the right lobe...A 74-year-old noncirrhotic woman presented with abdominal distension and pain in the right hypochondrium. Contrast-enhanced computed tomography (CT) demonstrated multiple large simple liver cysts occupying the right lobe of the liver, the largest of which was 19 cm in diameter. Gastric varices were enhanced in the fundus of the stomach. The patient underwent surgery to deroof the hepatic cysts with ablation using argon beam coagulation. Esophagogastroduodenoscopy (EGD) showed that the portal hypertensive gastropathy was ameliorated after the operation; however, the fundal varices were only slightly decreased. After the operation, we observed that the hepatic vein waveform gradually changed from a gently curved pattern to a normal triphasic pattern. We treated the fundal varices with balloon-occluded retrograde transvenous obliteration 3 months after the initial operation. We describe our successful treatment of this rare case and discuss the utility of hepatic vein waveform analysis in the study of portal hypertension.
Kimura Y, Morita M, Saeki H
… +15 more, Ikeda T, Ando K, Oki E, Sugimachi K, Yamashita Y, Uchiyama H, Kawanaka H, Ohta M, Sakaguchi Y, Kusumoto T, Yoshida S, Nakashima T, Watanabe M, Furuta T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620640
Total pharyngo-laryngo-esophagectomy (TPLE) is indicated for either cervical esophageal cancer or synchronous double cancer of the thoracic esophagus and head and neck and this operation is extremely invasive. We adopted...Total pharyngo-laryngo-esophagectomy (TPLE) is indicated for either cervical esophageal cancer or synchronous double cancer of the thoracic esophagus and head and neck and this operation is extremely invasive. We adopted minimally invasive surgery for three patients who underwent this operation: VATS (video-assisted thoracoscopic surgery) esophagectomy was undergone in left semi-prone position and laparoscopic approach was also applied to reconstruction with gastric tube. After pharyngo-laryngectomy and gastric tube pull-up through post-mediastinal route, cervical anastomosis was performed. Free jejunal interposition was added in a case, while microvascular venous anastomosis between short gastric vein and cervical vein in another two cases. All patients recovered well without any postoperative complications. This is the first report, which describes minimally invasive TPLE using both VATS and laparoscopic technique in addition with plastic surgery.
Egashira A, Taguchi K, Toh Y
… +9 more, Yamamoto M, Okamura T, Saeki H, Oki E, Morita M, Ikeda T, Mimori K, Watanabe M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620639
Patients with esophageal cancer are susceptible to other primary cancers, but multiple primary cancers involving the esophagus and jejunum are rare. We herein report a case of primary jejunal cancer as a component of met...Patients with esophageal cancer are susceptible to other primary cancers, but multiple primary cancers involving the esophagus and jejunum are rare. We herein report a case of primary jejunal cancer as a component of metachronous triple primary cancers including esophageal cancer and ascending colon cancer. A 63-year-old male patient with a history of surgery for esophageal cancer and ascending colon cancer was admitted to our hospital after experiencing 1 month of repeated vomiting and epigastric abdominal pain. Esophagogastroduodenoscopy, duodenography, and computed tomography revealed a jejunal tumor located 2 cm from the ligament of Treitz on the anal side. Partial resection of the jejunum with lymph node dissection was performed. The postoperative course was uneventful, and the patient remains well with no signs of recurrence 10 months after the operation. This is the first report of curative resection of triple primary cancers of the esophagus, jejunum, and colon. Patients with a history of esophageal cancer are susceptible to other primary cancers, and it is important to perform surveillance for the subsequent development of other cancers.
