57 results on '"Kyoji Ito"'
Search Results
2. Multivisceral resection for primary pancreatic signet ring cell carcinoma
- Author
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Mai Nakamura, Fuyuki Inagaki, Nobuyuki Takemura, Yuhi Yoshizaki, Kyoji Ito, Fuminori Mihara, and Norihiro Kokudo
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Gastroenterology ,General Medicine - Published
- 2023
3. Graft failure after allogeneic islet transplantation in a patient with type 1 diabetes and a high <scp>anti‐</scp> glutamic acid decarboxylase antibody titer
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Noriko Kodani, Daisuke Chujo, Aiko Terakawa, Kyoji Ito, Fuyuki Inagaki, Nobuyuki Takemura, Shinichi Matsumoto, Tsuyoshi Tajima, Norio Ohmagari, Kumiko Ajima, Tadashi Takaki, Yzumi Yamashita, Koya Shinohara, Hiroshi Kajio, Takuya Awata, and Masayuki Shimoda
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Endocrinology, Diabetes and Metabolism ,Internal Medicine ,General Medicine - Published
- 2023
4. Assessment of liver function-related mRNA expression and fluorescence imaging in outflow-obstructed regions in rats
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Daisuke Ito, Yoshikuni Kawaguchi, Yoshinori Inagaki, Kyoji Ito, Yuichiro Mihara, Junichi Kaneko, Mariko Tanaka, Masashi Fukayama, Norihiro Kokudo, and Kiyoshi Hasegawa
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Surgery ,General Medicine - Abstract
The liver function in outflow-obstructed regions is reportedly impaired; however, the functional decrease has not been quantitatively assessed. We therefore evaluated the uptake of indocyanine green (ICG) into hepatocytes and the mRNA expression associated with the liver function in outflow-obstructed regions using rat models.A total of 20 rats with the ligation of the right median hepatic vein to induce outflow obstruction were studied. Five rats each were grouped by the time of re-laparotomy, and the fluorescence intensity (FI) values of ICG. The mRNA expression, including that of Albumin, Cytochrome P450 (Cyp) 1a2, Cyp3a1, Cyp7a1, and Gamma-glutamylcysteine synthetase, in outflow-obstructed (mRNAMicroscopic fluorescence imaging showed that the FI values were significantly lower in outflow-obstructed regions than in non-outflow-obstructed regions at 12 h, 24 h, and 3 days after ligation of the hepatic vein. The mRNAThe liver function in outflow-obstructed regions was impaired in terms of the uptake of ICG and the mRNA expression. Our findings may help estimate the postoperative functional remnant liver volume by considering the decrease in the liver function in outflow-obstructed regions.
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- 2022
5. Estimation of Physiologic Ability and Surgical Stress (E-PASS) Predicts Postoperative Major Complications After Hepato-Pancreato Biliary Surgery in the Elderly
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Yu, Norimatsu, Kyoji, Ito, Nobuyuki, Takemura, Fuyuki, Inagaki, Fuminori, Mihara, and Norihiro, Kokudo
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Biliary Tract Surgical Procedures ,Postoperative Complications ,Risk Factors ,Humans ,Surgery ,Risk Assessment ,Aged ,Retrospective Studies - Abstract
As society ages, an increasing number of elderly patients require hepato-pancreato-biliary (HPB) surgery. We investigated the risk factors for complications in elderly patients undergoing HPB surgery using surgical risk scoring models.We retrospectively investigated 184 elderly patients (≥ 65 years old) who underwent HPB surgery, including the liver, pancreas, bile duct, and/or gallbladder resection, with exemption to simple cholecystectomy between January 2017 and December 2019. The surgical risk scoring models used included the Estimation of Physiological Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and Geriatric 8 (G8). We evaluated the correlations between the scores and severe complications. Complications were classified as severe (Clavien-Dindo classification [C-D] ≥ III) or non-severe (C-D ≤ II).Complications occurred in 78 patients (24 C-D ≥ III, 54 C-D ≤ II). Preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were significantly higher in patients with C-D ≥ IIIa than in those with C-D ≤ II. Multiple logistic regression analysis revealed that PRS (P = 0.01) and SSS (P = 0.04) were independent predictive factors for severe complications. However, the POSSUM and G8 models showed no significant correlations to severe complications.E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.
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- 2022
6. Bowel perfusion demonstrated using indocyanine green fluorescence imaging in two cases of strangulated ileus
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Kyoko Nohara, Nobuyuki Takemura, Kyoji Ito, Ryo Oikawa, Syusuke Yagi, Hitomi Wake, Naoki Enomoto, Kazuhiko Yamada, and Norihiro Kokudo
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Indocyanine Green ,Intestines ,Perfusion ,Ileus ,Optical Imaging ,Gastroenterology ,Humans ,General Medicine ,Intestinal Obstruction - Abstract
We report the use of indocyanine green (ICG) fluorescence for intraoperative diagnosis in two cases of strangulated ileus. We successfully preserved the bowel and avoided postoperative complications by detecting adequate perfusion and no necrosis in the intestine's strangulated regions. In the first case, enhanced computed tomography (CT) revealed a closed loop intestine, which showed poor contrast, and we performed laparotomy with ICG fluorescence. In the second case, the CT scan revealed bowel obstruction without ascites. We conservatively treated the patient with the insertion of a long tube. The patient's condition did not improve, and we performed laparotomy using ICG fluorescence. In both of these cases, the visual observation during laparotomy showed that the ileum had dark-red discoloration. We demonstrated perfusion and preserved the ileum by injecting 2.5 mg of ICG intravenously; fluorescence was observed in the dark-red ileum using the PINPOINT system (Novadaq, Kalamazoo, MI, US). Both patients recovered successfully after the surgery with no adverse events. Our data suggest that ICG fluorescence imaging can be one of the decision-making modalities in patients with strangulated ileus.
