Publications by authors named "Takashi Maeda"

166 Publications

Prognostic significance of preoperative PNI and CA19-9 for pancreatic ductal adenocarcinoma: A multi-institutional retrospective study.

Pancreatology 2021 Aug 18. Epub 2021 Aug 18.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: The aim of this study was to investigate the clinical value of nutritional and immunological prognostic scores as predictors of outcomes and to identify the most promising scoring system for patients with pancreatic ductal adenocarcinoma (PDAC) in a multi-institutional study.

Methods: Data were retrospectively collected for 589 patients who underwent surgical resection for PDAC. Prognostic analyses were performed for overall (OS) and recurrence-free survival (RFS) using tumor and patient-related factors, namely neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Prognostic Nutritional Index (PNI), Glasgow Prognostic Score (GPS), modified GPS, C-reactive protein-to-albumin ratio, Controlling Nutritional Status score, and the Geriatric Nutritional Risk Index.

Results: Compared with PDAC patients with high PNI values (≥46), low PNI (<46) patients showed significantly worse overall survival (OS) (multivariate hazard ratio (HR), 1.432; 95% CI, 1.069-1.918; p = 0.0161) and RFS (multivariate HR, 1.339; 95% CI, 1.032-1.736; p = 0.0277). High carbohydrate antigen 19-9 (CA19-9) values (≥450) were significantly correlated with shorter OS (multivariate HR, 1.520; 95% CI, 1.261-2.080; p = 0.0002) and RFS (multivariate HR, 1.533; 95% CI, 1.199-1.961; p = 0.0007). Stratification according to PNI and CA19-9 was also significantly associated with OS and RFS (log rank, P < 0.0001).

Conclusions: Our large cohort study showed that PNI and CA19-9 were associated with poor clinical outcomes in PDAC patients following surgical resection. Additionally, combining PNI with CA19-9 enabled further classification of patients according to their clinical outcomes.
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http://dx.doi.org/10.1016/j.pan.2021.08.003DOI Listing
August 2021

Short- to Mid-Term Clinical Outcomes of Posterior-Stabilized Cementless Total Knee Arthroplasty with Trabecular Metal Components.

Ther Clin Risk Manag 2021 10;17:809-816. Epub 2021 Aug 10.

Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Nagano, 390-8601, Japan.

Objective: This study aimed to evaluate the short- to mid-term clinical results of posterior-stabilized trabecular metal total knee arthroplasty (TKA) with cementless fixation of all components and investigate the radiographic changes of tibial and patellar components and cut bone surfaces over time.

Methods: We retrospectively collected the data of 128 knees from 88 consecutive patients who had undergone initial TKA with NexGen LPS-Flex TM implants. A total of 66 knees from 45 patients (mean ± standard deviation age: 70.3 ± 7.5 years) met the selection criteria, which had been employed cementless fixation of all parts and at least 3 years of postoperative follow-up duration. Clinical evaluations included range of motion, conventional knee score, function score, postoperative complications, and revision. For radiological evaluations, the bone contact surface of each implant was divided into 7 zones for tibial component and 2 zones for patellar component. Each region was examined immediately after surgery, at 6 and 12 months, and then every year afterwards.

Results: The mean observation period of 45 subjects was 4.2 years. Adequate fixation of tibial components was maintained during follow-up, although the patellar components of 2 knees required revision after repeated falls. No loosening was observed in any implants. The initial gap in tibial components disappeared in all knees, and a reactive line remained in 4 knees. There were no revisions, except for 2 cases, which were ascribed to patellar component fracture caused by repeated falls.

Conclusion: Cementless posterior-stabilized trabecular metal TKA appears to be a good surgical option. Longer-term examination for revision cases is required to validate our results.
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http://dx.doi.org/10.2147/TCRM.S320941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364354PMC
August 2021

Trajectory of the incidence of brushes on preterm electroencephalogram and its association with neurodevelopment in extremely low birth weight infants.

Brain Dev 2021 Jul 29. Epub 2021 Jul 29.

Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Aichi, Japan.

Background: Brush or delta brush is a well-known characteristic waveform in preterm electroencephalograms. However, the longitudinal trajectory of brushes and its association with neurodevelopment remain uncertain.

Methods: We analyzed the longitudinal incidence of brushes in 36 extremely low birth weight infants without severe brain lesions and its association with neurodevelopment and white matter abnormality. Conventional eight-channel electroencephalograms were recorded at 30, 32, 36, and 40 postmenstrual weeks (PMW). Incidence of brushes was calculated as the sum of brushes from each channel separated by active sleep and quiet sleep. A developmental delay was defined as a developmental quotient of <85 assessed at corrected age of 18 months. White matter abnormalities were evaluated with term-equivalent magnetic resonance imaging.

