| 1. |
K Chijiiwa, K Nishiyama, M Takashima, K Mizumoto, H Noshiro, S Shimizu, K Yamaguchi, M Tanaka, Diffuse bile duct carcinoma treated by major hepatectomy and pancreatoduodenectomy with the aid of pre-operative portal vein embolization. Report of two cases, HEPATO-GASTROENTEROLOGY, Vol.46, No.27, pp.1634-1638, 1999.05, A successful resection rate for diffuse bile duct carcinoma is low. Major hepatectomy combined with pancreatoduodenectomy is a possible choice for curative resection, but the post-operative mortality rate after such an extensive surgery has been reported to be high. The main reason for post-operative death is liver failure. With the aid of pre-operative portal vein embolization, major hepatectomy (left lobectomy and extended right lobectomy with caudate lobectomy) and pylorus-preserving pancreatoduodenectomy was successfully applied to 2 patients with diffuse bile duct carcinoma as a one-stage surgery. We herein report these 2 cases discussing the usefulness of pre-operative portal vein embolization.. |
| 2. |
【よくわかる術後感染の予防と対策】 腹腔鏡下胆嚢摘出術におけるlevofloxacin経口薬投与
腹腔鏡下胆嚢摘出術(LSC)における予防的抗菌療法は,セフェム系抗生剤の静脈内投与が中心に行われている.LSCに際しセフメタゾールとレボフロキサシン経口投与による術後感染予防効果を比較した.レポフロキサシンはセフメタゾールと同等以上の感染防止効果を示し,LSCにおける有用で適切な予防的抗菌療法であることが示唆された. |
| 3. |
Shuji Shimizu, Ho-Seong Han, Koji Okamura, Koji Yamaguchi, Masao Tanaka, Live multi-station teleconferences at the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association via academic broadband Internet, JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY, 10.1007/s00534-007-1255-0, Vol.15, No.3, pp.344-345, 2008.05, Telecommunication is useful, but it is not widely accepted in medicine, partly because image quality is often inadequate for medical use and partly because an initial investment in special equipment is necessary. We conducted live multi-station teleconferences at the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association (APHPBA), using a new telemedicine system which transmits original-quality images in a simple and economical manner. The venue in Japan was linked to Hong Kong, Singapore, and Manila for an endoscopic surgery session, and to Seoul, Beijing, and Taipei for a pancreas transplant session. A digital video transport system (DVTS), which transforms digital video signals directly to Internet protocol, was set up at each station. The presentations were smooth and clear, and were followed by interactive discussion between the four stations for each session. Although our system requires a broadband Internet connection of at least 30 Mbps, a high-speed academic network has been established already in many countries in the Asia-Pacific region and is readily used for research and educational purposes. Application of this high-performance but user-friendly system can make teleconferences more useful and exciting. Telecommunication based on DVTS and a high-speed academic network should revolutionize the future of such conferences as the APHPBA, as well as those in other fields and locations.. |
| 4. |
Ho SH, Uedo N, Aso A, Shimizu S, Saito Y, Yao K, Goh KL, Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences, J Clin Gastroenterol, 52(4):295-306, 2018.04. |
| 5. |
Shimizu S, Kudo K, Tomimatsu S, Moriyama T, Moriyama T, Sadakari Y, Nakashima N, International Telemedicine Activities in Thailand, Siriraj Medical Journal, 70(5):471-475, 2018.04. |
| 6. |
Aso A, Ihara E, Nakamura K, Sudovykh I, Ito T, Nakamura M, Ikeda T, Takizawa N, Oka Y, Shimizu S, Solid pseudopapillary neoplasm of the pancreas in young male patients: three case reports, Case Rep Gastrointest Med, 10.1155/2017/9071678, 2017:1-4, 2017.04, Abstract
A preoperative diagnosis of solid pseudopapillary neoplasms (SPNs) in young male patients is difficult to achieve using radiological images. We herein present three cases of young male patients with relatively small SPNs. Endoscopic ultrasound (EUS) showed well-encapsulated, smooth-surfaced, heterogeneous solid lesions in all patients, and all preoperative diagnoses were achieved by EUS-guided fine needle aspiration (EUS-FNA). The final pathological diagnosis after surgery was an SPN with a Ki-67 labeling index of |
| 7. |
