Jiro Ohuchida

Usefulness of Drain Amylase, Serum C-Reactive Protein Levels and Body Temperature to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

BackgroundPostoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. Recently, early drain removal has been recommended as a means ofxa0preventing POPF. The present study sought to determine how to distinguish clinical POPF from non-clinical POPF in the early postoperative period after PD to aid in early drain removal.MethodsFrom March 2002 through December 2010, 176 patients underwent PD and were enrolled in this study to examine factors predictive of clinical POPF after PD. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline, and grade B/C POPF was defined as clinical POPF.ResultsGrade A POPF occurred in 39 (22.2xa0%) patients, grade B in 19 (10.8xa0%) patients, and grade C in 11 (6.3xa0%) patients. Clinical POPF (grade B/C) occurred in 17.1xa0% of patients. Multivariate analysis revealed male gender and body mass index (BMI) ≥22.5xa0kg/m2 to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the combination of drain amylase ≥750xa0IU/L, C-reactive protein (CRP) ≥20xa0mg/dL, and body temperature ≥37.5xa0°C on postoperative day 3 could effectively distinguish clinical POPF from non-clinical POPF. Sensitivity, specificity, and accuracy were 84.6, 98.2, and 95.7xa0%, respectively.ConclusionsMale gender and BMI ≥22.5 were the independent preoperative predictive risk factors for POPF. We assume that when amylase is <750xa0IU/L, serum CRP is <20xa0mg/dL, and body temperature is <37.5xa0°C the drain can safely be removed, even if POPF is indicated.

Segmentectomy for reactive lymphoid hyperplasia of the liver : Report of a case

We report a case of reactive lymphoid hyperplasia (RLH) of the liver in a 72-year-old woman without any symptoms. To our knowledge, only 11 other cases of this disease have ever been reported. The lesion was found incidentally during a medical examination, as a hypoechoic mass in segment 3 of the liver on ultrasonography. The findings of computed tomography, magnetic resonance imaging, and angiography suggested a malignancy. Frozen section diagnosis of an intraoperative needle biopsy suggested malignant lymphoma, so we performed lateral segmentectomy of the liver. Macroscopically, the tumor was well defined, white, and firm. Microscopically, there was polymorphous lymphoplasmacytic infiltration, with various-sized and -shaped lymphoid follicles. Lymphocytic infiltration was also observed in the portal tracts around the nodular lesion. Immunohistochemical study revealed polyclonality, confirming a pathological diagnosis of RLH of the liver. We discuss the clinicopathologic characteristics of this unusual disease.

Establishment and characterization of SUIT-58 pancreas cancer cell line and its subline S58-SF adapted to serum-free condition derived from metastatic liver tumor

A new pancreas cancer cell line, SUIT-58, was established from metastatic liver tumor. The cultured cells exhibited polygonal shape, and proliferated in a form of sheet-structure showing prominent nucleoli and frequent mitotic features. Chromosome count ranged from 54 to 73 with modal chromosome numbers 72 and 73. It was noteworthy that this cell line grew in the serum-free media and maintained in this condition for 30 passages (designated as S58-SF). Both SUIT-58 and S58-SF cell lines were successfully transplanted into nude mice, and their tumor doubling times in xenografts were calculated as 5.4 and 2.8xa0days, respectively. Histopathologically, the xenografts formed glandular structure that resembled the original tumor. In culture media, the doubling time of SUIT-58 and S58-SF cell lines was calculated as 32 and 35.7xa0h, respectively. Although the cellular arrangements of SUIT-58 and S58-SF cell lines are different to some extent, their subcellular structures under electron microscope were similar with a large number of lysosomes and distinct desmosomes at cell-cell adhesion sites. The present SUIT-58 and its derivative cell line S58-SF will be applicable for biological studies to develop a new clinical treatment of refractory pancreatic cancer.