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The pathophysiology of adhesion formation needs to be clarified to reduce the adhesion-related morbidity. The epithelial characteristics of the peritoneum suggest a protective role against adhesion formation, yet how the peritoneum is involved in adhesion formation is not well characterized. We microscopically observed an experimental model of adhesion formation to investigate the effects of an injured tissue on the opposite intact peritoneum. Adhesions were induced between injured and intact hepatic lobes, and the intact peritoneum opposite to the injured tissue was examined for 8 days. The opposite intact peritoneum was denuded of mesothelial cells for 6hours, and the remnant mesothelial cells changed morphologically for 24hours. The detachment of mesothelial cells allowed fibrin to attach to the basement membrane of the opposite peritoneum, connecting the two lobes. Moreover, macrophages and myofibroblasts accumulated between the two lobes, and angiogenesis occurred from the opposite intact lobe to the injured lobe. These observations indicate that an injured tissue deprives the opposite intact peritoneum of its epithelial structure and causes fibrous adhesions to the opposite intact tissue. This study implies a possible role of mesothelial cells for barrier function against adhesion formation, that is, keeping mesothelial cells intact might lead to its prophylaxis.

DOI： 10.1038/srep07668

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Introduction: Protein induced by vitamin K absence/antagonist-II (PIVKA-II) is an abnormal protein, and several reports have demonstrated the efficacy of PIVKA-II in the diagnosis of hepatocellular carcinoma (HCC). We report an extremely rare case of adenocarcinoma of the colon with a high serum PIVKA-II level. Presentation of Case: A 95-year-old woman presented with right lower quadrant pain and appetite loss. An abdominal computed tomography scan and ultrasonography showed an ascending colon tumor and multiple metastatic tumors in the liver. The serum level of PIVKA-II was extremely high, 11,900 ng/mL. Colonoscopic examination revealed a tumor accompanied by an ulcer in the ascending colon, which was highly suspicious for malignancy. Multiple biopsies showed well-differentiated adenocarcinoma of the colon, which was evaluated as colon cancer, stage IV. PIVKA-II-productive colon cancer was confirmed. Chemotherapy with TS-1 was administered. The patient died 3 months after initial admission. Discussion: The expression of PIVKA-II was detected in non-cancer areas, with non-specific expression observed in plasma cells in our case. There might be some possibility that hepatoid differentiation exists in other regions of the colon tumor or in the liver tumor, parenchymal cells or lung metastases, which were composed of PIVKA-II-positive and AFP-negative cells. Conclusion: To the best of our knowledge, high serum levels of PIVKA-II resulting from colon adenocarcinoma have not been reported previously. We report this rare case together with a review of the literature. © 2014 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.

DOI： 10.1016/j.ijscr.2014.11.072

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Introduction Rhabdomyolysis associated with the use of pravastatin has been demonstrated to be a rare but potentially life-threatening adverse effect of statins. Here, we report a rare case of rhabdomyolysis and purpura fulminans in a patient who had used pravastatin and developed chronic renal failure (CRF) necessitating the initiation of dialysis. Presentation of case We present the case of an 86-year-old man with chronic kidney disease (CKD) treated with dialysis who was admitted with back pain. He was prescribed and took pravastatin for almost 3 years to treat hyperlipidemia. He received hemodialysis therapy 7 times prior to presentation. Laboratory values included a serum creatine concentration of 6.6 mg/dl and a creatinine phosphokinase (CPK) concentration of 2350 IU/L. An abdominal computed tomography scan showed swollen muscles with reduced muscle density and air density in the multifidus muscle. Two days after admission, he had large, tender ecchymotic lesions and purpuric progressive skin necrosis over the back, abdomen, and upper and lower extremities. The patient died 6 days after the initial admission due to disseminated intravascular coagulation (DIC). Based on these findings and the clinical history, a diagnosis of pravastatin-induced rhabdomyolysis and purpura fulminans was made. Discussion The long-term use of statin therapy and the initiation of dialysis therapy due to ESRD, followed by a rapid onset of rhabdomyolysis within 6 days, is indicative of an elevated statin concentration. Conclusion We report an extremely rare case of pravastatin-induced rhabdomyolysis and purpura fulminans with DIC in a patient with CRF. © 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.

DOI： 10.1016/j.ijscr.2015.01.042

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Background Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. Methods In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. Results A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. Conclusion CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement. © 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjsurg.2014.10.029

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Introduction Multiorgan procurement is not an easy procedure and requires special technique and training. Since sufficient donors are not available for on-site training in Japan, establishment of the educational program for multiorgan procurement is mandatory. Materials and methods Development of e-learning and simulation using pigs are our main goals. E-learning contains three dimensional computer graphic (3DCG) animations of the multiorgan procurement, explanation of both donor criteria and procurement procedure, and self-assessment examination. To clarify the donor criteria, the risk factors to 3-month survival of the recipients were analyzed in 138 adult cases of liver transplantation. The 3DCG animation for liver procurement was developed, which was used in the lecture prior to the simulation on August 10, 2013. The results of the examination after this lecture (exam 2013) were compared with the results after the lecture without using animation in 2012 (exam 2012). The simulation was performed by 97 trainees divided into 9 teams, and the surveys were conducted. Results The risk factors for early outcome of the recipients were cold ischemia time (≥10 hours), Model for End-stage Liver Disease score (≥20), and donor age (≥55 years). Results of examination showed that overall percentage of the correct answers was significantly higher in exam 2013 than in exam 2012 (48.3% vs 32.7%; P =.0001). The survey after the simulation of multiorgan procurement revealed that most trainees thought that the simulation was useful and should be continued. Conclusion The novel educational program could allow young surgeons to make precise assessments and perform the exact procedure in the multiorgan procurement. © 2014 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2014.02.002

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Because of the critical shortage of deceased donor grafts, using a donation after cardiac death (DCD) donor is an important resource. However, the ischemic damage of those DCD grafts jeopardizes organ viability during cold storage. Maintaining organ viability after donation until transplantation is important for optimal graft function and survival. This review describes the effective preservation in transplantation for DCD livers. Concepts and development of machine perfusion for DCD liver grafts to reduce ischemia/reperfusion injury are discussed. Despite the fact that hypothermic machine perfusion might be superior to static cold preservation, DCD livers are exposed to hypothermia-induced damage. Recently, some groups introduced the beneficial effects of normothermic or subnormothermic machine perfusion in DCD liver preservation and transplantation. © 2014 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2013.11.135

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The prognosis of intestinal failure has improved dramatically in the past few decades with the development of parenteral nutrition (PN). However, PN-dependent patients still have numerous complications. Intestinal transplantation can significantly improve their prognosis and quality of life. We report on the impact of intestinal transplantation for intestinal failure in Japan. Methods. Intestinal transplantations have been performed in Japan since 1996. Standardized forms were sent to all known intestinal transplantation programs, asking for information on intestinal transplantations performed between 1996 and June 31, 2012. All programs responded. Patient and graft survival estimates were obtained using the Kaplan-Meier method and analyzed with the Wilcoxon statistic. Results. Five institutions provided data on 24 grafts in 21 patients. There were 12 cadaveric and 12 living related donor transplants. Causes of intestinal failure included short gut syndrome (n = 9), intestinal motility function disorders (n = 11), retransplantation (n = 3), and other (n = 1). The overall 1- and 5-year patient survival rates were 86% and 68%, respectively. In cases (n = 15) after 2006, the 1-year patient survival rate was 92%, and the 5-year survival rate was 83%. One- and five-year graft survival rates were 87% and 78%, respectively. More than 80% of all current survivors discontinued PN. Conclusions. Intestinal transplantation has become an effective therapy for patients with intestinal failure who cannot tolerate PN. After 2006, patient and graft survival rates approached rates associated with standard treatment for end-stage intestinal failure. Further improvements are expected with early referral due to suitable donor organ and pretransplant management. © 2014 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2014.06.037

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AIM: To evaluate the clinical utility of hepatic clearance (HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) to estimate the degree of liver fibrosis.

DOI： 10.3748/wjg.v20.i44.16714

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AIM: To present our experiences in studying the clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs). METHODS: The subjects included 9 patients with NFpNETs who underwent pancreatectomy between April 1996 and September 2012. The surgical procedure, histopathological findings, and prognosis were assessed. RESULTS: All tumors were incidentally detected by computed tomography. The median diameter was 10 mm (5-32 mm). One patient was diagnosed with von Hippel-Lindau disease, and the others were sporadic cases. For the histopathological findings, 7 patients were G1; 1 patient was G2; and 1 patient, whose tumor was 22 mm, had neuroendocrine carcinoma (NEC). One patient who had a tumor that was 32 mm had direct invasion to a regional lymph node and 1 patient with NEC, had regional lymph node metastases. Six of the 7 patients with sporadic NF-pNETs, excluding the patient with NEC, had tumors that were smaller than 10 mm. Tumors smaller than 10 mm showed no malignancy and lacked lymph node metastasis. CONCLUSION: Sporadic NF-pNETs smaller than 10 mm tend to have less malignant potential. These findings suggest that lymphadenectomy may be omitted for small NF-pNETs after further investigation. © 2014 Baishideng Publishing Group Inc. All rights reserved.

