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Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Surgical Science 2017年第8期8卷 326-333页

作者： Hiroyuki Kinoshita Hideaki Tsubakihara shinji Yamazoe Tomoya kato Kazunari Mori Department of Surgery Naga Municipal Hospital Wakayama Japan

Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections after pancreatobiliary surgery still represent significant clinical issues. In addition, insufficient attention is paid to the fact that severe stenosis of the PV can result in life-threatening complications. Material and Methods: At our institution, lymph node dissection within the hepatoduodenal ligament was performed for biliary or pancreatic neoplasms in 68 patients between October 2005 and April 2017. The diameter of the PV was measured on computed tomography scans obtained before and after the operation. PV stenosis was defined as a >50% reduction in the diameter of the PV. The degree of PF (Pancreatic Fistula) was defined by the International Study Group of Pancreatic Fistula after pancreaticoduodenectomy. Furthermore, the Clavien-Dindo (CD) classification was used to assess the complications that occurred in cases in which pancreatojejunostomy was not performed. The relationship between the degree of PV stenosis and the occurrence of postoperative complications was analyzed. Results: The overall frequency of PF was 56.3% (18 patients). Grade B or C PF occurred in 5 patients (15.6%). In the present small series, a correlation was detected between the degree of PV stenosis and the occurrence of postoperative complications after pancreatobiliary surgery (p Conclusions: Clinicians should keep in mind that the PV can narrow in cases in which grade B or C PF or intra-abdominal abscesses occur after pancreatobiliary surgery.

关键词： Portal Vein Stenosis Pancreatobiliary Surgery Pancreatic Fistula Intra-Abdominal Infection

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Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis

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World Journal of Gastroenterology 2007年第44期13卷 5918-5925页

作者： Tomohide Hori Shintaro Yagi Taku Iida Kentaro Taniguchi Kentaro Yamagiwa Chiduru Yamamoto Takashi Hasegawa Koichiro Yamakado Takuma kato Kanako Saito Linan Wang Mie Torii Yukinobu Hori Kan Takeda Kazuo Maruyama shinji Uemoto Departments of Hepatobiliary Pancreatic Surgery Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Cellular and Molecular Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Hepatobiliary Pancreatic and Transplant Surgery Kyoto University Hospital 54 Kawahara-cho Shogoin Sakyo-ku Kyoto 606-8507 Japan Department of Anesthesiology and Critical Care Medicine Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Radiology Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Medical Oncology and Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Nagoya Economic University Graduate School of Law 61-1 Uchikubo Inuyama City Aichi Prefecture 484-8504 Japan

AIM： To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation （LDLT）, and to clarify how systemic hemodynamics impact on local graft circulation after LDLT.METHODS： Systemic hemodynamics, indocyanine green （ICG） elimination rate （K,cG） and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry （PDD） and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output （CO） to blood volume （BV） and mean transit time （MTT）, defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function.RESULTS： Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance （TPR） were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and M＇IT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow.CONCLUSION： We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.

关键词： Cirrhosis Hyperdynamic Portal hypertension Splanchnic Indocyanine green

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Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report

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Open Journal of Anesthesiology 2022年第3期12卷 105-112页

作者： Yui Ikuta Hideya kato Yuko YNishiwaki Junko Tamura Ryuhei Araki shinji Nozuchi Department of Anesthesiology Saiseikai Shiga Hospital Ritto Japan

Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.

关键词： COPD Hernia Repair Peripheral Nerve Block Epidural Anesthesia

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Dopamine receptor D3R and D4R mRNA levels in peripheral lymphocytes in patients with schizophrenia correlate with severity of illness

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Open Journal of Psychiatry 2011年第2期1卷 33-39页

作者： Mitsuhiko Kawano Ken Sawada Emi Tsuru Makoto Nishihara Kunio kato William G. Honer shinji Shimodera Department of Neuropsychiatry Kochi Medical School Kochi Japan

Schizophrenia is a disease that affects many areas of the brain. The dopamine hypothesis is one of the most widely-accepted ideas in the pathophysiology of schizophrenia. Besides alterations in the dopaminergic system in the central nervous system, there have been several reports of changes in dopaminergic systems in the peripheral blood of schizophrenic patients. Several reports have shown that dopamine receptor expression by lymphocytes is altered in patients with schizophrenia, but the results have been conflicting. We therefore re-assessed D3R and D4R mRNA levels in 11 patients with schizophrenia and 12 healthy subjects and correlated levels with severity of symptoms. D3R and D4R expression in lymphocytes and granulocytes was measured by quantitative RT-PCR and the severity of symptoms and cognitive impairment were assessed using the PANSS and BACS-J. There were no significant differences in mean D3R or D4R mRNA levels in lymphocytes from schizophrenic patients and controls and no significant difference in mean D4R mRNA levels in granulocytes (D3R mRNA undetectable). In patients with schizophrenia, D3R expression was inversely correlated with the total PANSS score (r = 0.768, p = 0.009), while D4R expression was positively correlated with working memory scales (r = 0.895, p = 0.001). In conclusion, these results imply that lymphocyte D3R and D4R are involved in the mechanisms of the disorder and could be used as target markers in the treatment of schizophrenia.

