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Nakanishi R, Ozawa H, Toyota N, Mise M, Akutsu R, Fujita S. Acute Infectious Purpura Fulminans Complicated by Bacterial Translocation after Rectal Cancer Surgery: A Case Report. Medicina (Kaunas) 2024; 60:644. [PMID: 38674289 PMCID: PMC11051725 DOI: 10.3390/medicina60040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
The patient was a man in his 80s who had undergone laparoscopic anterior resection for rectal cancer. Bowel obstruction occurred on the third postoperative day but improved with a decompression tube by the fifth postoperative day. A high fever (in the 38 °C range) was also observed. Blood culture tests detected two sets of the gram-negative bacilli Klebsiella aerogenes within 24 h of collection. On the seventh postoperative day, the patient subsequently went into septic shock with disseminated intravascular coagulation (DIC). On the eighth postoperative day, the fingertips and toes became black, and the palms and dorsal surfaces of both feet were dark purple due to peripheral circulatory failure. This suggested acute infectious purpura associated with sepsis (acute infectious purpura fulminans (AIPF)). Intensive care was provided; however, the necrosis of both middle fingers worsened, both middle fingers were gangrenous, and the patient died on the thirtieth postoperative day. AIPF is rarely reported, especially in early-onset cases after elective surgery. We encountered a rare complication of bacterial translocation from postoperative bowel obstruction, leading to AIPF.
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Affiliation(s)
- Ryo Nakanishi
- Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya 320-0834, Japan; (H.O.); (N.T.); (M.M.); (R.A.); (S.F.)
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Kato H, Takada T, Strasberg S, Isaji S, Sano K, Yoshida M, Itoi T, Okamoto K, Kiriyama S, Yagi S, Matsubara T, Higuchi R, Ohyama T, Misawa T, Mukai S, Mori Y, Asai K, Mizuno S, Abe Y, Suzuki K, Homma Y, Hata J, Tsukiyama K, Kumamoto Y, Tsuyuguchi T, Maruo H, Asano Y, Hori S, Shibuya M, Mayumi T, Toyota N, Umezawa A, Gomi H, Horiguchi A. A multi-institutional study designed by members of Tokyo Guidelines (TG) Core Meeting to elucidate the clinical characteristics and pathogenesis of acute cholangitis after bilioenteric anastomosis and biliary stent insertion with a focus on biliary obstruction: Role of transient hepatic attenuation difference (THAD) and pneumobilia in improving TG diagnostic performance. J Hepatobiliary Pancreat Sci 2024; 31:12-24. [PMID: 37882430 DOI: 10.1002/jhbp.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND/PURPOSE The aim of this study was to clarify the clinical characteristics of acute cholangitis (AC) after bilioenteric anastomosis and stent-related AC in a multi-institutional retrospective study, and validate the TG18 diagnostic performance for various type of cholangitis. METHODS We retrospectively reviewed 1079 AC patients during 2020, at 16 Tokyo Guidelines 18 (TG 18) Core Meeting institutions. Of these, the post-biliary reconstruction associated AC (PBR-AC), stent-associated AC (S-AC) and common AC (C-AC) were 228, 307, and 544, respectively. The characteristics of each AC were compared, and the TG18 diagnostic performance of each was evaluated. RESULTS The PBR-AC group showed significantly milder biliary stasis compared to the C-AC group. Using TG18 criteria, definitive diagnosis rate in the PBR-AC group was significantly lower than that in the C-AC group (59.6% vs. 79.6%, p < .001) because of significantly lower prevalence of TG 18 imaging findings and milder bile stasis. In the S-AC group, the bile stasis was also milder, but definitive-diagnostic rate was significantly higher (95.1%) compared to the C-AC group. The incidence of transient hepatic attenuation difference (THAD) and pneumobilia were more frequent in PBR-AC than that in C-AC. The definitive-diagnostic rate of PBR-AC (59.6%-78.1%) and total cohort (79.6%-85.3%) were significantly improved when newly adding these items to TG18 diagnostic imaging findings. CONCLUSIONS The diagnostic rate of PBR-AC using TG18 is low, but adding THAD and pneumobilia to TG imaging criteria may improve TG diagnostic performance.
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Affiliation(s)
- Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven Strasberg
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University, St. Louis, Missouri, USA
| | - Shuji Isaji
- Matsusaka City Hospital, Mie University, Tsu, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Ichikawa, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Takashi Matsubara
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shugo Mizuno
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuta Abe
- Department of Surgery, Keio University, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Yuki Homma
- Department of Gastroenterological Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Kana Tsukiyama
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepato-Biliary-Pancreatic Surgery, Kitasato University, Sagamihara, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Katori, Japan
| | - Hirotoshi Maruo
- Department of Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University, Tokyo, Japan
| | - Makoto Shibuya
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Naoyuki Toyota
- Department of Surgery, Tsudanuma Central General Hospital, Narashino, Japan
| | - Akiko Umezawa
- Department of Surgery, Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Harumi Gomi
- International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
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Mita K, Oda H, Sato M, Takahashi K, Shimaguchi M, Kobayashi N, Kouno M, Toyota T, Toyota N, Hatano M, Sasaki J, Kawamura Y, Nishida K. [A Case of Advanced Esophagogastric Junction Adenocarcinoma with Enlarged Lymph Node Metastases of the Middle Mediastinum and Intraperitoneal That Exhibited pCR by Preoperative SOX Therapy]. Gan To Kagaku Ryoho 2023; 50:909-912. [PMID: 37608419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
A 79-year-old man was diagnosed with esophagogastric junction adenocarcinoma, cT3N3M0, cStage Ⅲ, including enlarged lymph node metastases(Bulky N)in the middle mediastinum and intraperitoneal. A total of 2 cycles of S-1 plus oxaliplatin(SOX)was administered. After neoadjuvant chemotherapy, the primary tumor and enlarged lymph nodes had greatly decreased in size. Subsequently, thoracoscopic subtotal esophagectomy and reconstruction with a gastric tube were performed. Histopathological examinations showed no residual cancer cells in the primary lesion and dissected lymph nodes (pathological complete response). Preoperative chemotherapy containing SOX could be a useful treatment strategy for patients with esophagogastric junction adenocarcinoma with enlarged lymph node metastasis.
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Affiliation(s)
- Kazuhito Mita
- Dept. of Surgery, Tsudanuma Central General Hospital
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Ozawa H, Toyota N, Sakamoto J, Nakanishi H, Nakanishi R, Fujita S. Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today 2023:10.1007/s00595-022-02636-y. [PMID: 36656391 DOI: 10.1007/s00595-022-02636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE There is still insufficient discussion of the mid- to long-term safety of the intracorporeal anastomosis (IA) method of reconstruction after laparoscopic colectomy (LAC) for colon cancer. The present study clarified the postoperative mid-term results of IA based on recurrence and the incidence of incision hernia. METHODS This single-institution observational retrospective study included 268 patients with colon cancer who underwent IA or extracorporeal anastomosis (EA) after LAC at our institution between 2018 and 2021. The mid-term results of the IA group were compared with those of the EA group using a propensity score matching method. RESULTS The median follow-up periods were 36 and 25 months in the EA and IA groups, respectively (p < 0.0001). In this matched cohort study, the recurrence-free survival (RFS) rates were comparable between the IA and EA groups (each group, n = 72; 3-year RFS: IA, 92.1%; EA, 88.2%; hazard ratio, 0.78; 95% confidence interval, 0.25-2.40; p = 0.66). The cumulative incisional hernia rates were 9.8% and 9.9% (p = 0.99) for the IA and EA groups, respectively. CONCLUSION The safety of IA after LAC was demonstrated in this study, as IA after LAC showed good mid-term results, including with regard to the rates of recurrence and incisional hernia.
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Affiliation(s)
- Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan.
| | - Naoyuki Toyota
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Junichi Sakamoto
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Hiroki Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Ryo Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
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Yamaguchi A, Tazuma S, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Toyota N, Sudo T, Kuraoka K, Kohno H. Long-standing diabetes mellitus increases concomitant pancreatic cancer risk in patients with intraductal papillary mucinous neoplasms. BMC Gastroenterol 2022; 22:529. [PMID: 36539713 PMCID: PMC9764692 DOI: 10.1186/s12876-022-02564-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND When monitoring patients with an intraductal papillary mucinous neoplasm (IPMN), it is important to consider both IPMN-derived carcinoma and concomitant ductal adenocarcinoma (PDAC). The latter is thought to have a poorer prognosis. We retrospectively analyzed the risk factors for concomitant PDAC in IPMN. METHODS In total, 547 patients with pancreatic cysts, including IPMNs inappropriate for surgery on initial diagnosis, encountered from April 2005 to June 2019, were reviewed. We performed surveillance by imaging examination once or twice a year. RESULTS Five IPMNs with high-grade dysplasia and one IPMN associated with invasive carcinoma were encountered. In comparison, 14 concomitant PDACs were encountered. The prognosis was very poor for concomitant PDACs. All 14 PDAC patients had IPMNs. In patients with IPMNs, long-standing diabetes mellitus was the only significant risk factor for concomitant PDAC in both univariate and multivariate analyses (P < 0.001 and P < 0.01, respectively). Furthermore, patients with IPMNs and diabetes mellitus had a high frequency of concomitant PDACs (9.5%, 9/95) in a median 48-month surveillance period. CONCLUSIONS When monitoring IPMNs, the development of not only IPMN-derived carcinomas but also concomitant PDACs should be considered. During this period, it may be prudent to concentrate on patients with other risk factors for PDAC, such as long-standing diabetes mellitus.
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Affiliation(s)
- Atsushi Yamaguchi
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
| | - Susumu Tazuma
- grid.416874.80000 0004 0604 7643Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Yuzuru Tamaru
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
| | - Ryusaku Kusunoki
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
| | - Toshio Kuwai
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
| | - Hirotaka Kouno
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
| | - Naoyuki Toyota
- grid.440118.80000 0004 0569 3483Department of Radiology, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Takeshi Sudo
- grid.440118.80000 0004 0569 3483Department of Surgery, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kazuya Kuraoka
- grid.440118.80000 0004 0569 3483Department of Pathology, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Hiroshi Kohno
- grid.440118.80000 0004 0569 3483Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, 737-0023, Aoyamacho 3-1, Kure, Hiroshima, Japan
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Yamaguchi A, Kato N, Sugata S, Hamada T, Furuya N, Mizumoto T, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Toyota N, Sudo T, Kuraoka K, Kohno H. Effectiveness of Abdominal Ultrasonography for Improving the Prognosis of Pancreatic Cancer during Medical Checkup: A Single Center Retrospective Analysis. Diagnostics (Basel) 2022; 12:diagnostics12122913. [PMID: 36552920 PMCID: PMC9777348 DOI: 10.3390/diagnostics12122913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Recent advancements in surgical and anti-cancer therapies have provided significant hope of long survival in patients with pancreatic cancer (PC). To realize this hope, routine medical checkups of asymptomatic people should be performed to identify operable PCs. In this study, we evaluated the efficacy of medical checkups using abdominal ultrasonography (US). We retrospectively analyzed 374 patients with PC at our institute between 2010 and 2021. We divided these patients into several groups according to the diagnostic approach and compared their background and prognosis. These groups comprised PCs diagnosed through (a) symptoms, 242 cases; (b) US during medical checkup for asymptomatic individuals, 17; and other means. Of the 374 patients, 192 were men (51.3%), and the median age was 74 years (34−105). Tumors were located in the pancreatic tail in 67 patients (17.9%). Excision ratio and 5-year survival rate were significantly better in group (b) than in (a) (58.8% vs. 23.1%, p < 0.01 and 42.2% vs. 9.4%, p < 0.001, respectively). The prognosis of patients diagnosed using US during medical checkup was better than that of patients identified through symptomatic presentation of PC. US for asymptomatic individuals with PC might be one of the useful modalities for promoting better prognosis of PCs.
