Yoshitsugu Tajima

An intraductal papillary component is associated with prolonged survival after hepatic resection for intrahepatic cholangiocarcinoma.

The outcome after surgery for intrahepatic cholangiocarcinoma (ICC) is dismal and data on long‐term survival are not available. This study evaluated prognostic indicators and characteristic features of long‐term survivors after hepatic resection for ICC.

Use of the time–signal intensity curve from dynamic magnetic resonance imaging to evaluate remnant pancreatic fibrosis after pancreaticojejunostomy in patients undergoing pancreaticoduodenectomy†

This study assessed the value of the time–signal intensity curve (TIC) obtained from dynamic magnetic resonance imaging (MRI) in the evaluation of remnant pancreatic fibrosis after pancreaticojejunostomy in patients undergoing pancreaticoduodenectomy.

Evolution of living donor liver transplantation over 10 years: experience of a single center.

PurposeTo evaluate the changes in living donor liver transplantations (LDLTs) over the last 10 years, we analyzed our experience of performing LDLT in a single center.MethodsWe performed 73 LDLTs over the 10 years between 1997 and 2007 in Nagasaki University Hospital, Japan.ResultsInitially, from 1997 to 2003, LDLT was performed for pediatric patients; then, between 2004 and 2007, adult-to-adult LDLT was introduced, primarily for hepatocellular carcinoma (HCC) in liver cirrhosis. We also began performing LDLTs for adults with ABO-incompatible blood type combination in the latter period. As the number of adult-to-adult LDLTs increased, left-sided grafts became fi rst choice for these patients. Survival rates were 88.3%, 77.2%, 70.2% at 1, 3, and 5 years, respectively. There was a relatively low incidence of arterial complications, and although the incidence of biliary complications was high initially, it decreased with experience. Likewise, the operative time, blood loss, and hospital stay after LDLT also improved remarkably.ConclusionOver the last 10 years the indications for, and operative techniques used in LDLT have changed dramatically, even in a single center in Japan.

Genetic alterations in gallbladder carcinoma.

Gallbladder carcinoma is an aggressive cancer associated with a poor prognosis. Unfortunately, the precise molecular mechanisms of development and progression of this highly malignant tumor remain unknown. It is still unclear whether loss of heterozygosity (LOH) plays a significant role in gallbladder carcinogenesis, but recent studies have found a high incidence of LOH at several chromosomes in gallbladder carcinoma. In particular, LOH on chromosomes 1p, 3p, 5p, 8p, 9p, 9q, 13q, 16q, and 17p has been highlighted and LOH on 3p, 9p, 13q, 16q, and 17p has been detected in preneoplastic lesions and in the early phase of gallbladder carcinoma during multistep carcinogenesis. The proto-oncogene, K-ras, is the best known genetic alteration in several human neoplasms, including gallbladder carcinoma. The accumulation of these genetic changes leads to a disruption in cell-cycle regulation and also continuous cell proliferation. We present an overview of K-ras alteration and LOH at several chromosome loci in gallbladder carcinoma. Further studies of the molecular mechanism in gallbladder carcinoma and the delineation of the genetic influence involved should promote our understanding of gallbladder carcinogenesis.

Two-surgeon technique using saline-linked electric cautery and ultrasonic surgical aspirator in living donor hepatectomy: its safety and efficacy

BACKGROUND Saline-linked electric cautery (SLC) is introduced as an effective device to reduce blood loss in liver surgery. The aim of the current study was to evaluate the safety and efficacy of a 2-surgeon technique using SLC and the Cavitron Ultrasonic Surgical Aspirator (CUSA; Valleylab, Boulder, CO) in living donor hepatectomy. METHODS Forty-three living donor right hepatectomy cases were enrolled in this study. The first 28 cases underwent liver transection with CUSA alone (CUSA group), while additional SLC was applied in the current 15 cases (2-surgeon technique, TS group). RESULTS Blood loss was significantly reduced by the 2-surgeon technique (1,115.2 +/- 652.9 g in CUSA group vs 732.3 +/- 363.6 g in TS group, P < .05). In the TS group, there was no bile leakage from the cut surface. The early graft function and postoperative recipient survival were not significantly different between the groups. CONCLUSIONS According to our single-center experience, blood loss and donor complications in living donor hepatectomies were significantly reduced using a 2-surgeon technique using CUSA and SLC, while maintaining the graft viability.

