Hideaki Andoh

Role of positron emission tomography with 2-deoxy-2-[18F]fluoro-D-glucose in evaluating the effects of arterial infusion chemotherapy and radiotherapy on pancreatic cancer

BackgroundThis study evaluated the usefulness of positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose (FDG-PET) in monitoring the response to continuous arterial infusion chemotherapy (CAI) combined with external radiation therapy (ERT) for unresectable pancreatic carcinomas.MethodsTen patients with unresectable pancreatic cancer were enrolled in this study. Computed tomography (CT) and FDG-PET were done before and after CAI (5-fluorouracil [FU], 500 mg/body per day) combined with ERT (50.4 Gy total dose). Tumor regression was evaluated by standardized uptake value (SUV) with FDG-PET, tumor size on CT, and changes in blood levels of carbohydrate antigen (CA) 19-9. The three methods of evaluation were compared.ResultsThe ten patients were classified in three categories. In category I, tumor changes evident on CT and FDG-PET were consistent. In category II, CT could not accurately detect the area of the tumor. However, tumor uptake on FDG-PET decreased markedly after the treatment in category II patients. In category III, both CT and FDG-PET detected the tumor, as in category I. Although there was no definite change in tumor size on CT, FDG-PET uptake was markedly reduced immediately after the treatment. Reduction in tumor size did not appear on CT until 2 months later.ConclusionsFDG-PET aids in analysis of the effectiveness of chemotherapy and/or radiotherapy.

Laparoscopy-assisted Ruge procedure for the creation of a neovagina in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

OBJECTIVE To describe the successful use of a laparoscopy-assisted Ruge procedure for the reconstruction of a vagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. DESIGN Case report. SETTING A university hospital. PATIENT(S) A 19-year-old Japanese woman with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTION(S) Creation of a neovagina by a laparoscopy-assisted Ruge technique. MAIN OUTCOME MEASURE(S) Clinical examinations were performed during the follow-up period. The depth and diameter of the neovagina were measured by vaginography. Patient satisfaction also was determined. RESULT(S) The neovagina was 12 cm in length and 4 cm in diameter. The mucosa of the neovagina was pinkish and had a moist surface. No intraoperative or postoperative complications were observed. CONCLUSION(S) The use of an isolated segment of the sigmoid colon for vaginal construction has the advantages of providing a sufficient length of neovagina and not requiring immediate postoperative self-dilatation. We believe that our procedure has various advantages in addition to those of the original Ruge method, including its minimally invasive nature and excellent cosmetic results. Further, a laparoscopy-assisted operation allows for the diagnosis of uterine defects and the creation of a neovagina at the same time.

Outcomes and Indications of Segmental Pancreatectomy

Background/Aim: To preserve pancreatic function, segmental pancreatectomy has been proposed for benign or low-malignancy tumors in the pancreatic body. Indications for the procedure, however, are still controversial. Methods: In this study, we investigated the advantages and disadvantages of segmental pancreatectomy compared with distal pancreatectomy and subsequently determined indications for segmental pancreatectomy. Results: The distal pancreatectomy patients had shorter operation times, lower incidence of operative complications, and shorter hospital stays compared to segmental pancreatectomy patients. Endocrine function in distal pancreatectomy patients deteriorated compared to that of segmental pancreatectomy patients. The postoperative 75-gram oral glucose tolerance test showed a diabetic pattern in 3 of 7 distal pancreatectomy patients, whereas none of the segmental pancreatectomy patients became diabetic after surgery. The relation between the length of the removed pancreas and plasma glucose at 2 h after the 75-gram glucose intake showed a significant correlation. Conclusion: According to our results, if the length of removed pancreas is longer than 12 cm, the patients will have a risk of acquiring diabetes. In those cases, the segmental pancreatectomy should be considered.

Positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose for diagnosis of intraductal papillary mucinous tumor of the pancreas with parenchymal invasion

We used positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose (FDG-PET) in the diagnosis of two cases of malignant intraductal papillary mucinous tumor (IPMT) of the pancreas. A 56-year-old man and a 72-year-old man, both with tumors in the pancreatic head, were referred to Akita University Medical Center. Computed tomography revealed tumors with multiple cystic components in both patients. FDG-PET images showed markedly high FDG uptake in the area corresponding to a solid component found in one patient and diffuse faint uptake, higher than that of the surrounding tissue, in the other patient, who had no solid component. Histological examination of the resected specimens after pancreatectomy showed invasive carcinoma involving the pancreatic parenchyma in both patients. Although our experience is limited and preliminary, FDG-PET seems to be useful for the detection of malignancy in IPMT, especially in patients not showing any solid component on conventional diagnostic images such as computed tomography.

Minimally invasive needlescopic cholecystectomy

We utilized a mini-sized grasper and retractor measuring 2.5 mm in diameter and a new mini-sized laparoscope measuring 3 mm in diameter to perform a laparoscopic cholecystectomy. A 10/12-mm trocar was inserted as the first trocar for the laparoscope and specimen extraction. Under a direct laparoscopic view, the mini-sized grasper and retractor were inserted and the laparoscopic procedures were performed mainly through the 5-mm trocar placed on the left upper quadrant as the working port. These procedures were successfully performed on five patients with a comparable operation time to that of a conventional laparoscopic cholecystectomy, but appeared to be more minimally invasive.

