| 1. |
Fujimoto T, Mori Y, Nakashima Y, Ohtsuka T, Nakamura S, Gotoh Y, Date K, Sadakari Y, Nakata K, Miyasaka Y, Osoegawa T, Aso A, Ihara E, Nakamura K, Ogawa Y, Shimizu S, Nakamura M, Endoscopic retrograde cholangiopancreatography in patient with surgically altered gastrointestinal anatomy: a retrospective study, Int Surg, https://doi.org/10.9738/INTSURG-D-17-00137.1, 103, 3, 184-190, 2018.03. |
| 2. |
Shindo K, Castillo J, Ohuchida K, Moriyama T, Nagai S, Moriyama T, Ohtsuka T, Nagai E, Shimizu S, Nakamura M, Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis, Surgery Today, https://doi.org/10.9738/INTSURG-D-18-00011.1, 103, 11, 585-592, 2020.11. |
| 3. |
Oki A, Shimizu S, Adiatman M, Cahyati M, Knowledge Dissemination for Indonesian Dental Communities Through Telemedicine - A Report, International Journal of Innovation, Creativity and Change , 15, 2, 2021.01. |
| 4. |
Shimizu S, Tomimatsu S, Kudo K, Ueda S, Kekalih A, Makmun D, Estiasari R, Oki A, Moriyama T, Remote Medical Education in Indonesia: Analysis of 10 Years of Activities, Journal of the International Society for Telemedicine and eHealth, 8, e6, 1-6, 2020.12. |
| 5. |
Tomimatsu S, Kudo K, Moriyama T, Ueda S, Hirai Y, Shimizu S:, Technical Support for Rapid Replacement of Face to face Events with Online Events due to the COVID 19 Pandemic: a Case Study from Kyushu University Hospital, Conference Proceedings of the 11th Biennial Conference of the Asia-Pacific Association for Medical Informatics, 66-70, 2020.11. |
| 6. |
Ueda S, Kudo K, Moriyama T, Tomimatsu S, Shimizu S, Barriers against and Improvement Measures of Discussion during Bilateral Video-conferencing in an Early Gastric Cancer Case Study, Conference Proceedings of the 11th Biennial Conference of the Asia-Pacific Association for Medical Informatics, 77-81, 2020.11. |
| 7. |
Kudo K, Ueda S, Shitoh H, Narikiyo T, Tomimatsu S, Watanabe S, Nakahara T, Nakashima N, Moriyama T, Nakano T, Shimizu S, Participants’ Evaluation of a Virtual Academic Conference: Report from the 24th Japan Association of Medical Informatics Spring Symposium., Conference Proceedings of the 11th Biennial Conference of the Asia-Pacific Association for Medical Informatics , 71-76, 2020.11. |
| 8. |
Manabe T, Takasaki M, Ide T, Kitahara K, Sato S, Yunotani S, Hirohashi Y, Iyama A, Taniguchi M, Ogata T, Shimizu S, Noshiro H, Regional Education on Endoscopic Surgery Using a Teleconference System with High-quality Video via the Internet: Saga Surgical Videoconferences, BMC Medical Education, 20, e329, 2020.09. |
| 9. |
Kudo K, Moriyama T, Tomimatsu S, Ueda S, Shimizu S, A Train-the-Trainers(TtT) Program for Engineers for Hosting Multiparty International Clinical Teleconferences, Journal of the International Society for Telemedicine, 10.29086/JISfTeH.7.e16, 7, e16, 1-8, 2019.04. |
| 10. |
Moriyama T, Kudo K, Ueda S, Tomimatsu S, Shimizu S, Remote Education of Early Gastric Cancer in Central Asia and Russia, News of the Academy of Sciences of the Republic of Tajikistan, 257, 105-111, 2019.04. |
| 11. |
Moriyama T, Han HS, Kudo K, Sadakari Y, Moriyama T, Nakashima N, Nakamura M, Shimizu S, Role of international tele-education with live surgery for pre-clinical medical students, Proceedings of the APAN – Research Workshop 2019, 48-53, 2019.04. |
| 12. |
Ueda S, Kudo K, Moriyama T, Suyama Y, Shimizu S, A Step Forward in Sharing Images during Telemedicine Conferences, 日本遠隔医療学会雑誌, 14, 2, 151-154, 2018.04. |
| 13. |
Ohtsuka T, Mori Y, Fujimoto T, Miyasaka Y, Nakata K, Ohuchida K, Nagai E, Oda Y, Shimizu S, Nakamura M, Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection, Am Surg, 84, 1, 149-153, 2018.04, Abstract
The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with (n = 10) and without (n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer (P |
| 14. |
Tomimatsu S, Kudo K, Moriyama T, Moriyama T, Taguchi N, Shimizu S, How to Prevent Technical Issues in Large Multiparty Medical Videoconferencing, J Int Soc Telemed eHealth, 6, e10, 2018.04. |
| 15. |
Aly MYF, Mori Y, Miyasaka Y, Ohtsuka T, Sadakari Y, Nakata K, Oda Y, Shimizu S, Nakamura M, Laparoscopic surgery for congenital biliary dilatation: a single-institution experience, Surg Today, 10.1007/s00595-017-1545-3, 48, 1, 44-50, 2018.04, Abstract
PURPOSE:
Laparoscopic surgery as a treatment for congenital biliary dilatation is uncommon. We herein present a series of laparoscopic surgeries for congenital biliary dilatation performed in our institution and review our experience with this approach over a long period of time.
METHODS:
Medical records of 36 consecutive patients who underwent laparoscopic surgery for congenital biliary dilatation from 1996 to 2015 were retrospectively reviewed. Data on patient demographics, operative time, blood loss, hospital stay, and complications were evaluated. A comparison between the former period (Group A, 1996-2005) and the latter period (Group B, 2006-2015) was performed.
RESULTS:
The patients comprised 23 females and 13 males with a median age of 34 years. The median operative time, blood loss, and hospital stay was 493 min, 154 g, and 11 days, respectively. Total early and late complications occurred in 7 (19%) and 2 (5%) patients, respectively. A comparison between Groups A and B revealed no significant difference in operative time or complications, but operative blood loss, open conversion, and hospital stay were significantly lower in Group B than in Group A (P
CONCLUSION:
Laparoscopic surgery for congenital biliary dilatation is feasible and provides acceptable results. Further prospective studies of larger numbers of patients are needed.. |
| 16. |
Ohtsuka T, Gotoh Y, Nakashima Y, Okayama Y, Nakamura S, Morita M, Aly MYF, Velasquez VVDM, Mori Y, Sadakari Y, Nakata K, Miyasaka Y, Ishigami K, Fujimori N, Mochidome N, Oda Y, Shimizu S, Nakamura M, Role of SpyGlass-DStm in the preoperative assessment of pancreatic intraductal papillary mucinous neoplasm involving the main pancreatic duct, Pancreatology, 10.1016/j.pan.2018.04.012, 18, 5, 566-571, 2018.04, Abstract
BACKGROUND/OBJECTIVES:
It is often difficult to determine an adequate resection line during pancreatectomy for intraductal papillary mucinous neoplasm involving the main pancreatic duct during partial pancreatectomy. The aim of this study was to evaluate the usefulness of improved peroral pancreatoscopy using SpyGlass-DStm in the preoperative assessment of intraductal papillary mucinous neoplasm involving the main pancreatic duct.
METHODS:
We collected and retrospectively analyzed clinicopathological data from seven consecutive patients who underwent preoperative assessment of intraductal papillary mucinous neoplasm involving the main duct using SpyGlass-DStm.
RESULTS:
Good imaging quality of the intraductal protruding lesion was obtained in all seven patients, and only one adverse event was noted wherein a patient had mild pancreatitis. Six patients underwent pancreatectomy. In one patient, masked-type concomitant pancreatic ductal adenocarcinoma and low-length dysplastic lesion was found near the surgical margin, which was not detected by preoperative imaging modalities including SpyGlass-DStm. The sensitivity of targeting biopsy during SpyGlass-DStm to diagnose high-grade dysplasia was 0%.
CONCLUSIONS:
SpyGlass-DStm can be safely performed in patients with intraductal papillary mucinous neoplasm involving the main duct, and has excellent visualization of the target lesion. However, challenges include poor diagnostic ability of targeting biopsy, and, therefore, intraoperative frozen section is still needed to obtain negative surgical margins. |
| 17. |
Ohtsuka T, Mori Y, Ishigami K, Fujimoto T, Miyasaka Y, Nakata K, Ohuchida K, Nagai E, Oda Y, Shimizu S, Nakamura M, Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy, Am J Surg, 214, 2, 267-272, 2017.04, Abstract
BACKGROUND:
Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy.
METHODS:
The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas.
RESULTS:
Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups.
CONCLUSIONS:
Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.. |
| 18. |
Ohuchida K, Nagai E, Moriyama T, Shindo K, Manabe T, Ohtsuka T, Shimizu S, Nakamura M, Feasibility and safety of modified inverted T-shaped method using linear stapler with movable cartridge fork for esophagojejunostomy following laparoscopic total gastrectomy, Transl Gastroenterol Hepatol., 23, 2, 50, 2017.04, Abstract
BACKGROUND:
We previously reported the use of an inverted T-shaped method to obtain a suitable view for hand sewing to close the common entry hole when the linear stapler was fired for esophagojejunostomy after laparoscopic total gastrectomy (LTG). This conventional method involved insertion of the fixed cartridge fork to the Roux limb and the fine movable anvil fork to the esophagus to avoid perforation of the jejunum. However, insertion of the movable anvil fork to the esophagus during this procedure often requires us to strongly push down the main body of the stapler with the fixed cartridge fork to bring the direction of the anvil fork in line with the direction of the long axis of the esophagus while controlling the opening of the movable anvil fork. We therefore modified this complicated inverted T-shaped method using a linear stapler with a movable cartridge fork. This modified method involved insertion of the movable cartridge fork into the Roux limb followed by natural, easy insertion of the fixed anvil fork into the esophagus without controlling the opening of the movable cartridge fork.
METHODS:
We performed LTG in a total of 155 consecutive patients with gastric cancer from November 2007 to December 2015 in Kyushu University Hospital. After LTG, we performed the conventional inverted T-shaped method using a linear stapler with a fixed cartridge fork in 61 patients from November 2007 to July 2011 (fixed cartridge group). From August 2011, we used a linear stapler with a movable cartridge fork and performed the modified inverted T-shaped method in 94 patients (movable cartridge group). We herein compare the short-term outcomes in 94 cases of LTG using the modified method (movable cartridge fork) with those in 61 cases using the conventional method (fixed cartridge fork).
RESULTS:
We found no significant differences in the perioperative or postoperative events between the movable and fixed cartridge groups. One case of anastomotic leakage occurred in the fixed cartridge group, but no anastomotic leakage occurred in the movable cartridge group.
CONCLUSIONS:
Although there were no remarkable differences in the short-term outcomes between the movable and fixed cartridge groups, we believe that the modified inverted T-shaped method is technically more feasible and reliable than the conventional method and will contribute to the improved safety of LTG.. |
| 19. |
Kudo K, Tomimatsu S, Houkabe Y, Moriyama T, Nakashima N, Shimizu S, Five year teechnological changes of distant medical education in Asia, J. Int. Soc. Telemed. eHealth, 5, e10, 1-7, 2017.04. |
| 20. |
Kudo K, Tomimatsu S, Moriyama T, Tanimoto A.M, Villalon S, Shimizu S, Remote medical education in Latin America, TICAL 2017, 267-276, 2017.04. |
| 21. |
Ho SH, Rerknimitr R, Kudo K, Tomimatsu S, Ahmad MZ, Aso A, Seo DW, Goh KL, Shimizu S, Telemedicine for gastrointestinal endoscopy: The Endoscopic Club E-conference in the Asia Pacific Region, Endosc Int Open., 10.1055/s-0043-102935, 5, 4, E244-E252, 2017.04, Abstract
Background and study aims An Endoscopic Club E-conference (ECE) was set up in May 2014 to cater to increased demand for gastrointestinal endoscopy-related teleconferences in the Asia-Pacific region which were traditionally organized by the medical working group (MWG) of Asia-Pacific Advanced Network. This study describes how the ECE meeting was run, examines the group dynamics, outlines feedback and analyzes factors affecting the enthusiasm of participants. It is hoped that the findings here can serve as guidance for future development of other teleconference groups. Methods The preparation, running of and feedback on the ECE teleconference were evaluated and described. The country's economic situation, time zone differences, connectivity with a research and education network (REN) and engineering cooperation of each member were recorded and analyzed with regard to their association with participant enthusiasm, which was taken as participation in at least 50 % of the meetings since joining. Associations were calculated using 2-way table with chi-square test to generate odds ratio and P value. Results To date, ECE members have increased from 7 to 29 (increment of 314 %). Feedback received indicated a high level of satisfaction with program content, audiovisual transmission and ease of technical preparation. Upper gastrointestinal luminal endoscopy-related topics were the most favored program content. Those topics were presented mainly via case studies with a focus on management challenges. Time zone differences of more than 6 hours and poor engineering cooperation were independently associated with inactive participation (P values of 0.04 and 0.001 respectively). Conclusions Good program content and high-quality audiovisual transmission are keys to the success of an endoscopic medical teleconference. In our analysis, poor engineering cooperation and discordant time zones contributed to inactive participation while connectivity with REN and a country's economic situation were not significantly associated with participant enthusiasm.. |
| 22. |
Kohei Nakata, Eishi Nagai, Kenoki Ohuchida, Shuji Shimizu, Masao Tanaka, Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-014-3870-6, 29, 7, 1817-1822, 2015.07, Since its widespread acceptance for the treatment of early gastric cancer, laparoscopic gastrectomy has been gaining popularity as a treatment option for advanced gastric cancer. However, laparoscopic total gastrectomy (LTG) with splenectomy is seldom performed, because of its difficulty of removal of station 10 lymph nodes; splenectomy is technically essential for complete removal of these lymph nodes. The purpose of this study was to describe the details of the LTG procedure and to evaluate the short- and long-term outcomes of LTG with splenectomy.
Of 725 consecutive patients with gastric cancer who underwent laparoscopic gastrectomy with lymph node dissection in our institution from January 1996 to December 2012, 18 consecutive patients who underwent LTG with splenectomy were enrolled in this study.
No operative mortality occurred, and the pathological margins were free from cancer cells in all patients. The mean operation time was 388 min (range 324-566 min). The mean volume of blood loss was 45 ml (range 5-347 ml), and the mean number of dissected lymph nodes was 51 (range 40-105). Postoperative morbidity occurred in six patients (33.3 %) (each with grade B postoperative pancreatic fistula, postoperative bleeding, chylous ascites, atelectasis, ileus, and intra-abdominal infection). Five patients (27.8 %) developed recurrence (four in the peritoneum and one in the liver), and the overall 3- and 5-year survival rates were 83.0 and 72.6 %, respectively.
Considering the 0 % mortality rate and low rates of postoperative morbidity and locoregional recurrence, LTG with splenectomy is technically and oncologically acceptable. This procedure can be expanded to include advanced gastric cancer, which generally requires splenectomy for lymph node dissection.. |
| 23. |
Nohara Y, Kai E, Islam R, Ahmed A, Kuroda M, Inoue S, Hiramatsu T, Kimura M, Shimizu S, Kobayashi K, Baba Y, Kashima H, Tsuda K, Sugiyama M, Blondel M, Ueda N, Kitsuregawa M, Nakashima N, Health checkup and teleｍedical intervention program for preventive medicine in developing countries : A verification study, J. Med. Internet. Res, 17, 1, e2, 2015.04, Abstract
BACKGROUND:
The prevalence of non-communicable diseases is increasing throughout the world, including developing countries.
OBJECTIVE:
The intent was to conduct a study of a preventive medical service in a developing country, combining eHealth checkups and teleconsultation as well as assess stratification rules and the short-term effects of intervention.
METHODS:
We developed an eHealth system that comprises a set of sensor devices in an attaché case, a data transmission system linked to a mobile network, and a data management application. We provided eHealth checkups for the populations of five villages and the employees of five factories/offices in Bangladesh. Individual health condition was automatically categorized into four grades based on international diagnostic standards: green (healthy), yellow (caution), orange (affected), and red (emergent). We provided teleconsultation for orange- and red-grade subjects and we provided teleprescription for these subjects as required.
RESULTS:
The first checkup was provided to 16,741 subjects. After one year, 2361 subjects participated in the second checkup and the systolic blood pressure of these subjects was significantly decreased from an average of 121 mmHg to an average of 116 mmHg (P<.001 based on these results we propose a cost-effective method using machine learning technique forest the medical interview subject profiles and checkup as predictor to avoid costly measurements of blood sugar ensure sustainability program in developing countries.>CONCLUSIONS:
The results of this study demonstrate the benefits of an eHealth checkup and teleconsultation program as an effective health care system in developing countries.
KEYWORDS:
body area network; developing countries; preventive medicine; public health informatics; sensor; teleconsultation. |
| 24. |
Hu M, Sugimoto M, Andrew RH, Nohara Y, Moriyama M, Ahmed A, Shimizu S, Nakashima N, Health Checkup and telemedicine System in Post-Disaster Situations, Japanese Journal of Telemedicine and Telecare, 11, 2, 135-138, 2015.04, Abstract
Portable Healthcare Clinic (PHC) is a mobile healthcare system comprising of medical sensors and health assessment criteria. It has been applied in Bangladesh for the last two years as a pilot program to identify non-communicable diseases. In this study, we adapted PHC to fit post-disaster conditions. The PHC health assessment criteria are redesigned to deal with emergency cases and healthcare worker insufficiency. A new algorithm makes an initial assessment of age, symptoms, and whether the person is seeing a doctor. These changes will make the turn-around time shorter and will enable reaching the most affected patients better. We tested the operability and turn-around time of the adapted system at the debris flow disaster shelters in Hiroshima, Japan. Changing the PHC health assessment criteria and other solutions such as a list of medicine preparation makes the PHC system switch into an emergency mode more smoothly following a natural disaster.. |
| 25. |
Hu M, Sugimoto M, Andrew RH, Nohara Y, Moriyama M, Ahmed A, Shimizu S, Nakashima N, Mobile Healthcare System for Health Checkups and Telemedicine in Post-Disaster Situations, Stud Health Technol Inform, 216, 79-83, 2015.04, Abstract
Portable Healthcare Clinic (PHC) is a mobile healthcare system comprising of medical sensors and health assessment criteria. It has been applied in Bangladesh for the last two years as a pilot program to identify non-communicable diseases. In this study, we adapted PHC to fit post-disaster conditions. The PHC health assessment criteria are redesigned to deal with emergency cases and healthcare worker insufficiency. A new algorithm makes an initial assessment of age, symptoms, and whether the person is seeing a doctor. These changes will make the turn-around time shorter and will enable reaching the most affected patients better. We tested the operability and turn-around time of the adapted system at the debris flow disaster shelters in Hiroshima, Japan. Changing the PHC health assessment criteria and other solutions such as a list of medicine preparation makes the PHC system switch into an emergency mode more smoothly following a natural disaster.. |
| 26. |
Ueki T, Manabe T, Nagayoshi K, Yanai K, Moriyama T, Shimizu S, Tanaka M, Reduced-port laparoscopic restorative proctocolectomy without diverting ileostomy, Asian J Endosc Surg, 8, 4, 487-490, 2015.04, Abstract
INTRODUCTION:
We introduced a reduced-port procedure for laparoscopic restorative proctocolectomy without diverting ileostomy for patients with familial adenomatous polyposis and ulcerative colitis.
MATERIALS AND SURGICAL TECHNIQUE:
A multichannel port was inserted through a 2.5-cm umbilical incision. A 12-mm port in the right lower abdomen and a 3- or 5-mm port were also employed. A proctocolectomy was performed intracorporeally, and the entire colon and rectum were delivered through the umbilical incision. An ileal J-pouch was made extracorporeally following division of the mesenteric vessels. Ileal j-pouch-anal anastomosis was performed intracorporeally or transanally after rectal mucosectomy. A drain was inserted through the 12-mm port incision, and a transanal decompression tube was placed in the pouch. Two women and one man underwent this surgery, and their postoperative recovery was uneventful.
DISCUSSION:
Laparoscopic restorative proctocolectomy without a diverting stoma by a reduced-port technique is feasible and provides excellent cosmetic outcomes in selected patients.
© 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
KEYWORDS:
One-stage operation; reduced-port surgery; restorative proctocolectomy. |
| 27. |
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, Digestive Endoscopy, 28, 1, 92-97, 2015.04, Abstract
Live demonstration of endoscopy is one of the most attractive and useful methods for education and is often organized locally in hospitals. However, problems have been apparent in terms of cost, preparation, and potential risks to patients. Our aim was to evaluate a new approach to live endoscopy whereby remote hospitals are connected by the Internet for live endoscopic demonstrations. Live endoscopy was transmitted to the Congress of the Japan Gastroenterological Endoscopic Society by 13 domestic and international hospitals. Patients with upper and lower gastrointestinal diseases and with pancreatobiliary disorders were the subjects of a live demonstration. Questionnaires were distributed to the audience and were sent to the demonstrators. Questions concerned the quality of transmitted images and sound, cost, preparations, programs, preference of style, and adverse events. Of the audience, 91.2% (249/273) answered favorably regarding the transmitted image quality and 93.8% (259/276) regarding the sound quality. All demonstrators answered favorably regarding image quality and 93% (13/14) regarding sound quality. Preparations were completed without any outsourcing at 11 sites (79%) and were evaluated as 'very easy' or 'easy' at all but one site (92.3%). Preparation cost was judged as 'very cheap' or 'cheap' at 12 sites (86%). Live endoscopy connecting multiple international centers was satisfactory in image and sound quality for both audience and demonstrators, with easy and inexpensive preparation. The remote transmission of live endoscopy from demonstrators' own hospitals was preferred to the conventional style of locally organized live endoscopy.
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.
KEYWORDS:
education; international; internet; live demonstration; telemedicine. |
| 28. |
Kasetsermwiriya W, Nagai E, Nakata K, Nagayoshi Y, Shimizu S, Tanaka M, Surgery of GI gastrointestinal stromal tumors: Our experience, prognostic analysis, Hepato-Gastroenterology, 62, 87-92, 2015.04, Abstract
BACKGROUND/AIMS:
To review our treatment experience of gastrointestinal stromal tumors (GISTs) of the upper gastrointestinal tract and identify the prognostic factors that influence tumor recurrence.
METHODOLOGY:
Data of 46 consecutive patients with upper GI GISTs who underwent surgery from 1988 to 2011 were reviewed. The overall and disease-free survival rates and influence of clinicopathologic variables on disease-free survival rate were evaluated.
RESULTS:
The median age was 64 years (range, 20-86 years). R0 resections were performed in 43 (93.5%) patients. With a median follow-up time of 33 months (1-275 months), there were 5 (10.9%) recurrences and 2 mortalities in the high-risk group. The overall survival and recurrence-free survival rates at 5 years were 92.1% and 84.6%, respectively. Male gender, tumor size of >10 cm, high numbers of mitotic figures, R1 resection, high risk according to the Joensuu criteria, and a Ki-67 index of >10% were associated with a poor prognosis.
