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World Journal of Clinical Cases 2022年第7期10卷 2357-2362页

作者： Ryuji Sawada Kunitaro Watanabe Joho Tokumine Alan Kawarai Lefor Tadao Ando Tomoko Yorozu Department of Pain Clinic NTT Medical Center TokyoHigashigotanda 141-8625TokyoJapan Department of Anesthesiology Hino Municipal HospitalTamadaira 191-0062TokyoJapan Department of Anesthesiology Kyorin University School of MedicineMitaka 181-8611TokyoJapan Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves.This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block.The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair.Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1%lidocaine 20 mL.The pain was relieved after the block.The diagnosis was anterior cutaneous nerve entrapment syndrome.Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.

关键词： Anterior cutaneous nerve entrapment syndrome Rectus sheath block Hydrodissection Laparoscopic surgery Case report

Airway ultrasound for patients anticipated to have a difficult airway:Perspective for personalized medicine

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World Journal of Clinical Cases 2023年第9期11卷 1951-1962页

作者： Harumasa Nakazawa Kohji Uzawa Joho Tokumine Alan Kawarai Lefor Akira Motoyasu Tomoko Yorozu Department of Anesthesiology Kyorin University School of MedicineMitaka 181-8611TokyoJapan Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

Airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck access.Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation.However,no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy.This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making.The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed.The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

关键词： Airway ultrasound Difficult airway Point-of-care ultrasound Cricothyroidotomy Intubation Mask ventilation

Multidisciplinary management of acute mesenteric ischemia:Surgery and endovascular intervention

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 806-813页

作者： Takashi Sakamoto Tadao Kubota Hiraku Funakoshi Alan Kawarai Lefor Department of Clinical Epidemiology and Health Economics School of Public HealthThe University of TokyoTokyo 1130033Japan Department of Surgery Tokyo Bay Urayasu Ichikawa Medical CenterChiba 2790001Japan Department of Interventional Radiology Tokyo Bay Urayasu Ichikawa Medical CenterChiba 2790001Japan Department of Surgery Jichi Medical UniversityTochigi 3290498Japan

Acute mesenteric ischemia(AMI)is a rare cause of the“acute abdomen”,characterized by impaired blood flow to the intestine.The principle of treatment is restoration of perfusion to ischemic bowel and resection of any necrotic intestine.Surgery and endovascular intervention are two complementary approaches to mesenteric ischemia.Endovascular intervention is not an alternative to the surgical approach,but it has the potential to improve the prognosis of patients with AMI when judiciously combined with a surgical approach.Due to the need for emergent treatment of patients with acute mesenteric ischemia,the treatment strategy needs to be modified for each facility.This review aims to highlight cutting-edge studies and provide reasonable treatment strategies for patients with acute mesenteric ischemia based on available evidence.

关键词： Acute mesenteric ischemia Endovascular intervention Acute mesenteric arterial embolism Acute mesenteric arterial thrombosis

Barium appendicitis: A single institution review in Japan

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World Journal of Gastrointestinal Surgery 2016年第9期8卷 651-655页

作者： Hideki Katagiri Alan Kawarai Lefor Tadao Kubota Ken Mizokami Department of Surgery Tokyo Bay Urayasu Ichikawa Medical Center Department of Surgery Jichi Medical University

AIM To review clinical experience with barium appendicitis at a single institution.METHODS A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography(CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units(HU). Barium appendicitis is defined as:(1) patients diagnosed with acute appendicitis;(2) the patient has a history of a prior barium study; and(3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis.RESULTS In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients(3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU(± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU(± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis wassignificantly higher than in patients with nonbarium fecaliths(P < 0.01).CONCLUSION Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.

关键词： Acute appendicitis Barium appendicitis Barium sulfate Upper gastrointestinal imaging Gastric cancer screening

Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma

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World Journal of Gastroenterology 2022年第38期28卷 5614-5625页

作者： Atsushi Miki Yasunaru Sakuma Hideyuki Ohzawa Akira Saito Yoshiyuki Meguro Jun Watanabe Kazue Morishima Kazuhiro Endo Hideki Sasanuma Atsushi Shimizu Alan Kawarai Lefor Yoshikazu Yasuda Naohiro Sata Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.

