Publications by authors named "Hiroyuki Kashiwagi"

31 Publications

Sigmoid colon strangulation caused by bilateral fallopian tubes: A case report.

Int J Surg Case Rep 2021 Sep 19;86:106329. Epub 2021 Aug 19.

Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan.

Introduction: There are no reports regarding sigmoid colon strangulation caused by bilateral fallopian tubes, which is a rare type of large bowel obstruction. Herein, we report a case of successful laparoscopic treatment of sigmoid colon strangulation.

Presentation Of Case: A 54-year-old woman presented to our hospital with intermittent abdominal pain. Her medical history was significant for endometriosis; however, there was no surgical history. The physical examination revealed tenderness over the lower abdomen. CT scan shows closed loop obstruction of sigmoid colon. Exploratory laparoscopy was performed, and a sigmoid colon strangulated by bilateral fallopian tubes was detected. The adhesions consisting of bilateral fallopian tubes were dissected laparoscopically. The patient's postoperative course was uneventful, with no complications.

Discussion: The most common cause of large bowel obstruction (LBO) is colorectal cancer, including volvulus and diverticulitis. In this case, the adhesion of both the right and left fallopian tubes caused LBO, and it is conceivable that the etiology involved is endometriosis. Few cases have reported bowel obstruction associated with a fallopian tube, and the laparoscopic approach is very rare. In our case, we immediately performed laparoscopic exploration before colon strangulation led to necrosis or perforation. Therefore, we succeeded in releasing the strangulation laparoscopically.

Conclusion: We report a case of sigmoid colon strangulation that was treated laparoscopically. This approach can be the treatment of choice for sigmoid colon strangulation.
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http://dx.doi.org/10.1016/j.ijscr.2021.106329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411245PMC
September 2021

Endovascular aortic repair for abdominal aortic injury complicated with bowel injury due to blunt abdominal trauma: A case report.

Int J Surg Case Rep 2021 Aug 18;85:106216. Epub 2021 Jul 18.

Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan.

Introduction And Importance: Blunt abdominal aortic injury (BAAI) resulting from blunt abdominal trauma is rare; therefore, there are no standard guidelines for its treatment. Herein, we report the successful treatment of BAAI via endovascular aortic repair (EVAR) performed immediately after emergency laparotomy to repair a bowel injury.

Case Presentation: A 78-year-old man was injured after being caught between a shovel car and the bumper of his own car for approximately 15 s. Upon arrival at the hospital, the patient was conscious and had stable vital signs, abdominal and low back pain, and numbness in the right lower limb. Computed tomography revealed contrast medium leakage into the mesentery, as well as aortic dissection and rupture. Hemostasis and intestinal resection were completed, and EVAR was performed immediately after abdominal closure. The patient was discharged from the hospital at 35 days after surgery.

Clinical Discussion: In this case, there existed a risk of artificial blood vessel infection if reconstruction was simultaneously performed with intestinal resection. Symptoms of lower limb ischemia that were observed prior to surgery resolved. After open surgery, bleeding was controlled, and the patient's vital signs were stable. EVAR was performed as treatment for aortic injury, thereby reducing the risk of direct implant infection and enabling minimally invasive treatment.

Conclusion: EVAR may be useful for the treatment of BAAI in the presence of intestinal injuries, reduce the risk of implant infection, and allow for a one-time, minimally invasive treatment.
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http://dx.doi.org/10.1016/j.ijscr.2021.106216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319751PMC
August 2021

Laparoscopic treatment for renal paratransplant hernia: A case report.

Int J Surg Case Rep 2021 May 1;82:105849. Epub 2021 Apr 1.

Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan.

Introduction: There are limited reports regarding renal paratransplant hernia (RPH), which is a rare type of internal hernia. Herein, we report a case of successful laparoscopic treatment of RPH.

Presentation Of Case: A kidney transplant recipient presented to our emergency department with a 6-h history of abdominal pain and vomiting. The patient had received a living-related donor kidney transplantation and native nephrectomy in our hospital last year. Computed tomography (CT) confirmed a diagnosis of RPH. We performed laparoscopic exploration, and the findings showed an incarcerated small bowel in the retroperitoneal space through a peritoneal defect. Short laparotomy was performed to resect the non-viable bowel. The peritoneal defect was opened adequately. The patient's postoperative course was uneventful, with no complications.

Discussion: RPH is an uncommon variant of internal hernia, which is a rare surgical complication after kidney transplantation. Early diagnosis and treatment are important once RPH develops. Due to immunosuppression in kidney transplant recipients, typical signs of peritonitis were not observed. This event can be critical to the patient. Laparoscopic surgery has recently become a treatment option for small bowel obstructions. We believe that this surgical procedure is useful for patients with RPH.

Conclusion: We report a case of RPH treated laparoscopically. This approach can be a treatment of choice for RPH.
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http://dx.doi.org/10.1016/j.ijscr.2021.105849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055603PMC
May 2021

The Efficacy of Medium- to Long-term Anti-TNF-α Antibody-based Maintenance Therapy in Behçet's Disease Patients with Intestinal Lesions.

Intern Med 2020 1;59(19):2343-2351. Epub 2020 Oct 1.

Institute of Gastroenterology, Tokyo Women's Medical University, Japan.