Shimizu S, Ohtsuka T, Takahata S, Nagai E, Nakashima N, Tanaka M, Remote transmission of live endoscopy over the Internet: Report from the 87th Congress of the Japan Gastroenterological Endoscopy Society, Dig. Endosc., 28(1):92-97, 2016.04. |
| 8. |
Shimizu S, Thomson S, Doyle G, Mandyoli S, Torata N, Ueki T, Kitamura Y, Minh CD, Antoku Y, Okamura K, Nakashima N, Tanaka M, Live surgery broadcast from Japan to South Africa: High-quality image transmission over a high-speed academic network, J. Int. Soc. Telemed. eHealth, 1(3):80-85, 2013.04. |
| 9. |
Minh CD, Shimizu S, Antoku Y, Torata N, Kudo K, Okamura K, Nakashima N, Tanaka M, Emerging Technologies for Telemedicine, Korean J Radiol, 13(suppl1):S21-S30, 2012.04, Abstract
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
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| 10. |
Shimizu S, Han HS, Okamura K, Bao C, Kitamura Y, Nakashima N, Tanaka M, Live Surgery and teleconferencing at the 19th World Congress of the International Association of Surgeons, Gastroenterologists, and Oncologists(IASGO), Hepato-Gastroenterology, 58(110-111):1-3, 2011.04. |
| 11. |
Shimizu S, Itaba S, Yada S, Takahata S, Nakashima N, Okamura K, Rerknimitr R, Akarabiputh T, Lu XH, Tanaka M, Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures, J. Hepatobiliary Pancreat Sci., 18:366-374, 2011.04. |
| 12. |
Otsuka T, Nagai E, Toma H, Ohuchida K, Takanami H, Odate S, Eguchi D, Ueki T, Shimizu S, Tanaka M, Single-incision laparoscopy-assisted surgery for bowel obstruction: Report of three cases.
, Surg Today. , 41(11):1519-1523, 2011.04, Abstract
We applied single-incision laparoscopy-assisted surgery for several different types of bowel obstruction in selected patients. Before the operation, a long nasal tube was inserted for intestinal decompression and assessment of a stenotic lesion. A specially-designed instrument for single-incision laparoscopic surgery, the SILS Port, was introduced at the umbilicus or proposed ileostomy site. After intracorporeal procedures, extracorporeal resection and reconstruction of the intestine was performed as needed. Three patients with bowel obstruction due to jejunal carcinoma, colonic stenosis, and adhesion underwent single-incision laparoscopy-assisted surgery. The port site was used for subsequent extracorporeal resection and anastomosis of the jejunum in two patients, and for ileostomy in the remaining patient. All of the procedures were completed safely, and there were no postoperative complications. Single-incision laparoscopy can therefore be applied for selected patients with bowel obstruction. In such cases, the preoperative insertion of a long nasal tube for decompression of intestinal contents and assessment of the stenotic lesion is necessary.
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| 13. |
Shimizu S, Han HS, Okamura K, Nakashima N, Kitamura Y, Tanaka M, Technologic developments in telemedicine: State-of-the-art academic interactions, Surgery, 147(5):597-601, 2010.04. |
| 14. |
Nakashima N, Shimizu S, Okamura K, Broadband Medical Network in Asia Pacific, Asian Hospital & Healthcare Management, 14:65-66, 2007.04. |
| 15. |
Shimizu S, Han HS, Okamura K, Yamaguchi K, Tanaka M, Live demonstration of surgery across international borders with uncompressed high definition quality, HPB, 9:398-399, 2007.04, To provide more efficient medical education and clinical training opportunities, we report our first successful experience of uncompressed high-definition (HD) transmission of live surgery from Korea to Japan. Laparoscopic distal pancreatectomy was performed in Korea and broadcast to Fukuoka, Japan, at the venue of the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association (APHPBA) via super-fast broadband Internet on an academic fiber-optic network. The streaming of uncompressed HD images of live surgery was successfully performed with an interactive discussion between the two stations. The network remained stable throughout the session at as large a bandwidth as 1.6 Gbps. With respect to HD image quality, 92% of respondents reported that it was 'very good'. Use of this extraordinary high-quality image transmission will usher in a new era by providing much more accurate remote diagnosis and much better tele-education, not only in the field of hepato-pancreato-biliary surgery but also in many other fields of medicine.
