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Prognostic value of baseline FDG uptake on PET-CT in esophageal carcinoma

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World Journal of Gastrointestinal Oncology 2014年第5期6卷 139-144页

作者： Omar S Al-Taan Amar Eltweri David Sharpe Peter M Rodgers Sukhbir S Ubhi David J Bowrey departments of surgery University Hospitals of Leicester departments of radiology University Hospitals of Leicester

AIM: To evaluate the influence of baseline maximum standardized uptake value(SUVmax) on survival in a cohort of patients, undergoing positron emission tomography-computed tomography(PET-CT) scan for esophageal carcinoma. METHODS: The pre-treatment SUVmax numeric reading was determined in patients with confirmed esophageal or junctional cancer having PET-CT scan during the time period 1st January 2007 until 31 st July 2012. A minimum follow up of 12 mo was required. Patients were subdivided into quartiles according to SUVmax value and the influence of SUVmax on survival was assessed using univariate and multivariate analysis. The following pre-treatment factors were investigated: patient characteristics, tumor characteristics and planned treatment. RESULTS: The study population was 271 patients(191male) with esophageal or junctional carcinoma. The median age was 65 years(range 40-85) and histologic subtype was adenocarcinoma in 197 patients and squamous carcinoma in 74 patients. The treatment intent was radical in 182 and palliative in 89 patients. SUVmax was linked to histologic subtype(P = 0.008), tumor site(P = 0.01) and Union for International Cancer Control(UICC) stage(P < 0.001). On univariate analysis, prognosis was significantly associated with SUVmax(P = 0.001), T-stage(P < 0.001) and UICC stage(P < 0.001). On multivariate analysis, only T-stage and UICC stage remained significant. CONCLUSION: Pretreatment SUVmax was not a useful marker in isolation for determining prognosis of patients with esophageal carcinoma.

关键词： Esophageal neoplasms Fluorodeoxyglucose F18 Positron emission tomography Positron emission tomography-computed tomography Prognosis

Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery

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World Journal of Gastroenterology 2014年第42期20卷 15763-15770页

作者： Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Joji Tani Hisaaki Miyoshi Asahiro Morishita Tsutomu Masaki departments of Gastroenterology and Neurology Facultyof Medicine Kagawa University Department of gastroenterological surgery Ehime Rosai Hospital

AIM: To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.

关键词： Laparoscopic and endoscopic cooperative surgery Systemic gastric lavage Disinfection Bacterial counts Duodenal balloon occlusion

Subspecialty radiology and surgery

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Hepatobiliary & Pancreatic Diseases International 2013年第2期12卷 122-124页

作者： Steven C Cunningham Saleem Farooqui departments of surgery and radiology Saint Agnes Hospital

The Master said: "Yu! Shall I teach you the meaning of knowledge?When you know a thing to recognize that you know it; and when you do not, to know that you do not know

关键词： Subspecialty radiology and surgery FNH

Bronchial bleeding caused by recurrent pneumonia after radical esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2015年第11期21卷 3394-3401页

作者： Toshihiro Kitajima Kota Momose Seigi Lee Shusuke Haruta Masaki Ueno Hisashi Shinohara Sakashi Fujimori Takeshi Fujii Ryoji Takei Tadasu Kohno Harushi Udagawa Department of gastroenterological surgery Toranomon Hospital Department of Thoracic surgery Toranomon Hospital Department of Pathology Toranomon Hospital Department of radiology Toranomon Hospital

We herein report a case of bronchial bleeding afterradical esophagectomy that was treated with lobectomy.A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden *** the esophagectomy,bilateral vocal cord paralysis was observed,and the patient suffered from repeated episodes of aspiration *** revealed hemosputum in the right middle lobe bronchus,and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe *** bronchial arterial embolization was performed twice to control the recurrent hemoptysis,the procedures were *** middle lobectomy was therefore performed via video-assisted thoracic *** bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected *** patient recovered uneventfully and was discharged on postoperative day 14.

关键词： Hemoptysis Esophagectomy Recurrent laryngeal nerve

Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture:A case report

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World Journal of Gastroenterology 2007年第6期13卷 970-972页

作者： Toshiaki Ichihara Tsutomu Sato Hideaki Miyazawa Satoshi Shibata Manabu Hashimoto Koichi Ishiyama Yuzo Yamamoto departments of gastroenterological surgery and radiology Akita University School of Medicine Hondo Akita 010-8543 Japan

To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoan-eurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenec-tomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts nor-malized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.