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Affiliation(s)
- Atsushi Yamaguchi
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
- Correspondence: ; Tel.: +81-823223-111; Fax: +81-823-21-0478
| | - Naohiro Kato
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Shuhei Sugata
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Takuro Hamada
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Nao Furuya
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Takeshi Mizumoto
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Ryusaku Kusunoki
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Naoyuki Toyota
- Department of Radiology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Takeshi Sudo
- Department of Surgery, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Kazuya Kuraoka
- Department of Pathology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
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Sakamoto J, Toyota N, Nakanishi H, Ozawa H, Fujita S. [Usefulness of Nutritional Evaluation in Adjuvant Chemotherapy for Colorectal Cancer in Older Patients]. Gan To Kagaku Ryoho 2022; 49:1087-1091. [PMID: 36281600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To clarify the usefulness of Onodera's prognostic nutritional index(OPNI)in adjuvant chemotherapy(AC)for older patients with colorectal cancer. MATERIALS AND METHODS This study included 39 patients aged over 70 years who underwent AC for colorectal cancer from August 2009 to February 2018. We evaluated the association of OPNI with AC toxicities and prognosis. RESULTS OPNI was an independent predictor of toxicities of Grade 3 or higher(OR: 0.18, 95%CI: 0.043-0.75, p=0.019). The 3-year recurrence-free survival rate was significantly better in the higher OPNI group than in the lower OPNI group(89.9% and 66.7%, respectively; HR: 0.19, 95%CI: 0.04-0.92, p=0.038). There was a positive correlation with Spearman's rank correlation coefficient of 0.66 in OPNI before and after AC(p<0.001). CONCLUSION OPNI could be one of the valuable predictors of AC toxicities and the prognosis. There was a high correlation between OPNI before and after AC. These findings suggest the importance of early nutritional support for patients with lower OPNI.
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Sakamoto J, Ozawa H, Nakanishi H, Toyota N, Fujita S. Laparoscopic Colectomy for a Patient with Situs Inversus Totalis: The Usefulness of Preoperative Assessment. Am J Case Rep 2022; 23:e935538. [PMID: 35869611 PMCID: PMC9326785 DOI: 10.12659/ajcr.935538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Patient: Female, 63-year-old
Final Diagnosis: Transverse colon cancer
Symptoms: None
Medication:—
Clinical Procedure: —
Specialty: Oncology
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Affiliation(s)
- Junichi Sakamoto
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Hiroki Nakanishi
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Naoyuki Toyota
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Shin Fujita
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
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Sakamoto J, Ozawa H, Nakanishi H, Toyota N, Fujita S. [Retrospective Analysis of Adjuvant Chemotherapy for Elderly Patients with Stage Ⅲ Colorectal Cancer]. Gan To Kagaku Ryoho 2022; 49:553-556. [PMID: 35578933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the efficacy and toxicity of adjuvant chemotherapy(AC)in elderly patients with Stage Ⅲ colorectal cancer(CRC). METHODS We performed a single-institutional retrospective analysis of 84 patients aged≥75 years with Stage Ⅲ CRC who underwent curative resection from August 2009 to February 2018. RESULTS Thirty-seven(44.0%) patients received AC. Eleven(29.7%)patients required dose reduction at the start of AC. Twenty-three(62.2%)patients accomplished AC, and 13(35.1%)needed dose reduction during AC. Although toxicities of Grade 3 or higher occurred in 56.8% of patients, they were controllable. The 3-year recurrence-free survival rate was significantly better in the AC group than in the non-AC group(70.3% versus 50.5%, respectively; p=0.011). The prognosis tended to be worse in the group that started AC with dose reduction than in the group with the normal dose. CONCLUSION AC is effective and well tolerated in elderly patients with Stage Ⅲ CRC. When reducing the initial dose, the need for dose reduction should be carefully considered.
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Takada T, Isaji S, Yoshida M, Horiguchi A, Ando H, Miyakawa S, Kiriyama S, Gomi H, Mukai S, Higuchi R, Abe Y, Okamoto K, Suzuki K, Toyota N, Hori S, Homma Y, Kato H, Umezawa A, Hata J, Inoue D, Kobayashi M, Tsuyuguchi T, Maruo H, Kumamoto Y, Asano Y, Kondo Y, Arakawa S, Asai K, Mori Y, Nagamachi Y, Mizuno S, Yagi S, Ohyama T, Misawa T, Sano K, Itoi T, Taniai N, Unno M, Yamamoto M, Mayumi T. Modified Socratic Method (planned and executed by Takada) for medical education: Grade II Acute Cholecystitis of Tokyo Guidelines 2018 as an example case. J Hepatobiliary Pancreat Sci 2021; 29:505-520. [PMID: 34758180 DOI: 10.1002/jhbp.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/26/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Socratic method, which is an educational method to promote critical thinking through a dialogue, has never been practiced in a large number of people at the academic societies. METHODS Modified Socratic method was performed for the first time as an educational seminar using an example case of moderate acute cholecystitis based on the evidence described in Tokyo Guidelines 2018. We adopted a method that Takada had been modifying for many years: the instructor first knows the degree of recognition of the audience, then the instructor gives a lecture in an easy-to-understand manner and receives questions from the audience, followed by repeated questions and answers toward a common recognition. RESULTS Using slides, video, and an answer pad, 281 participants including the audience, instructors and moderators came together to repeatedly ask and answer questions in the five sessions related to the case scenario. The recognition rate of the topic of Critical View of Safety increased significantly before vs after this method (53.0% vs 90.3%). The seminar had been successfully performed by receiving a lot of praise from the participants. CONCLUSION This educational method is considered to be adopted by many academic societies in the future as an effective educational method.
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Affiliation(s)
- Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Isaji
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health & Welfare, Ichikawa, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Hisami Ando
- Aichi Developmental Disability Center, Kasugai, Japan
| | | | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Harumi Gomi
- Office of Medical Education and Center of Infection Diseases, International University of Health and Welfare, Narita, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Naoyuki Toyota
- Department of Surgery, Tsudanuma Central General Hospital, Narashino, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University, Tokyo, Japan
| | - Yuki Homma
- Department of Gastroenterological Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Akiko Umezawa
- Department of Surgery, Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki City, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Motoyuki Kobayashi
- Department of Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Katori, Japan
| | - Hirotoshi Maruo
- Department of Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepato-Biliary-Pancreatic Surgery, Kitasato University, Sagamihara, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yuka Kondo
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiko Nagamachi
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shugo Mizuno
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | | | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Nobuhiko Taniai
- Department of Digestive Surgery, Nippon Medical School, Musashikosugi Hospital, Kawasaki, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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11
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Asai K, Iwashita Y, Ohyama T, Endo I, Hibi T, Umezawa A, Suzuki K, Watanabe M, Kurata M, Mori Y, Higashida M, Kumamoto Y, Shindoh J, Yoshida M, Honda G, Misawa T, Abe Y, Nagakawa Y, Toyota N, Yamada S, Norimizu S, Matsumura N, Sata N, Sunagawa H, Ito M, Takeda Y, Nakamura Y, Rikiyama T, Higuchi R, Gocho T, Honma Y, Hirashita T, Kanemoto H, Nozawa M, Watanabe Y, Kohga A, Yazawa T, Tajima H, Nakahira S, Asaoka T, Yoshioka R, Fukuzawa J, Fujioka S, Hata D, Haruta H, Asano Y, Nomura R, Matsumoto J, Kameyama N, Miyoshi A, Urakami H, Seyama Y, Morikawa T, Kawano Y, Ikoma H, Kin T, Takada T, Yamamoto M. Application of a novel surgical difficulty grading system during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 2021; 29:758-767. [PMID: 34748289 DOI: 10.1002/jhbp.1068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Prevention of bile duct injury and vasculo-biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading. METHODS We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fifty-one experts on LC assessed unedited surgical videos. Inter-rater agreement was assessed by Fleiss's κ and Gwet's agreement coefficient (AC). RESULTS Except for one item ("edematous change"), κ or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability = 0.923, κ = 0.712, 90% CI: 0.587-0.837; AC2 = 0.870, 90% CI: 0.768-0.972). CONCLUSION The previously published video clip library and our novel surgical difficulty grading system should serve as a universal objective tool to assess surgical difficulty in LC.
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Affiliation(s)
- Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasuhisa Mori
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepatobiliary-Pancreatic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junichi Shindoh
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Goro Honda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Tsudanuma Central General Hospital, Chiba, Japan
| | | | - Shinji Norimizu
- Department of Surgery, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Naohiro Sata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jicji Medical University, Tochigi, Japan
| | | | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Osaka, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Honma
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Masayuki Nozawa
- Department of Surgery, Shimada Municipal Hospital, Shizuoka, Japan
| | - Yusuke Watanabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Kohga
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Tajima
- Department of General, Pediatric and Hepatobiliary-Pancreatic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shin Nakahira
- Department of Hepato-Biliary-Pancreatic Surgery, Sakai City Medical Center, Osaka, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ryuji Yoshioka
- Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Junya Fukuzawa
- Department of Gastroenterological Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan
| | - Shuichi Fujioka
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Daigo Hata
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hidenori Haruta
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jicji Medical University, Tochigi, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Ryohei Nomura
- Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan
| | - Joe Matsumoto
- Department of Surgery, Obihiro Kosei Hospital, Hokkaido, Japan
| | - Noriaki Kameyama
- Department of Digestive Surgery, KKR Tachikawa Hospital, Tokyo, Japan
| | - Atsushi Miyoshi
- Department of Gastroenterological Surgery, Saga-ken Medical Center Koseikan, Saga, Japan
| | - Hidejiro Urakami
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuji Seyama
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Yoichi Kawano
- Department of Gastroenterological Surgery, Nippon Medical School Chibahokusoh Hospital, Chiba, Japan
| | - Hisashi Ikoma
- Department of Gastroenterological Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuhiro Kin
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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12
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Sakamoto Y, Mimura T, Kamigaichi A, Mito M, Nakano K, Toyota N, Ishikawa A, Kuraoka K, Yamashita Y. [Rapid Growing Anterior Mediastinal Leiomyosarcoma with Pericardial Infiltration:Report of a Case]. Kyobu Geka 2021; 74:720-723. [PMID: 34446630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Primary mediastinal leiomyosarcoma is extremely rare, and few reports in the literature have described the clinical features of this malignancy. We report a case of a small anterior mediastinal leiomyosarcoma that showed rapid growth within a short period. An 85-year-old woman showed a small anterior mediastinal tumor on chest computed tomography (CT), three months prior to presentation. Contrast-enhanced chest CT revealed rapid tumor growth, and positron emission tomography/CT revealed significant 18-fluorodeoxyglucose uptake, suggestive of malignancy. Thoracoscopic tumor resection was performed via the left thoracic approach. In addition to the tumor and surrounding anterior mediastinal tissue, we resected an area of pericardial infiltration. The tumor was diagnosed as a primary mediastinal leiomyosarcoma based on histopathological and immunohistochemical findings.