Results: The median incidence of brushes (per minute) in 36 infants at PMW 30, 32, 36, and 40 was 16.4, 20.4, 22.5, and 1.8 during active sleep and 7.5, 10.3, 11.5, and 1.7 during quiet sleep, respectively. Among the 36 infants, 14 infants were diagnosed with developmental delay. Longitudinal trajectories of the incidence of brushes were different between the normal and the delayed development groups. Brushes were observed most frequently at 36 PMW in the delayed development group. The incidence of brushes at 36 PMW was significantly correlated with the severity of white matter abnormalities and negatively correlated with the developmental quotient.

Conclusion: The incidence of brushes at 36 PMW can be a unique predictor of early neurodevelopment in extremely low birth weight infants without severe brain lesions.
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http://dx.doi.org/10.1016/j.braindev.2021.07.003DOI Listing
July 2021

Transmission of extended-spectrum cephalosporin-resistant Salmonella harboring a bla-carrying IncA/C plasmid chromosomally integrated by ISEcp1 or IS26 in layer breeding chains in Japan.

J Vet Med Sci 2021 Sep 16;83(9):1345-1355. Epub 2021 Jul 16.

Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashi-Murayama, Tokyo 208-0011, Japan.

Dissemination of extended-spectrum cephalosporin (ESC)-resistant Salmonella is a public health concern in the egg production industry. ESC-resistant Salmonella often acquires the bla gene via insertion sequences (ISs). Therefore, this study aimed to assess antimicrobial resistance in Salmonella from Japanese layer breeding chains and egg processing chains, and determine the genetic profiles of IS-like elements in ESC-resistant Salmonella. Antimicrobial susceptibility testing was performed on 224 isolates from 49 facilities involving layer breeder farms, hatcheries, pullet-rearing farms, and layer farms in breeding chains along with egg processing chains. ESC-resistant Salmonella strains were whole-genome sequenced. Among them, 40 (17.9%) were resistant to at least streptomycin, tetracycline, ampicillin, chloramphenicol, cefpodoxime, nalidixic acid, ciprofloxacin, and/or kanamycin despite lacking resistance to azithromycin and meropenem. Moreover, 15 were ESC-resistant Salmonella harboring bla (Salmonella enterica serovar Ohio, n=12; S. Braenderup, n=1; untypeable with O7:b:-, n=1) and bla (S. Cerro, n=1). IncA/C plasmids containing ISEcp1, IS26, and multiple antimicrobial resistance genes (including bla) were identified in S. Ohio isolates from pullet-rearing and layer farms belonging to the same company. Chromosomal integration of partial or whole IncA/C plasmids was seen with two S. Ohio isolates via ISEcp1 or IS26, respectively. Antimicrobial resistance genes such as bla might be transmitted among the upper and the lower levels of layer breeding chains via the replicon type IncA/C plasmids containing ISEcp1 and IS26.
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http://dx.doi.org/10.1292/jvms.21-0085DOI Listing
September 2021

Prognostic Impact of Lymphocyte-C-Reactive Protein Ratio in Patients Who Underwent Surgical Resection for Hepatocellular Carcinoma.

J Gastrointest Surg 2021 Jul 13. Epub 2021 Jul 13.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan.

Background: Systemic inflammation-related factors, either independently or in combination, are recognized as prognostic factors for various cancers. The ratio of lymphocyte count to C-reactive protein concentration (lymphocyte-CRP ratio; LCR) is a recently identified prognostic marker for several cancers. Here, we examined the prognostic value of the LCR in patients with hepatocellular carcinoma (HCC).

Methods: This was a single-center retrospective study of patients who underwent surgical resection for HCC between 2004 and 2017. Patients were divided into high- and low-LCR status groups, and the relationships between LCR status, prognosis, and other clinicopathological characteristics were analyzed.

Results: A total of 454 patients with HCC were enrolled and assigned to the high- (n=245) or low- (n=209) LCR groups. Compared with the high-LCR group, patients in the low-LCR group had a significantly lower serum albumin level (median 4.1 vs. 3.9 g/dL, P <0.0001), lower platelet count (median 14.0 vs. 12.0 ×10/μL, P=0.0468), lower prothrombin time (median 93.2 vs. 89.6 %, P=0.0006), and larger tumor size (median 2.3 vs. 2.5 cm, P=0.0056). Patients with low-LCR status had significantly worse outcomes of overall survival and disease-free survival than patients with high-LCR status (P=0.0003 and P=0.0069, respectively). Low-LCR status was significantly associated with worse overall survival in multivariate analysis (hazard ratio 1.57, 95% confidence interval 1.14-2.17, P=0.0058).

