Publications by authors named "Takashi Ishibashi"

43 Publications

Granular cell tumor coexisting with adenocarcinoma in the stomach: Report of a rare case.

Ann Med Surg (Lond) 2021 May 26;65:102271. Epub 2021 Apr 26.

Division of Surgery Gastroentelogical Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: and importance: Granular cell tumor (GCT) is a benign, mesenchymal tumor that originates from Schwann cells.

Case Presentation: A 75-year-old Japanese woman was referred to our hospital due to epigastric discomfort. Upper gastrointestinal endoscopy revealed an ulcerated cancer lesion, approximately 1.2 cm in diameter, at the angle of the stomach in the posterior gastric wall and a yellowish submucosal tumor, 5 mm in diameter, near an anal ulcerated lesion. Based on these findings, the patient was scheduled for laparoscopic distal gastrectomy and lymph node dissection. The pathological diagnosis was a moderately differentiated tubular adenocarcinoma invading mucosal stroma without lymph node metastasis and GCT in the stomach. Tumor cells were positive for S-100 and were consistent with the characteristics of GCT.

Clinical Discussion: To the best of our knowledge, this is an extremely rare case with reports of only 6 cases of such a combination, including our case.

Conclusions: We believe that the coexistence of a GCT and gastric cancer in our patient was accidental and that there was no relation between them.
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http://dx.doi.org/10.1016/j.amsu.2021.102271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100089PMC
May 2021

Collision Tumor Comprising Primary Malignant Lymphoma and Adenocarcinoma in the Ascending Colon.

Case Rep Gastroenterol 2021 Jan-Apr;15(1):379-388. Epub 2021 Mar 18.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, Osaka, Japan.

We describe the case of a 78-year-old man with collision tumor from the primary malignant lymphoma and adenocarcinoma in the ascending colon. He suffered anemia from sigmoid colon cancer, and colonoscopy revealed early-stage colorectal cancer with a diameter of 20 mm in the cecum, the biopsy specimen showed moderately differentiated adenocarcinoma. Contrast-enhanced computed tomography (CT) revealed bowel wall thickening with contrast enhancement at the cecum; however, no lymph node and organ metastases were found. As above, we performed laparoscopic ileocecal resection with D3 lymph node dissection. The postoperative course was uneventful, and he was discharged from the hospital on postoperative day 11. Histopathological findings were moderately differentiated adenocarcinoma which invaded the muscularis propria and serosa from the submucosa, while the adjacent serosa showed a highly diffuse proliferation of atypical cells with an irregular nuclear-to-cytoplasmic ratio. Besides, immunohistochemical staining findings were diffuse large B-cell lymphoma, and diffuse large B-cell lymphoma was coexistent with moderately differentiated adenocarcinoma. We treated the patient with cyclophosphamide, doxorubicin, vincristine, and prednisolone in combination with rituximab (R-CHOP therapy) during 3 months postoperatively. When the 8 courses had been completed, postoperative positron emission tomography-CT (PET-CT) confirmed complete response, and the disease control has been doing well. Malignant lymphoma of the colorectal region is relative rare, and the occurrence of synchronous lymphoma and adenocarcinoma of the colon is also rare. Furthermore, collision tumor by these different entities is very unusual. We presented here such a case. The accurate clinical determination of the dominant tumor and a close follow-up is required for proper treatment in these cases.
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http://dx.doi.org/10.1159/000513972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077522PMC
March 2021

Commercial Production of Astaxanthin with Paracoccus carotinifaciens.

Adv Exp Med Biol 2021 ;1261:11-20

Biotechnology R&D Group, HPM Research & Development, Department High Performance Materials Company, ENEOS Corporation, Naka-ku, Yokohama, Japan.

Paracoccus carotinifaciens is an aerobic Gram-negative bacterium that exhibits motility by a peritrichous flagellum. It produces a carotenoid mixture containing astaxanthin as the main component. Selective breeding of P. carotinifaciens has been performed using classical techniques for mutation induction, such as chemical treatment and ultraviolet irradiation, and not using genetic engineering technology. The commercial production of astaxanthin with P. carotinifaciens has been established by optimizing fermentation medium and conditions in the process. Dehydrated P. carotinifaciens is used as a coloring agent for farmed fish and egg yolks. Compared with the administration of chemically synthesized astaxanthin, dehydrated P. carotinifaciens imparts more natural coloration, which is favored by consumers. In addition, astaxanthin-rich carotenoid extracts (ARE) derived from P. carotinifaciens are developed for human nutrition. Animal and clinical studies with ARE for evaluating its efficacy have been conducted and suggested that ARE would be useful for preventing anxiety, stomach ulcer, and retinal damage, as well as improving cognitive function. The efficacy is anticipated to result from not only astaxanthin but also other carotenoids in ARE, such as adonirubin and adonixanthin, in some studies. Hence, astaxanthin commercially produced with P. carotinifaciens has been applied widely in animals and humans.
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http://dx.doi.org/10.1007/978-981-15-7360-6_2DOI Listing
April 2021

Total pancreatectomy for pancreatic remnant carcinoma five years after pancreaticoduodenectomy: Report a case.

Int J Surg Case Rep 2021 Apr 20;81:105795. Epub 2021 Mar 20.

Department of Gastroenterological Center Surgery, Shunjukai Shiroyama Hospital, Osaka, Japan.