Uchiyama H, Shirabe K, Yoshizumi T
… +13 more, Ikegami T, Soejima Y, Ikeda T, Kawanaka H, Yamashita Y, Morita M, Oki E, Mimori K, Sugimachi K, Saeki H, Watanabe M, Takenaka K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620638
BACKGROUND: Hepatectomy in a patient with situs inversus patient is technically challenging because of its complete mirror image anatomy, especially for a tumor located deep in the liver. Incorrectly identifying intrahep...BACKGROUND: Hepatectomy in a patient with situs inversus patient is technically challenging because of its complete mirror image anatomy, especially for a tumor located deep in the liver. Incorrectly identifying intrahepatic vessels and biliary system would lead to serious complications. We experienced a hepatectomy for a tumor in a patient with situs inversus totalis with referring to computer-generated mirror images. METHODS: A 66-year-old female patient with situs inversus totalis was diagnosed with hepatocellular carcinoma, 5 cm in diameter, centrally located just above the hepatic hilum compressing the right and left hepatic duct. The liver infected with hepatitis C was cirrhotic with a moderate amount of ascites. We preoperatively created several diagrams of the mirror image anatomy and made plans for how to resect this tumor, presupposing the patient had an ordinary anatomy. The tumor was successfully enucleated with referring to these diagrams. RESULTS: The operation time was 454 minutes. Five units of fresh frozen plasma was transfused intraoperatively. Although she suffered refractory ascites which needed repeated paracentesis, she managed to leave the hospital two months after the operation. CONCLUSION: Creating a mirror image anatomy enables surgeons to safely perform a complex hepatectomy in a patient with situs inversus totalis.
Itoh S, Kohnoe S, Yoshida D
… +10 more, Nishida T, Kawanaka H, Ikeda T, Morita M, Soejima Y, Uchiyama H, Saeki H, Yamashita Y, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620637
We report a case of 90-year-old patient who underwent preoperative 3-dimensional (3D) computed tomography (CT) volumetric analysis using SYNAPSE VINCENT imaging software and anatomical resection of segment VIII using ult...We report a case of 90-year-old patient who underwent preoperative 3-dimensional (3D) computed tomography (CT) volumetric analysis using SYNAPSE VINCENT imaging software and anatomical resection of segment VIII using ultrasound-guided vessel compression. Preoperative abdominal CT revealed a liver mass measuring 5.0 cm in diameter, and the patient was diagnosed with hepatocellular carcinoma. Liver function was preserved. Preoperative 3D volumetry using SYNAPSE VINCENT revealed the volume of the entire liver to be 1,339 mL and the volume of segment VIII to be 327 mL. Anatomical hepatic resection of segment VIII was performed using ultrasound-guided vessel compression. Operative duration was 372 min and estimated blood loss was 760 mL. Resected liver volume was 290 g. The patient's postoperative course was uneventful, and there has been no evidence of recurrence since the surgery.
Tashiro Y, Nakashima Y, Okazaki K
… +6 more, Mawatari T, Fukushi J, Ohishi M, Oyamada A, Yamada H, Iwamoto Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620636
AIMS: To investigate the impact of adalimumab on the biologic-naive (bio-naïve) and bio-switch rheumatoid arthritis (RA) patients, and to clarify the appropriate indications for adalimumab treatment. METHODS: The retenti...AIMS: To investigate the impact of adalimumab on the biologic-naive (bio-naïve) and bio-switch rheumatoid arthritis (RA) patients, and to clarify the appropriate indications for adalimumab treatment. METHODS: The retention rate, efficacy and safety of adalimumab in twenty-one RA patients were analyzed. Fourteen of the patients were bio-naive and seven were bio-switched from other biologics. Concomitant methotrexate was used in 85% of the bio-naive and 71% of the bio-switch patients. The radiographic findings before and after the 1 year and the two years treatment were also surveyed. RESULTS: In the bio-naive group, 63% of patients continued adalimumab for 2 years, and remission was achieved in approximately 50% of patients. The mean 28-joint Disease Activity Scores improved from 5.2 to 2.6. Radiographically, the joint damage did not progress in either erosions or joint space narrowing. In the bio-switch group, the retention rate was 29%, and only patients who were switched from infliximab showed responses to the treatment. Herpes zoster requiring hospitalization occurred in two cases and injection site reactions were noted in other two cases. CONCLUSION: Adalimumab combined with methotrexate would be a useful first choice biologic regimen in bio-naïve RA patients. As a second biologic, adalimumab could be useful only when treatments are switched from infliximab.
