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Edaravone inhibits apoptosis caused by ischemia/reperfusion injury in a porcine hepatectomy model

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World Journal of Gastroenterology 2012年第27期18卷 3520-3526页

作者： mitsugi shimoda Yoshimi Iwasaki Toshie Okada Keiichi Kubota Second Department of Surgery Dokkyo Medical University880 Kita KobayashiMibuTochigi 321-0293Japan

AIM： TO investigate the effect of E3-methyl-l-phe- nyl-2-pyrazolin-5-one （Edr） on hepatic ischemia-reper- fusion （I/R） injury and liver regeneration in a porcine hepatectomy model. METHODS： One hour ischemia was induced by occlud- ing the vessels and the bile duct of the right and median lobes. A 40% left hepatectomy was performed after re- perfusion. Six animals received Edr （3 mg/kg per hour） intravenously and six control animals received saline just before reperfusion. Remnant liver volume, hemody- namics, aspartate aminotransferase （AST）, alanine ami- notransferase, lactate dehydrogenase and lactic acid, were compared between the groups. The expression of transforming growth factor-β （TGF-β1） and toll-like receptor （TRL） mRNA in hepatic tissues was examined using reverse transcription polymerase chain reaction. Apoptosis was demonstrated by terminal deoxynucleo- tidyl transferase dUTP nick end labeling （TUNEL） stain- ing, respectively. RESULTS： Serum AS-I- （P = 0.029）, and toll like recep- tor 4 level （P = 0.043） were significantly lower after 3 hin animals receiving Edr. In addition, TUNEL staining in Edr-treated pigs showed significantly fewer hepatocytes undergoing apoptosis compared with control pigs. After 1 mo, all factors were non-significantly different between the two groups. CONCLUSION： Edr is considered to reduce hepatic injury in the early stage of I/R injury in a porcine model.

关键词： Edaravone Ischemia-reperfusion injury Liver resection Transforming growth factor-13 Toll likereceptor 4

Erythropoietin ameliorates early ischemia-reperfusion injury following the Pringle maneuver

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World Journal of Gastroenterology 2010年第38期16卷 4838-4845页

作者： Masato Kato Tokihiko Sawada Junji Kita mitsugi shimoda Keiichi Kubota Second Department of Surgery Dokkyo Medical UniversityKitakobayash 880

AIM:To investigate the protective effect of erythropoietin (Epo) against ischemia-reperfusion injury (IR/I) following the Pringle maneuver (PM),in comparison with conventional steroid administration in a prospective randomized trial. METHODS:Patients were randomized by age, sex, diagnosis, and surgical method, and assigned to three groups:(1) A steroid group (STRD, n= 9) who received 100 mg of hydrocortisone before PM, and on postoperative days 1, 2 and 3, followed by tapering until postoperative day 7; (2) An EPO1 group (n=10) who received 30 000 U of Epo before the PM and at the end of surgery; and (3) An EPO2 group (n=8) who received 60 000 U of Epo before the PM. Hemoglobin (Hb), hematocrit (Ht), aspartate aminotransferase (AST), alanine transaminase (ALT),lactate dehydrogenase (LDH), lactate, interleukin-6 (IL-6),and tumor necrosis factor(TNF)-α were measured before and just after (Day 0) surgery, and on postoperative days 1, 3, 7 and 14. RESULTS: There were no increases in Hb and Ht in the EPO1 and EPO2 groups. AST was signif icantly lower in EPO1 than in STRD on Day 0 (P=0.041), and lower in EPO1 than in STRD and EPO2 on Day 1 (P=0.018). ALT was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.020) and Day 1 (P=0.004). There were no signif icant inter-group differences in the levels of LDH and lactate. IL-6 was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0036) and Day 1 (P=0.0451). TNF-α was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0006) and Day 1 (P<0.0001). Furthermore, hospitalization was signif icantly shorter in EPO1 and EPO2 than in ***:Epo has greater potential than steroids to ameliorate IR/I after the PM. Epo at a dose of 30000 U, administered before PM and just after surgery, yields better results.

关键词： Erythropoietin Hepatic resection Pringle maneuver Steroid Prospective randomized study

Preoperative assessment of liver function and perioperative management of posthepatectomy liver failure

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 527-529页

作者： Masahiro Shiihara mitsugi shimoda Shuji Suzuki Department of Gastroenterological Surgery Ibaraki Medical CenterTokyo Medical UniversityIbarakiJapan

PHLF is the status of disfunction in synthesis,excretion and *** to International Study Group of Liver Surgery(ISGLS),PHLF is defined by an increased bilirubin level and international normalized ratio(INR)on or after postoperative 5 days,and is graded by clinical severity from grades A to C(1,2).Grade A is the condition without any *** B deviates from normal postoperative management and requires blood products,diuretics,oxygen administration,and so *** C is the status with multiple organ failure which requires intensive management including respirator,dialysis,and liver transplantation,*** mortality rates in A,B and C were estimated 0%,12%,and 54%,respectively(1).Although PHLF has decreased due to extensive studies of risk factors for PHLF and improvements in surgical techniques,it remains high for several types of *** to a nationwide survey of board-certified training institutions by the Japanese Society of Hepato-Biliary-Pancreatic Surgery,90-day mortality rates is 10.3%and 6.7%after left trisectionectomy and hepatopancreatectomy,respectively(3).Further,the mortality rates after associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)was reported over 5%(4).