DOI： 10.3748/wjg.v20.i47.17949

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The symptoms of gallbladder cancer (GBC) are vague and non-specific. Therefore, GBC is often detected at an advanced or metastatic stage. The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis. Therefore, numerous GBC patients undergo chemotherapy. This study reports the case of a 60-year-old female with GBC who underwent successful surgical curative resection following a single dose of the chemotherapeutic agent, S-1, twice daily for 4 weeks followed by a 14-day rest period for 36 months. S-1 is a novel orally administered drug composed of a combination of the 5-fluorouracil (5-FU) prodrug, tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and oteracil potassium in a 1:0.4:1 molar concentration ratio. The focus of the present study was the candidate factors that affect the therapeutic efficacy of S-1-based chemotherapy. In particular, the gene expression involved in the S-1 metabolic pathway was investigated by assessing the intratumoral dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase gene expression. The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer. Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor. © 2014, Spandidos Publications. All rights reserved.

DOI： 10.3892/ol.2014.2565

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Background and Purpose. The objective of this study was to determine the success rate and complications of using the percutaneous approach of the external jugular vein (EJV) for placement of a totally implantable venous-access port (TIVAP) with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V). Methods. A prospective cohort study of 45 patients in whom placement of a TIVAP was attempted via the right EJV was conducted. The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using a Multidetector Helical 16-section CT. The angulation between the right EJV and the right subclavian vein, anterior jugular vein, transverse cervical vein, and suprascapular vein was estimated. Results. CT-V success was achieved in 45 of 45 patients (100 %). A plexus of veins under the clavicle was most commonly responsible for the insertion of the central venous catheter. The EJV approach resulted in a successful cannulation rate of 93 %. No initial complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Late complications occurred in three patients. These included one port erosion (2 %), one catheter occlusion (2 %), and one wound hematoma (2 %). Catheter-related infections were observed in one patient (2 %). Conclusions. The percutaneous EJV approach with CT-V guidance is an optional method for patients with multiple central venous cannulations, those in hemodialysis, or those with long catheter indwelling periods. © 2013 Society of Surgical Oncology.

DOI： 10.1245/s10434-013-3405-8

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A 61-year-old female with pancreatic body cancer underwent a distal pancreatectomy. The tumor was a moderately- to poorly-differentiated adenocarcinoma. Tumor growth filled the dilated main pancreatic duct (MPD) and infiltrated the surrounding area. Six months later, metastases to the left diaphragm and MPD of the remnant pancreatic head were detected. Chemoradiotherapy was administered, but the patient succumbed 22 months after surgery. An autopsy demonstrated that a moderately- to poorly-differentiated adenocarcinoma had arisen from the pancreatic head and infiltrated the duodenum and bile duct. Huge liver metastases and multiple peritoneal disseminations were also present. Microscopically, a portion of the tumor had a pseudo-rosette appearance in the adenocarcinoma component, while another section showed characteristics of a neuroendocrine tumor (NET) immunohistochemically. The original surgically-resected tumor also showed NET characteristics immunohistochemically. It is therefore necessary to search for NET components in pancreatic cancer with atypical growth and metastases, even when adenocarcinoma has been diagnosed histologically.

DOI： 10.3892/ol.2014.1873

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Alcoholic liver cirrhosis (ALC) is an established indication for liver transplantation (LT). Most LT procedures in Japan are living donor liver transplantation (LDLT) because of an extreme shortage of deceased donors. Social circumstances enabling LDLT could be favorable for preventing relapse. The aims of this retrospective study were to analyze the outcomes of LDLT for ALC and to evaluate risk factors for relapse in this cohort. One hundred ninety-five subjects underwent LT [LDLT (n = 187), deceased donor LT (n = 5), or domino LT (n = 3)] for ALC in Japan from November 1997 to December 2011. Risk factors for alcohol relapse and the impact of relapse on outcomes were analyzed for 140 patients after the exclusion of 26 patients who died in the hospital and 29 patients without information about alcohol relapse. The incidence of alcohol consumption after LT was 22.9%. The risk factors for patient survival were a donor age ≥ 50 years (P < 0.01) and a Model for End-Stage Liver Disease score ≥ 19 (P = 0.03). The 10-year patient survival rates were 21.9% and 73.8% for patients who had relapsed and patients who had not relapsed 18 months after LT, respectively (P = 0.01). The relapse rates were 50.0%, 34.5%, 13.3%, 19.7%, and 14.3% for patients who had received livers from parents, siblings, spouses, sons/daughters, and deceased or domino donors, respectively. A history of treatment for psychological diseases other than alcoholism before LT was a significant indicator for the risk of recidivism (P = 0.02), and noncompliance with clinic visits after LT and smoking after transplantation were promising indicators for the risk of recidivism (P = 0.06, and P = 0.05, respectively). Preoperative alcohol consumption was not a risk factor. In conclusion, rather than selecting patients on the basis of preoperative alcohol use, we should provide sociomedical support to improve adherence after LT for ALC in Japan. © 2013 AASLD.

DOI： 10.1002/lt.23797

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Background: The present study aimed to evaluate etiology-based differences in the risk of waiting list mortality, and to compare the current Japanese transplant allocation system with the Child-Turcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scoring systems with regard to the risk of waiting list mortality in patients with primary biliary cirrhosis (PBC). Methods: Using data derived from all adult candidates for deceased donor liver transplantation in Japan from 1997 to 2011, we assessed factors associated with waiting list mortality by the Cox proportional hazards model. The waiting list mortality risk of PBC patients was further estimated with adjustment for each scoring system. Results: Of the 1056 patients meeting the inclusion criteria, 743 were not on the list at the end of study period; waiting list mortality was 58.1 % in this group. In multivariate analysis, increasing age and PBC were significantly associated with an increased risk of waiting list mortality. In comparison with patients with hepatitis C virus (HCV) infection, PBC patients were at 79 % increased risk and had a shorter median survival time by approximately 8 months. The relative hazard of PBC patients was statistically significant with adjustment for CTP score and medical point score, which was the priority for ranking candidates in the Japanese allocation system. However, it lost significance with adjustment for MELD score. Stratification by MELD score indicated a comparable waiting list survival time between patients with PBC and HCV. Conclusions: PBC patients are at high risk of waiting list mortality in the current allocation system. MELD-based allocation could reduce this risk. © 2013 Springer Japan.

DOI： 10.1007/s00535-013-0782-5

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Intraperitoneal (i.p.) chemotherapy with paclitaxel (PTX) has been shown to be a promising treatment strategy for peritoneal metastasis. The present study focused on the comparative evaluation of the therapeutic efficacy of nanoparticle albumin-bound PTX (Nab-PTX) and i.p. administration of the conventional solvent-based PTX (Sb-PTX). We also investigated the difference in antitumor activity depending on the route of administration in the Nab-PTX treatment. Nab-PTX was administered i.p. or intravenously (i.v.) and Sb-PTX was administered i.p. at equitoxic and equal doses to nude mice bearing gastric cancer OCUM-2MD3 cell subcutaneous and peritoneal xenografts. Therapeutic efficacy of Sb-PTX and Nab-PTX was evaluated as inhibition of tumor growth using a peritoneal metastatic model with subcutaneous xenografts. The survival rate was also investigated using mouse peritoneal models. For assessment of subcutaneous tumors, the change in tumor volume was measured, and for assessment of peritoneal tumors, the weight of ascitic fluid and the total peritoneal tumor burden were measured for each individual mouse. At equitoxic doses, treatment with Nab-PTX resulted in a greater reduction in the size of subcutaneous tumors and the weight of ascites and peritoneal burden as compared with i.p. Sb-PTX (P<0.05). Treatment with i.p. and i.v. Nab-PTX also achieved greater survival benefit than i.p. Sb-PTX (P<0.05). In contrast, there was no significant difference in the degree of tumor reduction and the survival time between both drugs at equal doses. With regard to the route of administration, the antitumor efficacy of Nab-PTX after i.v. administration was equivalent to the efficacy after i.p. administration. These results suggest that i.v. Nab-PTX may be another encouraging treatment option that can target peritoneal dissemination in gastric cancer.

