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Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

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World Journal of Gastroenterology 2022年第17期28卷 1860-1870页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Yoshinori Okubo Jun Nakamura Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takumi Yanagita Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversityFukushima 9601295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601295Japan

BACKGROUND Endoscopic biliary drainage using a self-expandable metallic stent(SEMS)has been widely performed to treat distal malignant biliary obstruction(DMBO).However,the optimal position of the stent remains *** To determine the ideal position for SEMS *** In total,135 DMBO patients underwent SEMS(uncovered or covered)placement over a ten-year period.A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were *** SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients(Hilar group)or near the top of the biliary obstruction in 44 patients(Lower group).Technical and functional success,adverse events,and risk factors for SEMS dysfunction were *** The stent patency period was significantly longer in the Hilar group than in the Lower group(P value<0.01).In multivariate analysis,the only statistically significant risk factor for SEMS dysfunction was being in the Lower group(hazard ratio:9.94,95%confidence interval:2.25–44.0,P<0.01).CONCLUSION A longer patency period was achieved by positioning the SEMS near the biliary hilar duct.

关键词： Endoscopic biliary drainage Malignant biliary obstruction Uncovered self-expandable metallic stent Covered self-expandable metallic stent Biliary hilar duct Patency period

Forearm compartment syndrome due to acquired hemophilia that required massive blood transfusions after fasciotomy:A case report

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World Journal of Clinical Cases 2021年第31期9卷 9592-9597页

作者： Takuya Kameda Takeru Yokota Soichi Ejiri Shin-ichi Konno Department of Orthopaedic Surgery Fukushima Medical UniversityFukushima 960-1295FukushimaJapan Department of Hand and Limb Reconstructive Surgery Fukushima Medical UniversityFukushima 960-1295FukushimaJapan

BACKGROUND Acquired hemophilia is *** some cases,the bleeding in muscle causes compartment ***,it is not clear whether fasciotomy should be performed for the compartment syndrome caused by acquired hemophilia because of the risk of bleeding and the unknown functional *** SUMMARY A 75-year-old woman was admitted with severe pain of the right forearm with no preceding traumatic *** right forearm was obviously swollen,and stretch pain was *** hematomas were suspected in various parts of the *** pressure was 110 mmHg on the volar *** partial thromboplastin time(aPTT)was prolonged to 54.9 *** was performed,and hematoma was observed in the volar *** laboratory examinations revealed a low level of factor Ⅷ(FⅧ)activity(12.5%)and a high level of FⅧ inhibitor(15.2 bethesda units/mL).Acquired hemophilia A was *** recombinant clotting factors were administered,transfusion of red blood cells reached 46 units(140 mL/unit).Hemostasis was achieved 9 d after *** total cost of the clotting factor concentrates administered reached 28834600 *** prednisolone,FⅧ activity and aPTT recovered *** function of the hand was good in the index finger and excellent in the *** Fasciotomy resulted in good function of the hand in a case of non-traumatic compartment syndrome caused by acquired hemophilia,but life-threatening bleeding occurred,and the cost of clotting factor treatment was *** of sufficient blood transfusion,preoperative administration of recombinant activated clotting factor Ⅶ,and prompt fasciotomy could be ideal for such cases.

关键词： Acquired hemophilia Compartment syndrome Fasciotomy Bleeding Cost Case report

Comparison between surgical outcomes of colorectal cancer in younger and elderly patients

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World Journal of Gastroenterology 2011年第12期17卷 1642-1648页

作者： Longxue Jin Norio Inoue Naoki Sato Susumu Matsumoto Hitoshi Kanno Yuko Hashimoto Kazuhiro Tasaki Kinya Sato Shun Sato Katsutoshi Kaneko Center for Digestive Diseases Northern Fukushima Medical Center Fukushima 960-0502 Japan Department of Pathology Fukushima Medical University Hospital Fukushima 960-1295 Japan Division of Anesthesiology Northern Fukushima Medical Center Fukushima 960-0502 Japan

AIM:To compare the outcome of surgical treatment of colorectal adenocarcinoma in elderly and younger ***:The outcomes of 122 patients with colorectal adenocarcinoma who underwent surgical treatment between January 2004 and June 2009 were *** clinicopathological and blood biochemistry data of the younger group(<75 years) and the elderly group (≥75 years) were ***:There were no significant differences between the two groups in operation time,intraoperative blood loss,hospital stay,time to resumption of oral intake,or *** elderly group had a significantly higher rate of hypertension and cardiovascular *** perioperative serum total protein and albumin levels were significantly lower in the elderly than in the younger *** serum carcinoembryonic antigen level was lower in the elderly than in the younger group,and there was a significant decreasing trend after the operation in the elderly ***:The short-term outcomes of surgical treatment in elderly patients with colorectal adenocarcinoma were *** treatment in elderly patients was considered a selectively effective approach.

