Publications by authors named "Rai Shimoyama"

27 Publications

  • Page 1 of 1

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

Resolution of fibrosis by siRNA HSP47 in vitamin A-coupled liposomes induces regeneration of chronically injured livers.

J Gastroenterol Hepatol 2021 Jun 20. Epub 2021 Jun 20.

Department of Molecular Target Exploration, School of Medicine, Sapporo Medical University, Sapporo, Japan.

Background And Aim: In chronic hepatic diseases where treatment strategies are not available, deposited fibrotic tissues deteriorate the intrinsic regeneration capacity of the liver by creating special restrictions. Thus, if the anti-fibrosis modality is efficiently applied, the regeneration capacity of the liver should be reactivated even in such refractory hepatic diseases.

Methods: Rat liver fibrosis was induced by dimethyl-nitrosamine (DMN). Another liver fibrosis model was established in CCl4 treated Sox9CreERT2ROSA26: YFP mice. To resolve hepatic fibrosis, vitamin A-coupled liposomes containing siRNA HSP47 (VA-liposome siHSP47) were employed. EpCAM + hepatic progenitor cells from GFP rats were transplanted to DMN rat liver to examine their trans-differentiation into hepatic cells after resolution of liver fibrosis.

Results: Even under continuous exposure to such strong hepatotoxin as DMN, rats undergoing VA-liposome siHSP47 treatment showed an increment of DNA synthesis of hepatocytes with the concomitant restoration of impaired liver weight and normalization of albumin levels. These results were consistent with the observation that GFP + EpCAM hepatic progenitor cells transplanted to DMN rat liver, trans-differentiated into GFP + mature hepatic cells after VA-liposome siHSP47 treatment. Another rodent model also proved regeneration potential of the fibrotic liver in CCl4 administered Sox9CreERT2ROSA26: YFP mice, VA-liposome siHSP47 treatment-induced restoration of liver weight and trans-differentiation of YEP + Sox9 + cells into YFP + hepatic cells, although because of relatively mild hepatotoxicity of CCl4, undamaged hepatocytes also proliferated.

Conclusions: These results demonstrated that regeneration of chronically damaged liver indeed occurs after anti-fibrosis treatment even under continuous exposure to hepatotoxin, which promises a significant benefit of the anti-fibrosis therapy for refractory liver diseases.
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http://dx.doi.org/10.1111/jgh.15587DOI Listing
June 2021

Chemoprevention of pancreatic cancer by inhibition of glutathione-S transferase P1.

Invest New Drugs 2021 May 24. Epub 2021 May 24.

Division of Gastroenterology, Shonan Kamakura General Hospital, 247-8533, Kamakura, Japan.

Pancreatic cancer is among the most refractory malignancies with poor prognosis. Thus, preventive approaches, in addition to the development of novel therapeutic strategies are essential for this type of cancer. KRAS mutations occur very early in the development of pancreatic cancers and could be targeted for its prevention, yet specific inhibitors for mutated KRAS are lacking. Accordingly, Glutathione-S Transferase p1 (GSTP1), which we recently found to be an autocrine stimulator of mutated KRAS signaling, is predicted to be an alternative target for chemoprevention of pancreatic cancer. In this study, chemopreventive effects of O-Hexadecyl-γ-glutamyl-S-benzyl-cysteinyl-D-phenyl glycine-Ethylester (HGBPE), which we previously synthesized to inhibit GSTP1 activity, was analyzed for its effect on the prevention of a rat pancreatic carcinogenesis model induced by 7,12-dimethyl-benzanthracene (DMBA). Rats administered with DMBA were grouped into five cohorts. In the treated group I, which was treated neither with HGBPE nor vehicle, sequential appearance of precancerous lesions, ductal complexes, and adenocarcinoma was confirmed as previously reported. We also confirmed in this group that mutations of KRAS and expression of GSTP1 simultaneously occurred in the ductal complex. To rats of groups II and IV, HGBPE was administered, and vehicle to those of group III and V. In groups of II and IV, the incidence of both ductal complex and adenocarcinoma were significantly lower than those in groups III and V. These data clearly suggest the efficacy of HGBP as a potential chemopreventive agent for pancreatic cancer.
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http://dx.doi.org/10.1007/s10637-021-01129-yDOI Listing
May 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

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

A CRAF/glutathione-S-transferase P1 complex sustains autocrine growth of cancers with and mutations.

Proc Natl Acad Sci U S A 2020 08 27;117(32):19435-19445. Epub 2020 Jul 27.

Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461.

The Ras/RAF/MEK/ERK pathway is an essential signaling cascade for various refractory cancers, such as those with mutant (m) and (m). However, there are unsolved ambiguities underlying mechanisms for this growth signaling thereby creating therapeutic complications. This study shows that a vital component of the pathway CRAF is directly impacted by an end product of the cascade, glutathione transferases (GST) P1 (GSTP1), driving a previously unrecognized autocrine cycle that sustains proliferation of m and m cancer cells, independent of oncogenic stimuli. The CRAF interaction with GSTP1 occurs at its N-terminal regulatory domain, CR1 motif, resulting in its stabilization, enhanced dimerization, and augmented catalytic activity. Consistent with the autocrine cycle scheme, silencing GSTP1 brought about significant suppression of proliferation of m and m cells in vitro and suppressed tumorigenesis of the xenografted m tumor in vivo. GSTP1 knockout mice showed significantly impaired carcinogenesis of m colon cancer. Consequently, hindering the autocrine loop by targeting CRAF/GSTP1 interactions should provide innovative therapeutic modalities for these cancers.
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http://dx.doi.org/10.1073/pnas.2000361117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430992PMC
August 2020

A Surgical Case of Bronchial Artery Aneurysm Connecting to a Pulmonary Artery and Vein Complicated by Racemose Hemangioma.

Ann Thorac Cardiovasc Surg 2020 May 18. Epub 2020 May 18.

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

We report a surgical case of bronchial artery aneurysm (BAA) that directly connected to a pulmonary artery and a pulmonary vein through an abnormal vessel. It was complicated by racemose hemangioma. This is a rare vascular malformation. An 82-year-old female had a large BAA that was found incidentally. First, we consider treating the BAA with embolization by interventional radiology (IVR). However, because of strong meandering of the bronchial artery, we could not advance a microcatheter into the BAA. Therefore, a surgical operation was performed through a standard posterior lateral thoracotomy. The BAA was located between the upper and lower lobes and directly connected to the pulmonary artery. Some bronchial artery branches that provided inflow to the aneurysm were ligated, and the abnormal vessel that connected the BAA to the upper pulmonary vein was ligated easily. A fistula between the BAA and pulmonary artery was sutured by the cardiovascular surgeon using an artificial cardiopulmonary device, with permissive stenosis of A2b (ascending A2).
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http://dx.doi.org/10.5761/atcs.cr.19-00302DOI Listing
May 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

Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review.

Case Rep Oncol Med 2018 19;2018:9851397. Epub 2018 Dec 19.

Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura City, Kanagawa 247-8533, Japan.

Background: Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known.

Case Presentation: We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective.

Conclusions: With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.
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http://dx.doi.org/10.1155/2018/9851397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313998PMC
December 2018

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

Panitumumab in combination with irinotecan plus S-1 (IRIS) as second-line therapy for metastatic colorectal cancer.

Cancer Chemother Pharmacol 2016 Aug 24;78(2):397-403. Epub 2016 Jun 24.

Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.

Background: Irinotecan plus S-1 (IRIS) is the only oral fluoropyrimidine-based regimen reported to be non-inferior to FOLFIRI and widely used in clinical practice for metastatic colorectal cancer (mCRC) patients. However, the combination of IRIS plus an anti-EGFR agent has not been evaluated previously. This study aimed to investigate the feasibility and efficacy of IRIS with panitumumab as second-line therapy for wild-type KRAS mCRC.

Methods: Main inclusion criteria were patients with wild-type KRAS mCRC refractory to one prior chemotherapy regimen for mCRC, ECOG PS 0-2, and age ≥20 years. Patients received panitumumab (6 mg/kg) and irinotecan (100 mg/m(2)) on days 1 and 15 and S-1 (40-60 mg according to body surface area) twice daily for 2 weeks, repeated every 4 weeks. The primary endpoint was the feasibility of the therapy. The secondary endpoints were response rate (RR), progression-free survival (PFS), and overall survival (OS).

Results: A total of 36 patients received protocol treatment in eight centers. Of these, 23 patients (63.9 %) completed protocol treatment, demonstrating achievement of the primary endpoint. The most frequent grade 3/4 toxicities were diarrhea (16.7 %), acne-like rash (13.9 %), and neutropenia (11.1 %). The overall RR was 33.3 % (12/36). Of these patients, five underwent conversion surgery. Median PFS and OS were 9.5 months (95 % CI 3.5-15.4 months) and 20.1 months (95 % CI 16.7-23.2 months), respectively.