CONCLUSIONS:
Surgical resection of low- and intermediate-risk GISTs has excellent results. High counts of mitotic figures, male gender, incomplete resection, large tumor size, and a high Ki-67 index are associated with a poor prognosis.. |
| 29. |
Wisit Kasetsermwiriya, Eishi Nagai, Kohei Nakata, Yosuke Nagayoshi, Shuji Shimizu, Masao Tanaka, Surgery of Upper GI Gastrointestinal Stromal Tumors: Our Experience, Prognostic Analysis, HEPATO-GASTROENTEROLOGY, 10.5754/hge12819, 62, 137, 87-92, 2015.01, Background/Aims: To review our treatment experience of gastrointestinal stromal tumors (GISTs) of the upper gastrointestinal tract and identify the prognostic factors that influence tumor recurrence. Methodology: Data of 46 consecutive patients with upper GI GISTs who underwent surgery from 1988 to 2011 were reviewed. The overall and disease-free survival rates and influence of clinicopathologic variables on disease-free survival rate were evaluated. Results: The median age was 64 years (range, 20-86 years). R0 resections were performed in 43 (93.5%) patients. With a median follow-up time of 33 months (1-275 months), there were 5 (10.9%) recurrences and 2 mortalities in the high-risk group. The overall survival and recurrence-free survival rates at 5 years were 92.1% and 84.6%, respectively. Male gender, tumor size of >10 cm, high numbers of mitotic figures, R1 resection, high risk according to the joensuu criteria, and a Ki-67 index of >10% were associated with a poor prognosis. Conclusions: Surgical resection of low- and intermediate-risk GISTs has excellent results. High counts of mitotic figures, male gender, incomplete resection, large tumor size, and a high Ki-67 index are associated with a poor prognosis.. |
| 30. |
Takao Ohtsuka, Shunichi Takahata, Hideki Takanami, Junji Ueda, Kazuhiro Mizumoto, Shuji Shimizu, Masao Tanaka, Laparoscopic surgery is applicable for larger mucinous cystic neoplasms of the pancreas, JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 10.1002/jhbp.32, 21, 5, 343-348, 2014.05, BackgroundMucinous cystic neoplasms (MCN) of the pancreas frequently develop in the distal pancreases of young women. Laparoscopic surgery can enhance cosmetic benefits and ease of surgery. This study assessed the feasibility of laparoscopic surgery for MCN.
MethodsThe medical records of 21 patients pathologically diagnosed with benign MCN after laparoscopic resection were reviewed. Clinical data were compared in the 11 patients with tumors 45mm (large tumor group) and the 10 patients with tumors ResultsLaparoscopic resection was completed in all patients, including distal pancreatectomy with (n = 9) and without (n = 11) spleen preservation and enucleation for pancreatic head lesion (n = 1). Operation time, blood loss, postoperative morbidity, and hospital stay were similar in the two groups. Spleen-preserving pancreatectomy could be more frequently completed in the small MCN group (P = 0.02). No recurrence was observed during a median follow-up period of 12 months.
ConclusionsLaparoscopic surgery can be completed in all patients with benign MCN, even those with large tumors, and patients with small MCN can get the additional benefit of spleen preservation.. |
| 31. |
Kudo K, Shimizu S, Chiang TC, Antoku Y, Hu M, Houkabe Y, Nakashima N, Evaluation of videoconferencing systems for remote medical education, Creative Education, 1064-1070, 2014.04. |
| 32. |
Kasetsermwiriya W, Nagai E, Nakata K, Nagayoshi Y, Shimizu S, Tanaka M, Laparoscopic surgery for gastric gastrointestinal stromal tumor is feasible irrespective of tumor size, Journal of laparoendoscopic & advanced surgical techniques, 24, 3, 123-129, 2014.04, Abstract
PURPOSE:
To compare the outcomes of laparoscopic surgery and open surgery for gastric gastrointestinal stromal tumors (GISTs) by size-matched analysis and evaluate whether laparoscopic surgery for lesions of >5 cm is feasible.
PATIENTS AND METHODS:
Data of 44 consecutive patients with gastric GIST who underwent surgery from 1988 to 2011 were reviewed. Twenty-three patients who underwent successful laparoscopic surgery were compared with 10 patients with similar tumor sizes who underwent open surgery. Among the 23 patients in the laparoscopic group, we compared postoperative results between GISTs of ≤5 cm and >5 cm.
RESULTS:
There were no differences in clinicopathological characteristics between the laparoscopic surgery group (LG) and the open surgery group (OG). The operation time was not different, but the blood loss (5.5 mL [range, 0-425 mL] in LG and 125 mL [range, 0-676 mL] in OG) (P=.008) and postoperative hospital stay (21 days in OG and 8 days in LG) (P<.001 were significantly less in the lg. postoperative complications and recurrence not different. comparison between patients with lesions of>5 cm and patients with smaller lesions in the LG found that smaller lesions were associated with a shorter postoperative hospital stay (7.5 days versus 11 days) (P=.037).
CONCLUSIONS:
Laparoscopic resection of primary gastric GISTs is feasible even for tumors of >5 cm.. |
| 33. |
Ohtsuka T, Takahata S, Takanami H, Ueda J, Mizumoto K, Shimizu S, Tanaka M, Laparoscopic surgery is applicable for larger mucinous cystic neoplasms of the pancreas, J Hepatobiliary Pancreat Sci., 21, 5, 343-348, 2014.04, BACKGROUND:
Mucinous cystic neoplasms (MCN) of the pancreas frequently develop in the distal pancreases of young women. Laparoscopic surgery can enhance cosmetic benefits and ease of surgery. This study assessed the feasibility of laparoscopic surgery for MCN.
METHODS:
The medical records of 21 patients pathologically diagnosed with benign MCN after laparoscopic resection were reviewed. Clinical data were compared in the 11 patients with tumors ≥45 mm (large tumor group) and the 10 patients with tumors
RESULTS:
Laparoscopic resection was completed in all patients, including distal pancreatectomy with (n = 9) and without (n = 11) spleen preservation and enucleation for pancreatic head lesion (n = 1). Operation time, blood loss, postoperative morbidity, and hospital stay were similar in the two groups. Spleen-preserving pancreatectomy could be more frequently completed in the small MCN group (P = 0.02). No recurrence was observed during a median follow-up period of 12 months.
CONCLUSIONS:
Laparoscopic surgery can be completed in all patients with benign MCN, even those with large tumors, and patients with small MCN can get the additional benefit of spleen preservation.. |
| 34. |
Nagai E, Nakata K, Ohuchida K, Miyasaka Y, Shimizu S, Tanaka M, Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study, Surg Endosc., 28, 1, 289-296, 2014.04, BACKGROUND:
The benefits and feasibility of laparoscopic surgery for remnant gastric cancer are still unclear. The purpose of this study was to describe the detailed procedure and to evaluate the clinical short-term outcomes of laparoscopic total gastrectomy (LTG) compared with open total gastrectomy (OTG) for remnant gastric cancer (RGC).
METHODS:
Of 1,247 consecutive patients who underwent gastrectomy for gastric cancer in our department at Kyushu University Hospital from January 1996 to May 2012, 22 patients who underwent successful curative resection of RGC with precise nodal dissection were enrolled in this study. Twelve patients underwent LTG and the remaining ten patients underwent OTG. We analyzed the clinical short-term outcomes of LTG and compared the results between LTG and OTG groups to evaluate the safety and feasibility of LTG.
RESULTS:
Twelve patients with RGC successfully underwent LTG without open conversion and morbidity. The mean operation time of LTG, 362.3 ± 68.4 min, was significantly longer than that of OTG (p = 0.0176), but the mean blood loss of LTG, 65.8 ± 62 g, was smaller than that of OTG (p
CONCLUSIONS:
This study shows that LTG is a feasible and reliable procedure for the treatment of RGC in terms of short-term outcomes.. |
| 35. |
Nakamura M, Shindo K, Ideno N, Ueda J, Takahata S, Nakashima H, Ohtsuka T, Shimizu S, Oda Y, Tanaka M, Prediction of Pancreatic Fistula by Preoperatively Assessable Factors; Retrospective Review of Unified Operations by Single Surgeon, Hepato-Gastroenterology, 2014, 61, 834-837, 2014.04, Abstract
BACKGROUND/AIMS: This retrospective study was conducted to find preoperatively assessable risk factors for postoperative pancreatic fistula (POPF) in patients undergoing laparoscopic distal pancreatectomy (LDP) using a slow compression method with a stapler, which we call pen-firing compression (PFC).
METHODOLOGY: Fifty-two patients underwent LDP, of whom 42 underwent PFC for pancreatic division using a stapler. The relationship between preoperatively assessable factors and the incidence of clinical POPF was statistically analyzed.
RESULTS: Overall rate of POPF was 7.1% in 42 patients. Univariate analysis showed that greater BMI (p = 0.004) and thicker pancreatic stump (0.0022) were significant risk factors for POPF. BMI and stump thickness remained significant (P CONCLUSIONS: High BMI value and thick pancreatic stump are significant risk factors for POPF after LDP. Alternative treatment of the pancreatic stump may prevent POPF in high-risk patients.. |
| 36. |
Nakata K, Nagai E, Ohuchida K, Shimizu S, Tanaka M, Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes., Surg Endosc., 29, 7, 1817-22, 2014.04, BACKGROUND:
Since its widespread acceptance for the treatment of early gastric cancer, laparoscopic gastrectomy has been gaining popularity as a treatment option for advanced gastric cancer. However, laparoscopic total gastrectomy (LTG) with splenectomy is seldom performed, because of its difficulty of removal of station 10 lymph nodes; splenectomy is technically essential for complete removal of these lymph nodes. The purpose of this study was to describe the details of the LTG procedure and to evaluate the short- and long-term outcomes of LTG with splenectomy.
METHODS:
Of 725 consecutive patients with gastric cancer who underwent laparoscopic gastrectomy with lymph node dissection in our institution from January 1996 to December 2012, 18 consecutive patients who underwent LTG with splenectomy were enrolled in this study.
RESULTS:
No operative mortality occurred, and the pathological margins were free from cancer cells in all patients. The mean operation time was 388 min (range 324-566 min). The mean volume of blood loss was 45 ml (range 5-347 ml), and the mean number of dissected lymph nodes was 51 (range 40-105). Postoperative morbidity occurred in six patients (33.3 %) (each with grade B postoperative pancreatic fistula, postoperative bleeding, chylous ascites, atelectasis, ileus, and intra-abdominal infection). Five patients (27.8 %) developed recurrence (four in the peritoneum and one in the liver), and the overall 3- and 5-year survival rates were 83.0 and 72.6 %, respectively.
CONCLUSIONS:
Considering the 0 % mortality rate and low rates of postoperative morbidity and locoregional recurrence, LTG with splenectomy is technically and oncologically acceptable. This procedure can be expanded to include advanced gastric cancer, which generally requires splenectomy for lymph node dissection.. |
| 37. |
Shimizu S, Kudo K, Antoku Y, Hu M, Okamura K, Nakashima N, Ten-year experience of remote medical education in Asia, Telemedicine and eHealth, 20, 11, 1021-1026, 2014.04, Abstract
BACKGROUND:
Moving images are often essential in medical education, to learn new procedures and advanced skills, but, in the past, high-quality movie transmission was technically much more challenging than transmitting still pictures because of technological limitations and cost.
MATERIALS AND METHODS:
We established a new system, taking advantage of two advanced technologies, the digital video transport system (DVTS) and the research and education network (REN), which enabled satisfactory telemedicine on a routine basis.
RESULTS:
Between 2003 and 2013, we organized 360 programs connecting 221 hospitals or facilities in 34 countries in Asia and beyond. The two main areas were endoscopy and surgery, with 113 (31%) and 106 (29%) events, respectively. Teleconferences made up 76% of the total events, with the remaining 24% being live demonstrations. Multiple connections were more popular (63%) than one-to-one connections (37%). With continuous technological development, new high-definition H.323 and Vidyo(®) (Hackensack, NJ) systems were used in 47% and 39% of events in 2011 and 2012, respectively. The evaluation by questionnaires was favorable on image and sound quality as well as programs.
CONCLUSIONS:
Remote medical education with moving images was well accepted in Asia with changing needs and developing technologies.
KEYWORDS:
Internet; digital video transport system; remote education; research and education network; telemedicine. |
| 38. |
Eishi Nagai, Kohei Nakata, Kenoki Ohuchida, Yoshihiro Miyasaka, Shuji Shimizu, Masao Tanaka, Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-013-3186-y, 28, 1, 289-296, 2014.01, The benefits and feasibility of laparoscopic surgery for remnant gastric cancer are still unclear. The purpose of this study was to describe the detailed procedure and to evaluate the clinical short-term outcomes of laparoscopic total gastrectomy (LTG) compared with open total gastrectomy (OTG) for remnant gastric cancer (RGC).
Of 1,247 consecutive patients who underwent gastrectomy for gastric cancer in our department at Kyushu University Hospital from January 1996 to May 2012, 22 patients who underwent successful curative resection of RGC with precise nodal dissection were enrolled in this study. Twelve patients underwent LTG and the remaining ten patients underwent OTG. We analyzed the clinical short-term outcomes of LTG and compared the results between LTG and OTG groups to evaluate the safety and feasibility of LTG.
Twelve patients with RGC successfully underwent LTG without open conversion and morbidity. The mean operation time of LTG, 362.3 +/- A 68.4 min, was significantly longer than that of OTG (p = 0.0176), but the mean blood loss of LTG, 65.8 +/- A 62 g, was smaller than that of OTG (p This study shows that LTG is a feasible and reliable procedure for the treatment of RGC in terms of short-term outcomes.. |
| 39. |
Nagai E, Ohuchida K, Nakata K, Miyasaka Y, Maeyama R, Toma H, Shimizu S, Tanaka M, Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: Inverted T-shaped anastomosis using linear staplers., Surgery, 153, 5, 732-738, 2013.04, BACKGROUND:
Although laparoscopic distal gastrectomy has been widely accepted in clinical practice, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty in esophagojejunostomy. The purpose of this study was to evaluate perioperative and short-term outcomes of our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG.
METHODS:
Of 98 consecutive patients who underwent LTG for gastric cancer in our department between August 2002 and December 2010, 94 patients underwent esophagojejunostomy with a linear stapling device. After October 2007, we modified the esophagojejunostomy; ie, the most recent 57 patients underwent transection of the esophagus in the ventrodorsal direction and insertion of a linear stapler from the anterior wall of the Roux limb to the posterior wall so as to make an inverted T-shaped anastomosis. We evaluated the results in these 57 patients (recent group) and compared them with the results in the earlier 37 patients (early group).
RESULTS:
The mean operative time in the recent group was 368 to 94.6 min, and the mean estimated blood loss was 57 to 33 g; both were comparable with those in the early group. Neither open conversion nor intraoperative complications were encountered. Two patients experienced anastomotic leakage in the earlier group, but anastomotic leakage did not occur in the recent group. No mortality was encountered.
CONCLUSION:
We herein report our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Our procedure of esophagojejunostomy using linear staplers is safe and feasible and has acceptable morbidity.
Copyright © 2013 Mosby, Inc. All rights reserved.. |
| 40. |
Yamanaka N, Nagai E, Ohuchida K, Ueda J, Toma H, Shimizu S, Oda Y, Tanaka M, Feasibility of laparoscopic gastrectomy for advanced gastric cancer with positive peritoneal cytology, Surg Today, 43, 8, 859-864, 2013.04, Abstract
PURPOSE:
The role of gastrectomy for patients with positive peritoneal cytology, but a negative macroscopic peritoneal implant (P-/cy+), remains unclear. The aim of this study was to evaluate laparoscopic gastrectomy for P-/cy+ patients.
METHODS:
This study reviewed a prospectively maintained gastric cancer database of gastric-cancer patients those underwent surgical resection. P-/cy+ gastric cancer that had invaded the subserosa, or deeper layers, of the stomach wall without distant organ metastases was considered operable in this institution. P-/cy+ patients underwent either open or laparoscopic gastrectomy with D2 lymphadenectomy. The short-term results were examined to assess differences in outcome between the two groups.
RESULTS:
Eighteen P-/cy+ patients without distant organ metastases underwent surgery between 2000 and 2010. Laparoscopic gastrectomy was performed in nine patients and open gastrectomy in nine patients. The estimated blood loss was significantly smaller, the resumption of food intake earlier, and the length of postoperative hospital stay shorter in the patients that underwent laparoscopic gastrectomy than in the patients that underwent open gastrectomy. There were no significant differences in the 2-year survival rates between the groups.
CONCLUSION:
Laparoscopic gastrectomy for P-/cy+ patients is a minimally invasive and safe oncologic procedure with good short-term results.. |
| 41. |
Lee SP, Lee HL, Hahm JS, Choi HS, Joe IW, Shimizu S, International live endoscopic multichannel demonstration using superfast broadband Internet connections, Clin Endosc, 45, 1, 73-77, 2012.04, Abstract
BACKGROUND/AIMS:
Telemedicine is a convenient and efficient tool for remote education in various fields. The telemedicine system can also be used to educate doctors and medical students. The aim of our study was to establish the effectiveness of the telemedical system for use in a live endoscopic multichannel demonstration conference and to test the effectiveness and usefulness of a multicenter-based live endoscopic demonstration through live, interactive, high resolution video transmission using advanced networks and the digital video transport system (DVTS).
METHODS:
This study is a prospective multicenter pilot study. A live demonstration of an endoscopic submucosal dissection (ESD) and an endoscopic retrograde cholangiopancreatography (ERCP) using advanced network technology was performed.
RESULTS:
The DVTS successfully transmitted uncompressed, high-resolution, digital lectures with endoscopy video during a multichannel endoscopic live demonstration of ESD and ERCP over multiple advanced networks. The overall satisfaction rating when the endoscopic lecture demonstration was performed by combining DVTS was generally good.
CONCLUSIONS:
We believe that a multicenter-based live endoscopic demonstration is a very effective conferencing method when using advanced networks and DVTS.. |
| 42. |
Nakamura M, Nagayoshi Y, Kono H, Mori Y, Otsuka T, Takahata S, Shimizu S, Tanaka M, Lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy., Surgery, 150, 2, 326-331, 2011.04, AIM: We sought to evaluate the feasibility of the lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy (LA-SVPDP).
BACKGROUND: Complete preservation of the splenic vessels is an ideal outcome in spleen-preserving distal pancreatectomy (SPDP). However, the preservation of the vessels is challenging in laparoscopic surgery because the splenic vein is often embedded in the pancreatic parenchyma. Herein we have described LA-SVPDP, the most feasible method for laparoscopic SPDP, and the outcome of our initial experience.
PATIENTS: Twenty-three patients underwent laparoscopic SPDP. Before we adopted LA-SVPDP, 8 patients underwent the Warshaw method and 6 underwent SVPDP. After the adoption of LA-SVPDP, 8 patients underwent LA-SVPDP and 1 donor underwent the Warshaw method.
RESULTS: None of patients undergoing LA-SVPDP required conversion to an open operation, whereas 2 patients undergoing the other procedures were converted to open operations. Five out of 8 patients who underwent the Warshaw method showed engorgement of the gastric veins, revealed by computed tomography. However, only 1 of the 5 patients showed mild gastric varices on endoscopy.
CONCLUSION: Although the Warshaw method is acceptable with a low incidence of gastric varices in our analysis, SVPDP is a feasible approach for SPDP. Our LA-SVPDP technique may contribute to safer and easier SVPDP in laparoscopic surgery.. |
| 43. |
Nakamura M, Ueda J, Kono H, Aly MY, Takahata S, Shimizu S, Tanaka M, Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy., Surg Endosc., 25, 3, 867-871, 2011.04, BACKGROUND: Laparoscopic distal pancreatectomy (Lap-DP) is one of the most accepted laparoscopic procedures in the field of pancreatic surgery. However, pancreatic fistula remains a major and frequent complication in Lap-DP, as in open surgery. The aim of this retrospective study is to clarify the advantages of prolonged peri-firing compression (PFC) with a linear stapler for prevention of pancreatic fistula after laparoscopic distal pancreatectomy.
PATIENTS AND METHODS: Incidence of pancreatic fistula in clinical levels (equivalent to grades B and C defined by the International Study Group of Pancreatic Fistula (ISGPF)) was retrospectively compared between patients who underwent Lap-DP with PFC (PFC group, n = 17) and those who underwent Lap-DP without PFC (no-PFC group, n = 25).
RESULTS: Incidence of clinical pancreatic fistula was significantly lower in the PFC group than in the no-PFC group. Consistent with the results for pancreatic fistula, peritoneal drainage period and postoperative hospital stay were shorter in the PFC group than in the no-PFC group.
CONCLUSIONS: Our data show that PFC effectively prevents pancreatic fistula and shortens postoperative hospital stay after Lap-DP.. |
| 44. |
Shimizu S, Itaba S, Yada S, Takahata S, Nakashima N, Okamura K, Rerknimitr R, Akaraviputh T, Lu X, Tanaka M, Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures., J Hepatobiliary Pancreat Sci., 18, 3, 366-374, 2011.04, BACKGROUND: With the rapid and marked progress in gastrointestinal endoscopy, the education of doctors in many new diagnostic and therapeutic procedures is of increasing importance. Telecommunications (telemedicine) is very useful and cost-effective for doctors' continuing exposure to advanced skills, including those needed for hepato-pancreato-biliary diseases. Nevertheless, telemedicine in endoscopy has not yet gained much popularity. We have successfully established a new system which solves the problems of conventional ones, namely poor streaming images and the need for special expensive teleconferencing equipment.
METHODS: The digital video transport system, free software that transforms digital video signals directly into Internet Protocol without any analog conversion, was installed on a personal computer using a network with as much as 30 Mbps per channel, thereby providing more than 200 times greater information volume than the conventional system. Kyushu University Hospital in Japan was linked internationally to worldwide academic networks, using security software to protect patients' privacy.
RESULTS: Of the 188 telecommunications link-ups involving 108 institutions in 23 countries performed between February 2003 and August 2009, 55 events were endoscopy-related, 19 were live demonstrations, and 36 were gastrointestinal teleconferences with interactive discussions. The frame rate of the transmitted pictures was 30/s, thus preserving smooth high-quality streaming.
CONCLUSIONS: This paper documents the first time that an advanced tele-endoscopy system has been established over such a wide area using academic high-volume networks, funded by the various governments, and which is now available all over the world. The benefits of a network dedicated to research and education have barely been recognized in the medical community. We believe our cutting-edge system will be a milestone in endoscopy and will improve the quality of gastrointestinal education, especially with respect to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures.. |
| 45. |
Aly MY, Tsutsumi K, Nakamura M, Sato N, Takahata S, Ueda J, Shimizu S, Redwan AA, Tanaka M, Comparative study of laparoscopic and open distal pancreatectomy, J Laparoendosc Adv Surg Tech A, 20, 5, 435-440, 2010.04, BACKGROUND: Laparoscopic distal pancreatectomy (LDP) has been shown to be an effective surgical option for benign lesions in the body and tail of the pancreas. However, its advantages and disadvantages have not been well characterized. In this study, we compared the outcomes of LDP and open pancreatectomy performed in our clinic.
MATERIALS AND METHODS: Peri- and postoperative outcomes were retrospectively compared between patients with benign pancreatic disorders who underwent open distal pancreatectomy (ODP) (n = 35) and those who underwent LDP (n = 40). The peri- and postoperative factors analyzed included operative time, blood loss, hospital stay, postoperative recovery, biochemical findings, and complications.
RESULTS: LDP was associated with significantly less operative blood loss (363 versus 606 mL; P = 0.001) and shorter hospital stay (22 versus 27 day; P = 0.009), but longer operative time (342 versus 250 min; P = 0.000), compared with ODP. There were no significant differences between the two groups in complication rates or postoperative recovery, except for the significantly shorter duration of postoperative pain-killer intake and earlier improvement of the biochemical analysis in LDP than in ODP.