Introduction And Importance: The prognosis of non-invasive intraductal papillary mucinous neoplasma (IPMN) is better than that of pancreatic cancer. However, if the first surgical finding revealed an invasive IPMC, the risk of recurrence was found to be 7-21%.

Case Presentation: A 76-year-old Japanese man had undergone subtotal stomach-preserving pancreaticoduodenectomy for intraductal papillary mucinous carcinoma non-invasive type at our hospital. No signs of adenocarcinoma at the resection margin were found by pathological examination of frozen sections. Five years later, a blood analysis showed increased serum CA19-9 level. A contrast-enhanced computed tomography scan of the abdomen revealed a mass adjacent to the pancreaticogastrostomy anastomosis. The patient underwent a total pancreatectomy. The tumor was identified as a recurrent IPMC with subserosal invasion, but without nodal involvement. The resection margins were negative. The patient's postoperative course was uneventful, and he was discharged after 12 days. He is being followed up without adjuvant chemotherapy.

Discussion: The prognosis of IPMN is better than that of pancreatic cancer. However the risk of recurrence in invasive IPMC was found to be 7-21%. Therefore, IPMC must be surveilled every three months using tumor markers and imaging. Local recurrence in remnant pancreas is usually treated with systemic therapy. The median long-term survival after total pancreatectomy (range 7-24 months) was shown to be better than when chemotherapy alone was used (range 10-13 months).

Conclusion: We chose secondary surgery in term of survival time although there are quality of life drawbacks that currently make total pancreatectomy more inappropriate in patients than chemotherapy.
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http://dx.doi.org/10.1016/j.ijscr.2021.105795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024913PMC
April 2021

Malignant solitary fibrous tumor of the breast.

Breast J 2021 04 28;27(4):391-393. Epub 2021 Jan 28.

Department of Pathology, Osaka Medical College, Osaka, Japan.

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http://dx.doi.org/10.1111/tbj.14175DOI Listing
April 2021

Combined Intraoperative Identification and Monitoring of Recurrent Laryngeal Nerve Paresis during Minimally Invasive Esophagectomy: Surgical Technique Using Nerve Integrity Monitoring for Esophageal Carcinoma.

Case Rep Gastroenterol 2020 Sep-Dec;14(3):644-651. Epub 2020 Nov 30.

Division of Surgery Gastroenterology, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Recurrent laryngeal palsy occurs after No. 106 rec RL lymphadenectomy procedure, which is assumed to cause postoperative respiratory complications. A 71-year-old Japanese man with T1b N0 M0 stage 1 esophageal cancer was scheduled for thoracoscopic esophagectomy with two-field lymph node dissection using nerve integrity monitoring (NIM). The patient demonstrated an uneventful postoperative course with 56 days remission. Under general anesthesia conditions, a single-lumen intubation tube was inserted for NIM. The automatic periodic stimulation electrode was placed on the bilateral vagus nerves on the left and right, respectively. The NIM had set and enabled the identification of the nerve accurately and continuous intraoperative nerve monitoring using impulses from the stimulation probe. The postoperative outcomes and comparison of the potential amplitudes of electromyography were observed while no postoperative vocal cord paresis was present. Combined intraoperative identification and monitoring of recurrent laryngeal nerve significantly changes the quality of the lymphadenectomy procedure and is a promising optical imaging technique. It has gained recognition for being able to reduce or prevent recurrent laryngeal nerve paralysis. It was considered a reasonable method, but it has been superseded by NIM, which is a novel technology.
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http://dx.doi.org/10.1159/000510209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772838PMC
November 2020

Laparoscopic cholecystectomy for cholecystitis using direct gallbladder indocyanine green injection fluorescence cholangiography: A case report.

Ann Med Surg (Lond) 2020 Sep 4;57:218-222. Epub 2020 Aug 4.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

: Laparoscopic cholecystectomy is the treatment of choice for almost all biliary diseases. We present a novel technique using near-infrared fluorescence imaging for laparoscopic cholecystectomy.

: A 78-year-old woman diagnosed with acute cholecystitis (Grade II) was scheduled for emergency laparoscopy according to Tokyo Guidelines 2018. We performed a direct percutaneous drainage of the gallbladder to grasp the gallbladder itself. Subsequently, indocyanine green was administered into the gallbladder through the same tube, and the cystic and common bile ducts could be easily detected. The postoperative course was good, and the patient was discharged in remission nine days after the surgery.

: Real-time fluorescence cholangiography with indocyanine green is reliable for biliary anatomy visualization before the dissection of the Calot's triangle. Our method of indocyanine green injection into the same drainage catheter does not require pre-preparation and can be simultaneously performed with drainage intraoperatively. This surgical technique is simple, straightforward, and effective and can be useful in intraoperative decision-making, especially during laparoscopic cholecystectomy.
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http://dx.doi.org/10.1016/j.amsu.2020.07.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415627PMC
September 2020

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method).