DOI： 10.3892/or.2014.3210

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Objective: To determine the success rate and complications of using the external jugular vein (EJV) for central venous access with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V). Design: Prospective, observational human study. Setting: Surgical intensive care unit. Patients: Fifty-two patients who were undergoing EJV cannulations with CT-V using a Multidetector Helical 16-section CT (MDCT). Intervention: The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using an MDCT. In particular, the angulation between the EJV and the right subclavian vein (SCV) was measured. The anatomical abnormalities and the angulation between the EJV and the anterior jugular vein (AJV), transverse cervical vein (TCV), and suprascapular vein (SSV) were estimated. Measurements and Main Results: The success of CT-V was achieved in 52 of 52 patients (100%). The mean angulation between the right EJV and the right SCV was 144 ± 36 degrees in the obtuse-angle cases (88%) and 72 ± 28 degrees in the sharp-angle cases (12%). A plexus of veins under the clavicle was most commonly responsible for insertion of the central venous catheter (CVC). The EJV approach resulted in a 93% rate of successful cannulations. No complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Conclusions: The EJV route is associated with comparable technical success and lower major procedural complication. The EJV approach with CT-V guidance is an option as the initial method when central venous cannulation must be performed under suboptimal conditions. © 2014 Informa Healthcare USA, Inc.

DOI： 10.3109/08941939.2013.865818

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Objective: Cholangiocarcinoma is a refractory cancer whose incidence has been increasing worldwide in recent years. Neoangiogenesis plays an important role in the growth of various solid cancers, including cholangiocarcinoma. Vascular endothelial growth factor plays an important role in tumor-induced angiogenesis and its expression is associated with the progression and prognosis of cholangiocarcinoma. This study examined whether axitinib (AG-013736, INLYTA®), a potent and selective second-generation inhibitor of vascular endothelial growth factor receptors 1, 2 and 3, could be a potentially useful therapeutic agent for cholangiocarcinoma. Methods: We performed expression profiling of angiogenesis-related molecules in eight cholangiocarcinoma cell lines and found that three of them showed high vascular endothelial growth factor expression. Among them, we examined the in vivo anti-tumor effect of axitinib on NCC-BD1 (a gemcitabine-sensitive extra-hepatic cholangiocarcinoma cell line) and TKKK (a gemcitabine-resistant intra-hepatic cholangiocarcinoma cell line) using subcutaneous xenograft models. Results: Oral administration of axitinib significantly inhibited the growth of TKKK xenografts at a dose of 6 mg kg-1 day-1 (P,0.05), and the growth of NCC-BD1 xenografts at 30 mg kg-1 day-1 (P,0.05). Treated tumors showed a significant decrease of microvessel density and the tumor cell proliferation index and a mild but significant increase of the apoptotic index in comparison with untreated tumors. Conclusions: Our results suggest that axitinib should be a promising therapy for vascular endothelial growth factor-expressing cholangiocarcinoma, irrespective of tumor origin and gemcitabine sensitivity. © The Author 2014. Published by Oxford University Press. All rights reserved.

DOI： 10.1093/jjco/hyu045

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The purpose of this study was to describe the cyst infection of intraductal papillary mucinous neoplasm in 2 patients. The patients were 62- and 74-year-old men. The initial symptom was acute febrile abdominal pain. Laboratory tests revealed severe infection (C-reactive protein concentrations were 23.3 μg/mL in patient 1 and 22.3 μg/mL in patient 2) and multilocular cystic masses (the diameters were 70 mm in patient 1 and 50 mm in patient 2) at the pancreatic head that involved peripancreatic vessels were demonstrated by computed tomography. Laboratory and radiographic findings were markedly improved by endoscopic transpapillary drainage. The enteric bacteria were detected in the drainage specimens. Curative resection was achieved, and histological findings indicated a carcinoma in situ in patient 1 and an invasive carcinoma in patient 2. Neither hyperamylasemia nor histological fat necrosis, frequently observed in acute pancreatitis, was evident. Both patients were free from recurrence after surgery (17 months in patient 1, and 18 months in patient 2). Cyst infection is an unknown complication of intraductal papillary mucinous neoplasm. Transpapillary drainage is highly recommended as an initial intervention. It is difficult to distinguish between cyst infection and unresectable invasive carcinoma with imaging modalities; however, surgical intervention after drainage may contribute to long-term survival. © 2014 by Lippincott Williams & Wilkins.

DOI： 10.1097/MPA.0000000000000036

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

当科で行っている腹腔鏡補助下胃切除術(LAG)における簡便な肝圧排法を紹介する。5本のポートを挿入し、気腹下に胃前庭部小彎側と肝左葉外側区下縁を確認。その直上に4.5cmの正中切開をおき、Alexis Wound Retractorを装着。手術用手袋で気密性を保ち、手袋の手掌部分からオクトパス扁平鉤を腹腔内に挿入し、肝外側区域を適切な位置に圧排して視野を確保する。この視野で鏡視下にリンパ節郭清を行った後、正中創から標本摘出と再建を行う。本法において手袋は気腹圧によって鉤に被ったまま密着するため、手袋の指部分を切り柄を通して固定することは不要である。そのため気腹を中断することなく短時間で容易に肝を圧排できる。また扁平鉤で面により肝を圧排するため愛護的で、術後のトランスアミナーゼ値の上昇も軽微であった。小開腹創からの再建を伴うLAGにおいて簡便で有用な方法であると考えられる。(著者抄録)

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

症例は72歳の女性で,多数のリンパ節腫大を伴う4cm大の膵頭部腫瘍に対し幽門輪温存膵頭十二指腸切除を施行した.病理組織学的検査所見ではリンパ節転移陽性の多形細胞型膵退形成癌と診断されたが,術後4年経過後も無再発生存中である.膵退形成癌は予後不良とされているが,長期生存例も報告されている.その特徴は不明であるが,過去の報告からは免疫応答の関与が長期生存に寄与する可能性が示唆されている.本例も間質に好中球とCD8陽性リンパ球の顕著な浸潤を認め,同様の機序が推察された.治療は切除が第一選択で,報告された長期生存例も全て切除例である.本例は多数の腫大リンパ節を認めたものの,画像所見から通常型膵管癌以外の特殊な組織型を想定して切除し長期生存が得られている貴重な症例である.本疾患の治療戦略を明らかにするためには,欧米と分類を統一して複雑な用語を整理し,多数例での解析を行うことが重要であると考えられた.(著者抄録)

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

症例は61歳の女性で15年前にWegener肉芽腫症と診断された.治療により寛解したが,60歳時,Wegener肉芽腫症に関連した頸椎の脊髄症を発症した.ステロイドパルス療法,シクロホスファミドの投与を受け一時改善したが,再燃したため入院した.入院50病日に強い腹痛を発症し,消化管穿孔を疑い開腹したところ横行結腸に穿孔を認めた.結腸を部分切除し人工肛門を造設した.術後14日目に再度消化管穿孔を発症し開腹した.人工肛門口側の結腸に穿孔を認めたため,右側結腸を切除,回腸人工肛門を造設した.穿孔部位の病理所見はいずれも血栓を伴う非特異的な虚血性潰瘍であった.Wegener肉芽腫症に関連した消化管病変はまれであり,病理組織学的検査で特徴的な血管炎が証明されないことも多いが,文献的考察によると消化管病変は血管炎が原因であり,治療中は消化管病変の合併も念頭に置き治療経過を観察するべきである.(著者抄録)

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

症例は49歳、女性。上腹部不快感、腹満を主訴に当科を受診し、上行-横行結腸癌、大動脈周囲リンパ節～総腸骨リンパ節転移の診断がなされた。肝・肺転移なし。狭窄症状を認めたため、2007年10月下旬に拡大右半結腸切除術を施行。術後約1ヵ月後に全身化学療法の一次治療としてベバシズマブ(bevacizumab:BV 5mg/kg)+mFOLFOX6を開始。腫瘍マーカーは減少、遠隔リンパ節転移も縮小しPRを得た。2009年7月に右肺門部リンパ節転移が出現しPDとなり、cetuximab+FOLFIRIに変更するも、3ヵ月後に両側鼠径リンパ節転移出現を認めBV(10mg/kg)+FOLFIRIに変更。2ヵ月半後に腹部リンパ節はわずかに縮小したが、鼠径リンパ節が増大したためBVを10mg/kgに増量したBV+mFOLFOX6に変更した。その2ヵ月後に皮膚転移が出現するも、鼠径リンパ節、腹部リンパ節には変化を認めなかった。その後、癌性腹膜炎などを生じ死亡したが、30ヵ月を超える生存期間が得られた。一次治療でPDとなったBV+FOLFOX療法でも、二次治療以降でBVを増量し再投与することで、長期生存が得られる可能性が示唆された。(著者抄録)