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- 2022
7. Surgical treatment for a rare case of duodenal gangliocytic paraganglioma accompanied with lymph node metastasis
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Toko Miyazaki, Nobuyuki Takemura, Fuminori Mihara, Kyoji Ito, Hideki Miyazaki, Toru Igari, and Norihiro Kokudo
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Paraganglioma ,Duodenal Neoplasms ,Lymphatic Metastasis ,Gastroenterology ,Humans ,Female ,General Medicine ,Middle Aged ,Endoscopy, Gastrointestinal ,Pancreaticoduodenectomy - Abstract
We report a rare case of duodenal gangliocytic paraganglioma accompanied with lymph node metastasis. An asymptomatic 58-year-old woman was admitted for the evaluation of abnormal liver enzyme test results. Abdominal computed tomography and upper gastrointestinal endoscopy revealed a 27-mm pedunculated tumor of the papilla of Vater. Adenocarcinoma of the papilla with muscularis propria invasion was suspected; therefore, pancreaticoduodenectomy with lymph node dissection was performed. There were no perioperative complications. A definitive diagnosis of gangliocytic paraganglioma of the papilla of Vater with lymph node metastases was confirmed by pathological examinations, which is a rare condition. The patient was discharged on her 16th postoperative day, and no recurrence or metastases were identified during the 18-month follow-up period. We herein discuss the surgical treatment for this rare case and present a review of related literature.
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- 2022
8. Quality of life after total pancreatectomy with islet autotransplantation for chronic pancreatitis in Japan
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Tadashi Takaki, Daisuke Chujo, Toshiaki Kurokawa, Akitsu Kawabe, Nobuyuki Takahashi, Kyoji Ito, Koji Maruyama, Fuyuki Inagaki, Koya Shinohara, Kumiko Ajima, Yzumi Yamashita, Hiroshi Kajio, Mikio Yanase, Chihaya Hinohara, Makoto Tokuhara, Yukari Uemura, Yoshihiro Edamoto, Nobuyuki Takemura, Norihiro Kokudo, Shinichi Matsumoto, and Masayuki Shimoda
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Endocrinology ,Endocrinology, Diabetes and Metabolism - Published
- 2023
9. Percutaneous Transhepatic Gallbladder Intervention as a Bridge to Cholecystectomy: Aspiration or Drainage?
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Yuki Nakamura, Mai Kuwahara, Kyoji Ito, Fuyuki Inagaki, Fuminori Mihara, Nobuyuki Takemura, and Norihiro Kokudo
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Surgery - Published
- 2023
10. Surgical management of appendicitis in patients with human immunodeficiency virus (HIV) positivity: a propensity score-matched analysis in a base hospital for HIV treatment in Japan
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Yu Norimatsu, Kyoji Ito, Nobuyuki Takemura, Fuyuki Inagaki, Fuminori Mihara, Kunihisa Tsukada, Shinichi Oka, and Norihiro Kokudo
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Surgery ,General Medicine - Published
- 2023
11. Elevation in creatine kinase isoenzyme-MM associated with hepatocellular carcinoma: a case report and review of literature
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Yuki Nakamura, Kyoji Ito, Nobuyuki Takemura, Fuyuki Inagaki, Fuminori Mihara, and Norihiro Kokudo
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Isoenzymes ,Carcinoma, Hepatocellular ,Myositis ,Liver Neoplasms ,Gastroenterology ,Humans ,Female ,General Medicine ,Creatine Kinase ,Aged - Abstract
We report the case of a 79-year-old woman with hepatocellular carcinoma (HCC) who presented with creatine kinase (CK)-MM elevation. On admission, her serum CK-MM level exceeded 4000 IU/L (normal, 44-206 IU/L), and computed tomography revealed two HCCs in hepatic segment VIII (23 mm, 86 mm). The patient denied experiencing muscular symptoms such as weakness or pain. Hypothyroidism, ischemic heart disease, muscular dystrophy, autoimmune myopathy, drug-induced rhabdomyolysis, and paraneoplastic inflammatory myositis syndrome (PIMS) were included in the differential diagnosis for high CK-MM, but none were suspected. Although the cause of elevated CK-MM was not elucidated, an HCC-related mechanism was considered and the tumor was resected. The CK-MM levels declined gradually to 300 IU/L postoperatively without any special perioperative management. Nineteen cases of HCC-associated CK-MM elevation have been reported in English thus far, in all of which, inflammatory myositis was concluded as the cause of CK-MM elevation. However, in this case, the elevation of CK-MM was associated with HCC-related mechanisms distinct from PIMS, suggesting HCC-related mechanisms should not be excluded as a cause of high CK-MM, even though PIMS is negative.
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- 2022
12. Laparoscopic Repair and Relief of Obstruction of a Diaphragmatic Hernia after Percutaneous Radiofrequency Ablation: A Case Report
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Satomi Miura, Kyoji Ito, Nobuyuki Takemura, Fuminori Mihara, Katsuya Deguchi, Tomomichi Kiyomatsu, and Norihiro Kokudo
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2022
13. Laparoscopic hemostasis for abdominal brunt massive hemorrhage due to endometriosis
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Junko Yagi, Shiori Seki, Norihiro Kokudo, Nobuyuki Takemura, Kensuke Tomio, Hajime Oishi, Hikaru Koutake, Kyoji Ito, Fuminori Mihara, Ryo Oikawa, and Misao Nakanishi
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medicine.medical_specialty ,Abdominal pain ,medicine.diagnostic_test ,business.industry ,Uterine fibroids ,Endometriosis ,Adhesion (medicine) ,General Medicine ,medicine.disease ,Surgery ,Blunt trauma ,medicine.artery ,medicine ,Hemoperitoneum ,medicine.symptom ,business ,Uterine artery ,Laparoscopy - Abstract
In the gynecological literature, a limited number of studies have reported intraperitoneal bleeding due to abdominal blunt trauma. In this report, we describe a rare case of massive intraabdominal hemorrhage from the uterine artery triggered by a fall injury without apparent abdominal bruising in the presence of severe endometriosis and a uterine fibroid. A 28-year-old woman who fell from a railway platform was transported to an emergency hospital. Although she did not sustain abdominal bruising and initially had no abdominal symptoms, she complained of gradually worsening abdominal pain. Abdominal CT identified intraabdominal massive hematoma, and emergency exploratory laparoscopy revealed active bleeding from the right uterine artery eroded by endometriosis, which was treated with laparoscopic electrocoagulation. The cause of the intraabdominal bleeding was associated with avulsion of the endometriosis adhesion between the right perimetrium and the right uterine artery due to inertial forces of the uterus during the fall injury. A uterine fibroid discovered during laparoscopy was suspected to strengthen the inertial forces of the uterus. In the case of hemoperitoneum after trauma, gynecological sources of bleeding must be kept in mind, especially for patients with a known history of fibroids or endometriosis.
