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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

Visualizing the hepatic vascular architecture using superb microvascular imaging in patients with hepatitis C virus: A novel technique

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World Journal of Gastroenterology 2016年第26期22卷 6057-6064页

作者： Hidekatsu Kuroda Tamami Abe Keisuke Kakisaka Yudai Fujiwara Yuichi yoshida Akio Miyasaka Kazuyuki Ishida Hideaki Ishida Tamotsu Sugai yasuhiro Takikawa Division of Hepatology Department of Internal Medicine Iwate Medical University School of Medicine Department of Molecular Diagnostic Pathology Iwate Medical University Center of Diagnostic Ultrasound Akita Red Cross Hospital

AIM: To identify the hepatic vascular architecture of patients with hepatitis C virus (HCV) using superb microvascular imaging (SMI) and investigate the use of SMI in the evaluation of liver ***: SMI was performed in 100 HCV patients. SMI images were classified into five types according to the vascular pattern, and these patterns were compared with the fibrosis stage. Moreover, the images were analyzed to examine vascularity by integrating the number of SMI signals in the region of interest ROI [number of vascular trees (VT)]. The number of VT, fibrosis stage, serum parameters of liver function, and CD34 expression were ***: There was a significant difference between SMI distribution pattern and fibrosis stage (P < 0.001). The mean VT values in each of the fibrosis stages were as follows: 26.69 ± 7.08 in F0, 27.72 ± 9.32 in F1, 36.74 ± 9.23 in F2, 37.36 ± 5.32 in F3, and 58.14 ± 14.08 in F4. The VT showed excellent diagnostic ability for F4 [area under the receiver operator characteristic (AUROC): 0.911]. The VT was significantly correlated with the CD34 labeling index (r = 0.617, P < 0.0001).CONCLUSION: SMI permitted the detailed delineation of the vascular architecture in chronic liver disease. SMI appears to be a reliable tool for noninvasively detecting significant fibrosis or cirrhosis in HCV patients.

关键词： Superb microvascular imaging Number of vascular trees Chronic liver disease Ultrasound Liver fibrosis CD34

Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1484-1496页

作者： Koji Nakada Masami Ikeda Masazumi Takahashi Shinichi Kinami Masashi yoshida Yoshikazu Uenosono Masanori Terashima Atsushi Oshio yasuhiro Kodera University School of Medicine Tokyo 105-8461Japan Department of Surgery Asama General HospitalSaku 385-0022Japan Division of Gastroenterological Surgery Yokohama Municipal Citizen’s HospitalYokohama 240-8555Japan Department of Surgical Oncology Kanazawa Medical SchoolKanazawa 920-0293Japan Department of Surgery International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Digestive Surgery Imamura General HospitalKagoshima 890-0064Japan Division of Gastric Surgery Shizuoka Cancer CenterShizuoka 411-8777Japan Faculty of Letters Arts and SciencesWaseda UniversityTokyo 169-8050Japan Department of Gastroenterological Surgery Nagoya University Graduate School of MedicineNagoya 466-8550Japan

BACKGROUND Defecation disorders are obscure sequelae that occurs after gastrectomy,and its implication on daily lives of patients have not been sufficiently *** To examine the features of defecation disorders after gastrectomy and to explore its implication on daily lives of patients in a large cohort using the Postgast rectomy Syndrome Assessment Scale(PGSAS)-*** We conducted a nationwide multi-institutional study using PGSAS-45 to examine the prevalence of postgastrectomy syndrome and its impact on daily lives of patients after various types of *** were obtained from 2368 eligible patients at 52 institutions in *** these,1777 patients who underwent total gastrectomy(TG;n=393)or distal gastrectomy(DG;n=1384)were *** severity of defecation disorder symptoms,such as diarrhea and constipation,and their correlation with other postgastrectomy symptoms were *** importance of defecation disorder symptoms on the living states and quality of life(QOL)of postgastrectomy patients,and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression *** Among seven symptom subscales of PGSAS-45,the ranking of diarrhea was 4th in TG and 2nd in *** ranking of constipation was 5th in TG and 1st in *** symptoms that correlated well with diarrhea were dumping and indigestion in both TG and DG;while those with constipation were abdominal pain and mealrelated distress in TG,and were meal-related distress and indigestion in *** five main outcome measures(MOMs)of living status domain,constipation significantly impaired four MOMs,while diarrhea had no effect in *** diarrhea and constipation impaired most of five MOMs in *** six MOMs of QOL domain,diarrhea impaired one MOM,whereas constipation impaired all six MOMs in *** diarrhea and constipation equally impaired all MOMs in *** sex,younger age,division of the celiac branch of vagus nerv