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| 16. |
Sawada F, Yoshimura R, Ito K, Nakamura Kazuhiko, Nawata H, Mizumoto K, Shimizu S, Inoue T, Yao T, Tsuneyoshi M, Kondo A, Harada N, Adult case of an omphalomesenteric cyst resected by laparoscopic-assisted surgery, World Journal of Gastroenterology, 12(5):825-827, 2006.04, This report describes an extremely rare adult case of an omphalomesenteric cyst resected by laparoscopic-assisted surgery. A 29-years-old Japanese man was referred and admitted to Kyushu University Hospital because of an abdominal mass and an elevated serum CEA (carcinoembryonic antigen) level (21.3 ng/mL) in August 2001. Abdominal CT and US demonstrated a cystic mass with septum and calcification. Laparoscopy showed a large mass to be attached to his abdominal wall, measuring 110 mm x 70 mm x 50 mm and filled with mucus. The mass was resected by laparoscopic-assisted surgery. The histological findings of its wall showed fibromuscular tissue, adipose tissue, calcification, and an intestinal structure. It was finally diagnosed to be an omphalomesenteric cyst.
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| 17. |
Koga Y, Uchiyama A, Noshiro H, Rai M, Miyatake E, Shimizu S, Tanaka M, Complete extirpation of a bronchogenic cyst causing recurrent laryngeal nerve palsy by thoracoscopy: Report of a case, Surg Today, 36(1):79-81, 2006.04, We excised a bronchogenic cyst causing recurrent laryngeal nerve palsy using thoracoscopic surgery. A 28-year-old woman presented after the sudden onset of hoarseness, and laryngoscopic examination showed left vocal cord palsy. Computed tomography and magnetic resonance imaging showed a cystic mass, 4 cm in diameter, in the aortopulmonary window. Thoracoscopic examination revealed that the mass was adhered to the recurrent laryngeal nerve below the aortic arch. We extirpated the cyst via thoracoscopy without any injury to the nerves or major blood vessels. This case illustrates the benefits of thoracoscopic surgery for providing good visualization of the perineural structures and as a safe surgical treatment for a cystic mass in the aortopulmonary window.
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| 18. |
Shimizu S, Tanaka M, Konomi H, Tamura T, Mizumoto K, Yamaguchi K, Spleen-preserving laparoscopic distal pancreatectomy after division of the splenic vessels
, J Laparoendosc Adv Surg Tech A., 14(3):173-177, 2004.04, A 37-year-old woman with a history of syncope was hospitalized with a diagnosis of hypoglycemia due to insulinoma. Computed tomography (CT) and magnetic resonance imaging revealed an enhanced solid mass, 1.5 cm in diameter, at the tail of the pancreas. Angiography via the splenic artery revealed a hypervascular mass. Because the tumor was located deep in the pancreatic parenchyma, laparoscopic distal pancreatectomy was performed. The pancreas was exposed by dissecting the greater omentum, and the tumor was located by intraoperative ultrasonography. After division of the splenic artery, the pancreas, main pancreatic duct, and splenic vein were transected with an endoscopic linear stapler. The pancreatic pedicle was divided at the splenic hilum to preserve the spleen. The postoperative course was uneventful except for the appearance of splenic infarction on a CT scan 2 weeks after surgery but without any overt symptoms. Spleen-preserving laparoscopic distal pancreatectomy by division of splenic vessels is a feasible treatment option for benign pancreatic disease.
