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Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis

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World Journal of Gastroenterology 2009年第11期15卷 1394-1397页

作者： Fumihiko Miura Takehide Asano Hodaka Amano Masahiro Yoshida Naoyuki Toyota keita Wada Kenichiro Kato Tadahiro Takada Junichi Fukushima Fukuo Kondo Hajime Takikawa Department of Surgery Teikyo UniversitySchool of MedicineTokyo173-8605Japan Department of Pathology Teikyo UniversitySchool of MedicineTokyo173-8605Japan Department of Medicine Teikyo University School of MedicineTokyo173-8605Japan

Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice. Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pyloruspreserving pancreatoduodenectomy and liver biopsy. On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sderosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis （PSC）. Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia.

关键词： Eosinophilc cholangiopathy Primarysclerosing cholangitis Secondary sclerosing cholangitis Obstructive jaundice

Stomach Cancer: Surgical Management and Impact of Lymph Node Dissection in Survival at the Surgery “A” Department of the National Hospital of Point “G” (Mali)

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Surgical Science 2020年第12期11卷 458-468页

作者： Sidiki keita Koniba keita Moussa Sissoko Mahamadou Coulibaly Lamine Soumare Oumar Sacko Sekou Koumaré Adama K. Koita Soumaîla keita Zimogo Zié Sanogo General Surgery “A” Department Hospital Point-G. Bamako Mali General Surgery Department Hospital BSS Kati Mali

Introduction: Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4th most common cancer in men, the 5th in women, and the third leading cause of cancer death in men, the 5th in women. Patients and Methods: This was an analytical, prospective and descriptive study. Study Framework: Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. Study Period: August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). Inclusion Criteria: All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. Result: The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%);Stage III (21 cases, or 27.27%);Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases;cardiac fundus in 2 cases;antrum in 24 cases;antro-pyloric in 28 cases;Pylorus in 1 case;great curvature in 5 cases;small curvature in 2 cases. Posto

关键词： Cancer Stomach Resectability Lymph Node Dissection Survival

Occult hepatitis B virus infection and surgical outcomes in non-B, non-C patients with curative resection for hepatocellular carcinoma

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World Journal of Hepatology 2017年第35期9卷 1286-1295页

作者： Hiroki Koga keita Kai Shinichi Aishima Atsushi Kawaguchi Koutaro Yamaji Takao Ide Junji Ueda Hirokazu Noshiro Department of Surgery Saga University Faculty of Medicine Department of Pathology Saga University Hospital Department of Pathology and Microbiology Saga University Faculty of Medicine Center for Comprehensive Community Medicine Saga University Faculty of Medicine

AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS This study retrospectively examined the cases of 78 NBNC patients with curative resection for HCC for whom DNA could be extracted from formalin-fixed paraffin-embedded tissue. OBI was determined by the HBV-DNA amplification of at least two different sets of primers by TaqM an realtime polymerase chain reaction. Possibly carcinogenetic factors such as alcohol abuse, diabetes mellitus, obesity and non-alcoholic steatohepatitis(NASH) were examined. Surgical outcomes were evaluated according to diseasefree survival(DFS), overall survival(OS) and diseasespecific survival(DSS).RESULTS OBI was found in 27/78 patients(34.6%) with NBNC HCC. The OBI patients were significantly younger than the non-OBI cases at the time of surgery(average age 63.0 vs 68.1, P = 0.0334) and the OBI cases overlapped with other etiologies significantly more frequently compared to the non-OBI cases(P = 0.0057). OBI had no impact on the DFS, OS or DSS. Only tumorrelated factors affected these surgical *** Our findings indicate that OBI had no impact on surgical outcomes. The surgical outcomes of NBNC HCC depend on early tumor detection; this reconfirms the importance of a periodic medical examination for individuals who have NBNC HCC risk factors.

关键词： Hepatocellular carcinoma Non-B non-C Occult hepatitis B virus infection Surgery Surgical outcome

CO_2 insufflation for potentially diffi cult colonoscopies: Effi cacy when used by less experienced colonoscopists

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World Journal of Gastroenterology 2009年第41期15卷 5186-5192页

作者： Toshio Uraoka Jun Kato Motoaki Kuriyama Keisuke Hori Shin Ishikawa keita Harada Koji Takemoto Sakiko Hiraoka Hideyuki Fujita Joichiro Horii Yutaka Saito Kazuhide Yamamoto Department of Endoscopy Okayama University Hospital Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Division of Endoscopy National Cancer Center Hospital

AIM： To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists. METHODS： One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insuffiation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist （EC） group and a less experienced colonoscopist （LEC） group. Study measurements included a 100-mm visual analogue scale （VAS） for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times. RESULTS： Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group （P〈 0.001, two-way ANOVA） from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group （P = 0.29）, however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group （P = 0.023） immediately after colonoscopies and up to 4 h afterwards. CONCLUSION： CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

关键词： CO2 insufflation Colonoscopy Difficult colonoscopy Experienced colonoscopist Training

Experience of the Department of Surgery “A” Point-G Hospital in the Management of Hemorrhoids (Mali)

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Surgical Science 2020年第12期11卷 435-445页

作者： Sidiki keita Koniba keita Mahamadou Coulibaly Lamine Soumare Moussa Sissoko Oumar Sacko Sekou Koumaré Adama K. Koita Soumaîla keita Zimogo Zié Sanogo General Surgery “A” Department Hospital Point-G. Bamako Mali General Surgery Department Hospital BSS Kati Mali

Introduction: Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. Patients and Method: This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. Results: Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. Conclusion: Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.