关键词： Extrahepatic portal vein stenosis Jejunalvarices Interventional radiology Stent-graft

Lymphoepithelial cysts of the pancreas:a management dilemma

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 539-544页

作者： Julie Martin Keith J Roberts Maria Sheridan Gavin A Falk Daniel Joyce R Matthew Walsh Andrew M Smith Gareth Morris-Stiff departments of Pancreatic surgery St James's University Hospital departments of radiology St James's University Hospital Department of General surgery Section of Surgical Oncology/HPB Cleveland Clinic Foundation

Pancreatic lymphoepithelial cysts（LECs） are rare,benign lesions that are typically unexpected post-operative pathological findings. We aimed to review clinical, radiological and pathological features of LECs that may allow their preoperative diagnosis. Histopathology databases of two large pancreatic units were searched to identify LECs and notes reviewed to determine patient demographic details, mode of presentation, investigations, treatment and outcome. Five male and one female patients were identified. Their median age was 60 years. Lesions were identified on computed tomography performed for abdominal pain in two patients, and were incidentally observed in four patients. Five LECs were located in the tail and one in the body of the pancreas, with a median cyst size of 5 cm. Obtaining cyst fluid was difficult and a largely acellular aspirate was yielded. The pre-operative diagnosis was mucinous cystic neoplasm in all patients. This series of patients were treated distal pancreatectomy and splenectomy. A retrospective review of radiological examinations suggested that LECs have a relatively low signal on T2 imaging and a high signal intensity on T1 weighted images. LECs appear more common in elderly males, and are typically incidental, large, unilocular cysts. Close attention to signal intensity on MRI may allow preoperative diagnosis of these lesions.

关键词： lymphoepithelial cyst pancreas

Exocrine pancreatic function assessed by secretin cholangio-Wirsung magnetic resonance imaging

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 192-195页

作者： Lucia Calculli Raffaele Pezzilli Marta Fiscaletti Riccardo Casadei Carla Brindisi Giampaolo Gavelli departments of radiology Digestive Diseases and Internal Medicineand General SurgerySant'Orsola-Malpighi Hospital Bologna Italy

BACKGROUND:Magnetic resonance cholangiopancreato-graphy (MRCP) is useful to assess exocrine pancreatic function by combining rapid imaging acquisition with the administration of secretin, a gastrointestinal hormone that stimulates the secretion of bile and pancreatic juice. However, extensive data on this method are lacking. This study aimed to determine whether MRCP with secretin administration is able to simultaneously detect alterations of both the pancreatic ducts and exocrine pancreatic function. METHODS:All subjects older than 18 years who underwent magnetic resonance imaging (MRI) and cholangio-Wirsung magnetic resonance imaging (CWMRI) for suspicion of benign or malignant pancreatic diseases from January 2006 to December 2006 were enrolled in the study. MRI and CWMRI were carried out using a dedicated apparatus. RESULTS:Eighty-seven patients (46 males, 41 females, mean age 59.7±14.6, range 27-87 years) were enrolled. Of the 87 patients, 39 had a normal pancreas on imaging, 20 had an intrapapillary mucinous tumor (IPMT), and the rest had chronic pancreatitis (7), serous cystadenoma (6), a previous attack of acute biliary pancreatitis (5), congenital ductal abnormalities (5), mucinous cystadenoma (3), previous pancreatic head resection for autoimmune pancreatitis (1), or cholangiocarcinoma (1). Morphologically, we found two pseudocysts (one of the 7 patients with chronic pancreatitis, and one of the 5 patients after an attack of acute pancreatitis;the latter pseudocyst communicated with the main pancreatic duct). Calcifications were found in 3 of the 7 patients with chronic pancreatitis. All patients with IPMT and mucinous cystadenoma and 3 patients with serous cystadenoma were histologically confirmed. The remaining patients were followed up adequately to confirm the diagnosis by imaging. According to the Matos criteria, 73 patients (83.9%) were of grade 3, 8 grade 2, 4 grade 1, and 2 grade 0. The only pancreatic diseases which impaired the exocrine pancreati

