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Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients

World Journal of Gastroenterology 2011年第10期17卷 1343-1353页

作者： Masayuki Imamura Izumi Komoto Shuichi Ota Takuya Hiratsuka Shinji Kosugi Ryuichiro Doi Masaaki Awane Naoya Inoue Department of surgery Kansa Electric Power Company Hospital departments of surgery and Pathology Saiseikai Noe Hospital Medical Gene Research Center Graduate School of Medicine Kyoto University Department of surgery Graduate School of MedicineKyoto University

AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 （MEN 1） and Zollinger-Ellison syndrome （ZES） underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors （NETs） between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test （SASI test） with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy （SRS） and other imaging methods such as computed tomography （CT） or magnetic resonance imaging （MRI）. The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery： pancreaticoduodenectomy （PD） was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes （LR）, and recently pancreas-preserving total duodenectomy （PPTD） has been performed for multiple duodenal gastrinomas. RESULTS： Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients （87.5%）; that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR （although in 2 patients （33.3%） second LR was performed for recurrence of duodenal gastri- noma）, and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the

关键词： Gastrinoma Duodenopancreatic neuroendocrine tumors Multiple endocrine neoplasia type 1 Selective arterial secretagogue injection test 5omatostatin receptor scintigraphy Pancreas-preserving total duode- nectomy Pancreaticoduodenectomy

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Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

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World Journal of Gastroenterology 2017年第29期23卷 5438-5450页

作者： Alexandra Dili Claude Bertrand Unit of Digestive Endocrine and General Surgery Department of Surgery University Hospital - Godinne Université catholique de Louvain

To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy. METHODSWe present a MEDLINE and PubMed literature search, having used the key-words “laparoscopic intraoperative ultrasound” and “laparoscopic cholecystectomy”. All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed. RESULTSWe report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. L

关键词： Intraoperative ultrasound Laparoscopic cholecystectomy Bile duct injury Choledocolithiasis Biliary anomalies

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Specific CYP450 Genotypes in the Chinese Population Affect Sorafenib Toxicity in HBV/HCV-associated Hepatocellular Carcinoma Patients

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Biomedical and Environmental Sciences 2018年第8期31卷 586-595页

作者： GUO Xing Gang WANG Zhi Heng DONG Wei HE Xu Dong LIU Fu Chen LIU Hui The Third Department of Hepatic surgery Eastern Hepatobiliary Surgery Hospital Second Military Medical University Respiratory and endocrine Department The People's Hospital of Wuwei County

Objective The purpose of this study was to screen for frequencies of different CYP450 genotypes in the Chinese population and explore the relationship between sorafenib toxicity and CYP450 polymorphism. Methods A total of 600 peripheral blood samples were obtained from two groups for this study. The first group of 300 samples were from Chinese patients with HBV/HCV-associated HCC, while the remaining 300 samples were from a healthy population of recruited subjects. Allele-specific PCR and long-fragment gene sequencing was used to identify the frequencies of CYP450 polymorphism. Aflatoxin-induced HCC rat models expressing CYP3A4*1, CYP3A5*3, CYP2C19*2, and CYP2D6*10 were established and treated with sorafenib at certain time points. Hepatic and renal function, along with plasma concentration of sorafenib, were monitored regularly. Results The most common forms of CYP mutations in the Chinese population were identified. The levels of sorafenib plasma concentration, as well as damage to hepatic and renal function in aflatoxin-induced HCC rat models varied significantly across the different CYP genotypes. Conclusion The mutational frequencies of CYP3A5, CYP3A4, CYP2C19, and CYP2D6 genotypes varied among different ethnic groups and populations. Individuals with CYP3A5*3 demonstrated minimal sorafenib metabolism, which led to severe hepatic and renal damage. Inter-individual variability in sorafenib-toxicity may be interpreted by CYP450 genetic polymorphisms, suggesting that identification of CYP polymorphism within a certain population should be considered in sorafenib therapy.

