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Local recurrence after successful endoscopic submucosal dissection for rectal mucinous mucosal adenocarcinoma:A case report

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World Journal of Gastrointestinal Oncology 2023年第1期15卷 186-194页

作者： Yuki Murakami Hiroki Tanabe Yusuke Ono Yuya Sugiyama Yu Kobayashi Takehito Kunogi takahiro sasaki Keitaro Takahashi Katsuyoshi Ando Nobuhiro Ueno Shin Kashima Sayaka Yuzawa Kentaro Moriichi Yusuke Mizukami Mikihiro Fujiya Toshikatsu Okumura Division of Metabolism and Biosystemic Science Department of Gastroenterology and Hematology/OncologyDepartment of MedicineAsahikawa Medical UniversityAsahikawa 078-8510HokkaidoJapan Institute of Biomedical Research Sapporo-Higashi Tokushukai HospitaSapporo 065-0033HokkaidoJapan Department of Diagnostic Pathology Asahikawa Medical UniversityAsahikawa 078-8510HokkaidoJapan

BACKGROUND Mucinous adenocarcinoma of the colorectum is a rare histological subtype characterized by an abundant mucinous component.Mucinous tumors are frequently diagnosed at an advanced stage,which indicates an aggressive subtype.However,few case reports have been published,and little information is available concerning genetic alterations in mucinous adenocarcinoma.CASE SUMMARY A 76-year-old man underwent en bloc endoscopic submucosal dissection(ESD)for the management of a type 0-Is+IIa lesion.Histological examination revealed an intramucosal mucinous adenocarcinoma with signet-ring cell carcinoma and well-to-moderately differentiated tubular adenocarcinoma.Three years after the ESD,local recurrence was detected by an endoscopic examination,revealing a new 0-Is+IIa lesion with a phenotype similar to the previously resected lesion.Re-ESD was chosen for the management of the recurrent tumor,and the histological examination showed positive tumor infiltration at the vertical margin.Additional surgical resection was performed for the curative treatment.Genetic analysis showed pathogenic alterations in RNF43 and TP53 in the adenoma and an additional SMAD4 alteration in the carcinoma.CONCLUSION This mucinous mucosal adenocarcinoma case was suggested to have an aggressive phenotype and a careful and close follow-up are required.

关键词： Rectal cancer Mucinous adenocarcinoma Endoscopic submucosal dissectio TP53 Colitic cancer pathway Case report

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Gastric submucosa-invasive carcinoma associated with EpsteinBarr virus and endoscopic submucosal dissection: A case report

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World Journal of Gastrointestinal Oncology 2019年第10期11卷 925-932页

作者： Yu Kobayashi Takehito Kunogi Hiroki Tanabe Yuki Murakami Takuya Iwama takahiro sasaki Keitaro Takahashi Katsuyoshi Ando Yoshiki Nomura Nobuhiro Ueno Shin Kashima Kentaro Moriichi Hidehiro Takei Mikihiro Fujiya Toshikatsu Okumura Division of Gastroenterology and Hematology/Oncology Department of Medicine Asahikawa Medical UniversityAsahikawa 078-8510Japan Pathological Department of Asahikawa Medical University Hospital Asahikawa Medical UniversityAsahikawa 078-8510Japan

BACKGROUND Epstein-Barr virus(EBV)-associated carcinoma is a gastric cancer subtype with a morphology characterized by gastric carcinoma with lymphoid stroma(GCLS).Clinicopathological studies have indicated a better prognosis for GCLS than for common gastric carcinomas.Some previous cases of early gastric cancer associated with EBV had been diagnosed by endoscopic resection.CASE SUMMARY We present two GCLS cases subjected to endoscopic submucosal dissection(ESD)for a definitive diagnosis.A protruded gastric lesion was identified by routine endoscopic examination,but forceps biopsy showed no atypical cells before ESD.The resected specimen showed a poorly differentiated adenocarcinoma with lymphoid cells involving the mucosa and submucosa.The final diagnosis was submucosa-invasive poorly differentiated gastric adenocarcinoma.Accordingly,additional gastrectomy was recommended to obtain a complete cure.One patient underwent additional distal gastrectomy with lymph node dissection,but the other was refused because of cardiovascular complications.Both patients remained in remission for more than half a year.EBV positivity was determined by EBV-encoded RNA in situ hybridization.We also conducted a literature review of cases of early gastric cancer associated with EBV that had been diagnosed by ESD.CONCLUSION Submucosa-invasive GCLS could be dissected using ESD,and EBV positivity should be subsequently assessed to determine whether or not any additional curative surgery is required.Further prospective investigations on the prevalence of lymph node metastasis in EBV-associated carcinoma should be performed to expand the indications for endoscopic resection.