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

症例は62歳,男性.黄疸を主訴に前医を受診し,CTで肝門部に造影効果を伴う2cm大の腫瘍を認めた.生検で腺癌と診断され,乳頭膨張型肝門部胆管癌の診断で肝右葉,尾状葉,肝外胆管切除を施行した.病理検査では胆管腔内の腫瘍は乳頭腺癌であったが,これと連続して肝実質に浸潤する扁平上皮癌を認めた.腺癌と扁平上皮癌には組織的な移行部分を認め,腺扁平上皮癌と診断した.術後3ヵ月で局所再発を認め,8ヵ月で原病死した.肝外胆管原発の腺扁平上皮癌は稀で,わが国では39例が報告されている.臨床的に腺癌と異なる特徴的な所見はなく,生検による正診率も低いが,CTで早期から造影効果を認める場合には本疾患を疑う必要がある.(著者抄録)

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

症例は18歳,男性。2日前より続く発熱と下腹部痛にて当院へ救急搬送された。腹部は板状硬で,腹部造影CT検査にてfree airおよび小腸より連続する盲端部分を認め,Meckel憩室穿孔による急性汎発性腹膜炎の診断で,緊急手術を施行した。手術は腹腔鏡補助下で施行し,膿性腹水およびMeckel憩室の穿孔を認め,楔状切除および洗浄ドレナージを行った。病理組織学的検査所見では憩室先端付近で穿孔を認め,高度な炎症細胞浸潤と壊死を伴っていた。異所性粘膜の存在は認められなかった。近年の画像診断の進歩により,術前にMeckle憩室の診断が可能であった症例が増加してきている。急性腹症の診断の際,Meckel憩室も鑑別にあげた腹部CTの慎重な読影が重要であると考えられた。(著者抄録)

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

83歳女。脾静脈非再建の上腸間膜静脈・脾静脈合流部切除を併施した幽門輪温存膵頭十二指腸切除術後、補助化学療法を施行中であったが下血を繰り返すようになった。上部消化管内視鏡で膵空腸吻合部に静脈瘤を認め、出血源と考えられた。CTでは脾静脈から下腸間膜静脈、横行結腸辺縁静脈、回結腸静脈に連続する側副血行路を認め、横行結腸付近で一部欠損していた。膵腸吻合部にも側副血行路の形成を認めた。膵腸腸吻合部静脈瘤に対し部分的脾動脈塞栓術を施行したが、その後も出血を認めたため、遠位脾腎静脈吻合術を施行し、脾静脈を3cmほど膵背面から遊離し、左腎静脈と端側吻合した。術後1週のCTでは横行結腸間膜内と膵腸吻合部の側副血行路が消失しており、脾腎静脈吻合部の開存性は良好であった。脾静脈瘤術後1年3ヵ月の現在、消化管出血は認めていない。

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

患者は24歳,女性.イレウスとの診断にて紹介され,入院となった.3年前に交通事故による腹部打撲,腹腔内出血に対して保存的治療を受けた既往があるが,開腹手術の既往はなかった.イレウス管による治療で症状は軽快せず,造影にて回腸の狭窄,途絶を認めたため手術を施行した.術中に回腸間膜裂孔への内ヘルニアを認め,腹腔鏡補助下にこれを解除し,裂孔を縫合閉鎖した.腹部鈍的外傷後に遅発性に発症するイレウスは,開腹歴のないイレウスの鑑別診断として念頭に置くべきである.症状が急速に悪化して腸管の壊死をきたす症例が報告されていることから,本疾患の臨床・画像的特徴を熟知し,手術の時期を適正に判断することが重要だと考えられた.(著者抄録)

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

症例は34歳,女性.腹痛で当科を紹介受診し絞扼性イレウスの診断で同日緊急手術を施行した.空腸間膜に8cm大の黄白色の柔らかい多房性腫瘤を認め,これを中心に空腸が捻転していた.腫瘤を含めて約30cmの空腸を切除した.嚢胞内溶液は漿液性で,病理検査にてリンパ管腫と診断した.腸間膜嚢腫は比較的まれな疾患で,病理学的にはリンパ管腫が最多である.腸管軸捻を併発した腸間膜リンパ管腫症例は,自験例を加えて過去に本邦で7例報告されている.治療には完全切除が必要だが,急性腹症で発症した場合には,緊急手術となることが多く,併存する炎症や不良な全身状態のため,病変の完全切除に悪影響を及ぼした症例も報告されている.腸管軸捻を契機として治療を受けた症例の多くにも腹痛などの先行症状を認めていることから,本疾患を認知し,的確な術前診断の元,急性腹症を発症する前に切除することが必要であると考えられた.(著者抄録)

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

症例は75歳,男性.タール便を主訴に診断された十二指腸第2部から3部にかけての全周性十二指腸側方発育型腺腫を約6年間経過観察ののち切除した.半年に1回の内視鏡,低緊張性十二指腸造影を行い,最終的に生検で癌が検出され膵頭十二指腸切除(PD)を行ったが,切除時点ではリンパ節転移を伴う進行癌であった.十二指腸腺腫は前癌病変と考えられ切除が推奨される.本例は病変の大部分が腺腫であり,癌の局在はごく一部に限られていたため,生検での癌の検出が困難であった.さらに画像的にも大きな変化がなく経過したため経過中早期の癌の診断が困難であった.癌の確定診断がない状態で侵襲の大きいPDを受けることに患者が同意できなかったことが長期の経過観察となった要因と考えられた.本例は十二指腸腺腫の自然史と,長期にわたる経過観察の危険性を示す症例であると考えられた.(著者抄録)

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

Intestinal motility disorders are a major cause of intestinal failure. Severe cases such as idiopathic pseudo-obstruction represent life-threatening illnessed. Intestinal transplantation is a treatment for severe motility disorders with irreversible intestinal failure. However, the prevalence of severe motility disorders is unknown. We performed a national survey to identify patients with intestinal motility disorders who require an intestinal transplant. The national survey of 302 institutions treating intestinal motility disorders identified 147 patients treated from 2006 to 2011 at 46 institutions. The mean patient age was 12.1 years (range, 0.3-77.5). The mean age of onset was 3.0 years (range, 0.0-68.8). Diagnoses included chronic idiopathic intestinal pseudo-obstruction (n = 96), Hirschsprung disease (n = 29), megacystis microcolon intestinal hypoperistalsis syndrome (n = 18), and other (n = 6). There were 126 survivors and 21 patients who died during the last 5 years. The mortality rate was 14.3%. Eighty-five percent of patients required parenteral nutrition for more than 6 months, which was defined as irreversible intestinal failure. Among surviving patients with irreversible intestinal failure, 8 (9.4 %) developed hepatic failure with jaundice and 27 (31.8%) 2 or more central vein thromboses. In all, at least 35 patients (41%) with irreversible failure due to intestinal motility disorders may be candidates for transplantation. The prevalence of severe intestinal motility disorders was elucidated in Japan. Severe cases should be referred to transplant centers. Copyright © 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2013.01.092

Scopus

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

Background: Triglyceride-rich, low-density lipoproteins (TG-rich LDL) have been reported as an oxidized lipoprotein species in patients with severe liver disease. Using TG-rich LDL as an immunogen, we obtained a monoclonal antibody (G11-6) that reacted with TG-rich LDL from patients with liver disease and with metal-oxidized LDL only in the early process of the oxidation reaction. This study determined the G11-6-reactive lipoproteins in hypertriglyceridemic serum. Methods: Serum samples from healthy volunteers (n = 12) and hypertriglyceridemic patients (n = 9) were fractionated by gel filtration and subjected to a sandwich enzyme-linked immunosorbent assay (ELISA) using G11-6 and polyclonal anti-apolipoprotein B antibodies. Results: Small LDL and larger lipoproteins reacted with G11-6. G11-6-reactive small LDL was identified in both the healthy subjects and hypertriglyceridemic patients, whereas G11-6-reactive larger lipoproteins were found only in the hypertriglyceridemic patients. Conclusions: G11-6 is a useful tool for detecting increased large oxidized lipoproteins in hypertriglyceridemic patients © The Author(s) 2013.