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Affiliation(s)
- Yuki Sakamoto
- Department of General Thoracic Surgery, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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13
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Yamaguchi A, Hamada T, Wada K, Moriuchi R, Tao K, Konishi H, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Ishiyama K, Hadano N, Sudo T, Toyota N, Zaitsu J, Kuraoka K, Kohno H. A case of intraductal tubulopapillary neoplasm of the pancreas in a branch duct: a rare case report and literature review. BMC Gastroenterol 2021; 21:162. [PMID: 33849435 PMCID: PMC8045350 DOI: 10.1186/s12876-021-01744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a new disease concept defined by the World Health Organization in 2010. ITPN progresses with tubulopapillary growth in the pancreatic duct and is known to have a fair prognosis. Localization in the main pancreatic duct (MPD) is one characteristic. There are few case reports of ITPN in a branch of the pancreatic duct (BD). CASE PRESENTATION We encountered a case of ITPN localized in BD. An 85-year-old man was followed after colonic surgery for rectal carcinoma. An abdominal computed tomography scan revealed a cystic mass in the pancreatic head and further examination was done. A T2 weighted intension picture in magnetic resonance imaging showed a 20 mm cystic lesion with an internal mass of 15 mm. Duodenal papilla were slightly open and endoscopic retrograde pancreatography revealed mild and diffuse dilatation of the main pancreatic duct and mucin in the MPD. In consideration with the image examinations, we diagnosed the tumor as an intraductal papillary mucinous neoplasm with carcinoma because of its large mural nodule (> 10 mm in size) in a cyst. Consequently, a pancreaticoduodenectomy was performed. Macroscopically, a white solid tumor sized 2.5 × 1.8 × 1.0 was identified in the head of the pancreas. The cut surface of the resected pancreas showed a side-branch type intraductal tumor with tubulopapillary architecture without mucin secretion. Immunohistochemical staining was positive for MUC1, and negative for MUC2 and MUC5AC. The final diagnosis was determined to be pancreatic ITPN from BD. At the time of this report (48 months post-surgery), the patient remains disease-free without evidence of recurrence. CONCLUSION ITPNs localized in BD are rare and diagnosis prior to surgery is difficult. In our case, the shape was round, not papillary, and with little fluid. These characteristics are different from a branch duct type IPMN and can be a clue to suspect ITPN in BD.
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Affiliation(s)
- Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan.
| | - Takuro Hamada
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kaoru Wada
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Riho Moriuchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kanae Tao
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hirona Konishi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Ryusaku Kusunoki
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kohei Ishiyama
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Naoto Hadano
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Takeshi Sudo
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Naoyuki Toyota
- Department of Radiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Junichi Zaitsu
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
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14
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Hotta A, Ishikawa M, Tachikake T, Matsuura N, Toyota N, Awai K. Comparison of the effectiveness of celiac versus common hepatic artery injection for the detection of hepatocellular carcinoma and of the feeding artery on cone-beam computed tomographs obtained during hepatic angiography. Acta Radiol Open 2021; 10:2058460121994735. [PMID: 34104477 PMCID: PMC8164560 DOI: 10.1177/2058460121994735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cone-beam computed tomography (CBCT) has been widely used during
transcatheter arterial chemoembolization for hepatocellular carcinoma. Purpose To evaluate the sensitivity of CBCT for the detection of hepatocellular
carcinomas and the tumor feeders by comparing celiac artery (CA) and common
hepatic artery (CHA) injection. Material and methods We retrospectively enrolled 30 patients (52 hepatocellular carcinoma lesions)
who had undergone CBCT-assisted transcatheter arterial chemoembolization. In
17 procedures (28 hepatocellular carcinomas) we acquired CBCT scans using CA
injections (CBCT-CA) and in 18 (24 hepatocellular carcinomas) we used CHA
injections (CBCT-CHA). Of the 30 patients, 5 underwent CBCT-CA and CBCT-CHA
at different transcatheter arterial chemoembolization procedures. We
performed inter-group comparisons of the detectability of hepatocellular
carcinoma, the feeding artery, the intrahepatic artery branch order, and the
tumor-to-liver contrast. Results CBCT-CA detected all 28 hepatocellular carcinomas and 27 of their feeders
(96.4%); CBCT-CHA identified 22 of 24 hepatocellular carcinomas (91.7%) and
21 of their feeders (95.5%). There was no significant inter-group difference
in the detectability of hepatocellular carcinoma lesions (p = 0.21) or
feeding arteries (p = 0.69). CBCT-CHA was superior for the assessment of the
tumor-to-liver contrast and the intrahepatic artery branch order (both:
p < 0.01). Conclusion CBCT-CA and CBCT-CHA were equally useful for the detection of hepatocellular
carcinoma and of the feeding artery, although CBCT-CHA yields better
visualization of hepatocellular carcinoma and the hepatic artery. Thus CA
injection seems sufficient for lesion and vessel detection when the
insertion of an angiographic catheter into the CHA is difficult.
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Affiliation(s)
- Akihiro Hotta
- Department of Diagnostic Radiology, National Hospital
Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima,
Japan
- Akihiro Hotta, Kokuritsu Byoin Kiko Kure
Iryo Center, Chugoku Gan Center, Aoyamacho 3-1, Kure 737-0023, Japan.
| | - Masaki Ishikawa
- Department of Diagnostic Radiology, National Hospital
Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima,
Japan
| | - Toshihiro Tachikake
- Department of Diagnostic Radiology, Hiroshima City Hiroshima
Citizens Hospital, Hiroshima, Japan
| | - Noriaki Matsuura
- Department of Diagnostic Radiology, National Hospital
Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima,
Japan
| | - Naoyuki Toyota
- Department of Diagnostic Radiology, National Hospital
Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima,
Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of
Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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15
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Kurata M, Iwashita Y, Ohyama T, Endo I, Hibi T, Umezawa A, Suzuki K, Watanabe M, Asai K, Mori Y, Higashida M, Kumamoto Y, Shindoh J, Yoshida M, Honda G, Misawa T, Abe Y, Nagakawa Y, Toyota N, Yamada S, Norimizu S, Matsumura N, Sata N, Sunagawa H, Ito M, Takeda Y, Nakamura Y, Rikiyama T, Higuchi R, Gocho T, Ueno K, Kumagai Y, Kanaji S, Takada T, Yamamoto M. Assembling a library of typical surgery video clips to construct a system for assessing the surgical difficulty of laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 2021; 28:255-262. [PMID: 33260262 DOI: 10.1002/jhbp.871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/08/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To explore best practices for acute cholecystitis, it is necessary to construct a system to assess the difficulty of laparoscopic cholecystectomy (LC) based on intraoperative findings. In this study, multiple evaluators assessed videos of LC to assemble a library of typical video clips for 25 intraoperative findings. METHODS We have previously identified 25 items that contribute to surgical difficulty in LC. For each item, roughly 30-second video clips were submitted from videos of LC performed at member institutions. We then selected one typical video from the collected clips based on simple tabulation of the instances of agreement. Inter-rater agreement was assessed with Fleiss's κ and Gwet's agreement coefficient (AC). RESULTS Except in the case of two assessment items ("edematous change" and "easy bleeding"), κ or AC significantly exceeded 0.5 and the typical videos were judged to be applicable. For the two remaining items, the evaluation was repeated after clarifying the definitions of positive and negative findings. Eventually, they were recognized as typical. The completed video clip library contains 31 clips and is divided into five categories (http://www.jshbps.jp/modules/project/index.php?content_id=13). CONCLUSIONS This clip library may be highly useful in clinical settings as a more objective standard for assessing surgical difficulty in LC.
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Affiliation(s)
- Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepatobiliary-Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junichi Shindoh
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Goro Honda
- Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.,Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | | | - Shinji Norimizu
- Department of Surgery, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | | | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Yutaka Takeda
- Department of Suregery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kimihiko Ueno
- Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Surgery, Kobe Medical Center, Kobe, Japan
| | - Yuko Kumagai
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Suzuki K, Hashimoto T, Osugi S, Toyota N, Omagari K, Tamura A. Spontaneous Biloma Resulting from Intrahepatic Bile Duct Perforation Coexisting with Intrahepatic Cholelithiasis and Cholangiocarcinoma: A Case Report and Literature Review. Am J Case Rep 2020; 21:e926270. [PMID: 33064672 PMCID: PMC7576686 DOI: 10.12659/ajcr.926270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 74-year-old Final Diagnosis: Biloma Symptoms: Epigastralgia • fever • nausea Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Keiichi Suzuki
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Takeo Hashimoto
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Syoko Osugi
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Naoyuki Toyota
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Kenshi Omagari
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Akihiko Tamura
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
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Mori T, Yamaguchi A, Kuwai T, Kouno H, Matsuura N, Toyota N, Nakahira S, Kuraoka K, Kohno H. Carcinoma in situ of the pancreas with fibrosis area around the carcinoma: A case report. Medicine (Baltimore) 2020; 99:e22645. [PMID: 33080703 PMCID: PMC7571982 DOI: 10.1097/md.0000000000022645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Pancreatic cancer (PC) has the worst prognosis among all carcinomas. However, patients with carcinoma in situ (CIS) of the pancreas, usually, have a good prognosis. Many previous reports have mentioned the high frequency of fibrosis around CIS. In some cases, the fibrosis is detected on endoscopic ultrasonography (EUS), but there are few past reports of fibrosis detected on computed tomography (CT). PATIENT CONCERNS We encountered a case of fibrosis around CIS detected by CT. A 74-year-old man was being followed for chronic hepatitis C. On a contrast-enhanced CT (CE-CT), a space-occupied lesion (7 mm in size) in the pancreatic head was identified in the delayed phase. DIAGNOSIS It was shown to be a hypo echoic lesion in EUS, and EUS-fine-needle aspiration was performed. Cytological examination revealed abnormal cells suspicious for a neuroendocrine tumor. INTERVENTIONS Consequently, a pancreaticoduodenectomy was performed. Histopathological examination showed CIS in the branch duct with 10 mm of fibrosis around CIS. The fibrotic area corresponded to the mass detected by preoperative CE-CT. OUTCOMES He had no relapse of PC but died 2 years later from another cause. LESSONS This case highlights the importance of identifying the enhanced area in the delayed phase on CE-CT, as this can be fibrosis around CIS.
