Kazuhisa Yabushita

Cytokine profile in the liver of primary biliary cirrhosis.

We characterized the cytokine profile in the liver of patients with primary biliary cirrhosis (PBC). Total RNA was extracted from the biopsy specimens of 9 patients with early-stage PBC, 10 with chronic hepatitis C (CHC), and 4 normal controls. cDNA was prepared and amplified with a polymerase chain reaction using primers for interferon (IFN)-γ and interleukin (IL)-2, -4, -5, -6, -10, -12 (p40), and -15. Cytokines such as IFN-γ and IL-5, -6, -10, -12, and -15 were expressed in most cases of PBC. Expression rates of IL-5 and IL-6 were higher than in CHC and controls. The higher expression rate of IL-5 in PBC was associated with eosinophil infiltration. IL-2 and IL-4 were rarely detected. Semiquantitative analysis revealed that the expression of IFN-γ and IL-10 was reversed in PBC and CHC: high IFN-γ and low IL-10 in PBC and high IL-10 and low IFN-γ in CHC. These results suggest that cytokine expression is skewed in PBC and both Th1 and Th2 cytokines may play a role in the pathogenesis.

Prognostic significance of expression of thymidine phosphorylase and vascular endothelial growth factor in human gastric carcinoma.

Both thymidine phosphorylase (dThdPase) and vascular endothelial growth factor (VEGF) are well‐characterized inducers of angiogenesis. The purpose of this study was to examine the expression of these antigens and their prognostic significance in gastric carcinoma.

Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: Historical study of 300 patients ☆

BACKGROUND Pancreaticojejunostomy is the most problematic anastomosis in the reconstruction after pancreaticoduodenectomy. In the past, much of the morbidity and mortality associated with this operation was related to problems with this anastomosis. Recent data, however, suggest that the use of duct-to-mucosa sutures has led to a marked drop in both morbidity and mortality associated with pancreaticojejunostomy. METHODS Among the 300 patients who underwent pancreaticoduodenectomy, including pylorus-preserving pancreaticoduodenectomy, 87 patients underwent traditional pancreaticojejunostomy by invagination of the end of the pancreas into the bowel (group B). Recently three-layer anastomosis was created in 213 patients. The outer layer was created between the pancreatic capsule and the serosa of jejunum. The middle layer was created between the pancreatic parenchyma and the seromuscular wall of jejunum. The inner layer was placed between the pancreatic duct and a small opening in the antimesenteric border of the jejunal mucosa. Among the 213 patients, the inner anastomosis was created with interrupted absorbable sutures (group A1) in 93 patients and continuous absorbable sutures (group A2) in 120 patients. RESULTS The three groups were similar with respect to age, gender, and primary disease. In the anastomosis, the incidence of leakage in group A2 (4.2%) was significantly less than in groups B (17.2%, p < 0.01) and A1 (11.8%, p < 0.05). The operative mortality rates were 3.2% in group A1, 1.7% in group A2, and 5.7% in group B. CONCLUSIONS We recommend continuous anastomosis of the pancreatic duct and jejunal mucosa as a safe procedure after pancreaticoduodenectomy.

Intussusception of a mucocele of the appendix secondary to an obstruction by endometriosis: Report of a case

We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab’s claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed.

Expression of Perforin and Fas Ligand mRNA in the Liver of Viral Hepatitis

Cytotoxic T lymphocytes (CTLs) play an important role in the pathogenesis of viral hepatitis. We studied the expression of mRNAs of perforin and Fas ligand (Fas-L) in biopsy specimens from chronic hepatitis B (CHB) (15 cases) and hepatitis C (CHC) patients (13 cases). Both perforin and Fas-L mRNAs were detected in all cases of both CHB and CHC. No messages were detected in the control livers from two cases of fatty liver, a case of Gilberts syndrome, and a case of Dubin–Johnson syndrome. Semiquantitative analysis revealed a positive correlation between the intensity of perforin and Fas-L mRNAs in both CHB and CHC. In CHB, the intensity of both perforin and Fas-L mRNAs showed a positive correlation with the histological activity and serum alanine aminotransferase level, while the correlation was not apparent in CHC. These results suggest that both perforin and Fas/Fas-L systems are involved in the pathogenesis of liver cell injury of CHB and CHC.