Detection of circulating anti-p53 antibodies in patients with colorectal carcinoma and the antibody's relation to clinical factors

PURPOSE: Mutation of the p53 tumor suppressor gene is the most common genetic alternation in colorectal carcinoma and is assessed mainly by molecular analysis of the gene sequence or by immunohistochemical analysis of p53 protein accumulation. Purpose of this study was to detect circulating antibody against p53 proteins in serum of patients with colorectal carcinoma and to evaluate its clinical significance. METHODS: We used immunoblotting techniques to detect circulating anti-p53 antibodies. Relationship among staging, immunohistochemical expression of p53 in the primary tumor, and serum carcinoembryonic antigen level was investigated. RESULTS: Circulating anti-p53 antibodies were detected in 32 (68 percent) of 47 patients. Antibody was found in patients at all clinical stages of disease. In 33 patients whose sera and primary tumor tissues were available for testing, 16 (48 percent) were positive for both circulating anti-p53 antibody and p53 expression in the tumor. The anti-p53 antibody test was positive in 78 and 56 percent of patients with high and normal serum carcinoembryonic antigen levels, respectively. CONCLUSION: Detection of anti-p53 antibodies may become a new diagnostic indicator of colorectal carcinomas.

Heat shock protein 70 in rat liver with necrosis and regeneration induced by thioacetamide

Heat shock protein (hsp), which changes both its concentration and localization in reaction to stresses such as heating, ischemia, etc., is thought to protect protein structure and act as a chaperone in intracellular transportation. We examined one of the hsps, hsp 70, in rat liver with necrosis and regeneration produced by thioacetamide (TAA). Hsp 70 was determined by immunoblotting and detected histologically by immunostaining, using a specific antibody. Generally, hsp 70 moves from the cytosol to the nucleus, where it concentrates 15 min after TAA injection. After 15 min, hsp 70 was not detected in the nuclei of hepatocytes around the central vein, where the hepatocytes olater became necrotic. However, hsp 70 immunostaining was increasingly strong in the nuclei of hepatocytes around the portal area, which did not become necrotic. These findings show that, in acute necrosis, hsp 70 seems to correlate with nuclear protection or with the transportation of some protein from the cytosol to the nucleus. Hepatocytes probably neither survive nor regenerate without hsp 70 in their nuclei.

Cholangiocarcinoma coincident with schistosomiasis japonica

The relationship of parasitic liver disease to cholangiocarcinoma has long been debated, and it has been reported that cholangiocarcinoma is associated with opisthorchiasis viverrini. We report herein a rare case of cholangiocarcinoma associated with schistosomiasis japonica. A 76-year-old Japanese man with jaundice was diagnosed with cholangiocarcinoma. Radical resection was not done because of hepatic arterial and portal vein invasion. Biliary microwave tissue coagulation therapy was performed with placement of a metallic stent endoprosthesis. Twenty-two months after the treatment, however, the patient died from hematemesis. Autopsy findings revealed that there was no distant metastasis, even in the area of regional lymph node metastasis. The primary tumor in the hepatic hilar region had been replaced by necrotic debris resulting from the microwave therapy, and an expandable metallic stent was located in the center of the debris. Histological findings showed schistosome eggs, which were old and microcalcified, in veins in the colonic submucosa. Glisson’s fibrosis around the cancer lesion suggested that schistosomiasis japonica and cholangiocarcinoma can occur together with severe chronic inflammation of the portal vein.

Resection of a solitary pancreatic metastasis from renal cell carcinoma with a gallbladder carcinoma: Report of a case

Most metastatic pancreatic tumors are detected at an advanced stage and are not considered suitable for surgery; however, resection is sometimes indicated for a solitary pancreatic metastasis from renal cell carcinoma (RCC) and improves the prognosis. We report such a case, in which the hilar liver was resected with lymph node dissection and distal pancreatectomy. Histological examination revealed regional lymph node metastasis of gallbladder carcinoma (GBC), but all the surgical margins were free of cancer. Postoperative extra-beam radiation therapy was delivered to the hepatic portal lesion to prevent GBC recurrence. The patient remains disease-free 14 months after the completion of radiation therapy. Thus, if all affected areas can be resected, the prognosis associated with pancreatic metastasis from RCC may be favorable.

Acute Emphysematous Cholecystitis Preceded by Symptoms of Ileus: Report of a Case

Abstract We herein describe a case of acute emphysematous cholecystitis in which the patient presented with symptoms of ileus. The patient was a 72-year-old man with no history of diabetes mellitus. He presented with epigastric pain, vomiting, and low-grade fever. Plain abdominal radiography showed some intestinal gas and niveau, and he was admitted to our hospital with a diagnosis of ileus. The next day, the abdominal pain increased and was accompanied by muscular defense. Plain radiography and computed tomography of the abdomen were carried out, and an emergency laparotomy was performed under a diagnosis of panperitonitis due to a perforation of the gallbladder caused by acute emphysematous cholecystitis. The patient made favorable progress after the operation and was discharged on postoperative day 14. Percutaneous transhepatic gallbladder drainage has been increasingly performed for the treatment of acute emphysematous cholecystitis, but when a perforation of the gallbladder is suspected, a laparotomy first should be considered.