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Does massive intraabdominal free gas require surgical intervention?

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World Journal of Gastroenterology 2016年第32期22卷 7383-7388页

作者： Tadashi Furihata Makoto Furihata Kunibumi Ishikawa Masato Kosaka Naoki Satoh keiichi kubota Department of General Surgery Kyouwa Chuo Hospital Department of Gastroenterological Surgery Dokkyo Medical University

We describe a rare case of an 81-year-old man who presented with severe epigastralgia. A chest radiograph showed massive free gas bilaterally in the diaphragmatic spaces. Computed tomography(CT) scan also showed massive free gas in the peritoneal cavity with portal venous gas. We used a wait-andsee approach and carefully considered surgery again when the time was appropriate. The patient received conservative therapy with fasting, an intravenous infusion of antibiotics, and nasogastric intubation. The patient soon recovered and was able to start eating meals 4 d after treatment; thus, surgical intervention was avoided. Thereafter, colonoscopy examination showed pneumatosis cystoides intestinalis in the ascending colon. On retrospective review, CT scan demonstrated sporadic air-filled cysts in the ascending colon. The present case taught us a lesson: the presence of massive intraabdominal free gas with portal venous gas does not necessarily require surgical intervention. Pneumatosis cystoides intestinalis should be considered as a potential causative factor of free gas with portal venous gas when making the differential diagnosis.

关键词： Case reports Portal vein Pneumatosis cystoides intestinalis Colonoscopy General surgery

Intraoperative frozen section diagnosis of bile duct margin for extrahepatic cholangiocarcinoma

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World Journal of Gastroenterology 2018年第12期24卷 1332-1342页

作者： Takayuki Shiraki Hajime Kuroda Atsuko Takada Yoshimasa Nakazato keiichi kubota Yasuo Imai Department of Gastroen- terological Surgery Dokkyo Medical University Department of Diagnostic Pathology Dokkyo Medical University

AIM To evaluate the usefulness of frozen section diagnosis(FSD) of bile duct margins during surgery for extrahepatic cholangiocarcinoma(CCA). METHODS We retrospectively analyzed 74 consecutive patients who underwent surgery for extrahepatic CCA from 2012 to 2017, during which FSD of bile duct margins was performed. They consisted of 40 distant and 34 perihilar CCAs(45 and 55 bile duct margins, respectively). The diagnosis was classified into three categories: negative, borderline(biliary intraepithelial neoplasia-1 and 2, and indefinite for neoplasia), or positive. FSD in the epithelial layer, subepithelial layer, and total layer was compared with corresponding permanent section diagnosis(PSD) ***, association between FSD and local recurrence was analyzed with special reference to *** Analysis of 100 duct margins revealed that concordance rate between FSD and PSD was 68.0% in the total layer, 69.0% in the epithelial layer, and 98.0% in the subepithelial layer. The extent of remaining biliary epithelium was comparable between FSD and PSD, and more than half of the margins lost > 50% of the entire epithelium, suggesting low quality of the samples. In FSD, the rate of negative margins decreased and that of borderline and positive margins increased according to the extent of the remaining epithelium. Diagnostic discordance between FSD and PSD was observed in 31 epithelial layers and two subepithelial layers. Alteration from borderline to negative was the most frequent(20 of the 31 epithelial layers). Patients with positive margin in the total and epithelial layers by FSD demonstrated a significantly worse local recurrence-free survival(RFS) compared with patients with borderline and negative margins, which revealed comparable local RFS. Patients with borderline and negative margins in the epithelial layer by PSD also revealed comparable local RFS. These results suggested that epithelial borderline might be regarded substantially as negati

关键词： Cholangiocarcinoma Bile duct cancer Frozen section diagnosis Permanent section diagnosis Bile duct margin Biliary intraepithelial neoplasia Dysplasia Indefinite for neoplasia Borderline lesion Local recurrence

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

Multi-disciplinary treatment for cholangiocellular carcinoma

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World Journal of Gastroenterology 2007年第10期13卷 1500-1504页

作者： Mitsugi Shimoda keiichi kubota Second Department of Surgery Dokkyo Medical University School of Medicine880 Kita KobayashiMibuTochigi 321-0293Japan

