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Successful resection of metachronous para-aortic, Virchow lymph node and liver metastatic recurrence of rectal cancer

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World Journal of Gastroenterology 2015年第44期21卷 12722-12728页

作者： Nobuyoshi Takeshita Toru Fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Isamu Hoshino Takumi Ota Tetsuro Maruyama tomohide Tamachi Takashi Hosokawa Yo asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 66-year-old female presented with the main complaint of defecation trouble and abdominal distention. With diagnosis of rectal cancer, c SS, c N0, c H0, c P0, c M0 c Stage Ⅱ, Hartmann's operation with D3 lymph node dissection was performed and a para-aortic lymph node and a disseminated node near the primary tumor were resected. Histological examination showed moderately differentiated adenocarcinoma, p SS, p N3, p H0, p P1, p M1(para-aortic lymph node, dissemination) f Stage Ⅳ. After the operation, the patient received chemotherapy with FOLFIRI regimen. After 12 cycles of FOLFIRI regimen, computed tomography(CT) detected an 11 mm of liver metastasis in the posteroinferior segment of right hepatic lobe. With diagnosis of liver metastatic recurrence, we performed partial hepatectomy. Histological examination revealed moderately differentiated adenocarcinoma as a metastatic rectal cancer with cut end microscopically positive. After the second operation, the patient received chemotherapy with TS1 alone for 2 years. Ten months after the break, CT detected a 20 mm of paraaortic lymph node metastasis and a 10 mm of lymph node metastasis at the hepato-duodenal ligament. With diagnosis of lymph node metastatic recurrences, we performed lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma as metastatic rectal cancer in paraaortic and hepato-duodenal ligament areas. After the third operation, we started chemotherapy with modified FOLFOX6 regimen. After 2 cycles of modified FOLFOX6 regimen, due to the onset of neutropenia and liver dysfunction, we switched to capecitabine aloneand continued it for 6 mo and then stopped. Eleven months after the break, CT detected two swelling 12 mm of lymph nodes at the left supraclavicular region. With diagnosis of Virchow lymph node metastatic recurrence, we started chemotherapy with capecitabine plus bevacizumab regimen. Due to the onset of neutropenia and hand foot syndrome(Grade 3), we managed

关键词： Rectal cancer Surgical resection Virchow lymph nod

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Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

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World Journal of Hepatology 2014年第8期6卷 596-600页

作者： tomohide Hori Kyoichi Takaori Shinji Uemoto Department of Hepato-Pancreato-Biliary and Transplant Surgery Kyoto Uni-versity Hospital Kyoto 606-8507 Japan

Pancreatic neuroendocrine tumor(P-NET) is rare and slow-growing. Current classifications predict its progno-sis and postoperative recurrence. Curative resection is ideal, although often difficult, because over 80% of pa-tients have unresectable multiple liver metastases and extrahepatic metastasis. Aggressive surgery for liver metastases is important to improve survival. Aggressive or cytoreductive surgery for liver metastases is indi-cated to reduce hormone levels and improve symptoms and prognosis. Liver transplantation was originally con-ceived as an ideal therapy for unresectable liver metas-tases. Unfortunately, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases. Surgeons still face questions in deciding the best surgical scenario in patients with P-NET with unresectable liver metastases.

关键词： Gastroenteropancreatic neuroendocrine tumor Pancreas Liver metastasis Liver surgery Liver transplantation

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Assessment of cardiac output in liver transplantation recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 362-366页

作者： tomohide Hori Chiduru Yamamoto Shintaro Yagi Taku Iida Kentaro Taniguchi Takashi Hasegawa Koichiro Yamakado Yukinobu Hori Kan Takeda Kazuo Maruyama Shinji Uemoto Department of Hepato-Pancreato-Biliary Surgery and Transplantation Kyoto University Hospital54 Shogoinkawara- choSakyo-kuKyoto606-8507Japan Department of Hepatobiliary Pancreatic Surgery Mie University Hospital2-174 EdobashiTsu CityMie Prefecture514-8507 Japan Department of Anesthesiology and Critical Care Medicine Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Department of Radiology Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Nagoya Economic University Graduate School of Law 61-1 UchikuboInuyama City Aichi Prefecture 484-8504Japan

BACKGROUND:Liver cirrhosis causes peculiar systemic hemodynamics,and accurate evaluation of systemic hemodynamic state is important for cirrhotic recipients who underwent living donor liver transplantation(LDLT). We investigated the clinical advantages of a novel non- invasive method for measuring systemic hemodynamic parameters using indocyanine green(ICG). METHODS:Twenty-eight LDLT recipients were evaluated. Simultaneous measurements of cardiac output(CO)using Swan-Ganz catheters and pulse dye densitometry(PDD) were performed every 12 hours after LDLT.A total of 155 sets of simultaneous CO measurements were obtained. RESULTS:The CO values obtained by PDD correlated well with those obtained by the invasive catheter *** addition,none of the recipients developed any side-effects, and we verified the safety of repeated ICG *** is safe,even for repeated use over time in the same recipient. Moreover,PDD can measure the blood volume(BV).CONCLUSIONS:Since the cirrhotic systemic hemody- namics characterized by high CO and large BV remains, even after LDLT,the ability to measure CO and BV in a non-invasive,simple and real-time manner using PDD has advantages for cirrhotic LDLT recipients.