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- 2021
14. Xanthogranulomatous Pancreatitis Accompanied by Xanthogranulomatous Cholecystitis
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Fuminori Mihara, Tomoki Imokawa, Fuyuki Inagaki, Norihiro Kokudo, Nobuyuki Takemura, and Kyoji Ito
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Pathology ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Enucleation ,Diagnosis, Differential ,Endocrinology ,Positron Emission Tomography Computed Tomography ,Cholecystitis ,Xanthomatosis ,Internal Medicine ,medicine ,Humans ,Mucinous carcinoma ,Pancreas ,Xanthogranulomatous Cholecystitis ,Aged, 80 and over ,Pancreatic duct ,Hepatology ,business.industry ,Gallbladder ,Jaundice ,medicine.disease ,Adenocarcinoma, Mucinous ,Pancreatic Neoplasms ,Adenocarcinoma, Papillary ,medicine.anatomical_structure ,Pancreatitis ,Biliary tract ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Carcinoma, Pancreatic Ductal - Abstract
Xanthogranulomatous pancreatitis (XGP) is extremely rare, with only 31 cases reported in the English literature to date. We reviewed previously reported 17 articles about XGP and report an additional case of XGP. This is the first case of XGP with xanthogranulomatous cholecystitis accompanied by intraductal papillary mucinous carcinoma (IPMC) in an 80-year-old woman. She was referred to our hospital with jaundice and general malaise and was found to have a cystic mass at the pancreatic head and a solid mass at the pancreatic tail, with dilation of both the main pancreatic duct and biliary tract noted on computed tomography. Diagnosis of IPMC at the pancreatic head with neuroendocrine tumor at the pancreatic tail was made, and the patient underwent subtotal stomach-preserving pancreatoduodenectomy with enucleation of the mass at the tail. Pathological examination revealed IPMC with xanthogranulomatous changes around the IPMC and at the pancreatic tail and gallbladder. Xanthogranulomatous pancreatitis could be induced by inflammatory reaction due to obstruction of the pancreatic duct and biliary tract by mucin produced in the IPMC. It is sometimes difficult to preoperatively differentiate XGP from malignant pancreatic tumors, such as pancreatic carcinoma or neuroendocrine tumor, using imaging studies.
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- 2021
15. Liver resection in a patient with persistent positive PCR test for coronavirus disease 2019 (COVID-19): a case report
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Akiho Sugita, Fuyuki F. Inagaki, Nobuyuki Takemura, Mai Nakamura, Kyoji Ito, Fuminori Mihara, Kei Yamamoto, Shinichiro Morioka, and Norihiro Kokudo
- Abstract
Background The perioperative mortality rate is high in patients with coronavirus disease 2019 (COVID-19), and infection control measures for medical care providers must be considered. Therefore, the timing for surgery in patients recovering from COVID-19 is difficult. Case presentation A 65-year-old man was admitted to a hospital with a diagnosis of moderate COVID-19. He was transferred to our hospital because of risk factors, including heavy smoking history, type 2 diabetes mellitus, and obesity (BMI 34). Vital signs on admission were a temperature of 36.1 °C, oxygen saturation > 95% at rest, and 94% on exertion with 3 L/min of oxygen. Chest computed tomography (CT) showed bilateral ground-glass opacities, predominantly in the lower lungs. Contrast-enhanced abdominal CT incidentally revealed a liver tumor with a diameter of 80 mm adjacent to the middle hepatic vein, which was diagnosed as hepatocellular carcinoma (HCC). After being administered baricitinib, remdesivir, dexamethasone, and heparin, the patient’s COVID-19 pneumonia improved, his oxygen demand resolved, and he was discharged on day 13. Furthermore, the patient was initially scheduled for hepatectomy 8 weeks after the onset of COVID-19 following a discussion with the infection control team. However, 8 weeks after the onset of illness, a polymerase chain reaction (PCR) test was performed on nasopharyngeal swab fluid, which was observed to be positive. The positive results persisted till 10 and 11 weeks after onset. Both Ct values were high (≥ 31) out of 45 cycles, with no subjective symptoms. Since we determined that he was no longer contagious, surgery was performed 12 weeks after the onset of COVID-19. Notably, medical staff wearing personal protective equipment performed extended anatomical resection of the liver segment 8 ventral area in a negative-pressure room. The patient had a good postoperative course, with no major complications, including respiratory complications, and was discharged on postoperative day 14. Finally, none of the staff members was infected with COVID-19. Conclusions We reported a case regarding the timing of surgery on a patient with persistently positive PCR test results after COVID-19, along with a literature review.
