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Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 502-509页

作者： Masataka Amisaki Ei Uchinaka Masaki Morimoto Naruo Tokuyasu Teruhisa sakamoto Soichiro Honjo Hiroaki Saito Yoshiyuki Fujiwara Division of Surgical Oncology Department of Surgery School of Medicine Tottori University Faculty of Medicine

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients’ long-term outcomes( P = 0.020 and P < 0.001, respectively, for overall survival, and P = 0.012 and P = 0.015, respectively, for recurrence-free survival). Post-operative ALBI grade was associated with patients’ surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.

关键词： Prognosis Hepatic resection Albumin Bilirubin

Complete response with sorafenib and transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2016年第42期22卷 9445-9450页

作者： Michitoshi Takano Takashi Kokudo Yoshihiro Miyazaki Yumiko Kageyama Amane Takahashi Katsumi Amikura Hirohiko sakamoto Division of gastroenterological surgery Saitama Cancer Center

Patients with advanced hepatocellular carcinoma(HCC) showing portal vein tumor thrombosis(PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization(TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.

关键词： Hepatocellular carcinoma Sorafenib Complete response Portal vein tumor thrombosis Transcatheter arterial chemoembolization

Prognostic Impact of Surgical Margin Width in Hepatectomy for Colorectal Liver Metastasis

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 705-717页

作者： Katsunori sakamoto Toru Beppu Kohei Ogawa Kei Tamura Masahiko Honjo Naotake Funamizu Yasutsugu Takada Department of Hepato-Biliary-Pancreatic and Breast Surgery Ehime University Graduate School of MedicineToon EhimeJapan Department of Surgery Yamaga City Medical CenterKumamotoJapan

As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resection of CRLM. So the current sur-vival impact of sub-centi/millimeter surgical margins in he-patectomy for CRLM should be evaluated. In the current era of multidisciplinary treatment options, this review focused on the prognostic impact of a sub-centi/millimeter surgical margin width in hepatectomy for CRLM. We systematically reviewed retrospective studies that clearly described the sur-gical margin width for hepatectomy for CRLM. We selected studies conducted since 2000 that involved patients diag-nosed as having CRLM. We focused on studies that investi-gated not only surgical margins, but also microscopic surgical curability such as R0 (microscopically complete resection) or R1 (microscopically incomplete resection), which clearly de-scribe their definitions. Based on our literature review, 1, 2, or 5 mm was considered the minimum surgical margin width for hepatectomy for CRLM. Although a surgical margin width of 1 mm is acceptable for hepatectomy for CRLM, submil-limeter margins, which are defined as R1 in many reports, are only acceptable for limited patients such as those who have undergone preoperative chemotherapy. Zero-mm mar-gins are also acceptable in limited patients such as those who show a good response to preoperative chemotherapy. New chemotherapy agents have been reported to reduce the prognostic impact of a narrow surgical margin width. The incidence of margin recurrence, which is a major concern regarding R1 resection of CRLM, is about 20-30% according to the majority of earlier reports. As evaluations of the actual prognostic impact of the surgical margin remain difficult, fur-ther study is warranted.

关键词： Surgical margin Colorectal liver metastasis Chemotherapy.

Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma:A case report and review of the literature

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World Journal of Gastroenterology 2018年第37期24卷 4291-4296页

作者： Hideki Ishimaru Minoru Morikawa Takayuki Sakugawa Ichiro sakamoto Yasuhide Motoyoshi Yohei Ikebe Masataka Uetani Department of Radiology Nagasaki University HospitalNagasaki 852-8501Japan Department of Radiology Nagasaki Harbor Medical CancerNagasaki 850-8555Japan Department of Gastroenterology Nagasaki Harbor Medical CancerNagasaki 850-8555Japan Department of Radiological Sciences Nagasaki University Graduate School of Biomedical SciencesNagasaki 852-8501Japan

A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.

关键词： Transcatheter arterial chemoembolization Arteriovenous shunt Hepatocellular carcinoma Vascular lake Cerebral embolism

Observation of Impurity Accumulation After Hydrogen Multi-Pellet Injection in Large Helical Device

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Plasma Science and Technology 2013年第3期15卷 230-234页

作者：董春凤 Shigeru MORITA Motoshi GOTO 王二辉 Gen MOTOJIAMA Izumi MURAKAMI Ryuichi sakamoto Norimasa YAMAMOTO National Institute for Fusion Science Department of Fusion Science Graduate University for Advanced Studies Center of Applied Superconductivity & Sustainable Energy Research Chubu University

