Hiroshi Shibata

Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: An analysis of 16 346 treated nodules in 13 283 patients

Aim:u2002 We surveyed multiple centers to identify types and frequency of complications and mortality rate associated with radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).

Development of fluorescence-emitting antibody labeling substance by near-infrared ray excitation

Abstract Indocyanine green succinimidyl esters, near-infrared labeling dyes, were synthesized. These reagents were indocyanine green derivatives possesing N-hydroxysuccinimidyl groups capable of reacting with proteins. The absorption maximum of indocyanine green-labeled human IgG was 785 nm, and its fluorescent excitation and emission maxima were 768 nm and 807 nm, respectively.

Development of agents for reinforcement of fluorescence on near-infrared ray excitation for immunohistological staining

Fluorescence intensity of indocyanine green (ICG) derivative (ICG-sulfo-OSu) was too low for its use to detect microlesions. Therefore, we examined the effects of reinforcement agents on ICG-sulfo-OSu labeled antibodies. Solutions of distearoylphosphatic acid sodium salt (DSPA) and octylglucoside (OG) in physiological phosphate buffered saline (PBS) were found to increase the intensity of fluorescence of ICG-sulfo-OSu labeled antibodies, with shift in the fluorescence peak wavelength from 804 to 821 nm.

Endoscopic sonography in the diagnosis of xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis (XGC) is an unusual inflammatory disease of the gallbladder that may simulate gallbladder cancer. We report the findings with conventional sonography, endoscopic sonography (EUS), and CT in 3 cases of XGC. EUS could visualize hyperechoic nodules in the gallbladder wall, probably representing xanthogranulomas, but loss of the multilayered structure of the gallbladder wall and infiltration into adjacent organs make differentiating XGC from gallbladder cancer difficult with EUS alone.

Incidence of hepatitis C virus (HCV) antibodies and HCV-RNA in blood donors and patients with liver diseases in the inshore area of the Yangtze River

The Nantong area is a high risk region for primary hepatocellular carcinoma (PHC) in the inshore area of the Yangtze River. However, no detailed data are available about hepatitis C virus (HCV) infection in this area. We examined the incidences of anti‐HCV and HCV‐RNA in blood donors with hepatitis B surface antigen (HBsAg)‐ and hepatitis B core antibody (HBcAb)‐negative and patients with chronic liver diseases in the Nantong area at Nantong Medical College, Jiangsu Province, the Peoples Republic of China. The incidences of HBV markers (HBsAg and/or HBcAb), anti‐HCV (C100‐3), second generation anti‐HCV, HCV‐RNA and any marker of HCV in the Nantong area were found to be: 0.0, 0.7, 0.4, 0.2 and 0.7% in donor bloods; 16.9, 0.0, 3.4, 15.7 and 16.9% in patients with acute hepatitis; 82.8, 2.7, 4.8, 7.5 and 10.2% in those with chronic hepatitis; 86.4, 4.5, 9.1, 4.5 and 11.4% in those with liver cirrhosis; 87.5, 6.3, 0.0, 0.0 and 6.3% in those with PHC; and 21.8, 1.3, 1.3, 0.0 and 1.3% in patients without liver diseases, respectively. Although the Nantong area is a high risk region for PHC, these data suggest that HCV infection is not an important aetiological factor for PHC in this area.

Is autonomic dysfunction a necessary condition for chronic peptic ulcer formation

Background: The relationship between 1/f fluctuation of the heart rate variability and Helicobacter pylori infection was evaluated, in order to clarify whether autonomic nervous dysfunction is a necessary condition for chronic peptic ulcer formation.

Usefulness and Limitations of Endoscopic Ultrasonography in Diagnosis of Adenomyomatosis of the Gallbladder

Abstract: Although endoscopic ultrasonography (EUS) is commonly used to examine lesions in the gallbladder, its ability to accurately diagnose adenomyomatosis (ADM) has not been evaluated. We compared the accuracy of EUS and various other imaging techniques in the diagnosis of ADM. Thirty‐one patients undergoing cholecystectomy after elevated lesions were found in the gallbladder by various imaging techniques were studied retrospectively. Based on histopathologic examination, the sensitivity and specificity of EUS were evaluated in ADM. The sensitivity of abdominal ultrasonography, CT and ERCP in ADM were also evaluated. Of the 11 patients diagnosed with ADM by EUS, 9 cases were confirmed histologically (81.8%). Of the 11 patients with histologic diagnosis of ADM, 9 were accurately diagnosed preoperatively by EUS (81.8%). EUS proved more reliable for diagnosis of ADM than the other imaging techniques. Important diagnostic features include preservation of the three‐layered structure of the gallbladder, wall‐thickening exceeding 3 mm, and 2 or more Rokitansky‐Aschoff sinuses occurring within a 1 cm area of the gallbladder.