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- 2022
16. Risk Factors of Atherosclerotic Celiac Artery Stenosis Among Patients Undergoing Pancreaticoduodenectomy
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Ryo, Oikawa, Kyoji, Ito, Nobuyuki, Takemura, Fuminori, Mihara, Yoshitaka, Shida, Tsuyoshi, Tajima, and Norihiro, Kokudo
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Pancreatectomy ,Endocrinology ,Hepatology ,Celiac Artery ,Risk Factors ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Humans ,Constriction, Pathologic ,Pancreaticoduodenectomy - Published
- 2022
17. Using Indocyanine Green Fluorescence Imaging to Identify an Anomalous Cystohepatic Duct During Laparoscopic Cholecystectomy
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Ryo Oikawa, Kyoji Ito, Nobuyuki Takemura, Mikiya Fujii, Mai Nakamura, Fuminori Mihara, Fuyuki Inagaki, and Norihiro Kokudo
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General Medicine - Published
- 2023
18. Intraoperative indocyanine green fluorescence navigation facilitated complete removal of lymph node metastases from hepatocellular carcinoma
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Toshiaki Kurokawa, Fuminori Mihara, Nobuyuki Takemura, Kyoji Ito, Fuyuki Inagaki, and Norihiro Kokudo
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Pathology ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Communication ,Hepatocellular carcinoma ,medicine ,medicine.disease ,business ,Lymph node ,digestive system diseases ,Indocyanine green fluorescence - Abstract
Indocyanine green (ICG) is a fluorescent dye that selectively accumulates in primary hepatocellular carcinoma (HCC) as well as in extrahepatic metastases of HCC. Reported here is a case of metachronous lymph node (LN) metastases from HCC that were resected using ICG fluorescence navigation. A man in his 70s was referred to this department for suspected LN metastasis from HCC. Computed tomography revealed an enlarged suprapancreatic LN. After a laparotomy, an ICG fluorescence imaging system intraoperatively revealed strong fluorescence of this LN, which was then easily resected. An examination after the removal of the LN revealed fluorescence from the adjacent lymphatic tissue as well, so an additional resection was performed. Pathologically, both LNs were confirmed to be metastases from HCC. In this case, some lymphatic tissue metastases from HCC could not be identified prior to surgery, but intraoperative use of ICG fluorescence navigation facilitated their complete removal.
- Published
- 2021
19. Diagnosis of celiac artery stenosis using multidetector computed tomography and evaluation of the collateral arteries within the mesopancreas of patients undergoing pancreaticoduodenectomy
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Kyoji Ito, Fuminori Mihara, Fuyuki Inagaki, Norihiro Kokudo, Nobuyuki Takemura, Tsuyoshi Tajima, and Yoshitaka Shida
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Male ,Histology ,medicine.medical_treatment ,Collateral Circulation ,Arterial Occlusive Diseases ,Dissection (medical) ,Asymptomatic ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Celiac Artery ,Celiac artery ,medicine.artery ,Multidetector Computed Tomography ,Multidetector computed tomography ,medicine ,Humans ,Superior mesenteric artery ,Pancreas ,Aged ,Retrospective Studies ,0303 health sciences ,business.industry ,030206 dentistry ,General Medicine ,Middle Aged ,medicine.disease ,humanities ,eye diseases ,Stenosis ,medicine.anatomical_structure ,030301 anatomy & morphology ,embryonic structures ,Female ,Anatomy ,medicine.symptom ,Nuclear medicine ,business ,human activities ,Artery - Abstract
Introduction Celiac artery (CA) stenosis (CAS), caused by various factors, is often asymptomatic because collateral blood flow from the superior mesenteric artery (SMA) supplies the CA outflow region. The purpose of this study was to investigate the usefulness of multidetector computed tomography (MDCT) for diagnosing CAS and associated collateral artery formation, and elucidating the effect of CAS on the numbers and diameters of the arteries within the mesopancreas. Materials and methods We investigated 106 patients who underwent contrast-enhanced MDCT, before pancreaticoduodenectomy (PD), between January 2015 and September 2019. MDCT was used to determine the percentage stenosis of the CAs; patients were classified into CAS (-) (0-29% stenosis) and CAS (+) (30-100% stenosis) groups. The dissection lines of the mesopancreas were classed as Level I or II, and the numbers and diameters of the arteries along each dissection line were counted and measured. Results There were 27 CAS (+) patients and 79 CAS (-) patients. In the CAS (+) group there were more arteries and they had larger diameters than those in the CAS (-) group, at both Levels I and II. There were significantly more arteries when the CA stenosis was ≥30% and they had larger diameters when the stenosis was ≥50%. Conclusions MDCT is useful for diagnosing CAS, and CAS is associated with larger numbers and diameters of the arteries within the mesopancreas. This article is protected by copyright. All rights reserved.
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- 2021
20. Resection of a Large Hepatocellular Carcinoma Located in the Dorsocaval Spiegel Lobe at the Origin of the Inferior Vena Cava Ligament —A Case Report
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Nobuyuki Takemura, Fuminori Mihara, Tomomichi Kiyomatsu, Kyoji Ito, Kazuhiko Yamada, and Norihiro Kokudo
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medicine.medical_specialty ,business.industry ,Family medicine ,Medicine ,business - Published
- 2021
21. Definition of the caudate lobe of the liver based on portal segmentation
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Chihiro Ebashi, Yoshihiro Sakamoto, Kyoji Ito, Masamitsu Kumon, Tatsuya Kumon, Tsutomu Namikawa, and Emiko Tsutsui
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business.industry ,Bile duct ,Anatomy ,Inferior vena cava ,Lobe ,medicine.anatomical_structure ,medicine.vein ,Medicine ,Caudate lobe ,Original Article ,Segmentation ,business ,Vein ,Process (anatomy) ,Artery - Abstract
Models of liver corrosion were developed by injecting colored Mercox, epoxy resin, silicon rubber and other materials into the portal vein, hepatic artery, bile duct and hepatic vein of autopsied livers. The glissonean or venous branches that obstructed the view of the caudate lobe of the liver were subsequently removed. The detailed anatomy of the caudate vessels was studied and the three parts of the caudate lobe (Spiegel lobe, paracaval portion and caudate process) were defined based on portal segmentation. Caudate portal branches should be defined as dorsal branches arising from the main trunk, or from the first order branches of the portal vein covering the hepatic region in front of the inferior vena cava. The hepatic region, where the internal branches from segment eight cover the front of the inferior vena cava, should be defined as segment eight, and not as the paracaval portion. Prof. Couinaud defined the right side of the caudate lobe as segment IX based on the spatial position; however, this classification of the caudate section seemed to lack consistency with that of other hepatic segments, which were defined based on portal segmentation. We have sustained the dogma that any hepatic segment should be defined based on portal segmentation, and our classification of the definition and boundary of the caudate lobe, which was published in 1985, has sufficient consistency to be used as an international standard.