Conclusion: IRIS plus panitumumab has an acceptable toxicity profile and a promising efficacy in patients with previously treated wild-type KRAS mCRC. Accordingly, this regimen can be an additional treatment option for second-line chemotherapy in wild-type KRAS mCRC.
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http://dx.doi.org/10.1007/s00280-016-3096-5DOI Listing
August 2016

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

[Early diagnosis of capecitabine-induced acute leukoencephalopathy by using diffusion-weighted MRI].

Gan To Kagaku Ryoho 2014 Oct;41(10):1251-3

Dept. of Surgery, Shonankamakura General Hospital.

A 63-year-old woman with colon cancer who was treated with capecitabine as adjuvant chemotherapy presented with vertigo on day 5, and dysarthria and dysphagia on day 7 of the treatment. Diffusion-weighted magnetic resonance imaging of the brain revealed high signal intensity in the corpus callosum and corona radiata. The patient was diagnosed with acute leukoencephalopathy, and the capecitabine treatment was discontinued. Her symptoms recovered immediately. On the basis of these findings, it can be concluded that diffusion-weighted imaging is useful for the early detection and diagnosis of acute leukoencephalopathy.
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October 2014

Protocol-based strategy for endovascular repair of ruptured abdominal aortic aneurysms.

Ann Vasc Dis 2013 20;6(2):169-74. Epub 2013 Apr 20.

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

Objective: Compared with conventional open surgery (COS), endovascular aneurysm repair (EVAR) has been reported to decrease the 30-day mortality rate in patients with ruptured abdominal aortic aneurysms (rAAAs). We developed an EVAR-first strategy for rAAAs that incorporates the Shonan ruptured abdominal aortic aneurysm protocol (SRAP). We describe short-term results with this protocol at our institution and compare them with outcomes in patients who underwent COS.

Methods: The records of all 57 patients in whom a rAAA was repaired during a 7-year period were reviewed retrospectively. Patients in the COS group (n = 30) were treated between January 2005 and December 2009; those in the SRAP group (n = 27) were treated between January 2010 and March 2012. The two groups were compared with respect to patient characteristics at admission, including severity of condition; operative and in-hospital variables; and 30-day mortality.

Results: The baseline patient characteristics in the COS and SRAP groups were similar except that the SRAP group had a significantly higher rate of cerebrovascular disease. The 30-day mortality rate was significantly higher in the COS group (43% vs. 19%), as were the intraoperative mortality rate (27% vs. 5%) and the in-hospital mortality rate (57% vs. 26%; P < 0.05 for all comparisons). The technical success rate for EVAR was 96%; no conversions to open surgery were required.

Conclusions: Use of the SRAP is a promising strategy for improving initial outcomes in patients with rAAAs.
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http://dx.doi.org/10.3400/avd.oa.12.00085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692986PMC
July 2013

Weekly paclitaxel for heavily treated advanced or recurrent gastric cancer refractory to fluorouracil, irinotecan, and cisplatin.

Gastric Cancer 2009 5;12(4):206-11. Epub 2010 Jan 5.

Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan.

Background: Although triweekly administration of paclitaxel is approved for gastric cancer in Japan, currently, the drug is often delivered with a weekly schedule because of the equivalent efficacy and lesser toxicity of this dosing schedule as compared with the triweekly administration schedule. Weekly administration of paclitaxel as second-line or first-line chemotherapy for gastric cancer has been reported to yield a response rate of about 20%. Because there has been no report of the efficacy of weekly paclitaxel in the third-line setting, this retrospective study investigated the efficacy and toxicities of weekly paclitaxel used in the third-line setting for the treatment of gastric cancer refractory to all three key drugs, fluorouracil, irinotecan, and cisplatin, used in clinical practice.

Methods: In 85 patients with advanced or recurrent histologically confirmed gastric adenocarcinoma who had failed to respond to prior chemotherapy regimens containing fluorouracil, irinotecan, and cisplatin, paclitaxel (80 mg/m(2)) was administered weekly, three times, for 3 weeks out of 4.

Results: The median number of courses was 3 (range, 1-38). The overall response rate was 23.2% (19/82) in the patients with measurable lesions, and ascites disappeared in 15 of 48 patients (31.3%). Progression-free survival was 105 days and the median survival time was 201 days from the initiation of paclitaxel administration. Grade 3 or 4 leukopenia, neutropenia, anemia, and thrombocytopenia were observed in 25 (29%), 25 (29%), 37 (44%), and 3 (4%) patients. Other, nonhematological, toxicities were nausea, vomiting, anorexia, sensory neuropathy, fatigue, and febrile neutropenia.