Case Rep Gastroenterol 2020 Jan-Apr;14(1):248-254. Epub 2020 Apr 29.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

A 58-year-old Japanese man, with a body mass index of 41.7 kg/m2 (height: 179.8 cm; weight: 133.8 kg), underwent a laparoscopic pull-through procedure with delayed coloanal anastomosis performed in two surgical stages for lower rectal cancer. This method was selected because the volume of the abdominal wall was fairly thick and it would have been impossible to perform diverting ileostomy and colostomy, which are routinely conducted. First, a colonic pull-through segment of about 10 cm was left outside the anal canal without any tension and was fixed by sutures under indocyanine green fluorescence imaging (ICG FI). The second surgical stage was performed 10 days after the first operation under general anesthesia. Final coloanal anastomosis was performed with near-infrared light without diverting the stoma under ICG FI. The patient demonstrated a good postoperative course and was discharged from our hospital in remission 15 days after the latest operation. We could inspect the coloanal flow of the anastomosis under ICG FI before the reconstruction. This procedure was considered to be a standard method, but it was overtaken by new technology, ICG FI. This procedure is an ultimate stomaless surgery for ultralow rectal cancer that can be performed in selected cases, such as in patients with a high body mass index and with hope for stomaless operation.
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http://dx.doi.org/10.1159/000507076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252201PMC
April 2020

Successful multi-stage treatment of stoma limb perforation following Hartmann's operation report a case.

Surg Case Rep 2020 May 14;6(1):102. Epub 2020 May 14.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino city, Osaka, 583-0872, Japan.

Background: Stoma-related complications are not rare, whereas the spontaneous perforation of the stoma limb is relatively rare. Herein, we report a case of stoma limb perforation which occurred after Hartmann's operation.

Case Presentation: A 50-year-old Japanese man presented to our Hospital with acute and severe abdominal pain. Abdominal computed tomography (CT) scan revealed that an abscess with free air was formed around the sigmoid colon. We performed Hartmann's operation, whereas he experienced redness, purulent discharge, and swelling around the colostomy at 10 days postoperatively. The contrast-enhanced CT scan of the abdomen revealed an abscess formation with air around the colostomy. He was diagnosed with an abdominal wall abscess due to perforation of the stoma limb. After the drainage, his symptoms were ameliorated by oral analgesics, anti-inflammatory drugs, and prophylactic antibiotic. Four months after the first operation, we performed a closedown of the sigmoid colostomy and fistula resection. The patient's postoperative course was uneventful, and he was discharged 14 days later.

Conclusions: This case depicts rare complications of Hartmann's operation. Operation is usually performed in patients with stoma limb perforation. However, if they are stable and the abscess is located in their abdominal wall, they may be treated successfully using a multi-stage approach of local drainage toward the stoma wall followed by stoma closure.
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http://dx.doi.org/10.1186/s40792-020-00827-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225223PMC
May 2020

Usefulness of repair using Hem-o-lok™ for peritoneal tear as a complication of totally extraperitoneal repair: Case series.

Ann Med Surg (Lond) 2020 Jan 23;49:5-8. Epub 2019 Nov 23.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: Peritoneal tear (PT) is a frequent intraoperative event during totally extraperitoneal repair (TEP). We aimed to introduce our surgical technique for PT during TEP to avoid the more difficult TEP procedure.MethodsOne surgeon with 10 years of experience performed our TEP method in 147 TEP cases from January 2012 to June 2019. We investigated the repair time of each repair technique using endoscopic suturing (suturing group, SG) and endoscopic Hem-o-lok stapling (CG).

Results: Twenty-three (15.6%) PT cases occurred as TEP complication. The mean repair times (with standard deviation) of the PT were 16.2 ± 13 and 7.6 ± 7.0 min in the SG and CG, respectively, indicating a significant difference (P = 0.043). The repair time of the PT using Hem-o-lok (Teleflex, Wayne, PA, USA) stapling was shorter than that using endoscopic suturing, which was significantly different despite the length of the PT.

Conclusion: Hem-o-lok stapling is feasible in case of PT during TEP.
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http://dx.doi.org/10.1016/j.amsu.2019.11.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911983PMC
January 2020

[Malignant gastrointestinal lymphoma with cicatricial stenosis after complete response to chemotherapy].

Nihon Shokakibyo Gakkai Zasshi 2019 ;116(10):826-832

Second Department of Internal Medicine, Osaka Medical College.

A 75-year-old woman presented complaining of anorexia. A malignant gastrointestinal lymphoma was diagnosed, and chemotherapy was initiated. After 2 months, she developed vomiting. Computed tomography (CT) revealed thickening of the jejunal wall and dilatation of the intestine proximal to that area. Positron emission tomography-CT showed no uptake. Small bowel stenosis due to cicatricial stenosis after chemotherapy was suspected. Laparoscopic partial resection of the stenotic small bowel segment was performed. Histopathologically, only granulation tissue was seen with no evidence of tumor. Occasionally, cicatricial stenosis can develop after chemotherapy for malignant gastrointestinal lymphoma. Therefore, this condition must be considered an important complication of treatment for this disease.
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http://dx.doi.org/10.11405/nisshoshi.116.826DOI Listing
October 2019

Novel technique with the IRIS U kit to prevent urethral injury in patients undergoing transanal total mesorectal excision.

Ann Med Surg (Lond) 2019 Oct 13;46:1-3. Epub 2019 Aug 13.

Department of Colorectal Surgery Osaka Medical College, Osaka, Japan.

Background: Low anterior resection of the rectum with total mesorectal excision (TME) has been the gold standard for the surgical treatment of rectal cancer as it has the lowest recurrence rates. The key issue while performing transanal TME (TaTME) is avoiding iatrogenic urethral injury. We introduce our surgical technique for TaTME.

Surgical Technique: Intraurethral indocyanine green injection using the IRIS U kit with subsequent visualization under NIR was safely utilized during the TaTME. We were able to easily detect and visualize the IRIS urethral kit. The prostatic segment of the urethra can be identified in real-time using the infrared illumination system urethral kit (IRIS U kit).