Conclusions: Low-LCR status may predict worse outcomes in patients with HCC. Measurement of LCR is routine and can easily be applied for risk stratification in the assessment of patients with HCC.
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http://dx.doi.org/10.1007/s11605-021-05085-zDOI Listing
July 2021

A woman complicated by sudden cardiac arrest owing to spontaneous coronary artery dissection after stillbirth.

J Cardiol Cases 2021 Feb 10;23(2):61-64. Epub 2020 Oct 10.

Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan.

Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndrome in pregnant women. Pregnancy-associated SCAD frequently occurs in the third trimester or postpartum period. However, little is known regarding the relationship between the occurrence of SCAD and stillbirth. We describe here a 41-year-old woman complicated by sudden cardiac arrest owing to SCAD in the distal segment of the right coronary artery 13 days after stillbirth. After contacting emergency medical services, she was resuscitated by an automated external defibrillator because the initial electrocardiographic waveform was ventricular fibrillation. After cardiopulmonary resuscitation, the diagnosis of SCAD was confirmed by coronary angiography and intracoronary imaging, including intravascular ultrasound and optical coherence tomography. The patient was managed with conservative medical therapy because the culprit lesion was present in the distal segment of the right coronary artery and coronary blood flow was preserved. No major adverse cardiovascular events, including recurrent ventricular arrhythmia, were observed during hospitalization. Our findings indicate that pregnancy-associated SCAD leading to sudden cardiac arrest may occur in the postpartum period, even after stillbirth. Intravascular imaging plays a pivotal role in diagnosing SCAD. < Pregnancy-associated spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome in pregnant or postpartum women. However, whether the risk of pregnancy-associated SCAD in the postpartum period is different between normal birth and stillbirth remains unknown. Pregnancy-associated SCAD leading to sudden cardiac arrest owing to acute myocardial ischemia may occur in postpartum women, regardless of fetal survival.>.
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http://dx.doi.org/10.1016/j.jccase.2020.09.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817906PMC
February 2021

Deficiency of C1q/TNF-related protein 3 (CTRP3) decreases adipose tissue weight in diet-induced obesity mice.

Mol Biol Rep 2020 Nov 15;47(11):9219-9224. Epub 2020 Oct 15.

Department of Anatomy and Cell Biology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Adipokines are important regulators of lipid and glucose metabolism. A family of adiponectin paralogs is known as C1q and tumor necrosis factor (TNF)-related proteins (CTRPs). One line of Ctrp3-deficient mice shows reduced liver size in response to obesity. We generated and characterized another line of Ctrp3 knockout (KO) mice to reveal novel physiological functions of CTRP3. Interestingly, high fat diet (HFD)-fed Ctrp3 KO mice displayed a decrease in the epididymal white adipose tissue (WAT) weight to total body weight ratio. Histologically, adipocyte size was significantly smaller in the epididymal WAT of HFD-fed Ctrp3 KO mice than wild-type (WT) controls. The expression of several genes involved in lipogenesis, lipolysis and adipogenesis in the epididymal WAT of Ctrp3 KO mice fed a HFD was decreased. The present findings provide new insight into the role of CTRP3 as adipokine in the regulation of adipose tissue in obesity.
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http://dx.doi.org/10.1007/s11033-020-05905-6DOI Listing
November 2020

Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors.

Am Surg 2021 Mar 29;87(3):376-383. Epub 2020 Sep 29.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy.
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http://dx.doi.org/10.1177/0003134820949995DOI Listing
March 2021

Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report.

Surg Case Rep 2020 Sep 29;6(1):229. Epub 2020 Sep 29.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion.

Case Presentation: A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits.

Conclusions: Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family.
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http://dx.doi.org/10.1186/s40792-020-00985-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524929PMC
September 2020

Laparoscopic surgery for sigmoid colon cancer with complicated communication between the superior and inferior mesenteric arteries.

Asian J Endosc Surg 2021 Apr 12;14(2):267-270. Epub 2020 Aug 12.

Department of Surgery, Tsushima City Hospital, Tsushima, Japan.

To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.
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http://dx.doi.org/10.1111/ases.12844DOI Listing
April 2021

l-carnitine supplementation vs cycle ergometer exercise for physical activity and muscle status in hemodialysis patients: A randomized clinical trial.

Ther Apher Dial 2021 Jun 3;25(3):304-313. Epub 2020 Sep 3.

Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan.

