Teijiro Hirashita

Expression of matrix metalloproteinase-7 is an unfavorable prognostic factor in intrahepatic cholangiocarcinoma.

BackgroundIntrahepatic cholangiocarcinoma (IHCC) is a highly malignant neoplasm, but the prognostic factors of IHCC are not yet fully understood. The matrix metalloproteinases (MMPs) are known to be related to tumor viability. The aim of this study was to evaluate the prognostic significance of clinicopathological and immunohistochemical characteristics of resected IHCC.Patients and MethodsFrom 1996 to 2006, we surgically treated 35 patients with IHCC. Clinicopathological and immunohistochemical characteristics, including expression of MMPs, vascular endothelial growth factor, and epidermal growth factor receptor in the resected specimens, were investigated, and overall survival rates were evaluated with regard to the characteristics using univariate and multivariate analyses.ResultsUnivariate analysis revealed the significant prognostic factors to be preoperative serum CEA and CA19-9, intraoperative transfusion, tumor size, surgical margin, lymph node metastasis, invasion of portal and hepatic vein, intrahepatic metastasis, UICC stage, and expression of MMP-7. Subsequent multivariate analysis indicated that MMP-7 was an independent prognostic factor (hazard ratio (HR), 4.698; 95% confidence interval (CI), 0.057–0.866; P = 0.03) along with intrahepatic metastasis (HR, 5.694; 95% CI, 0.029–0.706; P = 0.017).ConclusionMMP-7 expression is associated with a poor prognosis in patients with resected IHCC.

Large Mucinous Cystadenoma of the Pancreas During Pregnancy: Report of a Case

A 33-year-old woman, gravida 2, para 1, was diagnosed to have a benign mucinous cystic neoplasm of the pancreas 5 months before delivery. The tumor measured 12 cm in diameter at the time of diagnosis. The antenatal course was uneventful, and a vaginal delivery produced a normal infant. By 2 months after delivery, the tumor reached 18 cm. At surgery, a huge cyst was found to originate from the pancreas, and a distal pancreatectomy with splenectomy was performed. The cystic mass was multilocular 18 × 17 × 12 cm, 2450 g, and red to yellowish-gray. The histologic diagnosis was benign mucinous cystadenoma. The postoperative course was uneventful, and the patient remains free of recurrence at 7 months after surgery. To our knowledge, this is only the fifth reported case of pancreatic mucinous cystadenoma in association with pregnancy. This is the first reported case of a successful resection of such a tumor after delivery.

Effects of visceral fat resection and gastric banding in an obese diabetic rat model

BACKGROUND Although the function of visceral fat has gradually become clear, the effects of its resection on insulin resistance and glucose metabolism are still unknown. This study aimed to clarify the effects of visceral fat resection and gastric banding in an obese diabetic rat model. METHODS Forty male Zucker diabetic fatty rats were divided into 4 groups: sham operation, visceral fat resection, gastric banding, and gastric banding with visceral fat resection. The rats were followed for 8 weeks after operation, and the change in body weight, amount of food intake, metabolic parameters, insulin tolerance, oral glucose tolerance, and adipocytokines were examined. RESULTS Compared with the sham operation and visceral fat resection groups, the gastric banding and gastric banding + visceral fat resection groups showed significant decreases in weight gain and cumulative food intake, as well as improvement in secretion of adipocytokines and in insulin resistance. Although no differences were found between the sham operation and visceral fat resection groups in weight gain and food intake, high-molecular-weight adiponectin, tumor necrosis factor-α levels, and insulin resistance were improved in the visceral fat resection group compared with the sham operation group. The gastric banding + visceral fat resection group had greater serum levels of high-molecular-weight adiponectin than did the gastric banding group, but no difference was found between the gastric banding and gastric banding + visceral fat resection groups in insulin resistance and glucose metabolism. CONCLUSION In diabetic fatty rats, the surgical removal of visceral fat effected some improvement in insulin resistance and glucose metabolism. Because the effect was relatively minimal compared with that of gastric banding, visceral fat resection combined with gastric banding did not appear to exert additional effects on insulin resistance and glucose metabolism compared with gastric banding alone.

Effects of sleeve gastrectomy on lipid metabolism in an obese diabetic rat model.

BackgroundLaparoscopic sleeve gastrectomy (SG) is a popular bariatric procedure for treating morbid obesity. This study aimed to investigate the relation between SG and lipid metabolism in an obese diabetic rat model.MethodsForty-five male Zucker diabetic fatty (ZDF) rats were divided into three groups: sham-operated (SO) control, gastric banding (GB), and SG. Six weeks after surgery, metabolic parameters, including plasma adiponectin level, small bowel transit, mRNA expression of peroxisome proliferator-activated receptor (PPAR)-α and PPARγ in the liver, skeletal muscle and white adipose tissue, and that of adiponectin in white adipose tissue, and triglyceride (TG) contents in the liver and skeletal muscle were measured.ResultsMetabolic parameters in the GB and SG groups were significantly improved compared with those in the SO group. However, plasma total cholesterol (TC) and free fatty acid (FFA) concentrations were significantly lower while the plasma adiponectin level was significantly higher in the SG group than in the GB and SO groups. In addition, small bowel transit time was significantly shorter in the SG group than in the other two groups. Furthermore, in the SG group, mRNA expression of PPARα in the liver and skeletal muscle and that of adiponection and PPARγ in white adipose tissue were significantly higher, while TG in the liver and skeletal muscle were significantly lower, compared with those in the other two groups.ConclusionsThese results suggest that SG improves lipid metabolism compared with GB, although there were no significant differences in the effect on weight loss between the two procedures.