Benefits: The prostatic segment of the urethra was easily and quickly identified by the green fluorescence during TaTME.

Conclusion: Our TaTME technique is an easy and feasible approach that provides real-time urethral images.
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http://dx.doi.org/10.1016/j.amsu.2019.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706455PMC
October 2019

Laparoscopic omentectomy in primary torsion of the greater omentum: report of a case.

Surg Case Rep 2019 May 9;5(1):76. Epub 2019 May 9.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan.

Background: Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies; however, the preoperative diagnosis can be easily confirmed with the use of computed tomography (CT). Herein, we report a case of laparoscopic omentectomy for primary torsion of the omentum, which was not improved by conservative treatment.

Case Presentation: A 50-year-old Japanese man presented to our hospital with acute right lower quadrant abdominal pain of a few hours' duration. Routine blood tests showed a white blood cell count of 8900/mm, and the C-reactive protein (CRP) level was 8.13 mg/dl. Contrast-enhanced CT scan of the abdomen revealed twisting of the omentum with a local mass of fat density and fluid distributed in a whirling oval-shaped mass pattern at the right flank and iliac fossa. Therefore, the patient was admitted to our hospital based on a diagnosis of omental torsion. The patient was treated with conservative treatment with analgesics, anti-inflammatories, and antibiotics. Although his symptoms were ameliorated, his laboratory and radiological findings worsened. We performed laparoscopic omentectomy 6 days after admission. The resected omentum was 24 cm × 22 cm in size and was twisted and dark red in color, suggesting infarction. Histological analysis revealed that the specimen was ischemic and hemorrhagic omentum, accompanied by inflammatory infiltration. The patient's postoperative course was uneventful, and he was discharged 9 days later.

Conclusion: This is a rare case of primary torsion of the greater omentum that was treated successfully with laparoscopic omentectomy. Considering the increase in surgical difficulty due to inflammation from prolonged torsion and the limited efficacy of conservative treatment, we conclude that surgical intervention is warranted as early as possible when torsion of the greater omentum is suspected.
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http://dx.doi.org/10.1186/s40792-019-0618-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509293PMC
May 2019

Laparoscopic Total Devascularization of the Upper Stomach and Splenectomy (Hassab's Procedure) Under Indocyanine Green Fluorescence Imaging: Initial Experience.

Surg Innov 2019 Aug 8;26(4):432-435. Epub 2019 Feb 8.

1 Medico Shunju Shiroyama Hospital, Osaka, Japan.

The use of surgical treatment for refractory isolated gastric varices has decreased owing to the development of endoscopic and radiologic procedures, although surgeries are sometimes required as the final method. A 75-year-old Japanese woman was diagnosed with solitary gastric varices. Initially, intraoperative splenic artery embolization was performed using the balloon transcatheter technique under general anesthesia. Laparoscopic splenectomy was performed safely owing to preoperative splenic artery embolization. Intraoperative indocyanine green (ICG) fluorescence angiography was performed following the injection of 5 mL of ICG; the remnant stomach was observed using laparoscopic equipment with an ICG imaging system, and blood flow from the remnant gastric artery was confirmed. The blood did not pool or wash out immediately, which confirmed successful devascularization of the stomach. The total operative time was 269 minutes, and the intraoperative blood loss was 500 mL. The patient's postoperative course was good, and at 21 days after the last operation, she was discharged from our hospital in remission. Real-time fluorescence angiography with ICG is a reliable and objective technique of assessing blood flow of the stomach. Accurate, extensive devascularization in the lower esophagus and upper stomach was performed using Hassab's procedure in combination with ICG imaging.
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http://dx.doi.org/10.1177/1553350619828912DOI Listing
August 2019

Laparoscopic Excisional Cholecystectomy with Full-Thickness Frozen Biopsy in Suspected Gallbladder Carcinoma.

Case Rep Gastroenterol 2018 Sep-Dec;12(3):747-756. Epub 2018 Dec 13.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Owing to the advantages of a laparoscopic approach, laparoscopic cholecystectomy (LC) is thought to be the treatment of choice in gallbladder disease, even in cases of suspected malignancy. However, it is difficult to differentiate between cholecystitis and gallbladder carcinoma (GBC). We performed radical hepatectomy in patients with pT2 GBC diagnosed by full-thickness frozen biopsy. A 75-year-old Japanese man presented to our hospital with discomfort in the right upper quadrant of the abdomen. This patient was diagnosed with suspected GBC and was scheduled to undergo LC and intraoperative histological examination. Following the procedure, we made a diagnosis of GBC with negative invasion of the cystic duct stump. We converted the laparoscopic procedure to an open surgery involving wedge liver resection with lymphadenectomy. The patient was discharged from our hospital in remission 14 days following the radical hepatectomy. Histological examination showed that the GBC had invaded the liver (T3a), but there was no lymph node metastasis (N0): stage IIIA. Between April 2009 and September 2018, 580 patients underwent cholecystectomy for gallbladder disease at our hospital. Among these, 8 (1.4%) were suspected to have GBC preoperatively and underwent laparoscopic excisional cholecystectomy. We performed elective surgery in the early stage in two patients and second-look surgery in two patients recently. We were able to perform what we termed a laparoscopic excisional cholecystectomy, involving LC with a full-thickness frozen biopsy, even in situations where intraoperative histological examination was not available. Altogether, laparoscopic excisional cholecystectomy is an effective surgical treatment for suspected early GBC.
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http://dx.doi.org/10.1159/000495603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341341PMC
December 2018

Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type III Mirizzi syndrome.

