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Tubulopapillary adenoma of the gallbladder accompanied by bile duct tumor thrombus

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World Journal of Gastroenterology 2014年第26期20卷 8736-8739页

作者： Kentaroh Yamamoto Fumio Yamamoto Atsuhiro Maeda Hirotsune Igimi Mami Yamamoto Ryosuke Yamaguchi yuichi Yamashita Department of Surgery Yamamoto Memorial Hospital Department of Internal Medicine Maeda Hospital Department of Gastroenterological Surgery Fukuoka University School of Medicine

Intraductal papillary mucinous neoplasm of the bile duct(IPNB)is recognized as a precancerous lesion;however,both its pathogenesis and progression remain unclear.We present here a case of IPNB arising from the gallbladder accompanied by bile duct tumor thrombus in a 79-year-old female.The resected specimen revealed a tubulopapillary adenoma with no malignant cells.This case suggests that even in the absence of malignant cells,these tumors can behave as malignant tumors requiring aggressive treatment.Even if no malignant cells are present,intraepithelial neoplasms occurring in the ampullopancreatobiliary tract can behave as malignant tumors.

关键词： Intraductal papillary mucinous neoplasm of the bil

Acute pancreatitis successfully diagnosed by diffusion-weighted imaging: A case report

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World Journal of Gastroenterology 2008年第35期14卷 5478-5480页

作者： Satoshi Shinya Takamitsu Sasaki Yoshifumi Nakagawa Zhang Guiquing Fumio Yamamoto yuichi Yamashita Department of Gastroenterological Surgery Yamamoto Memorial Hospital88-4 HachiyagaramiNirimachiImariSaga 848-0031Japan Department of Gastroenterological Surgery Fukuoka University School of MedicineNanakuma 7-45-1Jonan-kuFukuoka 814-0180Japan

Diffusion-weighted imaging (DWI) is an established diagnostic method of acute stroke. The latest advances in magnetic resonance imaging (MRI) technology have greatly expanded the utility of DWI in the examination of various organs. Recent studies have revealed the usefulness of DWI for imaging of the liver, kidney, ovary, and breast. We report a patient with acute pancreatitis detected by DWI and discussed the efficacy of DWI in diagnosing acute pancreatitis. A 50-year old man presented with a primary complaint of abdominal pain. We performed both DWI and computed tomography (CT) for this patient. The signal intensity in a series of DWI was measured and the apparent diffusion coefficient (ADC) values were calculated to differentiate inflammation from normal tissue. Two experienced radiologists evaluated the grade of acute pancreatitis by comparing the CT findings. Initially, the pancreas and multiple ascites around the pancreas produced a bright signal and ADC values were reduced on DWI. As the inflammation decreased, the bright signal faded to an iso-signal and the ADC values returned to their normal level. There was no difference in the abilities of DWI and CT images to detect acute pancreatitis. However, our case indicates that DWI can evaluate the manifestations of acute pancreatitis using no enhancement material andhas the potential to replace CT as a primary diagnostic strategy for acute pancreatitis.

关键词：急性胰腺炎加权扩散成像表观扩散常数磁共振成像诊断

Safety and Feasibility of Oral Rehydration Solution Prior to Endoscopic Retrograde Cholangiopancreatography

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Surgical Science 2015年第3期6卷 91-99页

作者： Takamitsu Sasaki Daisuke Kato Ryohei Sakamoto Satoshi Shinya Hironari Shiwaku Kanefumi yamashita Ryo Nakashima yuichi Yamashita Department of Gastroenterological Surgery Fukuoka University School of Medicine Fukuoka Japan