DOI： 10.1177/0004563212473446

Scopus

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

Background/Aims. While biological drugs are useful for relieving the disease activity and preventing abdominal surgery in patients with Crohn's disease (CD), it is unclear whether the use of biological drugs in CD patients with no history of abdominal surgery is appropriate. We evaluated the effects of infliximab and other factors on extending the duration until the first surgery in CD patients on a long-term basis. Methods. The clinical records of 104 CD patients were retrospectively investigated. The cumulative nonoperation rate until the first surgery was examined with regard to demographic factors and treatments. Results. The 50% nonoperative interval in the 104 CD patients was 107 months. The results of a univariate analysis revealed that a female gender, the colitis type of CD, and the administration of corticosteroids, immunomodulators, or infliximab were factors estimated to improve the cumulative nonoperative rate. A multivariate analysis showed that the colitis type and administration of infliximab were independent factors associated with a prolonged interval until the first surgery in the CD patients with no history of abdominal surgery. Conclusions. This study suggests that infliximab treatment extends the duration until the first surgery in CD patients with no history of abdominal surgery. The early use of infliximab before a patient undergoes abdominal surgery is therefore appropriate. © 2013 Aki Sakatani et al.

DOI： 10.1155/2013/879491

Scopus

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Introduction: We assessed the impact of intestinal transplantation on Japanese pediatric patients with intestinal failure with data from the Japanese intestinal transplant registry. Methods: Standardized forms were sent to all known intestinal transplantation programs, requesting information on transplants performed between 1996 and June 30, 2012. Patients younger than 18 years were analyzed. Patient and graft survival estimates were obtained using the Kaplan-Meier method. Results: Of the 14 intestinal transplants, 4 were deceased and 10 were living donor transplants. The primary indications were: short gut syndrome (n = 7), intestinal functional disorder (n = 6), and re-transplantation (n = 1). The overall 1- and 5-year patient survival rates were 77 and 57 %, respectively. In transplants performed after 2006 (n = 6), the one-year patient survival rate was 83 %, and the 5-year survival rate was 83 %. Graft one- and 5-year survival rates were 83 and 83 %, respectively. The living-related transplant survival rate was 80 % at 1 year and 68 % at 2 years, compared to 67 and 67 % for cadaveric transplant recipients. There were no statistically significant differences in patient (p = 0.88) and graft (p = 0.76) survival rates between living donor and cadaveric transplant recipients. All current survivors discontinued PN. Conclusion: Intestinal transplantation has become an effective therapy for patients with intestinal failure who cannot tolerate PN. © 2013 Springer-Verlag Berlin Heidelberg.

DOI： 10.1007/s00383-013-3392-7

Scopus

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A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor. We compared the imaging and pathological findings, and examined the possibility of preoperatively diagnosing a benign liver schwannoma. A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver. A malignant tumor was suspected, and a right hepatectomy was performed. After this, the diagnosis of a primary benign schwannoma of the liver was made through pathological examination. Contrast-enhanced ultrasonography (CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase; most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells. In the postvascular phase, CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas; most likely due to aggregation of siderophores. Because discriminating between a benign and malignant schwannoma of the liver is difficult, surgery is generally recommended. However, the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.

DOI： 10.3748/wjg.v18.i35.4967

PubMed

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

症例は61歳,女性.本年4月,全身倦怠感を主訴に当院内科を受診し,貧血と便潜血陽性を認めたため消化管精査目的に入院となった.入院後,腸閉塞症状が出現し,CTにて左下腹部に腫瘤像と口側小腸の拡張を認め,小腸腫瘍によるイレウスの診断で当科紹介となり手術を施行した.術中所見では,直径7×4cmの壁外性に発育する小腸腫瘍を認め小腸部分切除を行った.病理組織学的には小腸海綿状血管腫の診断で,粘膜下での血管腫の破綻による慢性的出血と血腫形成があり,それに対する肉芽反応と線維化が生じた病変と思われた.血管腫は全消化管腫瘍の0.05%,小腸良性腫瘍の7～11%を占めるまれな疾患で,消化管出血を主訴に発見されることが多く,腸閉塞に至った症例の報告はない.治療は外科的切除が第一選択とされている.今回われわれは貧血を主訴とし腸閉塞症状を呈した小腸血管腫の1例を経験したので報告する.(著者抄録)

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AIMS: Cirrhotic patients commonly have a liver zinc deficiency, which may aggravate liver fibrosis due to the lack of antioxidative effects of zinc. This study examined the ability of polaprezinc, N-(3-aminopropionyl)-l-histidinato zinc, to prevent fibrosis in a rat model of thioacetamide (TAA)-induced hepatic fibrosis. MAIN METHODS: Liver cirrhosis was induced by orally administering TAA for 20 weeks. The rats were cotreated with one of the following for the last 10 weeks of TAA treatment: (1) polaprezinc (50 or 200mg/kg/day); (2) l-carnosine (155 mg/kg/day), which contained equal amounts of l-carnosine as 200mg/kg/day polaprezinc; (3) zinc sulfate (112 mg/kg/day) or (4) zinc-l-aspartic complex (317.8 mg/kg/day). Both zinc supplementations contained equal amounts of zinc as high-dose polaprezinc. KEY FINDINGS: Hepatic zinc levels fell significantly in rats treated with TAA for 20 weeks. Cotreating with high-dose polaprezinc and zinc-l-aspartic complex for 10 weeks prevented hepatic zinc loss. Hepatic hydroxyproline and tissue inhibitor of metalloproteinases-1 (TIMP-1) were significantly higher in rats treated with TAA for 20 weeks than 10 weeks, whereas polaprezinc prevented changes in these fibrosis markers and reduced hepatic transforming growth factor-beta1 protein concentration, macroscopic and histologic changes. TAA caused oxidative stress-related changes in the liver that were prevented by high-dose polaprezinc and partially by zinc-l-aspartic complex. Treatment with l-carnosine, low-dose polaprezinc or zinc sulfate for 10 weeks did not affect liver fibrosis progression or oxidative stress-related changes. SIGNIFICANCE: Polaprezinc may prevent ongoing fibrosis by preventing zinc depletion, oxidative stress and fibrosis markers in cirrhotic livers.

DOI： 10.1016/j.lfs.2011.10.022

PubMed

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

Oxaliplatin-induced peripheral neurotoxicity (OPN) is commonly associated with peripheral hypersensitivity to cold sensations (CS) but the mechanism is unknown. We hypothesized that the transient receptor potential melastatin 8 (TRPM8), a putative cold and menthol receptor, contributes to oxaliplatin cold hypersensitivity. To determine whether the TRPM8 is involved in acute OPN, varying concentrations of menthol were topically applied to the tongues of healthy subjects (n = 40) and colorectal cancer patients (n = 36) before and after oxaliplatin administration. The minimum concentration of menthol to evoke CS at the menthol application site was determined as the CS detection threshold (CDT). In healthy subjects, the mean CDT was 0.068. Sex and age differences were not found in the CDT. In advanced colorectal cancer patients, the mean CDT significantly decreased from 0.067% to 0.028% (P = 0.0039) after the first course of oxaliplatin infusions, and this marked CS occurred in patients who had grade 1 or less neurotoxicity, and grade 2 neurotoxicity, but not in those with grade 3 neurotoxicity. Further, the mean baseline CDT in oxaliplatin-treated patients was significantly higher than that of chemotherapy-naive patients and healthy subjects (0.151% vs. 0.066%, P = 0.0225), suggesting that acute sensory changes may be concealed by progressive abnormalities in sensory axons in severe neurotoxicity, and that TRPM8 is subject to desensitization on repeat stimulation. Our study demonstrates the feasibility of undertaking CDT test in a clinical setting to facilitate the identification of early neurotoxicity. Moreover, our results indicate potential TRPM8 involvement in acute OPN.