CONCLUSIONS: LDP appears to be a safe, desirable procedure for the management of benign pancreatic diseases, with outcomes similar to ODP. |
| 46. |
Obuchi T, Iwasaki A, Shiraishi T, Okumura M, Moriyama S, Shimizu S, Teleconferences on thoracoscopic surgery using an academic network between Asian institutions, Asian J Endosc Surg, 3, 4, 185-188, 2010.04. |
| 47. |
Noshiro H, Ohuchida K, Kawamoto M, Ishikawa M, Uchiyama A, Shimizu S, Tanaka M, Intraabdominal Roux-en-Y reconstruction with a novel stapling technique after laparoscopic distal gastrectomy, Gastric Cancer, 12, 3, 164-169, 2009.04, AbstractLaparoscopic gastrectomy is widely used as minimally invasive surgery for gastric carcinoma. Billroth I or Roux-en-Y reconstruction is commonly performed after laparoscopic distal gastrectomy (LDG). Roux-en-Y reconstruction after LDG is one of the best methods for reconstruction of the alimentary tract when Billroth I reconstruction is difficult. There are few reports of intracorporeal Roux-en-Y reconstruction after LDG because of the technical difficulties of such a procedure. In particular, in the case of a very small gastric remnant, gastrojejunostomy using endoscopic linear staplers becomes more complicated. We developed a new technique for intracorporeal Roux-en-Y reconstruction: a modified stapling technique to allow the gastrojejunostomy to be made on the stomach transecting line that is applicable even when the residual stomach is very small. Roux-en-Y reconstruction with our modified technique was performed in six patients. There was
no intraoperative complication or conversion to minilaparotomy or conventional celiotomy in any patient. Oral intake was easy and adequate after surgery. The present Roux-en-Y reconstruction procedure is feasible. Herein we describe an intraabdominal Roux-en-Y reconstruction with a modified stapling technique after LDG.. |
| 48. |
Shimizu S, Nakashima N, Okamura K, Tanaka M, One hundred case studies of Asia-pacific telemedicine using a digital video transport system over a research and education network, Telemed J E Health, 15, 1, 112-117, 2009.04. |
| 49. |
Kaltenbach T, Muto M, Soetikno R, Dev P, Okamura K, Hahm J, Shimizu S, Teleteaching endoscopy: feasibility of real-time uncompressed video transmission by using advanced network technologies, Gastrointest Endosc, 70, 5, 1013-1017, 2009.04, BACKGROUND: Teleteaching of endoscopy has been limited by the exorbitant cost and time inherent in high-quality digital endoscopy video transmission. The Digital Video Transport System (DVTS) transmitted over advanced networks, such as Internet2 and the Asia-Pacific Advanced Network (APAN), provides a unique infrastructure for sharing uncompressed digital videos of endoscopy. This may allow high-quality, real-time, international training of diagnostic and therapeutic endoscopy techniques at a low cost. OBJECTIVE: To test the proof of concept of long-distance teaching through live, interactive, high-resolution video transmission by using advanced networks and the DVTS. We used teleteaching of image-enhanced endoscopy techniques as a model. DESIGN: Prospective multicenter pilot study. SETTING AND PARTICIPANTS: Trainees, faculty, and staff at 3 international endoscopy units. INTERVENTION: An image-enhanced endoscopy video lecture with advanced-network technologies. MAIN OUTCOME MEASUREMENTS: We compared image-based prelecture and postlecture test scores and secondarily assessed technical feasibility and quality. RESULTS: The DVTS transmitted over advanced networks successfully transmitted uncompressed, high-resolution, digital lectures with endoscopic video (digital video format 720 x 480 pixels). Postsession scores improved. Participants highly rated the technical and informational quality. The majority reported a definite interest in participating in future sessions, with a mean rating (out of 5 [scale 1-5]) of 4.7 +/- 0.5. LIMITATIONS: Pilot study with a limited number of participants and sessions. CONCLUSION: The DVTS transmitted over advanced networks such as Internet2 and APAN can provide the infrastructure for transmission of high-resolution, uncompressed video endoscopy for the purpose of teleteaching endoscopy.. |
| 50. |
Shimizu S, Okamura K, Navatil J, DVTS Videoconferencing with Quatre-A Reasonable Tool for Medical Multipoint Applications-., CESNET Conference 2008, 113-121, 2008.04. |
| 51. |
Shimizu S, Han HS, Okamura K, Yamaguchi K, Tanaka M, Live multi-station teleconferences at the First Biennial Congress of the Asian-Pacific Hepato-Pancreato-Biliary Association via academic broadband Internet., J Hepatobiliary Pancreat Surg, 15, 3, 344-345, 2008.04, 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.
Related articles
One hundred case studies of Asia-pacific telemedicine using a digital video transport system over a research and education network. Telemed J E Health. 2009 Jan; 15(1):112-7.
[Telemed J E Health. 2009]
Live demonstration of surgery across international borders with uncompressed high-definition quality. HPB (Oxford). 2007; 9(5):398-9.
[HPB (Oxford). 2007]
Development of a broadband telemedical network based on internet protocol in the Asia-Pacific region. Methods Inf Med. 2007; 46(6):709-15.
[Methods Inf Med. 2007]
Review[Telemedicine: perspectives and multidisciplinary approach] Schweiz Med Wochenschr. 2000 Mar 4; 130(9):314-23.
[Schweiz Med Wochenschr. 2000]
Review[Support by telecommunication of decisions in diagnostic pathology. Experience with the first telepathology system in Hungary] Orv Hetil. 1996 Oct 20; 137(42):2299-303.
[Orv Hetil. 1996]
» See reviews... | » See all.... |
| 52. |
Huang KJ, Qiu ZJ, Fu CY, Shimizu S, Okamura K, Uncompressed Video Image Transmission of Laparoscopic or Endoscopic Surgery for Telemedicine., Telemed J E Health., 14, 5, 479-485, 2008.04, Traditional narrowband telemedicine cannot provide quality dynamic images. We conducted videoconferences of laparoscopic and endoscopic operations via an uncompressed video transmission technique. A superfast broadband Internet link was set up between Shanghai in the People's Republic of China and Fukuoka in Japan. Uncompressed dynamic video images of laparoscopic and endoscopic operations were transmitted by a digital video transfer system (DVTS). Seven teleconferences were conducted between June 2005 and June 2007. Of the 7 teleconferences, 5 were live surgical demonstrations and 3 were recorded video teleconsultations. Smoothness of the motion picture, sharpness of images, and clarity of sound were benefited by this form of telemedicine based upon DVTS. Telemedicine based upon DVTS is a superior choice for laparoscopic and endoscopic skill training across the borders.. |
| 53. |
Hahm JS, Lee HL, Kim SI, Shimizu S, Choi HS, Ko Y, Lee KG, Kim SI, Kim TE, Yun JW, Park YJ, Nakashima N, Okamura K, A Remote Educational System in Medicine Using Digital Video, Hepato-Gastroenterology, 54, 74, 373-376, 2007.04, BACKGROUND/AIMS: Telemedicine has opened the door to a wide range of learning experience and simultaneous feedback to doctors and students at various remote locations. However, there are limitations such as lack of approved international standards of ethics. The aim of our study was to establish a telemedical education system through the development of high quality images, using the digital transfer system on a high-speed network. METHODOLOGY: Using telemedicine, surgical images can be sent not only to domestic areas but also abroad, and opinions regarding surgical procedures can be exchanged between the operation room and a remote place. The Asia Pacific Information Infrastrucuture (APII) link, a submarine cable between Busan and Fukuoka, was used to connect Korea with Japan, and Korea Advanced Research Network (KOREN) was used to connect Busan with Seoul. Teleconference and video streaming between Hanyang University Hospital in Seoul and Kyushu University Hospital in Japan were realized using Digital Video Transfer System (DVTS) over Ipv4 network. RESULTS: Four endoscopic surgeries were successfully transmitted between Seoul and Kyushu, while concomitant teleconferences took place between the two throughout the operations. Enough bandwidth of 60 Mbps could be kept for two-line transmissions. The quality of transmitted video image had no frame loss with a rate of 30 images per second. The sound was also clear, and time delay was less than 0.3 sec. CONCLUSIONS: Our experience has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video transmission over Internet protocol, which is easy to perform, reliable, and economical. Our network system may become a promising tool for worldwide telemedical communication in the future.. |
| 54. |
Eto M, Lee TY, Gill IS, Koga H, Tatsugami K, Shimizu S, Ukimura O, Naito S, Broadcast of Live Endoscopic Surgery From Korea to Japan Using the Digital Video Transport System, J. Endourology, 21, 12, 1517-1520, 2007.04, PURPOSE: To assess the quality of sound and uncompressed images during an international broadcast of live surgery using the newly developed digital video transport system (DVTS). METHODS: Three networks connected hospitals in Seoul, Korea, and Fukuoka, Japan. A teleconference system with bidirectional transmission over the network was set up. DVTS was used to send and receive visual and audio signals during a live broadcast of a laparoscopic partial nephrectomy to viewers at the 94th annual meeting of the Japanese Urological Association. A questionnaire was used to assess the quality of images and sound. RESULTS: Of 713 questionnaires distributed, 418 were collected. The quality of image and voice was ranked very good or good by 95% and 92% of the audience, respectively. The quality of live surgery was considered high by 94% of the audience. CONCLUSION: Digital video images can be transformed directly to an Internet protocol without compression of the motion images using DVTS. Live surgery via teleconference using DVTS can help surgeons learn the skills of endoscopic surgery.. |
| 55. |
Nakashima N, Shimizu S, Okamura K, Hahm JS, Kim YW, Han HS, Torata N, Antoku Y, Lee YS, Tanaka M, Development of a broadband telemedical network based on internet protocol in the Asia-Pacific region., Methods. Info. Med., 46, 6, 709-715, 2007.04, OBJECTIVES: To promote the exchange of knowledge and standardization of medical procedures and medical systems in the Asia-Pacific region, we established a medical network with high-quality moving images over broadband Internet lines in February 2003. METHODS: Real-time teleconferences and live demonstrations with medical-quality videos, broadcast via the Digital Video Transport System, have been used to teach surgical techniques and other medical procedures across national borders. The Asia-Pacific Advanced Network (APAN) committee in August 2005 formally approved our proposal to establish a medical working group within APAN. The network was expanded by the launch of the Trans-Eurasia Information Network 2 in 2006. By the end of 2006, we had conducted 82 events, in 10 countries in the Asia-Pacific region. The multi-station event has increased every year. RESULTS: There have been no serious transmission problems or ethical conflicts so far. With these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific. CONCLUSION: This system is a promising and very useful tool for the standardization of medical system and procedures across national borders. Drawing upon these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific region.. |
| 56. |
Konishi K, Shimizu S, Mizushima H, Kitamura Y, Igi S, International Collaborations over Advanced Networks, J eHealth Tech Application, 5, 2, 1-7, 2007.04. |
| 57. |
Noshiro H, Nagai E, Shimizu S, Uchiyama A, Kojima M, Tanaka M, Minimally invasive radical esophagectomy for esophageal cancer, Esophagus, 4, 59-65, 2007.04. |
| 58. |
Shimizu S, Nakashima N, Okamura K, Han HS, Tanaka M, Telesurgery system with original-quality moving images over high-speed Internet: expansion within the Asia-Pacific region., J Laparoendosc Adv Surg Tech A., 17, 5, 673-677, 2007.04, BACKGROUND: Amid rapid changes in surgical techniques and patient care, education and training for the new generation of health care providers is of utmost importance. An international telesurgical system, which we established between Japan and Korea through super-fast broadband Internet without any loss of quality, was shown to be a powerful tool for this purpose. We attempted to expand our advanced system throughout the Asia-Pacific region and studied its usefulness. METHODS: Kyushu University Hospital (Fukuoka, Japan) was linked to 33 medical institutions and meeting venues in China, Taiwan, Thailand, Vietnam, Singapore, and Australia by academic optic fiber network. Digital video signals were directly converted into Internet protocol, and cipher security programs were used to protect patient privacy. RESULTS: Of 49 international surgical teleconferences conducted, 16 were real-time demonstrations of surgery, and 33 involved recorded videos. For 37 events, two stations were connected pier-to-pier, and for the remaining 12, multiple stations were connected. The network remained stable, and the time delay between stations was restricted to 0.3-1.0 seconds. Responding to questionnaires, 70.6% of participants rated the image quality as "very good," and 22.5% rated it "good." CONCLUSIONS: We succeeded in establishing a high-quality telesurgical system in a wide area of the Asia-Pacific region, and this is the first time high-speed Internet technology has been applied to surgery on such a large scale. Because it is not only of high quality but also economical and easy to set up, we believe this system will promote efficient remote surgical education and active academic exchange worldwide.
PMID: 17907987 [PubMed - in process]. |
| 59. |
Hahm JS, Shimizu S, Nakashima N, Hyun YS, Choi HS, Ko Y, Lee KG, Kim SI, Kim TE, Yun JW, Park YJ, A Remote Educational System in Medicine Using Digital Video Transfer System, Korean J Gastrointest Endosc, 32, 3, 161-167, 2006.04. |
| 60. |
Carati C, Shimizu S, Okamura K, Lomanto D, Tanaka M, Oouli J, High definition digital video links for surgical training, Journal of Telemedicine and Telecare, 12, 53, 26-28, 2006.04. |
| 61. |
Shimizu S, Nakashima N, Okamura K, Hahm JS, Kim YW, Moon BI, Han HS, Tanaka M, International transmission of uncompressed endoscopic surgery images via superfast broadband Internet connections., Surg Endosc, 20, 1, 167-170, 2006.04, Abstract
BACKGROUND:
Although telecommunication is increasing in popularity, poor-quality images sent through a narrowband network limit its use in the medical field.
METHODS:
Kyushu University Hospital in Japan and four hospitals in Korea were linked via superfast broadband Internet connection. The digital video transfer system, which can transmit digital videos without loss of image quality, was used, and the bandwidth was 30 Mbps per line.
RESULTS:
Of the 16 teleconferences conducted, 6 demonstrated real-time endoscopic surgery. In addition to the surgical images, preoperative diagnostic images, images of the operating room, and images of the staff in the conference room were transmitted to facilitate discussion. The network remained stable, and the sound delay was restricted to less than 0.3 s. In the other 10 teleconferences, recorded video images were used for discussion.
CONCLUSIONS:
The authors have established a high-quality, practical teleconference system that is economical and easy to use in clinical practice. This system shows promise for remote education beyond geographic borders.. |
| 62. |
Kawamoto M, Konomi H, Kobayashi K, Shimizu S, Yamaguchi K, Tanaka M, Type of gastrointestinal reconstruction affects postoperative recovery after pancreatic head resection, J Hepatobiliary Pancreat Surg., 13, 4, 336-343, 2006.04, BACKGROUND/PURPOSE: The postoperative recovery of gastric motility with various reconstructions after pancreatic head resection has been reported. However, little is known about this recovery after pancreatic head resection with segmental duodenectomy (PHRSD). Some have attributed gastric stasis after pylorus-preserving pancreatoduodenectomy (PPPD) to tube gastrostomy, but its effect on gastric motility has not been investigated. In this study, the postoperative recovery after PHRSD and PPPD, and gastric motility with and without gastrostomy after PPPD were investigated. METHODS: We analyzed the first appearance of gastric phase III motility, postoperative systemic status, and body weight (BW; n = 32). The Imanaga PPPD and PHRSD were compared because the procedures differ only in the length of the remaining duodenum. Traverso and Roux-en-Y PPPDs were compared because the two procedures are similar except for the creation of gastrostomy. RESULTS: (1) Times to first appearance of gastric phase III motility and BW recovery were significantly better after PHRSD than after the Imanaga PPPD (P |
| 63. |
H Noshiro, E Nagai, S Shimizu, A Uchiyama, M Tanaka, Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-005-0175-9, 19, 12, 1592-1596, 2005.12, Background: Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer.
Methods: This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection.
Results: The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p Conclusions: According to this study, LADG with D2 lymph node dissection is feasible and provides several advantages similar to those of limited lymph node dissection (D1+alpha). Depending on surgeons' technical proficiency, LADG can be used with standard radical lymph node dissection for patients with gastric cancers.. |
| 64. |
Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M, Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer, Surg Endosc, 19, 12, 1592-1596, 2005.04, BACKGROUND: Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer. METHODS: This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection. RESULTS: The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p |
| 65. |
Nakashima N, Okamura K, Hahm JS, Kim YW, Mizushima H, Tatsumi H, Moon BI, Han HS, Park YJ, Lee JH, Youm Sk, Kang CH, Shimizu S, Telemedicine with digital video transport system in Asia-Pacific area, Proceeding of the 19th International Conference on Advanced Information Networking and Applications(AINA'05), 253-257, 2005.04. |
| 66. |
S Shimizu, M Tanaka, H Konomi, T Tamura, K Mizumoto, K Yamaguchi, Spleen-preserving laparoscopic distal pancreatectomy after division of the splenic vessels, JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES-PART A, 14, 3, 173-177, 2004.06, 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.. |
| 67. |
A Uchiyama, S Shimizu, H Murai, A Ohshima, H Konomi, Y Ogura, N Ishikawa, H Yamashita, S Matsumoto, S Kuroki, M Tanaka, Infrasternal mediastinoseopic surgery for anterior mediastinal masses, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-003-8191-0, 18, 5, 843-846, 2004.05, Background: Infrasternal mediastinoscopic surgery is a new alternative to the thoracoscopic approach for patients with anterior mediastinal masses.
Methods: We applied this technique to 18 thymectomies, one thymomectomy, and one cystectomy in a total of 20 patients with anterior mediastinal masses and then assessed the surgical results.
Results: Infrasternal mediastinoscopic surgery was accomplished in 18 of the 20 patients (90%). The pathological diagnoses included 13 Masaoka stage I thymomas, one stage II thymoma, two stage III thymomas, one thymic cyst, one pericardial cyst, one thymic granuloma, and one mature teratoma. Two patients with stage III thymoma required conversion to sternotomy, one for invasion into the innominate vein and the other for invasion into the pericardium. There was no surgically related mortality or complications in any patients.
Conclusion: Infrasternal mediastinoscopic surgery is safe and feasible for stage I thymoma and other benign tumors in the anterior mediastinum.. |
| 68. |
Kim YW, Kang CH, Youm SK, Shimizu S, Nakashima N, Noshiro H, Yi YS, You BS, Sung DH, Jeong SY, Chung KW, Baik YH, Lee WJ, Development of international medical teleconference system using advanced research network and digital video transport system(DVTS), J Kor Med Informatics, 10, 4, 397-406, 2004.04. |
| 69. |
Uchiyama A, Shimizu S, Nurai H, Ohshima A, Konomi H, Ogura Y, Ishikawa N, Yamashita H, Matsumoto S, Kuroki S, Tanaka M, Infrasternal mediastinoscopic surgery for anterior mediastinal masses, Surg Endosc, 18, 5, 843-846, 2004.04, BACKGROUND: Infrasternal mediastinoscopic surgery is a new alternative to the thoracoscopic approach for patients with anterior mediastinal masses. METHODS: We applied this technique to 18 thymectomies, one thymomectomy, and one cystectomy in a total of 20 patients with anterior mediastinal masses and then assessed the surgical results. RESULTS: Infrasternal mediastinoscopic surgery was accomplished in 18 of the 20 patients (90%). The pathological diagnoses included 13 Masaoka stage I thymomas, one stage II thymoma, two stage III thymomas, one thymic cyst, one pericardial cyst, one thymic granuloma, and one mature teratoma. Two patients with stage III thymoma required conversion to sternotomy, one for invasion into the innominate vein and the other for invasion into the pericardium. There was no surgically related mortality or complications in any patients. CONCLUSION: Infrasternal mediastinoscopic surgery is safe and feasible for stage I thymoma and other benign tumors in the anterior mediastinum.. |
| 70. |
Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K, Laparoscopic pancreatic surgery: current indications and surgical results, Surg Endosc., 18, 3, 402-406, 2004.04, BACKGROUND: Although minimally invasive surgery has achieved worldwide acceptance in various fields, laparoscopic surgery for pancreatic diseases has been reported only rarely. The purpose of this study was to evaluate the outcomes and feasibility of laparoscopic pancreatic surgery. METHODS: Fifteen patients, comprising eight men and seven women with an average age of 54 years, underwent laparoscopic pancreatic surgery. Distal pancreatectomy was indicated for solid tumors ( n = 4), cystic lesions ( n = 3), and chronic pancreatitis ( n = 2). Cystogastrostomy was performed for pseudocysts ( n = 4) and enucleation for insulinomas ( n = 2). The lesions varied in size from 1 to 9 cm (2.9 +/- 2.4 cm) and were located in the pancreatic head ( n = 2), body ( n = 3), or tail ( n = 10). For distal pancreatectomy, the splenic artery was divided and the parenchyma was transected with a linear stapler. Laparoscopic ultrasonography was used to determine the distance between the tumor and the main pancreatic duct for enucleation as well as to localize the lesion for distal pancreatectomy. Cystogastrostomy, 4.5 cm in length, was also performed with the linear stapler through the window of the lesser omentum. RESULTS: Mean operation time was 249 +/- 70 min (293 +/- 58 min in distal pancreatectomy, 185 +/- 14 min in enucleation, 204 +/- 50 min in cystogastrostomy), and mean blood loss was 138 +/- 184 g (213 +/- 227 g, 75 +/- 35 g, 38 +/- 48 g, respectively). Two distal pancreatectomies (13%) were converted to open surgery due to severe peripancreatic inflammation. There was no related mortality, but there were two cases (15%) of pancreatic fistula, one in a distal pancreatectomy case and the other in an enucleation case, and both were treated conservatively. CONCLUSIONS: Laparoscopic pancreatic surgery is safe and feasible for patients with benign tumors and cystic lesions.. |
| 71. |
Hahm JS, Shimizu S, Nakashima N, Byun TJ, Lee HL, Choi HS, Ko Y, Lee KG, Kim SI, Kim TE, Yun I, Park YI, Telemedicine with Digital Video Transport Sysytem, Kr.J. Gastroenterol, 43, 6, 370-375, 2004.04, BACKGROUND/AIMS: The growth of technology based on internet protocol has affected on the informatics and automatic controls of medical fields. The aim of this study was to establish the telemedical educational system by developing the high quality image transfer using the DVTS (digital video transmission system) on the high-speed internet network. METHODS: Using telemedicine, we were able to send surgical images not only to domestic areas but also to international area. Moreover, we could discuss the condition of surgical procedures in the operation room and seminar room. The Korean-Japan cable network (KJCN) was structured in the submarine between Busan and Fukuoka. On the other hand, the Korea advanced research network (KOREN) was used to connect between Busan and Seoul. To link the image between the Hanyang University Hospital in Seoul and Kyushu University Hospital in Japan, we started teleconference system and recorded image-streaming system with DVTS on the circumstance with IPv4 network. RESULTS: Two operative cases were transmitted successfully. We could keep enough bandwidth of 60 Mbps for two-line transmission. The quality of transmitted moving image had no frame loss with the rate 30 per second. The sound was also clear and the time delay was less than 0.3 sec. CONCLUSIONS: Our study has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video transmission over internet protocol. It is easy to perform, reliable, and also economical. Thus, it will be a promising tool in remote medicine for worldwide telemedical communication in the future.. |
| 72. |
S Shimizu, M Tanaka, H Konomi, K Mizumoto, K Yamaguchi, Laparoscopic pancreatic surgery - Current indications and surgical results, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-003-8164-3, 18, 3, 402-406, 2004.03, Background: Although minimally invasive surgery has achieved worldwide acceptance in various fields, laparoscopic surgery for pancreatic diseases has been reported only rarely. The purpose of this study was to evaluate the outcomes and feasibility of laparoscopic pancreatic surgery.
Methods: Fifteen patients, comprising eight men and seven women with an average age of 54 years, underwent laparoscopic pancreatic surgery. Distal pancreatectomy was indicated for solid tumors (n = 4), cystic lesions (n = 3), and chronic pancreatitis (n = 2). Cystogastrostomy was performed for pseudocysts (n = 4) and enucleation for insulinomas (n = 2). The lesions varied in size from 1 to 9 cm (2.9 +/- 2.4 cm) and were located in the pancreatic head (n = 2), body (n = 3), or tail (n = 10). For distal pancreatectomy, the splenic artery was divided and the parenchyma was transected with a linear stapler. Laparoscopic ultrasonography was used to determine the distance between the tumor and the main pancreatic duct for enucleation as well as to localize the lesion for distal pancreatectomy. Cystogastrostomy, 4.5 cm in length, was also performed with the linear stapler through the window of the lesser omentum.