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- 2020
22. Immunohistochemical staining as supportive diagnostic tool for pseudomyxoma peritonei arising from intraductal papillary mucinous neoplasm: A report of two cases and literature review
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Fuminori Mihara, Hideaki Yano, Fuyuki Inagaki, Yoshimasa Gohda, Mitsunori Yamakawa, Kazuhiko Yamada, Naoki Kojima, Atsuko Kataoka, Kyoji Ito, Norihiro Kokudo, Tomomichi Kiyomatsu, Nobuyuki Takemura, and Toru Igari
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Pathology ,medicine.medical_specialty ,Diagnostic methods ,endocrine system diseases ,Hepatology ,Intraductal papillary mucinous neoplasm ,business.industry ,Endocrinology, Diabetes and Metabolism ,Gastroenterology ,Clinical course ,medicine.disease ,medicine.anatomical_structure ,medicine ,Pseudomyxoma peritonei ,Immunohistochemistry ,Pancreas ,business ,Pathological ,Immunostaining - Abstract
Background/Objectives Pseudomyxoma peritonei (PMP) arising from an intraductal papillary mucinous neoplasm of the pancreas (IPMN) is a rare condition. The diagnosis of IPMN as the origin of PMP is mainly inferred from the clinical course and the exclusion of PMP from other organs. The pathological diagnosis has not yet been established. To evaluate the usefulness of immunohistochemical staining for the diagnosis of the primary lesion of PMP as IPMN. Methods There are 2 cases of PMP arising from IPMN between March 2010 and December 2019 at National Center for Global Health and Medicine. A PubMed search that reported PMP arising from IPMN identified 16 additional cases. Diagnostic methods and clinicopathological features of 18 cases were compared. Results Four cases including our two cases used immunohistochemical staining for the diagnosis of PMP arising from IPMN. The correspondence of the immunohistochemical staining between PMP and IPMN was shown in the three cases including previously reported two cases and one of our two cases to identify the primary lesion of PMP as IPMN. In addition, we revealed that the comparison of the immunostaining pattern of PMP with the representative immunostaining pattern of the candidate primary lesions is helpful for the diagnosis of the primary lesion of PMP. Conclusions Immunohistochemical staining is helpful to identify the primary lesion of PMP as IPMN.
- Published
- 2020
23. Descending Aorta Finger Clamping to Control Intra-Abdominal Bleeding Due to Rupture of Anterior Superior Pancreaticoduodenal Artery Aneurysm
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Nobuyuki Takemura, Fuminori Mihara, Hayato Ono, Hitomi Wake, Kaito Yano, Kyoji Ito, and Norihiro Kokudo
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Aorta ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Surgery ,Blood pressure ,Aneurysm ,Hemostasis ,medicine.artery ,Descending aorta ,Laparotomy ,cardiovascular system ,Medicine ,Thoracotomy ,business ,Median arcuate ligament syndrome - Abstract
Background: Open aortic cross-clamping via a resuscitative left thoracotomy is effective in maintaining adequate blood pressure in patients with abdominal bleeding until achieving hemostasis. However, the procedure to encircle the descending aorta to secure cross-clamping is technically demanding for general surgeons, especially in emergency situations. Case Presentation: We report a case of rupture of the anterior superior pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome, which required surgical hemostasis. Because of severe hypotension after laparotomy, open aortic cross-clamping with a left thoracotomy was performed by general surgeons. However, the aortic clamps repeatedly slipped off because the clamping was conducted without encircling the aorta. Then, we attempted finger clamping of the descending aorta, and the blood pressure was quite effectively stabilized. Conclusion: Descending aorta finger clamping via a resuscitative left thoracotomy is easy and feasible and might be an effective procedure to maintain adequate blood pressure for general surgeons.
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- 2020
24. Primary Splenic Lymphoma with Hemophagocytic Syndrome : Report of a Case with Treatment and Diagnosis by Splenectomy
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Fuminori Mihara, Norihiro Kokudo, Nobuyuki Takemura, Hideki Miyazaki, Kyoji Ito, Toru Igari, and Yu Norimatsu
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Splenectomy ,medicine ,Primary Splenic Lymphoma ,business ,Gastroenterology - Published
- 2020
25. Added value of indocyanine green fluorescence imaging in liver surgery
- Author
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Nobuyuki Takemura, Kyoji Ito, Fuyuki Inagaki, Fuminori Mihara, and Norihiro Kokudo
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Indocyanine Green ,Carcinoma, Hepatocellular ,Hepatology ,Liver Neoplasms ,Optical Imaging ,Gastroenterology ,Hepatectomy ,Humans - Abstract
Recently, indocyanine green (ICG) fluorescence imaging has been widely used as a substitute for cholangiography in hepatobiliary surgery, to detect hepatic tumors, for accurate anatomical hepatectomy, and to increase the safety and accuracy of minimally invasive (laparoscopic and robotic) hepatectomy. The clinical relevance of this method has been increasing gradually, as new procedures develop in this field. Various important roles and the latest added value of ICG fluorescence imaging in liver surgery are discussed in this report.
- Published
- 2021
26. Hepatectomy for liver metastases from cervical cancer with portal vein tumor thrombosis: a case report
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Mai Nakamura, Kyoji Ito, Nobuyuki Takemura, Fuminori Mihara, and Norihiro Kokudo
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Carcinoma, Hepatocellular ,Portal Vein ,Liver Neoplasms ,Gastroenterology ,Hepatectomy ,Humans ,Uterine Cervical Neoplasms ,Female ,Thrombosis ,General Medicine ,Middle Aged ,Retrospective Studies - Abstract
The prognosis of patients with liver metastasis of cervical cancer is poor with an extremely short survival period, and there have been no reports of cervical cancer complicated by portal vein tumor thrombosis (PVTT). We report a case of cervical cancer developing liver metastasis with PVTT. A 49-year-old woman developed liver metastasis from cervical cancer with PVTT. The primary tumor was locally controlled with multidisciplinary treatment, including systemic therapy, surgical resection, and radiation. However, her follow-up abdominal computed tomography results showed two irregular tumors in the liver's segments 2 and 6. From the latter lesion, a low-density filling defect extended to the posterior branch of the portal vein, suggesting PVTT. Hepatectomy of the two metastases was performed to prevent portal vein obstruction during subsequent chemotherapy. Pathological analysis revealed metastatic squamous cell carcinoma from cervical cancer that developed a tumor thrombus at the posterior branch of the portal vein. The patient received adjuvant chemotherapy, but died 10 months after surgery for recurrent liver metastasis. We present the first case of liver resection for liver metastasis from cervical cancer with PVTT. Although cervical cancer with PVTT is associated with a poor prognosis, surgical resection is a feasible option for preventing portal vein obstruction during subsequent chemotherapy.