DOI： 10.1002/brb3.34

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Because of the serious organ shortage in Japan, the use of extended criteria (EC) donors is inevitable to increase the number of deceased donors. However, the influence of this practice on recipient outcomes has not been clarified yet. We analyzed donor and recipient factors to determine whether those factors, especially from EC donors impacted early recipient outcomes. From February 1999 to January 2011, 100 deceased liver transplantations were performed in Japan, including 85 consecutive adult cases (age <18 years) who were studied to evaluate whether 6 recipient and 16 donor factors affected 3-month (90-day) recipient survival. Upon univariate analysis, Model for End-stage Liver Disease (MELD) score < 25 (P =.018), donor age < 55 years (P =.040), and cold ischemia time (CIT) < 10 hours (P =.00013) significantly reduced 3-month survival. Multivariate analysis confirmed the independent contributions of, three adverse factors including MELD score < 25 (P =.0133, odds ratio [OR] = 12.3, 95% confidence interval [CI] = 1.790.3), donor age < 55 years (P =.013, OR = 14.0, 95% CI = 1.6119.5), and CIT < 10 hours (P =.0024, OR = 67.6, 95% CI = 4.51024.9). Three-month recipient survivals with 0, 1, 2, and 3 positive factors were 100% (n = 34), 94.4% (n = 36), 53.8% (n = 13), and 0% (n = 2), respectively (P <.0001). In conclusion, to improve recipient short-term survivals, minimizing CIT is the first priority. In the long-term, we must promote deceased donation to reduce recipient MELD scores by shortening the waiting time, and revise the allocation system to minimize CIT by giving priority to the local area. © 2012 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2012.01.010

Scopus

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Background: Mesothelin is expressed in various types of malignant tumour, and we recently reported that expression of mesothelin was related to an unfavourable patient outcome in pancreatic ductal adenocarcinoma. In this study, we examined the clinicopathological significance of the mesothelin expression in gastric cancer, especially in terms of its association with the staining pattern. Methods: Tissue specimens from 110 gastric cancer patients were immunohistochemically examined. The staining proportion and intensity of mesothelin expression in tumour cells were analysed, and the localisation of mesothelin was classified into luminal membrane and/or cytoplasmic expression. Results: Mesothelin was positive in 49 cases, and the incidence of mesothelin expression was correlated with lymph-node metastasis. Furthermore, luminal membrane staining of mesothelin was identified in 16 cases, and the incidence of luminal membrane expression was also correlated with pT factor, pStage, lymphatic permeation, blood vessel permeation, recurrence, and poor patient outcome. Multivariate analysis showed that luminal membrane expression of mesothelin was an independent predictor of overall patient survival. Conclusion: We described that the luminal membrane expression of mesothelin was a reliable prognostic factor in gastric cancer, suggesting the functional significance of membrane-localised mesothelin in the aggressive behaviour of gastric cancer cells. © 2012 Cancer Research UK All rights reserved.

DOI： 10.1038/bjc.2012.235

Scopus

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

生体肝移植後の無気肺に対する改善策として腹臥位を導入し、その効果を検討した。生体肝移植を受けた成人(12歳以上)27例を後方視的に検討した。腹臥位施行群は9例、非施行群18例であった。14 PODの無気肺面積と全肺野面積との比は、7 PODに比べ両群ともに有意に減少し、14 PODでは腹臥位群がより改善を示した。吸入器酸素分画の経時的変化は、両群間で交互作用を認め、腹臥位群でより改善し、肺炎を併発した3例を除いた検討においても腹臥位群で有意に改善した。拒絶反応、脈管系合併症および細菌性肺炎の発症、ICUおよび在院期間、生存率は統計学的有意差を認めなかったが、腹臥位群では肺炎を認めなかった。肝機能については、prothrombin timeは2群間で交互作用を認めたが、その他の血液検査結果および腹水量に差は認めなかった。

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

経皮内視鏡的胃瘻造設(PEG)対象例のうち、通常のPEGが施行困難である5例(男)を対象として、腹腔鏡下外科手術手技を用いて安全に腹腔鏡下経皮内視鏡的胃瘻造設術(L-PEG)を施行した。対象群は、平均年齢85.4歳で、全例嚥下障害に伴う老人性肺炎で、低栄養例であった。手術はまず臍下に5mmの第一トロカールを挿入し、さらに左前腋窩線上で臍部のやや下方に5mmの第二トロカールを挿入した。次に第二トロカールから挿入した鉗子で胃前壁を露出させて、穿刺可能な位置に誘導した。胃内視鏡を施行してPEGを行い、腹壁より胃前壁を穿刺した後ガイドワイヤーを挿入し、胃瘻用チューブを接続してガイドワイヤーとともにチューブを体外へ誘導して胃瘻造設を終了した。全例で術後合併症もなく、24時間後より経腸栄養を開始した。

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

Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation (LDLT). However, in the cases that show pancreatic fistula, the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula. As a result, the pancreatic fistula may result in the death of the patient. We present 2 cases in which endoscopic treatment was effective against pancreatic fistulas that developed after LDLT. In case 1, a 61-year-old woman underwent LDLT for primary biliary cirrhosis. Because of a portal venous thrombus caused by a splenorenal shunt, the patient underwent portal vein reconstruction, and a splenorenal shunt was ligated on postoperative day (POD) 7. The main pancreatic duct was injured during the manipulation to achieve hemostasis, thereby necessitating open drainage. However, discharge of pancreatic fluid continued even after POD 300. Endoscopic naso-pancreatic drainage (ENPD) was performed, and this procedure resulted in a remarkable decrease in drain output. The refractory pancreatic fistula healed on day 40 after ENPD. In case 2, a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus. When the portal vein was exposed during thrombectomy, the pancreatic head was injured, which led to the formation of a pancreatic fistula. Conservative therapy was ineffective; therefore, ENPD was performed. The pancreatic fistula healed on day 38 after ENPD. The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.

DOI： 10.3748/wjg.v17.i30.3560

PubMed

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

35歳男性。34歳時にアルコール性肝硬変と診断され、今回、著者らの施設にて生体肝移植が予定されたが、術前の全身精査中に頭蓋内の異常所見が指摘され、脳神経外科へ受診となった。脳MRIおよび脳血管撮影では頭蓋内に脳動静脈奇形が認められたが、無症候性であったため、原疾患の治療を優先し、生体肝移植が施行された。その後、手術から2年3ヵ月で血小板数・肝機能、凝固能が正常化したため再診となったが、脳MRIとMRAで頭蓋内のAVMの自然消失が確認された。

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

Rhabdomyolysis associated with fenofibrate monotherapy is extremely rare. Here, we report a rare case of rhabdomyolysis of the psoas muscle in an 82-year-old man with chronic myelogenous leukemia (CML). He was prescribed fenofibrate because of a hypertriglyceridemia. The patient reported generalized muscle pain and right abdominal pain while receiving fenofibrate monotherapy. An abdominal computed tomography scan and an abdominal ultrasound showed a large and low attenuation and high echogenicity, respectively, in the right middle abdominal area. Laboratory values included a serum creatine concentration of 4.1 mg/dl and a creatinine phosphokinase concentration of 5,882 IU/l. During laparotomy, a large hematoma and necrotic mass was identified in the right psoas muscle. Histological examination revealed that the resected specimens were of the psoas muscle with irregular fiber sizes, degenerating fibers surrounding the inflammatory reaction, and fiber necrosis that is typical for polymyositis. Based on these findings and the clinical history, a diagnosis of fenofibrate-induced rhabdomyolysis was made. To the best of our knowledge, no patient has ever been diagnosed with fulminant psoas rhabdomyolysis due to a fenofibrate monotherapy. This report details the rare case of rhabdomyolysis in a patient with CML associated with fenofibrate monotherapy and offers a review of the literature.

DOI： 10.1159/000331559

PubMed

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

OBJECTIVE: The aim of this study was to define the relevance of mural nodules (MNs) as a "direct" indicator of malignancy of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. METHODS: Thirty-nine surgically resected IPMNs excluding obviously invasive carcinomas were examined. The distribution of the most severely dysplastic lesions was mapped on specimens. Immunohistochemical analysis for MUC1 and MUC2 was performed on sections containing the histologically predominant lesions and the most severely dysplastic areas. RESULTS: The presence of MNs correlated well with the histological grade of IPMN (P < 0.01); however, the most severely dysplastic lesions were associated with a flat/nonelevated area rather than MNs (78.9%). In the MUC1-positive subgroup, minimally invasive carcinoma was colocalized to MNs, whereas most severely dysplastic foci including minimally invasive carcinoma with components of mucinous and tubular adenocarcinoma were observed in the areas apart from MNs in the MUC2-positive and MUC1/2-negative subgroups, respectively. CONCLUSIONS: Although our data support the concept that MNs represent areas of higher-grade dysplasia within IPMN, development of invasive lesions from MNs may be limited to cases that are MUC1-positive. Careful attention should be paid to the emergence of invasive IPMN from flat foci in MUC2-positive and MUC1/2-negative cases.

DOI： 10.1097/MPA.0b013e31820d1a03

PubMed

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

BACKGROUND: Recurrence of Crohn's disease usually occurs at anastomotic sites. OBJECTIVE: A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses. DESIGN AND SETTINGS: The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed. PATIENTS: : From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003. MAIN OUTCOME MEASURES: A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated. RESULTS: The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P = .008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P = .0013). The absence of postoperative infliximab did not affect the restenosis rate in group S. LIMITATIONS: This study was limited by its historical retrospective nature. CONCLUSION: The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.