Asian J Endosc Surg 2019 Apr 13;12(2):227-231. Epub 2018 Dec 13.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: A 50-year-old Japanese man presented with obstructive jaundice. We performed endoscopic retrograde biliary drainage before biliary decompression. CT showed a thickened gallbladder wall with low-density areas and a 35-mm gallstone; the stone was impacted in the gallbladder neck and cystic duct. The patient was therefore diagnosed with Mirizzi syndrome (type II or III) and scheduled for laparoscopic treatment. We performed subtotal cholecystectomy and intraoperative choledochoscopy because we recognized a fistula between the gallbladder and common bile duct preoperatively.

Materials And Surgical Technique: We opened the ductus choledochus, and a choledochoscope was introduced under laparoscopic guidance. An electrohydraulic lithotripsy probe with irrigation was passed through the choledochoscope to extract the gallstone.

Discussion: This fragmentation technique is effective for impacted large stones observed in Mirizzi syndrome. Therefore, electrohydraulic lithotripsy with laparoscopy is effective in cases of difficult gallbladder access such as that that occurs in type II or III Mirizzi syndrome.
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http://dx.doi.org/10.1111/ases.12602DOI Listing
April 2019

Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy.

Ann Med Surg (Lond) 2018 Sep 2;33:56-59. Epub 2018 Aug 2.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Purpose: This paper presents an overview of the surgical strategy for patients with suspected gallbladder carcinoma (GBC), including incidental GBC cases, preoperatively or intraoperatively, as well as their outcomes.

Methods: Between April 2009 and December 2017, 529 patients underwent cholecystectomy for gallbladder disease at our hospital. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of GBC. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion.

Results: Of 529 patients, eight were diagnosed with GBC during/after cholecystectomy, including four women and four men. Mean age was 75.4 (range, 59-89) years. Five patients had gallbladder stones and three had cholecystitis. Three patients with stages T1b and T2 underwent additional liver bed wedge resections with or without prophylactic common bile duct excision. Five of the eight patients are still alive and two of the remaining three died from other diseases; one patient with pT3 died of recurrent GBC (peritonitis carcinomatosa).

Conclusion: Because of the ability to obtain full-thickness frozen biopsies during laparoscopic cholecystectomy, we could diagnose GBC intraoperatively, allowing for rapid diagnosis and tumor resection. We recommend developing a surgical treatment strategy for suspected early GBC in advance of cholecystectomy.
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http://dx.doi.org/10.1016/j.amsu.2018.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127871PMC
September 2018

Protective effects of the astaxanthin derivative, adonixanthin, on brain hemorrhagic injury.

Brain Res 2018 11 6;1698:130-138. Epub 2018 Aug 6.

Molecular Phamacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan. Electronic address:

Astaxanthin is beneficial for human health and is used as a dietary supplement. The present study was performed in order to examine the protective effects of the astaxanthin derivative, adonixanthin, against cell death caused by hemoglobin, collagenase, lipopolysaccharide, and hydrogen peroxide, which are associated with hemorrhagic brain injury. In an in vitro study, adonixanthin exerted cytoprotective effects against each type of damage, and its effects were stronger than those of astaxanthin. The increased production of reactive oxygen species in human brain endothelial cells in the hemoglobin treatment group was inhibited by adonixanthin. Moreover, adonixanthin suppressed cell death in SH-SY5Y cells. In an in vivo study, the oral administration of adonixanthin improved blood-brain barrier hyper-permeability in an autologous blood ICH model. We herein demonstrated for the first time that adonixanthin exerted protective effects against hemorrhagic brain damage by activating antioxidant defenses, and has potential as a protectant against intracerebral hemorrhage.
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http://dx.doi.org/10.1016/j.brainres.2018.08.009DOI Listing
November 2018

Surgical technique of laparoscopic hybrid approach for recurrent inguinal hernia: Report a case.

Int J Surg Case Rep 2018 7;50:13-16. Epub 2018 Jul 7.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: Currently, laparoscopic surgery (LS) is a widely accepted surgical treatment for inguinal hernias, and it has major advantages, especially for recurrent cases.

Presentation Of Case: We diagnosed the recurrent inguinal hernia after wound infection and performed the laparosocopic approach. We would like to introduce our method. We distinguished between the presence and absence of bilateral inguinal hernia with an intra-abdominal scope using the transabdominal preperitoneal inguinal hernia repair (TAPP) technique, which we call laparoscopic examination. Thus, we can distinguish between the types of inguinal hernias and whether they are bilateral or not. We dissected the Retzius space on the inside of an epigastric arteriovenous fistula as part of TEP part A, and dissection was performed without a balloon. We separated and dissected the Retzius space. We also performed lateral dissection of the preperitoneal space. We made an incision in the peritoneum at the inner groin ring (hernia sac). We isolated the cord structures (parietalization) using TAPP. We finally checked this operation from the abdominal space (TAPP filed) and determined whether the repair was satisfactorily completed or not.

Discussion: Our hybrid method is not special but the conventional laparoscopic approach adapted each merits both TAPP and TEP.

Conclusion: Our method is effective for difficult recurrent inguinal hernias.
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http://dx.doi.org/10.1016/j.ijscr.2018.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083376PMC
July 2018

Effect of astaxanthin-rich extract derived from on cognitive function in middle-aged and older individuals.