关键词： Dopamine receptor D3R Dopamine Receptor D4R Schizophrenia RT-PCR Lymphocyte Cognitive Function

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Thrombotic microangiopathy-like disorder after living-donor liver transplantation:A single-center experience in Japan

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World Journal of Gastroenterology 2011年第14期17卷 1848-1857页

作者： Tomohide Hori Toshimi Kaido Fumitaka Oike Yasuhiro Ogura Kohei Ogawa Yukihide Yonekawa Koichiro Hata Yoshiya Kawaguchi Mikiko Ueda Akira Mori Yasutsugu Takada Hiroto Egawa Atsushi Yoshizawa shinji Uemoto Hajime Segawa Kimiko Yurugi Takuma kato Kanako Saito Linan Wan Mie Torii Feng Chen Ann-Marie T Baine Lindsay B Gardner Departments of Hepato-pancreato-biliary Transplant and Pediatric Surgery Kyoto University Hospital Kyoto 606-8507 Japan Department of Critical Care Medicine Kyoto University Hospital Kyoto 606-8507 Japan Department of Transfusion Medicine and Cell Therapy Kyoto University Hospital Kyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Hospital Graduate School of Medicine Mie 514-8507 Japan Department of Neuroscience Mayo Clinic Florida FL 32224 United States

AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated,and the TMA-like disorder (TMALD) occurred in seven recipients. RESULTS:These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered,the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells,the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD,the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD,such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies,must be decided according to each case. CONCLUSION:The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT.

关键词： Thrombotic microangiopathy Liver transplan-tation von Willebrand factor A disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs Complication

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Protocol for laparoscopic cholecystectomy: Is it rocket science?

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World Journal of Gastroenterology 2016年第47期22卷 10287-10303页

作者： Tomohide Hori Fumitaka Oike Hiroaki Furuyama Takafumi Machimoto Yoshio Kadokawa Toshiyuki Hata Shigeru kato Daiki Yasukawa Yuki Aisu Maho Sasaki Yusuke Kimura Yuichiro Takamatsu Masato Naito Masaya Nakauchi Takahiro Tanaka Daigo Gunji Kiyokuni Nakamura Kiyoko Sato Masahiro Mizuno Taku Iida Shintaro Yagi shinji Uemoto Tsunehiro Yoshimura Department of Gastrointestinal and General Surgery Tenriyorodusoudanjyo Hospital Department of Gastrointestinal Surgery Mitsubishi Kyoto Hospital Department of Anesthesiology Mitsubishi Kyoto Hospital Department of Gastroenterology and Hepatology Mitsubishi Kyoto Hospital Department of Hepatobiliary Pancreatic Surgery Kyoto University Hospital

Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical ***, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

关键词： Laparoscopic cholecystectomy Gallbladder Critical view of safety biliary injury Protocol

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Comprehensive and innovative techniques for livertransplantation in rats: A surgical guide

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World Journal of Gastroenterology 2010年第25期16卷 3120-3132页

作者： Tomohide Hori Justin H Nguyen Yasuhiro Ogura Toshiyuki Hata Shintaro Yagi Ann-Marie T Baine Norifumi Ohashi Christopher B Eckman Aimee R Herdt Hiroto Egawa Yasutsugu Takada Fumitaka Oike Seisuke Saka-moto Mureo Kasahara Kohei Ogawa Koichiro Hata Taku Iida Yukihide Yonekawa Lena Sibulesky Kagemasa Kuribayashi Takuma kato Kanako Saito Mie Torii Naruhiko Sahara Naoko Kamo Tomoko Sahara Motohiko Yasutomi shinji Uemoto Department of Neuroscience Mayo Clinic Jacksonville Florida FL 32224 United States Division of Hepato-Pancreato-Biliary Transplant and Pediatric Surgery Department of Surgery Kyoto University HospitalSakyo-ku Kyoto 606-8507 Japan Division of Transplant Surgery Department of Transplantation Mayo Clinic Jackson-ville Florida FL 32224 United States Institute for Laboratory Animal Science and Ex-perimental Surgery RWTH-Aachen University D-52074 AachenGermany Department of Cellular and Molecular Immu-nology Mie University Graduate School of Medicine Tsu Mie514-8507 Japan New Zealand Liver Transplant Unit Auckland City Hospital Auckland 92024 New Zealand

AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful ***: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.