Serum carnitine is decreased in hemodialysis patients, which induces muscle atrophy. Thus, we examined the different effects of l-carnitine and exercise on exercise activity and muscle status in hemodialysis patients. Twenty patients were divided into l-carnitine and cycle ergometer groups and were followed for 3 months. Muscle and fat mass, physical activities, and muscle status were evaluated by an impedance, physical function test, and magnetic resonance imaging, respectively. The l-carnitine significantly increased muscle mass (P = .023) and thigh circumference (P = .027), decreased fat mass (P = .007), and shortened chair stand-up time (P = .002) and 10-m walk test (P = .037). The fat fraction was improved by the l-carnitine (P = .047). Compared with the exercise group, l-carnitine improved the changes in 10-m walk test (P = .026), chair stand-up time (P = .014), and thigh circumference (P = .022). Baseline fibroblast growth factor-21 and myostatin levels predicted the l-carnitine-associated changes in exercise activities. l-carnitine, rather than exercise, improved physical activity and muscle status in hemodialysis patients.
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http://dx.doi.org/10.1111/1744-9987.13576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247310PMC
June 2021

Large surgically resected leiomyosarcoma of the liver: a case report.

Surg Case Rep 2020 Jul 9;6(1):168. Epub 2020 Jul 9.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, Japan.

Background: Primary hepatic leiomyosarcoma (PHL) is an extremely rare type of tumor. We herein report a case of a large surgically resected leiomyosarcoma of the liver.

Case Presentation: A 69-year-old man with a feeling of epigastric compression was referred for examination of an abdominal mass. He had no history of liver disease or alcohol abuse. Liver function tests indicated Child-Pugh class A. Tumor markers were negative. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a relatively well-contrasted 12 × 11 × 8 cm tumor with well-defined boundary replacing the lateral segment of the liver alongside multiple intrahepatic metastases. Several nodules up to 12 mm were found in both lungs, suggestive of metastasis. SUVmax of the liver mass and lung tumor in positron emission tomography were 10.4 and 1.5, respectively. Hepatocellular carcinoma was primarily suspected. Lateral segmentectomy of the liver was performed to confirm diagnosis and prevent tumor rupture. Macroscopically, the lateral segment of the liver had been replaced by a lobular or multinodular tumor with a maximum diameter of 15 cm. In pathological findings, the tumor consisted of bundle-like proliferation of complicated banding spindle-like cells with clear cytoplasm, accompanied by storiform pattern and compressed blood vessels. Nuclear fission images were observed in 8/10 HPF. Partial necrosis was present, with associated venous invasion and intrahepatic metastasis. Immunohistochemical staining for tumor cells revealed desmin, α-smooth muscle actin (αSMA), and h-caldesmon were all positive, informing a final diagnosis of PHL. The postoperative course was uneventful, and he was discharged on the 12th postoperative day.

Conclusions: PHL is a rare malignant disease with relatively poor prognosis. To confirm a diagnosis of PHL, immunohistochemical analysis as well as histopathological findings is important. The preferred treatment is surgical resection, sometimes in combination with adjuvant chemotherapy and radiotherapy. Further studies are needed to elucidate and better understand this uncommon clinical entity.
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http://dx.doi.org/10.1186/s40792-020-00934-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347740PMC
July 2020

Mixed adenoneuroendocrine carcinoma of the distal bile duct: a case report.

Surg Case Rep 2020 Jul 6;6(1):160. Epub 2020 Jul 6.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Mixed adenoneuroendocrine carcinoma (MANEC) of the common bile duct (CBD) is very rare, with only 10 reported cases. Here, we report a case of MANEC of the distal bile duct (DBD) that was surgically resected under a diagnosis of cholangiocarcinoma (CCA).

Case Presentation: A 60-year-old male had epigastric pain and was admitted to our hospital for the treatment of a suspected CBD stone. Upon admission, laboratory findings revealed elevated hepatobiliary enzymes including serum aspartate aminotransferase, serum alanine aminotransferase, serum glutamyltransferase, and serum alkaline phosphatase. Both carcinoembryonic antigen and carbohydrate antigen 19-9 were negative. Computed tomography (CT) showed dilation of the CBD. Endoscopic retrograde cholangiopancreatography (ERCP) showed circumferential stenosis and a 5-mm elevated lesion in the DBD. Brush cytology showed atypical ductal cells, indicating adenocarcinoma (AC) of the DBD. Under a diagnosis of CCA of the DBD, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Neither peritoneal dissemination nor lymph node metastasis was found. Microscopically, the lesion was seen to be composed of predominantly well-differentiated tubular AC in the superficial layer of the tumor, admixed with neuroendocrine carcinoma (NEC) in the deeper portion, indicating a diagnosis of MANEC of the DBD. After immunohistochemical staining, NEC components were positive for synaptophysin and CD56 and were for SSTR2, SSTR5, and mammalian target of rapamycin (mTOR). Three months postsurgery, postoperative adjuvant chemotherapy with S-1 was started. More than 3 years postsurgery, he is alive without recurrence.

Conclusions: MANEC is highly malignant, progresses rapidly, and has a poor prognosis. Preoperative diagnosis is difficult; therefore, identifying NEC components by immunohistochemical staining using resected specimens is important.
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http://dx.doi.org/10.1186/s40792-020-00921-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338298PMC
July 2020

A case of perforation of Meckel's diverticulum with enterolith.