Objective Anti-tumor necrosis factor (TNF)-α antibody-based regimens are effective in Behçet's disease (BD) with intestinal lesions. We therefore evaluated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance therapy of BD intestinal and non-intestinal lesions. Methods In this retrospective study, the response to the treatment was assessed endoscopically and clinically. Treatment responders were transferred to maintenance therapy. We evaluated the sustain rate of maintenance therapy, reductions in the dose of prednisolone (PSL), and the presence of non-intestinal BD involvement before and after the start of anti-TNF-α antibody-based the maintenance therapy. Patients We assessed 20 BD patients with intestinal lesions who underwent anti-TNF-α antibody-based therapy. Results Treatment was discontinued in 3 patients (18%). Loss of response was noted in 1 (5.9%) patient. Maintenance therapy was continued in 13 (76%) patients. The cumulative sustain rates to maintenance therapy after 2, 4, and 6 years were 94%, 87%, and 72%, respectively. In the 13 patients with remission of intestinal lesions, the mean PSL dose decreased from 13.4±2.16 mg/day before treatment to 0.92±0.47 after treatment (p<0.0001). PSL was discontinued in 9 (69%) patients. Five of the 13 (38%) patients developed clinical features of non-intestinal BD during the remission-maintenance treatment. Conclusion Our results demonstrated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance treatment against BD intestinal lesions. Nevertheless, some cases with well-controlled intestinal lesions developed active non-intestinal BD symptoms. The results highlight the importance of a carefully planned treatment strategy for BD patients with intestinal involvement.
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http://dx.doi.org/10.2169/internalmedicine.5000-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644480PMC
November 2020

Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding.

Acute Med Surg 2020 Jan-Dec;7(1):e549. Epub 2020 Aug 13.

Department of Surgery Shonan Kamakura General Hospital Kamakura Japan.

Aim: Bleeding in the small bowel rarely occurs, and its treatment is challenging. Surgery is sometimes required in unstable patients; however, intraoperative identification of the bleeding site is extremely difficult. Many methods have been reported, but no standard strategy has been established yet. Here, we aimed to assess the safety and feasibility of intraoperative angiography with indocyanine green staining to accurately identify small bowel bleeding sites.

Methods: This retrospective study analyzed contrast-enhanced computed tomography images of patients ( = 8) with small bowel extravasation who underwent surgery. If extravasation or other vessel abnormalities that were potential bleeding sites were detected on intraoperative angiography, a microcatheter was placed as close as possible to the extravasation site. Laparotomy was carried out, and 3-5 mL indocyanine green was injected through the microcatheter. The green-stained segment of the small bowel was resected.

Results: Seven of the eight patients had positive angiographic findings and underwent bowel resection. The eighth patient had no abnormalities and hence did not undergo laparotomy. The rate of hemostatic success among the resected cases was 85.7% (six of seven cases). The resected specimens showed pathologic features in six of the seven patients (85.7%), all of whom achieved hemostasis. One patient had pneumonia and congestive heart failure that required longer hospital stay, but no mortality occurred.

Conclusions: Intraoperative angiography with indocyanine green injection, followed by resection for massive small bowel bleeding is effective. This can be a therapeutic option for hemodynamically unstable patients.
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http://dx.doi.org/10.1002/ams2.549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426192PMC
August 2020

Association of pre-operative chronic kidney disease and acute kidney injury with in-hospital outcomes of emergency colorectal surgery: a cohort study.

World J Emerg Surg 2020 03 26;15(1):22. Epub 2020 Mar 26.

Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan.

Background: Pre-operative kidney function is known to be associated with surgical outcomes. However, in emergency surgery, the pre-operative kidney function may reflect chronic kidney disease (CKD) or acute kidney injury (AKI). We examined the association of pre-operative CKD and/or AKI with in-hospital outcomes of emergency colorectal surgery.

Methods: We conducted a retrospective cohort study including adult patients undergoing emergency colorectal surgery in 38 Japanese hospitals between 2010 and 2017. We classified patients into five groups according to the pre-operative status of CKD (defined as baseline estimated glomerular filtration rate < 60 mL/min/1.73 m or recorded diagnosis of CKD), AKI (defined as admission serum creatinine value/baseline serum creatinine value ≥ 1.5), and end-stage renal disease (ESRD): (i) CKD(-)AKI(-), (ii) CKD(-)AKI(+), (iii) CKD(+)AKI(-), (iv) CKD(+)AKI(+), and (v) ESRD groups. The primary outcome was in-hospital mortality, while secondary outcomes included use of vasoactive drugs, mechanical ventilation, blood transfusion, post-operative renal replacement therapy, and length of hospital stay. We compared these outcomes among the five groups, followed by a multivariable logistic regression analysis for in-hospital mortality.

Results: We identified 3002 patients with emergency colorectal surgery (mean age 70.3 ± 15.4 years, male 54.5%). The in-hospital mortality was 8.6% (169/1963), 23.8% (129/541), 15.3% (52/340), 28.8% (17/59), and 32.3% (32/99) for CKD(-)AKI(-), CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD, respectively. Other outcomes such as blood transfusion and post-operative renal replacement therapy showed similar trends. Compared to the CKD(-)AKI(-) group, the adjusted odds ratio (95% confidence interval) for in-hospital mortality was 2.54 (1.90-3.40), 1.29 (0.90-1.85), 2.86 (1.54-5.32), and 2.76 (1.55-4.93) for CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD groups, respectively. Stratified by baseline eGFR (> 90, 60-89, 30-59, and < 30 mL/min/1.73 m) and AKI status, the crude in-hospital mortality and adjusted odds ratio increased in patients with baseline eGFR < 30 mL/min/1.73 m among patients without AKI, while these were constantly high regardless of baseline eGFR among patients with AKI. Additional analysis restricting to 2162 patients receiving the surgery on the day of hospital admission showed similar results.