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| 19. |
Nakashima N, Mizushima H, Kim YW, Hahm JS, Okamura K, Park YJ, Lee Y, Kang CH, Dong M, Kimura M, Shimizu S, Telemedicine beyond the bordes by broad band in Asia-Pacific Area, Vietnam-Japan Med Info 2004 , 1-4, 2004.04. |
| 20. |
Nakashima N, Mizushima H, Kim YW, Moon BI, Hahm JS, Tatsumi H, Han HS, Okamura K, Park YJ, Lee JW, Youm SK, Kang Ch, Dong M, Shimizu S, Telemedicine with high quality moving image by DVTS between China, Japan and Korea, Proceeding of the 6th China-Japan-Korea Medical Informatic conference, 85 -88, 2004.04. |
| 21. |
Kawamoto M, Shimizu S, Tanaka M, Nakashima N, Okamura K, Kim YW, Hahm JS, Telesurgery between Korea and Japan over broadband Internet, Kyushu University Asia Resarch Organization News Letter (KUARO) KNL03, 3:7, 2004.04. |
| 22. |
Shirahane K, Yamaguchi K, Ogawa T, Shimizu S, Yokohata K, Mizumoto K, Tanaka M, Gallbladder duplication successfully removed laparoscopically using endoscopic nasobiliary tube, Surgical Endoscopy, 17(7):1156-1157, 2003.04, Laparoscopic cholecystectomy is sometimes difficult due to complicated biliary anatomy including gallbladder duplication, a rare anomaly of the biliary tract. We report a case of duplicated gallbladder successfully removed under laparoscopy using endoscopic nasobiliary (ENB) tube cholangiography. A 61-year-old Japanese woman presented us with right upper abdominal pain. Ultrasonography revealed two cystic structures lying in the gallbladder fossa, and the upper one contained multiple stones. Endoscopic retrograde cholangiography showed two gallbladders, each of which has a cystic duct draining into the common bile duct separately. Laparoscopic cholecystectomy was planned under the preoperative diagnosis of double gallbladder with gallstones in the accessory gallbladder. The ENB tube was inserted just before the operation. Laparoscopic removal of the double gallbladder was successfully done using the ENB tube to identify the biliary tree anatomy and to close the stump of the cystic duct. In this communication, we would like to stress the usefulness of the ENB tube at the time of laparoscopic biliary surgery in patients with biliary anomalies including gallbladder duplication.
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| 23. |
Masatsugu T, Shimizu S, Noshiro H, Mizumoto K, Yamaguchi K, Chijiiwa K, Tanaka M, Liver cyst with biliary communication successfully treated with laparoscopic deroofing: a case report, JSLS., 7(3):249-252, 2003.04, A 71-year-old Japanese woman complained of right upper abdominal fullness and pain. Computed tomography revealed a huge cyst in the right lobe of the liver, measuring 16 cm in diameter. She underwent laparoscopic deroofing of the liver cyst. On operation, needle aspiration of the cyst yielded clear serous fluid without any bile contamination. However, after the cyst was deroofed with laparoscopic coagulating shears, bile leakage was recognized from a tiny orifice in the cyst cavity. A catheter was inserted via the orifice for cholangiography, which demonstrated a communication with the biliary tract. The orifice was easily closed with a laparoscopic suturing device. Operation time was 5 hours and 30 minutes, and blood loss was 300 grams. Pathological examination of the liver cyst was consistent with a simple cyst. The postoperative course was uneventful, and the patient has had no recurrence to date at 13 months. Laparoscopic deroofing is a recommended treatment for a liver cyst even in the presence of cystobiliary communication.
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| 24. |
Shimizu S, Yokohata K, Mizumoto K, Yamaguchi K, Chijiiwa K, Tanaka M, Laparoscopic choledochotomy for bile duct stones, J. Hepatobiliary Pancreat. Surg., 9(2):201-205, 2002.04, In the era of laparoscopic surgery, treatment strategies for common bile duct stones remain controversial. Laparoscopic choledochotomy is usually indicated only when transcystic duct exploration is not feasible. However, laparoscopic choledochotomy provides complete access to the ductal system and has a higher clearance rate than the transcystic approach. In addition, primary closure of the choledochotomy with a running suture and absorbable clips facilitates the procedure. Therefore, to avoid postoperative biliary stenosis, all patients with bile duct stones can be indicated for choledochotomy, except for those with nondilated common bile duct. Placement of a C-tube also provides access for the clearance of possible retained stones by endoscopic sphincterotomy as a backup procedure. C-tube placement, in contrast to T-tube insertion, is advantageous in terms of a relatively short hospital stay. In conclusion, laparoscopic choledochotomy with C-tube drainage is recommended as the treatment of choice for patients with common bile duct stones.. |