Surg Case Rep 2020 Jul 6;6(1):161. Epub 2020 Jul 6.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography.

Case Presentation: A 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel's diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient's postoperative course was uneventful.

Conclusions: It is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel's diverticulum as a possible diagnosis to facilitate prompt treatment.
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http://dx.doi.org/10.1186/s40792-020-00926-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338335PMC
July 2020

Argon plasma coagulation for successful treatment of bile leakage after subtotal cholecystectomy.

Surg Case Rep 2020 May 24;6(1):111. Epub 2020 May 24.

Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan.

Background: Subtotal cholecystectomy is an effective surgical method to decrease the risk of complications for gallbladders that are difficult to remove. However, there is a risk for postoperative refractory bile leakage through the gallbladder stump. Here, we report a new management technique involving the use of argon plasma coagulation (APC) to stop bile leakage after a subtotal cholecystectomy.

Case Presentation: A 74-year-old man was referred to our hospital for abdominal pain and fever. Contrast-enhanced computed tomography of the abdomen showed fluid collection, such as an abscess, surrounding the gallbladder and hepatic flexure colon. The patient was diagnosed with colonic perforative peritonitis, and he underwent emergency surgery. On laparotomy, the abscess was observed outside of the hepatic flexure colon and gallbladder necrosis was detected. The neck of the gallbladder and the area close to the hepatoduodenal ligament was severely inflamed prohibiting dissection. The hepatic flexure colon was part of the abscess wall, and resection was needed. A subtotal cholecystectomy and right hemicolectomy confirmed peritonitis caused by cholecystic perforation. The mucous membrane of the gallbladder neck that remained was necrotic or detached. Therefore, the stump of the gallbladder was closed by primary sutures without cauterization of the mucosa. On postoperative day 6, bile leakage from the gallbladder stump was revealed. Percutaneous and endoscopic retrograde cholangiography drainage were performed. However, the liquid, which seemed to be secreted from the mucosa of the remnant gallbladder, was continuously obtained. We used APC to cauterize the gallbladder mucosa through the fistula of the abdominal drainage tube. Bile leakage and mucus discharge were improved after three rounds of APC cauterization.

Conclusions: APC effectively treated refractory bile leakage from a gallbladder stump after subtotal cholecystectomy for severe cholecystitis.
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http://dx.doi.org/10.1186/s40792-020-00876-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246268PMC
May 2020

Cranial-first approach for safe laparoscopic surgery in right-sided colon cancer.

Tech Coloproctol 2020 05 10;24(5):489-490. Epub 2020 Feb 10.

Department of Surgery, Tsushima City Hospital, Tsushima City, Aichi, Japan.

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http://dx.doi.org/10.1007/s10151-020-02158-0DOI Listing
May 2020

Complete Resection without Any Ostomies by Laparoscopic Extended Surgery for Locally Advanced T4 Sigmoid Colon Cancer Invading the Urinary Bladder and Ureter.

Case Rep Surg 2019 21;2019:9598183. Epub 2019 Dec 21.

Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, Japan.

The feasibility and safety of laparoscopic surgery for locally advanced colorectal cancer remain controversial due to the high rate of incomplete resection and conversion to open surgery. Especially for T4 colorectal cancer, laparoscopic techniques are still demanding mainly because of the difficulty in distinguishing between inflammation and tumor involvement, which often lead surgeons to do overtreatment in surgery. We believe laparoscopic magnified and multidirectional approach might be useful for pathologically complete resection and minimizing an unnecessary extended surgery for these cases. A 49-year-old man was diagnosed with locally advanced T4 sigmoid colon cancer invading the urinary bladder and ureter. We performed laparoscopic anterior resection with en bloc resection of the urinary bladder and the left ureter. Total operative time was 462 min, and the estimated blood loss was 50 ml. This patient was discharged on the 28th day after surgery without any ostomies and urinary functional disorders. The magnified view by laparoscopic techniques from multiple directions would enable surgeons to set surgical landmarks for another approach, which is the key for safe and feasible laparoscopic surgery in patients with locally advanced T4 colorectal cancer.
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http://dx.doi.org/10.1155/2019/9598183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942784PMC
December 2019

[A case of liver metastasis 11 years after resection of a gastrointestinal stromal tumor of the duodenum].

Nihon Shokakibyo Gakkai Zasshi 2019 ;116(12):1030-1038

Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital.