Conclusions: The differentiation of pre-operative CKD and AKI, especially the identification of AKI, is useful for risk stratification in patients undergoing emergency colorectal surgery.
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http://dx.doi.org/10.1186/s13017-020-00303-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098074PMC
March 2020

A Rare Case of Pancreatic Endometrial Cyst and Review of the Literature.

Intern Med 2019 Apr 18;58(8):1097-1101. Epub 2018 Dec 18.

Department of Surgery, Tokyo-west Tokushukai Hospital, Japan.

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are extremely rare lesions that are difficult to diagnose before surgery. We report the case of a 26-year-old patient with a recent episode of left abdominal pain who presented with a large cyst in the pancreatic body. Laboratory results showed white blood cell and C-reactive protein elevation, whereas the patient's tumor marker levels were within the normal range. Distal pancreatectomy with splenectomy was performed. The final histopathological examination confirmed the presence of endometriotic cysts within the pancreas. Only 13 cases of endometriotic cysts of the pancreas have been previously reported. The preoperative diagnosis is challenging, and most patients undergo pancreatic resection because of suspected neoplasms. This case report reviews previous studies and discusses the clinicopathological features, pathogenesis, and appropriate treatment for pancreatic endometrial cysts.
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http://dx.doi.org/10.2169/internalmedicine.1702-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522422PMC
April 2019

Successful treatment of hepatic gas gangrene by open drainage: A case report and review of the Japanese literature.

Int J Surg Case Rep 2018 30;49:121-125. Epub 2018 Jun 30.

Department of Surgery, Shonan Kamakura General Hospital, Japan.

Introduction: Liver gas gangrene is rare and has a low prognosis. This case, reports a successful treatment of hepatic gas gangrene using an open drainage technique, followed by antibiotics and hyperbaric oxygen therapy (HBO).

Presentation Of The Case: An 82-year-old male with a history of left hepatectomy and bile duct resection for hilar cholangiocarcinoma presented with chilling, lethargy and dyspnea. He had a history of diabetes mellitus, hypertension, atrial fibrillation, and angina pectoris. Physical examination revealed scleric icterus, right hypochondrium tenderness and percussion tenderness of the liver, with warm extremities. Laboratory findings revealed leukocytosis and increased levels of hepatobiliary enzymes. A computed tomography (CT) scan showed gas accumulation in an S8 lesion with portal vein gas. Percutaneous drainage was performed immediately, and broad-spectrum antibiotics were started, but the drainage was insufficient. Consequently, laparotomy drainage was carried out, followed by HBO. No abscess was detected at one-year of follow-up.

Discussion: Hepatic gas gangrene progresses rapidly and has a high mortality rate. Malignant disease and diabetes mellitus may be predisposing factors. While half of non-clostridial cases survive, most cases of hepatic gas gangrene are associated with clostridial infection and have a fatal outcome.

Conclusion: All survival cases of hepatic gas gangrene were treated by laparotomy drainage, thus immediate laparotomy seems essential to prevent a fatal outcome.
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http://dx.doi.org/10.1016/j.ijscr.2018.06.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037661PMC
June 2018

Small intestinal metastases from esophageal carcinoma presenting as a perforation: A case report and review of the literature.

Int J Surg Case Rep 2018 5;48:104-108. Epub 2018 Jun 5.

Department of Surgery, Shonan Kamakura General Hospital, Japan.

Introduction: Small intestinal metastasis from oesophageal carcinoma is rare. We report a case of small intestinal metastases from oesophageal carcinoma presenting as a perforation and discuss the aetiology with other cases of small intestinal metastasis from oesophageal carcinoma reported in previous literature.

Presentation: An 86-year-old man presented with fever and coughing. He had choked while eating and had history of weight loss. He was diagnosed with aspiration pneumonia. Two days after the admission, he complained of abdominal pain. Physical examination revealed guarding and rebound tenderness in the upper abdomen. A contrast computed tomography of the abdomen showed ascites, free air, and irregular thickness of the small intestinal walls. Small intestinal perforation was noted, and surgical resection of the small intestine was performed. The pathological findings of the resected small intestine revealed ulcers with squamous cell carcinoma, and upper gastrointestinal endoscopy demonstrated oesophageal tumour, whose biopsy revealed squamous cell carcinoma. A diagnosis of small intestinal metastases from oesophageal carcinoma was made, but the patient died one month after the diagnosis.

Discussion: Most cases found in the literature of oesophageal tumour involve squamous cell carcinoma with male patients, and specific symptoms are divided into obstruction and perforation. All patients with small intestinal metastasis from oesophageal carcinoma who survived were treated by a combination of resection and radiation and/or chemotherapy; thus, immediate treatments seem essential to improve the prognosis.

Conclusion: Physicians should keep in mind the possibility of small intestinal metastasis when patients with a history of oesophageal cancer have abdominal symptoms.
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http://dx.doi.org/10.1016/j.ijscr.2018.05.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041422PMC
June 2018

Lumbar Arterial Bleeding Treated with Endovascular Aneurysm Repair: A Report of 4 Patients.

Ann Vasc Surg 2018 May 1;49:316.e11-316.e15. Epub 2018 Mar 1.

Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.

Background: Lumbar arterial bleeding is a severe condition. Surgical exploration is not indicated because of its rich collateral flow. Transarterial embolization (TAE) is reportedly effective, but there have been cases of failure. It may be a time-consuming procedure for patients with multiple bleeding sources or those with poor vital signs. In this case series, we used endovascular aneurysm repair (EVAR) instead of TAE.

Method: In this case series, we described 4 male patients (2 with traumatic injury, 1 with iatrogenic injury, and 1 with drug-induced hypocoagulability) with lumbar arterial bleeding. The reasons we chose EVAR are because 2 patients had poor vital signs, one patient was a technically difficult case for selective cannulation, and one patient had accompanying aortic dissection.