- Published
- 2021
27. Efficacy and safety of total pancreatectomy with islet autotransplantation: A clinical study in Japan
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Norihiro Kokudo, Masayuki Shimoda, Nobuyuki Takemura, Kumiko Ajima, Tadashi Takaki, Mikio Yanase, Koya Shinohara, Daisuke Chujo, Kyoji Ito, Yzumi Sugahara, Toshiaki Kurokawa, Yoshihiro Edamoto, Makoto Tokuhara, Akitsu Kawabe, Shinichi Matsumoto, Hiroshi Kajio, Koji Maruyama, Nobuyuki Takahashi, Yukari Uemura, and Chihaya Hinohara
- Subjects
medicine.medical_specialty ,geography ,geography.geographical_feature_category ,Total pancreatectomy ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,MEDLINE ,Islets of Langerhans Transplantation ,medicine.disease ,Islet ,Prognosis ,Combined Modality Therapy ,Transplantation, Autologous ,Autotransplantation ,Surgery ,Clinical study ,Pancreatectomy ,Japan ,Diabetes mellitus ,Pancreatitis, Chronic ,medicine ,Humans ,Patient Safety ,business - Published
- 2021
28. Lower risk of postoperative delirium using laparoscopic approach for major abdominal surgery
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Daisuke Koike, Yoshikuni Kawaguchi, Nobutaka Tanaka, Mariko Yamamoto, Keishi Kawasaki, Yukihiro Nomura, Kyoji Ito, Motoki Nagai, and Yusuke Suka
- Subjects
Male ,medicine.medical_specialty ,Lower risk ,Risk Assessment ,behavioral disciplines and activities ,Postoperative Complications ,Japan ,Risk Factors ,Internal medicine ,Abdomen ,mental disorders ,medicine ,Humans ,Cumulative incidence ,Propensity Score ,Retrospective Studies ,Proportional hazards model ,business.industry ,Incidence ,Hazard ratio ,Delirium ,Middle Aged ,Hepatology ,Confidence interval ,Surgery ,Female ,Laparoscopy ,medicine.symptom ,business ,Abdominal surgery - Abstract
A laparoscopic approach is increasingly being used for major abdominal surgeries and is reportedly associated with a lower incidence of postoperative complications. However, the association of laparoscopic approach and postoperative delirium remains unclear. We aimed to retrospectively investigate risk factors for postoperative delirium after abdominal surgery particularly assessing the association between a laparoscopic approach and postoperative delirium. We retrospectively studied 801 patients who underwent major abdominal surgery between April 2012 and December 2013. Among these, 181 (22.6%) patients underwent a laparoscopic and 620 (77.4%) patients underwent an open procedure. A Cox proportional hazard model analysis was used to identify risk factors for the development of postoperative delirium or overall survival within 180 days after surgery. Cumulative incidence of postoperative delirium was assessed using a propensity score-matching analysis. Postoperative delirium occurred in 56 patients (7.0%). A Multivariate Cox proportional hazard model analysis revealed that a laparoscopic approach reduced the risk of postoperative delirium [hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.07–0.84, p = 0.019]. Postoperative delirium was associated with worse overall survival within 180 days (HR 4.91, 95% CI 1.96–12.22, p = 0.001) after adjusting for other confounders using the Cox proportional hazard model analysis. Patients who developed postoperative delirium showed worse outcomes including higher rate of morbidity except delirium (p
- Published
- 2019
29. Seventeen primary malignant neoplasms involving the skin, ovary, esophagus, colon, oral cavity, and ear canal: a case report and review of the literature
- Author
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Fuminori Mihara, Hideki Miyazaki, Ryusuke Sumiya, Reiko Arakawa, Norihiro Kokudo, Norihiro Kato, Kyoji Ito, Nobuyuki Takemura, and Naohiko Aozasa
- Subjects
Pathology ,medicine.medical_specialty ,Mouth ,Xeroderma pigmentosum ,business.industry ,Colon ,Ovary ,Gastroenterology ,Microsatellite instability ,Cancer ,General Medicine ,medicine.disease ,Neoplasms, Multiple Primary ,Esophagus ,Cancer screening ,Medicine ,Neoplasm ,Humans ,Female ,Neoplasm Recurrence, Local ,business ,Ovarian cancer ,Exome sequencing ,Ear Canal ,Rare disease - Abstract
Multiple primary malignant neoplasm (MPMN) is a rare disease with two or more malignant neoplasms in one patient. In less than 0.1% of cancer patients, four or more occur. MPMN is frequently associated with hereditary cancer syndrome, although in rare cases, it is not. A female patient developed 17 MPMNs. Although they were successfully treated with surgery, radiation, and adjuvant chemotherapy, the patient died from the recurrence of ovarian cancer. To explore genetic susceptibility to MPMN, immunohistochemical analysis, microsatellite instability analysis, germ line exome sequencing, and unscheduled DNA synthesis assays were performed. However, the results of immunohistochemical analysis and microsatellite instability indicated that there were no known hereditary cancer syndromes, and exome sequencing with 88 representative genes associated with hereditary cancer syndrome revealed no variants. An unscheduled DNA synthesis assay to rule out xeroderma pigmentosum was also performed, but the result was negative. While the presence of multiple neoplasms is rare, the present case represents 17 primary neoplasms with no associations with hereditary cancer syndrome. Although the cause of MPMN was not detected in this patient, careful follow-up and deliberate cancer screening enabled successful disease management over 17 years from the appearance of the first neoplasm.
