Nobuhiro Tsutsui

Fibrogenesis and Carcinogenesis in Nonalcoholic Steatohepatitis (NASH): Involvement of Matrix Metalloproteinases (MMPs) and Tissue Inhibitors of Metalloproteinase (TIMPs)

Nonalcoholic steatohepatitis (NASH) is emerging worldwide because life-styles have changed to include much over-eating and less physical activity. The clinical and pathophysiological features of NASH are very different from those of HBV- and HCV-chronic liver diseases. The prognosis of NASH is worse among those with nonalcoholic fatty liver diseases (NAFLD), and some NASH patients show HCC with or without cirrhosis. In the present review we discuss fibrogenesis and the relationship between fibrosis and HCC occurrence in NASH to clarify the role of MMPs and TIMPs in both mechanisms. Previously we proposed MMP and TIMP expression in the multi-step occurrence of HCC from the literature based on viral-derived HCC. We introduce again these expressions during hepatocarcinogenesis and compare them to those in NASH-derived HCC, although the relationship with hepatic stem/progenitor cells (HPCs) invasion remains unknown. Signal transduction of MMPs and TIMPs is also discussed because it is valuable for the prevention and treatment of NASH and NASH-derived HCC.

Laparoscopic cholecystectomy using the PINPOINT endoscopic fluorescence imaging system with intraoperative fluorescent imaging: A case report

We report on a laparoscopic cholecystectomy performed using the PINPOINT endoscopic fluorescence imaging system (Novadaq, Mississauga, ON, Canada), which enables surgery to be performed while simultaneously viewing fluorescent images. The patient was a 43-year-old man diagnosed with cholecystolithiasis. Indocyanine green (ICG) was administered 18h prior to surgery. The PINPOINT system made it possible to perform the procedure while viewing ICG fluorescence in the cystic duct. As the gallbladder was also imaged with this technique, it was easy to determine at which layer to detach the gallbladder from the liver bed. The operative time was 1h and 32min, and blood loss was 5ml. There were no perioperative complications.

Blood flow evaluation using PINPOINT® in a case of incarcerated inguinal hernia: A case report.

Indocyanine green (ICG) fluorescence for intestinal blood flow has been reported, but application during laparoscopic surgery for incarcerated inguinal hernia has not been reported. Here, we report the case of a patient with an incarcerated inguinal hernia in whom the bowel was preserved after evaluation of intestinal blood flow with ICG fluorescence using PINPOINT®, a brightfield full‐color, near‐infrared fluorescence camera. A man in his 80s was diagnosed with incarcerated inguinal hernia and underwent laparoscopic surgery. The ascending colon and mesentery showed deep red discoloration on gross evaluation. However, intravenous injection of ICG revealed uniform fluorescence of the mesentery and bowel wall, indicating the absence of irreversible ischemic changes of the bowel. As such, no resection was performed, and transabdominal preperitoneal patch plasty was completed. The patient had a good postoperative course. In this case, ICG fluorescence with the PINPOINT was useful to avoid bowel resection during laparoscopic surgery.

A case of incarcerated femoral hernia with intestinal blood flow assessment by brightfield full-color near-infrared fluorescence camera: Report of a case

Highlights • We report the case of a patient with incarcerated obturator femoral hernia.• The intestinal blood flow was evaluated by Indocyanine green (ICG) fluorescence.• The bowel could be preserved after intraoperative evaluation of intestinal blood flow.• PINPOINT, a brightfield color fluorescence camera was used for ICG fluorescence.

Intraoperative ICG fluorescence contrast imaging of the main artery watershed area in colorectal cancer surgery: Report of a case

Highlights • We have reported the case that underwent colorectal resection with intraoperative indocyanine green (ICG) fluorescence angiography from the resection-side of the superior rectal artery.• Watershed area of the SRA fluoresced 33 s after the intra-arterial injection of ICG.• PINPOINT, a brightfield color fluorescence camera was used for ICG fluorescence.• This method can be expected to provide useful information for maintaining the blood flow at the anastomotic site.