关键词： Sorafenib Hepatocellular carcinoma CYP450 polymorphism Inter-individual adverse events

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Resection of the primary tumor in stage Ⅳ breast cancer

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World Journal of Clinical Oncology 2014年第2期5卷 82-85页

作者： Tadahiko Shien Hiroyoshi Doihara Department of Breast and endocrine surgery Okayama University Hospital

Stage Ⅳ breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage Ⅳ is intended to "prolong survival and palliate symptoms". Resection of a primary tumor is considered to be "effective only at alleviating chest symptoms and providing local control" in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treatment strategy according to breast cancer subtypes. Positron emission tomography-computed tomography can detect and diagnose the very small metastases and recurrences which can potentially be cured even if they are distant metastases. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. The goal of treatment has to be clearly identified:increase the patient's survival time, provide local control or perform histology to determine the cancer's properties. The best evidence is absolutely essential to treat patients who need surgery at the right time. We need to evaluate the treatment strategy, including primary resection for stage Ⅳ breastcancer particularly, and find new evidence by prospective analysis.

关键词： Breast cancer Metastasis surgery Survival StageⅣ Clinical trial

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The Effects of Etomidate and Propofol Induction on Hemodynamic and endocrine Response in Patients Undergoing Coronary Artery Bypass Graft surgery on Cardiopulmonary Bypass

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World Journal of Cardiovascular surgery 2012年第3期2卷 48-52页

作者： Anil K Pandey Neeti Makhija Sandeep Chauhan Sambhunath Das Usha Kiran A. K. Bisoi R Lakshmy departments of Cardiac Anaesthesia All India Institute of Medical Sciences New Delhi India departments of Cardiac Biochemistry All India Institute of Medical Sciences New Delhi India departments of Cardiac surgery All India Institute of Medical Sciences New Delhi India

Aim: To compare the effects of propofol and etomidate induction on hemodynamic parameters and serum cortisol levels in patients with normal left ventricular function undergoing elective coronary artery bypass graft surgery on cardiopulmonary bypass. Material and Method: After approval from the Institute Ethics committee hundred American Society of Anesthesiologists (ASA) grade II or III patients undergoing scheduled coronary artery bypass surgery on cardiopulmonary bypass were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for anesthesia induction. Anesthesia was maintained in both groups with sevoflurane, vecuronium bromide for muscle relaxation (0.1 mg/kg, boluses) and fentanyl up to a total dose of 20 mcg/kg. Result: The baseline serum cortisol values were within normal limits in both the groups. The serum cortisol levels in the propofol group increased more than two fold, whereas the values in the etomidate group decreased by close to fifty percent on weaning from cardiopulmonary bypass (CPB). There was no significant difference in serum cortisol levels in the two groups at twenty-four hours after induction, although the values were close to double the baseline levels. Hemodynamically, etomidate group was more stable than propofol group following induction of anesthesia (P < 0.05). Conclusion: The surge in serum cortisol levels on the initiation of CPB seen after the use of propofol is prevented by the use of etomidate. Serum cortisol levels in both groups are well above the baseline at twenty-four hours without any untoward effects. Etomidate provides more stable hemodynamic parameters when used for induction of anesthesia as compared to propofol.

关键词： Etomidate Propofol Coronary Artery Bypass Grafting (CABG) Cardiopulmonary Bypass (CPB)

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The Number of Lymph Nodes and Relationship with Presence of Thyroiditis and Thymic Tissue in the Central Neck Dissection Materials for Thyroid Papillary Carcinoma: Pathologic Analysis

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International Journal of Clinical Medicine 2016年第9期7卷 566-576页

作者： Banu Bilezikçi Seyfettin Ilgan Serdar Özbaş Savaş Koçak departments of Pathology Guven Hospital Ankara Turkey departments of Nuclear Medicine Guven Hospital Ankara Turkey departments of endocrine surgery Guven Hospital Ankara Turkey

Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.

关键词： Thyroid Papillary Carcinoma Central Lymph Node Dissection Thyroiditis Thymus

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A robotic-assisted approach is safe and effective for repairing giant epiphrenic diverticulum

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Laparoscopic, Endoscopic and Robotic surgery 2022年第3期5卷 116-120页

作者： Anna K.Gergen Akshay Pratap Division of GI Traumaand Endocrine SurgeryDepartment of SurgeryUniversity of ColoradoAuroraCO80045USA

Epiphrenic esophageal diverticulum is a rare disorder accounting for<10%of all esophageal *** treatment may be necessary for larger diverticula causing significant *** this technical note,we describe a robotic-assiste... 详细信息

Epiphrenic esophageal diverticulum is a rare disorder accounting forsurgery,University of Colorado in January 2020 with a long-standing history of dysphagia and regurgitation associated with *** a thorough preop-erative workup,the patient underwent a robotic-assisted transhiatal approach with resection of the diverticulum followed by complete myotomy and Dor *** patient had no perioperative complications and demonstrated complete relief of symptoms at the 6-month follow-up.A robotic-assisted transhiatal approach is a safe and effective technique for the resection of large epiphrenic *** myotomy followed by an antireflux procedure is critical to reducing perioperative complications and maintaining long-term symptom *** prospective studies are needed to evaluate the specific morbidity risks associated with this approach.