A 77-year-old Japanese man with a gastrointestinal stromal tumor (GIST) had undergone a duodenectomy 11 years prior. At that time, he had an incidentally detected left renal cell carcinoma, for which he underwent a nephrectomy and was followed-up at our institution. Twenty-four months after the nephrectomy, a 13-mm low-density mass was found on abdominal computed tomography (CT). Contrast-enhanced ultrasonography indicated an irregular hyperenhancement in the vascular phase and a defect on the post-vascular image. A tumor biopsy for differential diagnosis revealed that the tumor was a GIST. Since positron emission tomography-CT and capsule endoscopy revealed no evidence of a primary lesion, we performed a partial hepatectomy without adjuvant treatment. Microscopic examination revealed that the tumor consisted of uniform spindle cells with a fascicular growth pattern. Immunohistochemical examination revealed c-kit and CD34 expressions, similar to those found in the resected duodenal GIST specimen 11 years prior. We diagnosed metastatic liver tumor from the duodenal GIST resected 11 years prior. The patient remains alive without disease recurrence 24 months after the hepatectomy. Long-term surveillance is required after resection of a high-risk primary GIST.
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http://dx.doi.org/10.11405/nisshoshi.116.1030DOI Listing
December 2019

A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy.

Surg Case Rep 2019 Nov 9;5(1):177. Epub 2019 Nov 9.

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.

Background: In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare.

Case Presentation: A 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture.

Conclusions: When a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered.
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http://dx.doi.org/10.1186/s40792-019-0745-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842380PMC
November 2019

Prognostic nutritional index is superior as a predictor of prognosis among various inflammation-based prognostic scores in patients with hepatocellular carcinoma after curative resection.

Hepatol Res 2020 Jan 14;50(1):101-109. Epub 2019 Nov 14.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Aim: There is increasing evidence that inflammation-based prognostic scores are stage-independent predictors of poor outcome in patients with hepatocellular carcinoma (HCC). However, these findings were observed in a small-sized study comparing the prognostic value of these scores for patients after curative resection for HCC.

Methods: We retrospectively analyzed 717 consecutive patients with HCC who underwent curative liver resection at Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital. Clinicopathological variables including preoperative inflammation-based prognostic scores, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Controlling Nutritional Status score, prognostic nutritional index (PNI), and Glasgow Prognostic Score were analyzed. The prognostic value of these scores was compared by the time-dependent receiver operating characteristic curve analyses.

Results: The integrate area under the curve of PNI, Controlling Nutritional Status score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Glasgow Prognostic Score were 0.6751, 0.6435, 0.5845, 0.5276, and 0.5351 for overall survival (OS), respectively, and 0.5955, 0.5694, 0.4692, 0.4873, and 0.5272 for disease-free survival, respectively. Multivariate analyses for prognosis factor in HCC patients showed that PNI was an independent predictor of both OS (HR 0.91, P < 0.001) and disease-free survival (HR 0.94, P < 0.001). When the patients were divided into high and low PNI groups, the patients in the low PNI group had significant poorer OS (P < 0.001) and disease-free survival (P < 0.001), even after background factors were matched between these two groups.

Conclusions: PNI is superior to Controlling Nutritional Status score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, or Glasgow Prognostic Score as a predictor of OS and recurrence-free survival in patients with HCC who underwent curative hepatic resection.
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http://dx.doi.org/10.1111/hepr.13431DOI Listing
January 2020

Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota's fascia.

Surg Case Rep 2019 Oct 28;5(1):159. Epub 2019 Oct 28.

Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan.

Background: The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a "Goal" that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach.

Case Presentation: A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota's fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a "Goal" at the inferior border of the pancreas for safe resection of the Gerota's fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota's fascia, and the resection margin was negative for cancer.

Conclusions: The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota's fascia.
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http://dx.doi.org/10.1186/s40792-019-0720-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816766PMC
October 2019

Elevation of Mac-2 binding protein glycosylation isomer after hepatectomy is associated with post-hepatectomy liver failure, total Pringle time, and renal dysfunction.

Ann Gastroenterol Surg 2019 Sep 8;3(5):515-522. Epub 2019 Jul 8.

Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan.

Background: Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel serum glycomarker used to assess liver fibrosis. However, it has been reported that M2BPGi is likely to reflect other factors not limited to liver fibrosis.

Methods: We retrospectively analyzed 79 patients with liver tumors who underwent liver resection. M2BPGi was measured within 1 week before operation and almost 1 month after operation. We introduced a value termed the "ΔM2BPGi ratio" (=M2BPGi/M2BPGi), and analyzed factors that influenced the ΔM2BPGi ratio.

Results: The median value of the ΔM2BPGi ratio was 1.28 (range, 0.36-5.68). In 64 patients (81.0%), the cutoff index values of M2BPGi were elevated approximately 1 month after operation, especially in patients who experienced post-hepatectomy liver failure (PHLF). Multiple linear regression showed total Pringle time, PHLF grade ≥B, and preoperative value of creatinine were significant predictors of the ΔM2BPGi ratio. The mean values of the ΔM2BPGi ratio were 1.37 ± 0.07, 1.52 ± 0.22, and 2.94 ± 0.30 for PHLF grade 0, grade A, and grade B, respectively, resulting in statistically significant differences by the Kruskal-Wallis test (=0.022).