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

PurposeIdiopathic portal hypertension (IPH) is considered to be closely related to portal vein thrombosis (PVT). The aim of this study was to clarify the incidence, clinical characteristics, and outcomes of PVT in patients with IPH after splenectomy.MethodsWe investigated the rates, clinical characteristics, and outcomes of PVT in 18 patients who underwent splenectomy for IPH, during a mean follow-up period of 152 ± 83 months.ResultsSeven of the 18 patients (39%) experienced gastrointestinal bleeding, which was from the varices in 4. Eight patients (44%) had PVT, and the mean interval until its detection after splenectomy was 22 ± 41 months. The cumulative gastrointestinal bleeding rates 5, 10, and 15 years after surgery were 24%, 31%, and 41%, respectively. The cumulative survival rates 5, 10, and 15 years after surgery were 94%, 74%, and 65%, respectively. There were no significant differences in the cumulative gastrointestinal bleeding and survival rates between patients with and those without PVT.ConclusionDespite the high incidence of PVT in IPH patients postsplenectomy, it may not be related to their gastrointestinal bleeding or prognosis.

A case of retroperitoneal mucinous cystadenoma treated successfully by laparoscopic excision.

A case of retroperitoneal mucinous cystadenoma treated laparoscopically is reported. A 26-year-old woman, who complained of abdominal fullness, was referred to us after a large intra-abdominal mass was discovered at her local hospital. Ultrasound and computed tomography showed a fluid-filled mass, 9 cm in diameter, in the left retroperitoneal space. Laparoscopic surgery was performed. We found a smooth and thin-walled cystic tumor that displaced the descending colon to the right and arose from the retroperitoneum, loosely adhering to the psoas muscle. We successfully extirpated the tumor laparoscopically. The surgical specimen consisted of a multilocular, red to yellowish-gray, cystic mass with a smooth, glistening external surface, and inner lining. The mass was filled with thin, yellowish fluid. The histologic diagnosis was benign mucinous cystadenoma. The postoperative course was uneventful, and the patient remains free of recurrence 15 months after surgery. Retroperitoneal mucinous cystadenoma is a rare entity, and the treatment of choice is surgical excision. Laparoscopic extirpation should be considered for the treatment of selected retroperitoneal cystic lesions.

Risk factors of liver failure after right-sided hepatectomy

BACKGROUND To prevent hepatic failure after major hepatectomy, it is important to assess preoperative factors related to liver failure. METHODS We examined 80 patients who underwent right-sided hepatectomy. Hyperbilirubinemia, uncontrolled ascites, and prolonged postoperative hospital stay were defined as liver failure after hepatectomy, and these 3 factors were evaluated in relation to clinicopathological and surgical factors. RESULTS In the 80 patients, hyperbilirubinemia was observed in 10 (12.7%) patients, uncontrolled ascites in 18 (22.5%) patients, and prolonged hospital stay after surgery in 39 (48.8%) patients. Multivariate analyses identified platelet count as a risk factor of hyperbilirubinemia, uncontrolled ascites, and prolonged postoperative hospital stay, and the ratio of remnant liver volume to body surface area (RLV/BSA ratio) as an additional risk factor of hyperbilirubinemia and prolonged postoperative hospital stay. CONCLUSIONS Platelet count and RLV/BSA ratio are useful risk factors for prediction of liver failure after right-sided hepatectomy.

Laparoscopic diagnosis and treatment of a hydrocele of the canal of Nuck extending in the retroperitoneal space: A case report

Highlights • Hydrocele of the canal of Nuck in the adult female is a rare condition.• Laparoscopic diagnosis is useful for groin mass connected with the retroperitoneal space.• TEP offers a useful alternative in selected patients with hydrocele of the canal of Nuck.

Initial experience in laparoscopic sleeve gastrectomy for Japanese morbid obesity

Introduction: We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in Japanese patients with morbid obesity.

Prediction of the surgical difficulty of single-port laparoscopic cholecystectomy.

The aim of this study was to use the difficulty score for a laparoscopic cholecystectomy procedure to predict the surgical difficulty of single-port laparoscopic cholecystectomy. From January 2009 to April 2011, single-port laparoscopic cholecystectomy was performed in 30 patients at our institution. The patients were evaluated using the difficulty score and classified into 3 groups: low, intermediate, and high difficulty. All surgeries were successfully completed without conversion to conventional laparoscopic surgery. A strong relationship was observed between the increasing score and longer surgical time. The mean surgical time was longer and the amount of blood loss was greater in the intermediate-difficulty and high-difficulty groups than in the low-difficulty group. Moreover, the high-difficulty group had a higher rate of insertion of an additional trocar than the low-difficulty group. Thus, the difficulty of single-port laparoscopic cholecystectomy is well predicted using the difficulty score.