| 25. |
Uchiyama A, Shimizu S, Tanaka M, Injury to the phrenic and recurrent nerves needs to be avoided in the performance of thymectomy for myasthenia gravis: Reply (letter), Ann Thorac Surg, 74:634, 2002.04. |
| 26. |
Uchiyama A, Shimizu S, Tanaka M, Reply to the editor, Ann Thorac Surg, 2002(74):632-635, 2002.04. |
| 27. |
Yamanaka N, Shimizu S, Chijiiwa K, Nishiyama K, Noshiro H, Yamaguchi K, Tanaka M, Hepatectomy and marked retention of indocyanine green and bromosulfophtalein, Hepatogastroenterology, 48(41):1450-1452, 2001.04, A 61-year-old man was admitted to our hospital with right lateral abdominal pain. The patient had chronic hepatitis type B and type C and was diagnosed as hepatocellular carcinoma in the anterior-superior segment of the liver by ultrasonography and abdominal computed tomography. Although laboratory examinations were within normal limits, the indocyanine green retention rate at 15 min was as high as 72.0% and the bromosulfophtalein retention rate at 45 min 17.3%. We additionally performed technetium-99m-galactosyl human serum albumin liver scintigraphy and liver biopsy, both of which indicated only mild chronic liver damage, indicating that the liver function is adequate for surgery. After partial hepatectomy, a pathological examination revealed well to moderately differentiated hepatocellular carcinoma with only mild chronic inflammation in adjacent liver tissue. The indocyanine green retention rate at 15 min is the best discriminating preoperative test for evaluating hepatic functional reserve, but when marked retention of both indocyanine green and bromosulfophtalein show the discrepancy with normal routine liver function tests, technetium-99m-galactosyl human serum albumin liver scintigraphy and liver biopsy are helpful diagnostic methods for assessing the preoperative hepatic function.. |
| 28. |
Okido M, Shimizu S, Kuroki S, Goto K, Yokohata K, Uchiyama A, Mizumoto K, Tanaka M, Video-assisted parathyroidectomy by a skin-lifting method for primary hyperparathyroidism, JSLS, 5(2):197-200, 2001.04, OBJECTIVE: The use of endoscopic surgical procedures has rapidly spread to abdominal and thoracic surgeries and subsequently to surgeries of the neck region. Several surgeons initiated endoscopic parathyroidectomy using CO2 insufflation to create the working space; however, they reported various complications. We describe here a skin-lifting method that may have few complications. METHODS: A 65-year-old man was diagnosed with primary hyperparathyroidism due to a solitary adenoma of the left inferior parathyroid gland. A 3-cm oblique incision was made below the left clavicle, and a 5-mm incision was made on the lateral neck. After the skin was lifted up, we performed video-assisted parathyroidectomy. RESULTS: Parathyroid extirpation took 2 hours and blood loss was minimal. The patient had minimal pain and no complications postoperatively. Serum concentrations of calcium and intact parathyroid hormone were normalized on the next day. CONCLUSION: Using the skin-lifting method, we obtained a sufficient operative view and encountered no complications. This procedure is cosmetically desirable, and we consider it a feasible alternative for the treatment of parathyroid adenoma. ". |
| 29. |
Shimizu S, Morisaki T, Noshiro H, Mizumoto K, Yamaguchi K, Chijiiwa K, Tanaka M, Laparoscopic cystogastrostomy for pancreatic pseudocyst: a case report., JSLS, 4(4):309-312, 2000.04, A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 x 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst.. |
| 30. |
Yamaguchi K, Shimizu S, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M, Ductal branch-oriented minimal pancreatectomy:Two cases of successful treatment., J. Hepatobiliary Pancreat. Surg., 6(1):69-73, 1999.04, Two patients with intraductal papillary-mucinous adenoma of the pancreas were successfully treated by ductal branch-oriented minimal pancreatectomy. We propose this novel less invasive ductal branch-oriented pancreatectomy, as indicated for benign ductal ectasia of the pancreas. The cystically dilated branch duct is identified by intraoperative ultrasonography, intraoperative balloon pancreatography, and injection of indigocarmine into the cyst. The cystically dilated branch is resected from the surrounding pancreas together with minimal removal of the pancreatic parenchyma. The communicating duct and cutting margins are tightly ligated to prevent pancreatic juice leakage and fistula. A drainage tube is placed in the main pancreatic duct whenever possible. Histopathologic examination of the transected branch duct is necessary to check for mucosal extension of dysplastic epithelium. This ductal branch-oriented minimal pancreatectomy is the least invasive pancreatectomy and a suitable operation for branch-type ductal ectasia of the pancreas, which is usually benign.". |