Conclusions: Total Pringle time, PHLF grade ≥B, and preoperative creatinine significantly influenced the elevation of M2BPGi almost 1 month after liver resection. This study strongly affirms the previous suggestion that M2BPGi is likely to reflect other factors not limited to liver fibrosis.
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http://dx.doi.org/10.1002/ags3.12271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749955PMC
September 2019

Esophageal perforation with orogastric tube malposition in low-birth-weight infant.

Clin Case Rep 2019 Sep 22;7(9):1794-1795. Epub 2019 Jul 22.

Department of Pediatric Surgery Ogaki Municipal Hospital Japan.

Esophageal perforation is an uncommon, but serious complication which can be caused with gastric tube placement. Physicians should suspect the malposition of the gastric tube when there is a straight course of the lower segment of the tube.
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http://dx.doi.org/10.1002/ccr3.2321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745443PMC
September 2019

Design of a prospective multicenter randomized controlled trial evaluating the effects of gastric lavage on coffee-ground emesis in neonates: study protocol.

Nagoya J Med Sci 2019 May;81(2):227-232

Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Neonates who swallow a considerable amount of maternal blood may exhibit vomiting and suckling disorder during the first few days of the postnatal period. Some clinicians treat these neonates with gastric lavage (GL) to prevent vomiting and the establishment of enteral feeding empirically, but there was no study assessing the effect of GL for neonates with coffee-ground emesis. We designed a multicenter randomized controlled trial to evaluate the efficacy and safety of GL in neonates with coffee-ground emesis. Vigorous neonates with birth weight ranging from 2500 g to 3999 g and gestational age between 37w0d and 41w6d who presented with coffee-ground emesis on more than twice and diagnosed as false melena, were divided into two groups using computerized randomization. We defined feeding intolerance (FI) as (1) ≥2 vomiting episodes in 4h or ≥3 episodes in 24h and/or (2) feeding failure on at least two occasions because of retching or poor sucking. Primary outcome is percentage of infants who present FI within 24 hours from admission. We also assessed the residual volumes, number of vomiting episodes, percentage of weight reduction at postnatal day 4, rates of body weight gain at 1 month of age, and peak serum total bilirubin value before discharge. To our knowledge, this is the first study to evaluate the safety and efficacy of GL for neonates with coffee-ground emesis. This trial is registered at UMIN Clinical Trials Registry as UMIN000026483.
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http://dx.doi.org/10.18999/nagjms.81.2.227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556448PMC
May 2019

The incidence and risk factor of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction.

J Orthop Sci 2020 May 13;25(3):477-480. Epub 2019 Jun 13.

Department of Orhtopaedic Surgery, Marunouchi Hospital, Nagisa1-7-45, Matsumoto, 390-8601, Japan.

Purpose: To retrospectively analyze the incidence and risk factors of deep venous thrombosis (DVT) detected by ultrasonography after arthroscopically assisted Anterior Cruciate Ligament Reconstruction (ACLR).

Methods: We retrospectively reviewed medical records of arthroscopically assisted ACLR surgery performed at our institution between 2012 and 2015. Revision ACLR, bone patella tendon bone (BTB) graft reconstruction, and concomitant multiple ligament reconstructions were excluded. We performed a standardized double-bundle reconstruction procedure using hamstrings graft for ACLR. All patients routinely received DVT screening by using venous ultrasonography on postoperative day 7 from 2012 to 2013, and postoperative days 7 and 14 from 2014 to 2015. The prevalence of DVT was calculated and clinical factors such as age, gender, Body Mass Index (BMI), operative time, and duration of tourniquet application were evaluated in relation to the risk factor of DVT.

Results: Two hundred and fifty-six patients (129 men and 127 women) with a mean age of 28.9 were enrolled. Sixteen patients (6.6%) were detected with DVT on postoperative day 7. Among 146 patients who received venous ultrasonography on both postoperative days 7 and 14, DVT were detected in five additional patients on postoperative day 14. In a total of 21 patients who were diagnosed with DVT, two were proximal, the remaining 19 were distal, and no patient had progressed to pulmonary embolism (PE). In terms of predisposing factors for developing DVT on postoperative day 7, only age ≥30 showed a statistically significant higher risk of DVT (P = 0.03).

Conclusion: Incidence of DVT after ACLR detected by ultrasonography on postoperative day 7 was 6.6%. Patients aged ≥30 years have a potentially higher risk for developing DVT. Great care for DVT should be taken if prolonged immobilization is applied after ACLR surgery.