关键词： liver transplantation indocyanine green pulse dye densitometry blood volume cardiac output liver cirrhosis

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Cervical Castleman's disease mimicking lymph node metastasis of esophageal carcinoma

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World Journal of Gastrointestinal Oncology 2017年第9期9卷 397-401页

作者： Takumi Yamabuki Masanori Ohara Mototsugu Kato Noriko Kimura tomohide Shirosaki Kunishige Okamura Aki Fujiwara Ryo Takahashi Kazuteru Komuro Nozomu Iwashiro Satoshi Hirano Department of Surgery National Hospital Organization Hakodate Hospital Department of Gastroenterology National Hospital Organization Hakodate Hospital Department of Pathology National Hospital Organization Hakodate Hospital Department of Gastroenterological Surgery Ⅱ Hokkaido University Hospital

Castleman's disease(CD) is an uncommon benign lymphoproliferative disorder of unknown etiology. A rare case of cervical CD diagnosed at lymph node dissection for esophageal carcinoma is reported. An esophageal tumor was identified in a 67-year-old man during a follow-up examination after surgery for oral carcinoma. Esophagoscopy revealed a type 1 tumor in the cervical esophagus. Histology of esophagoscopic biopsies indicated squamous cell carcinoma. Contrastenhanced computed tomography revealed swollen lymph nodes of the right cervical region. No distant metastasis was detected. Esophageal carcinoma, T2N2M0, Stage ⅢA was diagnosed. Neoadjuvant chemotherapy was recommended, but the patient rejected the chemotherapy. The patient underwent laparoscopic-assisted transhiatal esophagectomy. The histopathological diagnosis was moderately differentiated squamous cell carcinoma with pT1bN0M0, Stage ⅠA. On histology, the swollen lymph nodes of the right cervical region revealed CD. The patient's postoperative course was relatively good.

关键词： Castleman’s disease Lymph node metastasis Esophageal carcinoma

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Use of Artificial Dermis and Cultured Epithelial Autograft for Extensive Deep Dermal Burns —A Case Report

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Open Journal of Emergency Medicine 2018年第4期6卷 73-81页

作者： Takahiro Ueda tomohide Matsushima Kohei Ichinohashi Yasuhide Kitazawa Department of Emergency and Critical Care Medicine Faculty of Medicine Kindai University Osaka Japan

In the treatment of extensive burns, cultured epithelial autograph (CEA) became available commercially in Japan from 2009. Based on the 6 years multicenter surveillance data on using CEA for extensive burns, it is reported that using 6:1 split thickness skin graft together with CEA is successful after wound bed preparation for extensive deep dermal burn or patients with deep burn [1].

关键词： Artificial Dermis Extensive Burn Cultured Epithelial Autograft

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Effectiveness of ICU Diaries: Improving “Distorted Memories” Encountered during ICU Admission

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Open Journal of Nursing 2015年第4期5卷 313-324页

作者： tomohide Fukuda Tomoko Inoue Yoshiko Kinoshita Tamiko Yukawa Department of Critical and Invasive Palliative Care Nursing Tokyo Medical and Dental University Tokyo Japan Department of Nursing NTT East Japan Kanto Hospital Tokyo Japan

Background: It is said that after ICU discharge, 40% of patients suffer from acute stress symptoms, such as anxiety and depression, caused by “distorted memories” (memory loss and delusions) due to various treatments in the ICU. This study focused on the quantitative and qualitative effects of ICU diaries on distorted memories that patients encountered during their time in the ICU. Aim: To assess improving distorted memories by providing information during ICU admission to patients to relieve the acute stress symptoms after ICU discharge. Design and Methods: This nonrandomized controlled trial included patients aged ≥20 years who had received treatment for ≥3 days in the ICU. Using ICU memory tool, the Hospital Anxiety and Depression Scale (HADS) and the Acute Stress Disorder Scale (ASDS) approximately 1 week after ICU discharge, then HADS and ASDS prior to hospital discharge, the change in mean values were compared between two groups (control and intervention) using a Wilcoxon signed-rank test. The intervention group was surveyed prior to hospital discharge using semi-structured interviews, and descriptions were analyzed by the content analysis method of Krippendorff. Results: Twenty-three participants were included in the control group, and 17 in the intervention group. When comparing subjects with distorted memories between the groups, we found reduced values for HADS anxiety (7.1 ± 3.8 to 5.7 ± 2.7, p = 0.011), HADS depression (8.6 ± 5.0 to 7.2 ± 4.3, p = 0.003), and ASDS (46.9 ± 13.8 to 43.8 ± 11.4, p = 0.012) in the intervention group. Based on the narrations, patients wanted to investigate facts in the ICU diary while having someone help them to remember these events. Conclusion: Improving distorted memories during ICU admissions may relieve acute stress symptoms. In addition, these patients needed someone to investigate facts from the ICU admission.