| 31. |
Kuba H, Yamaguchi K, Shimizu S, Yokohata K, Sugitani A, Chijiiwa K, Tanaka M, Chronic asymptomatic pseudocyst with sludge aggregates masquerading as mucinous cystic neoplasm of the pancreas., J. Gastroenterol., 33(5):766-769, 1998.04, Pseudocyst of the pancreas is sometimes difficult to distinguish from mucinous cystic neoplasm of the pancreas. A 37-year-old asymptomatic Japanese man was diagnosed with hypertension. He had a 20-years history of habitual drinking of alcohol, but no history of pancreatitis or abdominal trauma. During examinations to ascertain the cause of hypertension, ultrasonography and computed tomography incidentally demonstrated a huge cyst in the head of the pancreas. Laboratory data were within normal limits, including serum levels of amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9. Imaging studies showed a huge unilocular cyst, measuring 7 cm, in the head-to-body of the pancreas, and two small unilocular cysts, measuring 1.4 and 1.5 cm, in the tail and head of the pancreas, respectively. A mural nodule was suspected in the largest cyst. Endoscopic retrograde cholangiopancreatography demonstrated communication of the main pancreatic duct with the two small cysts in the head and tail of the pancreas but not with the huge cyst. There were no ductal changes suggesting chronic pancreatitis. Laparotomy was performed under the tentative diagnosis of potentially malignant mucinous cystic neoplasms of the pancreas. However, inflammatory adhesion was dense around the pancreas and the mural nodule suspected preoperatively was found to be sludge aggregates in a pseudocyst. The diagnosis of an intraoperative frozen section of the cyst wall was pseudocyst of the pancreas. Cystojejunostomy was performed. We report this case because the preoperative diagnosis was mucinous cystic neoplasm of the pancreas, but the diagnosis changed with careful intraoperative examinations, to pseudocyst of the pancreas. We discuss the differential diagnosis of the two conditions.". |
| 32. |
Kuba K, Yamaguchi K, Nishiyama K, Noshiro H, Shimizu S, Tanaka M, Gallbladder carcinoma in an asymptomatic biliary typhoid carrier: report of a case., Am J Gastroenterol., 93(4):656-657, 1998.04. |
| 33. |
Shimura H, Tanaka M, Shimizu S, Mizumoto K, Laparoscopic treatment of congenital choledochal cyst , Surg. Endosc., 12(10):1268-1271, 1998.04, We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally, end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure. Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division and anastomosis of the digestive tract.". |
| 34. |
Niiyama H, Yamaguchi K, Shimizu S, Yokohata K, Chijiiwa K, Yonemasu H, Tanaka M, Pancreatic carcinoma in remnant pancreas after pancreatectomy for mucinous cystadenoma, Eur. J. Gastroenterol. Hepatol., 10(8):703-707, 1998.04, There are very few benign or malignant diseases which arise in the remnant pancreas after pancreatectomy. Pancreatic carcinoma in the remnant pancreas after pylorus preserving pancreatoduodenectomy (PpPD) for mucinous cystadenoma in a 66-year-old Japanese man is reported in this paper. The patient underwent PpPD for a mucinous cystadenoma in the pancreatic head 39 months prior to the present operation. The surgical margins of the PpPD specimen were free from atypical cells. Follow-up ultrasonography revealed a hypoechoic lesion in the body of the remnant pancreas. Magnetic resonance cholangiopancreatography (MRCP) revealed a stenosis of the main pancreatic duct, with upstream dilatation in the remnant pancreas. Segmental resection of the remnant pancreas, splenectomy, pancreaticojejunostomy and intraoperative radiotherapy were performed under the diagnosis of pancreatic carcinoma of the remnant pancreas. Final histopathological diagnosis was adenocarcinoma of the pancreas. There were no malignant cystic components. The present pancreatic carcinoma was regarded as independent of the previous mucinous cystadenoma. Postoperative radiation therapy and chemotherapy were added. He is doing well 20 months after the second operation although diabetes mellitus has slightly deteriorated. In this communication, we would like to recommend that clinicians should constantly be on guard against the development of pancreatic carcinoma even in the remnant pancreas after pancreatectomy for mucinous cystadenoma.". |
| 35. |