Saeki H, Oki E, Tsuda Y
… +15 more, Ando K, Hiyoshi Y, Itoh S, Morita M, Ikeda T, Sugimachi K, Yamashita Y, Ikegami T, Uchiyama H, Yoshizumi T, Soejima Y, Kawanaka H, Mimori K, Watanabe M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Nov · PMID 24620635
PURPOSE: Although the use of laparoscopic gastrectomy for gastric cancer has been widespread, it has remained controversial whether it can be applied for the patients with advanced gastric cancer. The aim of this study w...PURPOSE: Although the use of laparoscopic gastrectomy for gastric cancer has been widespread, it has remained controversial whether it can be applied for the patients with advanced gastric cancer. The aim of this study was to clarify the safety and usefulness of totally laparoscopic gastrectomy for patients with advanced gastric cancer. PATIENTS AND METHODS: Totally laparoscopic gastrectomy was applied for a total of 38 patients with pStage IB-III advanced gastric cancer at our institute. The surgical and long-term results were analyzed in those patients. RESULTS: Twenty-seven patents underwent distal gastrectomy and 11 patients underwent total gastrectomy. The mean number of dissected lymph nodes was 41 (range, 16-87). The mean length of the operation and amount of blood loss was 324 min and 123 ml, respectively. Two cases of postoperative bleeding were noted, while neither anastomosis-related complications nor in-hospital death was observed. The follow-up period after surgery was 8-72 months. Postoperative recurrence was observed in 6 patients (peritoneal dissemination: 3 patients, pleural dissemination: 1 patient, liver metastasis: 1 patient, ovarian metastasis: 1 patient). The overall survival rates at 1, 3 and 5 years were 94.7%, 76.3% and 76.3%, respectively. CONCLUSION: Totally laparoscopic gastrectomy is safe and can lead to satisfactory long-term outcomes in cases of advanced gastric cancer. Prospective controlled studies are warranted to confirm our findings.
Kawano D, Okamoto T, Morodomi Y
… +7 more, Kono M, Shimamatsu S, Kitahara H, Kawasaki J, Miyazaki M, Yamagata M, Sonoda T
Fukuoka Igaku Zasshi
· 2013 Oct · PMID 24511672
A 65-year-old male underwent a chest CT scan, which revealed an 8 mm nodule on the wall of a bulla in the left lower lobe of the lung, and was thus suspected to be lung cancer. Pulmonary wedge resection of the left lower...A 65-year-old male underwent a chest CT scan, which revealed an 8 mm nodule on the wall of a bulla in the left lower lobe of the lung, and was thus suspected to be lung cancer. Pulmonary wedge resection of the left lower lobe by means of video-assisted thoracoscopic surgery was thus performed. A specimen of the lung revealed the presence of intrapulmonary lymph node on the wall of a bulla. The histopathological findings of the resected lung specimen showed non-caseating granulomas in the lymph node, and adenocarcinoma in situ. We concluded that the sarcoid-like reaction observed in the intrapulmonary lymph node was therefore related to the adenocarcinoma in situ.
Watanabe M, Matsuura K, Baba H
… +13 more, Yoshizumi T, Ikegami T, Soejima Y, Ikeda T, Kawanaka H, Uchiyama H, Yamashita Y, Morita M, Oki E, Mimori K, Sugimachi K, Saeki H, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Oct · PMID 24511671
Peptic ulcer occurring in the gastric conduit for esophageal reconstruction sometimes penetrates into the mediastinal structures. We herein reported a case of pericardial penetration of gastric tube ulcer successfully tr...Peptic ulcer occurring in the gastric conduit for esophageal reconstruction sometimes penetrates into the mediastinal structures. We herein reported a case of pericardial penetration of gastric tube ulcer successfully treated with thoracoscopic pericardial drainage. A 66-year-old Japanese man, who had undergone esophagectomy for esophageal cancer 20 months before, visited our emergency room complaining severe back pain. Computed tomography revealed gastric tube ulcer penetrated into the pericardial space. Thoracoscopic pericardiotomy and drainage was performed and the patient made an uneventful recovery. Thoracoscopic pericardial drainage is useful to manage acute pyogenic pericarditis due to penetration of peptic ulcer which occurred in the gastric tube.