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Affiliation(s)
| | | | | | | | | | | | | | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
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Berardi G, Wakabayashi G, Igarashi K, Ozaki T, Toyota N, Tsuchiya A, Nishikawa K. Full Laparoscopic Anatomical Segment 8 Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence. Ann Surg Oncol 2019; 26:2577-2578. [DOI: 10.1245/s10434-019-07422-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Indexed: 12/31/2022]
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Iwashita Y, Hibi T, Ohyama T, Honda G, Yoshida M, Miura F, Takada T, Han HS, Hwang TL, Shinya S, Suzuki K, Umezawa A, Yoon YS, Choi IS, Huang WSW, Chen KH, Watanabe M, Abe Y, Misawa T, Nagakawa Y, Yoon DS, Jang JY, Yu HC, Ahn KS, Kim SC, Song IS, Kim JH, Yun SS, Choi SH, Jan YY, Shan YS, Ker CG, Chan DC, Wu CC, Lee KT, Toyota N, Higuchi R, Nakamura Y, Mizuguchi Y, Takeda Y, Ito M, Norimizu S, Yamada S, Matsumura N, Shindoh J, Sunagawa H, Gocho T, Hasegawa H, Rikiyama T, Sata N, Kano N, Kitano S, Tokumura H, Yamashita Y, Watanabe G, Nakagawa K, Kimura T, Yamakawa T, Wakabayashi G, Mori R, Endo I, Miyazaki M, Yamamoto M. An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 2017; 24:191-198. [PMID: 28196311 DOI: 10.1002/jhbp.440] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Toyota N, Tsuruta M, Hasegawa H, Okabayashi K, Ishida T, Kondo T, Kitagawa Y. The impact of pulmnary emphysema evaluated by CT on lung metastasis in rectal cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
582 Background: Our previous study suggested that smoking history could be a risk factor for pulmonary metastasis following rectal cancer surgery. Smoking causes emphysematous change in the lung, however, it remains unclear how much impact of pulmonary emphysema (PE) on the pathogenesis of pulmonary metastasis in rectal cancer. The objective of this study is to clarify the influence of PE on the pulmonary metastasis. Methods: Patients with rectal cancer who underwent curative resection from September 2005 to May 2014 in our institution were enrolled and their medical records were reviewed including the percentage volume of low attenuation area in the whole lung (LAA%), which were calculated from their preoperative chest CT by using AZE virtual place. PE was defined as more than 10% in LAA% and statistically evaluated the correlation with relapse free survival for pulmonary metastasis (RFSP). Results: A total of 286 patients, who consists of 7 in stage0,102 in StageⅠ, 75 in StageⅡ, and 102 in stageⅢ, were enrolled. The median LAA% was 3.16±3.78% and 14 patients (4.9%) were diagnosed PE by LAA%. Postoperative pulmonary metastasis was observed in 22 patients, including 3 patients in PE. Five-year RFSP rate in PE was significantly poorer than non-PE (25.4% vs 7.7%, p=0.02) by log-rank test. Multivariate survival analysis using Cox’s regression model revealed that PE was an independent risk factor for RFSP (Hazard Ratio = 19.14 [3.18 – 115.20], p < 0.001). Conclusions: Pulmonary emphysema may have a robust impact on pulmonary relapse after curative surgical resection of rectal cancer.
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Affiliation(s)
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Ishida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Kondo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Hibi T, Iwashita Y, Ohyama T, Honda G, Yoshida M, Takada T, Han HS, Hwang TL, Shinya S, Suzuki K, Umezawa A, Yoon YS, Choi IS, Huang WSW, Chen KH, Miura F, Watanabe M, Abe Y, Misawa T, Nagakawa Y, Yoon DS, Jang JY, Yu HC, Ahn KS, Kim SC, Song IS, Kim JH, Yun SS, Choi SH, Jan YY, Sheen-Chen SM, Shan YS, Ker CG, Chan DC, Wu CC, Toyota N, Higuchi R, Nakamura Y, Mizuguchi Y, Takeda Y, Ito M, Norimizu S, Yamada S, Matsumura N, Shindoh J, Sunagawa H, Gocho T, Hasegawa H, Rikiyama T, Sata N, Kano N, Kitano S, Tokumura H, Yamashita Y, Watanabe G, Nakagawa K, Kimura T, Yamakawa T, Wakabayashi G, Endo I, Miyazaki M, Yamamoto M. The “right” way is not always popular: comparison of surgeons’ perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan. J Hepatobiliary Pancreat Sci 2017; 24:24-32. [PMID: 28026137 DOI: 10.1002/jhbp.417] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ando Y, Yamashita Y, Tsubokawa N, Takasaki T, Taniyama D, Kuraoka K, Toyota N, Mimura T, Harada H. [Anomalous Systemic Arterialization of a Normal Basal Lung Segment with Aneurysm of the Aberrant Artery]. Kyobu Geka 2016; 69:1003-1007. [PMID: 27821825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 40-year-old woman was noted to have clubbing of the nails during an outpatient service for smoking cessation. Chest computed tomography showed an aneurysm of an aberrant artery running from the descending aorta to the left lower lobe. Hence, we diagnosed anomalous systemic arterialization of the lung. The proximal part of the aberrant artery measured 13 mm in diameter;moreover, it had developed an aneurysm(17 mm in diameter) in the lung parenchyma. The aberrant artery was ligated with a covering material (absorbable felt) and cut via a small access thoracotomy by a cardiovascular surgeon;subsequently, left lower lobectomy was performed. Pathological examination revealed significant atherosclerosis in the aberrant artery, demonstrating its severe fragility. To apply appropriate safety procedures and approaches are recommended when treating an aberrant artery to the lung, especially in the presence of an aneurysm.
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Affiliation(s)
- Yuki Ando
- Department of Surgery, Oita Prefectural Hospital, Oita, Japan
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23
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Iwashita Y, Ohyama T, Honda G, Hibi T, Yoshida M, Miura F, Takada T, Han HS, Hwang TL, Shinya S, Suzuki K, Umezawa A, Yoon YS, Choi IS, Huang WSW, Chen KH, Watanabe M, Abe Y, Misawa T, Nagakawa Y, Yoon DS, Jang JY, Yu HC, Ahn KS, Kim SC, Song IS, Kim JH, Yun SS, Choi SH, Jan YY, Sheen-Chen SM, Shan YS, Ker CG, Chan DC, Lee KT, Toyota N, Higuchi R, Nakamura Y, Mizuguchi Y, Takeda Y, Ito M, Norimizu S, Yamada S, Matsumura N, Shindoh J, Sunagawa H, Hasegawa H, Rikiyama T, Sata N, Kano N, Kitano S, Tokumura H, Yamashita Y, Watanabe G, Nakagawa K, Kimura T, Yamakawa T, Wakabayashi G, Endo I, Miyazaki M, Yamamoto M. What are the appropriate indicators of surgical difficulty during laparoscopic cholecystectomy? Results from a Japan-Korea-Taiwan multinational survey. J Hepatobiliary Pancreat Sci 2016; 23:533-47. [PMID: 27490841 DOI: 10.1002/jhbp.375] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/02/2016] [Indexed: 12/15/2022]
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24
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Maeda Y, Goto K, Honda Y, Kuroda N, Sentani K, Yasui W, Hayashi T, Teishima J, Matsubara A, Nakamura Y, Toyota N, Iida M, Awai K. A case of tubulocystic carcinoma of the kidney with aggressive features. Jpn J Radiol 2016; 34:307-11. [PMID: 26830902 DOI: 10.1007/s11604-016-0525-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/20/2016] [Indexed: 12/17/2022]
Abstract
Tubulocystic carcinoma of the kidney is rare and typically indolent. Our case involved an aggressive tubulocystic carcinoma as well as the radiological confirmation of its relation to papillary renal cell carcinoma. A 46-year-old male presented with renal multiloculated cysts with a solid part. On computed tomography and magnetic resonance imaging, the solid part showed the characteristics of papillary renal cell carcinoma. Contrast enhancement of the solid part was fluffy and sparse because of the coexistence of cysts. Perirenal fat invasion resulted in exophytic cysts, and renal-hilar cystic lymph node metastasis existed. The histopathological diagnosis was tubulocystic carcinoma associated with areas of papillary renal cell carcinoma and poorly differentiated carcinoma with metastasis. Our case suggests that the solid part enhancement of tubulocystic carcinoma tends to be fluffy and sparse, and exophytic cysts and cystic lymph nodes may show radiologically aggressive findings.
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Affiliation(s)
- Yoko Maeda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan.,Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima, 7370023, Japan
| | - Keisuke Goto
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan.,Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan.
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Kochi Red Cross Hospital, 2-13-51 Shin-honmachi, Kochi, 7808562, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan.,Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Kville Pike, Building 10, B3B47, Bethesda, MD, 20892, USA
| | - Naoyuki Toyota
- Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima, 7370023, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
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Hayano K, Miura F, Wada K, Suzuki K, Takeshita K, Amano H, Toyota N, Sano K, Asano T. Diffusion-weighted MR imaging of pancreatic cancer and inflammation: Prognostic significance of pancreatic inflammation in pancreatic cancer patients. Pancreatology 2015; 16:121-6. [PMID: 26596539 DOI: 10.1016/j.pan.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic cancer often accompanies chronic obstructive pancreatitis (COP) due to obstruction of the main pancreatic duct, and the inflammatory environment may enhance cancer progression. The purpose of this study is to evaluate COP using the apparent diffusion coefficient (ADC) value measured by diffusion-weighted MR imaging (DWI), and to assess its prognostic significance in pancreatic cancer. METHODS Twenty-eight patients (16 men, 12 women; mean age 67.1 years) with pancreatic cancers who underwent DWI followed by curative surgery were evaluated. The ADC value of pancreatic parenchyma upstream to the tumor (upstream pancreas) was measured and compared with the upstream pancreatic duct dilatation to assess whether DWI could reflect COP. The ADC values of tumor and upstream portion were compared with overall survival (OS) using Cox regression and Kaplan-Meier analysis. RESULTS The ADC value of upstream pancreas was significantly lower in patients with greater dilated pancreatic duct than those with less (P = 0.03). In univariate Cox regression analysis, the ADC value of upstream pancreas showed a significant association with OS (P = 0.01), but that of tumor did not (P = 0.06). In Kaplan-Meier analysis, patients with lower ADC value of upstream pancreas (<1.36 × 10(-3) mm(2)/s) were significantly associated with poor OS (P = 0.0006). In multivariate analysis, the ADC value of upstream pancreas was identified as an independent prognostic factor (P = 0.01; hazards ratio, 0.05; 95% CI, 0.004-0.59). CONCLUSIONS The ADC value of upstream pancreas was an independent prognostic factor for OS in pancreatic cancer patients. Inflammatory environment may play an important role in pancreatic cancer progression.
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Affiliation(s)
- Koichi Hayano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazufumi Suzuki
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koji Takeshita
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takehide Asano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Miura F, Sano K, Amano H, Toyota N, Wada K, Tokairin T, Kondo F, Hayano K, Matsubara H, Takada T. Is it possible to define early distal cholangiocarcinoma? Langenbecks Arch Surg 2015; 401:25-32. [DOI: 10.1007/s00423-015-1351-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/20/2015] [Indexed: 01/28/2023]
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Wada K, Sano K, Amano H, Miura F, Toyota N, Ito H, Shibuya M, Ikeda Y, Kainuma M, Takada T. Biweekly gemcitabine plus S-1 for locally advanced and metastatic pancreatic cancer: a preliminary feasibility study. J Hepatobiliary Pancreat Sci 2015; 22:692-8. [PMID: 26136371 DOI: 10.1002/jhbp.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/02/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chemotherapy for unresectable pancreatic cancer should not only prolong survival but maintain quality of life, considering its limited life expectancy. To achieve these goals, biweekly gemcitabine plus S-1 was assessed in the clinical practice setting. METHODS Fifty-two patients with either locally advanced or metastatic pancreatic cancer who received biweekly gemcitabine plus S-1 as a first-line anti-cancer treatment were included in this study. Treatment delivery, toxicity, response, and survival were reviewed to assess the feasibility and efficacy. RESULTS The completion rate of treatment delivery was 95.1%, with relative dose intensity of 97.1% for gemcitabine and 97.3% for S-1. Overall, grade 3 or worse adverse events were rare, with hematologic toxicities occurring in 5.8%. The objective response rate was 30.8%, and more than a 50% reduction of CA19-9 was observed in 77.1%. Surgical conversion was completed with a margin-negative resection in four patients whose tumor had shrunk for at least 6 months. The median progression-free and overall survivals were 10.4 and 18.2 months, respectively. Reduction of CA19-9 was associated with longer survival. CONCLUSIONS Biweekly gemcitabine plus S-1 may be a good alternative to current standard chemotherapies for unresectable pancreatic cancer with less toxicity and less treatment burden without losing efficacy.