Early Pancreatic Cancer

The results of surgical treatment for ordinary carcinoma of the pancreas, even now considered the only means for cure, have been dismal. In order to define early pancreatic cancer, aiming amelioration of surgical results, early pancreatic cancer has been seeked. It may be readily conceivable that the smaller the tumor size, the earlier the lesion. The relationship between tumor size and surgical results was reviewed from the literature, some of which included articles written in Japanese. Tumor size ≤2 cm in diameter is not always an early cancer. Tumor <1 cm could be an early cancer but does not definitely reveal long-term survival. An increase of pancreatic cancer in Japan may be strongly related with the increased elderly population. Small cystic lesions which develop in elderly persons seem to indicate carcinogenesis of ordinary ductal cancer of the pancreas. Carcinoma in situ may be an early pancreatic cancer. Early pancreatic cancer is defined as an intraductal adenocarcinoma without any invasion or with minimal invasion to the stroma, regardless of size or extent of the lesion.

Human T-cell leukemia virus type I–associated myelopathy following living-donor liver transplantation

This report describes a patient who developed human T‐cell leukemia virus type I–associated myelopathy (HAM) following a living‐donor liver transplantation (LDLT) for liver cirrhosis due to hepatitis C virus (HCV) infection. Both the recipient and the living donor (his sister) were human T‐cell leukemia virus type I (HTLV‐I) carriers. Since the LDLT, he had been treated with immunosuppressive drugs such as tacrolimus and steroids as well as interferon‐α to prevent rejection and a recurrence of the HCV infection, respectively. Even though the HTLV‐I proviral load had decreased upon interferon treatment, he developed a slowly progressive gait disturbance with urinary disturbance 2 years after the LDLT and was diagnosed with HAM. This appears to be the first report of HAM development in an HLTV‐I–infected LDLT recipient. Liver Transpl 14:647–650, 2008.

Glycine reduces hepatic warm ischaemia-reperfusion injury by suppressing inflammatory reactions in rats.

Background: Glycine, a non‐essential amino acid, is known to have an anti‐inflammatory effect on haemorrhagic and endotoxic shock in animals. In the present study, we examined the effects of glycine on inflammatory reactions and hepatocellular damage after hepatic warm ischaemia–reperfusion (I–R) in rats.

Role of hypermethylation on carcinogenesis in the pancreas.

Pancreatic cancer is a disease with a dismal outcome and a 5-year survival rate of under 5%. Recent studies have shown that pancreatic cancer consists of an accumulation of genetic and epigenetic alterations during tumor development as in other human cancers. Therefore, new diagnostic methods for early detection and more effective therapeutic strategies based on a better understanding of the molecular biology of pancreatic cancer are urgently required. Recently, promoter hypermethylation of cancer-related genes has emerged as an important mechanism in carcinogenesis. The present review summarizes an overview of the alterations of promoter hypermethylation in pancreatic cancer, and suggests that the further study of promoter hypermethylation involvement in pancreatic cancer and the delineation of molecular mechanisms involved may lead to an improvement in the outcome of this aggressive disease.

A secured technique for bile duct division during living donor right hepatectomy

Accordingly, we should cutthe bile duct as close as possible to the commonhepatic duct, but biliary stricture in the remnant liverof the donor is a great concern. To overcome theseproblems, we describe our technical inventions forsafe and accurate bile duct division during living do-nor right hepatectomy.During hilar dissection, the right hepatic artery andright portal vein are fully exposed and isolated fromthe hilar plate. At the final step of subsequent paren-chymal transection, the right hilar plate is fully ex-posed and encircled with radiopaque marker fila-ment, which is obtained from surgical gauze (Fig. 1).Intraoperative cholangiography is then performed viaa catheter placed in the cystic duct (Fig. 2A). C-armfluoroscopy is adapted during this procedure to en-able us to check the optimal cutting point of the bileduct, which is made clear by pulling the filament andadjusting the accurate angle (Fig. 2B). The right hilarplate including the right hepatic duct is then sharplydivided with scissors, and the stump of the remnantbile duct is closed with continuous 6-0 absorbablemonofilament sutures ([Polydioxanone] Suture II,Ethicon, Somerville, NJ). Cholangiography with C-arm fluoroscopy is performed again to check the bil-iary leakage or stricture in the remnant bile duct (Fig.2C). The right liver graft is then removed after theright hepatic artery, portal vein, and hepatic veinhave been divided (Fig. 2D).Of 54 living donor hepatectomies from August 1997to December 2005, 38 underwent right hepatectomy,and the present procedure was adapted for use in thelast 10 cases. Compared to the first 28 cases withordinary cholangiography, the incidence of multipleducts in the graft was significantly reduced (3/10 vs.20/28, respectively;