Result: In all patients, EVAR was performed successfully, and hemostasis was obtained although one patient died of pneumonia on postoperative day 23.

Conclusions: EVAR is an effective alternative for lumbar arterial bleeding although TAE is a first choice of treatment.
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http://dx.doi.org/10.1016/j.avsg.2017.12.018DOI Listing
May 2018

Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer.

J Minim Access Surg 2018 Jul-Sep;14(3):236-240

Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan.

Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG.

Patients And Methods: : A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures.

Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13-60) mm.

Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.
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http://dx.doi.org/10.4103/jmas.JMAS_61_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001300PMC
October 2017

Scarless surgery for a huge liver cyst: A case report.

Int J Surg Case Rep 2017 1;39:328-331. Epub 2017 Sep 1.

Department of Surgery, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan.

Introduction: Symptomatic or complicated liver cysts sometimes require surgical intervention and laparoscopic fenestration is the definitive treatment for these cysts. We performed minimally invasive surgery, hybrid natural orifice transluminal endoscopic surgery (NOTES) without scarring, for a huge liver cyst.

Presentation Of Case: An 82-year-old female presented with a month-long history of right upper abdominal pain. We diagnosed her condition as a huge liver cyst by morphological studies. She denied any history of abdominal trauma. Her serum CEA and CA19-9 were normal and a serum echinococcus serologic test was negative. Laparoscopic fenestration, using a hybrid NOTES procedure via a transvaginal approach, was performed for a huge liver cyst because we anticipated difficulty with an umbilical approach, such as single incision laparoscopic surgery (SILS). Her post-operative course was uneventful and she was discharged from our hospital three days after surgery. Pain killers were not required during and after hospitalization. No recurrence of the liver cyst or bulging was detected by clinical examination two years later.

Discussion: A recent trend of laparoscopic procedure has been towards minimizing the number of incisions to achieve less invasiveness. This hybrid NOTES, with a small incision for abdominal access, along with vaginal access, enabled painless operation for a huge liver cyst.

Conclusion: We report a huge liver cyst treated by hybrid NOTES. This approach is safe, less invasive, and may be the first choice for a huge liver cyst.
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http://dx.doi.org/10.1016/j.ijscr.2017.08.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597879PMC
September 2017

Comparison of efficacies of the self-expandable metallic stent versus transanal drainage tube and emergency surgery for malignant left-sided colon obstruction.

Asian J Surg 2018 Sep 24;41(5):498-505. Epub 2017 Aug 24.

Shonan Kamakura General Hospital, Department of Surgery, Japan.

Background/objective: Patients with left-sided malignant colorectal obstruction require emergency treatment. Emergency stoma surgery has traditionally been recommended, however many stomas became permanent, decreasing patient quality of life. Recently, self-expandable metallic stents (SEMS) and transanal decompression tubes (TDT) have become widely used decompression methods to avoid stoma surgery. In this study, we evaluated: 1) the efficacy of SEMS compared with TDT and emergency surgery (ES) to avoid permanent stomas; and 2) the safety and success rate of each treatment.

Methods: We retrospectively reviewed data from 56 patients who underwent SEMS, TDT, or emergency surgery for malignant left-sided colon obstruction. We compared the permanent stoma rate of each group, and assessed whether or not each treatment was an independent risk factor for permanent stomas. We compared morbidity and mortality for each treatment group (SEMS, TDT, ES), and the success rate of the decompression procedures (SEMS and TDT).

Results: The permanent stoma rates in the SEMS, TDT, and ES groups were 5.3%, 50.0%, and 56.0%, respectively. Emergency surgery (vs. SEMS) and TDT (vs. SEMS) were independent risk factors for permanent stomas, as was age ≥ 75 years. Operative morbidity, mortality, and hospital stay were not different between groups. The success rate of SEMS was significantly higher than TDT; however, two deaths, including one perforation, occurred in the former group.

Conclusion: SEMS seems to be effective in avoiding permanent stomas, but caution should be taken to avoid complications.
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http://dx.doi.org/10.1016/j.asjsur.2017.06.003DOI Listing
September 2018

Fatal liver gas gangrene after biliary surgery.

Int J Surg Case Rep 2017 28;39:5-8. Epub 2017 Jul 28.

Department of Surgery, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.

Introduction: Liver gas gangrene is a rare condition with a highly mortality rate. It is mostly associated with host factors, such as malignancy and immunosuppression.

Presentation Of Case: A 57-year-old female was admitted to our hospital with abnormalities of her serum hepato-biliary enzymes. She had a history of hypertension, diabetes mellitus, cerebral infarction, and chronic renal failure. She was diagnosed with bile duct cancer of the liver hilum and a left hepatectomy was carried out, with extrahepatic bile duct resection. Initially her post-operative state was uneventful. However, she suddenly developed melena with anemia on post-operative day (POD) 18. A Computed tomography (CT) examination on POD 19 revealed a massive build up of gas and portal gas formation in the anterior segment of the liver. Although we immediately provided the drainage and a probe laparotomy, she died on POD 20 due to shock with disseminated intravascular coagulation.

Discussion: Liver gas gangrene is rare and has a high mortality rate. This case seems to have arisen from an immunosuppressive state after major surgery with biliary reconstruction for bile duct cancer and subsequent gastrointestinal bleeding, leading to gas gangrene of the liver.
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http://dx.doi.org/10.1016/j.ijscr.2017.07.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545817PMC
July 2017

Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report.

Int J Surg Case Rep 2017 20;38:154-157. Epub 2017 Jul 20.