关键词： Colorectal tumor Elderly patient Morbidity Carcinoembryonic antigen C-reactive protein

Dysbiosis of the duodenal microbiota as a diagnostic marker for pancreaticobiliary cancer

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2088-2100页

作者： Mitsuru Sugimoto Kazumichi Abe Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical University School of MedicineFukushima 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295Japan

BACKGROUND Pancreaticobiliary cancer(PB Ca)is a lethal disease,and a useful diagnostic marker is urgently needed.A correlation between the human microbiota and malignant gastrointestinal diseases was recently *** To investigate the efficacy of the duodenal microbiota for diagnosing PB *** We recruited 22 patients with benign pancreaticobiliary diseases(benign group)and 12 patients with PB Ca(malignant group).The duodenal microbiota of each patient was analyzed by the 16S rDNA terminal restriction fragment length polymorphism *** characteristics,tumor markers,and relative abundances of the duodenal microbiota were compared between the benign and malignant *** Cancer antigen 19-9(CA19-9),Bifidobacterium,Clostridium cluster XVIII,and Prevotella levels differed significantly between the benign and malignant *** cluster XVIII had the greatest area under the receiver operating characteristic curve(AUC)among the four factors with respect to diagnosing PB Ca(cutoff value:3.038%;sensitivity:58.3%;specificity:95.2%;AUC:0.81).The combination of Clostridium cluster XVIII(cutoff value:3.038%)and CA19-9 Levels(cutoff value:18.8 U/mL)showed 91.7%sensitivity and 71.4%specificity for diagnosing PB *** The duodenal microbiota may be useful for PB Ca screening.

关键词： Pancreaticobiliary cancer Diagnostic marker Duodenal microbiota Clostridium cluster XVIII Cancer antigen 19-9

A case of primary biliary cirrhosis complicated by Behcet's disease and palmoplantar pustulosis

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World Journal of Gastroenterology 2006年第13期12卷 2136-2138页

作者： Haruyo Iwadate Hiromasa Ohira Hironobu Saito Atsushi Takahashi Tsuyoshi Rai Junko Takiguchi Tomomi Sasajima Hiroko Kobayashi Hiroshi Watanabe Yukio Sato Department of Internal Medicine Ⅱ fukushima Medical university School of Medicine fukushima Japan

A 46-year-old woman was diagnosed with palmoplantar pustulosis （PPP） at the Department of Dermatology, fukushima Medical university Hospital in 2000, and was treated with ointment. However, because liver dysfunction developed in 2003, she was referred to our department, where primary biliary cirrhosis （PBC） was also diagnosed on the basis of clinical findings. One year later, at the age of 49, she developed manifestations of Behcet＇s disease （BD）, including erythema nodosum in the lower extremities. Because she had a history of uveitis, recurrent oral ulceration was present, and the HLA typing was positive for B51, BD was additionally diagnosed. Liver function normalized within three months of the start of treatment with ursodesoxycholic acid （UDCA）. This is the first case of PBC associated with BD and PPP.

关键词： Primary biliary cirrhosis Behcet's disease Palmoplantar pustulosis

Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: A case report

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World Journal of Gastroenterology 2008年第35期14卷 5474-5477页

作者： Atsushi Takahashi Yukiko Kanno Yuta Takahashi Natsumi Sakamoto Kyoko Monoe Hironobu Saito Kazumichi Abe Junko Yokokawa Atsushi Irisawa Hiromasa Ohira Department of Internal Medicine Ⅱ Fukushima Medical University School of MedicineFukushimaJapan

A 43-year-old woman with multiple sclerosis （MS） was treated with pulsed methylprednisolone and interferon 13 at a hospital. Four weeks after initiating treatment, liver dysfunction occurred and she was referred and admitted to our hospital. Clinical and laboratory findings were consistent with and fulfilled the criteria for drug-induced hepatitis, but not for autoimmune hepatitis （AIH）. She was successfully treated with corticosteroids. As ataxia developed after i year, she was treated with pulsed methylprednisolone for 3 days, then readmitted to our hospital when liver dysfunction occurred. Clinical and laboratory findings led to the diagnosis of AIH. To the best of our knowledge, this is the second case of AIH developed after pulsed methylprednisolone for MS.

