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New methods for the management of esophageal varices

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World Journal of Gastroenterology 2007年第11期13卷 1641-1645页

作者： Hiroshi Yoshida yasuhiro mamada Nobuhiko Taniai Takashi Tajiri Department of Surgery Nippon Medical School Tokyo 1138603 Japan

Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow- up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients’ quality of life. Recently, we have performed EVL at 2-mo (bimonthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.

关键词： Esophageal varices Surgery Interventional radiology Embolization Endoscopic treatment Bi-rnonthly

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

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World Journal of Gastroenterology 2008年第19期14卷 3000-3005页

作者： Takashi Tajiri Hiroshi Yoshida yasuhiro mamada NobuhikoTaniai Shigeki Yokomuro Yoshiaki Mizuguchi Departmentof Surgery Nippon Medical School1-1-5 SendagiBunkyo-ku

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we... 详细信息

关键词： Cholangiocarcinoma Obstructive jaundice Diagnosis Treatment Initial management

Effect of transforming growth factor-β1 on human intrahepatic cholangiocarcinoma cell growth

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World Journal of Gastroenterology 2006年第39期12卷 6316-6324页

作者： Tetsuya Shimizu Shigeki Yokomuro Yoshiaki Mizuguchi Yutaka Kawahigashi Yasuo Arima Nobuhiko Taniai yasuhiro mamada Hiroshi Yoshida Koho Akimaru Takashi Tajiri Surgery for Organ Function and Biological Regulation Graduate School of Medicine Nippon Medical School Tokyo 113-8603 Japan

AIM： To elucidate the biological effects of transforming growth factor-β1 （TGF-β1） on intrahepatic cholangiocarcinoma （ICC）.METHODS： We investigated the effects of TGF-β1 on human ICC cell lines （HuCCT1, MEC, and HUH-28） by monitoring the influence of TGF-β1 on tumor growth and interleukin-6 （IL-6） expression in ICC cells.RESULTS： All three human ICC cell lines produced TGF-β1 and demonstrated accelerated growth in the presence of TGF-β1 with no apoptotic effect. Studies on HuCCT1 revealed a TGF-β1-induced stimulation of the expression of TGF-β1, as well as a decrease in TGF-β1 mRNA expression induced by neutralizing anti-TGF-β1 antibody. These results indicate that TGF-β1 stimulates the production and function of TGF-β1 in an autocrine fashion. Further, IL-6 secretion was observed in all three cell lines and exhibited an inhibitory response to neutralizing anti-TGF-β1 antibody. Experiments using HuCCT1 revealed a TGF-β1-induced acceleration of IL-6 protein expression and mRNA levels. These findings demonstrate a functional interaction between TGF-β1 and IL-6. All three cell lines proliferated in the presence of IL-6. In contrast, TGF-β1 induced no growth effect in HuCCT1 in the presence of small interfering RNA against a specific cell surface receptor of IL-6 and signal transducer and activator of transcription-3.CONCLUSION： ICC cells produce TGF-β1 and confer a TGF-β1-induced growth effect in an autocrine ***-β1 activates ILo6 production, and the functional interaction between TGF-β1 and IL-6 contributes to ICC cell growth by TGF-β1.

关键词： Transforming growth factor-β1 Interleukin-6 Intrahepatic cholangiocarcinoma

Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

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World Journal of Gastroenterology 2009年第33期15卷 4201-4203页

作者： Hiroshi Yoshida yasuhiro mamada Nobuhiko Taniai Sho Mineta Yoshiaki Mizuguchi Yoichi Kawano Junpei Sasaki Yoshiharu Nakamura Takayuki Aimoto Takashi Tajiri Department of Surgery Nippon Medical School

This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy. Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-FF tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes onestep insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepaUc biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy.

关键词： Biliary tract Drainage Hepaticojejunostomy Stenosis Stents

Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

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World Journal of Gastroenterology 2006年第21期12卷 3450-3452页

作者： Tetsuya Shimizu Hiroshi Yoshida yasuhiro mamada Nobuhiko Taniai Satoshi Matsumoto Yoshiaki Mizuguchi Shigeki Yokomuro Yasuo Arima Koho Akimaru Takashi Tajiri Graduate School of Medicine Surgery for Organ Function and Biology Regulation Nippon Medical SchoolTokyo113-8603Japan

We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage （RTBD） tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative man- agement, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

关键词： Postoperative complication Bile leakage Ethanol ablation

Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma

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World Journal of Gastroenterology 2012年第23期18卷 3027-3031页

作者： Junji Ueda Hiroshi Yoshida yasuhiro mamada Nobuhiko Taniai Sho Mineta Masato Yoshioka Youichi Kawano Tetsuya Shimizu Etsuko Hara Chiaki Kawamoto Keiko Kaneko Eiji Uchida Department of Surgery Nippon Medical School Tokyo 113-8603 Japan Divisions of Cardiology Hepatology Geriatrics and Integrated Medicine Department of Internal Medicine Nippon Medical School Tokyo 113-8603 Japan

Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

关键词： Surgical resection Lymph node metasta-sis Hepatocellular carcinoma Hepatectomy Positronemission tomography

One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent

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World Journal of Gastroenterology 2006年第15期12卷 2423-2426页

作者： Hiroshi Yoshida yasuhiro mamada Nobuhiko Taniai Yoshiaki Mizuguchi Tetsuya Shimizu Shigeki Yokomuro Takayuki Aimoto Yoshiharu Nakamura Eiji Uchida Yasuo Arima Manabu Watanabe Eiichi Uchida Takashi Tajiri Department of Surgery 1 Nippon Medical School Japan Uchida Hospital Japan

AIM： To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent （EMS） used in the treatment of obstructive jaundice caused by unresectable malignancies. METHODS： Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure. RESULTS： One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered. CONCLUSIONS： One-step percutaneous transhepaticinsertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient＇s quality of life.

关键词： Expandable metallic stent Bile duct carcinoma Gall bladder carcinoma Pancreatic carcinoma Gastric carcinoma Obstructive jaundice

Preoperative liver functional volumetry performed by 3D-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT: a preliminary study

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Hepatoma Research 2016年第1期2卷 187-192页

作者： Hiroshi Yoshida Hiroshi Makino Tadashi Yokoyama Hiroshi Maruyama Atsushi Hirakata Junji Ueda yasuhiro mamada Nobuhiko Taniai Eiji Uchida Department of Surgery Nippon Medical School Tama Nagayama HospitalTokyo 206-8512Japan Department of Surgery Nippon Medical SchoolTokyo 113-8603Japan

Aim:The present study was designed to evaluate the feasibility of preoperative liver functional volumetry performed by 3D-technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin(99mTc-GSA)scintigraphy/vascular fusion imaging using SYNAPSE VINCENT and to examine the discrepancy between conventional and functional ***:The study group comprised 15 patients who underwent preoperative 3-dimensional(3D)-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT software before hepatectomy between July 2014 and August *** diagnosis was hepatocellular carcinoma(n=4),metastatic liver tumor(n=10),or intrahepatic cholangiocarcinoma(n=1).Right hepatectomy was performed in 2 patients,left hepatectomy in 3 patients,right posterior sectionectomy in 3 patients,segmentectomy in 2 patients,and partial hepatectomy in 4 patients.99mTc-GSA scintigraphy and computed tomography(CT)were performed to construct 3D-99mTc-GSA scintigraphy/vascular fused *** conventional volume ratio of the planned resection region without tumor(%CT),and the functional volume ratio of the planned resection region without tumor(%GSA)were *** discrepancy ratio was calculated as follows:discrepancy ratio=100-%GSA/%CT×100(%).Results:The%GSA(17.9±16.7%)was significantly lower than the%CT(21.5±17.6%)(P<0.036).In all except 2 patients,the%GSA was lower than the%*** discrepancy ratio ranged from-4%to 75%(median,20.7%).Conclusion:3D-99mTc-GSA scintigraphy/vascular fused images constructed using SYNAPSE VINCENT were useful for noninvasively performing functional liver volumetry in patients scheduled to undergo various patterns of *** planned resection regions without tumor,the functional volume ratio was about 20%lower than the conventional volume ratio.

关键词： Functional volumetry 99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin SYNAPSE VINCENT fusion image 3-dimensional computed tomography

Two-layer cold storage method for pancreas and islet cell transplantation

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World Journal of Gastroenterology 2010年第26期16卷 3235-3238页

作者： yasuhiro Fujino Department of Surgery Hyogo Cancer Center Akashi 673-8558 Japan

The two-layer cold storage method (TLM) was f irst reported in 1988, consisting of a perfluorochemical (PFC) and initially Euro-Collins' solution, which was later replaced by University of Wisconsin solution (UW). PFC is a biologically inert liquid and acts as an oxygen-supplying agent. A pancreas preserved using the TLM is oxygenated through the PFC and substrates are supplied by the UW solution. This allows the pancreas preserved using the TLM to generate adenosine triphosphate during storage, prolonging the preservation time. In a canine model, the TLM was shown to repair and resuscitate warm ischemically damaged pancreata during preservation, improve pancreas graft survival after transplantation, and also improve the islet yield after isolation. Clinical trials using the TLM in pancreas preservation before whole-pancreas transplantation and islet isolation have shown promising outcomes. We describe the role of the TLM in pancreas and islet transplantation.

关键词： Two-layer method Pancreas preservation Pancreas transplantation Islet transplantation Perfluorochemical