关键词： Herpesvirus 4 Human Stomach neoplasms Gastric carcinoma with lymphoid stroma Epstein-Barr virus-associated gastric carcinoma Case report

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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

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Angiodysplasia Presenting with Multiple Polypoid Lesions: An Unusual Cause of Small Bowel Obstruction

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Case Reports in Clinical Medicine 2014年第11期3卷 592-595页

作者： Yoshiharu Takenaka takahiro sasaki Nobuyoshi Miyajima Takehito Otsubo Department of Gastroenterological Surgery St. Marianna University School of Medicine Toyoko Hospital Kanagawa Japan

Angiodysplasia (AD), a morphologic vascular abnormality, is a common cause of gastrointestinal bleeding. We present a rare case of polypoid AD lesions. Three years after treatment for adhesive bowel obstruction, a 57-year-old man was admitted with recurrent abdominal distension, anorexia, and lower extremity edema. Computed tomography showed his dilated proximal and collapsed distal small bowel loops had disparate calibers. The transition point demonstrated mucosal enhancement and mesenteric lymphadenopathy. We observed small intestinal wall outpouching with strong mucosal enhancement and polypoid lesions dotting the dilated intestine. Intraoperative findings revealed a hard but elastic intraluminal nodule causing small bowel obstruction and the outpouching’s occurrence on the ileum’s antimesenteric border. We performed partial resection of the small intestine involving the nodule and Meckel’s diverticulum. Macroscopically, the nodule, diverticulum, and intestinal mucosa had polypoid lesions. Histopathologically, these lesions had foci within dilated thin- or thick-walled vascular channels in the submucosa, without specific histological abnormalities. These features led to a diagnosis of AD.

关键词： Angiodysplasia Polipoid Lesions Small Bowel Obstruction Meckel’s Diverticulum

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Reinforcement of the Production Capacity at Wakayama No.5 Sintering Plant

Reinforcement of the Production Capacity at Wakayama No.5 Si...

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Asia Steel International Conference 2012(Asia Steel 2012)

作者： takahiro sasaki Kei Watanabe Yasuyuki Masutani Masahide Yoshikawa Chikashi Kamijo Takazo Kawaguchi Sumikin Iron & Steel Corporation 1850MinatoWakayamaJapan Corporate Research & Development Laboratories Sumitomo Metal IndustriesLtd.16-1SunayamaKamisuIbarakiJapan

Reinforcement construction of Wakayama No.5 sintering plant performed from August 2006 to January 2009 to adapt expansion of blast furnaces.A new strand,which grate area is 185m,was built adjacent to an existing strand(122m) while the existing one had been operating continuously during construction.A packed bed type circular cooler was installed for the new strand to decrease energy consumption.In order to improve the granulation,a new separate granulation system using a pan pelletizer which diameter is 7.5m was installed.Moreover,exhaust gas treatment system was installed.In addition,existing raw materials bins and coke breeze bin were appropriated to decrease construction cost.These facilities are shared with both strands.As a result,increase of permeability of the sintering bed has achieved by using the separate granulation system while the finer average size of the raw materials can be used.Furthermore,the thickness of the sintering bed can increase and return fine ratio decrease so that the productivity increases.The concentrations of SOx,NOx,and dioxins are also kept low enough to attain an environment standard.The commercial operation of Wakayama No.5 sintering plant begins in January 2009 and has been continuing the favorable operation about 36t/d/m.

关键词： sinter plant Reinforcement raw material Production capacity sintering bed

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Narrow pelvic inlet plane area and obesity as risk factors for anastomotic leakage after intersphincteric resection

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World Journal of Gastrointestinal Surgery 2020年第10期12卷 425-434页

作者： Akira Toyoshima Toshihiro Nishizawa Eiji Sunami Ryuji Akai takahiro Amano Akiyoshi Yamashita Shin sasaki Takeshi Endo Yoshihiro Moriya Osamu Toyoshima Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Surgery The University of KyorinTokyo 113-8655Japan Department of Radiology Japanese Red Cross Medical CenterTokyo 150-8935Japan Tokyo Midtown Clinic Tokyo 107-6206Japan Miki Hospital Iwate 029-4201Japan