关键词： Proctology Hemorrhoids Management

Volvulus of the Sigmoid Colon—Management in the Surgery “A” Department of the Teaching Hospital of Point G

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Surgical Science 2020年第12期11卷 469-478页

作者： Sidiki keita Koniba keita Moussa Sissoko Mahamadou Coulibaly Lamine Soumare Oumar Sacko Sekou Koumare Adama K. Koita Soumaîla keita Zimogo Zié Sanogo General Surgery “A” Department Hospital Point-G. Bamako Mali General Surgery Department Hospital BSS Kati Mali

Introduction: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. Methodology: The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. Result: We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. Conclusion: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and m

关键词： Volvulus Sigmoid Sigmoidectomy Hartmann Bouilly-Volkmann Anastomosis

基于WHO 2016版分类探讨纹理分析对胶质瘤的鉴别诊断

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基于WHO 2016版分类探讨纹理分析对胶质瘤的鉴别诊断

作者： keita MAME FATOU 大连医科大学

学位级别：硕士

目的:基于2016版WHO中枢神经系统肿瘤分类,应用常规MRI纹理分析鉴别Ⅱ、Ⅲ、Ⅳ级脑胶质瘤以及其基因突变情况,探讨纹理参数与病理-基因变化的相关性,从而明确纹理分析是否可以常规应用于脑胶质瘤的无创性诊断和治疗计划中。材料和方法:... 详细信息

目的:基于2016版WHO中枢神经系统肿瘤分类,应用常规MRI纹理分析鉴别Ⅱ、Ⅲ、Ⅳ级脑胶质瘤以及其基因突变情况,探讨纹理参数与病理-基因变化的相关性,从而明确纹理分析是否可以常规应用于脑胶质瘤的无创性诊断和治疗计划中。材料和方法:回顾性研究51例脑胶质瘤患者(女27例,男24例):其中15例WHOⅡ型胶质瘤,19例WHOⅢ型胶质瘤,17例WHOⅣ型胶质瘤。术前使用1.5T MRI((Signa HDxt,General Electronic Co,Milwaukee,WI,USA)进行轴位T1WI、T2WI和T1WI增强序列扫描,在ADW4.6工作站生成DICOM格式图像。使用omnikinetics软件(GE Healthcare,CHINA)进行纹理分析(MR texture analysis,MRTA),在T1WI、T2WI、T1WI增强的每层图像上沿肿瘤全域的边缘手动描绘ROI,然后将所有层面的ROI累加为一个3D ROI。本研究分为五组:第一组根据肿瘤的等级(WHO II-III-IV)确定;其他四组根据特定基因(P53,IDH-1,GFAP,EGFR)确定,每组分别对比基因突变阳性者、突变阴性者及没有进行相同基因突变检测者。比较三种级别胶质瘤Ki-67的差异性,以及Ki-67与不同MRI序列纹理参数的相关性。测量并选择T1WI、T2WI、T1WI增强序列的一阶纹理参数(最小强度、最大强度、平均强度、均匀性、熵、标准差、偏度、峰度和百分位数),二阶纹理参数(灰度共生矩阵参数:灰度共生矩阵的熵、能量、角二阶矩、均匀性、相关性和差异性;游程长度矩阵参数:短期游程强度(Short Run Emphasis,SRE)、长期游程强度(Long Run Emphasis,LRE)、灰度不均匀性(Grey Level Non-Uniformity,GLNU)、游程不均匀性(Run Length Non-Uniformity,RLNU)、短游程低灰度(Short Run Low Grey Level,SRLGL)、长游程低灰度(Long Run Low Grey Level,LRLGL)、短游程高灰度强度(Short Run High Grey Level,SRHGL)、长游程高灰度强度(Long Run High Grey Level,LRHGL)),使用SPSS24版进行数据分析。应用单因素方差分析及秩和检验比较每组的纹理参数的差异性。应用受试者工作特征(Receiver Operating Characteristics,ROC)评估纹理参数对与鉴别不同等级的胶质瘤及基因突变情况的诊断效能。对有统计学意义的纹理参数使用Spearman相关性分析其与Ki-67的相关性。p<0.05代表有统计学差异。结果:本研究共纳入51例患者:女27例,男24例,平均年龄(21.78±21.13)岁。Ki-67的平均值为50.1%,最大值为72%,最小值为27%。在51例患者中,有27例IDH-1突变,30例P53表达阳性,33例GFAP和10例EGFR表达阳性。在Ⅱ、Ⅲ、Ⅳ级胶质瘤的鉴别中,MRI三种序列的纹理参数均有统计学差异,其中在T1WI增强上,偏度的诊断效能最佳,AUC为0.858,集群阴影对其诊断的敏感度为100%,其AUC为0.825。在T2WI上,方差的诊断特异度最高(83%),AUC为0.739(p=0.009)。在T1WI上,短期低灰度运行强度(p=0.033,AUC=0.670)对鉴别三种级别的胶质瘤具有统计学意义,其敏感度及特异度为80%,50%。在P53突变的鉴别中,其中在T2WI上,偏度鉴别P53突变诊断效能最佳,AUC为0.745,敏感度为92%。集群阴影鉴别P53突变的特异度为72%。在IDH突变的鉴别中,惯性矩在T1WI增强以及T2WI上均具有最佳诊断效能,AUC及敏感度分别为(0.828,92%),(0.832,100%)。在T1WI中,均匀性的诊断特异度最高(83%)。对于鉴别GFAP突变,在所有序列中,对比度,最小强度以及第5百分位数均具有较好的诊断效能,AUC分别为0.935,0.857,0.794,敏感度及特异度均为100%。对于EGFR基因突变鉴别中,在T2WI上,惯性矩有最佳诊断效能,AUC为0.837,敏感度为100%。集群阴影诊断的特异度最高(100%)。在T1WI上,第5百分位数的诊断效能最佳,AUC为0.748,特异度为75%,敏感度为72%。Ki-67与偏度(r=0.444,p=0.001),集群阴影(r=0.413,p=0.003),集群显著性(r=0.564,p=0.009),熵值(r=0.375,p=0.007),熵总和(r=0.371,p=0.007),Haralick熵值(r

