Norio Katayanagi

Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging: preliminary results of a prospective study.

Recently, a highly sensitive fluorescent imaging technique was developed for the real‐time identification of hepatic tumors. The authors applied this procedure for the intraoperative detection of radiographically occult hepatic micrometastases from pancreatic cancer.

Comparison of three different operative methods of video-assisted thoracoscopic esophagectomy

BackgroundAlthough the feasibility and advantages of video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer are well studied, its application is limited, possibly because it is technically complex.MethodsNinety-eight patients who underwent VATS-E at our institutes were divided into three groups by the type of thoracoscope, TV monitor, and patient position used. For the first 18 patients, we used the left lateral position, a flexible thoracoscope, and a single TV monitor (method A); for the next 58 patients, the left lateral position, a 30° thoracoscope, and two TV monitors (method B); and for the last 22 patients, the prone position with 30° thoracoscope and single TV monitor (method C). We compared the area of operative field and clinical outcomes in these three approaches.ResultsOn the basis of subjective assessment, method C afforded a better operative field than methods A and B. No significant differences were noted between the three positions in operative time, duration of intubation, rate of occurrence of recurrent nerve palsy, and anastomotic leakage. However, blood loss, rate of respiratory tract complications, and length of postoperative hospital stay were decreased in the order of position. The total number of dissected lymph nodes increased in the order of position.ConclusionsVATS-E in prone position with a 30° thoracoscope and a single TV monitor appear to be superior to VATS-E in the left lateral position in terms of operative field, blood loss, respiratory tract complication, and number of lymph nodes dissected. Randomized control studies would help confirm these results.

Diagnostic peritoneal lavage for diagnosing blunt hollow visceral injury: The accuracy of two different criteria and their combination

PurposeTo test the usefulness of diagnostic peritoneal lavage (DPL) for identifying blunt hollow visceral injury with two different sets of criteria or a combination of the two.MethodsFifty victims with physical examinations and/or computed tomography findings equivocal for blunt hollow visceral injury underwent DPL. Whether or not to perform surgery was determined based on Otomos DPL criteria [lavage white blood cell counts (L-WBC) over lavage red blood cell counts (L-RBC) divided by 150 (L-WBC ≥ L-RBC/150) in the presence of hemoperitoneum, or L-WBC over 500/mm3 (L-WBC ≥ 500) in the absence of hemoperitoneum]. The cell count ratio, a comparison of L-WBC, L-RBC, peripheral WBC (P-WBC), and peripheral RBC (P-RBC) [(L-WBC/L-RBC)/(P-WBC/P-RBC) ≥ 1] were all calculated retrospectively.ResultsThere were one and two false-positive cases based on Otomos criteria and the cell count ratio, respectively, with corresponding accuracies of 97.8% and 95.7%, respectively. There were no false-positive or -negative cases according to the combined use of Otomos criteria and cell count ratio, yielding an accuracy of 100%.ConclusionAlthough each criterion alone is very accurate in predicting the presence of blunt hollow visceral injury, the combined use of the two would further improve the accuracy of the diagnosis and thereby reduce the number of unnecessary celiotomies.

Jejunal Loop Obstruction by a Gallstone from Hepaticojejunostomy-Induced Acute Cholangitis : Report of a Case

We report a case of jejunal loop obstruction by a large gallstone caused by Roux-en-Y hepaticojejunostomy-induced acute cholangitis. The patient was admitted with sepsis as well as abdominal and back pain. Abdominal computed tomography showed a dilated jejunal loop and an obstructing large mass. After his clinical condition and laboratory values improved, we performed laparotomy, which revealed a dilated jejunal loop with a palpable mass, and a gallstone was removed via enterotomy. After the disimpaction of the stone and control of the infection, his clinical condition and laboratory values continued to improve. Gallstone formation is rare after hepaticojejunostomy and to our knowledge, no other cases of acute cholangitis caused by a stone obstructing the jejunal loop have ever been reported. As with other major complications, early diagnosis and prompt initiation of surgical treatment are important to prevent any deterioration in the patients general condition.