关键词： Hepatectomy posthepatectomy liver failure posthepatectomy liver failure(PHLF)

Intraductal papillary neoplasm of the bile duct developing in a patient with primary sclerosing cholangitis: A case report

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World Journal of Gastroenterology 2014年第42期20卷 15925-15930页

作者： Hiroyuki Hachiya Junji Kita Takayuki Shiraki Yukihiro Iso mitsugi shimoda Keiichi Kubota Second Department of Surgery Dokkyo Medical University

We report a case of intraductal papillary neoplasm of the bile duct(IPNB) that developed in a patient with primary sclerosing cholangitis. A 46-year-old woman was admitted to our hospital with obstructive jaundice. The liver function tests demonstrated increased serum liver enzyme levels. Computed tomography showed dilatation of the intrahepatic bile ducts. Abdominal ultrasonography revealed a highly echoic protruding lesion in the posterior bile duct near the right lobe of the liver. The lesion was suspected to be IPNB, but we were unable to confirm whether it was a carcinoma. A right hepatectomy was performed, and this showed that the dilated bile duct was filled with mucin and contained several yellowish papillary tumors. Histologically, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. The tumor was diagnosed as IPNB, high-grade intraepithelial neoplasia secreting abundant mucin. No recurrence has been detected 3 years after surgery.

关键词： Intraductal papillary neoplasm of the bile duct Primary sclerosing cholangitis Cholangiocarcinoma High-grade intraepithelial neoplasia Premalignant lesion

eGFR is a reliable preoperative renal function parameter in patients with gastric cancer

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World Journal of Gastroenterology 2010年第19期16卷 2417-2420页

作者： Takayuki Kosuge Tokihiko Sawada Yoshimi Iwasaki Junji Kita mitsugi shimoda Nobumi Tagaya Keiichi Kubota Sec-ond Department of Surgery Dokkyo Medical University Kitako-bayashi 880 Mibu Shimotsuga Tochigi 321-0293 Japan

AIM: To evaluate the validity of the estimated glomerular filtration rate (eGFR) as a preoperative renal function parameter in patients with gastric cancer. METHODS: A retrospective study was conducted in 147 patients with gastric cancer. Preoperative creatinine clearance (Ccr), eGFR, and preand postoperative serum creatinine (sCr) data were examined. Preoperative Ccr and eGFR were then compared for their reliability in predicting postoperative renal dysfunction. RESULTS: Among 110 patients with normal preoperative Ccr values, 7 (6.3%) had abnormal postoperative sCr values, and among 112 patients with normal preoperative eGFR values, postoperative sCr was abnormal in 5 (4.5%) (P = 0.53). Among 37 patients with abnormal preoperative Ccr values, 30 (81.1%) had normal postoperative sCr values, and of 35 patients with abnormal preoperative eGFR values, postoperative sCr was normal in 25 (71.4%) (P = 0.34). PreoperativeCcr was signifi cantly correlated with eGFR (r = 0.514), and postoperative sCr was significantly correlated with preoperative Ccr (r = -0.334) and eGFR (r = -0.02). CONCLUSION: Preoperative eGFR is as effective as Ccr for predicting postoperative renal dysfunction. eGFR should therefore be used as an indicator of preoperative renal function in place of Ccr since it is a cheaper and easier to perform test.

关键词： Estimated glomerular filtration rate Creatinine clearance test Gastric cancer

Gastrectomy for patients with gastric cancer and non-uremic renal failure

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World Journal of Gastroenterology 2007年第34期13卷 4589-4592页

作者： Shozo Mori Tokihiko Sawada Kiyoshige Hamada Junji Kita mitsugi shimoda Nobumi Tagaya Keiichi Kubota Second Department of Surgery Dokkyo University School of Medicine Kitakobayashi 880 Mibu Shimotsuga Tochigi 321-0293 Japan