关键词： chronic pancreatitis magnetic resonance cholangiopancreatography pancreatic neoplasms pancreatic insufficiency

Endoscopic management of a rare granulation polyp in a colonic diverticulum

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World Journal of Gastroenterology 2013年第48期19卷 9481-9484页

作者： Hirohito Mori Takaaki Tsushimi Hideki Kobara Noriko Nishiyama Shintaro Fujihara Tae Matsunaga Maki Ayagi Tatsuo Yachida Tsutomu Masaki departments of Gastroenterology and Neurology Kagawa University School of Medicine Kagawa 761-0793 Japan Department of gastroenterological surgery Ehime Rosai Hospital Ehime 792-8550 Japan

There are many case reports on colon diverticula that cause irritable bowel syndrome,constipation,bleeding,diverticulitis,stricture due to multiple recurrences of diverticulitis,and ***,few articles have examined neoplasms that arise from a diverticulum,such as adenoma and adenocarcinoma,and there have been no reports of granulation polyps that arise from a colon diverticulum after recurrent *** observed a rare granulation polyp that arose from a diverticulum as a result of repeated episodes of local *** band imaging magnified colonoscopy was very useful to diagnose the polyp as a granulation polyp because of the absence of a pit pattern on the surface of the *** successfully resected the polyp using endoscopic mucosal *** inverted the diverticulum,and the resected stalk of the polyp was used to close the diverticulum with an over-thescope *** a granulomatous polyp could arise from a diverticulum,differential diagnosis between a colon neoplasm and a granulomatous polyp would not only be difficult but also necessary for suitable endoscopic treatment.

关键词： Diverticulitis Endoscopy Granulation polyp Mucosal resection Neoplasm Recurrence

Validated preoperative computed tomography risk estimation for postoperative hepatocellular carcinoma recurrence

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World Journal of Gastroenterology 2017年第35期23卷 6467-6473页

作者： Wei Zhang Shao-Lv Lai Jie Chen Dong Xie Fei-Xiang Wu Guan-Qiao Jin Dan-Ke Su departments of radiology Affiliated Tumor Hospital of Guangxi Medical University Hepatobiliary surgery Affiliated Tumor Hospital of Guangxi Medical University

AIM To develop and validate a risk estimation of tumor recurrence following curative resection of operable hepatocellular carcinoma(HCC).METHODS Data for 128 patients with operable HCC(according to Barcelona Clinic Liver Cancer imaging criteria) who underwent preoperative computed tomography(CT) evaluation at our hospital from May 1, 2013 through May 30, 2014 were included in this study. Follow-up data were obtained from hospital medical records. Follow-up data through May 30, 2016 were used to retrospectively analyze preoperative multiphasic CT findings, surgical histopathology results, and serum α-fetoprotein and thymidine kinase-1 levels. The χ~2 test, independent t-test, and Mann-Whitney U test were used to analyze data. A P-value of < 0.05 was considered statistically *** During the follow-up period, 38 of 128 patients(29.7%) had a postoperative HCC recurrence. Microvascular invasion(MVI) was associated with HCC recurrence(χ~2 = 13.253, P < 0.001). Despite postoperative antiviral therapy and chemotherapy, 22 of 44 patients with MVI experienced recurrence after surgical resection. The presence of MVI was 57.9% sensitive, 75.6% specific and 70.3% accurate in predicting postoperative recurrence. Of 84 tumors without MVI, univariate analysis confirmed that tumor margins, tumor margin grade, and tumor capsule detection on multiphasic CT were associated with HCC recurrence(P < 0.05). Univariate analyses showed no difference between groups with respect to hepatic capsular invasion, Ki-67 proliferation marker value, Edmondson-Steiner grade, largest tumor diameter, necrosis, arterial phase enhanced ratio, portovenous phase enhanced ratio, peritumoral enhancement, or serum α-fetoprotein *** Non-smooth tumor margins, incomplete tumor capsules and missing tumor capsules correlated with postoperative HCC recurrence. HCC recurrence following curative resection may be predicted using CT.

关键词： Hepatocellular carcinoma Microvascular invasion Computed tomography Recurrence Tumor margin Tumor capsule