关键词： Multiple sclerosis Autoimmune hepatitis Pulsed methylprednisolone

Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis

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World Journal of Gastroenterology 2018年第27期24卷 3006-3012页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Yuichi Waragai Mika Takasumi Minami Hashimoto Yuko Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of Medicine Department of Endoscopy Fukushima Medical University Hospital Department of Diagnostic Pathology Fukushima Medical University

AIM To evaluate the efficacy of endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) of pancreatic head cancer when pushing(push method) or pulling the echoendoscope(pull method).METHODS Overall, 566 pancreatic cancer patients had their first EUS-FNA between February 2001 and December 2017. Among them, 201 who underwent EUS-FNA for pancreatic head lesions were included in this study. EUS-FNA was performed by the push method in 85 patients, the pull method in 101 patients and both the push and pull methods in 15 patients. After propensity score matching(age, sex, tumor diameter, and FNA needle), 85 patients each were stratified into the push and pull groups. Patient characteristics and EUSFNA-related factors were compared between the two *** Patient characteristics were not significantly different between the two groups. The distance to lesion was significantly longer in the push group than in the pull group(13.9 ± 4.9 mm vs 7.0 ± 4.9 mm, P < 0.01). The push method was a significant factor influencing the distance to lesion(≥ median 10 mm)(P < 0.01). Additionally, tumor diameter ≥ 25 mm(OR = 1.91, 95%CI: 1.02-3.58, P = 0.043) and the push method(OR = 1.91, 95%CI: 1.03-3.55, P = 0.04) were significant factors contributing to the histological diagnosis of *** The pull method shortened the distance between the endoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.

关键词： Endoscopic ultrasound-guided fine needle aspiration Pancreatic head Pancreatic cancer Push method Pull method

Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman

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World Journal of Gastroenterology 2008年第1期14卷 129-131页

作者： Atsushi Takahashi Hironobu Saito Yukiko Kanno Kazumichi Abe Junko Yokokawa Atsushi Irisawa Akira Kenjo Takuro Saito Mitsukazu Gotoh Hiromasa Ohira Department of Internal Medicine Ⅱ Fukushima Medical University School of Medicine 1 Hikarigaoka Fukushima 960-1295 Japan Department of Surgery Ⅰ Fukushima Medical University School of Medicine 1 Hikarigaoka Fukushima 960-1295 Japan

A 36-year-old woman was admitted to our department for close examination of a liver tumor that was found during a medical checkup. Abdominal US, CT and MRI showed a tumor in segment 7 (S7) of the liver. Although imaging suggested hepatocellular carcinoma, laboratory tests showed no abnormality in liver function, hepatitis virus markers were negative, and tumor markers including protein induced by vitamin K absence or antagonist Ⅱ (PIVKA-Ⅱ), α-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were all within normal ranges. Upon aspiration biopsy of the liver, the histopathological diagnosis was moderately differentiated hepatocellular carcinoma. Therefore, right hepatectomy was performed. Although a part of the tumor was necrotic, about 60% of the viable part showed a clear-cell variant. Consequently, it was diagnosed as clear-cell hepatocellular carcinoma. It was noted that the background liver tissue was normal. This case is worthy of reporting because development of clear-cell hepatocellular carcinoma in the normal liver of a middle-aged woman is rarely seen.

关键词： Clear-cell hepatocellular carcinoma Liver Middle-aged

Predictive factors for the failure of endoscopic stent-instent self-expandable metallic stent placement to treat malignant hilar biliary obstruction

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World Journal of Gastroenterology 2017年第34期23卷 6273-6280页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Ko Watanabe Jun Nakamura Hitomi Kikuchi Yuichi Waragai Mika Takasumi Yuki Sato Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of Medicine Department of Endoscopy Fukushima Medical University Hospital

AIM To investigate the factors predictive of failure when placing a second biliary self-expandable metallic stents(SEMSs). METHODS This study evaluated 65 patients with an unresectable malignant hilar biliary obstruction who were examined in our hospital. Sixty-two of these patients were recruited to the study and divided into two groups: the success group, which consisted of patients in whom a stent-in-stent SEMS had been placed successfully, and the failure group, which consisted of patients in whom the stent-in-stent SEMS had not been placed successfully. We compared the characteristics of the patients, the stricture state of their biliary ducts, and the implemented endoscopic retrograde cholangiopancreatography(ERCP) procedures between the two *** The angle between the target biliary duct stricture and the first implanted SEMS was significantly larger in the failure group than in the success group. There were significantly fewer wire or dilation devices(ERCP catheter, dilator, or balloon catheter) passing the first SEMS cell in the failure group than in the success group. The cut-off value of the angle predicting stent-in-stent SEMS placement failure was 49.7 degrees according to the ROC curve(sensitivity 91.7%, specificity 61.2%). Furthermore, the angle was significantly smaller in patients with wire or dilation devices passing the first SEMS cell than in patients without wire or dilation devices passing the first SEMS cell. CONCLUSION A large angle was identified as a predictive factor for failure of stent-in-stent SEMS placement.

关键词： Endoscopic stent-in-stent self-expandable metallic stent placement Predictive factor Endoscopic retrograde cholangiopancreatography Malignant hilar biliary obstruction Self-expandable metallic stent