Results: Mean operation time was 249 +/- 70 min (293 +/- 58 min in distal pancreatectomy, 185 +/- 14 min in enucleation, 204 +/- 50 min in cystogastrostomy), and mean blood loss was 138 +/- 184 g (213 +/- 227 g, 75 35 g, 38 +/- 48 g, respectively). Two distal pancreatectomies (13%) were converted to open surgery due to severe peripancreatic inflammation. There was no related mortality, but there were two cases (15%) of pancreatic fistula, one in a distal pancreatectomy case and the other in an enucleation case, and both were treated conservatively.
Conclusions: Laparoscopic pancreatic surgery is safe and feasible for patients with benign tumors and cystic lesions.. |
| 73. |
H Noshiro, S Shimizu, E Nagai, K Ohuchida, M Tanaka, Laparoscopy-assisted distal gastrectomy for early gastric cancer - Is it beneficial for patients of heavier weight?, ANNALS OF SURGERY, 10.1097/01.sla.0000094302.51616.2a, 238, 5, 680-685, 2003.11, Objective: In this retrospective review, we evaluated the advantages and disadvantages of LADG for patients of heavier weight with early gastric cancer.
Summary Background Data: LADG has been used to treat early gastric cancer. We and others have reported less operative blood loss, less pain, early recovery of bowel activity, early restart of oral intake, and a shorter hospital stay with LADG compared with a conventional open method. There is, however, little information on the advantages of LADG for obese patients with early gastric cancer.
Methods: Between January 1996 and March 2002, 76 patients with preoperatively diagnosed early gastric carcinoma underwent LADG in our department. We classified these patients into 2 groups on the basis of body mass index (BMI). Nineteen patients had a high-BMI (greater than or equal to 24.2 kg/m(2)), and 57 patients had a normal-BMI (Results: Extension of the minilaparotomic incision or conversion to laparotomy was needed in 6 (32%) of the 19 patients in the high-BMI group, whereas only 3 (5%) of 57 patients in the normal-BMI group required either. In the high-BMI group, Roux-en-Y anastomosis rather than Billroth I anastomosis was adopted more often than in the normal-BMI group, due to the difficulty of the reconstruction (58% versus 4%, P = 0.001). Significantly longer operative time (370 +/- 61 minutes versus 317 +/- 58 minutes, P = 0.015) and prolonged recovery of bowel activity (3.5 +/- 1.0 days versus 2.6 +/- 1.0 days, P = 0.007) were observed in the patients in the high-BMI group.
Conclusions: In the current study, LADG in patients of heavier weight was accompanied by more technical difficulties, and the disadvantages of longer operative time and delayed recovery of bowel activity was observed in patients of heavier weight. Heavier weight appears to be an ominous factor in the successful completion of LADG and should be considered in the decision to use LADG. There are still benefits of a decreased incidence of serious wound and hernia complications in successful cases.. |
| 74. |
S Shimizu, H Noshiro, E Nagai, A Uchiyama, M Tanaka, Laparoscopic gastric surgery in a Japanese institution: Analysis of the initial 100 procedures, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 10.1016/S1072-7515(03)00419-8, 197, 3, 372-378, 2003.09, BACKGROUND: Although endoscopic surgical procedures are popular in various fields, reports on its use in gastric surgical procedures are limited. This study was designed to review our initial experience with laparoscopic gastric surgical techniques to evaluate indications and surgical results.
STUDY DESIGN: We undertook a retrospective analysis of 100 patients (66 men and 34 women, mean age 63 years) who underwent laparoscopic gastric surgical procedures between 1995 and 2001. Procedures performed were distal gastrectomy (n = 76), wedge resection (n = 20), and intragastric surgical procedures (n = 4). Patients were divided into two groups according to the date of the procedure, from the earliest to the most recent.
RESULTS: There were 85 patients with gastric cancers, 14 submucosal tumors, and 1 duodenal ulcer. In 8 cases conversion was made to an open surgical procedure. Operation times required for distal gastrectomy, wedge resection, and intragastric surgical procedures were 330 +/- 69, 144 +/- 34, and 298 +/- 106 min, and blood loss was 354 +/- 251, 56 +/- 94, and 33 +/- 58 g, respectively. Complications included transient anastomotic stenosis (n = 5), leakage (n = 4), and bleeding (n = 1) after distal gastrectomy, and bleeding (n = 1) after intragastric surgical procedures. There were no complications after wedge resection. Comparing the first and second halves of the series, the percentage of distal gastrectomy significantly increased from 66% to 86% (p = 0.02) and the number of dissected lymph nodes at this procedure increased from 20 +/- 13 to 33 +/- 17 (p CONCLUSIONS: Laparoscopic gastric surgical procedures are safe and feasible for early gastric cancers and submucosal tumors. Technical advances in lymph node dissection have made distal gastrectomy a leading and increasingly popular laparoscopic procedure for early gastric cancer. (C) 2003 by the American College of Surgeons.. |
| 75. |
S Shimizu, H Noshiro, E Nagai, A Uchiyama, M Tanaka, Laparoscopic gastric surgery in a Japanese institution: Analysis of the initial 100 procedures, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 10.1016/S1072-7515(03)00419-8, 197, 3, 372-378, 2003.09, BACKGROUND: Although endoscopic surgical procedures are popular in various fields, reports on its use in gastric surgical procedures are limited. This study was designed to review our initial experience with laparoscopic gastric surgical techniques to evaluate indications and surgical results.
STUDY DESIGN: We undertook a retrospective analysis of 100 patients (66 men and 34 women, mean age 63 years) who underwent laparoscopic gastric surgical procedures between 1995 and 2001. Procedures performed were distal gastrectomy (n = 76), wedge resection (n = 20), and intragastric surgical procedures (n = 4). Patients were divided into two groups according to the date of the procedure, from the earliest to the most recent.
RESULTS: There were 85 patients with gastric cancers, 14 submucosal tumors, and 1 duodenal ulcer. In 8 cases conversion was made to an open surgical procedure. Operation times required for distal gastrectomy, wedge resection, and intragastric surgical procedures were 330 +/- 69, 144 +/- 34, and 298 +/- 106 min, and blood loss was 354 +/- 251, 56 +/- 94, and 33 +/- 58 g, respectively. Complications included transient anastomotic stenosis (n = 5), leakage (n = 4), and bleeding (n = 1) after distal gastrectomy, and bleeding (n = 1) after intragastric surgical procedures. There were no complications after wedge resection. Comparing the first and second halves of the series, the percentage of distal gastrectomy significantly increased from 66% to 86% (p = 0.02) and the number of dissected lymph nodes at this procedure increased from 20 +/- 13 to 33 +/- 17 (p CONCLUSIONS: Laparoscopic gastric surgical procedures are safe and feasible for early gastric cancers and submucosal tumors. Technical advances in lymph node dissection have made distal gastrectomy a leading and increasingly popular laparoscopic procedure for early gastric cancer. (C) 2003 by the American College of Surgeons.. |
| 76. |
K Shirahane, K Yamaguchi, T Ogawa, S Shimizu, K Yokohata, K Mizumoto, M Tanaka, Gallbladder duplication successfully removed laparoscopically using endoscopic nasobiliary tube, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 10.1007/s00464-002-4523-8, 17, 7, 2003.07, 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.. |
| 77. |
H Noshiro, K Chijiiwa, K Yamaguchi, S Shimizu, A Sugitani, M Tanaka, Factors affecting surgical outcome for gallbladder carcinoma, HEPATO-GASTROENTEROLOGY, 50, 52, 939-944, 2003.07, Background/Aims: The outcome of advanced gallbladder carcinoma is dismal despite aggressive surgery. The aim of this study was to evaluate the surgical outcome and prognostic factors for patients with gallbladder carcinoma and to identify patients who may benefit from radical surgery.
Methodology: Fifty-six patients who underwent surgical resection of gallbladder carcinoma were retrospectively reviewed. Their tumor markers, operative management, pathological factors and survival were analyzed.
Results: The serum carcinoembryonic antigen level was elevated in 9 of 51 patients (18%) with data available as was the serum carbohydrate antigen 199 level in 14 of 47 patients (30%). Univariate analysis showed that jaundice, serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels, the number, size, macroscopic type, and histological grade of the tumor, the depth of tumor invasion (pT), pathological stage, lymph node metastasis (pN), lymphatic invasion, vascular invasion, perineural infiltration, curability of lymph node dissection and surgical margins have prognostic significance for survival. Multivariate analysis revealed jaundice, high histological grade, pT3 or pT4, and surgical margins were independent prognostic factors for survival.
Conclusions: Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels are potential predictors and informative for survival There are still difficulties to treat gallbladder carcinoma infiltrating beyond subserosa or revealing jaundice.. |
| 78. |
H Noshiro, K Chijiiwa, K Yamaguchi, S Shimizu, A Sugitani, M Tanaka, Factors affecting surgical outcome for gallbladder carcinoma, HEPATO-GASTROENTEROLOGY, 50, 52, 939-944, 2003.07, Background/Aims: The outcome of advanced gallbladder carcinoma is dismal despite aggressive surgery. The aim of this study was to evaluate the surgical outcome and prognostic factors for patients with gallbladder carcinoma and to identify patients who may benefit from radical surgery.
Methodology: Fifty-six patients who underwent surgical resection of gallbladder carcinoma were retrospectively reviewed. Their tumor markers, operative management, pathological factors and survival were analyzed.
Results: The serum carcinoembryonic antigen level was elevated in 9 of 51 patients (18%) with data available as was the serum carbohydrate antigen 199 level in 14 of 47 patients (30%). Univariate analysis showed that jaundice, serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels, the number, size, macroscopic type, and histological grade of the tumor, the depth of tumor invasion (pT), pathological stage, lymph node metastasis (pN), lymphatic invasion, vascular invasion, perineural infiltration, curability of lymph node dissection and surgical margins have prognostic significance for survival. Multivariate analysis revealed jaundice, high histological grade, pT3 or pT4, and surgical margins were independent prognostic factors for survival.
Conclusions: Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels are potential predictors and informative for survival There are still difficulties to treat gallbladder carcinoma infiltrating beyond subserosa or revealing jaundice.. |
| 79. |
Noshiro H, Chijiiwa K, Yamaguchi K, Shimizu S, Sugitani A, Tanaka M, Factors affecting surgical outcome for gallbladder carcinoma, Hepatogastroenterology, 50, 52, 939-944, 2003.04, BACKGROUND/AIMS: The outcome of advanced gallbladder carcinoma is dismal despite aggressive surgery. The aim of this study was to evaluate the surgical outcome and prognostic factors for patients with gallbladder carcinoma and to identify patients who may benefit from radical surgery. METHODOLOGY: Fifty-six patients who underwent surgical resection of gallbladder carcinoma were retrospectively reviewed. Their tumor markers, operative management, pathological factors and survival were analyzed. RESULTS: The serum carcinoembryonic antigen level was elevated in 9 of 51 patients (18%) with data available as was the serum carbohydrate antigen 19-9 level in 14 of 47 patients (30%). Univariate analysis showed that jaundice, serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels, the number, size, macroscopic type, and histological grade of the tumor, the depth of tumor invasion (pT), pathological stage, lymph node metastasis (pN), lymphatic invasion, vascular invasion, perineural infiltration, curability of lymph node dissection and surgical margins have prognostic significance for survival. Multivariate analysis revealed jaundice, high histological grade, pT3 or pT4, and surgical margins were independent prognostic factors for survival. CONCLUSIONS: Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels are potential predictors and informative for survival. There are still difficulties to treat gallbladder carcinoma infiltrating beyond subserosa or revealing jaundice.. |
| 80. |
Shimizu S, Noshiro H, Nagai E, Uchiyama A, Tanaka M, Laparoscopic gastric surgery in a Japanese institution: analysis of the initial 100 procedures, Am Coll Surg, 197, 3, 372-378, 2003.04, BACKGROUND: Although endoscopic surgical procedures are popular in various fields, reports on its use in gastric surgical procedures are limited. This study was designed to review our initial experience with laparoscopic gastric surgical techniques to evaluate indications and surgical results. STUDY DESIGN: We undertook a retrospective analysis of 100 patients (66 men and 34 women, mean age 63 years) who underwent laparoscopic gastric surgical procedures between 1995 and 2001. Procedures performed were distal gastrectomy (n = 76), wedge resection (n = 20), and intragastric surgical procedures (n = 4). Patients were divided into two groups according to the date of the procedure, from the earliest to the most recent. RESULTS: There were 85 patients with gastric cancers, 14 submucosal tumors, and 1 duodenal ulcer. In 8 cases conversion was made to an open surgical procedure. Operation times required for distal gastrectomy, wedge resection, and intragastric surgical procedures were 330 +/- 69, 144 +/- 34, and 298 +/- 106 min, and blood loss was 354 +/- 251, 56 +/- 94, and 33 +/- 58 g, respectively. Complications included transient anastomotic stenosis (n = 5), leakage (n = 4), and bleeding (n = 1) after distal gastrectomy, and bleeding (n = 1) after intragastric surgical procedures. There were no complications after wedge resection. Comparing the first and second halves of the series, the percentage of distal gastrectomy significantly increased from 66% to 86% (p = 0.02) and the number of dissected lymph nodes at this procedure increased from 20 +/- 13 to 33 +/- 17 (p |
| 81. |
Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M, Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight?, Ann Surg., 238, 5, 680-685, 2003.04, OBJECTIVE: In this retrospective review, we evaluated the advantages and disadvantages of LADG for patients of heavier weight with early gastric cancer. SUMMARY BACKGROUND DATA: LADG has been used to treat early gastric cancer. We and others have reported less operative blood loss, less pain, early recovery of bowel activity, early restart of oral intake, and a shorter hospital stay with LADG compared with a conventional open method. There is, however, little information on the advantages of LADG for obese patients with early gastric cancer. METHODS: Between January 1996 and March 2002, 76 patients with preoperatively diagnosed early gastric carcinoma underwent LADG in our department. We classified these patients into 2 groups on the basis of body mass index (BMI). Nineteen patients had a high-BMI (>/= 24.2 kg/m2), and 57 patients had a normal-BMI ( |
| 82. |
Shimizu S, Hahm JS, Kim YW, Park YJ, Choi HS, Youm SW, Kang CH, Lee JW, Okamura K, Kawamoto M, Nakashima N, Tanaka M, Telemedicine with digital video transport system over the Korea-Japan cable network, J Kr Med Info, 9, S322-S326, 2003.04. |
| 83. |
A Ohshima, S Simizu, M Okido, K Shimada, S Kuroki, M Tanaka, Endoscopic neck surgery: current status for thyroid and parathyroid diseases, BIOMEDICINE & PHARMACOTHERAPY, 56, 48S-52S, 2002.11, During the last 3 years, 59 patients underwent endoscopic neck surgery. We started the video-assisted neck surgery with the gasless skin-lifting method for benign thyroid and parathyroid diseases to avoid complications of carbon dioxide (CO2) insufflation. Hemithyroidectomy was performed for benign thyroid tumors and subtotal thyroidectomy was selected for Graves' disease. Parathyroid adenomas were extirpated for primary hyperparathyroidism with precise preoperative localization by imaging modalities. In order to obtain a better visual field and to improve the cosmetic results, we have adopted the complete endoscopic method via breast approach with low CO2 insufflation pressure since August 2001. An intraoperative parathormone assay was introduced recently to confirm the complete removal of parathyroid adenomas. Both gasless and insufflation methods are feasible for endoscopic neck surgery with excellent cosmetic results. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.. |
| 84. |
Chijiiwa K, Ohtani K, Noshiro H, Yamasaki T, Shimizu S, Yamaguchi K, Tanaka M, Cholangiocellular carcinoma depending on the kind of intrahepatic calculi in patients with hepatolithiasis., Hepatogastroenterology., 49, 43, 96-99, 2002.04, BACKGROUND/AIMS: Association of cholangiocellular carcinoma in patients with hepatolithiasis has been reported. However, its incidence depending on the kind of stones is obscure. The aim was to examine the association rate of cholangiocellular carcinoma in patients with hepatolithiasis with a special reference to the kind of intrahepatic stones. METHODOLOGY: One hundred and thirty-nine patients with hepatolithiasis who have been treated from 1973 to 1997 were retrospectively reviewed to examine the characteristics of cholangiocellular carcinoma. The type and location of intrahepatic calculi were analyzed. RESULTS: Cholangiocellular carcinoma was found in 8 of 139 patients, the incidence being 5.8%. The incidence of carcinoma was more than twice in patients whose stones were located in intrahepatic bile duct only (9.3%; 5/54) than in those located in both intrahepatic and extrahepatic bile duct (3.5%; 3/85). Of 121 patients excluding 18 whose calculi were not available for classification, the kind of intrahepatic calculi was brown pigment in 106 patients (87.6%), cholesterol in 10 (8.3%), black pigment in 4, and fatty acid calcium in one. Cholangiocellular carcinoma was associated in 3 (2.8%) of 106 patients with brown pigment stones, 3 (30%) of 10 with cholesterol stones, in one with fatty acid calcium stones, and one patient whose stone was not available for analysis. The association rate of cancer was significantly (P |
| 85. |
Ohshima A, Shimizu S, Okido M, Shimda K, Kuroki S, Tanaka M, Endoscopic neck surgery: current status for thyroid and parathyroid diseases., Biomed. Pharmacother., 56, suppl, 48s-52s, 2002.04, During the last 3 years, 59 patients underwent endoscopic neck surgery. We started the video-assisted neck surgery with the gasless skin-lifting method for benign thyroid and parathyroid diseases to avoid complications of carbon dioxide (CO2) insufflation. Hemithyroidectomy was performed for benign thyroid tumors and subtotal thyroidectomy was selected for Graves' disease. Parathyroid adenomas were extirpated for primary hyperparathyroidism with precise preoperative localization by imaging modalities. In order to obtain a better visual field and to improve the cosmetic results, we have adopted the complete endoscopic method via breast approach with low CO2 insufflation pressure since August 2001. An intraoperative parathormone assay was introduced recently to confirm the complete removal of parathyroid adenomas. Both gasless and insufflation methods are feasible for endoscopic neck surgery with excellent cosmetic results.. |
| 86. |
Hotokezaka M, Shimizu S, Mibu R, Doi F, Mizumoto K, Tanaka M, Laparoscopic surgery for early colon cancer, Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons, 5, 2, 97-102, 2002.04. |
| 87. |
Shimizu S, Noshiro H, Nagai E, Uchiyama A, Mizumoto K, Tanaka M, Laparoscopic wedge resection of gastric submucosal tumors, Dig. Surg., 19, 3, 169-173, 2002.04, BACKGROUND/AIMS: The purpose of this study was to evaluate the clinical utility of laparoscopic surgery for gastric submucosal tumor. METHODS: The records of 11 patients who underwent laparoscopic wedge resection (LR group) for gastric submucosal tumors were reviewed and compared with those of 8 patients who underwent open surgery (OS group). RESULTS: Mean operation time was 145 +/- 43 min in the LR group and 127 +/- 33 min in the OS group (p = 0.301). Mean blood loss was 97 +/- 107 and 107 +/- 47 g, respectively (p = 0.387). Patients in the LR group began walking 1.4 +/- 0.7 days after surgery, which was significantly earlier than those in the OS group (2.7 +/- 1.3 days, p = 0.021). The first flatus (1.5 +/- 0.5 vs. 3.1 +/- 0.6 days, respectively, p = 0.0004) and resumption of oral food intake (3.0 +/- 1.7 vs. 4.3 +/- 0.9 days, respectively, p = 0.020) were also earlier in the LR group. White blood cell count on the first postoperative day was lower (7,000 +/- 2,100 vs. 11,900 +/- 3,580/mm(3), respectively, p = 0.004) in the LR group than in the OS group, and the duration of fever (>38.0 degrees C; 0.1 +/- 0.3 vs. 0.9 +/- 0.8 days, respectively, p = 0.014) and the period of postoperative hospitalization (13.2 +/- 3.7 vs. 20.8 +/- 6.1 days, respectively, p = 0.014) were significantly shorter in the LR group than in the OS group. No complications occurred in either group. CONCLUSION: Laparoscopic surgery was superior to open surgery in terms of postoperative recovery time with comparable operation time and blood loss. Laparoscopic wedge resection is a promising surgical alternative for the treatment of gastric submucosal tumors. Copyright 2002 S. Karger AG, Basel. |
| 88. |
K Chijiiwa, K Ohtani, H Noshiro, T Yamasaki, S Shimizu, K Yamaguchi, M Tanaka, Cholangiocellular carcinoma depending on the kind of intrahepatic calculi in patients with hepatolithiasis, HEPATO-GASTROENTEROLOGY, 49, 43, 96-99, 2002.01, Background/Aims: Association of cholangiocellular carcinoma in patients with hepatolithiasis has been reported. However, its incidence depending on the kind of stones is obscure. The aim was to examine the association rate of cholangiocellular carcinoma in patients with hepatolithiasis with a special reference to the kind of intrahepatic stones.
Methodology: One hundred and thirty-nine patients with hepatolithiasis who have been treated from 1973 to 1997 were retrospectively reviewed to examine the characteristics of cholangiocellular carcinoma. The type and location of intrahepatic calculi were analyzed.
Results: Cholangiocellular carcinoma was found in 8 of 139 patients, the incidence being 5.8%. The incidence of carcinoma was more than twice in patients whose stones were located in intrahepatic bile duct only (9.3%; 5/54) than in those located in both intrahepatic and extrahepatic bile duct (3.5%; 3/85). Of 121 patients excluding 18 whose calculi were not available for classification, the kind of intrahepatic calculi was brown pigment in 106 patients (87.6%), cholesterol in 10 (8.3%), black pigment in 4, and fatty acid calcium in one. Cholangiocellular carcinoma was associated in 3 (2.8%) of 106 patients with brown pigment stones, 3 (30%) of 10 with cholesterol stones, in one with fatty acid calcium stones, and one patient whose stone was not available for analysis. The association rate of cancer was significantly (PConclusions: An early and attentive evaluation for the possible presence of cholangiocellular carcinoma is mandatory not only in patients with brown pigment stones but also in those with intrahepatic cholesterol stones.. |
| 89. |
A Uchiyama, S Shimizu, H Murai, S Kuroki, M Okido, M Tanaka, Infrasternal mediastinoscopic thymectomy in myasthenia gravis: Surgical results in 23 patients, ANNALS OF THORACIC SURGERY, 10.1016/S0003-4975(01)03210-6, 72, 6, 1902-1905, 2001.12, Background. Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass.
Methods. We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores.
Results. Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent.
Conclusions. Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis. (C) 2001 by The Society of Thoracic Surgeons.. |
| 90. |
K Otani, S Shimizu, K Chijiiwa, K Yamaguchi, H Noshiro, M Tanaka, Immunohistochemical detection of 8-hydroxy-2 '-deoxyguanosine in gallbladder epithelium of patients with pancreaticobiliary maljunction, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 13, 11, 1363-1369, 2001.11, Objectives Pancreaticobiliary maljunction, an anomalous union of the pancreatic duct with the common bile duct, is a risk factor for biliary carcinoma. We hypothesized that, in patients with pancreaticobiliary maljunction, persistent regurgitation of pancreatic juice into the biliary tract induces oxidative DNA damage. We assessed the expression of an oxidative DNA base-modified product, 8-hydroxy-2'-deoxyguanosine, in gallbladder epithelium.
Design Eleven noncancerous gallbladders from patients with pancreaticobiliary maljunction, 12 gallbladder carcinomas from patients without pancreaticobiliary maljunction and 14 noncancerous gallbladders from patients without pancreaticobiliary maljunction (control) were studied.
Methods Immunohistochemistry was performed for 4-hydroxy-2-nonenal-modified protein (as a marker for lipid peroxidation), 8-hydroxy-2'-deoxyguanosine and p53 gene product.