关键词： Postgastrectomy syndrome Defecation disorders Quality of life Patientreported outcome measures Gastrectomy

Background factors influencing postgastrectomy syndromes after various types of gastrectomy

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World Journal of Clinical Cases 2018年第16期6卷 1111-1120页

作者： Shinichi Kinami Masazumi Takahashi Takashi Urushihara Masami Ikeda Masashi yoshida Yoshikazu Uenosono Atsushi Oshio Yoshimi Suzukamo Masanori Terashima yasuhiro Kodera Koji Nakada Department of Surgical Oncology Kanazawa Medical University Division of Gastroenterological Surgery Yokohama Municipal Citizen’s Hospital Department of Gastroenterological Breast and Transplant Surgery Hiroshima Prefectural Hospital Department of Surgery Asama General Hospital Department of Surgery International University of Health and Welfare Hospital Department of Surgery Imamura General Hospital Faculty of Letters Arts and Sciences Waseda University Department of Physical Medicine and Rehabilitation Tohoku University Graduate School of Medicine Division of Gastric Surgery Shizuoka Cancer Center Department of Gastroenterological Surgery Nagoya University Graduate School of Medicine Department of Laboratory Medicine The Jikei University Daisan Hospital

BACKGROUND Postgastrectomy syndromes(PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45) *** To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study(PGSAS) data as an additional analysis. METHODS The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy(DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy(PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures(MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach(laparoscopic or open), and the status of the celiac branch of the vagal *** The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several *** Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.

关键词： Postgastrectomy syndrome Gastrectomy Gastric cancer Postgastrectomy Syndrome Assessment Scale-45

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

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

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World Journal of Gastroenterology 2016年第40期22卷 8978-8990页

作者： Koji Nakada Masazumi Takahashi Masami Ikeda Shinichi Kinami Masashi yoshida Yoshikazu Uenosono Yoshiyuki Kawashima Sayumi Nakao Atsushi Oshio Yoshimi Suzukamo Masanori Terashima yasuhiro Kodera Department of Laboratory Medicine Daisan Hospital Jikei University School of MedicineTokyo 201-8601Japan Division of Gastroenterological Surgery Yokohama Municipal Citizen’s HospitalYokohama 240-8555Japan Department of Surgery Asama General HospitalSaku 085-0022Japan Department of Surgical Oncology Kanazawa Medical SchoolKanazawa 920-0293Japan Department of Surgery International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Digestive Surgery Breast and Thyroid SurgeryKagoshima University Graduate School of MedicineKagoshima 890-8620Japan Division of Gastroenterological Surgery Saitama Cancer CenterSaitanna 362-0806Japan Department of Surgery 2 Tokyo Women’s Medical UniversityTokyo 162-8666Japan Faculty of Letters Arts and SciencesWaseda UniversityTokyo 169-8050Japan Department of Physical Medicine and Rehabilitation Tohoku University Graduate School of MedicineSendai 980-8575Japan Division of Gastric Surgery Shizuoka Cancer CenterShizuoka 411-8777Japan Department of Gastroenterological Surgery Nagoya University Graduate School of MedicineNagaya 466-8550Japan