Purpose: The safety of oral rehydration therapy before endoscopic screening with respect to vital signs and complications after the screening procedure was assessed in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: A total of 107 patients scheduled for ERCP were assigned to either the intravenous drip injection (DIV) group during fasting (56 patients) or ORS group given oral rehydration solution (51 patients) prior to endoscopy. Vital signs after ERCP, including blood pressure and temperature, blood biochemical data and the incidence of post-ERCP complications were compared between the groups. Results: No cases of aspiration pneumonia were detected in either groups. Moreover, there were no statistically significant differences between the DIV group and ORS group in terms of the biochemical data and vital signs after ERCP. The intergroup difference in the development of pancreatitis after ERCP was 2.3% [95% CI: ?5.7, 10.3], which was not statistically significant. Conclusions: The safety of oral rehydration therapy was found to be equivalent to that of the customary practice of infusion as a method for managing hydration and replenishing electrolytes in patients receiving ERCP. Oral rehydration therapy may be easily utilized as rehydration therapy prior to endoscopic screening for ERCP and other procedures.

关键词： Endoscopic Retrograde Cholangiopancreatography Oral Rehydration Therapy Oral Rehydration Solution Post-ERCP Pancreatitis Complication

Efficacy and safety of endoscopic submucosal dissection under general anesthesia

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World Journal of Gastrointestinal Endoscopy 2016年第13期8卷 466-471页

作者： Kanefumi yamashita Hironari Shiwaku Toshihiro Ohmiya Hideki Shimaoka Hiroki Okada Ryo Nakashima Richiko Beppu Daisuke Kato Takamitsu Sasaki Seiichiro Hoshino Satoshi Nimura Ken Yamaura yuichi Yamashita Department of Gastroenterological Surgery Fukuoka University Faculty of Medicine Department of Pathology Fukuoka University Faculty of Medicine Department of Anesthesiology Fukuoka University Faculty of Medicine

AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD) under general anesthesia.METHODS: From January 2011 to July 2014, 206 consecutive patients had undergone ESD under general anesthesia for neoplasms of the stomach, esophagus, and colorectum were enrolled in this retrospective study. The efficacy and safety of ESD under general anesthesia were assessed.RESULTS: The en bloc resection rate of esophageal, gastric, and colorectal lesions was 100.0%, 98.3%, and 96.1%, respectively. The complication rate of perforationand bleeding were 0.0% and 0.0% in esophageal ESD, 1.7% and 1.7% in gastric ESD, and 3.9% and 2.0% in colorectal ESD, respectively. No cases of aspiration pneumonia were observed. All complications were managed by conservative treatment, with no surgical intervention required.CONCLUSION: With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications.

关键词： Complication Endoscopic submucosal dissection General anesthesia Conscious sedation

Early Ligation of the Inferior Pancreaticoduodenal Artery Using Intraoperative Ultrasonography during Pancreaticoduodenectomy

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Surgical Science 2015年第2期6卷 50-54页

作者： Takamitsu Sasaki Daisuke Kato Satoshi Shinya Kanefumi yamashita Ryo Nakashima Hironari Shiwaku Yasushi Yamauchi Tomoaki Noritomi yuichi Yamashita Department of Gastroenterological Surgery Fukuoka University School of Medicine Fukuoka Japan

Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastrointestinal operations. Various trials have been implemented in efforts to reduce the incidence of complications after PD. In particular, a large amount of intraoperative bleeding and the use of red blood cell transfusions are reportedly risk factors for postoperative complications after PD. Aim: In an attempt to reduce the amount of intraoperative bleeding during PD, consideration was given to the anatomical characteristics of the region of the pancreatic head, and the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in advance of separating the head from the portal vein. We herein report the use of ultrasonography during PD to facilitate the early identification and ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy. We used ultrasonography during the operation to initially identify the IPDA and then ligate it in advance, after which the GDA was ligated before separating the pancreatic head from the superior mesenteric artery and portal vein. Identification of the IPDA was performed with the SMA as a guide using ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235 ml. The patient left the hospital without any postoperative complications and has since demonstrated a good postoperative course, with no evidence of recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative US is non-invasive and makes it simple to identify the IPDA. This method may be a useful technique for reducing intraoperative bleeding during the normal course of PD procedures.

关键词： Intraoperative Bleeding Early Ligation Inferior Pancreaticoduodenal Artery Pancreaticoduodenectomy Ultrasonography