Conclusion: Weekly paclitaxel administration shows activity against advanced gastric cancer also in the third-line setting.
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http://dx.doi.org/10.1007/s10120-009-0524-9DOI Listing
March 2010

Single nucleotide polymorphism in ABCG2 is associated with irinotecan-induced severe myelosuppression.

J Hum Genet 2009 Oct 21;54(10):572-80. Epub 2009 Aug 21.

Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.

Irinotecan is an anti-neoplastic agent that is widely used for treating colorectal and lung cancers, but often causes toxicities such as severe myelosuppression and diarrhea. In this study, we performed a two-stage case-control association study for irinotecan-induced severe myelosuppression (grades 3 and 4). In the first stage, 23 patients who developed severe myelosuppression and 58 patients who did not develop any toxicity were examined for 170 single nucleotide polymorphisms (SNPs) in 14 genes involved in the metabolism and transport of irinotecan. A total of five SNPs were identified to show the possible association with severe myelosuppression (P(Fisher)<0.01) and were further examined in 7 cases and 20 controls in the second stage of the study. An intronic SNP, rs2622604, in ABCG2 showed P(Fisher)=0.0419 in the second stage and indicated a significant association with severe myelosuppression in the combined study (P(Fisher)=0.000237; P(Corrected)=0.036). Although only limited subjects were investigated, our results suggested that a genetic polymorphism in ABCG2 might alter the transport activity for the drug and elevate the systemic circulation level of irinotecan, leading to severe myelosuppression.
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http://dx.doi.org/10.1038/jhg.2009.80DOI Listing
October 2009

Pooled analysis of the reports of erlotinib after failure of gefitinib for non-small cell lung cancer.

Lung Cancer 2010 Apr 21;68(1):99-104. Epub 2009 Jun 21.

Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.

Purpose: The use of erlotinib after gefitinib failure in patients with non-small cell lung cancer (NSCLC) is not clearly clarified in clinical practice. We sought to compile the available clinical reports to better understand the effectiveness of erlotinib after failure of gefitinib.

Methods: We searched published reports including erlotinib and gefitinib. Eleven reports were identified (published between November 2004 and December 2008). Advanced NSCLC who documented progressive disease (PD) for gefitinib 250 mg/day, received erlotinib 150 mg once daily.

Results: A total of 106 patients were pooled from these studies. Asian was observed in 70.8%, women in 72.6%, adenocarcinoma in 85.1%, never smoker in 75.3%. In erlotinib therapy, there was observed in 9.9% in partial response (PR), 18.9% in stable disease (SD) and 70.8% in PD. Disease control (DC) rate for gefitinib and erlotinib was 71.7% and 29.2%, respectively. No significant difference of disease control rate (37.5% vs 21.7%, p=0.1503) and response rate (6.3% vs 8.7%, p=1.000) was observed between patients with EGFR mutations and those with wild type EGFR. The significantly different response on erlotinib therapy was observed in patients who had shown SD for gefitinib therapy (p=0.0095) and those who had a PFS of more than 6 months during gefitinib treatment (p=0.0261). The common toxicities were skin rash and diarrhea.

Conclusion: Erlotinib may produce clinical benefits in patients who had shown long SD on prior gefitinib therapy. Moreover, EGFR mutations were not positive predictors for erlotinib response after gefitinib failure.
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http://dx.doi.org/10.1016/j.lungcan.2009.05.006DOI Listing
April 2010

[A case of therapy for bevacizumab-induced hypertension].

Gan To Kagaku Ryoho 2009 Jan;36(1):143-5

Dept. of Pharmacy, Shonan Kamakura General Hospital, Japan.

The patient was a 73-year-old female with sigmoid colon cancer, who underwent resection of sigmoid colon cancer and liver metastasis. She was treated with 5-fluorouracil and levofolinate calcium(sLV5FU2)plus bevacizumab(BV) for advanced colorectal cancer. She was treated with angiotensin II receptor blocker(ARB)because hersystolic blood pressure was 200 mmHg and her diastolic blood pressure 100 mmHg after five courses of BV therapy. As a result, her blood pressure was controlled. It was possible to administer BV. Therefore, ARB may be the preferred antihypertensive agent in the management of BV-induced hypertension.
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January 2009
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