J Clin Biochem Nutr 2018 Mar 27;62(2):195-205. Epub 2018 Jan 27.

Research Institute for Production Development, 15 Shimogamohoncho, Sakyo-ku, Kyoto 606-0805, Japan.

This study was conducted to investigate the effect of dietary supplement containing astaxanthin-rich extract derived from (astaxanthin supplement) on cognitive function of subjects aged 45-64 years. Cognitive functions of 28 subjects orally administered 8 mg astaxanthin/day of astaxanthin supplement for 8 weeks (astaxanthin group) and 26 subjects given a placebo (placebo group) were compared by word memory test, verbal fluency test, and Stroop test. The astaxanthin group experienced significantly larger increase in blood astaxanthin level than the placebo group. However, there were no significant intergroup differences in the results of the tests. A subgroup analysis was performed after dividing subjects into the <55 years old and ≥55 years old age groups. The result of "words recalled after 5 minutes" in word memory test in <55 years old subjects showed significant improvement in the astaxanthin group than in the placebo group, which was not found in ≥55 years old subjects. Our results indicate that people aged 45-54 years may experience improved cognitive function after ingesting astaxanthin supplement for 8 weeks. On the basis of the parameters tested, administration of astaxanthin supplement was not associated with any problems related to safety.
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http://dx.doi.org/10.3164/jcbn.17-100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874228PMC
March 2018

[A case of adult gastric volvulus treated using upper gastrointestinal series].

Nihon Shokakibyo Gakkai Zasshi 2018;115(1):101-107

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital.

Here, we report a case of adult gastric volvulus that was treated using an upper gastrointestinal series and provide a review of relevant reports. A 55-year-old woman presented with upper abdominal pain. Abdominal computed tomography revealed mesenteroaxial gastric volvulus. We performed an upper gastrointestinal series after the placement of a nasogastric tube. We successfully performed detorsion by repositioning. There was no recurrence of gastric volvulus after the detorsion. However, considering the risk of recurrence, we also performed laparoscopic gastropexy. The postoperative course was uneventful, and she was discharged from the hospital on postoperative day 3. No recurrence of symptoms has been observed to date.
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http://dx.doi.org/10.11405/nisshoshi.115.101DOI Listing
April 2019

A case of multiple inflammatory hepatic pseudotumor protruding from the liver surface after colonic cancer.

Int J Surg Case Rep 2017 8;37:261-264. Epub 2017 Jun 8.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan; Division of Surgery Osaka Medical college, Osaka, Japan; Division of Pathology Osaka Medical college, Osaka, Japan.

Introduction: Inflammatory hepatic pseudotumor (IHPT) is an important benign liver disease because it is difficult to clinically and radiologically distinguish from malignant tumors.

Presentation Of Case: Here, we describe a case of a 67-year-old male patient diagnosed with multiple inflammatory hepatic pseudotumors. The patient had undergone left hemicolectomy for descending colonic cancer (T3 N0 M0 stage IIA) 2 years prior. He underwent segment 6 and segment 7 partial hepatectomy because of suspected liver metastasis. The patient had an unremarkable postoperative course and was discharged 7days after surgery. Marked infiltration of inflammatory cells was observed on histological examination. The patient was finally diagnosed with IHPT of the fibrohistiocytic type.

Discussion: Repeated imaging studies over 1 month showed the spontaneous regression of the hepatic tumors. Therefore, knowledge regarding this condition is necessary to allow for treatment, even in the absence of experience. During examination, it may be important to ascertain lesion size. Moreover, percutaneous needle biopsy and follow-up examinations are necessary for cases of suspected IHPT.

Conclusion: Hepatectomy should be considered if the lesion is suspected to be an IHPT.
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http://dx.doi.org/10.1016/j.ijscr.2017.05.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517786PMC
June 2017

A case of an anomalous biliary tract diagnosed preoperatively.

J Surg Case Rep 2017 Jun 23;2017(6):rjx106. Epub 2017 Jun 23.

Department of Gastroenterological Center Surgery, Shunjukai Shiroyama Hospital, Osaka, Japan.

We describe a 48-year-old man with cholecystolithiasis whose preoperative magnetic resonance cholangiopancreatography (MRCP) scan showed that the right accessory hepatic duct branching from the cystic duct dominated an anterior segment of the right hepatic lobe. We observed the right accessory hepatic duct using intraoperative cholangiography, and we were able to perform laparoscopic cholecystectomy without injuring it. He had no complication after discharge, and a drip-infusion cholangiography-computed tomography (DIC-CT) scan demonstrated that the right accessory hepatic duct was intact, and it dominated an anterior segment of the right hepatic lobe. During laparoscopic cholecystectomy, a bile duct injury is the most challenging perioperative complication. We selected MRCP preoperatively; however, if it is necessary for us to observe an anomalous biliary tract more precisely, we recommend selecting DIC-CT endoscopic retrograde cholangiopancreatography. Additionally, we think a bile duct injury can be avoided with intraoperative cholangiography, even if there is an anomalous biliary tract.
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http://dx.doi.org/10.1093/jscr/rjx106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499886PMC
June 2017

Astaxanthin analogs, adonixanthin and lycopene, activate Nrf2 to prevent light-induced photoreceptor degeneration.

J Pharmacol Sci 2017 Jul 21;134(3):147-157. Epub 2017 Jun 21.

Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan. Electronic address:

Carotenoids, in particular astaxanthin, possess potent antioxidant capabilities. Astaxanthin also induces NF-E2-related factor 2 (Nrf2), which plays a major regulatory role in the antioxidative response. However, little is known whether the carotenoid, by-products of astaxanthin, activate Nrf2. Toward this end, we screened eight astaxanthin analogs for Nrf2 activation in murine photoreceptor cell line, 661 W, by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). In addition, we monitored cell death in 661 W cells pretreated with astaxanthin analogs or only pretreated for 6 h with astaxanthin analogs and then exposed to light. Furthermore, we quantified the reactive oxygen species (ROS) production. Cell death was quantified after light exposure by nuclear staining. Nrf2-controlled genes Ho-1, Nqo-1, and Gclm by qRT-PCR and Nrf2 in the nucleus were upregulated in 661 W cells exposed astaxanthin, adonixanthin, echinenone, and lycopene. Moreover, astaxanthin, adonixanthin, echinenone, β-carotene, adonirubin, and lycopene, but not canthaxanthin, suppressed ROS production and protected cells against light-induced damage. Moreover, pretreatment with adonixanthin or lycopene only before light exposure protected against light-induced cell damage and Nrf2 silencing canceled these effects. These findings indicate that the more potent astaxanthin analogs, adonixanthin and lycopene, protect against light-induced cell damage through not only an anti-oxidative response but also through Nrf2 activation.
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http://dx.doi.org/10.1016/j.jphs.2017.05.011DOI Listing
July 2017

Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan.

Ann Med Surg (Lond) 2017 Jul 3;19:33-36. Epub 2017 Jun 3.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Objectives: We aimed to assess the efficacy of self-expanding metal stent (SEMS) implantation as palliative treatment for malignant colorectal obstruction.

Methods: We retrospectively reviewed the records of patients with malignant colorectal obstruction who underwent SEMS insertion as palliative treatment in our hospital between March 2013 and December 2016. We analyzed demographic, clinical, and operative characteristics.

Results: A total of 13 patients (8 males, 5 females; median age, 80.1 years) were reviewed. Tumor location included the left colon, rectum, and right colon in 38.5%, 38.5%, and 23% of the patients, respectively. Advanced and early colorectal cancer were noted in 7 (63.6%) and 4 (36.4%) cases, respectively. The mean ColoRectal Obstruction Scoring System score was 0.92 before stenting and 3.92 after stenting. Oral intake was resumed at a median of 2.1 days after SEMS placement. Median stent patency was 7.6 months, and 69.2% of patients maintained stent patency until death or the end of follow-up. Stent-related adverse effects included: re-occlusion (4 cases, 30.8%); stent migration (1 case, 7.7%), and pain with tenesmus (2 cases, 15.4%). In patients with re-occlusion (median follow-up interval, 1.3 months), stent patency was maintained for a median of 10.3 months (early failure, within 3 months; late failure, >11 months).

Conclusion: SEMS placement as a palliative treatment is likely to fail within a year, leading to re-occlusion. It is very important to maintain vigilant monitoring using X-ray, CT, and colonoscopy after SEMS placement, with close cooperation between the endoscopist and surgeon. A logistic framework involving careful follow-up, even in the absence of symptoms, and a combined team involving endoscopists and surgeons should be established to support re-intervention and surgery. We recommend vigilant monitoring of patients who received SEMS placement for palliation of malignant colorectal obstruction.
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http://dx.doi.org/10.1016/j.amsu.2017.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459568PMC
July 2017

Reocclusion after Self-Expandable Metallic Stent Placement for Relieving Malignant Colorectal Obstruction as a Palliative Treatment.

Case Rep Gastroenterol 2016 Sep-Dec;10(3):733-742. Epub 2016 Dec 8.

Division of Surgery, Gastroenterological Center, Medico Shunjyu Shiroyama Hospital, Habikino City, Japan.

Self-expandable metallic stent (SEMS) placement has been practiced in several hospitals in Japan, including ours, since January 2012. Here, we report the case of an 82-year-old Japanese man who presented to the hospital with a 1-week history of right hypochondrial pain. Computed tomography (CT) findings indicated colorectal cancer. The laboratory findings on admission indicated severe anemia (red blood cell count, 426 × 104/μL; hemoglobin, 7.9 g/dL). We performed SEMS placement because the patient refused to undergo surgery. He did not attend any of the scheduled follow-up visits after SEMS placement. However, a year and a half after the SEMS placement, the patient attended the hospital because of difficulty in passing stool. A plain abdominal CT scan showed bowel reobstruction due to the ascending colon cancer after SEMS placement. We performed an emergency operation, ascending colostomy, on the same day. Colorectal stent placement may be a good treatment option for patients who refuse to undergo conventional therapeutic treatments or in those with unresectable colorectal cancer. Patients should be carefully followed up every few months after SEMS placement because of the risk of reocclusion.
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http://dx.doi.org/10.1159/000452200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216238PMC
December 2016

[Maintenance of Long-Term Stable Disease(SD)in Metastatic Breast Cancer with Eribulin - A Case Report of Long-Term SD in Japan].

Gan To Kagaku Ryoho 2016 Dec;43(13):2543-2546

Dept. of Surgery, Medico Shunjyu Shiroyama Hospital.