Department of Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan.

Introduction: Adventitial cystic disease is relatively rare vascular disease, frequently occurred in the popliteal artery. No definitive treatment has been established yet.

Prentation Of Case: A 53-year-old woman presenting intermittent claudication of the right leg was diagnosed as adventitial cystic disease of popliteal artery. Percutaneous balloon dilation yielded an immediate recurrence. The disease was successfully treated by bypass grafting utilizing the short saphenous vein to replace the part of the popliteal artery containing the adventitial cyst. No postoperative complication was found six months after surgery.

Discussion: Comparing to a great saphenous vein, a short saphenous vein as a material of bypass graft has a significant advantage, as only a single surgical field is necessary.

Conclusion: We propose that bypass graft surgery employing a short saphenous vein is worth considering as a treatment of adventitial cystic disease at the popliteal artery.
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http://dx.doi.org/10.1016/j.ijscr.2017.07.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537433PMC
July 2017

A rare case of an infected tracheal diverticulum requiring emergency intervention: A case report.

Int J Surg Case Rep 2016 6;24:7-9. Epub 2016 May 6.

Department of General Surgery, Shonan Kamakura General Hospital, Okamoto 1370, Kamakura, Kanagawa, Japan. Electronic address:

Introduction: Recent advancement in radiological imaging has revealed an increasing amount of asymptomatic abnormalities. Tracheal diverticula are relatively rare entities and are incidentally found on radiological imaging such as computed tomography. Here, we present a case of an infected tracheal diverticulum presenting as a paratracheal mass, which required emergency intervention.

Case Presentation: A 65-year-old Japanese nonsmoker man presented with a fever, lower neck pain, and the aggravation of dyspnea for a week. An enhanced computed tomography scan demonstrated that the trachea was displaced by a paratracheal mass with a well-defined thin wall. His respiratory status was so urgent that emergency intubation and surgical drainage of the abscess were performed. A computed tomography scan performed 4days after admission demonstrated shrinking of the abscess, and he was extubated and discharged 7days after admission without any complications.

Conclusion: To the best of our knowledge, this is the first report to confirm an infected tracheal diverticulum presenting as a paratracheal abscess, which required emergency intervention. Moreover, computed tomography plays an important role in the differentiation of paratracheal masses.
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http://dx.doi.org/10.1016/j.ijscr.2016.04.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872469PMC
July 2016

[Successful Treatment of Empyema with Bronchial Fistulas by Filling under Thoracoscopic Observation; Report of a Case].

Kyobu Geka 2015 Nov;68(12):1035-7

Department of Thoracic Surgery, Shonankamakura General Hospital, Kamakura, Japan.

Empyema with fistula usually resists conservative treatment such as thoracic cavity drainage and administration of antibacterial agents, thus it often requires surgeries such as fenestration, omental/muscle filling, and thoracoplasty. However, due to advanced age and poor condition, conducting invasive surgeries is often difficult in elderly patients. We report a case with the improvement of empyema by bronchial filling with endobronchial Watanabe spigot (EWS) under thoracoscopic observation for an 89-year-old patient who had developed chronic empyema with a bronchial fistulas. After filling EWS, air-leakage from bronchial fistula disappeared and the patient could discharged from the hospital successfully.
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November 2015

Morgagni hernia treated by reduced port surgery.

Int J Surg Case Rep 2014 20;5(12):1222-4. Epub 2014 Nov 20.

Department of Surgery, Shounai-Amarume Hospital, Yamagata 999-7782, Japan.

Introduction: The laparoscopic repair of a rare diaphragmatic Morgagni hernia using the reduced port approach is described.

Presentation Of Case: An 85-year-old female presented with a 2 days history of upper abdominal discomfort and loss of appetite. We diagnosed her condition as a Morgagni hernia by morphological studies and performed laparoscopic mesh placement with a multi-channel port and 12-mm port. This elderly patient had a rapid postoperative recovery. A 2-year follow-up CT showed no recurrence of the hernia.

Discussion: Recent trends in laparoscopic procedures have been toward minimizing the number of incisions to reduce invasiveness. This case indicated that the reduced port approach can be considered a suitable and safe procedure for treatment of Morgagni hernia.

Conclusion: The reduced port approach is a good indication for Morgagni hernia.
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http://dx.doi.org/10.1016/j.ijscr.2014.11.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275975PMC
December 2014

Dual-port distal gastrectomy for the early gastric cancer.

Surg Endosc 2015 Jun 27;29(6):1321-6. Epub 2014 Aug 27.

Department of Surgery, Shonai Amarume Hospital, Shouyou 1-1-1, Shonai Town, Higashi-Tagawa, 999-7782, Japan,

Background: Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port.

Methods: Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall.

Results: The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053).

Conclusions: Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.
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http://dx.doi.org/10.1007/s00464-014-3827-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422851PMC
June 2015

Use of multifunctional sigma-2 receptor ligand conjugates to trigger cancer-selective cell death signaling.

Cancer Res 2012 Jan 7;72(1):201-9. Epub 2011 Nov 7.

Department of Surgery, Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri 63110, USA.