- Published
- 2021
30. Detailed anatomy and procedure of celiac artery decompression in median arcuate ligament syndrome
- Author
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Fuminori Mihara, Ryo Oikawa, Norihiro Kokudo, Nobuyuki Takemura, Kyoji Ito, and Fuyuki Inagaki
- Subjects
musculoskeletal diseases ,Duplex ultrasonography ,Aorta ,Left gastric artery ,Decompression ,business.industry ,Median arcuate ligament ,Anatomy ,medicine.disease ,Decompression, Surgical ,Stenosis ,medicine.anatomical_structure ,Median Arcuate Ligament Syndrome ,Celiac artery ,Celiac Artery ,medicine.artery ,parasitic diseases ,medicine ,Humans ,lipids (amino acids, peptides, and proteins) ,Surgery ,business ,Median arcuate ligament syndrome - Abstract
Median arcuate ligament (MAL) syndrome is a clinical syndrome caused by the compression of the celiac artery (CA) by the MAL. This study aimed to present the detailed anatomy and a step-by-step procedure of CA decompression for MAL syndrome. The CA decompression procedure involves exposing the diaphragmatic crura and aorta, taping the left gastric artery, and dividing the compressive tissues. The MAL and ganglionic tissue, which form a broad band with multiple layers overlying the CA, comprise the compressive tissues. Therefore, the compressive tissues overlying the CA are encircled and divided one by one until the CA stenosis is released. CA decompression is confirmed with intraoperative duplex ultrasonography of the CA, with a return to normal peak systolic velocities without variation between deep inspiration and expiration. This report presents the detailed anatomy and procedural steps for CA decompression in MAL syndrome.
- Published
- 2021
31. Idiopathic Spontaneous Intrahepatic Hemorrhage Initially Diagnosed as a Liver Neoplasm
- Author
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Fuminori Mihara, Kyoji Ito, Norihiro Kokudo, Nobuyuki Takemura, and Fumiya Sato
- Subjects
Pathology ,medicine.medical_specialty ,Text mining ,business.industry ,MEDLINE ,Medicine ,Liver neoplasm ,General Medicine ,business - Published
- 2021
32. Case report: direct suture repair of inferior vena cava to rescue a stab patient with hepatic and caval injury through left hepatectomy and total vascular exclusion
- Author
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Norihiro Kokudo, Nobuyuki Takemura, Reina Hirooka, Fuminori Mihara, and Kyoji Ito
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,Retrohepatic inferior vena cava injury ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,Total vascular exclusion ,Laparotomy ,medicine ,Left Hemihepatectomy ,030212 general & internal medicine ,Stab wound ,Damage control surgery ,Liver trauma ,business.industry ,030208 emergency & critical care medicine ,lcsh:RD1-811 ,medicine.disease ,Surgery ,medicine.anatomical_structure ,medicine.vein ,Epigastrium ,cardiovascular system ,Hepatectomy ,business - Abstract
Background The mortality of abdominal vena caval injuries is as high as 50–80%. Yet, there were few reports on how to repair injured inferior vena cava (IVC). This report presents a method of vena caval repair in a case of penetrating retrohepatic IVC injury, requiring hepatic resection and total vascular exclusion (TVE). Case presentation The patient was a 20-year-old man with a stab wound in the epigastrium. An emergency laparotomy was performed in the emergency room, and a stab incision on the left liver was detected. As the Pringle’s maneuver did not reduce bleeding, hepatic vein injury was suspected, and left hemihepatectomy was performed to confirm the bleeding point. After the hepatectomy, laceration was still evident deeper into the resection, and IVC injury was suspected. The bleeding was temporarily controlled by tentative hepatorrhaphy and gauze packing, and the initial damage control surgery was terminated. Definitive surgery was performed on the third postoperative day. The lacerated point was observed under TVE, and the laceration penetrated the retrohepatic IVC through its posterior wall. The slit of the posterior wall was sutured first, followed by suturing of the anterior wall of the IVC. Finally, the lacerated liver was closed with hepatorrhaphy. TVE was removed, and the massive bleeding was successfully controlled. Conclusion In severe liver injuries involving the retrohepatic IVC, hepatic resection and TVE may be useful for ensuring an optimized surgical field for repairing the injured IVC.
- Published
- 2021
33. Transverse colon invasion from intrahepatic cholangiocarcinoma with lymph node metastasis in the regional mesocolon: a case report
- Author
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Kenta Aso, Fuminori Mihara, Kyoji Ito, Norihiro Kokudo, Nobuyuki Takemura, and Fuyuki Inagaki
- Subjects
medicine.medical_specialty ,Adenosquamous carcinoma ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Colon invasion ,Intrahepatic Cholangiocarcinoma ,Intrahepatic cholangiocarcinoma ,Lymph node metastasis ,business.industry ,Gallbladder ,Transverse colon ,lcsh:RD1-811 ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Adenocarcinoma ,030211 gastroenterology & hepatology ,Lymph ,Radiology ,Hepatectomy ,business - Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is an aggressive cancer with high frequency of extrahepatic metastasis at diagnosis. However, there have been very few reports of direct invasion to transverse mesocolon with lymph node metastasis in the regional mesocolon. Case presentation A 71-year-old man presented to our hospital with anorexia and weight loss. Abdominal computed tomography (CT) revealed enlarged gallbladder wall with intrahepatic tumor extended from the gallbladder. The transverse colon was located adjacent to the gallbladder and its wall was thickened, indicating tumor invasion. Some enlarged lymph nodes were observed in the transverse mesocolon, suggesting metastatic or inflammatory lymph node swelling. Percutaneous liver biopsy detected poorly differentiated adenocarcinoma. After confirming the absence of remote metastasis and peritoneal dissemination, surgical resection including right hepatectomy and right hemicolectomy was performed. The pathological diagnosis was adenosquamous carcinoma of the liver and lymph node metastasis in the transverse mesocolon. The surgical margins were negative and R0 resection was achieved. Although adjuvant chemotherapy was administered, follow-up CT detected multiple metastases to the lung 4 months after surgery. The patient died 12 months after the operation. Conclusions Direct colon invasion from ICC may cause lymph node metastasis in the regional mesocolon. Careful assessment is necessary for the diagnosis of enlarged lymph nodes in ICC with direct colon invasion.