Stomaplasty with pannicuectomy in an obese patient with stomal retraction: A case report

Highlights • Stomal retraction is a common complication of stomas and results in poor fitting, frequent leakage, and peristomal dermatologic problems.• Treatment of stomal retraction typically involves an intraperitoneal stoma revision.• Stomaplasty with pannicuectomy is a feasible option in obese patients with stomal retraction.

Intestinal blood flow assessment by indocyanine green fluorescence imaging in a patient with the incarcerated umbilical hernia: Report of a case

After reduction of the incarceration during surgery for incarcerated hernia, intestinal blood flow (IBF) and the need for bowel resection must be evaluated. We report the case of a patient with incarcerated umbilical hernia in whom the bowel was preserved after evaluating IBF using indocyanine green (ICG) fluorescence. A woman in her 40s with a chief complaint of abdominal pain visited our hospital, was diagnosed with incarcerated umbilical hernia and underwent surgery. Laparotomy was performed to reduce bowel incarceration. After reducing the incarceration, IBF was observed using ICG fluorescence detected using a brightfield full-color fluorescence camera. The small bowel that had been incarcerated showed deep-red discoloration on gross evaluation, but intravenous injection of ICG revealed uniform fluorescence of the mesentery and bowel wall. This indicated an absence of irreversible ischemic changes of the bowel, so no resection was performed. The patient showed a good postoperative course, including resumption of eating on day 4 and discharge on day 11. In surgery for incarcerated hernia, ICG fluorescence may offer a useful method to evaluate IBF after reducing the incarceration. This case implied that PINPOINT could be used in open conventional surgery.

Endoscopic submucosal dissection for the diagnosis and therapy of pedunculated gastric cancer with prolapse into the duodenal bulb: A case report

Highlights • Preoperative diagnosis of gastric cancer invasion is not always sufficiently accurate.• We encountered a patient with the gastric cancer of which the pre-operative diagnosis of the invasion was indeterminable.• Diagnostic ESD was performed.• Pathohistological diagnosis revealed that the resection was curative and met the expanded criteria for ESD, so gastrectomy was not required.

New method of indocyanine green fluorescence sentinel node mapping for early gastric cancer

Background The present study describes the retrospective feasibility study of ICG fluorescence SN mapping in back-table for early gastric cancer using PINPOINT®. Method SN mapping were performed as following; the day before surgery, 0.5 ml ICG was injected endoscopically in four quadrants of the submucosa surrounding the gastric cancer using an endoscopic puncture. Intraoperatively, the gastrocolic ligament was divided to visualize all possible directions of lymphatic flow from the stomach. PINPOINT® (NOVADAQ, Canada) was used to illuminate regional lymph nodes from the serosal side. Positive staining was confirmed by at least 3 surgeons and an endoscopist during surgery (Figure 1). Lymph node dissection and gastrectomy were performed according to the criteria of gastric cancer treatment guidelines of JGCA. Result All 6 patients had gastrectomy with laparoscopic approach. ICG positive lymphatic flow and lymph nodes were able to be observed in all the patients. Final pathological diagnosis was all StageI and curative resection. All the patients had ICG positive lymphatic area in left gastric artery (LGA) area. Two patients with tumor located in L area had ICG positive flow to right gastroepipoloic artery (RGEA) area. The mean of ICG positive lymph nodes was 8.6. One patient had a metastatic lymph node in station No.4, which was positive for ICG. Conclusion Our method made identification of ICG positive lymph nodes easy in SN mapping in back-table under room light. Although further accumulation and analysis are necessary, we may be able to apply this method for intraoperative SN mapping of laparoscopic gastric cancer surgey.

New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report

Highlights • Negative pressure wound therapy for abdominal surgical site infection is effective, but we should take steps to avoid enterocutaneous fistula.• Separation of the wound from the intestine is important in preventing enterocutaneous fistula.• CT woundgraphy can be used to evaluate the distance by which the wound and intestine are separated.