One major challenge in the development of cancer therapeutics is the selective delivery of the drugs to their cellular targets. In the case of pancreatic cancer, the σ-2 receptor is a unique target that triggers apoptosis upon activation. We have previously developed a series of chemical compounds with high affinity for the σ-2 receptor and showed rapid internalization of the ligands. One particular specific ligand of the σ-2 receptor, SV119, binds to pancreatic cancer cells and induces target cell death in vitro and in vivo. In this study, we characterized the ability of SV119 to selectively deliver other death-inducing cargos to augment the cytotoxic properties of SV119 itself. When conjugated to SV119, small molecules that are known to interfere with intracellular prosurvival pathways retained their ability to induce cell death, the efficiency of which was enhanced by the combinatorial effect of SV119 delivered with its small molecule cargo. Our findings define a simple platform technology to increase the tumor-selective delivery of small molecule therapeutics via σ-2 ligands, permitting chemotherapeutic synergy that can optimize efficacy and patient benefit.
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http://dx.doi.org/10.1158/0008-5472.CAN-11-1354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251632PMC
January 2012

Single incision laparoscopic surgery for a life-threatening, cyst of liver.

Tokai J Exp Clin Med 2011 Apr 20;36(1):13-6. Epub 2011 Apr 20.

Shonai Amarume Hospital, Department of Surgery, Shouyou 1-1-1, Shounai Town, Higashi-Tagawa, Yamagata 999-7782, Japan.

Most liver cysts are asymptomatic and tend to have a benign clinical course. However, symptomatic or complicated liver cysts sometimes require surgical intervention. The laparoscopic approach is crucial and provides definitive treatment for such cysts. Recently, a trend of laparoscopic procedure has been toward minimizing the number of incisions. We performed single incision laparoscopic surgery (SILS) for a huge liver cyst with chronic heart failure and thrombosis of the inferior vena cava. An 83 year-old female presented with a month-long history of general fatigue and loss of appetite. She had a history of a huge liver cyst with chronic heart failure and this had been treated in another hospital eight months previously. Physical examination revealed a huge mass in the right upper abdomen without local tenderness or any peritoneal signs. A CT scan demonstrated simple liver cysts and compression of the IVC and right ventricule, with IVC thrombosis. After heparinization, we performed needle aspiration for cytology of the largest cyst and improvement of cardiac function. Six days later, we performed wide unroofing by Single Incision Laparoscopic Surgery (SILS). She was moved to a rehabilitation ward two weeks after surgery. No recurrence of the liver cyst was detected two months later.
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April 2011

Induction of Th17 cells in the tumor microenvironment improves survival in a murine model of pancreatic cancer.

J Immunol 2010 Oct 30;185(7):4063-71. Epub 2010 Aug 30.

Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.

An important mechanism by which pancreatic cancer avoids antitumor immunity is by recruiting regulatory T cells (Tregs) to the tumor microenvironment. Recent studies suggest that suppressor Tregs and effector Th17 cells share a common lineage and differentiate based on the presence of certain cytokines in the microenvironment. Because IL-6 in the presence of TGF-β has been shown to inhibit Treg development and induce Th17 cells, we hypothesized that altering the tumor cytokine environment could induce Th17 and reverse tumor-associated immune suppression. Pan02 murine pancreatic tumor cells that secrete TGF-β were transduced with the gene encoding IL-6. C57BL/6 mice were injected s.c. with wild-type (WT), empty vector (EV), or IL-6-transduced Pan02 cells (IL-6 Pan02) to investigate the impact of IL-6 secretion in the tumor microenvironment. Mice bearing IL-6 Pan02 tumors demonstrated significant delay in tumor growth and better overall median survival compared with mice bearing WT or EV Pan02 tumors. Immunohistochemical analysis demonstrated an increase in Th17 cells (CD4(+)IL-23R(+) cells and CD4(+)IL-17(+) cells) in tumors of the IL-6 Pan02 group compared with WT or EV Pan02 tumors. The upregulation of IL-17-secreting CD4(+) tumor-infiltrating lymphocytes was substantiated at the cellular level by flow cytometry and ELISPOT assay and mRNA level for retinoic acid-related orphan receptor γt and IL-23R by RT-PCR. Thus, the addition of IL-6 to the tumor microenvironment skews the balance toward Th17 cells in a murine model of pancreatic cancer. The delayed tumor growth and improved survival suggests that induction of Th17 in the tumor microenvironment produces an antitumor effect.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693576PMC
http://dx.doi.org/10.4049/jimmunol.0902609DOI Listing
October 2010

Targeting AKT with the proapoptotic peptide, TAT-CTMP: a novel strategy for the treatment of human pancreatic adenocarcinoma.

Int J Cancer 2009 Aug;125(4):942-51

Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.

Pancreatic adenocarcinoma carries an ominous prognosis and has little effective treatment. Several studies have demonstrated that the potently antiapoptotic phosphatidyl inositol 3'-kinase (PI3K)-protein kinase B/AKT pathway is active in pancreas cancer. A recent study identified an endogenous AKT antagonist, carboxyl terminal modulator protein (CTMP). CTMP inhibits the phosphorylation of AKT, preventing full activation of the kinase. We screened several cell permeable peptides from the N-terminal domain of CTMP (termed TAT-CTMP1-4) in vitro and found one that caused significant apoptosis in pancreatic adenocarcinoma cell lines. An inactive variant of this peptide was synthesized and used as a negative control. In all cell lines tested, TAT-CTMP4 induced a dose-dependent increase in apoptosis as detected by %-TUNEL positive cells and %-active caspase-3 (% active caspase-3 ranged from 31.2 to 61.9 at the highest dose tested (10 microM). A screening of various cell and tissue types revealed that the proapoptotic activity was highest in pancreatic adenocarcinoma. TAT-CTMP induced similar levels of active caspase-3 as several other known inducers of apoptosis: gemcitabine, radiation therapy, wortmannin and recombinant tumor necrosis factor (TNF)-alpha. No apoptosis was observed in donor human peripheral blood mononuclear cells (PBMC, p < 0.01). We further showed that TAT-CTMP4 could augment either gemcitabine chemotherapy or radiation therapy, standard therapies for pancreas cancer. Pancreatic adenocarcinoma xenografts treated with a single dose of TAT-CTMP4 demonstrated a marked increase in caspase-3 positive tumor cells when compared with untreated controls. Additionally, pancreatic adenocarcinoma allografts treated with intratumoral TAT-CTMP and systemic gemcitabine displayed a significantly smaller tumor burden while undergoing treatment than mice in control groups (p < 0.001). These data indicate that inhibiting AKT with CTMP may be of therapeutic benefit in the treatment of pancreatic adenocarcinoma and, when combined with established therapies, may result in an increase in tumor cell death.
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http://dx.doi.org/10.1002/ijc.24424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645501PMC
August 2009

