Nobuo Seo

Subcutaneous seeding of small hepatocellular carcinoma after fine needle aspiration biopsy

Ultrasonically guided fine needle (21 gauge) aspiration biopsy (FNAB) was performed on a patient with a hepatocellular carcinoma (HCC) measuring 1.5 × 1.5 cm in segment VI of the liver. The tumour was located just beneath the liver surface. Subsegmentectomy of segment VI was performed. Twelve months after the biopsy and 10 months after the operation, levels of alpha‐fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist‐II (PIVKA‐II) increased gradually without any evidence of recurrence of HCC in the liver. Thirteen months after the biopsy, the patient palpated a hard subcutaneous nodule 1.5 cm in diameter in the right lower anterior chest wall at the insertion site of the biopsy needle. A subcutaneous tumour was excised and histological examination revealed moderately differentiated HCC. The levels of AFP and PIVKA‐II normalized thereafter. These tumour markers were therefore useful for diagnosing the subcutaneous nodule as a metastatic HCC. The patient is currently doing well without further recurrence of HCC or needle‐tract seeding 23 months after subsegmentectomy and 11 months after excision of the subcutaneous tumour.

Tubulin and high molecular weight microtubule-associated proteins as endogenous substrates for protein carboxymethyltransferase in brain.

The endogenous substrate for protein carboxymethyltransferase in brain was examined. Several polypeptides were methylated when brain slices were incubated with L-methionine or when subcellular fractions of brain, such as the cytosolic fraction, were incubated with S-adenosyl L-methionine. Two methyl-accepting proteins in the cytoplasm were identified as tubulin and high molecular weight microtubule-associated proteins (300 kDa), which are components of microtubules. Tubulin behaved as a 43 kDa protein in acidic polyacrylamide gel electrophoresis, but as a 55 kDa protein in SDS-polyacrylamide gel electrophoresis. The methyl moiety transferred to these proteins from L-methionine was labile at alkaline pH. The high molecular weight microtubule-associated proteins showed higher methyl-accepting activity than tubulin or ovalbumin, which was used as a standard substrate: about 20 mmol of high molecular weight microtubule-associated proteins, 2 mmol of tubulin and 10 mmol of ovalbumin were methylated per mol of each protein in 30 min under the experimental conditions used.

Early Laparoscopic Cholecystectomy for Acute Cholecystitis in Accordance with the Tokyo Guidelines for the Management of AcuteCholangitis and Cholecystitis

Aims: To determine if early laparoscopic cholecystectomy (LC) for acute cholecystitis, performed in accordance with the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis, was more effective than delayed LC. Methodology: We compared surgical difficulties, clinical courses and complications between 32 patients undergoing delayed LC and 30 undergoing early LC. Results: Delayed LC was associated with more surgical difficulties than early LC, including severe adhesion of the greater omentum (15/32 vs. 1/30), severe cicatrization of Calot’s triangle (15/32 vs. 3/30), inability to identify or skeletonize the cystic duct (18/32 vs. 3/30), and severe cicatrization of the gallbladder bed (27/32 vs. 1/30). Delayed LC was also associated with longer operating times (163 vs. 93 minutes), more conversions to open surgery (7/32 vs. 0/30), more complications (3/32 vs. 1/30), and longer hospitalization (30.5 vs. 10.2 days). Most early LCs was performed during overtime. Conclusions: Despite the retrospective nature of this study, the results demonstrated that changing treatment for acute cholecystitis from delayed to early LC, in accordance with the Tokyo Guidelines, could effectively reduce operation time, duration of symptoms and hospital stay, and thus be of significant benefit to patients. Further, prospective studies are needed to confirm these findings.

Sa1099 Clinical Studies of Gastrectomy for Gastric Cancer in Patients Over 80 Years Old

G A A b st ra ct s indirect effect (2%) mediated by increasing a patients CSBM rate (Figure 1). Spontaneous bowel movements (SBMs) that were not associated with a sense of completeness and BMs associated with rescue medication use did not qualitatively increase the amount of mediated LIN pain effect. The results of the 2-way CSBM stratification analysis (Table 1) indicated that improvement in abdominal pain was influenced by the time since last CSBM and the number of recent CSBMs. However, consistent with the predominant direct effect of LIN on abdominal pain shown in the mediation analysis, in each cell of Table 1, the LIN-treated patients had greater abdominal pain relief than PBO-treated patients when controlling for these CSBM factors. Conclusions: The results of these analyses are consistent with the hypothesis that the LIN effect on abdominal pain (over PBO) was predominantly a direct effect and, to a lesser extent, a mediated effect of increasing CSBM frequency. Table 1. Percent Improvement in Abdominal Pain Stratified by Number of Recent CSBMs and Time Since Last CSBM by Treatment Group (LIN/PBO [LIN-PBO difference])

Clinical evaluation of porto-systemic collaterals in patients with portal hypertension.

門脈圧亢進症66例の側副血行路について検討した.遠肝性側副血行路のうち左胃静脈の発生頻度が最も高く, 次いで短胃, 脾-後腹膜, 下腸間膜, 傍臍, 脾-腎静脈の順であった.左胃静脈の直径が大きいと静脈瘤の程度も高度であったが, 門脈圧や有効肝血流量との間には相関がなかった.食道静脈瘤の形成に関与しない側副血行路が太くなると門脈圧は低下する傾向があり, 有効肝血流量は有意に低下した.これらの側副血行路の直径の和が10mm以上の症例で食道静脈瘤からの吐血歴があるものはなかったが, 猪瀬型肝性脳症を示すものがあった.門脈圧亢進症の治療においては側副血行路の状態を十分把握する必要があると考えられた.