Yusuke Miyagawa

Identification of hepatic venous territories in liver resection by using color Doppler ultrasonography: report of two cases.

Resection of the hepatic vein because of the proximity of tumors may result in increased congestion in the noncancerous parenchyma, which in turn may lead to functional hepatic volume loss and postoperative hepatic failure, especially in a case of low hepatic reserve. However, to our knowledge, no technique for estimating the extent of dependent hepatic venous territories before hepatic resection has been established. We examined the possibility of using color Doppler ultrasonography for this purpose.

High incidence of other primary malignancies in patients with synchronous multiple gastric cancers “a multi-center retrospective cohort study”

This study evaluated the relationship between synchronous multiple gastric cancer and other primary malignancies. During 2002–2013, 1094 consecutive surgically treated gastric cancer patients were enrolled. Preoperatively, we performed total colonoscopy and whole-body computed tomography. When malignancies in other organs were suspected, detailed organ-specific examinations were performed. Synchronous multiple gastric cancer occurred in 102 patients (9.3%)which was frequently observed in patients with preoperative other primary malignancies (p < 0.001). Preoperative other primary malignancy was an independent risk factor for synchronous multiple gastric cancer (p = 0.001; hazard ratio: 2.145, 95% confidence interval: 1.354–3.399) and an independent prognostic factor of overall survival in patients undergoing gastrectomy with curative intent (p = 0.021; hazard ratio: 1.481, 95% confidence interval: 1.060–2.070). Thus, patients with preoperative other primary malignancies have a high risk of synchronous multiple gastric cancer. Careful preoperative examination is recommended to improve survival.

Surgery for chronic mesh infection occurred 10 years after sacrectomy − Mesh resection and mesentric leaf repair: A case report

Highlights • An 83-years old woman underwent sacrectomy combined with mesh reconstruction for chordoma suffered chronic mesh infection and bowel penetration 10 years after surgery.• This is the first report of mesh infection after sacrectomy and its surgical strategy.• We performed subtotal mesh resection and Mesenteric leaf repair for pelvic reconstruction.• Mesentric leaf repair might be a useful procedure for pelvic reconstruction when the use of a mesh has to be avoided.

Development of Hepatocellular Carcinoma in an Adult Patient with Alagille Syndrome

アラジール症候群 (Alagille syndrome; 以下, AGS) は常染色体優性遺伝の疾患で, 特異な顔貌, 心血管異常, 組織学的には肝内胆管の消失・低形成などが特徴とされる. 患者は49歳の男性で, 10歳時に当院にて開腹肝生検を施行され, 肝内胆管消失を認めAGSと診断されて以降, 近医にて治療経過観察されていた. 49歳時に腹部超音波検査にて肝右葉に巨大腫瘤を指摘され, 検査目的に当科へ紹介された. 精査にて肝腫瘍は肝細胞癌と診断され, 肝切除術が施行された. 術後経過は良好で術後第19病日に退院した. 切除肝の肉眼検査所見上, 腫瘍の最大径は12.5cmで, 部分的に壊死を認めた. 病理組織学的検査上, 腫瘍は中分化型肝細胞癌と診断され, 背景肝に胆管消失はなく, 慢性肝炎あるいは肝硬変の所見も認められなかった. AGSの長期観察症例, 肝硬変非合併症例の肝細胞癌発生・切除の報告はまれであり, 文献的考察を加えて報告する.