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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

Malignant pheochromocytoma:Hepatectomy for liver metastases

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World Journal of Gastrointestinal Surgery 2013年第11期5卷 309-313页

作者： Tomohide Hori kentaro yamagiwa Tadataka Hayashi Shintaro Yagi Taku Iida kentaro Taniguchi Yoshifumi Kawarada Shinji Uemoto Divisions of Hepato-Pancreato-Biliary Transplant and Pediatric SurgeryDepartment of SurgeryKyoto University HospitalKyoto 606-8507Japan First Department of Surgery Mie University HospitalTsuMie Prefecture514-8507Japan Second Department of Surgery Hamamatsu University HospitalHamamatsuShizuoka431-3192Japan

Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy. Four months after surgery, multiple liver metastases were detected. In spite of ongoing chemotherapy, catecholamine levels eventually became uncontrollable. Serum and urine noradrenaline andvanillylmandelic acid levels increased, but adrenaline and dopamine levels stayed within the normal range. Preoperative liver imaging revealed multiple metastases in all segments except segment 4. Percutaneous transhepatic portal vein embolization(PTPE) of the right and lateral branches of the portal vein was performed. The functional liver volume of segment 4 increased after PTPE. Right hepatectomy, lateral segmentectomy and partial resection of segment 1 were performed 10 mo after the initial surgery. Intraoperative ultrasonography detected two small tumors in segment 4, which were treated with intraoperative microwave coagulation therapy. Noradrenaline levels normalized immediately after the second hepatectomy. As there was increased telomerase activity in the resected specimen, she received adjuvant chemotherapy. She remained in good health for 2 years. However, further metastases eventually occurred and she subsequently died due to a brain hemorrhage. Hepatectomy may be a therapeutic option for reduction of tumor mass in pheochromocytoma with liver metastases.

关键词： Malignant pheochromocytoma Liver metastasis Mass reduction Percutaneous transhepatic portal vein embolization Hepatectomy

Diversion colitis and pouchitis: A mini-review

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World Journal of Gastroenterology 2018年第16期24卷 1734-1747页

作者： kentaro Tominaga Kenya Kamimura Kazuya Takahashi Junji Yokoyama Satoshi yamagiwa Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

Diversion colitis is characterized by inflammation of the mucosa in the defunctioned segment of the colon after colostomy or ileostomy. Similar to diversion colitis, diversion pouchitis is an inflammatory disorder occurring in the ileal pouch, resulting from the exclusion of the fecal stream and a subsequent lack of nutrients from luminal bacteria. Although the vast majority of patients with surgically-diverted gastrointestinal tracts remain asymptomatic, it has been reported that diversion colitis and pouchitis might occur in almost all patients with diversion. Surgical closure of the stoma, with reestablishment of gut continuity, is the only curative intervention available for patients with diversion disease. Pharmacologic treatments using short-chain fatty acids, mesalamine, or corticosteroids are reportedly effective for those who are not candidates for surgical reestablishment; however, there are no established assessment criteria for determining the severity of diversion colitis, and no management strategies to date. Therefore, in this mini-review, we summarize and review various recently-reported treatments for diversion disease. We are hopeful that the information summarized here will assist physicians who treat patients with diversion colitis and pouchitis, leading to better case management.

关键词： Diversion colitis Diversion pouchitis Ileitis Inflammatory bowel disease

Endoscopic ultrasound-guided fine-needle aspiration for diagnosing a rare extraluminal duodenal gastrointestinal tumor

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World Journal of Gastrointestinal Endoscopy 2017年第12期9卷 583-589页

作者： Kazunao Hayashi Kenya Kamimura Kazunori Hosaka Satoshi Ikarashi Junji Kohisa Kazuya Takahashi kentaro Tominaga Kenichi Mizuno Satoru Hashimoto Junji Yokoyama Satoshi yamagiwa Kazuyasu Takizawa Toshifumi Wakai Hajime Umezu Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University Division of Digestive and General Surgery Graduate School of Medical and Dental Sciences Niigata University Department of Pathology Niigata University Medical and Dental Hospital

Duodenal gastrointestinal stromal tumors(GISTs) are extremely rare disease entities, and the extraluminal type is difficult to diagnose. These tumors have been misdiagnosed as pancreatic tumors; hence, pancreaticoduodenectomy has been performed, although partial duodenectomy can be performed if accurately diagnosed. Developing a diagnostic methodology including endoscopic ultrasonography(EUS) and fine-needle aspiration(FNA) has allowed us to diagnose the tumor directly through the duodenum. Here, we present a case of a 50-year-old woman with a 27-mm diameter tumor in the pancreatic uncus on computed tomography scan. EUS showed a well-defined hypoechoic mass in the pancreatic uncus that connected to the duodenal proper muscular layer and was followed by endoscopic ultrasoundguided fine-needle aspiration(EUS-FNA). Histological examination showed spindle-shaped tumor cells positively stained for c-kit. Based on these findings, the tumor was finally diagnosed as a duodenal GIST of the extraluminal type, and the patient underwent successful mass resection with partial resection of the duodenum. This case suggests that EUS and EUS-FNA are effective for diagnosing the extraluminal type of duodenal GISTs, which is difficult to differentiate from pancreatic head tumor, and for performing the correct surgical procedure.

关键词： Gastrointestinal stromal tumor Duodenum Extraluminal type Pancreatic head tumor Endoscopic ultrasonography Endoscopic ultrasound-guided fineneedle aspiration Partial resection