Sigma-2 receptor ligands potentiate conventional chemotherapies and improve survival in models of pancreatic adenocarcinoma.

J Transl Med 2009 Mar 26;7:24. Epub 2009 Mar 26.

Department of Surgery, Washington University School of Medicine, 660 S, Euclid Avenue, Campus Box 8109, St, Louis, MO 63110, USA.

Background: We have previously reported that the sigma-2 receptor is highly expressed in pancreas cancer. Furthermore, we have demonstrated that sigma-2 receptor specific ligands induce apoptosis in a dose-dependent fashion. Here, we examined whether sigma-2 receptor ligands potentiate conventional chemotherapies such as gemcitabine and paclitaxel.

Methods: Mouse (Panc-02) and human (CFPAC-1, Panc-1, AsPC-1) pancreas cancer cell lines were used in this study. Apoptosis was determined by FACS or immunohistochemical analysis after TUNEL and Caspase-3 staining. Combination therapy with the sigma-2 ligand SV119 and the conventional chemotherapies gemcitabine and paclitaxel was evaluated in an allogenic animal model of pancreas cancer.

Results: SV119, gemcitabine, and paclitaxel induced apoptosis in a dose-dependent fashion in all pancreas cancer cell lines tested. Combinations demonstrated increases in apoptosis. Mice were treated with SV119 (1 mg/day) which was administered in combination with paclitaxel (300 microg/day) over 7 days to mice with established tumors. A survival benefit was observed with combination therapy (p = 0.0002). Every other day treatment of SV119 (1 mg/day) in combination with weekly treatment of gemcitabine (1.5 mg/week) for 2 weeks also showed a survival benefit (p = 0.046). Animals tolerated the combination therapy and no gross toxicity was noted in serum biochemistry data or on necropsy.

Conclusion: SV119 augments tumoricidal activity of paclitaxel and gemcitabine without major side effects. These results highlight the potential utility of the sigma-2 ligand as an adjuvant treatment in pancreas cancer.
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http://dx.doi.org/10.1186/1479-5876-7-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669042PMC
March 2009

Selective sigma-2 ligands preferentially bind to pancreatic adenocarcinomas: applications in diagnostic imaging and therapy.

Mol Cancer 2007 Jul 15;6:48. Epub 2007 Jul 15.

Department of Surgery, Washington University School of Medicine, Saint Louis, USA.

Background: Resistance to modern adjuvant treatment is in part due to the failure of programmed cell death. Therefore the molecules that execute the apoptotic program are potential targets for the development of anti-cancer therapeutics. The sigma-2 receptor has been found to be over-expressed in some types of malignant tumors, and, recently, small molecule ligands to the sigma-2 receptor were found to induce cancer cell apoptosis.

Results: The sigma-2 receptor was expressed at high levels in both human and murine pancreas cancer cell lines, with minimal or limited expression in normal tissues, including: brain, kidney, liver, lung, pancreas and spleen. Micro-PET imaging was used to demonstrate that the sigma-2 receptor was preferentially expressed in tumor as opposed to normal tissues in pancreas tumor allograft-bearing mice. Two structurally distinct sigma-2 receptor ligands, SV119 and WC26, were found to induce apoptosis to mice and human pancreatic cancer cells in vitro and in vivo. Sigma-2 receptor ligands induced apoptosis in a dose dependent fashion in all pancreatic cell lines tested. At the highest dose tested (10 muM), all sigma-2 receptor ligands induced 10-20% apoptosis in all pancreatic cancer cell lines tested (p < 0.05). In pancreas tumor allograft-bearing mice, a single bolus dose of WC26 caused approximately 50% apoptosis in the tumor compared to no appreciable apoptosis in tumor-bearing, vehicle-injected control animals (p < 0.0001). WC26 significantly slowed tumor growth after a 5 day treatment compared to vehicle-injected control animals (p < 0.0001) and blood chemistry panels suggested that there is minimal peripheral toxicity.

Conclusion: We demonstrate a novel therapeutic strategy that induces a significant increase in pancreas cancer cell death. This strategy highlights a new potential target for the treatment of pancreas cancer, which has little in the way of effective treatments.
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http://dx.doi.org/10.1186/1476-4598-6-48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939854PMC
July 2007

TAT-Bim induces extensive apoptosis in cancer cells.

Ann Surg Oncol 2007 May 6;14(5):1763-71. Epub 2007 Jan 6.

Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.

Background: Suppression of apoptosis is central to the development of cancer and is associated with resistance to modern adjuvant treatments. Therefore, molecules and pathways of apoptotic processes are critical targets for the development of anti-cancer therapeutics. Since apoptosis is executed by intracellular proteins, molecular approaches must incorporate a method to deliver the treatment into the tumor cells.