Results Stronger cytoplasmic staining of 4-hydroxy-2-nonenal-modified protein was observed in the gallbladder epithelium from patients with pancreaticobiliary maljunction than in epithelium from gallbladder cancer patients or from control subjects with normal gallbladders. Clear, strong nuclear staining of 8-hydroxy-2'-deoxyguanosine was observed in the gallbladder epithelial cells from patients with pancreaticobiliary maljunction. Densitometric quantitation revealed significantly higher expression of 8-hydroxy-2'-deoxyguanosine in gallbladder epithelial cells from patients with pancreaticobiliary maljunction (index 27.3 +/- 3.1) than in cells from patients with gallbladder carcinoma (11.4 +/- 1.5; P Conclusions These results suggest that reactive oxygen species are produced in the gallbladder of patients with pancreaticobiliary maljunction and that oxidative DNA injury is related to carcinogenesis in these patients. (C) 2001 Lippincott Williams & Wilkins.. |
| 91. |
M Okido, S Shimizu, S Kuroki, K Yokohata, A Uchiyama, M Tanaka, Video-assisted parathyroidectomy for primary hyperparathyroidism - A new approach involving a skin-lifting method, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, 10.1007/s004640080049, 15, 10, 1120-1123, 2001.10, Background: Recent advances have allowed the performance of parathyroidectomy as an endoscopic procedure. Carbon dioxide (CO2) insufflation can be used to create a working space in the anterior neck, but it has been associated with a number of complications. We have devised a skin-lifting method to overcome these problems.
Methods: Eleven consecutive patients underwent video-assisted parathyroidectomy. Preoperative imaging revealed a solitary adenoma in all 11 cases. A 3-cm oblique incision was made below the clavicle, and a 5-mm. incision was made on the lateral neck. After the skin was lifted, video-assisted parathyroidectomy was performed.
Results: Surgery required 186 +/- 50 min. No conversions to conventional cervicotomy were needed. Levels of serum calcium and intact parathormone decreased significantly in all patients on postoperative day 1. Laryngeal recurrent nerve paresis and seroma were noted in one patient each.
Conclusions: Our procedure eliminates any potential CO2 problems and offers the advantages of direct manipulation and improved cosmesis. Endoscopic parathyroidectomy should be considered a viable option for the surgical treatment of a solitary adenoma.. |
| 92. |
N Yamanaka, S Shimizu, K Chijiiwa, K Nishiyama, H Noshiro, K Yamaguchi, M Tanaka, Hepatectomy and marked retention of indocyanine green and bromosulfophtalein, HEPATO-GASTROENTEROLOGY, 48, 41, 1450-1452, 2001.09, 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 15min was as high as 72.0% and the bromosulfophtalein retention rate at 45min 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 15min 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.. |
| 93. |
M Tanaka, S Shimizu, K Mizumoto, K Yokohata, K Chijiiwa, K Yamaguchi, U Ogawa, Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, 10.1007/s004640000380, 15, 6, 545-551, 2001.06, Laparoscopic surgery for a congenital choledochal cyst was accomplished in five of eight adult patients for whom it was attempted (63%). Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy using a laparoscopic sewing instrument facilitated the procedure.
Background: Congenital choledochal cyst is a good indication for laparoscopic surgery. However, only two case reports are available at this writing.
Methods: Eight adult patients, ages 19 to 61 years (mean, 32.6 years), underwent laparoscopically assisted resection of the choledochal cyst and Roux-en-Y hepaticojejunostomy.
Results: The whole procedure was accomplished in five patients (63%). The duration of the procedure ranged from 525 to 680 min (average. 616 min). Open conversion in three patients was necessitated by severance of a small common hepatic duct because of disorientation caused by previous laparoscopic cholecystectomy, electrocautery injury to the common channel distal to the anomalous pancreaticobiliary junction, or heavy adhesion around the cyst secondary to recent severe cholangitis. Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy using a laparoscopic sewing instrument facilitated the procedure.
Conclusions: Laparoscopically assisted resection of the choledochal cyst and hepaticojejunostomy are technically feasible and deserve further clinical trials.. |
| 94. |
Ogawa T, Shimizu S, Mizumoto K, Uchiyama A, Yokohata K, Chijiiwa K, Tanaka M, Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement., J. Hepatobiliary Pancreat. Surg., 8, 2, 158-160, 2001.04, To evaluate the benefits and safety of laparoscopic cholecystectomy (LC) in patients with cardiac valve replacement (which frequently leads to cholelithiasis), 12 patients with cholelithiasis associated with cardiac valve replacement were studied. The patients were divided into two groups, of 6 patients each, according to the type of operation performed, open cholecystectomy (OC) or LC. The postoperative course was monitored with respect to laboratory data on postoperative days (POD) 1, 3, and 7. The mean duration of operation, blood loss, days to food resumption, length of hospital stay, and morbidity were compared between the two groups. Significant differences (P |
| 95. |
Otani K, Shimizu S, Chijiiwa K, Yamaguchi K, Noshiro H, Tanaka M, Immunohistochemical detection of 8-hydroxy-2'-deoxyguanosine in gallbladder epithelium of patients with pancreaticobiliary maljunction, Eur. J. Gastroenterol. Hepatol., 13, 11, 1363-1369, 2001.04, OBJECTIVES: Pancreaticobiliary maljunction, an anomalous union of the pancreatic duct with the common bile duct, is a risk factor for biliary carcinoma. We hypothesized that, in patients with pancreaticobiliary maljunction, persistent regurgitation of pancreatic juice into the biliary tract induces oxidative DNA damage. We assessed the expression of an oxidative DNA base-modified product, 8-hydroxy-2'-deoxyguanosine, in gallbladder epithelium. DESIGN: Eleven noncancerous gallbladders from patients with pancreaticobiliary maljunction, 12 gallbladder carcinomas from patients without pancreaticobiliary maljunction and 14 noncancerous gallbladders from patients without pancreaticobiliary maljunction (control) were studied. METHODS: Immunohistochemistry was performed for 4-hydroxy-2-nonenal-modified protein (as a marker for lipid peroxidation), 8-hydroxy-2'-deoxyguanosine and p53 gene product. RESULTS: Stronger cytoplasmic staining of 4-hydroxy-2-nonenal-modified protein was observed in the gallbladder epithelium from patients with pancreaticobiliary maljunction than in epithelium from gallbladder cancer patients or from control subjects with normal gallbladders. Clear, strong nuclear staining of 8-hydroxy-2'-deoxyguanosine was observed in the gallbladder epithelial cells from patients with pancreaticobiliary maljunction. Densitometric quantitation revealed significantly higher expression of 8-hydroxy-2'-deoxyguanosine in gallbladder epithelial cells from patients with pancreaticobiliary maljunction (index 27.3 +/- 3.1) than in cells from patients with gallbladder carcinoma (11.4 +/- 1.5; P |
| 96. |
Otani K, Shimizu S, Chijiiwa K, Yamaguchi K, Kuroki S, Tanaka M, Increased urinary excretion of bilirubin oxidative metabolites in septic patients: a new marker for oxidative stress in vivo., J Surg Res, 96, 1, 44-49, 2001.04, BACKGROUND:
Bilirubin oxidative metabolites (BOMs) are generated from bilirubin as a result of its scavenging action against free radicals. During sepsis, excess amounts of free radicals are produced, and they play an important role in the pathophysiological process. We studied whether urinary excretion of BOMs would increase under septic conditions in humans and compared BOM levels with other well-established clinical parameters of inflammation.
METHODS:
In 19 septic patients and 28 nonseptic control patients, the BOM concentrations in urine were measured by enzyme-linked immunosorbent assay with an anti-bilirubin antibody.
RESULTS:
Urinary BOM levels in septic patients were much higher than those in control patients (21.6 +/- 2.5 vs 1.4 +/- 0.4 micromol/g creatinine, P
CONCLUSIONS:
These results demonstrated a urinary increase in BOMs in septic patients. This increase indicates that urinary BOM level is a possible marker for continuous monitoring of sepsis severity in clinical practice.. |
| 97. |
Uchiyama A, Shimizu S, Murai H, Kuroki S, Okido M, Tanaka M, Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients., Ann. Thorac. Surg., 72, 6, 1902-1905, 2001.04, BACKGROUND: Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass. METHODS: We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores. RESULTS: Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent. CONCLUSIONS: Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.. |
| 98. |
Tanaka M, Shimizu S, Mizumoto K, Yokohata K, Chijiiwa K, Yamaguchi K, Ogawa Y, Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction., Surg. Endosc., 15, 6, 545-552, 2001.04, Laparoscopic surgery for a congenital choledochal cyst was accomplished in five of eight adult patients for whom it was attempted (63%). Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy using a laparoscopic sewing instrument facilitated the procedure. BACKGROUND: Congenital choledochal cyst is a good indication for laparoscopic surgery. However, only two case reports are available at this writing. METHODS: Eight adult patients, ages 19 to 61 years (mean, 32.6 years), underwent laparoscopically assisted resection of the choledochal cyst and Roux-en-Y hepaticojejunostomy. RESULTS: The whole procedure was accomplished in five patients (63%). The duration of the procedure ranged from 525 to 680 min (average, 616 min). Open conversion in three patients was necessitated by severance of a small common hepatic duct because of disorientation caused by previous laparoscopic cholecystectomy, electrocautery injury to the common channel distal to the anomalous pancreaticobiliary junction, or heavy adhesion around the cyst secondary to recent severe cholangitis. Creation of a Roux-en-Y jejunal limb by midline minilaparotomy and hepaticojejunostomy using a laparoscopic sewing instrument facilitated the procedure. CONCLUSIONS: Laparoscopically assisted resection of the choledochal cyst and hepaticojejunostomy are technically feasible and deserve further clinical trials.. |
| 99. |
Okido M, Shimizu S, Kuroki S, Yokohata K, Uchiyama A, Tanaka M, Video-assisted parathyroidectomy for primary hyperparathyroidism: a new approach involving a skin-lifting method., Surg. Endosc., 15, 10, 1120-1123, 2001.04, BACKGROUND: Recent advances have allowed the performance of parathyroidectomy as an endoscopic procedure. Carbon dioxide (CO2) insufflation can be used to create a working space in the anterior neck, but it has been associated with a number of complications. We have devised a skin-lifting method to overcome these problems. METHODS: Eleven consecutive patients underwent video-assisted parathyroidectomy. Preoperative imaging revealed a solitary adenoma in all 11 cases. A 3-cm oblique incision was made below the clavicle, and a 5-mm incision was made on the lateral neck. After the skin was lifted, video-assisted parathyroidectomy was performed. RESULTS: Surgery required 186 +/- 50 min. No conversions to conventional cervicotomy were needed. Levels of serum calcium and intact parathormone decreased significantly in all patients on postoperative day 1. Laryngeal recurrent nerve paresis and seroma were noted in one patient each. CONCLUSIONS: Our procedure eliminates any potential CO2 problems and offers the advantages of direct manipulation and improved cosmesis. Endoscopic parathyroidectomy should be considered a viable option for the surgical treatment of a solitary adenoma.
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.. |
| 100. |
K Otani, S Shimizu, K Chijiiwa, K Yamaguchi, H Noshiro, M Tanaka, Immunohistochemical detection of 8-hydroxy-2 '-deoxyguanosine in gallbladder epithelium of patients with pancreaticobiliary maljunction, GASTROENTEROLOGY, 10.1097/00042737-200111000-00016, 120, 5, A575-A575, 2001.04. |
| 101. |
K Otani, S Shimizu, K Chijiiwa, K Yamaguchi, S Kuroki, M Tanaka, Increased urinary excretion of bilirubin oxidative metabolites in septic patients: A new marker for oxidative stress in vivo, JOURNAL OF SURGICAL RESEARCH, 10.1006/jsre.2000.6036, 96, 1, 44-49, 2001.03, Background. Bilirubin oxidative metabolites (BOMs) are generated from bilirubin as a result of its scavenging action against free radicals. During sepsis, excess amounts of free radicals are produced, and they play an important role in the pathophysiological process. We studied whether urinary excretion of BOMs would increase under septic conditions in humans and compared BOM levels with other well-established clinical parameters of inflammation.
Methods. In 19 septic patients and 28 nonseptic control patients, the BOM concentrations in urine were measured by enzyme-linked immunosorbent assay with an anti-bilirubin antibody.
Results. Urinary BOM levels in septic patients were much higher than those in control patients (21.6 +/- 2.5 vs 1.4 +/- 0.4 mu mol/g creatinine, P Conclusions. These results demonstrated a urinary increase in BOMs in septic patients. This increase indicates that urinary BOM: level is a possible marker for continuous monitoring of sepsis severity in clinical practice. (C) 2001 Academic Press.. |
| 102. |
K Otani, S Shimizu, K Chijiiwa, T Morisaki, T Yamaguchi, K Yamaguchi, S Kuroki, M Tanaka, Administration of bacterial lipopolysaccharide to rats induces heme oxygenase-l and formation of antioxidant bilirubin in the intestinal mucosa, DIGESTIVE DISEASES AND SCIENCES, 10.1023/A:1005626622203, 45, 12, 2313-2319, 2000.12, Heme oxygenase (HO)-1, the rate-limiting enzyme in heme degradation, is induced by oxidative stress and its major end product, bilirubin, is a potent physiological antioxidant. We studied the induction of HO-1 and bilirubin production in intestinal mucosa using a rat model of sepsis. E. coli lipopolysaccharide was administered intraperitonealy to male Wistar rats and intestinal mucosa was harvested. Intestinal lipid peroxides increased significantly at 1 hy and peaked at 170% of the control value at 5 hr. GSH significantly decreased at 3 hr, reaching the nadir of 50% of the control value at 5 hr. HO-1 mRNA was maximally induced fivefold at 3 hr and HO-1 protein maximally increased to 10 times the control value at 7.5 hr. Both bilirubin and bilirubin oxidative metabolites were maximally increased at 10 hr, to 4.3 and 3.7 times the control value, respectively. These data suggest that oxidative stress in sepsis quickly induces HO-1 in intestinal mucosa and that subsequent production of bilirubin works as an antioxidant. The small intestinal mucose is an active participant in the general response to sepsis.. |
| 103. |
Otani K, Shimizu S, Chijiiwa K, Morisaki T, Yamaguchi T, Yamaguchi K, Kuroki S, Tanaka M, Administration of bacterial lipopolysaccharide to rats induces heme oxygenase-1 and formation of antioxidant bilirubin in the intestinal mucosa, Dig. Dis. Sci., 45, 12, 2313-2319, 2000.04, Heme oxygenase (HO)-1, the rate-limiting enzyme in heme degradation, is induced by oxidative stress and its major end product, bilirubin, is a potent physiological antioxidant. We studied the induction of HO-1 and bilirubin production in intestinal mucosa using a rat model of sepsis. E. coli lipopolysaccharide was administered intraperitonealy to male Wistar rats and intestinal mucosa was harvested. Intestinal lipid peroxides increased significantly at 1 hr and peaked at 170% of the control value at 5 hr. GSH significantly decreased at 3 hr, reaching the nadir of 50% of the control value at 5 hr. HO-1 mRNA was maximally induced fivefold at 3 hr and HO-1 protein maximally increased to 10 times the control value at 7.5 hr. Both bilirubin and bilirubin oxidative metabolites were maximally increased at 10 hr, to 4.3 and 3.7 times the control value, respectively. These data suggest that oxidative stress in sepsis quickly induces HO-1 in intestinal mucosa and that subsequent production of bilirubin works as an antioxidant. The small intestinal mucosa is an active participant in the general response to sepsis.. |
| 104. |
Shimizu S, Uchiyama A, Mizumoto K, Morisaki T, Nakamura Katsuya, Shimura H, Tanaka M, Laparoscopically assisted distal gastrectomy for early gastric cancer: Is it superior to open surgery?, Surg. Endosc., 14, 1, 27-31, 2000.04, BACKGROUND: The purpose of this study was to compare clinical outcomes between laparoscopically assisted and open distal gastrectomy for early gastric cancer. METHODS: The records of 21 patients who underwent laparoscopically assisted distal gastrectomy (LG) for preoperative diagnosis of intramucosal gastric carcinoma between January 1996 and August 1998 were reviewed and compared with those of 31 open distal gastrectomy patients during the same period. RESULTS: Age, gender, and size and histologic differentiation of the lesions were matched. Those located at the body of the stomach (p = 0.011) and those macroscopically depressed (p = 0.049) were subjected more frequently to open surgery. Laparoscopically assisted gastrectomy required significantly longer operative time (p |
| 105. |
Yamaguchi K, Noshiro H, Shimizu S, Morisaki T, Chijiiwa K, Tanaka M, Long-term and short-term survivors after pancreatectomy for pancreatic cancer, Int. Surg., 85, 1, 71-76, 2000.04, Out of 63 Japanese patients with pancreatic carcinoma who underwent surgical resection, 8 short-term survivors who died within 3 months after resection and 6 long-term survivors who were alive for more than 3 years after resection were compared regarding 26 clinicopathological parameters. The 8 short-term survivors were significantly older than the 6 long-term survivors (63.7 versus 47.8 years, P = 0.0099). The mean peripheral lymphocyte count was significantly smaller in the short-term survivors than in the long-term survivors (1,212 versus 2,115 /microl, P = 0.0459). Operative blood loss was significantly larger in the short-term survivors than in the long-term survivors (2,393 versus 1,043 g, P = 0.0157). The surgical margin was affected by malignant cells in 7 of the 8 short-term survivors, but in only 2 of the 6 long-term survivors (P = 0.0362). Of the 8 short-term survivors, 5 were in comprehensive stage IV and 3 in stage III, while 3 of the 6 long-term survivors were in stage III, two in stage II, and one in stage I (P = 0.0487). All the 8 short-term survivors were of the comprehensive curability C, while 3 of the 6 long-term survivors were of A, one B and the other two C (P = 0.0239). Multiple regression analysis of these 6 profound factors showed that the peripheral lymphocyte count was an independent significant parameter to differentiate the short-term and long-term survivors. These findings suggest that, although the aggressive nature of pancreatic cancer has been accepted, the clinical course after pancreatectomy would also depend upon the immunological state of the patient.. |
| 106. |
S Shimizu, A Uchiyama, K Mizumoto, T Morisaki, K Nakamura, H Shimura, M Tanaka, Laparoscopically assisted distal gastrectomy for early gastric cancer - Is it superior to open surgery?, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, 10.1007/s004649900005, 14, 1, 27-31, 2000.01, Background: The purpose of this study was to compare clinical outcomes between laparoscopically assisted and open distal gastrectomy for early gastric cancer.
Methods: The records of 21 patients who underwent laparoscopically ;assisted distal gastrectomy (LG) for preoperative diagnosis of intramucosal gastric carcinoma between January 1996 and August 1998 were reviewed and compared with those of 31 open distal gastrectomy patients during the same period.
Results: Age, gender, and size and histologic differentiation of the lesions were matched. Those located at the body of the Stomach (p = 0.011) and those macroscopically depressed (p = 0.049) were subjected more frequently to open surgery. Laparoscopically assisted gastrectomy required significantly longer operative time (p Conclusions: Although LG requires longer surgical time, this retrospective study suggests that it is superior to open surgery in terms of faster postoperative recoveries, shorter hospital stays, and cosmetic outcomes.. |
| 107. |
K Yamaguchi, H Noshiro, S Shimizu, T Morisaki, K Chijiiwa, M Tanaka, Long-term and short-term survivors after pancreatectomy for pancreatic cancer, INTERNATIONAL SURGERY, 85, 1, 71-76, 2000.01, Out of 63 Japanese patients with pancreatic carcinoma who underwent surgical resection, 8 short-term survivors who died within 3 months after resection and 6 long-term survivors who were alive for more than 3 years after resection were compared regarding 26 clinicopathological parameters. The 8 short-term survivors were significantly older than the 6 long-term survivors (63.7 versus 47.8 years, P = 0.0099). The mean peripheral lymphocyte count was significantly smaller in the short-term survivors than in the longterm survivors (1,212 versus 2,115/mu l, P = 0.0459). Operative blood loss was significantly larger in the short-term survivors than in the long-term survivors (2,393 versus 1,043 g, P = 0.0157). The surgical margin was affected by malignant cells in 7 of the 8 short-term survivors, but in only 2 of the 6 long-term survivors (P = 0.0362). Of the 8 short-term survivors, 5 were in comprehensive stage IV and 3 in stage III, while 3 of the 6 long-term survivors were in stage III, two in stage II, and one in stage I (P = 0.0487). All the 8 shortterm survivors were of the comprehensive curability C, while 3 of the 6 long-term survivors were of A, one B and the other two C (P = 0.0239). Multiple regression analysis of these 6 profound factors showed that the peripheral lymphocyte count was an independent significant parameter to differentiate the short-term and long-term survivors. These findings suggest that, although the aggressive nature of pancreatic cancer has been accepted, the clinical course after pancreatectomy would also depend upon the immunological state of the patient.. |
| 108. |
K Yamaguchi, S Shimizu, K Yokohata, H Noshiro, K Chijiiwa, M Tanaka, Pancreatic carcinoma: Reappraisal of surgical experiences in one Japanese University Hospital, HEPATO-GASTROENTEROLOGY, 46, 30, 3257-3262, 1999.11, BACKGROUND/AIMS: Even with the recent advances of diagnostic and therapeutic modalities, the clinical course of patients with pancreatic cancer remains dismal. Five-year survivors are rare, cure is exceptional, and the operative mortality rate is significant. In this study, univariate and multivariate retrospective analyses were performed with regard to the prognostic parameters to clarify the problems in order to improve survival rates after surgical resection.
METHODOLOGY: Clinical courses of 60 Japanese patients with pancreatic cancer who underwent surgical resection in one Japanese University Hospital were reviewed to scrutinize the influence of 22 prognostic (9 host-side, 5 operative and 8 tumor-side) factors. A special reference was made on intraoperative radiation therapy, portal vein resection, lymph node dissection around the aorta, and conventional pancreatoduodenectomy versus pylorus-preserving pancreatoduodenectomy in pancreatic head cancer.
RESULTS: Univariate analysis showed that operation time, comprehensive stage, comprehensive curability, histopathologic grade of differentiation and histopathologic venous invasion were statistically significant factors. Multivariate Cox regression analysis regarding the 5 profound factors showed that histopathologic grade of differentiation and histopathologic venous invasion were independently significant factors. The 1- and 3-year survival rates of 18 patients with intra-operative radiation therapy were 56% and 39%, while those of 36 patients without intra-operative radiation therapy were 54% and 18%. The 1- and 3-year survival rates of 43 patients with PV0,1 were 58% and 28%, while those of 17 with PV2,3 were 50% and 10%. Three patients with PV2 in I and PV3 in 2 underwent a portal vein resection. Two of the 3 patients were dead from liver metastasis 3 and 5 months after a surgical resection of liver metastasis. The 1- and 3-year survival rates of 17 with radical lymph node dissection including the para-aortic area were 61% and 26%, while those of 27 without para-aortic lymph node dissection were 66% and 25%. Of the 17 patients, the para-aortic lymph node was metastasized in 1 patient. The 1- and 3-year survival rates of 31 with pancreatoduodenectomy were 53% and 18%, while the 1- and 3-year survival rates with pylorus preserving pancreatoduodenectomy were 68% and 28%, respectively.
CONCLUSIONS: These findings suggest that the clinical outcome after surgical resection of pancreatic carcinoma depends on tumor-side factors not operative parameters or host-side parameters. The clinical course seems to rely upon the nature of pancreatic cancer not upon the operative procedure.. |
| 109. |
K Otani, S Shimizu, K Chijiiwa, T Ogawa, T Morisaki, A Sugitani, K Yamaguchi, M Tanaka, Comparison of treatments for hepatolithiasis: Hepatic resection versus cholangioscopic lithotomy, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 10.1016/S1072-7515(99)00109-X, 189, 2, 177-182, 1999.08, Background: Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported.