Toshima T, Yoshizumi T, Uchiyama H
… +13 more, Ikegami T, Soejima Y, Ikeda T, Kawanaka H, Yamashita Y, Morita M, Oki E, Mimori K, Sugimachi K, Saeki H, Watanabe M, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Oct · PMID 24511670
Liver transplantation (LT) is currently one of the best available strategies for treating multiple hepatocellular carcinoma (HCC) and decompensated liver cirrhosis. However, patients often undergo HCC recurrence after LT...Liver transplantation (LT) is currently one of the best available strategies for treating multiple hepatocellular carcinoma (HCC) and decompensated liver cirrhosis. However, patients often undergo HCC recurrence after LT, with most HCC recurrences detected at 1-2 years. CD133 was the first identified member of the prominin family of pentaspan membrane proteins and is a marker of hepatic stem cells. Here, we report a unique case of seven repeated recurrences of HCC in the lungs after LT, with all HCC recurrences resected curatively by a thoracoscopic approach. Pathological examination revealed moderately differentiated HCC identical to that in the original histology of the liver tumor. Interestingly, no CD133 immunoreactivity was observed in cancerous lesions of the primary HCC and the 1st to 2nd recurrences, as indicated by immunohistochemistry. However, CD133 was strongly stained in the cancerous lesions from the 3rd to 7th recurrences. The patient survived and had no recurrence after 9 years of the initial living donor LT. In conclusion, we investigated an evocative case of seven repeated recurrences of HCC in the lungs to elucidate the significance of circulating CD133-positive hepatic stem cells. This case illustrates the need for further research to clarify the mutual effect of CD133-positive hepatic stem cells for the development of new therapeutic strategies.
Ijichi H, Yoshizumi T, Ikegami T
… +13 more, Soejima Y, Ikeda T, Kawanaka H, Uchiyama H, Yamashita Y, Morita M, Oki E, Mimori K, Sugimachi K, Saeki H, Watanabe M, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Oct · PMID 24511669
Hepatitis B virus (HBV) recurrence after liver transplantation for HBV-associated liver diseases results in decreased patient and graft survival. Herein we have reported two cases of HBV recurrence following relapse of h...Hepatitis B virus (HBV) recurrence after liver transplantation for HBV-associated liver diseases results in decreased patient and graft survival. Herein we have reported two cases of HBV recurrence following relapse of hepatocellular carcinoma (HCC) after living donor liver transplantation (LDLT). Both cases had LDLT for end-stage liver disease secondary to HBV infection with nodules of HCC exceeding the Milan criteria. HBV prophylaxis using hepatitis B immunoglobulin with nucleos (t) ide analogues were given and HBV DNA levels were consistently undetectable after LDLT. HCC recurred at 5 months and 13 months posttransplant respectively, and chemotherapy and radiation therapy were performed. HBV recurrence occurred during the treatment of HCC. HBV DNA levels increased despite the treatment with anti-HBV agents after HBV recurrence. In hepatitis B surface antigen positive recipients, HBV prophylaxis should be intensified during the treatment of recurrent HCC.
Zhu L, Wada M, Usagawa Y
… +10 more, Yasukochi Y, Yokoyama A, Wada N, Sakamoto M, Maekawa T, Miyazaki R, Yonenaga E, Kiyomatsu M, Murata M, Furue M
Fukuoka Igaku Zasshi
· 2013 Oct · PMID 24511668
Cathepsin D is an aspartic lysosomal endopeptidase present in most mammalian cells. Overexpression of cathepsin D is associated with the progression of several human cancers including melanoma. We examined the expression...Cathepsin D is an aspartic lysosomal endopeptidase present in most mammalian cells. Overexpression of cathepsin D is associated with the progression of several human cancers including melanoma. We examined the expression levels of cathepsin D in 20 primary malignant melanomas, 20 metastatic malignant melanomas, 20 benign nevus pigmentosus and 10 normal skin samples in Japanese. In normal skin, granular or dotted pattern of positive staining was observed along the granular layer of epidermis and hair follicle with apparent moderate to strong staining in sebaceous and eccrine glands. The percent positivity and staining intensity of cathepsin D in primary and metastatic malignant melanomas were significantly higher than that of nevus pigmentosus. Moreover, the expression levels of cathepsin D in metastatic malignant melanomas were significantly higher than those of primary malignant melanomas. Data from our and previous reports strongly supports a notion that the upregulation of cathepsin D may be critically involved in the malignant transformation and progression of melanocytic tumors.