BACKGROUND Intersphincteric resection(ISR)has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer.The most critical complication of this technique is anastomotic leakage.The incidence rate of anastomotic leakage after ISR has been reported to range from 5.1%to 20%.AIM To investigate risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.METHODS This study was conducted at Department of Colorectal Surgery,Japanese Red Cross Medical Center,Tokyo,Japan,with a total of 117 patients.We enrolled 117 patients with extremely low rectal cancer who underwent laparotomic and laparoscopic ISRs at our hospital.We conducted retrospective univariate and multivariate regression analyses on 33 items to elucidate the risk factors for anastomotic leakage after ISR.Pelvic dimensions were measured using threedimensional reconstruction of computed tomography images.The optimal cutoff value of the pelvic inlet plane area that predicts anastomotic leakage was determined using a receiver operating characteristic(ROC)curve.RESULTS We observed anastomotic leakage in 10(8.5%)of the 117 patients.In the multivariate analysis,we identified high body mass index(odds ratio 1.674;95%confidence interval:1.087-2.58;P=0.019)and smaller pelvic inlet plane area(odds ratio 0.998;95%confidence interval:0.997-0.999;P=0.012)as statistically significant risk factors for anastomotic leakage.According to the receiver operating characteristic curves,the optimal cutoff value of the pelvic inlet plane area was 10074 mm2.Narrow pelvic inlet plane area(≤10074 mm2)predicted anastomotic leakage with a sensitivity of 90%,a specificity of 85.9%,and an accuracy of 86.3%.CONCLUSION Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR.Anastomotic leakage after ISR may be predicted from a narrow pelvic inlet plane area(≤10074 mm2).

关键词： Intersphincteric resection Anastomotic leakage Pelvimetry Pelvic dimensions Pelvic inlet plane area Rectal cancer

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Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study

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World Journal of Clinical Cases 2019年第12期7卷 1393-1402页

作者： Yosuke sasaki Fumiya Komatsu Naoyasu Kashima takahiro Sato Ikutaka Takemoto Sho Kijima Tadashi Maeda Takamasa Ishii Taito Miyazaki Yoshiko Honda Nagato Shimada Yoshihisa Urita Department of General Medicine and Emergency Care Toho University School of Medicine

BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate analyses.RESULTS In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In the logistic regression model, odds ratios (ORs) w

关键词： Abdominal pain Acute abdomen Appendicitis Clinical difference Creactive protein Diverticulitis Right lower quadrant pain

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End Point Force Control of a Flexible Timoshenko Arm

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Journal of Computer and Communications 2015年第11期3卷 106-112页

作者： Minoru sasaki Kouki Nagaya takahiro Endo Kojiro Matsushita Satoshi Ito Department of Mechanical Engineering Gifu University Gifu Japan Department of Mechanical Engineering and Science Graduate School of Engineering Kyoto University Kyoto Japan

This paper discusses a force control problem for a flexible Timoshenko arm. The effect of shear deformation and the effect of rotary inertia are considered in Timoshenko beam theory. Most of the research about force control of the flexible arm is based on Euler Bernoulli beam theory. There are a few researches about force control of the flexible arm using Timoshenko beam theory. The aim of the force control is to control the contact force at the contact point. To solve this problem, we propose a simple controller using Timoshenko beam theory. Finally, we describe simulation results using a numerical inversion of Laplace transform carried out to investigate the validity of the proposed controller for the force control problem. The results of the time response show the transverse displacement, the angle of deflection, the slider position, the rotational angle and the contact force toward the desired their values.

关键词： Flexible Arm Timoshenko Beam Theory Force Control Distributed Parameter Systems Control Laplace Transform

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Journal of Biomedical Science and Engineering 2012年第4期5卷 170-175页

作者： Ryozo Aoki Shinnya Okamoto takahiro Sakimoto Kazuki Yoshida Hitoshi sasaki Department of Electricity and Electronics College of Industrial Technology Amagasaki Japan Department of Electricity and Electronics College of Industrial Technology Amagasaki Japan Email: ryo Department of Physiology Graduate School of Medicine Osaka University Suita Japan

Two different pathways in the brain have been implicated in the human visual perception process. One involves emotional cognition of face features, and the other involves spatial pattern cognition. In the present study, we used the event-related potential (ERP) method to examine temporal activation of the perception pathways at a fine time resolution of less than 10 ms. Four electrodes were attached onto their heads at O2, Pz, T4, and Fz, and ERP waveforms were observed on each electrode simultaneously. Nine portraits of actresses and 9 geometrical figures were chosen respectively, and presented on a CRT display in random order. The two types of figures elicited different responses. For portraits, the first significant N100 peak appeared on Pz and Fz, but not O2. For patterns, it started at N130 on O2. A significant response to portraits mostly appeared on T4, Pz, and Fz, and to patterns on O2, Pz, and Fz.

关键词： Influenza Visual-Perception Cognition-System Limbic-System Oddball-Method ERP N100 N170 P300

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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 considerations.Finally, 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 胆囊炎胆囊安全的批评看法胆汁的损害协议

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