AIM： To investigate the safety and outcome of gastrectomy for patients with gastric cancer and nonuremic renal failure （NURF）.METHODS： One hundred forty-seven patients who underwent gastrectomy for carcinoma were retrospectively divided into two groups： a group with Ccr values of ≥ 50 mL/min （Group 1, n = 110）, and one with Ccr values of ≥ 20 to 〈 50 mL/min （Group 2, n = 37）. Preoperative patient characteristics, intraoperative parameters （including operation time and blood loss）, and postoperative management and complications were evaluated.RESULTS： There were no statistically significant differences between the two groups in operation time （297.9 rnin vs 272.6 rnin, P = 0.137） or blood loss （435 rnL vs 428 rnL, P = 0.078）. The differences in postoperative complications and hospital stay between the groups were not statistically significant. None of the patients in Group 2 required dialysis therapy, and no patients died due to gastrectorny or gastrectorny-related causes. The overall 4-year survival rates in Groups 1 and 2 were 86.6% and 81.8%, respectively （P = 0.48）, and the corresponding 4-year disease-free survival rates for stage I, I, and Ⅲ patients were 88.7% and 83.5%, respectively （P = 0.65）.CONCLUSION： Gastrectomy can be performed as safely in patients with NURF similar to patients with normal renal function.

关键词： Gastric cancer Non-uremic renal failure Gastrectomy Chronic kidney disease

Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

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World Journal of Gastroenterology 2009年第18期15卷 2252-2257页

作者： Yoshimi Iwasaki Tokihiko Sawada Shozo Mori Yukihiro Iso Masato Katoh Kyu Rokkaku Junji Kita mitsugi shimoda Keiichi Kubota Department of Gastroenterological Surgery Dokkyo Medical University880 KitakobayashiMibuTochigi321-0293Japan

AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing ***:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were *** values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 *** maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were ***:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal *** there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.

关键词： Estimated glomerular filtration rate Creatinine clearance test Hepatectomy Renal functiontest

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

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International Journal of Oral Science 2013年第3期5卷 176-182页

作者： Shingo Hara Masaharu mitsugi Takahiro Kanno Akihiko Nomachi Takehiko Wajima Yukihiro Tatemoto Hanarabi Orthodontic Dental Clinic Department of Oral and Maxillofacial Surgery Kochi Health Sciences Center Takamatsu Oral and Maxillofacial Surgery Clinic Department of Oral and Maxillofacial Surgery Shimane University Faculty of Medicine

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry,by implementing surgical planning with SimPlant *** this method,we conducted LF1 osteotomy,intraoral vertical ramus osteotomy（IVRO）,sagittal split ramus osteotomy（SSRO）,mandibular constriction and mandibular border *** only did we obtain a class I occlusal relationship,but the complicated surgery also improved the asymmetry of the frontal view,as well as of the profile view,of the *** virtual operation using three-dimensional computed tomography（3D-CT）could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

关键词： facial asymmetry mnandibular constriction transverse discrepancy of the dental arch width virtual operation

Metastatic basaloid-squamous cell carcinoma of the esophagus treated by 5-fluorouracil and cisplatin

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World Journal of Gastroenterology 2007年第26期13卷 3634-3637页

作者： Yoshihiro Shibata Eishi Baba Hiroshi Ariyama Ryusuke Miki Nobumichi Ogami Shuji Arita Baoli Qin Hitoshi Kusaba Kenji mitsugi Hirokazu Noshiro Takashi Yao Shuji Nakano First Department of Internal Medicine and Department of Biosystemic Science of Medicine Graduate School of MedicineKyushu UniversityFukuokaJapan Department of Surgery and Oncology Graduate School of Medical SciencesKyushu UniversityJapan Department of Anatomic Pathology Graduate School of Medical SciencesKyushu UniversityJapan

Basaloid squamous cell carcinoma （BSC） of the esophagus is a rare malignant disease. We report here a patient with recurrent esophageal BSC, who was successfully treated by systemic chemotherapy containing 5-fluorouracil （5-FU） and cisplatin （CDDP）. A 57-year-old woman was diagnosed as having SCluamous cell carcinoma of the esophagus upon endoscopic examination. Curative esophagectomy with lymph node dissection was performed under the thoracoscope. The pathological diagnosis of the surgical specimen was BSC. Five months after operation, the patient was diagnosed as having a recurrence of the BSC with metastases to the liver and spleen, and a right paraclavicular lymph node. She was given systemic chemotherapy consisting of continuous infusion of 800 mg/d of 5-FU and 3 h infusion of 20 mg/d of CDDP for 5 consecutive days every 4 wk. The metastatic lesions in the spleen and right paraclavicular lymph node disappeared, and the liver metastasis was apparently reduced in size after 2 courses of chemotherapy. The tumor regression was seen over 6 courses, with progression afterwards. Although subsequent treatment with CPT-11 and CDDP was not effective, docetaxel and vinorelbine temporarily controlled the tumor growth for 2 mo. 5-FU and CDDP combination may be useful for the patients with advanced BSC.

关键词： Basaloid-squamous cell carcinoma Esophagus Chemotherapy