This case report discusses a 48-year-old woman with metastatic breast cancer: T4c(10.5 cm)N2bM1,(OSS, LYM), stage IV, estrogen receptor(ER)(+), progesterone receptor(PgR)(+), human epidermal growth factor receptor-2(HER2) (-), and Ki-67 17.2%. Administration of eribulin was initiated after treatment with anthracycline and taxane. Thereafter, 28 courses of eribulin maintained a SD state for over a year and improved the quality of life(QOL). Eribulin is effective for both prolonging life and improving QOL, which are the main goals in the treatment of metastatic or recurrent cancer. Therefore, this evidence suggests that eribulin can be effective in various clinical situations.
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December 2016

Astaxanthin Protects Against Retinal Damage: Evidence from In Vivo and In Vitro Retinal Ischemia and Reperfusion Models.

Curr Eye Res 2016 11 9;41(11):1465-1472. Epub 2016 May 9.

a Molecular Pharmacology, Department of Biofunctional Evaluation , Gifu Pharmaceutical University , Gifu , Japan.

Purpose: Astaxanthin exhibits various pharmacological activities, including anti-oxidative, anti-tumor, and anti-inflammatory effects, and is thought to exert a neuroprotective effect via these mechanisms. The purpose of this study was to investigate the protective effects of astaxanthin on neuronal cell death using a retinal ischemia/reperfusion model.

Methods: In vivo, retinal ischemia was induced by 5 h unilateral ligation of the pterygopalatine artery (PPA) and the external carotid artery (ECA) in ddY mice. Astaxanthin (100 mg/kg) was administered orally 1 h before induction of ischemia, immediately after reperfusion, at 6 or 12 h after reperfusion, and twice daily for the following 4 days. Histological analysis and an electroretinogram (ERG) were performed 5 days after ischemia/reperfusion. In vitro, cell death was induced in the RGC-5 (retinal precursor cells) by oxygen-glucose deprivation (OGD), and the rates of cell death and production of intracellular reactive oxygen species (ROS) were measured using nuclear staining and a ROS reactive reagent, CM-HDCFDA.

Results: Histological studies revealed that astaxanthin significantly reduced retinal ischemic damage and ERG reduction. In in vitro studies, astaxanthin inhibited cell death and ROS production in a concentration-dependent manner.

Conclusions: Collectively, these results indicate that astaxanthin inhibits ischemia-induced retinal cell death via its antioxidant effect. Hence, astaxanthin might be effective in treating retinal ischemic pathologies.
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http://dx.doi.org/10.3109/02713683.2015.1127392DOI Listing
November 2016

A case of long-term 24-month survival in pancreatic anaplastic carcinoma (giant cell type) after S1 postoperative adjuvant chemotherapy.

Int J Surg Case Rep 2016 23;23:134-7. Epub 2016 Apr 23.

Gastroenterological Center Surgery, Medico Shunju Shiroyama Hospital, Osaka, Japan.

We herein describe the case of a 70-year-old female patient diagnosed with pancreatic carcinoma. An abdominal enhanced computed tomography scan revealed a poorly enhanced mass (17mm×15mm in size) in the pancreatic head. Magnetic resonance cholangiopancreatography revealed stenosis of the main pancreatic and common bile ducts caused by a mass-neighboring cyst. Based on these findings, we performed subtotal stomach-preserving pancreaticoduodenectomy. The patient demonstrated a good postoperative course, and was discharged from our hospital in remission 49 days after the surgery. Pathological findings confirmed that it was anaplastic pancreas carcinoma (giant cell type). After the surgery, we performed S-1 adjuvant chemotherapy 100mg/day for four weeks, repeated similarly every six weeks for a total of four courses. We have followed this case for over 2 years so far with adjuvant chemotherapy, and no recurrence or metastasis has been revealed. Adjuvant chemotherapy with S-1 in patients with resected anaplastic carcinoma of the pancreas is also recommended as a result of Japan Adjuvant Study Group of Pancreatic Cancer 01(JASPAC-01) like the ordinary pancreatic ductal carcinomas. There is a possibility to achieve long-term survival in cases in which multidisciplinary treatment such as a curative resection and adjuvant chemotherapy are performed.
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http://dx.doi.org/10.1016/j.ijscr.2016.04.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855735PMC
June 2016

Anaplastic carcinoma of the pancreas arising in an intraductal papillary mucinous neoplasm: A case report.

Mol Clin Oncol 2016 Jan 9;4(1):39-42. Epub 2015 Nov 9.

Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Takatsuki, Osaka 569-0801, Japan.

We herein report a case of anaplastic carcinoma of the pancreas arising in an intraductal papillary mucinous neoplasm (IPMN). A 68-year-old Japanese woman was admitted to our hospital complaining of fatigue. Computed tomography revealed an irregular mass in the pancreatic head, which displayed high-signal intensity on diffusion-weighted magnetic resonance imaging. Accordingly, the patient was diagnosed with pancreatic cancer and underwent pancreaticoduodenectomy. The histopathological findings revealed intraductal papillary proliferative changes involving the main and branch ducts of the pancreatic head. Based on the immunohistochemistry results, the intraductal lesion was diagnosed as IPMN. The pathological diagnosis for the invasive carcinoma was anaplastic giant-cell carcinoma of the pancreas (ACP), and the focus of IPMN dedifferentiation to ACP was found to be located at the periphery of the IPMN. At 18 months postoperatively, the patient remains disease-free.
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http://dx.doi.org/10.3892/mco.2015.671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727070PMC
January 2016
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