AIM To identify certain clinical factors other than the type of gastrectomy which affect the postoperative quality of life(QOL) of patients after *** The postgastrectomy syndrome assessment scale(PGSAS)-45 was designed to assess the severity of symptoms, the living status and the QOL of gastrectomized patients. It consists of 45 items, of which 22 are original items while 23 were retrieved from the SF-8 and Gastrointestinal Symptoms Rating Scale questionnaires with permission. A nationwide surveillance study to validate PGSAS was conducted and 2368 gastric cancer patients who underwent various types of gastrectomy at 52 medical institutions were enrolled. Of these, 1777 patients who underwent total gastrectomy(TG) reconstructed with Roux-Y(n = 393), distal gastrectomy(DG) reconstructed with Billroth-I(n = 909), or DG reconstructed with Roux-Y(n = 475) were evaluated in the current study. The influence of the type of gastrectomy and other clinical factors such as age, sex, duration after surgery, the symptom severity, the degree of weight loss, dietary intake, and the ability for working on the postoperative QOL(i.e., dissatisfaction for daily life subscale, physical component summary and mental component summary of the SF-8) were examined by multiple regression analysis(MRA). In addition, importance of various symptoms such as esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation and dumping on the postoperative living status and QOL were also appraised by *** The postoperative QOL were significantly deteriorated in patients who underwent TG compared to those after DG. However, the extent of gastrectomy was not an influential factor on patients' QOL when adjusted by the MRA. Among various clinical factors, the symptom severity, ability for working, and necessity for additional meals were the most influential factorsto the postoperative QOL. As for the individual symptoms, meal-related distress, dumping,

关键词： Postgastrectomy syndrome Quality of life Patient-reported outcome Effect size Gastrectomy

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

Fabrication and Characterization of PCBM:P3HT Bulk Heterojunction Solar Cells Doped with Germanium Phthalocyanine or Germanium Naphthalocyanine

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Materials Sciences and Applications 2013年第4期4卷 1-5页

作者： Kazumi yoshida Takeo Oku Atsushi Suzuki Tsuyoshi Akiyama yasuhiro Yamasaki Department of Materials Science The University of Shiga Prefecture Shiga Japan Department of New Business Orient Chemi- cal Industries Co. Ltd. Osaka Japan

[6,6]-phenyl C61-butyric acid methyl ester: poly (3-hexylthiophene) bulk heterojunction solar cells doped with germanium phthalocyanine or germanium naphthalocyanine were fabricated and characterized. Photovoltaic properties of the solar cells with inverted structures were investigated by optical absorption, current density-voltage characteristic and incident photon to current conversion efficiency. These germanium phthalocyanine and germanium naphthalocyanine blended as the third component absorbed light with wavelength longer than 700 nm. Morphology of solar cells was investigated by atomic force microscopy, and energy levels of the solar cells were discussed for power conversion efficiency.

关键词： Organic Solar Cell Inverted Structure Phthalocyanine Germanium P3HT PCBM

Fabrication and Characterization of Phthalocyanine/C<sub>60</sub>Solar Cells with Inverted Structure

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Advances in Chemical Engineering and Science 2012年第4期2卷 461-464页

作者： Kazumi yoshida Takeo Oku Atsushi Suzuki Tsuyoshi Akiyama yasuhiro Yamasaki Department of Materials Science The University of Shiga Prefecture Hikone Japan Orient Chemical Industries Co. Ltd. Department of New Business Osaka Japan

Photovoltaic and optical properties of fullerene/phthalocyanine heterojunction solar cells with normal and inverted structures were fabricated and investigated. Aluminum and gallium phthalocyanines were used for the n-type semiconductor. The solar cells with inverted structure had more stability compared to that with normal structure in the air. Nanostructures of the solar cells were investigated by transmission electron microscopy, and energy levels of the molecules were calculated and discussed.

关键词： Organic Thin Film Solar Cell Inverted Structure Phthalocyanine Fullerene PCBM TiO2 Sol-Gel