Study Design: Of 86 patients with hepatolithiasis admitted to our institution between 1980 and 1996, we reviewed 54 patients: 26 who underwent hepatic resection and 28 who underwent PTCSL. Five patients who underwent postoperative cholangioscopic lithotomy were included in the former group. The remainder of the hepatolithiasis patients were not treated by hepatic resection or PTCSL and, therefore, were excluded from this study. Hepatic resections were mainly indicated for left-sided localized intrahepatic calculi, atrophic liver, and possible presence of cholangiocellular carcinoma. PTCSL was performed for right-sided, bilateral or recurrent stones at an average of 6 treatments (rang 1 to 20 treatments) for each patient. There were no differences between the two groups in terms of gender or age. The recurrence rate of stones and longterm prognosis were analyzed using the Kaplan-Meier method, and other clinical factors listed below were statistically compared.
Results: The rate of complete removal of stones was similarly high in each group (96.2% in the hepatic resection group versus 96.4% in the PTCSL group). The complication (38.5% versus 21.4%) and 5-year survival (85.6% versus 100%) rates were comparable. Remaining bile duct stricture (18.2% versus 60.9%, p Conclusions: Hepatic resection, when combined with postoperative cholangioscopic lithotomy, is a preferable treatment for left-sided stones with strictures and bilateral stones. (J Am Coll Surg 1999;189:177-182. (C) 1999 by the American College of Surgeons).. |
| 110. |
K Yamaguchi, K Mizumoto, H Noshiro, A Sugitani, S Shimizu, K Chijiiwa, M Tanaka, Pancreatic carcinoma: INTERNATIONAL SURGERY, 84, 3, 213-219, 1999.07, Background: Despite recent progress in diagnosis and therapy, the clinical course: of patients with pancreatic carcinoma remains dismal. There have been several approaches to improve the clinical course of patients with pancreatic carcinoma, namely: (i) detection of small pancreatic carcinoma; (ii) radical resection with retroperitoneal clearance and portal vein resection; (iii) multidisciplinary therapy including chemoradiation; and so forth.
Methods: In this series, eight Japanese patients with small pancreatic carcinoma measuring less than 2 cm in diameter (including two with non-invasive carcinoma and one with minimally invasive carcinoma) and 53 with larger pancreatic carcinoma were reviewed to find the diagnostic and therapeutic clues to improve the clinical course of patients with pancreatic carcinoma.
Results: Lymphatic (ly) and perineural (pn) permeation was significantly more frequent and extensive in the 53 patients with large pancreatic carcinoma than in the eight with small pancreatic carcinoma (ly 0/1/2/3:3/24/18/8 versus 5/2/1/0, P = 0.0284; pn 0/1/2/3:4/29/14/6 versus 3/2/3/0, P = 0.0491). The surgical margin was affected by malignant cells in 18 (34%) of the 53 patients with large carcinoma but none (0%) of the eight with small carcinoma (P = 0.0004). The comprehensive stage was significantly earlier in the eight with small carcinoma than in the 53 with large carcinoma (comprehensive stage I/II/III/IV:4/0/3/1 versus 0/3/26/24, P Conclusions: These findings suggest that surgical resection frequently cures patients with small pancreatic carcinoma but more effective adjuvant therapy should be developed to control lymphatic permeation, venous invasion or perineural infiltration in surgical resection of large pancreatic carcinoma. The supreme goal is to detect noninvasive or minimally invasive pancreatic carcinoma with a dilatation of the main or branch pancreatic duct as a diagnostic aid.. |
| 111. |
Kozaki N, Shimizu S, Chijiiwa K, Yamaguchi K, Kuroki S, Shimoharada K, Yamaguchi T, Nakajima H, Tanaka M, Bilirubin as an anti-oxidant for surgical stress：a preliminary report of bilirubin oxidative metabolites, HPB Surg., 11, 4, 241-248, 1999.04, BACKGROUND: Bilirubin has been recognized as an anti-oxidant. The purpose of this study was to examine whether bilirubin would act as an antioxidant for surgical stress in humans. MATERIALS AND METHODS: Serum bilirubin and urinary bilirubin oxidative metabolites (BOM) were measured in 96 patients who underwent surgery. The antioxidant activity of bilirubin was assessed using BOM measured by enzyme-linked immunosorbent assay with an anti-bilirubin monoclonal antibody. RESULTS: Serum bilirubin levels increased after surgery in all 96 patients (p |
| 112. |
Otani K, Shimizu S, Chijiiwa K, Ogawa T, Morisaki T, Sugitani A, Yamaguchi K, Tanaka M, Comparison of treatments for hepatolithiasis: hepatic resection versus cholangioscopic lithotomy., J. Am. Coll. Surg., 189, 2, 177-182, 1999.04, BACKGROUND: Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported. STUDY DESIGN: Of 86 patients with hepatolithiasis admitted to our institution between 1980 and 1996, we reviewed 54 patients: 26 who underwent hepatic resection and 28 who underwent PTCSL. Five patients who underwent postoperative cholangioscopic lithotomy were included in the former group. The remainder of the hepatolithiasis patients were not treated by hepatic resection or PTCSL and, therefore, were excluded from this study. Hepatic resections were mainly indicated for left-sided localized intrahepatic calculi, atrophic liver, and possible presence of cholangiocellular carcinoma. PTCSL was performed for right-sided, bilateral or recurrent stones at an average of 6 treatments (range 1 to 20 treatments) for each patient. There were no differences between the two groups in terms of gender or age. The recurrence rate of stones and longterm prognosis were analyzed using the Kaplan-Meier method, and other clinical factors listed below were statistically compared. RESULTS: The rate of complete removal of stones was similarly high in each group (96.2% in the hepatic resection group versus 96.4% in the PTCSL group). The complication (38.5% versus 21.4%) and 5-year survival (85.6% versus 100%) rates were comparable. Remaining bile duct stricture (18.2% versus 60.9%, p |
| 113. |
Chijiiwa K, Nishiyama K, Takeshima M, Mizumoto K, Noshiro H, Shimizu S, Yamaguchi K, Tanaka M, Diffuse bile duct carcinoma treated by major hepatectomy and pancreatoduodenectomy with the aid of pre-operative portal vein embolization. Report of two cases., Hepatogastroenterology., 46, 27, 1634-1638, 1999.04, 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.. |
| 114. |
Yamaguchi K, Chijiiwa K, Shimizu S, Yokohata K, Morisaki T, Yonemasu H. Tanaka M, Intraductal papillary neoplasm of the pancreas：A clinical review of 13 benign and four malignant tumours., Eur. J. Surg., 165, 3, 223-229, 1999.04, OBJECTIVE: To assess of the grade of malignancy of intraductal papillary neoplasm of the pancreas (IPNP). DESIGN: Retrospective analysis. SETTING: University hospital, Japan. PATIENTS: 8 men and 9 women, mean age 67 years, with IPNP. RESULTS: 12 lesions were in the head of the pancreas, two in the body and three in the tail. There were no differences in the age and sex of the patients, the presence of diabetes mellitus or history of pancreatitis, serum concentrations of carcinoembryonic antigen, and CA 19-9, pancreatic function test, and the site of origin of benign and malignant IPNP. The mean diameter of the main pancreatic duct was 16 mm in the four malignant tumours, but 6 mm in the 13 benign IPNP (p |
| 115. |
Yamaguchi K, Mizumoto K, Noshiro H, Sugitani A, Shimizu S, Chijiiwa K, Tanaka M, Pancreatic carcinoma: 2 cm in size., Int Surg, 84, 3, 213-219, 1999.04, BACKGROUND:
Despite recent progress in diagnosis and therapy, the clinical course of patients with pancreatic carcinoma remains dismal. There have been several approaches to improve the clinical course of patients with pancreatic carcinoma, namely: (i) detection of small pancreatic carcinoma; (ii) radical resection with retroperitoneal clearance and portal vein resection; (iii) multidisciplinary therapy including chemoradiation; and so forth.
METHODS:
In this series, eight Japanese patients with small pancreatic carcinoma measuring less than 2 cm in diameter (including two with non-invasive carcinoma and one with minimally invasive carcinoma) and 53 with larger pancreatic carcinoma were reviewed to find the diagnostic and therapeutic clues to improve the clinical course of patients with pancreatic carcinoma.
RESULTS:
Lymphatic (ly) and perineural (pn) permeation was significantly more frequent and extensive in the 53 patients with large pancreatic carcinoma than in the eight with small pancreatic carcinoma (ly 0/1/2/3:3/24/18/8 versus 5/2/1/0, P = 0.0284; pn 011/2/3:4/29/14/6 versus 3/2/3/0, P = 0.0491). The surgical margin was affected by malignant cells in 18 (34%) of the 53 patients with large carcinoma but none (0%) of the eight with small carcinoma (P = 0.0004). The comprehensive stage was significantly earlier in the eight with small carcinoma than in the 53 with large carcinoma (comprehensive stage I/II/II/IV:4/0/3/1 versus 0/3/26/24, P
CONCLUSIONS:
These findings suggest that surgical resection frequently cures patients with small pancreatic carcinoma but more effective adjuvant therapy should be developed to control lymphatic permeation, venous invasion or perineural infiltration in surgical resection of large pancreatic carcinoma. The supreme goal is to detect non-invasive or minimally invasive pancreatic carcinoma with a dilatation of the main or branch pancreatic duct as a diagnostic aid.. |
| 116. |
Yamaguchi K, Shimizu S, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M, Pancreatic carcinoma：Reappraisal of surgical experiences in one Japanese university hospital, Hepatogastroenterology, 46, 30, 3257-3262, 1999.04, BACKGROUND/AIMS: Even with the recent advances of diagnostic and therapeutic modalities, the clinical course of patients with pancreatic cancer remains dismal. Five-year survivors are rare, cure is exceptional, and the operative mortality rate is significant. In this study, univariate and multivariate retrospective analyses were performed with regard to the prognostic parameters to clarify the problems in order to improve survival rates after surgical resection. METHODOLOGY: Clinical courses of 60 Japanese patients with pancreatic cancer who underwent surgical resection in one Japanese University Hospital were reviewed to scrutinize the influence of 22 prognostic (9 host-side, 5 operative and 8 tumor-side) factors. A special reference was made on intra-operative radiation therapy, portal vein resection, lymph node dissection around the aorta, and conventional pancreatoduodenectomy versus pylorus-preserving pancreatoduodenectomy in pancreatic head cancer. RESULTS: Univariate analysis showed that operation time, comprehensive stage, comprehensive curability, histopathologic grade of differentiation and histopathologic venous invasion were statistically significant factors. Multivariate Cox regression analysis regarding the 5 profound factors showed that histopathologic grade of differentiation and histopathologic venous invasion were independently significant factors. The 1- and 3-year survival rates of 18 patients with intra-operative radiation therapy were 56% and 39%, while those of 36 patients without intra-operative radiation therapy were 54% and 18%. The 1- and 3-year survival rates of 43 patients with PV0,1 were 58% and 28%, while those of 17 with PV2,3 were 50% and 10%. Three patients with PV2 in 1 and PV3 in 2 underwent a portal vein resection. Two of the 3 patients were dead from liver metastasis 3 and 5 months after a surgical resection of liver metastasis. The 1- and 3-year survival rates of 17 with radical lymph node dissection including the para-aortic area were 61% and 26%, while those of 27 without para-aortic lymph node dissection were 66% and 25%. Of the 17 patients, the para-aortic lymph node was metastasized in 1 patient. The 1- and 3-year survival rates of 31 with pancreatoduodenectomy were 53% and 18%, while the 1- and 3-year survival rates with pylorus preserving pancreatoduodenectomy were 68% and 28%, respectively. CONCLUSIONS: These findings suggest that the clinical outcome after surgical resection of pancreatic carcinoma depends on tumor-side factors not operative parameters or host-side parameters. The clinical course seems to rely upon the nature of pancreatic cancer not upon the operative procedure.". |
| 117. |
Nakatsuka A, Yamaguchi K, Shimizu S, Yokohata K, Morisaki T, Chijiiwa K, Tanaka M, Positive washing cytology in patients with pancreatic cancer indicates a contraindication of pancreatectomy., Int. J. Surg. Invest., 1, 4, 311-317, 1999.04, BACKGROUND: Although peritoneal washing cytology has been widely used in the field of gynecology, it has not been performed so frequently in patients with pancreatic cancer. Only a few papers have reported surgical implications of peritoneal washing cytology. MATERIALS AND METHODS: We reviewed results of peritoneal washing cytology performed immediately after laparotomy in 50 Japanese patients with pancreatic cancer. The 50 patients were divided into two groups according to the results of cytology. Clinicopathological findings were compared between these two groups. RESULTS: Cytology of peritoneal washing was positive in 13 (26%) of the 50 patients. Nine of the 13 patients had no visible peritoneal dissemination. There were no significant differences regarding the age, tumor size and serum level of the carcinoembryonic antigen. Moderately to poorly differentiated adenocarcinoma and perineural invasion (ne3) and lymphatic permeation (ly3) of marked degree were more frequent in the positive group than in the negative group (p |
| 118. |
Ogawa T, Shimizu S, Morisaki T, Sugitani A, Nakatsuka A, Mizumoto K, Yamaguchi K, Chijiiwa K, Tanaka M, The role of percutaneous transhepatic abscess drainage for liver abscess, J. Hepatobiliary Pancreat. Surg., 6, 3, 263-266, 1999.04, To evaluate the efficacy of percutaneous transhepatic abscess drainage (PTAD) as an initial choice of treatment for liver abscess, the medical records of 28 patients with liver abscess were retrospectively analyzed. The patients were predominantly men (23 of 28) with a mean age of 59 years (range, 19-86 years). Their chief complaints were fever (86%), right hypochondralgia (32%), and jaundice (11%). Fifteen of the 28 patients (54%) had hepatobiliary and pancreatic carcinoma, and 31% had postoperative liver abscess. PTAD was performed in 23 patients and surgical drainage in 5. The overall success rate for PTAD was 83%. The success rate for PTAD for patients with multiple abscesses was 83% (5 of 6), compared with a success rate of 82% (14 of 17) for patients with solitary abscess. The prognostic factors for survival were cancer and sepsis and the mortality rate for patients with cancer was 40% (6 of 15) while the mortality rate for patients with sepsis was 56% (5 of 9). As a complication of drainage, 1 patient (4%) in the PTAD group had pleural abscess due to the transpleural puncture. Our findings support the use of PTAD as the primary treatment for liver abscess, as it is safe and effective irrespective of the number of abscesses and the patient's condition.". |
| 119. |
K Yamaguchi, K Chijiiwa, S Shimizu, K Yokohata, T Morisaki, H Yonemasu, M Tanaka, Intraductal papillary neoplasm of the pancreas: a clinical review of 13 benign and four malignant tumours, EUROPEAN JOURNAL OF SURGERY, 10.1080/110241599750007081, 165, 3, 223-229, 1999.03, Objective: To assess of the grade of malignancy of intraductal papillary neoplasm of the pancreas (IPNP).
Design: Retrospective analysis.
Setting: University hospital, Japan.
Patients: 8 men and 9 women, mean age 67 years, with IPNP.
Results: 12 lesions were in the head of the pancreas, two in the body and three in the tail. There were no differences in the age and sex of the patients, the presence of diabetes mellitus or history of pancreatitis, serum concentrations of carcinoembryonic antigen, and CA 19-9, pancreatic function test, and the site of origin of benign and malignant IPNP. The mean diameter of the main pancreatic duct was 16 mm in the four malignant tumours, but 6 mm in the 13 benign IPNP (p Conclusions: IPNP is a unique variant of pancreatic exocrine neoplasm with a good prognosis after resection. The diameter of the main pancreatic duct, size of the mural nodule, and site of the tumour (main pancreatic duct or branch duct) differ significantly between benign and malignant tumours.. |
| 120. |
N Sato, K Yamaguchi, K Yokohata, S Shimizu, T Morisaki, K Chijiiwa, M Tanaka, Short-term and long-term pancreatic exocrine and endocrine functions after pancreatectomy, DIGESTIVE DISEASES AND SCIENCES, 10.1023/A:1026686824173, 43, 12, 2616-2621, 1998.12, Exocrine and endocrine functions of the pancreas were assessed in 44 Japanese patients who underwent pancreatic head resection. Functions were analyzed comparing levels before surgery, at a short-term follow-up (3 mm, |
| 121. |
K Shimoharada, S Inoue, M Nakahara, N Kanzaki, S Shimizu, DC Kang, N Hamasaki, S Kinoshita, Urine concentration of biopyrrins: A new marker for oxidative stress in vivo, CLINICAL CHEMISTRY, 44, 12, 2554-2555, 1998.12. |
| 122. |
N Sato, K Yamaguchi, K Yokohata, S Shimizu, T Morisaki, K Mizumoto, K Chijiiwa, M Tanaka, Preoperative exocrine pancreatic function predicts risk of leakage of pancreaticojejunostomy, SURGERY, 124, 5, 871-876, 1998.11, Background. The objective of this study was to clarify the relationship between preoperative exocrine pancreatic function and pancreatic anastomotic leakage after pancreatectomy.
Methods. Fifty-five patients who underwent proximal pancreatectomy with pancreaticojejunostomy were reviewed with regard to preoperative exocrine pancreatic function, size of the main pancreatic duct, post operative pancreatic juice output, and pancreaticojejunostomy leakage.
Results. There were 32 patients with a normal value at the preoperative N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion lest (> 70 %) and 23 with a low BT-PABA value (less than or equal to 70 %). The greatest diameter of the main pancreatic duct in the group with normal BT-PABA results was significantly smaller than that in the group with low, BT-PABA results (4.6 +/- 2.7 mm vs 7.1 +/- 4.2 mm; P Conclusions. Patients with normal exocrine pancreatic function produce a larger amount of pancreatic juice than those with low exocrine pancreatic function and have a potential risk of anastomotic leakage after pancreatectomy.. |
| 123. |
N Sato, K Yamaguchi, S Shimizu, T Morisaki, K Yokohata, K Chijiiwa, M Tanaka, Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy - The importance of early angiography, ARCHIVES OF SURGERY, 10.1001/archsurg.133.10.1099, 133, 10, 1099-1102, 1998.10, Objective: To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy.
Design: Retrospective case series.
Setting: University hospital; 6-year period between January 1992 and December 1997.
Patients and Intervention: Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization.
Results: Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique.
Conclusions: An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.. |
| 124. |
N Sato, K Yamaguchi, K Yokohata, S Shimizu, K Chijiiwa, M Tanaka, Long-term morphological changes of remnant pancreas and biliary tree after pancreatoduodenectomy on CT (vol 83, pg 136, 1998), INTERNATIONAL SURGERY, 83, 4, 368-368, 1998.10. |
| 125. |
N Kozaki, S Shimizu, H Higashijima, S Kuroki, H Yamashita, K Yamaguchi, K Chijiiwa, M Tanaka, Significance of serum delta-bilirubin in patients with obstructive jaundice, JOURNAL OF SURGICAL RESEARCH, 10.1006/jsre.1998.5357, 79, 1, 61-65, 1998.09, Background. Delta-bilirubin is a bilirubin covalently bound with albumin, which is nontoxic and excreted neither in urine nor in bile. We previously reported that the percentage of delta-bilirubin increased after biliary drainage and that the rapidly excretable bilirubin fraction (total minus delta-bilirubin) was a better parameter to predict the effectiveness of biliary decompression in the dog model. The aim of the present study was to elucidate whether it is applicable to humans.
Materials and Methods. The serum bilirubin concentration was measured and its fractions were analyzed by high-performance liquid chromatography in 22 patients with obstructive jaundice before and after biliary drainage. In addition, the patients were subgrouped into good and poor drainage groups according to the decline index of serum bilirubin to examine the significance of delta-bilirubin.
Results. The concentration of total bilirubin decreased from 14.1 mg/dl before biliary drainage to 5.4 mg/dl 28 days after drainage. During this period, the percentage of conjugated bilirubin steeply declined from 47.1 to 8.8% and that of excretable bilirubin from 63.4 to 28.6%. In contrast, the proportion of serum delta-bilirubin increased from 36.6 to 71.4%. There was an inverse correlation between percentage of delta-bilirubin and total bilirubin concentration (r = -0.69, P Conclusions. The increase in the percentage of serum delta-bilirubin indicates an effectiveness of biliary drainage in man. An analysis of serum delta-bilirubin for 7 days can distinguish the good drainage patients from the poor drainage patients. (C) 1998 Academic Press.. |
| 126. |
N Sato, K Yamaguchi, K Yokohata, S Shimizu, H Noshiro, K Mizumoto, K Chijiiwa, M Tanaka, Changes in pancreatic function after pancreatoduodenectomy, AMERICAN JOURNAL OF SURGERY, 10.1016/S0002-9610(98)00105-6, 176, 1, 59-61, 1998.07, BACKGROUND: The objective of this study was to compare the alterations in pancreatic function after pancreatoduodenectomy between malignant and benign diseases.
METHODS: In 34 patients who underwent pancreatoduodenectomy for pariampullary cancer (malignant group; n = 18) and benign pancreatic disorders (benign group; n = 16), exocrine and endocrine functions were analyzed before surgery, at a short-term period (less than or equal to 2 months), and at a long-term period (>12 months) after surgery. Assessment was based on the BT-PABA excretion test, fasting blood sugar level, and oral glucose tolerance test.
RESULTS: Compared with the preoperative level, urinary PABA excretion rate in the malignant group significantly decreased on short-term follow-up but recovered on long-term follow-up. However, that in the benign group increased on long-term follow-up without showing a shortterm decline. Diabetes mellitus was present in 11 (61 %) of the 18 patients in the malignant group and 6 (38%) of the 16 in the benign group before surgery. Glucose tolerance improved in 6 (55%) of the 11 patients in the malignant group but in only 1 (17%) of the 6 in the benign group shortly after surgery. In the benign group, 3 (30%) of 10 patients with normal preoperative glucose tolerance became diabetic after surgery, while no patient in the malignant group developed diabetes on short-term follow-up.
CONCLUSIONS: Surgeons should pay attention to exocrine pancreatic function in patients with a periampullary cancer and to glucose metabolism in patients with benign disease over the shortterm period after pancreatoduodenectomy. (C) 1998 by Excerpta Medica, Inc.. |
| 127. |
Yamaguchi K, Chijiiwa K, Shimizu S, Yokohata K, Tsuneyoshi M, Tanaka M, Anatomical limit of extended cholecystectomy for gallbladder carcinoma involving the neck of the gallbladder., Int. Surg., 83, 1, 21-23, 1998.04, BACKGROUND: Extended cholecystectomy is the common operation for gallbladder carcinoma. When extended cholecystectomy is performed, the liver bed can be generously resected from the fundus to the body of the gallbladder; however, the thickness of the liver parenchyma to be removed is limited to the neck of the gallbladder. There have been few reports providing convincing data with regard to how thick the liver can be anatomically resected by extended cholecystectomy. METHODS: The thickness of the liver tissue actually resected at the time of extended cholecystectomy and that potentially resected by extended cholecystectomy were measured in 24 clinical and 25 autopsy cases, respectively, to assess the anatomical limit of extended cholecystectomy. RESULTS: The mean anatomical distances from the neck of the gallbladder to the right hepatic duct and to the bifurcation of the anterior and posterior branch of the right hepatic duct were only 1.6 and 5.9 mm, respectively. The distance from the gallbladder to the bifurcation of the superior and inferior branch of the right anterior hepatic duct, and to the root of the right anterior inferior hepatic duct were 11.2 mm2, and 12.8 mm3, respectively (123:p |
| 128. |
Ogawa T, Shimizu S, Mizumoto K, Shimura H, Tanaka M, Benefits of laparoscopic cholecystectomy in patients with cardiac valve replacement., 6th World Congress. Endosc. Surg., 497-500, 1998.04, Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement.