关键词： Liver function Hepatectomy Cirrhosis Fusion image Complication Mortality

Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT

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World Journal of Gastroenterology 2014年第45期20卷 16964-16975页

作者： Shigeyoshi Kijima Takahiro Sasaki Koichi Nagata Kenichi Utano alan T lefor Hideharu Sugimoto Department of Radiology Jichi Medical University Department of Surgery Jichi Medical University

Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.

关键词： Colorectal cancer Preoperative evaluation T stagin

Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

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World Journal of Gastroenterology 2010年第29期16卷 3723-3726页

作者： Yasunao Ishiguro Masanobu Hyodo Takehito Fujiwara Yasunaru Sakuma Nobuyuki Hojo Koichi Mizuta Hideo Kawarasaki alan T lefor Yoshikazu Yasuda Department of Surgery School of MedicineJichi Medical University

A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son,who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years.The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation.With the use of cholangiography at the time of surgery,we found the right anterior segmental duct(RASD) emptying directly into the cystic duct,and the catheter passed into the RASD.After repairing the incision in the cystic duct,transplantation was successfully performed.Her postoperative course was uneventful.Biliary anatomical variations were frequently encountered,however,this variation has very rarely been reported.If the RASD was divided,the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor.Meticulous preoperative evaluation of the living donor's biliary anatomy,especially using magnetic resonance cholangiography and careful intraoperative techniques,is important to prevent bile duct injury and avoid the risk to the healthy donor.

关键词： Bile duct injury Cystohepatic duct Intraoperative cholangiography Living liver transplantation Magnetic resonance cholangiography

Diagnosis of a submucosal mass at the staple line after sigmoid colon cancer resection by endoscopic cuttingmucosa biopsy

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World Journal of Gastrointestinal Endoscopy 2016年第8期8卷 374-377页

作者： Mitsuaki Morimoto Koji Koinuma alan K lefor Hisanaga Horie Homare Ito Naohiro Sata Yoshikazu Hayashi Keijiro Sunada Hironori Yamamoto Department of Surgery Jichi Medical University Department of Gastroenterology Jichi Medical University

A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.

关键词： Submucosal tumor Staple line Endoscopic cutting-mucosa biopsy

Primary hepatic choriocarcinoma in a 49-year-old man:Report of a case

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World Journal of Gastroenterology 2013年第48期19卷 9485-9489页

作者： Ryosuke Sekine Masanobu Hyodo Masayuki Kojima Yoshiyuki Meguro Akifumi Suzuki Taku Yokoyama alan T lefor Norio Hirota Department of Emergency Medicine Ibaraki Prefectural Central Hospital Ibaraki 309-1793 Japan Department of Surgery Hitachiomiya Saiseikai Hospital Ibaraki 319-2256 Japan Department of Surgery Jichi Medical University Tochigi 329-0498 Japan Department of Pathology Hirota Institute for Surgical Pathology Tochigi 329-0403 Japan

We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course.The patient was a 49-year-old man who presented with acute right-sided abdominal pain.There were no masses palpable on physical examination.Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver.Fludeoxyglucosepositron emission tomography scan showed uptake only in the liver,and no uptake in the testes.We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma.However,the tumors grew rapidly and ruptured.Multiple lung metastases rapidly developed resulting in respiratory failure,preventing liver resection or even biopsy.He died 60 d after initial presentation with no pathological diagnosis.Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver.Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man.Establishing this diagnosis may enable treatment of the choriocarcinoma.Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.

关键词： Hepatic choriocarcinoma Male Human chorionic gonadotropin Liver biopsy Fludeoxyglucosepositron emission tomography

Emphysematous cholecystitis associated with constipation: A case report

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Case Reports in Clinical Medicine 2013年第1期2卷 9-10页

作者： Kenji Okumura alan T. lefor Takafumi Maeda Yoshiharu Takenaka Toshiyuki Suganuma Department of Surgery Tokyo-Bay Urayasu Ichikawa Medical Center Chiba Japan Department of Surgery Uwamachi General Hospital Yokosuka Japan

Constipation is one of the most common complaints in the general population, with a wide variety of causes. We present the case of a man with a four-week history of constipation who developed signs and symptoms of acute cholecystitis. Computed tomography scan of the abdomen revealed emphysematous cholecystitis and pericholecystic inflammatory changes extending to the adjacent colon. Emergent cholecystectomy was performed, and bowel function improved after surgery. Chronic inflammation of the gallbladder might be associated with constipation in this patient.

关键词： Constipation Emphysematous Cholecystitis