Impurity accumulation is studied for neutral beam-heated discharges after hydrogen multi-pellet injection in Large Helical Device （LHD）. Iron density profiles are derived from radial profiles of EUV line emissions of FeXV-XXIV with the help of the collisional-radiative model. A peaked density profile of Fe2a＋ is simulated by using one-dimensional impurity transport code. The result indicates a large inward velocity of -6 m/s at the impurity accumulation phase. However, the discharge is not entirely affected by the impurity accumulation, since the concentration of iron impurity, estimated to be 3.3x10-5 to the electron density, is considerably small. On the other hand, a flat profile is observed for the carbon density of C6＋, which is derived from the Zeff profile, indicating a small inward velocity of -1 m/s. These results suggest atomic number dependence in the impurity accumulation of LHD, which is similar to the tokamak result.

关键词： impurity accumulation EUV spectrometer inward velocity

Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

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World Journal of Gastrointestinal Surgery 2017年第7期9卷 161-166页

作者： Yasuhiro Matsuda Kazuki sakamoto Naoki Kataoka Tomoyuki Yamaguchi Masafumi Tomita Shinichiro Makimoto Department of Surgery Kishiwada Tokushukai HospitalKishiwada CityOsaka 596-8522Japan

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary *** This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were *** Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.

关键词： Duodenal neoplasm Endoscopic submucosal dissection Laparoscopic and endoscopic cooperative surgery

Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm

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World Journal of Gastroenterology 2009年第43期15卷 5489-5492页

作者： Hiroki sakamoto Masayuki Kitano Takamitsu Komaki Hajime Imai Ken Kamata Masatomo Kimura Yoshifumi Takeyama Masatoshi Kudo Division of Gastroenterology and Hepatology Department of Internal MedicineKinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589-8511Japan Department of Pathology Kinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589- 8511Japan Department of Surgery Kinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589-8511Japan

Endoscopic ultrasonography （EUS） is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas. Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS （CEH-EUS） which uses sonographic contrast agent for differentiation of a pancreatic mass. This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm （IPMN） in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the follow-up of the branch duct IPMN. A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body. She had been followed-up by EUS every 6 too. However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging. CHEUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma. The histopathological diagnosis was adenocarcinoma （10 mm） in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body. EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.

关键词： Intraductal papillary mucinous adenoma Small pancreatic cancer Endoscopic ultrasonography Contrast-enhanced harmonic endoscopic ultrasonography Pancreatic cancer Pancreas Contrast enhanced endoscopic ultrasonography

Factors Influencing on Drinking Water Source Selection in Rural Areas of the Bengal Region

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Journal of Environmental Science and Engineering(A) 2013年第11期2卷 664-676页

作者： Maiko sakamoto Department of lnternational Studies Graduate School of Frontier Sciences The University of Tokyo 5-1-5 Kashiwanoha KashiwaChiba 2778 563 Japan

The arsenic contamination of underground water is a serious problem in rural areas of the Bengal region, where the water pipeline supply is not equipped. Those, who suffer from the contamination are mainly in the poorest sector. In the region, the selection of drinking water sources is done by women. The local traditional custom of Parda may restrict women＇s behavior. In this paper, a quantitative way of evaluating women＇s psychological stress is proposed, and mechanisms of women＇s water selection are analyzed using behavioral model. Ultimately, the more acceptable ways of installing water facilities to local people in each village are discussed.

关键词： South Asia arsenic contamination drinking water gender space syntax.

Benefits of international trauma rotation in South Africa:comparison with a trauma center in Tokyo

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Emergency and Critical Care Medicine 2022年第4期2卷 179-180页

作者： Tsuyoshi Nagao Shinji Nakahara Takashi Fujita Tetsuya sakamoto Elmin Steyn Department of Emergency Medicine Teikyo University School of MedicineTokyoJapan Graduate School of Health Innovation Kanagawa University of Human ServicesKawasakiJapan Department of surgery Stellenbosch University and Tygerberg HospitalCape TownSouth Africa.

International rotations have been an option for young surgeons who face difficulties in obtaining sufficient trauma training in their own coun*** of the authors attended training in trauma surgery in South Africa for 6 months,where there are many trauma caseloads,and could experience the number of emergency operations equivalent to approximately 5 years in *** rotation allows trainees to expose clinical practices intensively and to learn principles and theories of care under experienced academic *** the other hand,they could contribute to the host hospital as part of the workforce and by assisting young surgical *** development of a more systematic and formalized framework for staff exchange between developed and developing countries will provide mutual benefits to both sides.

关键词： Low-and middle-income countries On-the-job training Trauma surgery