Augmentation of 5-fluorouracil cytotoxicity by epidermal growth factor in a newly established human signet-ring cell carcinoma of the stomach in culture

A cell line designated TSG6 was established from a signet-ring cell gastric carcinoma developed in a 57-year-old female patient. The TSG6 cells had well preserved the features of signet-ring cell carcinoma based on morphology. The cells exhibited both epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) immunoreactivities, and also secreted EGF. Moreover, the growth of TSG6 cells was stimulated in the presence of exogenous EGF. These results suggest that the possible presence of an EGF/EGFR autocrine growth mechanism is expressed in the TSG6 cells. The simultaneous treatment with EGF and 5-fluorouracil (5-FU) produced a nearly 2.4-fold enhancement of 5-FU cytotoxicity against TSG6 cells. A bromodeoxyuridine/DNA How cytometry analysis revealed that EGF augmented 5-FU cytotoxicity by inducing the accumulation of S phase cells which might be more susceptible to 5-FU. Moreover, we found that the incorporation of 5-FU into the TSG6 cells was increased with the addition of EGF. These data indicate that EGF may be a potent agent as a biological response modifier for 5-FU against the tumors which express the EGF/EGFR autocrine mechanism, and that the TSG6 cell line is useful in furthering our understanding of the interaction between anticancer drugs and EGF.

Flow Cytometric Analysis of Early Steps in Development of Adriamycin Resistance in a Human Gastric Cancer Cell Line

We have established a low‐level adriamycin (ADM)‐resistant human gastric cancer cell line (MKN45R) from the parental cell line (MKN45) by exposure to step wise increases of ADM concentration (final concentration, 0.026 μg/ml). The purpose of this study was to identify the early steps in the development of ADM resistance in MKN45R by flow cytometric (FCM) analysis. Comparison of the concentration required for 50% growth inhibition, determined by a tetrazolium‐based colorimetric assay, showed that MKN45R was about 2.6‐fold more resistant to ADM than MKN45. However, the inhibition index values were 89.5% for MKN45 and 86.4% for MKN4SR, respectively, showing that ADM was judged to be “effective” against both cell lines. On the other hand, cell kinetic analysis by FCM revealed that the increase of the ratio of G2M accumulation induced by ADM treatment was significantly lower (p0.01) in MKN45R. Moreover, the efflux of ADM estimated by FCM analysis was significantly increased (P<0.05) in MKN45R even though there was no significant increase of P‐glycoprotein expression. These results suggest that although ADM was still effective based on a standard drug sensitivity test, the cancer cells were already acquiring resistance to ADM as judged from FCM analysis. Moreover, the mechanism of this ADM resistance is considered to be independent of P‐glycoprotein expression. Thus, FCM analysis is useful for detecting the early steps in the development of drug resistance of cancer cells.

Bile duct stone formation around a nylon suture after gastrectomy: A case report

BackgroundMany cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case.Case presentationA 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far.ConclusionThe findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy.

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

The purpose of this study was to evaluate the safety and efficacy of a novel continuous incision technique for the cystic duct and the bile duct over the orifice for laparoscopic transcystic choledocholithotomy (LTCL).

A Resected Case Report of Retroperitoneal Leiomyosarcoma Invading the Inferior Vena Cava

症例は44歳の男性で, 上腹部痛を主訴として近医を受診, 腹部CTを施行し後腹膜腫瘍を指摘され当院に紹介, 入院した. 入院時右上腹部に巨大腫瘤を触知し, CTでは肝下面に接する巨大な腫瘤を認めた. 血管造影検査では門脈は腫瘍により圧排されていたが, 浸潤像は認めなかった. 下大静脈には右腎静脈より頭側に浸潤像を認めた. 後腹膜腫瘍の診断で開腹手術を施行した. 肝下面, 右腎静脈, 右副腎に接する巨大な腫瘍を認めた. 下大静脈には約10cmにわたり浸潤しており, 浸潤部を合併切除し腫瘍を摘出した. 下大静脈切除部は連続縫合により閉鎖した.腫瘍は大きさ19×14×12cm, 組織診断で平滑筋肉腫と診断された. 平滑筋肉腫に対する治療は外科的完全摘出が第1選択である. 特に, 後腹膜原発の場合, 大血管との関係を画像診断により十分に明らかにしておく必要がある. また, 術後再発も念頭におき, 画像所見による早期診断, 治療が求められる.

Surgical treatment for esophageal cancer in aged patients. Evaluation of preoperative risk factors and indications of operation.

70歳以上の高齢者胸部食道癌89例について術前リスク評価と術後合併症, 手術成績との関連より手術適応上の問題点について検討した. 術前リスク評価では70歳以上の症例に重要臓器機能の障害を持っているD群の占める割合が高かった. 肺合併症の発生率は70歳以上では69歳以下と比べ有意に高い値をしめし, 特にD群で高率に発生をみた. 術後合併症の発生と在院死亡率との間には相関を認めず70歳以上の群と69歳以下の群でも在院死亡率には有意差を認めなかった. 5年生存率は69歳以下の群と70歳以上の群との間に有意差を認めず, 高齢者といえども慎重な術前後の管理を前提とするならぼ十分手術適応はあると考えられる.