关键词：磁共振成像纹理分析脑胶质瘤

Long-term follow-up of ulcerative colitis patients treated on the basis of their cytomegalovirus antigen status

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World Journal of Gastroenterology 2014年第2期20卷 509-517页

作者： Toshihiro Inokuchi Jun Kato Sakiko Hiraoka Hideyuki Suzuki Asuka Nakarai Tomoko Hirakawa Mitsuhiro Akita Sakuma Takahashi keita Harada Hiroyuki Okada Kazuhide Yamamoto Department of Gastroenterology and Hepatology Okayama University Graduate School of MedicineDentistry and Pharmaceutical SciencesOkayama 700-8558Japan Second Department of Internal Medicine Wakayama Medical UniversityWakayama 641-0012Japan

AIM:To clarify the impact of cytomegalovirus(CMV)activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis(UC)***:UC patients with flare-up were divided into CMV-positive and-negative groups according to the CMV antigenemia *** main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ***:The median number of days to initial remission was significantly greater for the patients in the CMV-positive group(21 d vs 16 d,P=0.009).However,the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two *** analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive ***:CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy.

关键词： Ulcerative colitis Cytomegalovirus Cytomegalovirus antigenemia assay

Synchronous rectal and esophageal cancer treated with chemotherapy followed by two-stage resection

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World Journal of Clinical Cases 2013年第2期1卷 87-91页

作者： Setsuo Utsunomiya Keisuke Uehara Takuya Kurimoto Ken Hirose Masahide Fukaya Yu Takahashi Yoshiro Taguchi keita Itatsu Masato Nagino Department of Gastrointestinal Oncology Nagoya Kyoritsu Hospital Division of Surgical Oncology Department of Surgery Nagoya University Graduate School of Medicine Department of Gastroenterology Nagoya Kyoritsu Hospital

We report a case of 61-year-old male who had synchronous advanced rectal cancer involving the urinary bladder massively associated with multiple liver metastases, and esophageal cancer successfully treated by neoadjuvant chemotherapy followed by two-stage resection. Although complete resection of each of the lesions was considered possible by performing anterior pelvic exenteration, liver resection, and esophagectomy, it might be impossible for the patient to endure the stress of all of these operative procedures at once. Therefore, we planned to perform staged treatment with prioritizing consideration. First, we instituted chemotherapy with the FOLFOX(oxaliplatin + fluorouracil + leucovorin) plus cetuximab regimen, which could adequately control both rectal and esophageal cancer. After 6 cycles of chemotherapy, high anterior resection combined with cystoprostatectomy and lateral segmentectomy plus partial hepatectomy was performed followed by staged esophagectomy with three-field lymph node dissection. It was possible to use oxaliplatin and cetuximab safely as neoadjuvant therapy not only for advanced rectal cancer but for esophageal cancer, and it was effective.

关键词： Rectal cancer Esophageal cancer Neoadjuvant chemotherapy Cetuximab Oxaliplatin