Hisashi Kosaka

Interferon-gamma is a therapeutic target molecule for prevention of postoperative adhesion formation.

Intestinal adhesions are bands of fibrous tissue that connect the loops of the intestine to each other, to other abdominal organs or to the abdominal wall. Fibrous tissue formation is regulated by the balance between plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (tPA), which reciprocally regulate fibrin deposition. Several components of the inflammatory system, including cytokines, chemokines, cell adhesion molecules and neuropeptide substance P, have been reported to participate in adhesion formation. We have used cecal cauterization to develop a unique experimental mouse model of intestinal adhesion. Mice developed severe intestinal adhesion after this treatment. Adhesion development depended upon the interferon-γ (IFN-γ) and signal transducer and activator of transcription-1 (STAT1) system. Natural killer T (NKT) cell–deficient mice developed adhesion poorly, whereas they developed severe adhesion after reconstitution with NKT cells from wild-type mice, suggesting that NKT cell IFN-γ production is indispensable for adhesion formation. This response does not depend on STAT4, STAT6, interleukin-12 (IL-12), IL-18, tumor necrosis factor-α, Toll-like receptor 4 or myeloid differentiation factor-88–mediated signals. Wild-type mice increased the ratio of PAI-1 to tPA after cecal cauterization, whereas Ifng−/− or Stat1−/− mice did not, suggesting that IFN-γ has a crucial role in the differential regulation of PAI-1 and tPA. Additionally, hepatocyte growth factor, a potent mitogenic factor for hepatocytes, strongly inhibited intestinal adhesion by diminishing IFN-γ production, providing a potential new way to prevent postoperative adhesions.

Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy

Postoperative pancreatic fistula (PF) remains a major complication after pancreaticoduodenectomy (PD). We aimed to investigate the predictors of clinically relevant PF after PD.

Interferon γ and plasminogen activator inhibitor 1 regulate adhesion formation after partial hepatectomy

The pathophysiology of intra‐abdominal adhesions has not been studied extensively. The aim of this study was to elucidate the molecular mechanisms underlying adhesion formation in a murine model and in patients undergoing hepatectomy.

Delayed Arterial Hemorrhage After Pancreaticoduodenectomy

Delayed arterial hemorrhage is a rare complication of pancreaticoduodenectomy that is associated with a high mortality and has no standard management. Between 2000 and 2011, 204 pancreaticoduodenectomies were performed, and there were 3 cases of delayed arterial hemorrhage. We reviewed the role of endoscopy, laparotomy, and interventional radiology the management of delayed hemorrhage. One patient presented with intraluminal bleeding and upper gastrointestinal endoscopy failed to identify the bleeding site. Two patients presented with bleeding from the drain tube. Laparotomy was performed in the patient with intraluminal bleeding and interventional radiology was employed for the other 2 patients. There was no hemorrhage-related mortality or rebleeding, but the patient who underwent laparotomy developed sepsis. Endoscopy may have no role in the initial management of delayed arterial hemorrhage after pancreaticoduodenectomy. Interventional radiology is less invasive compared with laparotomy, and may be considered as the first-line treatment for delayed arterial hemorrhage in pancreaticoduodenectomy patients.

A Surgical Case of Synchronous Double Primary Cancers of the Bile Duct and Pancreas

Abstract A 54-year-old female was seen at another hospital because of jaundice. CT showed an unclear boundary and a poorly enhanced mass lesion in the pancreatic body, measuring 28 mm in diameter. MRCP showed stenosis of the lower bile duct and the main pancreatic duct in the pancreatic body and slight dilatation of the main pancreatic duct in the pancreatic tail. According to these findings, the preoperative diagnosis was synchronous double cancers of primary lower bile duct cancer and pancreatic body cancer. We performed pylorus-preserving pancreaticoduodenectomy with splenic artery and vein resection. A histopathological examination revealed that the lower bile duct tumor was moderately differentiated tubular adenocarcinoma, and the pancreatic body tumor was moderately differentiated tubular adenocarcinoma. These two tumors showed no histopathological continuity. According to these pathological findings, we diagnosed the patient with synchronous double cancers of primary lower bile duct cancer and panc...