关键词： Animal model Liver transplantation Microsurgery Rat Reperfusion injury Ultra-microsurgery

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日本分化型甲状腺癌患者首次131I低剂量清除残余甲状腺疗效的预测因子

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中华核医学与分子影像杂志 2018年第11期38卷 776-776页

作者：唐军 shinji Ito Shingo Iwano Katsuhiko kato shinji Naganawa 上海交通大学医学院附属苏州九龙医院核医学科 Department of Radiology Nagoya University Graduate School of Medicine Nagoya

目的确认低碘饮食(LID)和术后残余甲状腺组织的量对日本分化型甲状腺癌(DTC)患者行固定剂量I(1110MBq)清除残余甲状腺(RAI)疗效的预测作用。方法该前瞻性研究的对象包括45例甲状腺全切后未发现远处转移的DTC患者,分为自我管理LID组和严... 详细信息

目的确认低碘饮食(LID)和术后残余甲状腺组织的量对日本分化型甲状腺癌(DTC)患者行固定剂量I(1110MBq)清除残余甲状腺(RAI)疗效的预测作用。方法该前瞻性研究的对象包括45例甲状腺全切后未发现远处转移的DTC患者,分为自我管理LID组和严格LID组。LID后2周、RAI当天测量尿碘浓度,并测定促甲状腺激素(TSH)诱导的甲状腺球蛋白(Tg)水平,RAI后4 d行全身I显像(WBS)观察残余甲状腺组织的摄碘情况。RAI后6～8个月再次行WBS以确定疗效。结果严格LID组的患者2周后尿碘浓度低于自我管理LID组。RAI后6～8个月再次行WBS发现25例(56%)患者未见摄碘,20例(44%)有残余组织摄碘。未见摄碘与有残余组织摄碘的患者间尿碘浓度和Tg水平差异无统计学意义(P=0.253和P=0.234),但两者在RAI后第4天的显像中可见甲状腺床的I摄取差异有统计学意义(P=0.035)。结论就目前日本患者行2周LID而言,尿碘浓度并不是RAI治疗疗效的预测因子。与此相反,RAI后甲状腺床I的低摄取也许是一个较好的预测因子。

关键词： 131I清甲治疗分化型甲状腺癌低剂量131I 低碘饮食尿碘

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多机构回顾性分析FDG PET／CT在预测下咽鳞状细胞癌肺转移患者生存中的作用

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中华核医学与分子影像杂志 2018年第3期38卷 226-227页

作者：唐军上海交通大学医学院附属苏州九龙医院核医学科 215021

[摘要]目的研究^18F-脱氧葡萄糖（FDG） PET/CT显像最大标准摄取值（SUVmax）与来自2家机构的下咽鳞状细胞癌患者长期随访后总生存率间可能存在的相关性，分析SUVmax与几个生存状态间的关系，包括无肺转移生存。方法81例患者的生存率用... 详细信息

[摘要]目的研究^18F-脱氧葡萄糖（FDG） PET/CT显像最大标准摄取值（SUVmax）与来自2家机构的下咽鳞状细胞癌患者长期随访后总生存率间可能存在的相关性，分析SUVmax与几个生存状态间的关系，包括无肺转移生存。方法81例患者的生存率用乘积极限法（Kaplan-Meier法）计算。单变量和多变量分析采用Cox比例风险模型进行。

关键词：下咽鳞状细胞癌 ^18F-FDG PET/CT SUVmax 总生存率肺转移

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Ultraviolet-induced alloantigen-specific immunosuppression in transplant immunity

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World Journal of Transplantation 2015年第1期5卷 11-18页

作者： Tomohide Hori Kagemasa Kuribayashi Kanako Saito Linan Wang Mie Torii shinji Uemoto Taku Iida Shintaro Yagi Takuma kato Department of Hepato-Pancreato-Biliary and Transplant Surgery Kyoto University Graduate School of MedicineKyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Graduate School of MedicineTsu 514-8507 Japan Department of Hematology and Medical Oncology Mie University Graduate School of MedicineTsu 514-8507 Japan

After the first observation of the immunosuppressive effects of ultraviolet(UV) irradiation was reported in 1974, therapeutic modification of immune responses by UV irradiation began to be investigated in the context immunization. UV-induced immunosuppression is via the action of regulatory T cells(Tregs). Antigen-specific Tregs were induced by high-dose UV-B irradiation before antigen immunization in many studies, as it was considered that functional alteration and/or modulation of antigen-presenting cells by UV irradiation was required for the induction of antigen-specific immunosuppression. However, it is also reported that UV irradiation after immunization induces antigen-specific Tregs. UV-induced Tregs are also dominantly transferable, with interleukin-10 being important for UV-induced immunosuppression. Currently, various possible mechanisms involving Treg phenotype and cytokine profile have been suggested. UV irradiation accompanied by alloantigen immunization induces alloantigen-specific transferable Tregs, which have potential therapeutic applications in the transplantation field. Here we review the current status of UV-induced antigen-specific immunosuppression on the 40th anniversary of its discovery.

关键词： Alloantigen Ultraviolet irradiation Donorspecific immunosuppression Interleukin-10 Regulatory T cells

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