3560 Evaluation of solitary and scattered esophageal varices by infrared-ray endoscopy and endoscopic ultrasonography.

Objective: Solitary esophageal varices (SoV) sporadically develop in the upper and middle esophagus, while scattered esophageal varices (ScV) consist of more than two variceal lesions. It is considered that both SoV and ScV differ from portal hypertensive esophageal varices or so-called down hill varices. However, the etiology and clinical significance of SoV and ScV remain unclear. In the present study, using both IRE and EUS, we evaluated the internal characteristics and hemodynamics of SoV and ScV. Subjects and Methods: The subjects consisted of 44 lesions in 28 patients in whom SoV or ScV were detected by visible ray endoscopy (VRE). These lesions were evaluated by IRE and EUS. During IRE, the intensity of blueblack color was evaluated using GIF-Q200IR (Olympus Co., Ltd.). Subsequently, 2 mg/kg of ICG was rapidly injected intravenously to evaluate the degree of stainability by three stages. During EUS, the major location and echo patterns of SoV and ScV were observed using an ultrasonic miniprobe. Echo patterns were classified as follows: homogeneous low echo, mixed echoes, and homogeneous high echo. Results: When the relationship between the size of SoV or ScV and the degree of stainability during IRE was evaluated in densely stained lesions, the diameter of SoV or ScV was significantly smaller in lesions that showed stronger stainability than in those that showed weaker stainability. When the relationship between the size of SoV or ScV and echo patterns observed by EUS was evaluated, the diameter was significantly smaller in lesions that showed homogeneous low echo than in those that showed mixed echoes. When the relationship between echo patterns observed by EUS and the degree of stainability during IRE was evaluated, lesions that showed homogeneous high echo showed the weakest stainability, followed by lesions that showed mixed echoes and those that showed homogeneous low echo in ascending order. Conclusion: Concomitant i.v. injection of ICG was useful for observing hemodynamics of SoV and ScV during IRE, as well as observing the major location or morphology of these variceal lesions during EUS. SoV and ScV with larger diameters were stained later when hemodynamics were evaluated by IRE, and showed a mixture of low and high echo areas when the morphology was evaluated by EUS. These observations suggested that internal blood flow of SoV or ScV was arrested, and the severity of extravasation of blood increased with the diameter of variceal lesions.

7128 Three-dimensional ct pancreatography (3d-ctp) of pancreatic diseases.

Background: Endoscopic retrograde pancreatograpy (ERP) is common techniques used for the diagnosis of pancreatic diseases. However, conventional ERP under fluoroscopy (c-ERP) provides only two-dimensional projection images of the pancreatic ducts. Recent advances in the volumetric CT enable us to get whole pancreatic deta. CT images provide better tissue characterization than fluoloscopy images and ability to create 3D images from its data. Using volumetric CT technique with ERP is thought to be able to provide additional information. Aims: The present study was undertaken to assess the usefulness of 3D-CTP in the diagnosis of pancreatic diseases. Methods: The subjects of this study were 22 patients with pancreatic disease (5 with pancreatic cancer, 5 with chronic pancreatitis and 12 with pancreatic cystic disease). After c-ERP with balloon-catheter, 3D-CTP was performed with volumetric CT within a single brethhold period. Several 3D images per a case were made with the method of shaded surface display(SSD), multiplanar reconstruction (MPR) and maximum intensity projection (MIP) from CT data. Results: Images with SSD and MIP allowed us to realize the pancreatic ducts three dimensionally. The main pancreatic duct (MPD) was visualized three dimensionaly, but the side branches were not enough (see table).Images with MPR provide good visualization of both the pancreatic duct and its parenchyma. In the case of pancreatic cyst, the communication between the cyst and MPD was detected with 3D-CTP. In the case of mutin producing tumor, papillary intraductal tumor was detected more clearly. In the case of pancreatic cancer, dilated pancreatic ducts proximal to the stenosis were observed by 3D-CTP, which could not be visualized by c-ERP, with advantage of contrast resolution of CT. Conclusion: 3D-CTP provides three dimensional images of pancreatic ducts and its parenchyma. It provides additional information about the pancreatic pathologies to c-ERP. 3D-CTP with c-ERP seems to be applicable to simulation for the surgery. The accuracy and clinical usefulness of 3D-CTP will elevated by using improved devices under optimal condition.