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Affiliation(s)
- Keita Wada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hiromichi Ito
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Makoto Shibuya
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yutaka Ikeda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Masahiko Kainuma
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Zheng Y, Liu Y, Toyota N, Lortz R. Magnetic field induced enlargement of the regime of critical fluctuations in the classical superconductor V3Si from high-resolution specific heat experiments. J Phys Condens Matter 2015; 27:075701. [PMID: 25640214 DOI: 10.1088/0953-8984/27/7/075701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present high-resolution specific heat data from a high-purity single crystal of the classical superconductor V(3)Si, which reveal tiny lambda-shape anomalies at the superconducting transition superimposed onto the BCS specific heat jump in magnetic fields of 2 T and higher. The appearance of these anomalies is accompanied by a magnetic-field-induced broadening of the superconducting transition. We demonstrate, using scaling relations predicted by the fluctuation models of the 3d-XY and the 3d-lowest-Landau-level (3d-LLL) universality class that the effect of critical fluctuations becomes experimentally observable due to of a magnetic field-induced enlargement of the regime of critical fluctuations. The scaling indicates that a reduction of the effective dimensionality due to the confinement of quasiparticles into low Landau levels is responsible for this effect.
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Affiliation(s)
- Y Zheng
- Department of Physics, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, People's Republic of China
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29
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Miura F, Sano K, Amano H, Toyota N, Wada K, Yoshida M, Hayano K, Matsubara H, Takada T. Evaluation of portal vein invasion of distal cholangiocarcinoma as borderline resectability. J Hepatobiliary Pancreat Sci 2014; 22:294-300. [DOI: 10.1002/jhbp.198] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Fumihiko Miura
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
| | - Keiji Sano
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
| | - Hodaka Amano
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
| | - Naoyuki Toyota
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
| | - Keita Wada
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
| | - Masahiro Yoshida
- Clinical Research Center Kaken Hospital; International University of Health and Welfare; Tochigi Japan
| | - Koichi Hayano
- Department of Frontier Surgery; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; 2-11-1 Kaga Itabashi-ku Tokyo 173-8605 Japan
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Ishikawa M, Yamagami T, Kakizawa H, Hieda M, Toyota N, Fukumoto W, Kajiwara K, Yoshimatsu R, Aikata H, Chayama K, Awai K. Transarterial Therapy of Hepatocellular Carcinoma Fed by the Right Renal Capsular Artery. J Vasc Interv Radiol 2014; 25:389-95. [DOI: 10.1016/j.jvir.2013.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 01/30/2023] Open
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Nakamura Y, Urashima M, Toyota N, Ono C, Iida M, Fukumoto W, Kaichi Y, Tani C, Honda Y, Komoto D, Tatsugami F, Kakizawa H, Date S, Awai K. Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT. Jpn J Radiol 2013; 31:737-743. [PMID: 24022230 DOI: 10.1007/s11604-013-0245-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/26/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the diagnostic capability of multidetector computed tomography for detecting non-occlusive mesenteric ischemia (NOMI). METHODS We studied 11 NOMI patients and 44 controls. Radiologists evaluated the CT images for the presence of bowel ischemia and measured the diameters of the superior mesenteric artery and the superior mesenteric vein (D SMA and D SMV). We also performed linear discriminant analysis (LDA) using D SMA and D SMV. RESULTS All NOMI patients presented with more than 2 CT findings of bowel ischemia. D SMA and D SMV were significantly smaller in NOMI patients than in the controls (p < 0.01). At the optimal cut-off values for D SMA (6.5 mm), D SMV (9.0 mm), and the Z value in LDA (0.93), sensitivity and specificity were 81.8 and 81.8; 81.8 and 88.6; and 81.8 and 97.7 %, respectively. CONCLUSIONS D SMA and D SMV were significantly smaller in NOMI patients than in the controls and D SMV is a more significant parameter than D SMA.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan,
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Toyota N, Nakamura Y, Hieda M, Akiyama N, Terada H, Matsuura N, Nishiki M, Kono H, Kohno H, Irei T, Yoshikawa Y, Kuraoka K, Taniyama K, Awai K. Diagnostic capability of gadoxetate disodium-enhanced liver MRI for diagnosis of hepatocellular carcinoma: comparison with multi-detector CT. Hiroshima J Med Sci 2013; 62:55-61. [PMID: 24279123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate the diagnostic capability of gadoxetate disodium (Gd-EOB)-MRI for the detection of hepatocellular carcinoma (HCC) compared with multidetector CT (MDCT). Fifty patients with 57 surgically proven HCCs who underwent Gd-EOB-MRI and MDCT from March 2008 to June 2011 were evaluated. Two observers evaluated MR and CT on a lesion-by-lesion basis. We analyzed sensitivity by grading on a 5-point scale, the degree of arterial enhancement and the differences in histological grades in the diffusion-weighted images (DWI). The results showed that the sensitivity of Gd-EOB-MRI was higher than that of MDCT especially for HCCs that were 1 cm in diameter or smaller. The hepatobiliary phase was useful for the detecting of small HCC. We had few cases in which it was difficult to judge HCC in the arterial enhancement between MRI and MDCT. In the diffusion-weighted image, well differentiated HCC tended to show a low signal intensity, and poorly differentiated HCC tended to show a high signal intensity. In moderately differentiated HCC's, the mean diameter of the high signal intensity group was larger than that of the low signal intensity group (24.5 mm vs. 15.8 mm). In conclusion, Gd-EOB-MRI tended to show higher sensitivity compared to MDCT in the detection of HCC.
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Affiliation(s)
- Naoyuki Toyota
- Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan
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Kinoshita H, Akiyama N, Murao M, Yamauchi Y, Nakamura T, Sekiya N, Toyota N, Miyagatani Y. A case of hemothorax following seat-belt injury with a bulla in the apex of the lung: a subtype of spontaneous hemopneumothorax. Gen Thorac Cardiovasc Surg 2013; 63:302-6. [PMID: 23921966 DOI: 10.1007/s11748-013-0305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
We experienced a case of a subtype of spontaneous hemopneumothorax caused by external forces associated with a seat-belt injury. A female aged 39 years sustained a minor collision with an oncoming car while she was driving. Although pneumothorax was not detected, hemothorax and bleeding from the area surrounding the subclavian artery were observed on contrast-enhanced chest computed tomography (CT). After confirming continuous bleeding into the thoracic cavity after superselective arterial embolization, we performed emergency open surgery. We found a bulla in the apex of the lung, and the thoracic stump of the bulla was considered the source of bleeding. In this case, the direct cause of hemothorax was considered to be the external force associated with the seat-belt injury. When a bulla in the apex of the lung and continuous bleeding are both observed on CT, spontaneous hemopneumothorax should be suspected, necessitating open chest surgery in cases where pneumothorax is not observed.
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Affiliation(s)
- Haruyuki Kinoshita
- Department of Cardiology, National Hospital Organization Kure Medical Center Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan,
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Hayano K, Miura F, Amano H, Toyota N, Wada K, Kato K, Sano K, Takeshita K, Aoyagi T, Shuto K, Matsubara H, Asano T, Takada T. Correlation of apparent diffusion coefficient measured by diffusion-weighted MRI and clinicopathologic features in pancreatic cancer patients. J Hepatobiliary Pancreat Sci 2013; 20:243-8. [PMID: 22311389 DOI: 10.1007/s00534-011-0491-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the clinical usefulness of diffusion-weighted magnetic resonance imaging (DWI) in patients with pancreatic cancer by comparing the apparent diffusion coefficient (ADC) value with clinicopathologic features. METHODS Twenty-two consecutive patients (12 men, 10 women; mean age 64.4 years) with pancreatic cancer underwent DWI before surgery. We retrospectively investigated the correlations between tumor ADC value and clinicopathologic features. RESULTS Apparent diffusion coefficient value was significantly lower for pancreatic cancer than for noncancerous tissue (P < 0.001). Receiver operating characteristic analysis yielded an optimal ADC cutoff value of 1.21 × 10(-3) mm(2)/s to distinguish pancreatic cancer from noncancerous tissue. There was a significant negative correlation between ADC value and tumor size (r = -0.59, P = 0.004) and between ADC value and number of metastatic lymph nodes (r = -0.56, P = 0.007). Tumors with low ADC value had a significant tendency to show high portal venous system invasion (P = 0.02) and extrapancreatic nerve plexus invasion (P = 0.01). CONCLUSIONS Apparent diffusion coefficient value appears to be a promising parameter for detecting pancreatic cancer and evaluating the degree of malignancy of pancreatic cancer.
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Affiliation(s)
- Koichi Hayano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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Kadowaki S, Miura F, Amano H, Toyota N, Wada K, Shibuya M, Maeno S, Takada T, Sano K. Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy. J Hepatobiliary Pancreat Sci 2013; 19:566-77. [PMID: 22869100 DOI: 10.1007/s00534-012-0533-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND/PURPOSE It is generally thought that an internal short stent placed across the pancreaticojejunostomy (PJ) following pancreatoduodenectomy (PD) usually passes spontaneously through the rectum thereafter; however, we experienced some patients who presented with pancreatitis and cholangitis owing to delayed defecation of the stent. The purpose of this study was to clarify when the stent eventually became detached from the PJ and how it passed through the body until it was finally defecated. In addition, we also investigated the factors that may prevent such detachment and defecation. METHODS This study retrospectively analyzed 57 patients who had had internal short stents placed across the PJ following PD. Defecation from the body, detachment from the PJ, and distal migration of the stent was confirmed by X-ray or computed tomography (CT) during the postoperative course. The cumulative rates of defecation and detachment of the stents, complications in relation to delayed defecation of the stents, and factors predictive of the delayed defecation, delayed detachment, and distal migration of the stents were analyzed. RESULTS Defecation of the stent was confirmed in 35 patients. The median time to defecation after PD and the cumulative defecation rate at 1 year were 454 days and 41 %, respectively. Acute pancreatitis occurred in 2 patients with the stent remaining in the pancreatic duct. One patient experienced acute cholangitis owing to migration of the stent to the bile duct. Multivariate analysis showed that ≥5 stitches in the duct-to-mucosa anastomosis, stent size of ≥5 Fr, and pancreatic fistula classified as either Grade B or C were independent predictive factors for delayed defecation of the stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed detachment of the stent. A stent size of ≥5 Fr was a risk factor for distal migration of the stent. CONCLUSION In more than half of the study patients, internal short stents were not defecated within 1 year. Retrieval of the stent should be considered following the migration of an internal short stent. A stent size of ≥5 Fr was an independent predictive factor for delayed defecation and distal migration of a stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed defecation and detachment of a stent.