J Hepatobiliary Pancreat Surg. 2001;8(2):158-60.. |
| 129. |
Kuga H, Yamaguchi K, Shimizu S, Yokohata K, Chijiiwa K, Tanaka M, Carcinoma of the pancreas associated with anomalous junction of pancreaticobiliary tracts: report of two cases and review of the literature., J Hepatobiliary Pancreat Surg, 5, 1, 113-116, 1998.04, We report two cases of carcinoma of the pancreas with anomalous junction of the pancreaticobiliary tracts. A 71-year-old Japanese woman had obstructive jaundice. Ultrasonography showed a hypoechoic mass in the pancreatic head and computed tomography demonstrated a low-density nodule in the pancreatic head. Endoscopic retrograde cholangiopancreatography displayed a double duct sign and an anomalous junction of the pancreaticobiliary tracts. The patient underwent a pancreatoduodenectomy. The histopathologic diagnosis of the resected specimen was adenocarcinoma of the pancreatic head. A 56-year-old Japanese man also developed obstructive jaundice. Ultrasonography and computed tomography showed a huge mass almost replacing the whole pancreas and involving the superior mesenteric artery, splenic artery, splenic vein, and portal vein. Multiple hepatic metastases and peritoneal dissemination were present. Endoscopic retrograde cholangiopancreatography demonstrated an anomalous junction of the pancreaticobiliary tracts. The patient died of hemorrhage from esophageal varices. We discuss the relationship between the anomalous junction of the pancreaticobiliary tracts and pancreatic carcinoma.. |
| 130. |
Sato N, Yamaguchi K, Yokohata K, Shimizu S, Noshiro H, Mizumoto K, Chijiiwa K, Tanaka M, Changes in pancreatic function after pancreatoduodenectomy., Am. J. Surg., 176, 1, 59-61, 1998.04, BACKGROUND: The objective of this study was to compare the alterations in pancreatic function after pancreatoduodenectomy between malignant and benign diseases. METHODS: In 34 patients who underwent pancreatoduodenectomy for pariampullary cancer (malignant group; n = 18) and benign pancreatic disorders (benign group; n = 16), exocrine and endocrine functions were analyzed before surgery, at a short-term period (12 months) after surgery. Assessment was based on the BT-PABA excretion test, fasting blood sugar level, and oral glucose tolerance test. RESULTS: Compared with the preoperative level, urinary PABA excretion rate in the malignant group significantly decreased on short-term follow-up but recovered on long-term follow-up. However, that in the benign group increased on long-term follow-up without showing a short-term decline. Diabetes mellitus was present in 11 (61%) of the 18 patients in the malignant group and 6 (38%) of the 16 in the benign group before surgery. Glucose tolerance improved in 6 (55%) of the 11 patients in the malignant group but in only 1 (17%) of the 6 in the benign group shortly after surgery. In the benign group, 3 (30%) of 10 patients with normal preoperative glucose tolerance became diabetic after surgery, while no patient in the malignant group developed diabetes on short-term follow-up. CONCLUSIONS: Surgeons should pay attention to exocrine pancreatic function in patients with a periampullary cancer and to glucose metabolism in patients with benign disease over the short-term period after pancreatoduodenectomy.". |
| 131. |
Sato N, Yamaguchi K, Shimizu S, Morisaki T, Yokohata K, Chijiiwa K, Tanaka M, Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography., Arch Surg, 133, 10, 1099-1102, 1998.04, OBJECTIVE:
To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy.
DESIGN:
Retrospective case series.
SETTING:
University hospital; 6-year period between January 1992 and December 1997.
PATIENTS AND INTERVENTION:
Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization.
RESULTS:
Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique.
CONCLUSIONS:
An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.. |
| 132. |
Yamaguchi K, Chijiiwa K, Shimizu S, Yokohata K, Morisaki T, Tanaka M, Comparison of endoscopic retrograde and magnetic resonance cholangiopancreatography in the surgical diagnosis of pancreatic diseases., Am. J. Surg., 175, 3, 203-208, 1998.04, BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a newly developing noninvasive examination of the biliopancreatic trees. Roles of MRCP in the diagnosis of pancreatic diseases have not been scrutinized. METHODS: Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP were reviewed in 52 Japanese patients with various pancreatic diseases and 6 patients with normal pancreas to compare their diagnostic usefulness and limitation. RESULTS: In those with normal pancreas, only the main pancreatic duct was visualized by MRCP, while both the main pancreatic and branch ducts were clearly delineated by ERCP. In 3 patients with serous cystadenoma, the tumor was not visualized by ERCP, whereas it was visible as a high-intensity mass on MRCP. Of 18 patients with a ""mucin hypersecreting"" tumor of the branch type, MRCP demonstrated cystically dilated branch ducts in all, while ERCP failed to visualize the dilated ducts in 6 patients. However, the details of the cystic lesions (mural nodule, communication with the main pancreatic duct) were more exactly demonstrated by ERCP than MRCP. In 5 patients with a mucin hypersecreting tumor of the main pancreatic duct type, the dilated main pancreatic duct and the presence of mural nodules were similarly demonstrated both by ERCP and MRCP. In 12 patients with pancreatic adenocarcinoma, indirect findings were similarly demonstrated both by ERCP and MRCP, ie, stenosis (4 patients) and obstruction (8) together with dilation of the main pancreatic duct (9). In 3 patients, the center of the mass showed high intensity on MRCP, suggesting the secondary change of pancreatic carcinoma. In 8 patients with obstruction of the main pancreatic duct due to carcinoma, the distal pancreatic duct was visualized by MRCP but not by ERCP. In 9 patients who had undergone pylorus-preserving or standard pancreatoduodenectomy, follow-up MRCP was obtainable in all examined and displayed the main pancreatic duct. CONCLUSIONS: MRCP plays a complementary role in the surgical diagnosis of pancreatic disorders and is especially useful to examine the pancreatic duct after pancreatoduodenectomy.". |
| 133. |
Yoshida J, Chijiiwa K, Shimizu S, Sato H, Tanaka M, Hepatolithiasis:Outcome of cholangioscopic lithotomy and dilation of bile duct stricture., Surgery, 123, 4, 421-426, 1998.04, BACKGROUND: Cholangioscopic lithotomy (CSL) for hepatolithiasis, a minimally invasive procedure, has a place in complicated or recurrent hepatolithiasis. CSL itself, however, carries inherent risk for recurrence. We analyzed follow-up data after CSL for primary or repeat hepatolithiasis to determine the frequency of recurrence. METHODS: This retrospective analysis includes 21 patients with hepatolithiasis admitted to the hospital from September 1992 to December 1995 who underwent CSL. Through a percutaneous biliary drainage route, cholangioscopy was inserted to remove calculi with basket forceps or electrohydraulic lithotripter. Stenotic ducts, defined as less than 2 mm in diameter, were dilated with silicone rubber stenting or a balloon dilator. RESULTS: Ten patients were treated for primary hepatolithiasis and 11 for repeat hepatolithiasis. Of the patients with primary hepatolithiasis, one died of complications and the other nine patients underwent complete lithotomy. Among 11 patients who had repeat hepatolithiasis, four had undergone hepatectomy for hepatolithiasis and two previous CSLs; 10 patients (91%) underwent complete lithotomy. During the follow-up, four (40%) of the 10 patients with biliary stenosis at the time of cholangioscopic treatment showed recurrent calculi, whereas all eight patients without stricture had uneventful courses. Of the 19 patients who underwent complete lithotomy, calculi recurred in four (21%), three cases of which recurred less than 1 year after CSL. CONCLUSIONS: Against hepatolithiasis of primary and postoperative repeat cases, CSL can allow complete lithotomy. The bile duct stricture, however, carries a high risk for recurrent calculi; hence, permanent relief of stricture is mandatory.". |
| 134. |
Yamaguchi K, Chijiiwa K, Shimizu S, Yokohata K, Tanaka M, Litmus paper helps detect potential pancreatoenterostomy leakage., Am. J. Surg., 175, 3, 227-228, 1998.04, BACKGROUND: Leakage of pancreatoenterostomy remains as a serious and fatal complication after pancreatectomy. Several risk factors have been reported, ie, normal pancreatic parenchyma, small pancreatic duct, a large amount of intraoperative blood loss, management of the cut surface of the pancreas, and the presence of preoperative jaundice. Transected pancreatic ductules on the cut surface of the pancreas that are not drained into the main pancreatic duct after pancreatectomy are one of the risks. The pancreatic juice is alkaline and turns red litmus to blue. METHODS: In order to detect the transected pancreatic ductules on the cut surface of the pancreas, red litmus paper is applied to the cutting surface of the pancreas after stimulation of secretin. RESULTS: Nondrained, transected pancreatic ductules on the cut surface of the pancreas can be detected as blue spots on the red litmus paper. The corresponding areas to the blue spots can be transfixed with sutures to close the nondrained and transected pancreatic ductules. CONCLUSION: Litmus paper can be expected to detect pancreatoenterostomy leakage after pancreatectomy.". |
| 135. |
Sato N, Yamaguchi K, Yokohata K, Shimizu S, Morisaki T, Mizumoto K, Chijiiwa K, Tanaka M, Preoperative exocrine pancreatic function predicts risk of leakage of pancreaticojejunostomy., Surgery, 124, 5, 871-876, 1998.04, BACKGROUND: The objective of this study was to clarify the relationship between preoperative exocrine pancreatic function and pancreatic anastomotic leakage after pancreatectomy. METHODS: Fifty-five patients who underwent proximal pancreatectomy with pancreaticojejunostomy were reviewed with regard to preoperative exocrine pancreatic function, size of the main pancreatic duct, postoperative pancreatic juice output, and pancreaticojejunostomy leakage. RESULTS: There were 32 patients with a normal value at the preoperative N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion test (> 70%) and 23 with a low BT-PABA value ( |
| 136. |
Sato N, Yamaguchi K, Yokohata K, Shimizu S, Morisaki T, Chijiiwa K, Tanaka M, Short-term and long-term pancreatic exocrine and endocrine functions after pancreatectomy, Dig. Dis. Sci., 43, 12, 2616-2621, 1998.04, Exocrine and endocrine functions of the pancreas were assessed in 44 Japanese patients who underwent pancreatic head resection. Functions were analyzed comparing levels before surgery, at a short-term follow-up (3 mm, or =10 mm). The mean BT-PABA value (6-hr urinary PABA recovery rate) in group 1 showed no change during the postoperative period. In contrast, the BT-PABA values in groups 2 and 3 had dropped by the short-term follow-up and returned to the preoperative level by the long-term examination. FBS and 120-min OGTT levels were not different between the three groups preoperatively. Although these values showed no change in all the three groups at the short-term measurements, the FBS in group 3 and 120-min levels in all the three groups had increased at the long-term. These findings suggest that exocrine pancreatic function shows a short-term deterioration in patients with a dilated pancreatic duct but recovers to the preoperative level over the long term after pancreatic head resection. Endocrine insufficiency, however, may occur at a long-term point after surgery irrespective of the preoperative pancreatic ductal dilatation.". |
| 137. |
Kozaki N, Shimizu S, Higashijima H, Kuroki S, Yamashita H, Yamaguchi K, Chijiiwa K, Tanaka M, Significance of serum delta-bilirubin in patients with obstructive jaundice., J. Surg. Res., 79, 1, 61-65, 1998.04, BACKGROUND: Delta-bilirubin is a bilirubin covalently bound with albumin, which is nontoxic and excreted neither in urine nor in bile. We previously reported that the percentage of delta-bilirubin increased after biliary drainage and that the rapidly excretable bilirubin fraction (total minus delta-bilirubin) was a better parameter to predict the effectiveness of biliary decompression in the dog model. The aim of the present study was to elucidate whether it is applicable to humans. MATERIALS AND METHODS: The serum bilirubin concentration was measured and its fractions were analyzed by high-performance liquid chromatography in 22 patients with obstructive jaundice before and after biliary drainage. In addition, the patients were subgrouped into good and poor drainage groups according to the decline index of serum bilirubin to examine the significance of delta-bilirubin. RESULTS: The concentration of total bilirubin decreased from 14.1 mg/dl before biliary drainage to 5.4 mg/dl 28 days after drainage. During this period, the percentage of conjugated bilirubin steeply declined from 47.1 to 8.8% and that of excretable bilirubin from 63.4 to 28.6%. In contrast, the proportion of serum delta-bilirubin increased from 36.6 to 71.4%. There was an inverse correlation between percentage of delta-bilirubin and total bilirubin concentration (r = -0.69, P |
| 138. |
K Otani, S Shimizu, K Chijiiwa, K Yamaguchi, S Kuroki, M Tanaka, Comparison of treatments for hepatolithiasis: Hepatic resection vs cholangioscopic lithotomy., GASTROENTEROLOGY, 114, 4, A536-A536, 1998.04. |
| 139. |
J Yoshida, K Chijiwa, S Shimizu, H Sato, M TAnaka, Hepatolithiasis: Outcome of cholangioscopic lithotomy and dilation of bile duct stricture, SURGERY, 10.1016/S0039-6060(98)70163-1, 123, 4, 421-426, 1998.04, Background. Cholangioscopic lithotomy (CSL) for hepatolithiasis, a minimally invasive procedure, has a place in complicated or recurrent hepatolithiasis. CSL itself, however, carries inherent risk for recurrence. We analyzed follow-up data after CSL for primary or repeat hepatolithiasis to determine the frequency of recurrence.
Methods. This retrospective analysis includes 21 patients with hepatolithiasis admitted to the hospital from September 1992 to December 1995 who underwent CSL. Through a percutaneous biliary drainage route cholangioscopy was inserted to remove calculi with basket forceps or electrohydraulic lithotripter. Stenotic ducts, defined as less than 2 mm in diameter were dilated with silicone rubber stenting of a balloon dilator:
Results. Ten patients were treated for primary hepatolithiasis and 11 for repeat hepatolithiasis. Of the patients With primary hepatolithiasis, one died of complications and the other nine patients underwent complete lithotomy. Among 11 patients who had repeat hepatolithiasis, four had undergone hepatectomy for hepatolithiasis and two previous CSLs; 10 patients (91 %) underwent complete lithotomy. During the follow-up, four (40 %) of the 10 patients with biliary stenosis at the time of cholangioscopic treatment showed recurrent calculi, whereas all eight patients without stricture had uneventful courses. Of the 19 patients who underwent complete lithotomy, calculi recurred in four (21 %), three cases of which recurred less than 1 year after CSL.
Conclusions. Against hepatolithiasis of primary and postoperative repeat cases, CSL can allow complete lithotomy. The bile duct stricture however, carries a high risk for recurrent calculi; hence, permanent relief of stricture is mandatory.. |
| 140. |
N Sato, K Yamaguchi, K Yokohata, S Shimizu, K Chijiiwa, M Manaka, Long-term morphological changes of remnant pancreas and biliary tree after pancreatoduodenectomy on CT, INTERNATIONAL SURGERY, 83, 2, 136-140, 1998.04, Background. Despite the increasing number of long-term survivors after pancreatoduodenectomy, little is known about morphological appearance of the remnant pancreas or the biliary system after surgery.
Methods. To evaluate long-term morphological changes of the remnant pancreas and biliary tree after pancreatoduodenectomy, computed tomograms obtained at the time of surgery and more than 2 years after operation were reviewed in 19 Japanese patients.
Results. Two to three years after surgery, parenchymal atrophy of the remnant pancreas occurred in 9 (56%) of 16 patients without atrophy at the time of surgery, Three patients who had had parenchymal atrophy preoperatively showed no change after surgery. Of 10 patients with a dilated pancreatic duct preoperatively, 8 (80%) patients demonstrated a decline in ductal size, while the other 2 showed persistent ductal dilatation, Of 9 patients with a normal-sized pancreatic duct preoperatively, 2 patients (22%) developed ductal dilatation after surgery, and the other 7 showed no change. In 4 (57%) of 7 patients,vith a dilated hepatic duct preoperatively dilatation was reduced after surgery, whereas it persisted in the remaining 3, Only one (8%) of 12 patients with a nondilated biliary tree preoperatively showed ductal dilatation 6 months following surgery. Pneumobilia was revealed in 13 (68%) of 19 patients by the follow-up examinations.
Conclusions. Surgeons should be aware of these changes in morphology of the remnant pancreas and biliary tree after pancreatectoduodenectomy.. |
| 141. |
K Yamaguchi, K Chijiiwa, S Shimizu, K Yokohata, T Morisaki, M Tanaka, Comparison of endoscopic retrograde and magnetic resonance cholangiopancreatography in the surgical diagnosis of pancreatic diseases, AMERICAN JOURNAL OF SURGERY, 175, 3, 203-208, 1998.03, BACKGROUND: Magnetic resonance chorangiopancreatography (MRCP) is a newly developing noninvasive examination of the biliopancreatic trees. Roles of MRCP in the diagnosis of pancreatic diseases have not been scrutinized.
METHODS: Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP were reviewed in 52 Japanese patients with various pancreatic diseases and 6 patients with normal pancreas to compare their diagnostic usefulness and limitation.
RESULTS: In those with normal pancreas, only the main pancreatic duct was visualized by MRCP, while both the main pancreatic and branch ducts were clearly delineated by ERCP. In 3 patients with serous cystadenoma, the tumor was not visualized by ERCP, whereas it was visible as a high-intensity mass on MRCP. Of 18 patients with a "mucin hypersecreting" tumor of the branch type, MRCP demonstrated cystically dilated branch ducts in all, while ERCP failed to visualize the dilated ducts in 6 patients. However, the details of the cystic lesions (mural nodule, communication with the main pancreatic duct) were more exactly demonstrated by ERCP than MRCP. In 5 patients with a mucin hypersecreting tumor of the main pancreatic duct type, the dilated main pancreatic duct and the presence of mural nodules were similarly demonstrated both by ERCP and MRCP. In 12 patients with pancreatic adenocarcinoma, indirect findings were similarly demonstrated both by ERCP and MRCP, ie, stenosis (4 patients) and obstruction (8) together with dilation of the main pancreatic duct (9). In 3 patients, the center of the mass showed high intensity on MRCP, suggesting the secondary change of pancreatic carcinoma. In 8 patients with obstruction of the main pancreatic duct due to carcinoma, the distal pancreatic duct was visualized by MRCP but not by ERCP. In 9 patients who had undergone pylorus-preserving or standard pancreatoduodenectomy, follow-up MRCP was obtainable in all examined and displayed the main pancreatic duct.
CONCLUSIONS: MRCP plays a complementary role in the surgical diagnosis of pancreatic disorders and is especially useful to examine the pancreatic duct after pancreatoduodenectomy. (C) 1998 by Excerpta Medica, Inc.. |
| 142. |
K Yamaguchi, K Chijiiwa, S Shimizu, K Yokohata, M Tanaka, Litmus paper helps detect potential pancreatoenterostomy leakage, AMERICAN JOURNAL OF SURGERY, 10.1016/S0002-9610(97)00290-0, 175, 3, 227-228, 1998.03, BACKGROUND: Leakage of pancreatoenterostomy remains as a serious and fatal complication after pancreatectomy. Several risk factors have been reported, ie, normal pancreatic parenchyma, small pancreatic duct, a large amount of intraoperative blood loss, management of the cut surface of the pancreas, and the presence of preoperative jaundice. Transected pancreatic ductules on the cut surface of the pancreas that are not drained into the main pancreatic duct after pancreatectomy are one of the risks. The pancreatic juice is alkaline and turns red litmus to blue.
METHODS: In order to detect the transected pancreatic ductules on the cut surface of the pancreas, red litmus paper is applied to the cutting surface of the pancreas after stimulation of secretin.
RESULTS: Nondrained, transected pancreatic ductules on the cut surface of the pancreas can be detected as blue spots on the red litmus paper. The corresponding areas to the blue spots can be transfixed with sutures to close the non-drained and transected pancreatic ductules.
CONCLUSION: Litmus paper can be expected to detect pancreatoenterostomy leakage after pancreatectomy. (C) 1998 by Excerpta Medica, Inc.. |
| 143. |
K Yamaguchi, K Chijiiwa, S Shimizu, K Yokohata, M Tsuneyoshi, M Tanaka, Anatomical limit of extended cholecystectomy for gallbladder carcinoma involving the neck of the gallbladder, INTERNATIONAL SURGERY, 83, 1, 21-23, 1998.01, Background, Extended cholecystectomy is the common operation for gallbladder carcinoma. When extended cholecystectomy is performed, the liver bed can be generously resected from the fundus to the body of the gallbladder; however, the thickness of the liver parenchyma to be removed is limited to the neck of the gallbladder. There have been few reports providing convincing data with regard to how thick the liver can be anatomically resected by extended cholecystectomy.
Methods, The thickness of the liver tissue actually resected at the time of extended cholecystectomy and that potentially resected by extended cholecystectomy were measured in 24 clinical and 25 autopsy cases, respectively, to assess the anatomical limit of extended cholecystectomy,
Results. The mean anatomical distances from the neck of the gallbladder to the right hepatic duct and to the bifurcation of the anterior and posterior branch of the right hepatic duct were only 1.6(1 2 3) and 5.9(1) mm, respectively. The distance from the gallbladder to the bifurcation of the superior and inferior branch of the right anterior hepatic duct, and to the root of the right anterior inferior hepatic duct were 11.2 mm(2) and 12.8 mm(3), respectively ((1 2 3): pConclusions. Surgical strategy for gallbladder carcinoma should be considered to rely not only upon the depth of invasion but also upon the site of gallbladder tumor. When gallbladder carcinoma involves the muscle layer or further at the neck of the organ, more extensive hepatectomy than extended cholecystectomy should be considered.. |
| 144. |
S Saiki, K Yamaguchi, K Chijiiwa, S Shimizu, N Hamasaki, M Tanaka, Phosphoenolpyruvate prevents the decline in hepatic ATP and energy charge after ischemia and reperfusion injury in rats, JOURNAL OF SURGICAL RESEARCH, 10.1006/jsre.1997.5177, 73, 1, 59-65, 1997.11, Background: Phosphoenolpyruvate (PEP) is a high-energy metabolite in the final step of glycolysis. PEP is converted into pyruvate by pyruvate kinase. One molecule of adenosine triphosphate (ATP) is generated from one molecule of PEP. The aim of this study was to examine the effects of PEP on hepatic energy metabolism at an early phase after ischemia and reperfusion were examined in rats. Materials and methods: Male Wistar rats (250-350 g) were divided into two groups; after two 15-min periods of ischemia with 2 min reperfusion in between, either PEP or glucose solution (400 mmol/liter, pH 7.4) was infused into the portal vein (2.5 ml/300 g body wt/5 min). Before and 0, 5, 10, and 30 min after ischemia, arterial blood and liver tissue were collected for analyses. Results: During the two ischemic periods, ATP and total adenine nucleotide (TAN) of the liver decreased from 9.10 +/- 0.50 and 14.06 +/- 0.29 to 0.99 +/- 0.50 and 10.86 +/- 0.42 mmole/g liver, respectively (P |
| 145. |
K Yamaguchi, K Chijiiwa, S Saiki, S Shimizu, M Takashima, M Tanaka, Carcinoma of the extrahepatic bile duct: Mode of spread and its prognostic implications, HEPATO-GASTROENTEROLOGY, 44, 17, 1256-1261, 1997.09, Background/Aims: The postoperative course of patients with bile duct carcinoma after surgical resection remains dismal. The purpose of this study was to examine the mode of spread from the original site of the carcinoma and its prognostic significance.
Methodology: A total of 46 Japanese patients with extrahepatic bile duct carcinoma who underwent surgical resection from January 1976 to August 1995 were retrospectively reviewed.
Results: Out of 24 patients with upper bile duct carcinoma, 16 (67%) were papillary or well differentiated tubular adenocarcinoma of the polypoid or nodular type on gross configuration, whereas 7 of 11 patients (64%) with lower bile duct carcinoma had moderately differentiated tubular adenocarcinoma or poorly differentiated adenocarcinoma of the annular constrictive or diffusely infiltrating type (pConclusions: Extrahepatic bile duct carcinoma should be excised to a distance of 1.5 cm from the edge of the carcinoma as estimated on cholangiography to achieve cancer-free margins, especially at the resected margins in the hepatic direction.. |
| 146. |
K Yamaguchi, K Chijiiwa, S Saiki, S Shimizu, M Tsuneyoshi, M Tanaka, Reliability of frozen section diagnosis of gallbladder tumor for detecting carcinoma and depth of its invasion, JOURNAL OF SURGICAL ONCOLOGY, 65, 2, 132-136, 1997.06, Background: An accurate frozen section diagnosis is important when deciding the surgical strategy against a gallbladder tumor intraoperatively. Little has been reported on the accuracy of frozen section diagnosis of the gallbladder.