DOI： 10.1007/DCR.0b013e318208b90f

PubMed

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

症例は66歳男性で,2001年5月から気管支喘息の加療中であった.2008年9月から四肢のしびれ,筋力低下,食思不振が出現し,好酸球増多もあり,11月にChurg-Strauss症候群(以下,CSS)と診断され,ステロイドの維持療法を行っていた.2009年4月に腹痛出現,CT,X線写真でfree airを認め,消化管穿孔および汎発性腹膜炎の診断で緊急手術を施行した.回腸末端より90cmの部位に穿孔を認め,穿孔部を含め小腸部分切除術を行った.小腸穿孔をきたしたCSSの1例を経験したので報告する.(著者抄録)

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

Background:Cholangiocarcinoma (CC) is a highly malignant carcinoma. We attempted to clarify the prognostic significance of c-Met overexpression and its association with clinicopathological factors in patients with CC.Patients and methods:One hundred and eleven patients with intrahepatic CC (IHCC) and 136 patients with extrahepatic CC (EHCC) who had undergone curative surgery were divided immunohistologically into c-Met high and c-Met low groups. Clinicopathological factors and outcomes were compared between the groups. c-Met and epidermal growth factor receptor (EGFR) expression was also examined in 10 CC cell lines.Results:The positivity of c-Met was 45.0% in IHCC and 68.4% in EHCC; c-Met high expression was demonstrated in 11.7% of IHCC and 16.2% of EHCC. c-Met high expression was significantly correlated with the 5-year survival rate for CC overall (P0.0046) and for IHCC (P0.0013), histopathological classification in EHCC, and for EGFR overexpression in both IHCC and EHCC. Coexpression and coactivation of c-Met and EGFR were also observed in CC cell lines. Multivariate analysis revealed that c-Met high expression was an independent predictor of poor overall and disease-free survival in patients with IHCC.Conclusions:c-Met overexpression is associated with EGFR expression and is a poor prognostic factor in CC. © 2011 Cancer Research UK All rights reserved.

DOI： 10.1038/bjc.2011.199

Scopus

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

Although hepatocyte transplantation (HCTx) is expected to become a useful therapy for human liver diseases, allogenic hepatocytes still tend to be rejected within a short period due to host immunosurveillance. In the present study, we investigated the effect of prior bone marrow transplantation (BMTx) for the engraftment of allogenic hepatocytes using the analbuminemic rat transplantation model. The hepatocytes of Lewis (LEW) rats were not accepted in the liver of retrorsine (RS)/partial hepatectomy (PH)-treated analbuminemic F344 (F344-alb) rats, which express the disparate major histocompatibility complex (MHC) against that of LEW rats. Prior BMTx with the LEW bone marrow cells (BMCs) after sublethal irradiation achieved acceptance and repopulation of LEW hepatocytes in the liver of the RS/PH-treated F344-alb rats, associated with elevation of serum albumin. The replacement of hepatic parenchyma with albumin positive (Alb(+)) donor hepatocytes and elevation of serum albumin levels were dependent on the bone marrow reconstitution by donor BMCs, which was more efficiently achieved by intrabone marrow (IBM)-BMTx than by intravenous (IV)-BMTx. Our results demonstrate that efficient bone marrow reconstitution by IBM-BMTx enables the replacement of the hepatic parenchyma with allogenic hepatocytes in RS/PH-treated analbuminemic rats without immunosuppressants.

DOI： 10.3727/096368910X547453

PubMed

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

Carbohydrate antigen 19-9 (CA 19-9) is a sensitive marker for pancreatic and hepatobiliary malignancies. The highest frequency of elevated serum CA 19-9 levels is found among patients with pancreatic cancer. CA 19-9 has recently been demonstrated to be a marker of digestive tract malignancies. We report the case of a patient with a gastric cancer and a very high serum CA 19-9 level. During laparotomy, a large mass was found in the antrum. A distal gastrectomy with D2 dissection of the lymph nodes was performed. Histological examination, including immunohistochemistry, revealed an adenocarcinoma of the stomach producing CA 19-9. To the best of our knowledge, no patient with an extremely high serum CA 19-9 level resulting from a gastric adenocarcinoma has been reported previously.

DOI： 10.1159/000327984,

PubMed

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

DOI： 10.2957/kanzo.52.625

Scopus

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

Calcium and magnesium replacement is effective in reducing oxaliplatin-induced neurotoxicity. However, cetuximab treatment has been associated with severe hypomagnesaemia. Therefore, we retrospectively investigated whether cetuximab-induced hypomagnesaemia exacerbated oxaliplatin-induced neurotoxicity. Six patients with metastatic colorectal cancer who were previously treated with oxaliplatin-fluorouracil combination therapy were administered cetuximab in combination with irinotecan alone or irinotecan and fluorouracil as a second-line treatment. All patients had normal magnesium levels before receiving cetuximab. The Common Terminology Criteria for Adverse Events version 3.0 was used to evaluate the grade of neurotoxicity, hypomagnesaemia, hypocalcaemia, and hypokalemia every week. All six patients had grade 1 or higher hypomagnesaemia after starting cetuximab therapy. The serum calcium and potassium levels were within the normal range at the onset of hypomagnesaemia. Oxaliplatin-induced neurotoxicity occurred in all patients at the beginning of cetuximab therapy, with grade 1 neurotoxicity in five patients and grade 2 in one patient. After cetuximab administration, the neurotoxicity worsened in all six patients, and three progressed to grade 3. Among the three patients with grade 3 neurotoxicity, two required a dose reduction and one had to discontinue cetuximab therapy. A discontinuation or dose reduction in cetuximab therapy was associated with exacerbated oxaliplatin-induced neurotoxicity due to cetuximab-induced hypomagnesaemia in half of patients who had previously received oxaliplatin. Therefore, when administering cetuximab after oxaliplatin therapy, we suggest serially evaluating serum magnesium levels and neurotoxicity.

DOI： 10.3978/j.issn.2078-6891.2010.024,

PubMed

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

VHL病は遺伝性多発腫瘍症候群で膵病変も高率にきたすことが知られているが,これを契機に診断されることはめずらしい.本例は小脳,脊髄血管芽腫の手術歴を有する多発性膵SCN症例で,病歴よりVHL病を疑い遺伝子検査にて診断を確定した.VHL病の予後規定因子は中枢神経系腫瘍と腎癌であり,良性例の多い膵腫瘍に対しては長期予後を考慮した治療方針の立案が肝要である.本例は経過中増大傾向のなかった膵鉤部の小病変を遺残させ膵亜全摘術を施行した.VHL病は遺伝病であり,その取り扱いには人権に配慮した対応を要する.筆者らは複数科からなる遺伝カンファレンスで協議し,患者家族に対しても遺伝子検査を行った.(著者抄録)

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Despite the wide spectrum of selection criteria used by living donor liver transplantation (LDLT) centers in Japan, LDLT for hepatocellular carcinoma (HCC) can achieve an acceptable outcome comparable to the outcome for deceased donor liver transplantation (DDLT) for HCC. One of the most crucial considerations in liver transplantation for HCC is the advent of expanded criteria that allow more patients with HCC to receive the organs and offer similar or even better results compared to the Milan of UCSF criteria. Expanded criteria for HCC are proposed from three single-center and one multicenter study in Japan. These criteria are based on the independent predictors for outcome derived from the analyses of the pretransplant factors and explant pathology. The beneficial effect of those proposed criteria can be predicted by the inclusion rates of the patients compared to the Milan or UCSF criteria in the same cohort and the outcome for those included patients. While application of the UCSF criteria increases the inclusion rate compared to the Milan criteria by 5-10%, these proposed criteria increase the inclusion rates by 5-54% compared to the Milan criteria. The higher inclusion rates compared to the application of the Milan criteria are achieved by criteria including tumor markers, either AFP or PIVKA II or both. Inclusion of tumor markers in addition to parameters of tumor morphology might be the key to establish the best criteria for liver transplantation for HCC.