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Affiliation(s)
- Susumu Kadowaki
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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Ishikawa M, Kakizawa H, Hieda M, Toyota N, Katamura Y, Aikata H, Chayama K, Awai K. Long-term outcomes of hepatic arterial port implantation using a coaxial microcatheter system in 176 patients with hepatocellular carcinoma. Hiroshima J Med Sci 2012; 61:7-13. [PMID: 22702214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study is to evaluate the feasibility of hepatic arterial port implantation using a 2.9-Fr coaxial microcatheter for hepatic arterial infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) in the long-term follow-up period. Our study subjects were 176 patients with unresectable HCC who underwent hepatic arterial port implantation using a 2.9-Fr coaxial microcatheter via the femoral approach. A 2.9-Fr microcatheter with a side hole was introduced into the hepatic artery through a 5-Fr catheter. We determined the possible length of HAIC, starting with hepatic arterial port implantation and ending with the manifestation of technical difficulties or patient death. We also recorded the technical success rate, the time required for the procedure, and the complications encountered. The median duration of HAIC was 4.3 months (range 0.4-51.6 months) and the predictable cumulative rate of hepatic arterial port functioning at 6-, 12-, and 24 months was 75.1%, 60.9%, and 44.6%, respectively. Our technical success rate was 99.4% (175/176), and the mean time required for the procedure was 121 min. Complications were migration of the infusion hole (8.6%, 15/175), hepatic artery damage (5.7%, 10/175), port-catheter system occlusion (5.7%, 10/175), and problems involving the port or the puncture site (8.0%, 14/175). Our study demonstrates that the technical success rate of hepatic arterial port implantation using a coaxial microcatheter was high but that the incidence of port-catheter system occlusion and catheter dislocation was higher than in conventional methods. Our technique is another option to treat patients with HCC for whom conventional techniques cannot be used.
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Affiliation(s)
- Masaki Ishikawa
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
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Miura F, Sano K, Amano H, Toyota N, Wada K, Kadowaki S, Shibuya M, Maeno S, Takada T, Hayano K, Matsubara H. Is spleen-preserving distal pancreatectomy with excision of the splenic artery and vein feasible? Surgery 2011; 150:572. [PMID: 21813144 DOI: 10.1016/j.surg.2011.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/22/2011] [Indexed: 11/17/2022]
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Deshmukh A, Sharma SS, Gobal FG, Singla SS, Hebbar PH, Paydak HP, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Shavadia J, Otieno H, Yonga G, Jinah A, Qvist JF, Soerensen PH, Dixen U, Ramirez-Marrero MA, Perez-Villardon B, Gaitan-Roman D, Jimenez-Navarro M, Delgado-Prieto JL, De Teresa-Galvan E, De Mora-Martin M, Deshmukh A, Hebbar PB, Wei WX, Gobal FG, Singla SS, Sharma SS, Paydak HP, Bardari S, Zecchin M, Salame' R, Vitali Serdoz L, Di Lenarda A, Guerrini N, Barbati G, Sinagra G, Hanazawa K, Kaitani K, Nakagawa Y, Lenaerts I, Driesen R, Hermida N, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R, Sehra R, Krummen D, Briggs C, Narayan S, Tanaka Y, Hirao K, Nakamura T, Inaba O, Yagishita A, Higuchi K, Hachiya H, Isobe M, Kallergis E, Kanoupakis EM, Mavrakis HE, Goudis CA, Maliaraki NE, Vardas PE, Sehra R, Krummen D, Briggs C, Narayan S, Kiuchi K, Piorkowski C, Kircher S, Gaspar T, Watanabe N, Bollmann A, Hindricks G, Wauters K, Grosse A, Raffa S, Brunelli M, Geller JC, Maggioni AP, Gonzini L, Gussoni G, Vescovo G, Gulizia M, Pirelli S, Mathieu G, Di Pasquale G, Zecchin M, Bardari S, Vitali Serdoz L, Salame R, Buja G, Rovai N, Gargaro A, Sperzel J, Knops RE, Meine M, Speca G, Santini L, Haarbo J, Dubin K, Di Lenarda A, Carlson M, Garcia Quintana A, Mendoza-Lemes H, Garcia Perez L, Led Ramos S, Caballero Dorta E, Matinez De Espronceda M, Piro Mastracchio V, Serrano Arriezu L, Sciarra L, Barbati G, Marziali M, Marras E, Rebecchi M, Allocca G, Lioy E, Delise P, Calo' L, Santobuono VE, Iacoviello M, Nacci F, Magnani S, Luzzi G, Puzzovivo A, Memeo M, Quadrini F, Favale S, Trucco ME, Arce M, Palazzolo J, Uribe W, Baranchuk A, Sinagra G, Femenia F, Maggi R, Furukawa T, Croci F, Solano A, Brignole M, Lebreiro A, Sousa A, Correia AS, Lourenco P, Sakamoto T, Oliveira S, Paiva M, Freitas J, Maciel MJ, Linker N, Rieger G, Garutti C, Edvardsson N, Salguero Bodes R, De Riva Silva M, Kumagai K, Fontenla Cerezuela A, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Garcia Alvarez S, Arribas Ynsaurriaga F, Petix NR, Del Rosso A, Guarnaccia V, Zipoli A, Fuke E, Rabajoli F, Foglia Manzillo G, Tolardo C, Checchinato C, Chiaravallotti S, Santarone M, Spinnler MT, Podoleanu C, Maggi R, Brignole M, Nishiuchi S, Frigy A, Dobreanu D, Ginghina C, Carasca E, Hayashi T, Miki Y, Naito S, Oshima S, Hof IE, Vonken E, Velthuis BK, Meine M, Hauer RNW, Loh KP, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Lim HE, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Wichterle D, Bulkova V, Fiala M, Chovancik J, Simek J, Peichl P, Cihak R, Kautzner J, Glick A, Viskin S, Belhassen B, Navarrete A, Conte F, Ishti A, Sai D, Moran M, Chitovova Z, Ahmed H, Mares K, Skoda J, Sediva L, Petru J, Reddy VY, Neuzil P, Schmidt M, Dorwarth U, Leber A, Wankerl M, Krieg J, Straube F, Reif S, Hoffmann E, Mikhaylov E, Tikhonenko V, Lebedev D, Lim HE, Shin SY, Yong HS, Choi CU, Choi JI, Kim SH, Kim EJ, Na JO, Matsuo S, Yamane T, Hioki M, Ito K, Narui R, Date T, Sugimoto K, Yoshimura M, Rolf S, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Batalov R, Popov S, Antonchenko I, Suslova T, Fichtner S, Czudnochowsky U, Estner HL, Ammar S, Reents T, Jilek C, Hessling G, Deisenhofer I, Pokushalov E, Romanov A, Corbucci G, Artemenko S, Losik D, Shabanov V, Turov A, Elesin D, Mikhaylov E, Abramov M, Lebedev D, Piorkowski C, Sanders P, Jais P, Roberts-Thomson K, Hindricks G, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Roux Y, Tenkorang J, Carroz P, Schlaepfer J, Pascale P, Forclaz A, Fromer M, Pruvot E, Fiala M, Wichterle D, Bulkova V, Sknouril L, Nevralova R, Chovancik J, Dorda M, Januska J, Brunelli M, Grosse A, Santi R, Wauters K, Geller C, Kumagai K, Nakamura K, Hayashi T, Kasseno K, Naito S, Sakamoto T, Oshima S, Taniguchi K, Wutzler A, Rolf S, Huemer M, Parwani A, Boldt LH, Blaschke D, Dietz R, Haverkamp W, Coutu B, Malanuk R, Ait Said M, Vicentini A, Schade S, Ando K, Rousseauplasse A, Deering T, Picarra BC, Santos AR, Dionisio P, Semedo P, Matos R, Leitao M, Jacinto A, Trinca M, Wan C, Glad J, Szymkiewicz S, Habibovic M, Versteeg H, Pelle AJM, Theuns DAMJ, Jordaens L, Pedersen SS, Pakarinen S, Toivonen L, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Maier SKG, Lobitz N, Paule S, Becher J, Mustafa G, Ibrahim A, King G, Foley B, Wilkoff B, Freedman R, Hayes D, Kalbfleisch S, Kutalek S, Schaerf R, Fazal IA, Tynan M, Plummer CJ, Mccomb JM, Oto A, Aytemir K, Yorgun H, Canpolat U, Kaya EB, Tokgozoglu L, Kabakci G, Ozkutlu H, Greenberg S, Hamati F, Styperek R, Alonso J, Peress D, Bolanos O, Augostini R, Pelini M, Zhang S, Stoycos S, Witsaman S, Mowrey K, Bremer J, Oza A, Ciconte G, Mazzone P, Paglino G, Marzi A, Vergara P, Sora N, Gulletta S, Della Bella P, Nagashima M, Goya M, Soga Y, Hiroshima K, Andou K, Hayashi K, An Y, Nobuyoshi M, Kutarski A, Malecka B, Pietura R, Osmancik P, Herman D, Stros P, Kocka V, Tousek P, Linkova H, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Plebani L, Marino PN, Gorev MV, Alimov DG, Raju P, Kully S, Ugni S, Furniss S, Lloyd G, Patel NR, Richards MW, Warren CE, Anderson MH, Hero M, Rey JL, Ouali S, Azzez S, Kacem S, Hammas S, Ben Salem H, Neffeti E, Remedi F, Boughzela E, Kronborg MB, Mortensen PT, Poulsen SH, Nielsen JC, Simantirakis EN, Kontaraki JE, Arkolaki EG, Chrysostomakis SI, Nyktari EG, Patrianakos AP, Vardas PE, Funck RC, Harink C, Mueller HH, Koelsch S, Maisch B, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Bolzani V, Marino PN, Costandi P, Shehada RE, Butala N, Coppola B, Taborsky M, Heinc P, Fedorco M, Doupal V, Di Cori A, Zucchelli G, Soldati E, Segreti L, De Lucia R, Viani S, Paperini L, Bongiorni MG, Gutleben KJ, Kranig W, Barr C, Morgenstern MM, Simon M, Dalal YH, Landolina M, Pierantozzi A, Agricola T, Lunati M, Pisano' E, Lonardi G, Bardelli G, Zucchi G, Thibault B, Dubuc M, Karst E, Ryu K, Paiement P, Carlson MD, Farazi T, Alhous H, Mont L, Porres JM, Alzueta J, Beiras X, Fernandez-Lozano I, Macias A, Ruiz R, Brugada J, Viani SM, Segreti L, Di Cori A, Zucchelli G, Paperini L, Soldati E, De Lucia R, Bongiorni MG, Seifert M, Schau T, Moeller V, Meyhoefer J, Butter C, Ganiere V, Niculescu V, Domenichini G, Stettler C, Defaye P, Burri H, Stockburger M, De Teresa E, Lamas G, Desaga M, Koenig C, Cobo E, Navarro X, Wiegand U, Blich M, Carasso S, Suleiman M, Marai I, Gepstein L, Boulos M, Sasov M, Liska B, Margitfalvi P, Malacky T, Svetlosak M, Goncalvesova E, Hatala R, Takaya Y, Noda T, Yamada Y, Okamura H, Satomi K, Shimizu W, Aihara N, Kamakura S, Proclemer A, Boveda S, Oswald H, Scipione P, Rousseauplasse A, Da Costa A, Brzozowski W, Tomaszewski A, Kutarski A, Wysokinski A, Arbelo E, Tamborero D, Vidal B, Tolosana JM, Sitges M, Matas M, Brugada J, Mont L, Botto GL, Dicandia CD, Mantica M, La Rosa C, D' Onofrio A, Molon G, Raciti G, Verlato R, Foley PWX, Chalil S, Ratib K, Smith REA, Printzen