Patients and Methods: In a total of 86 consecutive patients with gallbladder tumor, the accuracy of the frozen section diagnosis was examined. There were 32 patients with polypoid lesions and 54 with nonpolypoid tumors.
Results: The frozen tissue diagnosis and final diagnosis were identical in 82 of the 86 cases, that is, benign in 65 and malignant in 17. The other four cases had different diagnoses, that is, conversion from benign to malignant in two and from malignant to benign in two. The overall accuracy of frozen diagnosis was 95.3% (97.0% for benign and 94.7% For malignant). In 32 polypoid lesions, the accuracy of frozen section diagnosis was 91% (93% for benign; 89% for malignant). In 54 nonpolypoid lesions, the accuracy of diagnosis was 98% (100% for benign; 93% for malignant). The diagnosis of depth of invasion was identical only in 7 (70%) of the 10 carcinoma cases examined, while it was diverse in the remaining 3, that is, conversion from adenocarcinoma invading the subserosa to that limiting to the mucosa in one, from carcinoma within the mucosa to that infiltrating the muscle coat in one, and from carcinoma affecting the muscle layer to that invading the subserosa in the other. Alterations of frozen section diagnosis about being benign or malignant and about the depth of invasion were encountered in seven patients, five of whom had a polypoid tumor.
Conclusions: The intraoperative frozen tissue diagnosis is fairly reliable as to whether lesions are malignant or benign; however, accuracy is low in patients with polypoid lesions of the gallbladder. Also, frozen section diagnosis does not reliably measure the depth of invasion of gallbladder carcinoma. (C) 1997 Wiley-Liss, Inc.. |
| 147. |
Yamaguchi K, Chijiiwa K, Saiki S, Shimizu S, Takashima M, Tanaka M, Carcinoma of the extrahepatic bile duct：Mode of spread and its prognostic implications., Hepatogastroenterology, 44, 17, 1256-1261, 1997.04, BACKGROUND/AIMS: The postoperative course of patients with bile duct carcinoma after surgical resection remains dismal. The purpose of this study was to examine the mode of spread from the original site of the carcinoma and its prognostic significance. METHODOLOGY: A total of 46 Japanese patients with extrahepatic bile duct carcinoma who underwent surgical resection from January 1976 to August 1995 were retrospectively reviewed. RESULTS: Out of 24 patients with upper bile duct carcinoma, 16 (67%) were papillary or well differentiated tubular adenocarcinoma of the polypoid or nodular type on gross configuration, whereas 7 of 11 patients (64%) with lower bile duct carcinoma had moderately differentiated tubular adenocarcinoma or poorly differentiated adenocarcinoma of the annular constrictive or diffusely infiltrating type (p |
| 148. |
Shimizu S, Chijiiwa K, Yamaguchi K, Tanaka M, Gallstone pancreatitis : Sixteen years of clinical management., J. Hep. Bil. Pancr. Surg., 4, 4, 436-440, 1997.04. |
| 149. |
Saiki S, Yamaguchi K, Chijiiwa K, Shimizu S, Hamasaki N, Tanaka M, Phosphoenolpyruvate prevents the decline in hepatic ATP and energy charge after ischemia and reperfusion injury in rats., J. Surg. Res., 73, 1, 59-65, 1997.04, BACKGROUND: Phosphoenolpyruvate (PEP) is a high-energy metabolite in the final step of glycolysis. PEP is converted into pyruvate by pyruvate kinase. One molecule of adenosine triphosphate (ATP) is generated from one molecule of PEP. The aim of this study was to examine the effects of PEP on hepatic energy metabolism at an early phase after ischemia and reperfusion were examined in rats. MATERIALS AND METHODS: Male Wistar rats (250-350 g) were divided into two groups; after two 15-min periods of ischemia with 2 min reperfusion in between, either PEP or glucose solution (400 mmol/liter, pH 7.4) was infused into the portal vein (2.5 ml/300 g body wt/5 min). Before and 0, 5, 10, and 30 min after ischemia, arterial blood and liver tissue were collected for analyses. RESULTS: During the two ischemic periods, ATP and total adenine nucleotide (TAN) of the liver decreased from 9.10 +/- 0.50 and 14.06 +/- 0.29 to 0.99 +/- 0.50 and 10.86 +/- 0.42 mmole/g liver, respectively (P |
| 150. |
Yamaguchi K, Chijiiwa K, Saiki S, Shimizu S, Tsuneyoshi M, Tanaka M, Reliability of frozen section diagnosis of gallbladder tumor for detecting carcinoma and depth of its invasion., J. Surg. Oncol., 65, 2, 132-136, 1997.04, BACKGROUND: An accurate frozen section diagnosis is important when deciding the surgical strategy against a gallbladder tumor intraoperatively. Little has been reported on the accuracy of frozen section diagnosis of the gallbladder. PATIENTS AND METHODS: In a total of 86 consecutive patients with gallbladder tumor, the accuracy of the frozen section diagnosis was examined. There were 32 patients with polypoid lesions and 54 with nonpolypoid tumors. RESULTS: The frozen tissue diagnosis and final diagnosis were identical in 82 of the 86 cases, that is, benign in 65 and malignant in 17. The other four cases had different diagnoses, that is, conversion from benign to malignant in two and from malignant to benign in two. The overall accuracy of frozen diagnosis was 95.3% (97.0% for benign and 94.7% for malignant). In 32 polypoid lesions, the accuracy of frozen section diagnosis was 91% (93% for benign; 89% for malignant). In 54 nonpolypoid lesions, the accuracy of diagnosis was 98% (100% for benign; 93% for malignant). The diagnosis of depth of invasion was identical only in 7 (70%) of the 10 carcinoma cases examined, while it was diverse in the remaining 3, that is, conversion from adenocarcinoma invading the subserosa to that limiting to the mucosa in one, from carcinoma within the mucosa to that infiltrating the muscle coat in one, and from carcinoma affecting the muscle layer to that invading the subserosa in the other. Alterations of frozen section diagnosis about being benign or malignant and about the depth of invasion were encountered in seven patients, five of whom had a polypoid tumor. CONCLUSIONS: The intraoperative frozen tissue diagnosis is fairly reliable as to whether lesions are malignant or benign; however, accuracy is low in patients with polypoid lesions of the gallbladder. Also, frozen section diagnosis does not reliably measure the depth of invasion of gallbladder carcinoma.". |
| 151. |
Tsuzuki T, Sakumi K, Shiraishi A, Kawate H, Igarashi H, Iwakuma T, Tominaga Y, Zhang S, Shimizu S, Ishikawa T, Sekiguchi M, Targeted disruption of the DNA repair methyltransferase gene rednders mice hypersensitive to alkylating agent., Carcinogenesis, 17, 6, 1215-1220, 1996.04, Alkylation of DNA at the O(6)-position of guanine is one of the most critical events leading to induction of mutation as well as to cancer. The enzyme O(6)-methylguanine-DNA methyltransferase repairs this and related lesions in DNA. By means of gene targeting, we established mouse lines deficient in the methyltransferase gene and tissues from these mice contained no methyltransferase activity. Administration of methylnitrosourea to these gene-targeted mice led to early death, and normal mice treated in the same manner showed no untoward effects. In mice given methylnitrosourea treatment, the bone marrow became hypocellular and there was a drastic decrease in the number of leukocytes and platelets, thereby indicating an impaired reproductive capacity of hematopoietic stem cells. Methyltransferase apparently protected these mice from the pancytopenia caused by the alkylating agent. ". |
| 152. |
K Chijiiwa, S Kuroki, S Shimizu, H Yamashita, M Tanaka, Bile acid synthesis and DNA synthesis rates after partial hepatectomy., GASTROENTEROLOGY, 110, 4, A1169-A1169, 1996.04. |
| 153. |
Nakabayashi A, Kitagawa Y, Suwa Y, Akimoto K, Asami S, Shimizu S, Hirose N, Sugano M, Yamada H, Alpha-Tocopherol enhances the hypocholesterolemic action of sesamin in rats., Int. J. Vitam. Nutr. Res., 65, 3, 162-168, 1995.04, The effect of alpha-tocopherol on the hypocholesterolemic action of sesamin was examined in rats given a cholesterol-enriched diet. When different levels (0.05 and 0.2%) of sesamin were fed, the supplementation of 1% alpha-tocopherol significantly accentuated the hypocholesterolemic action of sesamin, particularly with the higher sesamin level, although alpha-tocopherol alone did not affect the concentration of serum cholesterol. The dose-dependent promoting effect of alpha-tocopherol on the hypocholesterolemic action of sesamin was confirmed by supplementing different levels (0.2 and 1%) of alpha-tocopherol to a fixed level of sesamin (0.2%). alpha-Tocopherol was still effective at the 0.2% level. The metabolism of sesamin in the liver S9 fraction appeared to be interfered with alpha-tocopherol in vitro, suggesting a possible role of alpha-tocopherol in maintenance of the availability of sesamin. ". |
| 154. |
Akimoto M, Kitagawa Y, Akamatsu T, Hirose N, Sugano M, Shimizu S, Yamada H, Protective effects of sesamin against liver damage caused by alcohol or carbon tetrachloride in rodents., Ann. Nutr. Metab., 37, 4, 218-224, 1993.04, The effects of sesamin, a potent inhibitor of delta 5-desaturase in polyunsaturated fatty acid biosynthesis, on the fatty acid compositions of tissue lipids and liver functions were examined in rodents. When a mixture of sesamin and episesamin (51.1:48.2, w/w) was given to rats at a dietary level of 0.5% for 13 days, the proportions of dihomo-gamma-linolenic acid significantly increased not only in the liver but also in plasma and hemocytes, suggesting an interference with delta 5-desaturation by these lignans. The sesamin preparation at the dietary level of 1% improved changes in various blood parameters of the mouse, such as aspartate aminotransferase and alanine aminotransferase activities, and the concentrations of total cholesterol, triglyceride and total bilirubin, caused by continuous inhalation of ethanol. In addition, sesamin showed a significant protective effect against the accumulation of fat droplets and vacuolar degeneration in the mouse liver, as confirmed on histological examination. Sesamin, at the level of 100 mg/kg body weight, also tended to prevent liver lipid accumulation by carbon tetrachloride in mice. These results indicate that sesamin and a related lignan compound have an ability to improve liver function.. |
| 155. |
N DOMINGO, J GROSCLAUDE, ED BEKAERT, D MEGE, MJ CHAPMAN, S SHIMIZU, M AYRAULTJARRIER, JD OSTROW, H LAFONT, EPITOPE MAPPING OF THE HUMAN BILIARY AMPHIPATHIC, ANIONIC POLYPEPTIDE - SIMILARITY WITH A CALCIUM-BINDING PROTEIN ISOLATED FROM GALLSTONES AND BILE, AND IMMUNOLOGICAL CROSS-REACTIVITY WITH APOLIPOPROTEIN A-I, JOURNAL OF LIPID RESEARCH, 33, 10, 1419-1430, 1992.10, Biliary amphipathic anionic polypeptide (APF) the major protein of the pigment-lipoprotein complex in bile, and calcium-binding protein (CBP) from gallstones are both small ( |
| 156. |
M OKIDO, S SHIMIZU, JD OSTROW, F NAKAYAMA, ISOLATION OF A CALCIUM-REGULATORY PROTEIN FROM BLACK PIGMENT GALLSTONES - SIMILARITY WITH A PROTEIN FROM CHOLESTEROL GALLSTONES, HEPATOLOGY, 15, 6, 1079-1085, 1992.06, We have previously isolated from 13 cholesterol gallstones a low molecular weight acidic bili-protein that inhibited the precipitation of calcium carbonate in vitro. We now report the isolation of a similar protein from seven black pigment gallstones. Cholesterol was removed from the stones by Soxhlet apparatus with methyl t-butyl ether, and bile acids were extracted with methanol. The protein was purified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after demineralization of the stones with ethylenediaminetetraacetate. Structural and functional properties of the protein from the black stones that were similar to the protein from the cholesterol stones included the following: (a) an apparent molecular weight of about 5 kD; (b) a high content of acidic (19.8%) and hydrophobic (50.1%) amino acids with a low content of basic residues (8.4%) and little sulfide-containing amino acids (1.9%); (c) an inhibitory effect on both the initiation and growth of calcium carbonate crystals in vitro; and (d) very tight (possibly covalent) binding of a diazo-positive yellow pigment, presumably bilirubin, with maximum spectral absorbance at 410 nm. The structural and functional similarities of these bili-proteins from black pigment and cholesterol gallstones and their striking effects on calcium carbonate precipitation in vitro suggest that they play a common role in the regulation of precipitation of calcium salts during the formation of both types of gallstones.. |
| 157. |
S SHIMIZU, T TAKAYAMA, T KOSUGE, J YAMAMOTO, K SHIMADA, S YAMAZAKI, H HASEGAWA, M MAKUUCHI, BENIGN-TUMORS OF THE LIVER RESECTED BECAUSE OF A DIAGNOSIS OF MALIGNANCY, SURGERY GYNECOLOGY & OBSTETRICS, 174, 5, 403-407, 1992.05, Thirty-two benign hepatic lesions, which were resected because of a diagnosis of malignancy, were reviewed to demonstrate the characteristics of the problem and to consider the best course of management. The preoperative diagnoses included 21 hepatocellular carcinomas, six metastases and five others. As the final diagnosis, hemangioma and focal nodular hyperplasia were the two major lesions mimicking malignancy, accounting for seven and six patients, respectively. Four Of seven hemangiomas were atypical, with a considerable amount of fibrosis. Focal nodular hyperplasia and adenoma were misdiagnosed as hepatocellular carcinoma among other malignancies. Two instances each of necrotic tissue and hemangioma were diagnosed as metastatic carcinoma. The lesions that were studied had main features, including a diameter of less than 4 centimeters in 23 patients, evident discrepancy among the roentgenologic diagnoses in 25 patients and no rapid increase in size in 28 patients. Four of nine needle biopsies performed gave false-positive results and did not always provide adequate information. It was concluded that 15 of the 32 patients, who satisfied the aforementioned three criteria, could have been observed more carefully. However, in the other 1 7 patients, surgical intervention was considered justified because of an indication of a higher likelihood of a real malignancy.. |
| 158. |
Shimizu S, Takayama T, Kosuge T, Yamamoto J, Shimada K, Yamazaki S, Hasegawa H, Makuuchi M, Benign tumors of the liver resected because of a diagnosis of malignancy, Surg. Gynecol. Obstet., 174, 5, 403-407, 1992.04, Thirty-two benign hepatic lesions, which were resected because of a diagnosis of malignancy, were reviewed to demonstrate the characteristics of the problem and to consider the best course of management. The preoperative diagnoses included 21 hepatocellular carcinomas, six metastases and five others. As the final diagnosis, hemangioma and focal nodular hyperplasia were the two major lesions mimicking malignancy, accounting for seven and six patients, respectively. Four of seven hemangiomas were atypical, with a considerable amount of fibrosis. Focal nodular hyperplasia and adenoma were misdiagnosed as hepatocellular carcinoma among other malignancies. Two instances each of necrotic tissue and hemangioma were diagnosed as metastatic carcinoma. The lesions that were studied had main features, including a diameter of less than 4 centimeters in 23 patients, evident discrepancy among the roentgenologic diagnoses in 25 patients and no rapid increase in size in 28 patients. Four of nine needle biopsies performed gave false-positive results and did not always provide adequate information. It was concluded that 15 of the 32 patients, who satisfied the aforementioned three criteria, could have been observed more carefully. However, in the other 17 patients, surgical intervention was considered justified because of an indication of a higher likelihood of a real malignancy.. |
| 159. |
Okido M, Shimizu S, Ostrow JD, Nakayama F, Isolation of a calcium-regulatory protein from black pigment gallstones: Similarity with a protein from cholesterol gallstones, Hepatology, 15, 6, 1079-1085, 1992.04, We have previously isolated from 13 cholesterol gallstones a low molecular weight acidic bili-protein that inhibited the precipitation of calcium carbonate in vitro. We now report the isolation of a similar protein from seven black pigment gallstones. Cholesterol was removed from the stones by Soxhlet apparatus with methyl t-butyl ether, and bile acids were extracted with methanol. The protein was purified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after demineralization of the stones with ethylenediaminetetraacetate. Structural and functional properties of the protein from the black stones that were similar to the protein from the cholesterol stones included the following: (a) an apparent molecular weight of about 5 kD; (b) a high content of acidic (19.8%) and hydrophobic (50.1%) amino acids with a low content of basic residues (8.4%) and little sulfide-containing amino acids (1.9%); (c) an inhibitory effect on both the initiation and growth of calcium carbonate crystals in vitro; and (d) very tight (possibly covalent) binding of a diazo-positive yellow pigment, presumably bilirubin, with maximum spectral absorbance at 410 nm. The structural and functional similarities of these bili-proteins from black pigment and cholesterol gallstones and their striking effects on calcium carbonate precipitation in vitro suggest that they play a common role in the regulation of precipitation of calcium salts during the formation of both types of gallstones.. |
| 160. |
Hirose N, Doi F, Ueki T, Akazawa K, Chijiiwa K, Akimoto K, Shimizu S, Yamada H, Suppressive effect of sesamin against 7,12-dimethylbenz［a］-anthracene induced rat mammary carcinogenesis, Anticancer Res., 12, 1259-1266, 1992.04, The effects of dietary supplementation of sesamin on 7,12-dimethylbenz[a]anthracene (DMBA)-induced mammary carcinogenesis in female Sprague-Dawley rats were studied. Experimental diets containing 0.2% sesamin (an equiweight mixture of sesamin and episesamin) or 0.2% alpha-tocopheryl acetate were given to rats starting 1 week before intragastric administration of DMBA (10 mg/rat). Sesamin significantly (p less than 0.05) reduced the cumulative number of palpable mammary cancers by 36% at 12 weeks post-DMBA administration compared with animals on a control diet. Alpha-tocopheryl acetate inhibited both the incidence and the cumulative number of mammary tumors by 20% and 45%, respectively. Concentrations of lipid peroxides in plasma, liver and tumors were all decreased in both sesamin and alpha-tocopheryl acetate groups. The activity of peripheral blood mononuclear cells (PBMC) increased in rats fed sesamin (140 to 150% of the control and alpha-tocopheryl acetate groups). Fatty acid compositions of plasma, liver and tumor phosphatidylcholine showed a decreased tendency of the metabolism of linoleic acid to arachidonic acid and hence of the plasma concentration of prostaglandin E2 in the sesamin group. The inhibitory effect of sesamin on DMBA-induced mammary carcinogenesis may be ascribed, at least in part, to immunopotentiation and increased antioxidative activity.. |
| 161. |
Y KEIDA, T NAKANO, M TABATA, S SHIMIZU, F NAKAYAMA, SIGNIFICANCE OF DIFFERENT CONJUGATE FORMS OF BILIRUBIN IN THE FORMATION OF PIGMENT GALLSTONES, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 6, 6, 595-598, 1991.11, The aim of the present study was to analyse bile samples from cases with gallstones by high performance liquid chromatography according to the type of stones present, with special reference to the glucoside and xyloside conjugates of bilirubin, and to investigate their deconjugation. The composition of bilirubin conjugates in bile was similar between cholesterol and black pigment stones except that the total bilirubin concentration was about 5 times higher in black pigment stone cases with haemolysis. Unconjugated bilirubin was higher in brown pigment stone cases than in cholesterol stone cases, although total bilirubin concentration was lower in the former. In addition, in brown pigment stone cases, bile contained statistically less bilirubin diglucuronide and more bilirubin diglucoside and monoglucoside than in bile with cholesterol stones (P |
| 162. |
LG DAWES, EW MOORE, RV REGE, S SHIMIZU, JD OSTROW, CANINE BILE CONTAINS ANTICRYSTALLIZATION FACTORS THAT INHIBIT PRECIPITATION OF CALCIUM-CARBONATE, HEPATOLOGY, 14, 4, 701-706, 1991.10, Previous studies have strongly suggested that human bile contains a substance(s) that interferes with the precipitation of calcium phosphate and carbonate from solution. These studies, however, did not distinguish between calcium binding by biliary constituents resulting in decreased calcium carbonate saturation (alterations in solution thermodynamics) and true inhibition of calcium salt precipitation by kinetic factors. Because our recent studies have shown that canine common duct bile is always supersaturated with calcium carbonate (thermodynamically at risk for precipitation), we hypothesized that it must contain kinetic factors that inhibit formation and/or growth of calcium carbonate crystals. Effects of canine bile, bovine albumin and the bile salt taurocholate on calcium carbonate precipitation were studied in highly supersaturated solutions of calcium carbonate that spontaneously undergo rapid precipitation. Measured free ionized calcium concentrations, [Ca++], and calculated calcium carbonate saturation indices were compared in test solutions and controls to evaluate the thermodynamic effects of test solutions on the degree of saturation in the assay system. It is shown that addition of only 0.2 ml of normal canine gallbladder bile to the assay system (a 1:101 dilution of biliary components) abolished precipitation. A lesser inhibitory effect (a decrease in the rate of precipitation) was observed when gallbladder bile was diluted but was lost after 10-fold dilution. Canine common duct bile caused a decrease in the rate of precipitation similar to diluted gallbladder bile. In contrast, sodium taurocholate (250 mmol/L), the major bile salt in the dog, and albumin (1.5 gm/L), the most abundant protein in bile, had only a minimal inhibitory effect. We conclude that normal bile contains kinetic factors that inhibit calcium carbonate precipitation and protect against calcium-containing gallstones. These effects are not due to changes in calcium carbonate saturation but rather to alterations in precipitation kinetics.. |
| 163. |
M OKIDO, S SHIMIZU, JD OSTROW, F NAKAYAMA, THE CALCIUM-BINDING BILIPROTEIN (CBP) IN CHOLESTEROL GALLSTONES IS PRESENT ALSO IN BLACK PIGMENT GALLSTONES, HEPATOLOGY, 14, 4, A155-A155, 1991.10. |
| 164. |
S SHIMIZU, B SABSAY, A VEIS, JD OSTROW, RV REGE, LG DAWES, ISOLATION OF AN ACIDIC PROTEIN FROM CHOLESTEROL GALLSTONES, WHICH INHIBITS THE PRECIPITATION OF CALCIUM-CARBONATE INVITRO, JOURNAL OF CLINICAL INVESTIGATION, 84, 6, 1990-1996, 1989.12. |
| 165. |
Y IZUMI, M YAMAZAKI, S SHIMIZU, K SHIMIZU, T YAMAGUCHI, H NAKAJIMA, ANTI-BILIRUBIN MONOCLONAL-ANTIBODY .2. ENZYME-LINKED IMMUNOSORBENT-ASSAY FOR BILIRUBIN FRACTIONS BY COMBINATION OF 2 MONOCLONAL-ANTIBODIES, BIOCHIMICA ET BIOPHYSICA ACTA, 967, 2, 261-266, 1988.11. |
| 166. |
S SHIMIZU, Y IZUMI, M YAMAZAKI, K SHIMIZU, T YAMAGUCHI, H NAKAJIMA, ANTI-BILIRUBIN MONOCLONAL-ANTIBODY .1. PREPARATION AND PROPERTIES OF MONOCLONAL ANTIBODIES TO COVALENTLY COUPLED BILIRUBIN-ALBUMIN, BIOCHIMICA ET BIOPHYSICA ACTA, 967, 2, 255-260, 1988.11. |
| 167. |
LG DAWES, JD OSTROW, S SHIMIZU, EW MOORE, RV REGE, INHIBITION OF CACO3 PRECIPITATION BY CANINE GALLBLADDER BILE, GASTROENTEROLOGY, 94, 5, A534-A534, 1988.05. |