关键词： Epiphrenic diverticulum Esophageal diverticulectomy Robotic surgery

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Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 337-342页

作者： Nobuhiko Kurata Yasuhiro Ogura Satoshi Ogiso Yasuharu Onishi Hideya Kamei Yasuhiro Kodera Department of Transplantation and endocrine surgery(surgery II) Nagoya University Graduate School of MedicineNagoyaJapan Department of Transplantation surgery Nagoya University Hospital65 Tsurumai-choShowa-kuNagoya 466-8560Japan Department of Gastroenterological surgery(surgery II) Nagoya University Graduate School of MedicineNagoyaJapan

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in ***,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy ***:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively *** applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or ***,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after *** was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy ***:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup *** should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of *** splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

关键词： Living donor liver transplantation Splenectomy Portal venous pressure Graft-to-recipient weight ratio Portal vein thrombosis

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Papillary cystadenoma of the parotid gland: A case report

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World Journal of Clinical Cases 2019年第3期7卷 366-372页

作者： Li Wang Shi-Kun Zhang Ying Ma Patrick K Ha Zhi-Ming Wang Department of Oral and Maxillofacial surgery Shengjing Hospital of China Medical University Department of Pathology Shengjing Hospital of China Medical University Division of Head and Neck Oncologic and endocrine surgery Department of Otolaryngology-Head and Neck Surgery University of California-San Francisco

BACKGROUND Papillary cystadenoma is a rare benign epithelial tumor of the salivary gland,which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint(TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging(MRI) and computed tomography(CT) should be carefully studied, which allows for appropriate preoperative counseling and operative *** SUMMARY Here, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma(PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up *** The integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors.

关键词： Papillary cystadenoma Parotid gland Temporomandibular joint Case report

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Multifocal intraportal invasion of breast carcinoma diagnosed by laparoscopy-assisted liver biopsy

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World Journal of Gastroenterology 2005年第15期11卷 2360-2363页

作者： Tomoki Nakajima Satoru Sekoguchi Taichirou Nishikawa Hidetaka Takashima Tadashi Watanabe Masahito Minami Yoshito Itoh Naruhiko Mizuta Hiroo Nakajima Takeshi Mazaki Akio Yanagisawa Takeshi Okanoue Molecular Gastroenterology and Hepatology endocrine surgery Surgical Pathology

Hepar lobatum carcinomatosum (HLC) is defined as an acquired hepatic deformity consisting of an irregularly lobulated hepatic contour caused by intravascular infiltration of metastatic carcinoma. To date, only nine cases of HLC have been reported in the literature. We report a case of a 68-year-old woman showing hepatic metastasis of breast carcinoma in radiologically unidentified form. Initially, she received left partial mastectomy for breast cancer but solid hepatic metastases were identified in S2 and S6, 9 mo after surgery. Then, they responded to chemotherapy and radiologically disappeared. After radiological disappearance of the liver tumors, the patient's blood chemistry showed abnormal liver function. A CT scan demonstrated heterogeneous enhancement effect in the liver in the late phase,suggesting uneven hepatic blood supply. Hepatic deformity was not obvious. Laparoscopy revealed a slightly deformed liver surface with multiple indentations and shallow linear depressions. Furthermore, a wide scar was observed on the surface of S2 possibly at the site where the metastatic tumor existed before chemotherapy. Liver biopsy from the wide scar lesion showed intraportal tumor thrombi with desmoplastic change. Because of its similarity to the histology of the original breast cancer, we concluded that the hepatic functional abnormalities and slightly deformed liver surface were derived from the circulatory disturbance caused by microscopic tumor thrombi. Besides, since the wide scar was located at the site of the pre-existing tumor,it is probable that chemotherapy was an important cause of fibrous scarring as a result of tumor regression. These morphologic findings are compatible with those of ***-assisted liver biopsy was useful to make definite diagnosis, even though the hepatic deformity was radiologically undetectable.

关键词： Metastatic breast cancer Hepar lobatum carcinomatosum Laparoscopy

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