DOI： 10.1007/s00534-009-0168-5

PubMed

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

BACKGROUND: Currently, pancreatic islet transplantation to achieve normoglycemia in insulin-dependent diabetes mellitus (IDDM) requires two or more donors. This may be due to the inability to transplant functionally preserved and viable islets after isolation. Islets have already been subjected to various harmful stresses during the isolation process leading to apoptosis. One of the intracellular signaling pathways, the transcription factor nuclear factor-kappaB (NF-kappaB)-related pathway, is relevant to the mechanism of beta-cell apoptosis in isolated islets. We attempted to prevent islet apoptosis during isolation by a novel NF-kappaB inhibitor, dehydroxymethylepoxyquinomicin (DHMEQ). MATERIALS AND METHODS: DHMEQ was injected intraperitoneally into donor mice 2 h prior to isolation. NF-kappaB activation, the functioning of isolated islets, apoptosis after isolation, and cytokine- and apoptosis-related genes were analyzed. After 160 equivalents of islets were transplanted into diabetic mice, graft survival and function were evaluated. RESULTS: Intra-islet NF-kappaB was activated immediately after isolation, and DHMEQ inhibited NF-kappaB activation without deterioration of islet function. DHMEQ significantly prevented apoptosis by inhibiting caspase 3/7 activities and down-regulated Bax, a pro-apoptotic gene. Donor pretreatment with DHMEQ significantly improved engraftment in syngeneic islet transplantation in mice, thus preserving insulin contents in the graft liver, as assessed by functional and histologic analyses. CONCLUSIONS: DHMEQ is a promising agent in islet transplantation because it protects islets from apoptosis during isolation stress. Donor pretreatment with DHMEQ can significantly affect the success of islet engraftment.

DOI： 10.1016/j.jss.2010.04.044

PubMed

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

Because hepatic vasculatures exhibit variations, a preoperative evaluation of the vascular anatomy and an estimation of the volume of the liver graft are essential for successful adult living donor liver transplantation. Using 3-dimensional (3D) computed tomography (CT), we analyzed the volumetric and anatomical relationship of the hepatic vasculatures of liver grafts. The livers of 223 potential donors were analyzed by 3D CT. Volumetric analysis was performed for each hepatic vein and its tributaries. The anatomy of the portal vein and hepatic artery was assessed along with the biliary system via intraoperative cholangiography in 110 recipients. On the basis of the anatomical presentation of the inferior right hepatic vein (IRHV), the hepatic veins were classified as follows: in type I, the IRHV was absent; in type II, the IRHV was smaller than the right hepatic vein (RHV); and in type III, the IRHV was greater than or equal to the RHV in size. The drainage volume of the middle hepatic vein (MHV) and especially its tributaries in the right lobe increased with the size of the IRHV (P < 0.001). In type III hepatic veins with a large IRHV (17% of the donors), the MHV tributaries had the largest drainage volume in the right lobe (41.2% +/- 11.8%). Furthermore, type III hepatic veins typically exhibited biliary variations in 75% of the donors. No correlation was observed between variations in the hepatic artery and portal vein. In conclusion, a right lobe graft with a large IRHV is accompanied by a large drainage volume via the MHV and by bile duct variations in 17% of livers. Therefore, anatomical and volumetric analysis is important for preoperative evaluations.

DOI： 10.1002/lt.22109

PubMed

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

BACKGROUND: Portal vein (PV) complications in pediatric living donor liver transplantation (LDLT) are often asymptomatic in the early stages after transplantation and can be serious enough to lead to graft failure. There have been few reports on risk factors for PV complications in LDLT. The aim of this study is to investigate the influence of hepatic inflow upon PV complications and to predict patients at risk for these complications. MATERIAL/METHOD: From 1997 to 2008, 46 pediatric patients underwent LDLT at our center. Portal venous and hepatic arterial flows and PV diameter were analyzed. RESULTS: PV complications were identified in seven patients (15.2%) and occurred at a younger age and lower weight. As a result of appropriate treatment, none of the patients suffered graft failure. Analysis of the 46 patients and 27 patients under two yr of age identified smaller PV diameter in recipient and larger discrepancy of PV diameter as risk factors. Portal venous flow tended to be low, in contrast to hepatic arterial flow, which tended to be high. CONCLUSION: PV size strongly influences PV complications. Other factors such as younger age, low portal venous flow, and high hepatic arterial flow may be risk factors for PV complications.

DOI： 10.1111/j.1399-0012.2009.01123.x

PubMed

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

IPMNのムチン発現形質によるサブタイプ別予後、組織学的な異型度と壁在結節(MN)の関係に着目して、新たな切除適応の可能性について検討した。MUC2陽性型は最も予後が良好で、MNの有無と異型度に相関傾向を認めることから、MNが形成されるまでは経過観察が可能であると考えられた。MUC1陽性型もMNの有無と異型度に相関傾向を認めるものの、早期に浸潤を開始する可能性があるため、MNの有無にかかわらず切除適応と考えられた。一方、MUC1、2陰性型ではMNの有無と異型度に相関がなく、MNのないことが臨床的な安全性の高さを示すことにはならない。この型には経過観察が可能と思われる良性病変と、悪性度の高い病変が混在している可能性がある。MNの有無にかかわらず浸潤性管状腺癌の発生がみられることがあるため、経過観察において最も注意を要すると考えられた。(著者抄録)

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

生体または脳死肝移植を行った患者28例において、術後嚥下障害のため嚥下訓練を行った4症例に関して検討した。嚥下障害のなかった群は気管切開術を施行せず抜管可能であったが嚥下障害のあった群は全例気管切開術を行っていた。入院中に合併症によって死亡した1例を除き3例は嚥下訓練により3食経口摂取が確立し転院となった。今回の検討より全身状態の低下や合併症により術後の挿管・気管切開が長いと嚥下障害をきたす可能性が高くなるが、早期のST介入や訓練開始はその後の良好な経過に結びつく可能性があると考えられた。(著者抄録)

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：医歯薬出版（株）  

脳死状態が身体に及ぼす生理学的変化は多彩である。循環動態は脳幹の機能消失による血管拡張、循環血液量の減少、autonomic stormにより発生した心機能低下により、著明な低血圧が惹起される。肺においてはガス交換能が低下する。また、視床下部-下垂体機能障害として尿崩症が出現し、循環血液量の減少と血液浸透圧の上昇をもたらし電解質異常を引き起こす。さらには低体温、凝固能障害などがみられる。これらの生理学的変化に対し観血的動脈圧測定、中心静脈圧測定、心電図モニター、Swan-Ganzカテーテルなどによるモニタリング下に、適切な循環血液量・血圧・呼吸・電解質管理を行うとともに、カテコールアミン、バゾプレシンなどの薬物治療、さらにはホルモン補充療法などを行い、各臓器に至適な生理的環境を維持することが重要である。脳死ドナーとその家族の尊い意思に報いるためにも、われわれはこの脳死ドナーの特殊な病態とその管理に精通し、結果として臓器移植を成功に導くべく努力すべきである。(著者抄録)

Language：English   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：Am. J. Case Rep.  

Language：English   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：J. Med. Case Rep.  

DOI： 10.1186/1752-1947-5-521

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：日本臨床社  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(株)メディカルレビュー社  

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：日本医学館  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：医学図書出版  

胆道癌に対するEGFR/VEGFRを標的とした分子標的治療の可能性について検討した。臨床病理学的検討により、胆道癌においてEGFRおよびVEGFの発現が比較的高頻度に認められ、両分子が胆道癌の進展に関わっていることが示唆された。胆道癌マウスモデルと新規EGFR/VEGFR阻害剤であるvandetanibを用いた検討により、vandetanibが胆道癌に対して抗腫瘍効果を発揮することが示唆された。またKRAS遺伝子およびEGFR遺伝子の異常が、胆道癌に対するEGFR阻害剤の感受性予測マーカーとなる可能性が示唆された。胆道癌治療における化学療法の役割は大きいが、有効な化学療法は依然として少ないのが現状である。EGFRおよびVEGFR経路を標的とした分子標的治療は、一つの有望な治療手段となる可能性があると考えられた。胆道癌に対する分子標的治療の開発はいままさに黎明期であり、わが国でもその臨床的有効性が検討されていくことが期待される。(著者抄録)

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：医学書院  

脳死肝移植は,ほとんどが予定待機手術である生体肝移植と違って,全例臨時手術である.したがって定期フォローアップにおける画像診断による全身評価が不可欠となってくる.特に肝癌症例では遠隔転移を含めた肝癌の増悪の評価が重要である.さらに,肝硬変では,門脈血栓症,TIPS,腹腔動脈狭窄,脾動脈瘤などの特徴的な病態が存在することから手術時にはそれらをふまえた検討を行うことも重要である.また,脳死肝移植の肝グラフトは,下大静脈,総肝動脈を含めた全肝グラフトであること加え,腸骨動静脈グラフトも使用が可能となるため多様な術式が想定でき,術前の腹腔内の画像診断に基づいた手術プランニングが重要となる.(著者抄録)

Event date： 2012.9

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：札幌市  

Event date： 2012.8

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：旭川市  

Event date： 2012.8

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：旭川市  

Event date： 2012.6

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：札幌市  

Event date： 2012.6

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：福岡市