Level Of Evidence: Level Ⅳ.
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http://dx.doi.org/10.1016/j.jos.2019.05.014DOI Listing
May 2020

Preoperative course of patients undergoing endoscopic nasobiliary drainage during the management of resectable perihilar cholangiocarcinoma.

J Hepatobiliary Pancreat Sci 2019 Aug 9;26(8):341-347. Epub 2019 Jul 9.

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.

Background: Although there are many studies on technical outcomes of endoscopic nasobiliary drainage (ENBD), no authors reported on preoperative course of patients undergoing ENBD. The aim of this study was to investigate the course of patients with ENBD during the waiting period.

Methods: Patients who underwent resection of perihilar cholangiocarcinoma (PHCC) between January 2013 and September 2017 were retrospectively reviewed.

Results: During the study period, 191 consecutive patients underwent surgical resection of PHCC after ENBD. Of the study patients, 154 (80.6%) patients were discharged, returned to their home, then re-admitted for surgery. The remaining 37 patients were continuously hospitalized. The number of cholangitis events during the waiting period was 0 in 120 patients, 1 in 59 patients, 2 ≤ in 12 patients. Endoscopic re-intervention was needed in 52 patients. The median length between the first admission and surgery was 37 days (range 12-197 days) in the entire cohort; it was longer in patients with portal vein embolization than in those without (43 vs. 27 days, P < 0.001).

Conclusions: In patients undergoing resection of PHCC, ENBD is widely tolerable with relatively low incidence of cholangitis and thus recommended for preoperative biliary drainage.
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http://dx.doi.org/10.1002/jhbp.640DOI Listing
August 2019

Discrepancy between volume and functional recovery in early phase liver regeneration following extended hepatectomy with extrahepatic bile duct resection.

Hepatol Res 2019 Oct 11;49(10):1227-1235. Epub 2019 Jul 11.

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine.

Aim: To elucidate the clinical factors having an impact on liver regeneration rate following preoperative portal vein embolization (PVE) and subsequent extended hepatectomy. The correlation between liver volume and functional recovery after extended hepatectomy was also investigated.

Methods: Records of patients who underwent extended hepatectomy with extrahepatic bile duct resection following PVE for perihilar cholangiocarcinoma were reviewed retrospectively with attention to liver regeneration. All patients underwent computed tomography before PVE, after PVE (immediately before surgery), and on postoperative day (POD) 7. The kinetic growth rate (KGR) was calculated as the percent increase in liver volume relative to the future liver remnant volume per day after PVE (KGR ) and after POD 7 (KGR ) using the computed tomography images before PVE, after PVE, and on POD 7.

Results: In the 289 study patients, the median of KGR was 1.35%/day whereas that of KGR was 5.56%/day. The extent of liver resection had the greatest impact on both KGR and KGR and the impacts of other factors were less. There was a significant negative correlation between KGR and KGR (P = 0.002). No correlations were observed between KGR or KGR and serum total bilirubin and prothrombin time - international normalized ratio on POD 7, nor in the incidence of liver failure after surgery.

Conclusions: Early phase liver regeneration after extended hepatectomy was largely influenced by the extent of liver resection and showed no correlation with the indices of liver failure. There was a discrepancy between volume and functional recovery in early phase liver regeneration.
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http://dx.doi.org/10.1111/hepr.13378DOI Listing
October 2019

Acute median arcuate ligament syndrome after pancreaticoduodenectomy.

Surg Case Rep 2018 Nov 26;4(1):137. Epub 2018 Nov 26.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima City, Hiroshima, 730-0052, Japan.

Background: Median arcuate ligament syndrome (MALS) can cause severe complications after pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and can be treated efficiently by interventional radiology or division of the median acute ligament (MAL) fibers.

Case Report: A 69-year-old woman underwent PD with resection of the SMV for pancreatic head cancer. Intraoperative exploration showed normal anatomy of the celiac trunk. Intraoperative digital palpation revealed normal pulsation of the common hepatic artery after resection of the gastroduodenal artery. On postoperative day (POD) 3, her liver function tests were abnormal, and bloody fluids were found in the drain. Abdominal CT showed necrosis of the pancreatic body and ischemia in the liver secondary to MALS which was not detected in the preoperative CT. Interventional radiology was tried first but failed. Division of the MAL fibers markedly increased the blood flow in the hepatic artery. Resection of the remnant pancreas and spleen was also performed simultaneously. Abdominal CT on POD 20 showed re-occlusion of the celiac artery. She experienced rupture of the gastrojejunostomy site, severe hepatic cytolysis, and choledochojejunostomy stricture thereafter.

Conclusions: This is the third case of MALS that has developed acutely after PD. MALS can cause refractory complications even after MAL release.
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http://dx.doi.org/10.1186/s40792-018-0545-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261092PMC
November 2018
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