F, Auricchio A, Leyva F, Abu Sham'a R, Buber J, Luria D, Kuperstein R, Feinberg M, Granit H, Eldar M, Glikson M, Osmancik P, Herman D, Stros P, Vondrak K, Abu Sham'a R, Nof E, Kuperstein R, Carasso S, Feinberg M, Lipchenca I, Eldar M, Glikson M, Vatasescu RG, Iorgulescu C, Caldararu C, Vasile A, Bogdan S, Constantinescu D, Dorobantu M, Sakaguchi H, Miyazaki A, Yamamoto T, Fujimoto K, Ono S, Ohuchi H, Martinelli M, Martins S, Molina R, Siqueira S, Nishioka SAD, Peixoto GL, Alkmim-Teixeira R, Costa R, Versteeg H, Meine MM, Tuinenburg AE, Doevendans PA, Denollet J, Pedersen SS, Goscinska-Bis K, Zupan I, Van Der H, Anselme F, Hartog H, Block M, Borri A, Padeletti L, Toniolo M, Zanotto G, Rossi A, Raytcheva E, Tomasi L, Vassanelli C, Fernandez Lozano I, Mitroi C, Toquero Ramos J, Castro Urda V, Monivas Palomero V, Corona Figueroa A, Ruiz Bautista L, Alonso Pulpon L, Jadidi AS, Sacher F, Shah AS, Scherr D, Derval N, Hocini M, Haissaguerre M, Jais P, Castrejon Castrejon S, Largo-Aramburu C, Sachar J, Gang E, Estrada A, Doiny D, De Miguel E, Merino JL, Vergara P, Trevisi N, Ricco A, Petracca F, Baratto F, Bisceglie A, Maccabelli G, Della Bella P, El-Damaty A, Sapp J, Warren J, Macinnis P, Horacek M, Dinov B, Schoenbauer R, Piorkowski C, Bollmann A, Sommer P, Braunschweig F, Hindricks G, Arya A, Andreu D, Berruezo A, Ortiz JT, Silva E, Mont L, De Caralt TM, Fernandez-Armenta J, Brugada J, Castrejon Castrejon S, Estrada A, Doiny D, Perez-Silva A, Ortega M, Lopez-Sendon JL, Merino JL, Regoli F, Faletra F, Nucifora G, Pasotti E, Moccetti T, Klersy C, Auricchio A, Casella M, Dello Russo A, Moltrasio M, Zucchetti M, Fassini G, Di Biase L, Natale A, Tondo C, Sakamoto T, Kumagai K, Matsuhashi N, Nishiuchi S, Fuke E, Hayashi T, Naito S, Oshima S, Weig HJ, Kerst G, Weretk S, Seizer P, Gawaz MP, Schreieck J, Sarquella-Brugada G, Prada F, Brugada J, Reents T, Ammar S, Fichtner S, Salling CM, Jilek C, Kolb C, Hessling G, Deisenhofer I, Pytkowski M, Maciag A, Farkowski M, Jankowska A, Kowalik I, Kraska A, Szwed H, Maury P, Hocini M, Sacher F, Duparc A, Mondoly P, Rollin A, Jais P, Haissaguerre M, Pap R, Kohari M, Bencsik G, Makai A, Saghy L, Forster T, Ebrille E, Scaglione M, Raimondo C, Caponi D, Di Donna P, Blandino A, Delcre SDL, Gaita F, Roca Luque I, Dos LDS, Rivas NRG, Pijuan APD, Perez J, Casaldaliga J, Garcia-Dorado DGD, Moya AMM, Sato H, Yagi T, Yambe T, Streitner F, Dietrich C, Mahl E, Schoene N, Veltmann C, Borggrefe M, Kuschyk J, Sadarmin PP, Wong KCK, Rajappan K, Bashir Y, Betts TR, Svetlosak M, Leclercq C, Martins R, Hatala R, Daubert JC, Mabo P, Koide M, Hamano G, Taniguchi T, Yamato M, Sasaki N, Hirooka K, Ikeda Y, Yasumura Y, Dichtl W, Wolber T, Paoli U, Bruellmann S, Berger T, Stuehlinger M, Duru F, Hintringer F, Kanoupakis E, Mavrakis H, Kallergis E, Koutalas E, Saloustros I, Goudis C, Chlouverakis G, Vardas P, Herre JM, Saeed M, Saberi L, Neuman S, An Y, Ando K, Goya M, Nagashima M, Yamaji K, Soga Y, Iwabuchi M, Nobuyoshi M, Baranchuk A, Femenia F, Miranda Hermosilla R, Lopez Diez JC, Serra JL, Valentino M, Retyk E, Galizio N, Kwasniewski W, Filipecki A, Orszulak W, Urbanczyk-Swic D, Trusz - Gluza M, Piot O, Degand B, Da Costa A, Donofrio A, Scanu P, Quesada A, Rousseauplasse A, Padeletti L, Kloppe A, Mijic D, Bogossian H, Zarse M, Lemke B, Tyler J, Comfort G, Kalbfleisch S, Deering TF, Epstein AE, Greenberg SMG, Goldman DS, Rhude J, Majewski JP, Lelakowski J, Tomala I, Santos CM, Miranda RS, Sousa PJ, Cavaco DM, Adragao PP, Knops RE, Wilde AA, Da Costa A, Belhameche M, Hermida JS, Dovellini E, Frohlig G, Siot P, Degand B, Duray GZ, Israel CW, Brachmann J, Seidl KH, Foresti M, Birkenhauer F, Hohnloser SH, Ferreira C, Mateus P, Ribeiro H, Carvalho S, Ferreira A, Moreira J, Kadro W, Rahim H, Turkmani M, Abu Lebdeh M, Altabban A, Raimondo C, Scaglione M, Ebrille E, Caponi D, Di Donna P, Cerrato N, Delcre SDL, Gaita F, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Kvantaliani T, Akhvlediani M, Namdar M, Steffel J, Jetzer S, Bayrak F, Chierchia GB, Jenni R, Duru F, Brugada P, Bakos Z, Medvedev M MM, Jonas Carlsson JC, Fredrik Holmqvist FH, Pyotr Platonov PP, Nurbaev T, Pirnazarov M, Nikishin A, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Simeonidou E, Kastellanos S, Varounis C, Michalakeas C, Koniari C, Nikolopoulou A, Anastasiou-Nana M, Furukawa Y, Yamada T, Morita T, Tanaka K, Iwasaki Y, Kawasaki M, Kuramoto Y, Fukunami M, Blanche C, Tran N, Rigamonti F, Zimmermann M, Okisheva E, Tsaregorodtsev D, Sulimov V, Novikova D, Popkova T, Udachkina E, Korsakova Y, Volkov A, Novikov A, Alexandrova E, Nasonov E, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Kartsagoulis E, Asimakopoulos S, Stefanadis C, Marocolo M, Barbosa Neto O, Carvalho AC, Marques Neto SR, Mota GR, Barbosa PRB, Fernandez-Fernandez A, Manzano Fernandez S, Pastor-Perez FJ, Barquero-Perez O, Goya-Esteban R, Salar M, Rojo-Alvarez JL, Garcia-Alberola A, Takigawa M, Kawamura M, Aiba T, Kamakura S, Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kakizawa H, Toyota N, Hieda M, Ishikawa M, Tanitame K, Tani C, Okazaki A, Takaki S, Aikata H, Chayama K, Awai K. Portal-systemic shunt between the inferior mesenteric vein and inferior vena cava in a patient with hepatic encephalopathy: successful occlusion by balloon-occluded retrograde transvenous obliteration. Hiroshima J Med Sci 2011; 60:15-19. [PMID: 21675043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A large shunt between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is a rare type of portosystemic shunt in patients with hepatic encephalopathy. We report a patient with hepatic encephalopathy due to a large IMV-IVC shunt who was successfully treated by balloon-occluded retrograde transvenous obliteration. The procedure involved a combination of 11 metallic coils and 5 ml of 5% ethanolamine oleate with iopamidol as the sclerosing agent. After complete obliteration of the shunt, his symptoms disappeared. At 2-years follow-up he was free of clinical symptoms, the size of his liver had slightly increased, and his liver function was preserved.
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Affiliation(s)
- Hideaki Kakizawa
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
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Mori T, Iwamoto K, Kushibiki S, Honda H, Matsumoto H, Toyota N, Avila MA, Suekuni K, Takabatake T. Optical conductivity spectral anomalies in the off-center rattling system β-Ba8Ga16Sn30. Phys Rev Lett 2011; 106:015501. [PMID: 21231752 DOI: 10.1103/physrevlett.106.015501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 05/30/2023]
Abstract
We present optical conductivity studies of the type-I clathrate Ba8Ga16Sn30, using a terahertz time-domain spectrometer (0.3-3.0 THz). The lowest-lying spectral peak at 0.72 THz due to the Ba(2) ion's off-center vibration in the oversized cage shows a drastic and anomalous temperature dependence. Below about 100 K, the single broad peak splits into two subpeaks, and with further lowering of the temperature, the spectral shape of this so-called rattling phonon shows non-Boltzmann broadening to the point that the linewidth becomes comparable to the peak frequency. Whereas the initial splitting can be understood by assuming a multiwell anharmonic potential, the strong linewidth broadening toward low temperature cannot, since the Boltzmann factor generally sharpens the low-temperature spectra. The observed behavior suggests strong interaction between the local anharmonic phonons and other excitations.
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Affiliation(s)
- T Mori
- Department of Physics, Graduate School of Science, Tohoku University, Sendai 980-8578, Japan
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Hayano K, Asano T, Amano H, Miura F, Toyota N, Wada K, Kato K, Shibuya M, Kadowaki S, Maeno S, Takada T. Huge mucinous cystic adenocarcinoma of the pancreas. Dig Surg 2010; 27:467-8. [PMID: 21063122 DOI: 10.1159/000321007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Koichi Hayano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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Kodama H, Aikata H, Takaki S, Azakami T, Katamura Y, Kawaoka T, Hiramatsu A, Waki K, Imamura M, Kawakami Y, Takahashi S, Toyota N, Ito K, Chayama K. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices. Eur J Radiol 2010; 76:239-45. [DOI: 10.1016/j.ejrad.2009.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 06/09/2009] [Indexed: 01/07/2023]
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Hayano K, Miura F, Amano H, Toyota N, Wada K, Kato K, Takada T, Asano T. Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma. World J Radiol 2010; 2:374-6. [PMID: 21160700 PMCID: PMC2999336 DOI: 10.4329/wjr.v2.i9.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/20/2010] [Accepted: 06/27/2010] [Indexed: 02/06/2023] Open
Abstract
Significant hemobilia due to arterio-biliary fistula is a very rare complication of chemoradiation therapy (CRT) for unresectable intrahepatic cholangiocarcinoma (ICC). Here we report a case of arterio-biliary fistula after CRT for unresectable ICC demonstrated by angiographic examinations. This fistula was successfully treated by endovascular embolization. Hemobilia is a rare complication, but arterio-biliary fistula should be considered after CRT of ICC.
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Kakizawa H, Toyota N, Hieda M, Hirai N, Tachikake T, Matsuura N, Oda M, Ito K. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method. Hiroshima J Med Sci 2010; 59:43-50. [PMID: 21265263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.