Inoue S, Yamaguchi K, Shimizu S, Yokohata K, Chijiiwa K, Takashima M, Tanaka M, Serous cystadenoma of the pancreas with atypical imaging features : a new variant of serous cystadenoma of the pancreas?, Pancreas, 16(1):102-106, 1998.04. |
| 36. |
Akamine M, Araki Y, Chijiiwa Y, Shimizu S, Shimura H, Nawata H, A case of Meckel's diverticulum complicated by stenosis of the colon, Am. J. Gastroenterol., 92(11):2114-2116, 1997.04, Meckel's diverticulum is a common anomaly of the GI tract that is known to cause small intestinal obstruction. A 17-yr-old male who had no history of previous surgery was admitted with intermittent abdominal pain. A barium enema showed extraintestinal compression of the ascending colon, suggesting the existence of a congenital band. Laparoscopy revealed that the ascending colon was lifted up and compressed by the intestinal end of a Meckel's diverticulum with a fibrous band connecting to the umbilicus. The portion of the ileum including the Meckel's diverticulum was resected. This is the first case of stenosis of the colon caused by a Meckel's diverticulum. [References: 10] ". |
| 37. |
Yamaguchi K, Nakamura K, Yokohata K, Shimizu S, Chijiiwa K, Tanaka M, Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas. Report of two cases., Int J Pancreatol, 22(3):227-231, 1997.04, CONCLUSION:
We would like to recommend detailed examination of the pancreas including cytology of the pancreatic juice in patients with pancreatic cyst to find possible concomitant early pancreatic carcinoma. Further study is necessary to determine whether there is a rational relationship between mucinous cystadenoma of the pancreas and pancreatic adenocarcinoma.
BACKGROUND:
Two cases of in situ carcinoma of the pancreas first detected with pancreatic cyst as a diagnostic clue are reported. Cytologic examination of the pancreatic juice was positive for malignancy in both cases, and pancreatic cyst and in situ carcinoma were located independently.
METHODS AND RESULTS:
Case 1: Ultrasonography (US) and computed tomography (CT) in a 54-yr-old Japanese man with a known gastric cancer revealed a pancreatic cyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cyst in the tail of the pancreas, and cytology of the pure pancreatic juice revealed adenocarcinoma. Intraoperatively, the pancreas was cut along the portal vein, and cytology of the pancreatic juice from the pancreas distal to the cutting line showed adenocarcinoma. Resection of the body and tail of the pancreas was performed together with total gastrectomy. Histopathologically, the cyst was mucinous cystadenoma, and the surrounding pancreatic ducts and ductules showed epithelial dysplasia of moderate-to-severe degree having foci of unequivocal in situ carcinoma. No stromal invasion was seen. Case 2: A 55-yr-old Japanese man with known hepatocellular carcinoma was diagnosed as having pancreatic cyst in the tail of the pancreas on US and CT. ERCP showed a pancreatic cyst, and cytology of the pancreatic juice highly suggested adenocarcinoma. Distal pancreatectomy and splenectomy were performed. Histopathologic diagnosis of pancreatic cyst was mucinous cystadenoma. The pancreatic ductule 2 cm proximal to the pancreatic cyst showed carcinoma in situ. The diagnostic clue of in situ carcinoma of the pancreas in these two cases was a cystic lesion of the pancreas detected by check-up US and CT of known carcinoma of the stomach and liver. Cytology of the pancreatic juice was also positive for malignancy. In situ carcinoma of the pancreas was found to be independent of the cysts because of the different locations and divergent histopathologic natures of the two lesions.
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| 38. |
Nakamura M, Takayama T, Takayasu K, Shimada K, Yamamoto J, Kosuge T, Sakamoto M, Yamasaki S, Shimizu S, Makuuchi M, Retroperitoneal Schwannoma mimicking hepatic tumor in the caudate lobe., Jpn. J Clin. Oncol. , 27(4):282-284, 1997.04, We report a 41-year-old woman with a retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe. Dynamic computed tomography in the early phase showed an enhanced tumor (2.7 cm in diameter) in the Spiegel lobe of the liver, which compressed the inferior vena cava (IVC). We also performed left hepatic angiographic computed tomography, and found that the tumor was less enhanced. The patient underwent laparotomy under a preoperative diagnosis of primary hepatic caudate tumor with faint neovascularity. At surgery, the tumor was found to be located between the left caudate lobe and the IVC, and was resected as being of a retroperitoneal origin. This case illustrates that tumor location must be determined with great care when the mass seems to exist at the dorsal edge of the liver, and especially when the tumor is hypovascular. ". |