Methods: We utilized a peptide that contains two domains, a peptide transduction domain derived from the HIV-1 TAT protein and a biological effector domain, the BH3 domain from the pro-apoptotic Bcl-2 family member Bim. We examined whether this construct (TAT-Bim) induced apoptosis in several cancer cell lines (T-cell lymphoma (EL4), pancreatic cancer (Panc-02), and melanoma (B16)) and whether TAT-Bim treatment synergized with radiation. A mutant TAT-Bim peptide with no biologic activity (TAT-Bim-inactive) was used as a control. C57/BL6 mice were challenged with syngeneic cancer cell lines and the effects of intratumoral TAT-Bim injection on tumor growth and host survival were determined.

Results: TAT-Bim was internalized by all cancer cells within two hours. TAT-Bim resulted in apoptosis in a dose dependent fashion in all cell lines and sublethal irradiation augmented the effects of TAT-Bim induced apoptosis. TAT-Bim significantly slowed tumor growth in murine models of pancreatic cancer and melanoma.

Conclusion: TAT-Bim exemplifies a strategy for cancer therapy that involves inducing apoptosis by antagonizing the endogenous anti-apoptotic machinery. Small peptide therapeutics, in combination with traditional adjuvant therapies such as radiation, may provide a valuable 'second hit' and drive tumor cells into programmed cell death.
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http://dx.doi.org/10.1245/s10434-006-9298-zDOI Listing
May 2007

A case report: spontaneous rupture of dissecting aneurysm of the middle colic artery.

Tokai J Exp Clin Med 2004 Dec;29(4):155-8

Osamu CHINO, Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan.

Aneurysms of the superior mesenteric artery branches are rarely reported, even among them colic artery aneurysms are seldom. We report a case of 78-year-old male with ruptured dissecting aneurysm of middle colic artery. The patient complained abdominal pain and nausea during hospital stay for renal stone. The patient suddenly developed severe abdominal pain, leading to shock. He underwent emergency surgery under a preoperative diagnosis of intraperitoneal hemorrhage. At exploratory laparotomy, a large hematoma involving the mesentery root of the transverse colon was associated with a ruptured aneurysm measuring 15 x 10 mm in size, which was located to the mid-portion of middle colic artery. Right-hemicolectomy was carried out because of ischemic changes in the ascending colon. Histological examination demonstrated a ruptured dissecting aneurysm of the middle colic artery approximately 5 cm in length, associated with destruction of the tunica interna and media. The aneurysm was thought to result from idiopathic segmental arterial mediolysis, because no definitive evidence of atherosclerosis or arteritis was observed.
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December 2004

Clinicopathological significance of sialyl Lex expression in human gallbladder carcinoma.

Oncol Rep 2004 Jun;11(6):1139-43

Department of Surgery, Tokai University School of Medicine, Isehara 259-1193, Japan.

Sialyl Lex antigen, a member of a family of high molecular weight glycoproteins, is a ligand for E-selectin and may play an important role in tumor metastasis. However, expression patterns of sialyl Lex have not yet been established in human gallbladder carcinomas. In this study, we analyzed the clinicopathological significance of sialyl Lex expression and patients' prognosis in cases of human gallbladder adenocarcinoma. Sialyl Lex immunoreactivity was detected not only in cancer cells (cytoplasmic type; 51.9%, 28/54) but also in cancer stroma (stromal type; 38.9%, 21/54). Stromal sialyl Lex expression was detected in 50.0% (20/40) and 7.1% (1/14) of T2-4 and T1 cancers, respectively (p<0.05). Stromal sialyl Lex-positive gallbladder cancers frequently showed lymphatic invasion, venous invasion and lymph node metastasis (54.3, 50.0 and 60.0%, respectively) (p<0.05), and the expression was associated with a poor outcome. Sialyl Lex expression plays important roles in the vascular invasion and metastasis of human gallbladder adenocarcinoma.
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June 2004

Undifferentiated spindle and giant cell carcinoma of the common bile duct.

Tokai J Exp Clin Med 2003 Oct;28(3):127-30

Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

Undifferentiated spindle and giant cell carcinoma of the common bile duct has not been reported previously. We present here a case of 71-year-old man with the undifferentiated spindle and giant cell carcinoma of the common bile duct, including immunohistochemical findings. A nodular infiltrating tumor was located at the lower portion of the extrahepatic bile duct, and measured 1.2 x 0.6 cm in size. Histologically, the tumor was composed of proliferated sarcomatoid spindle tumor cells. Numerous multinucleated giant cells were intermingled with the sarcomatoid spindle tumor cells. Immunohistochemically, the tumor cells were positive for both cytokeratin and vimentin. We speculated that the tumor originated from epithelial cells, and showed sarcomatoid neplastic changes.
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October 2003

Epidermal growth factor receptor expression in human pancreatic cancer: Significance for liver metastasis.

Int J Mol Med 2003 Mar;11(3):305-9

Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan.

Pancreatic cancer is a malignant tumor with an extremely poor prognosis. The mechanisms of the aggressive growth and metastasis are not yet extensively understood. Over-expression of epidermal growth factor receptor (EGFR) was suggested to be associated with malignant transformation of pancreatic cancer. We examined EGFR expression in 77 cases of invasive ductal adenocarcinoma of the pancreas, and analyzed the relation between the EGFR expression pattern and clinicopathological factors. EGFR immunoreactivity was detected in 41.6% (32/77) of human pancreatic cancers; i.e. diffuse expression in 32.5% (25/77) and focal expression in 9.1% (7/77). The EGFR expression was associated with gender (p<0.05), histological differentiation (p<0.05) and metastatic status of TNM classification (p<0.01). The observations suggested that EGFR expression plays important roles in metastasis, especially liver metastasis and recurrence of human pancreatic cancer.
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March 2003
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