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Affiliation(s)
- Hideaki Kakizawa
- Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima 734-8551, Japan.
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Amano H, Miura F, Toyota N, Wada K, Katoh KI, Hayano K, Kadowaki S, Shibuya M, Maeno S, Eguchi T, Takada T, Asano T. Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer. ACTA ACUST UNITED AC 2010; 16:777-80. [PMID: 19820892 DOI: 10.1007/s00534-009-0202-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE The resectability of locally advanced pancreatic cancer depends upon, before anything else, the relationship between the tumor and the adjacent arterial structure. Pancreatic cancer that has developed at the caudal side of the pancreas can invade the common hepatic artery (CHA). Pancreatic cancers with CHA involvement can become candidates for surgery in selected cases. Pancreatic cancer arising at the caudal side of the pancreas head may sometimes invade the right and left hepatic arteries (RLHA) as well as the CHA. Pancreatic cancer with RLHA involvement may be assessed as unresectable unless complex vascular reconstruction is performed. METHODS We have experienced 3 cases of successfully resected pancreatic cancer with RLHA and portal vein (PV) invasion. Pancreatectomy (including total pancreatectomy in two cases and pancreatoduodenectomy in one case) with RLHA and PV reconstruction was performed. Three different techniques of arterial reconstruction that were suitable for the individual cases were used. They were: (1) end-to-end anastomosis between the CHA and the left hepatic artery (LHA) and end-to-end anastomosis between the middle hepatic artery (MHA) and the right hepatic artery (RHA), (2) end-to-end anastomosis between the left gastric artery (LGA) and the RHA and end-to-end anastomosis between the right gastroepiploic artery and the LHA, and (3) end-to-side anastomosis between the splenic artery (SA) and the LHA and end-to-end anastomosis between the SA and the RHA. RESULTS The mean operating time was 735 min (range 686-800 min) and the mean blood loss was 1726 ml (range 1140-2230 ml). Microscopic curative resection (R0) was possible in all cases even if their International Union Against Cancer (UICC) stage was IIb. There was one case of wound infection, although no serious complications, including hepatic artery thrombosis, liver failure, or biliary fistula were observed. By follow-up three-dimensional computed tomography (3D-CT) angiography, the patency of the anastomosed artery was confirmed to be maintained in all three cases. CONCLUSIONS R0 operation with 3 different arterial reconstruction techniques was able to be performed without presenting any risk.
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Affiliation(s)
- Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga-cho, Itabashi-ku, Tokyo 173-8605, Japan.
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Amano H, Miura F, Toyota N, Wada K, Katoh KI, Hayano K, Kadowaki S, Shibuya M, Maeno S, Eguchi T, Takada T, Asano T. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? ACTA ACUST UNITED AC 2010; 16:850-7. [PMID: 19844653 DOI: 10.1007/s00534-009-0190-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/10/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE We often encounter unresectable pancreatic cancer due to invasions of the major vessels. Vascular resection for locally advanced pancreatic cancers has an advantage in en block local resection. There are potential cases in which good outcomes can be achieved by arterial resection. METHODS Pancreatectomy (including total pancreatectomy in 15 cases, pancreatoduodenectomy in 7 cases and distal pancreatectomy in one case) was performed in 23 cases of invasive ductal carcinoma of the pancreas, in combination with resection and reconstruction of the hepatic artery in 15 cases, the superior mesenteric artery in 12 cases (there are overlaps) and the portal vein in 20 cases. RESULTS The median operating time was 686 min (416-1,190 min) and the median blood loss was 2,830 ml (440-19,800 ml). This shows that the surgery was highly-invasive. The operative mortality rate was 4.3%. On the basis of the UICC classification, there were 2 cases of Stage IIa, 4 cases of Stage IIb, 9 cases of Stage III, 8 cases of Stage IV, while there were 18 cases (78.3%) of R0 resection. On the other hand, the final histological findings showed that there were 8 cases (34.8%) of M1 (liver and non-regional lymph node metastases), so it is thought that decisions on operative indications should be not be made slightly. As for the overall survival rate, the 1-year survival rate was 51.2% and the 3-year survival rate was 23.1% while the median survival time (MST) was 12 months. As for 15 cases of M0, the 1-year survival rate was 61.9% and the 4-year survival rate was 38.7% while the MST was 16 months. On the other hand, the MST was poor (10 months) in 8 cases of M1, showing that a statistically significant difference was observed depending upon the degree of metastasis (log-rank P = 0.0409). In 18 cases of R0, the 1-year survival rate was 67.2%, the 4-year survival rate 30.2% and the MST 13 months, respectively, while in 5 cases of R1 and R2, the MST was 6 months, showing that there was a statistically significant difference between R0 cases and R1, R2 cases (log-rank P = 0.0002). CONCLUSIONS Further discussion is required concerning surgical indications and significance. However, it is thought that resection is useful only when surgery of R0 has taken place for selected locally advanced pancreatic cancer (M0).
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Affiliation(s)
- Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga-cho, Itabashi-ku, Tokyo 173-8605, Japan.
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Waki K, Aikata H, Katamura Y, Kawaoka T, Takaki S, Hiramatsu A, Takahashi S, Toyota N, Ito K, Chayama K. Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up. J Gastroenterol Hepatol 2010; 25:597-604. [PMID: 20074153 DOI: 10.1111/j.1440-1746.2009.06125.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS We evaluated the prognosis and associated factors in patients with small hepatocellular carcinoma (HCC; up to 3 nodules, each up to 3 cm in diameter) treated with percutaneous radiofrequency ablation (RFA) as first-line treatment. METHODS Eighty-eight consecutive patients who underwent percutaneous RFA as first-line treatment were enrolled, among whom 70 who had hypervascular HCC nodules which were treated by a combination of transcatheter arterial chemoembolization and RFA. RFA was repeated until an ablative margin was obtained. RESULTS The rate of local tumor progression at 1 and 3 years was 4.8% and 4.8%, respectively. The rate of overall survival at 3 and 5 years was 83.0% and 70.0%, and the rate of disease-free survival at 3 and 5 years was 34.0% and 24.0%, respectively. On multivariate analysis, age (< 70 years; hazard ratio [HR] = 2.341, 95% confidence interval [CI] = 1.101-4.977, P = 0.027) and indocyanine green retention rate at 15 min (< 15%; HR = 3.621, 95% CI = 1.086-12.079, P = 0.036) were statistically significant determinants of overall survival, while tumor number (solitary, HR = 2.465, 95% CI = 1.170-5.191, P = 0.018) was identified for disease-free survival. Overall survival of patients with early recurrence after RFA was significantly worse than that of patients with late recurrence. Tumor size was the only independent risk factor of early recurrence after RFA of HCC (tumor size > 2 cm; risk ratio [RR] = 4.629, 95% CI = 1.241-17.241, P = 0.023). CONCLUSION Percutaneous RFA under the protocol reported here has the potential to provide local tumor control for small HCC. In addition to host factors, time interval from RFA to recurrence was an important determinant of prognosis.
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Affiliation(s)
- Koji Waki
- Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Miura F, Amano H, Toyota N, Wada K, Kato K, Hayano K, Takada T, Takami H, Asano T, Ohira G, Matsubara H. A New Prognostic Factor for Long-Term Survival of Patients with Advanced Gallbladder Carcinoma. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaneyasu Y, Nagai N, Nagata Y, Hashimoto Y, Yuki S, Murakami Y, Kenjo M, Kakizawa H, Toyota N, Fujiwara H, Kudo Y, Ito K. Intra-arterial infusion chemotherapy using cisplatin with radiotherapy for Stage III squamous cell carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2009; 75:369-77. [PMID: 19735865 DOI: 10.1016/j.ijrobp.2009.02.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the effectiveness of concomitant intra-arterial infusion chemotherapy (IAIC) using cisplatin (CDDP) with radiotherapy for Stage III squamous cell carcinoma of the cervix. MATERIALS AND METHODS We analyzed 29 cases of Stage III squamous cell carcinoma of the uterine cervix treated with radiotherapy and IAIC of CDDP from 1991 to 2006. External-beam therapy was given to the whole pelvis using four opposing parallel fields with an 18-MV linear accelerator unit. A central shield was used after 30-40 Gy with external whole-pelvic irradiation, and the total dose was 50 Gy. High-dose-rate brachytherapy was given with (192)Ir microSelectron. The dose at Point A was 6 Gy per fraction, 2 fractions per week, and the total number of fractions was either 3 or 4. Two or three courses of IAIC were given concomitantly with CDDP 120 mg or carboplatin 300 mg. RESULTS We confirmed excellent medicine distribution directly by using computed tomographic angiography. The 5-year overall survival rate for Stage III patients was 62%, the cause-specific survival rate was 70%, and the local relapse-free survival rate was 89%. Local recurrence, distant metastasis, and occurrences of both were 7%, 38%, and 3%, respectively. The incidence of severe acute hematologic adverse reactions (Grade > or =3) was 27% for all patients; however, all recovered without interruption of radiotherapy. Severe nonhematologic effects (Grade > or =3) were 3%, including nausea and ileus. Only 1 patient's radiotherapy was interrupted for a period of 1 week because of ileus. Severe late complication rates (Grade > or =3) for the bladder, rectum, and intestine were 3%, 3%, and 10%, respectively. CONCLUSION A combination of IAIC and systemic chemotherapy should be considered to improve the prognosis of patients with Stage III squamous cell carcinoma of the cervix.
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Affiliation(s)
- Yuko Kaneyasu
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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Katamura Y, Aikata H, Takaki S, Azakami T, Kawaoka T, Waki K, Hiramatsu A, Kawakami Y, Takahashi S, Kenjo M, Toyota N, Ito K, Chayama K. Intra-arterial 5-fluorouracil/interferon combination therapy for advanced hepatocellular carcinoma with or without three-dimensional conformal radiotherapy for portal vein tumor thrombosis. J Gastroenterol 2009; 44:492-502. [PMID: 19330281 DOI: 10.1007/s00535-009-0033-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 01/02/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to elucidate the efficacy of intra-arterial 5-fluorouracil (5-FU) and interferon (IFN) alpha combined with three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombosis (PVTT). METHODS The study groups were 16 HCC patients with PVTT treated with 5-FU/IFN combined with 3D-CRT (RT group) and 16 matched controls treated with 5-FU/IFN alone (non-RT group). We compared the survival rate, response, time to progression (TTP), portal hypertension-related events (PREs) and safety. RESULT Complete response (CR) of PVTT, partial response (PR), stable disease (SD) and progressive disease (PR) were noted in three (19%), nine (56%), four (25%) and zero patients of the RT group, one (6%), three (19%), seven (44%) and five (31%) patients of the non-RT group, respectively. The objective response rate of PVTT was higher in the RT group (P = 0.012). The rate of PREs (variceal rupture, worsening of esophagogastric varices and emerging of uncontrollable ascites) was lower in the RT group than in the non-RT group (P = 0.0195). The median survival time of the RT group (7.5 months) was not significantly different from that of the non-RT group (7.9 months). RT-induced liver disease was not observed. CONCLUSION 5-FU/IFN combination with 3D-CRT for PVTT improved the response rate of PVTT and reduced the incidence of portal hypertension-related events.
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Affiliation(s)
- Yoshio Katamura
- Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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