关键词： Aftercare Acute Stress Symptoms ICU Diary Distorted Memories

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Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2015年第30期21卷 9223-9227页

作者： Nobuyoshi Takeshita Naoki Kanda Toru Fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Masaya Uesato Tetsutaro Sazuka Tetsuro Maruyama Naohiro Aida tomohide Tamachi Takashi Hosokawa Yo asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation,including redness,erosion,edema,bleeding,friability,and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine,gastrografinfilled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly,endoscopic balloon dilatation was performed and antifungal therapy was started in the hospital. Seven weeks later,endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently,the patient was discharged. At the latest follow-up,the patient was symptomfree and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.

关键词： Esophageal intramural pseudodiverticulosis Esophageal cancer Esophageal candidiasis Anastomoticstricture Esophagectomy Residual esophagus

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Oxidative stress and extracellular matrices after hepatectomy and liver transplantation in rats

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World Journal of Hepatology 2014年第2期6卷 72-84页

作者： tomohide Hori Shinji Uemoto Feng Chen Lindsay B Gardner Ann-Marie T Baine Toshiyuki Hata Takayuki Kogure Justin H Nguyen Division of Hepato-Biliary-Pancreatic and Transplant Surgery Department of Surgery Kyoto University Graduate School of Medicine Department of Neuroscience Mayo Clinic Department of Gastroenterology Tohoku University Graduate School of Medicine Division of Transplant Surgery Department of Transplantation Mayo Clinic

AIM:To investigate oxidative stress(OS)-mediated damage and the behavior of extracellular matrices in various rat models because shear stress with portal hypertension and cold ischemia/warm reperfusion injury trigger the liver regeneration cascade after surgery. These injuries also cause fatal liver ***: Rats were divided into four groups according to the surgery performed: control; hepatectomy with 40% liver remnant(60% hepatectomy); orthotopic liver transplantation(OLT) with whole liver graft(100% OLT); and split OLT(SOLT) with 40% graft(40% SOLT). Survival was evaluated. Blood and liver samples were collected at 6 h after surgery. Biochemical and histopathological examinations were performed. OSinduced damage, 4-hydroxynonenal, ataxia-telangiectasia mutated kinase, histone H2AX, phosphatidylinositol 3-kinase(PI3K) and Akt were evaluated by western blotting. Behavior of extracellular matrices, matrix metalloproteinase(MMP)-9, MMP-2, tissue inhibitor of metalloproteinase(TIMP)-1 and TIMP-2 were also evaluated by western blotting and zymography. RESULTS: Although 100% OLT survived, 60% hepatectomy and 40% SOLT showed poor survival. Histopathological, immunohistological, biochemical and protein assays revealed that 60% hepatectomy, 100% OLT and 40% SOLT showed liver damage. PI3K and Akt were decreased in 60% hepatectomy and 40% SOLT. For protein expression, 40% SOLT showed differences in MMP-9, MMP-2 and TIMP-2. TIMP-1 showed differences in 60% hepatectomy and 40% SOLT. For protein activity, MMP-9 demonstrated significant differences in 60% hepatectomy, 100% OLT and 40% SOLT. CONCLUSION: Under conditions with an insufficient liver remnant, prevention of OS-induced damage via the Akt/PI3K pathway may be key to improve the postoperative course. MMP-9 may be also a therapeutic target after surgery.

关键词： Free radicals Akt Phosphatidylinositol 3-ki-nase Matrix metalloproteinase Tissue inhibitors of metalloproteinase

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Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

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World Journal of Gastroenterology 2017年第32期23卷 5849-5859页

作者： tomohide hori takafumi machimoto yoshio kadokawa toshiyuki hata tatsuo ito shigeru kato daiki yasukawa yuki aisu yusuke kimura maho sasaki yuichi takamatsu taku kitano shigeo hisamori tsunehiro yoshimura department of gastrointestinal surgery tenriyorodusoudanjyo hospital

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

关键词： Laparoscopic appendectomy Acute appendicitis Interval appendectomy Surgery Delayed appendectomy

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Three Cases of Severe Stercoral Colitis

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Open Journal of Emergency Medicine 2018年第4期6卷 82-87页

作者： Kashio Toyoda Keiichi Yokoyama tomohide Matsushima Naoki Hashimoto Yasuhide Kitazawa Department of Emergency and Critical Care Medicine Faculty of Medicine Kindai University Osaka Japan

Stercoral colitis is the inflammation of the colonic wall caused by fecal impaction. When a patient with a history of chronic constipation visits the Emergency Center with diffuse abdominal pain, sepsis and or rectal bleeding, clinicians should consider the possibility of stercoral colorectal perforation. An accurate diagnosis on a computed tomography (CT) scan (for fecal impaction, intra-abdominal feces, intraperitoneal free air, stranding of the peri-colonic fat in the segment, presence of extraluminal bubbles of gas) may facilitate early surgical intervention and improve the patient’s prognosis based on our clinical experience dealing with three patients who had stercoral colitis.

关键词： Stercoral Colitis CT and Hartman’s Operation

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