Cholangiocarcinoma(CC)is rare malignant tumors composed of cells that resemble those of the biliary *** is notoriously difficult to diagnose,and is associated with a high ***,CC is divided into intrahepatic and extraheaptic disease according to its location within the biliary *** cholangiocellular carcinoma(IH-CCC)or peripheral cholangiocellular carcinoma(CCC)appears within the second bifurcation of hepatic bile duct,and is the second most common primary liver cancer following hepatocellular carcinoma(HCC),IH-CCC or peripheral CCC often presents with advanced clinical features,and the cause for this cancer rise is still ***,CT and PET provide useful diagnostic information in those *** resection is the only chance for cure,with results depending on selected patients and careful surgical *** transplantation could offer long-term survival in selected patients when combined with ***,radiation therapy or combination therapies remain as the only treatment for inoperable ***,these are uniformly ineffective in patients' survival.

关键词： Cholangiocellular carcinoma Surgical resection Liver transplantation Chemotherapy Radiation

Recent advances and limitations of surgical treatment for pancreatic cancer

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World Journal of Clinical Oncology 2011年第5期2卷 225-228页

作者： keiichi kubota Second Department of Surgery Dokkyo Medical University880 KitakobayashiMibuTochigi 321-0293 Japan

Recent advances in surgical treatment for pancreatic cancer have been *** is a standard surgical procedure for cancer of the pancreatic head,and is now indicated even for elderly patients over 80 years of *** with combined resection of the peripancreatic vessels has improved survival,but extended resection including lymph nodes is considered to have no extra survival ***,laparoscopic resection procedures including pancreatoduodenectomy,distal pancreatectomy,enucleation and central pancreatectomy can now be performed *** or adjuvant chemotherapy using gemcitabine may further improve the surgical *** understanding of the oncological aspects of pancreatic cancer and the development of surgical techniques and chemotherapy may further contribute to improving the outcome of surgery for pancreatic cancer.

关键词： Chemotherapy Laparoscopic surgery Pancreatic cancer Pancreatoduodenectomy Pancreatic fistula

Primary hepatic leiomyosarcoma:Case report and literature review

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World Journal of Gastrointestinal Oncology 2011年第10期3卷 148-152页

作者： Nairuthya Shivathirthan Junji Kita Yukihiro Iso Hiroyuki Hachiya Park KyungHwa Tokihiko Sawada keiichi kubota Second Department of Surgery Dokkyo Medical University880 Kita KobayashiMibuTochigi 321-0293Japan

Primary hepatic leiomyosarcoma are rare tumors with less than 30 cases reported in the English *** specific presentations and often diagnosis delayed until they reach a large size,is the norm with therapy leading to an often dismal prognosis.A 67-year-old man presented complaining of abdominal pain and a palpable abdominal mass since Jan *** ultrasonography and abdominal computed tomography revealed a large tumor in the left lobe of the *** exploration was undertaken and an extended left hepatectomy with extension onto the dorsal part of segment 8 preserving the MHV with partial resection of segment 6 was *** weight of the resected specimen was 1300 g of the left lobectomy specimen and 8 g of the segment 6 partial resection *** pathology report confirmed the diagnosis of *** immunohistochemistry,the tumor cells were positive for smooth muscle actin *** patient is on regular follow up and is currently 9 mo post resection with no evidence of *** report the case of a resected primary hepatic leiomyosarcoma and emphasize the need for a global database for these rare tumors to promote a better and broader understanding of this less understood subject.

关键词： Primary hepatic leiomyosarcoma Smooth muscle actin Smooth muscle Hepatectomy

Surgical treatment of HCC in a patient with lamivudine-resistant hepatitis B cirrhosis with adefovir dipivoxil

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World Journal of Hepatology 2010年第8期2卷 318-321页

作者： Takashi Akima Masaya Tamano Hidetsugu Yamagishi keiichi kubota Takahiro Fujimori Hideyuki Hiraishi Department of Gastroenterology Dokkyo Medical University Department of Gastroenterology Dokkyo Medical University Koshigaya Hospital Department of Surgical and Molecular Pathology Dokkyo Medical University Second Department of Surgery Dokkyo Medical University

We describe a 77-year-old woman with chronic hepatitis B who became resistant to *** was started on adefovir(10 mg daily)while still continuing lamivudine *** mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became *** years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful *** findings suggest tha-t the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis,but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis,allowing HCC surgery.

关键词： Hepatitis B virus Hepatocellular carcinoma Hepatocarcinogenesis Lamivudine Adefovir dipivoxil

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