Prevalence and associated factors with esophageal varices in early primary biliary cirrhosis

Background and Aims:  Recent routine testing for anti‐mitochondrial antibodies has increased the number of patients with early primary biliary cirrhosis (PBC). The prevalence and clinical significance of esophageal varices in those patients remains obscure.

Strangulation ileus resulting from encasement of a loop of the small intestine by the great omentum, caused by abnormal adhesion

We treated a patient with a mechanical ileus resulting from encasement of a loop of the small intestine by the great omentum, caused by abnormal adhesion. Apart from its occurrence postoperatively with laparotomy, strangulation of small intestine into the omentum is very rare, and its occurrence without underlying disease, except in children, has not been documented previously.

Highly aggressive behavior and poor prognosis of small-cell carcinoma in the alimentary tract: flow-cytometric analysis and immunohistochemical staining for the p53 protein and proliferating cell nuclear antigen.

The purpose of this study was to determine the clinical course, and effects of the histopathologic characteristics of specific tumors, including DNA contents and immunohistochemical aspects, in patients with small-cell carcinoma of the alimentary tract. Medical records of 14 patients who presented with small-cell carcinoma of the alimentary tract were retrospectively reviewed. Primary tumors were studied by immunohistochemical and flow cytometric analyses. Of these 14 small-cell carcinomas, 4 were esophageal, 8 gastric, and 2 colonic tumors. DNA aneuploidy was observed in 8 tumors. Staining for the p53 product was positive in 57.1% of all the tumors. The average proliferating cell nuclear antigen (PCNA) labeling rate (LR) was 72.4 ± 11.6%. The average PCNA LR was significantly higher for the p53-positive group (p < 0.05). The estimated median survival was 253 days for all patients. Noncurative resection was associated with a significantly less favorable prognosis (p < 0.01). Distant metastases were observed in 13 of 14 patients. A higher PCNA LR of small-cell carcinoma may be an unfavorable characteristic of biological behavior. The patients with disseminated disease should undergo a symptomatically palliative operation combined with chemotherapy.

Esophageal Sarcomas: Report of Three Cases

Background/Aims: Sarcomas of the esophagus, including carcinosarcoma, are rare neoplasms. Methods: The clinical and pathologic characteristics of 3 patients with esophageal sarcomas are presented, including the only recorded esophageal carcinosarcoma and 2 patients with leiomyosarcoma. Results: All 3 patients were males who presented with dysphagia or an abnormal shadow of the mediastinum on a plain chest X-ray. Two tumors were in the middle esophagus, and the remaining one was in the distal esophagus. On endoscopic examination, all three tumors were noted to be polypoid. These patients underwent surgical excision. One patient died 7 days following the operation, and the remaining 2 patients died of liver metastasis 10 and 22 months following the treatment. Conclusion: Esophagectomy or esophagogastrectomy is a surgical choice. Even if metastases are present, a palliative resection can still be performed.

Hepatocellular carcinoma presenting as extrahepatic mass on computed tomography

The authors describe an extremely rare case of extrahepatic hepatocellular carcinoma. The patient was a 70-year-old man who was examined by a local doctor because of abdominal discomfort. Barium meal examination demonstrated a defect occupying the lesser curvature of the stomach from the middle of the corpus to the fornix. On an abdominal computed tomography (CT) scan, the lesion, 10 cm in diameter, touched the lower surface of the caudate lobe of the liver. Under laparotomy, the tumor was found between the caudate lobe of the liver and posterior wall of the gastric corpus. As the tumor appeared to be connected with the caudate lobe by a pedicle, only the tumor was resected. Histological examination showed the tumor to be hepatocellular carcinoma of Edmondsons grade III–IV, pedunculated type.