- Published
- 2020
34. Difference in treatment algorithms for hepatocellular carcinoma between world's principal guidelines
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Norihiro Kokudo, Fuyuki Inagaki, Fuminori Mihara, Nobuyuki Takemura, and Kyoji Ito
- Subjects
business.industry ,Systemic chemotherapy ,Cancer ,Guideline ,Review ,medicine.disease ,digestive system diseases ,Clinical Practice ,Transplantation ,Hepatocellular carcinoma ,medicine ,Etiology ,business ,Algorithm - Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death globally. Clinical guidelines for HCC have been established and revised by many countries and regions. We summarized and compared the treatment algorithms in the updated HCC guidelines established by Japan, China, Hong Kong, the Asian-Pacific Association for the Study of the Liver, the American Association for the Study of Liver Diseases, and the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer. Variations in treatment algorithms between the guidelines is inevitable, considering the differences in the prevalence and etiology of HCC, local clinical practice, and medical and insurance systems between countries or regions, and this might be confusing for practitioners worldwide. A comprehensive understanding of the guidelines that are globally available might be useful for future improvement of each guideline.
- Published
- 2020
35. Major ongoing clinical trials for COVID-19 treatment and studies currently being conducted or scheduled in Japan
- Author
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Kyoji Ito, Norio Ohmagari, Wataru Sugiura, and Ayako Mikami
- Subjects
Oseltamivir ,medicine.medical_specialty ,business.industry ,Public health ,virus diseases ,Lopinavir ,Hydroxychloroquine ,Ciclesonide ,Review ,Favipiravir ,Clinical trial ,chemistry.chemical_compound ,chemistry ,Internal medicine ,medicine ,Ritonavir ,business ,medicine.drug - Abstract
The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a serious threat to global public health and economies. Currently, hundreds of clinical trials on a wide variety of treatments against COVID-19 are being conducted around the world. Here, we conducted a search for ongoing clinical trials for the treatment of COVID-19 at the clinicaltrials.gov database on April 2, 2020. In total, 48 clinical trials were identified, and of these, 41 trials adopted drug intervention and the other 7 trials utilized biological intervention. The number of trials stratified by a chief country conducting the investigation were 18 in China, 5 in the United States, 4 in Canada, 3 in Italy, 2 in France and Brazil, and 4 trials are being performed multinationally. The drugs utilized in more than one trials were remdesivir (6 trials), lopinavir/ritonavir (6 trials), hydroxychloroquine (6 trials), interferon (5 trials), methylprednisolone (3 trials), nitric oxide gas (3 trials), oseltamivir (2 trials), arbidol (2 trials), and vitamin C (2 trials). We also described the Japanese trials which are now being conducted or scheduled, utilizing lopinavir/ritonavir, remdesivir, favipiravir, ciclesonide and nafamostat.
- Published
- 2020
36. Complete remission of multiple liver metastases with only partial response of the primary rectal cancer after neoadjuvant chemotherapy
- Author
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Fuminori Mihara, Satomi Miura, Kyoji Ito, Tomomichi Kiyomatsu, Norihiro Kokudo, and Nobuyuki Takemura
- Subjects
medicine.medical_specialty ,Chemotherapy ,Bevacizumab ,Colorectal cancer ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,lcsh:RD1-811 ,medicine.disease ,Neoadjuvant chemotherapy ,Asymptomatic ,Primary tumor ,Oxaliplatin ,Metastasis ,Colorectal liver metastases ,medicine ,Liver-first strategy ,Radiology ,Hepatectomy ,medicine.symptom ,business ,medicine.drug - Abstract
Background Colorectal cancer is commonly diagnosed among the Japanese population, and various strategies in treating the colorectal liver metastasis have been introduced over the years. Here, we present a case of colorectal liver metastases in which we devised a multidisciplinary treatment plan for a better prognosis. Case presentation We report a case of a 44-year-old female who developed rectal cancer with advanced synchronous liver metastases and was treated by a liver-first surgical approach following neoadjuvant chemotherapy. At diagnosis, there were 12 bilobular lesions in the liver, and the primary rectal cancer was asymptomatic and unprogressive. We adopted a liver-first strategy because the control of the liver metastases was considered the key prognostic factor. Furthermore, because the lesions were highly progressive, we planned neoadjuvant systemic chemotherapy first to provide an observational period to identify potential new metastatic lesions that were refractory to systemic chemotherapy or contraindicative for surgical resection. We administered two courses of S-1 + oxaliplatin (SOX)+ bevacizumab (BV) and an additional course of SOX without BV as neoadjuvant chemotherapy in preparation for surgery. This resulted in a prominent minimalization of colorectal liver metastases, and no other remote metastasis was observed. Then, surgical resection of the colorectal liver metastases was performed safely, and the pathological result revealed complete remission of all tumors by neoadjuvant chemotherapy. The primary tumor in the colon was successfully resected 2 months after the hepatectomy. Although the patient experienced a recurrence in two different sites in the lungs 10 months after resection of the primary rectal lesion, these metastases were successfully resected after diagnosis. The patient is alive with no signs of recurrence 3 years after the diagnosis of colorectal cancer with synchronous liver metastases. Conclusions The combination of a liver-first strategy and neoadjuvant chemotherapy is a possible treatment of choice to cure colorectal cancer with simultaneous advanced colorectal liver metastases.
- Published
- 2020
37. Induced Pluripotent Stem Cell Elimination in a Cell Sheet by Methionine-Free and 42°C Condition for Tumor Prevention
- Author
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Nobuhisa Hagiwara, Shoen Kume, Nobuaki Shiraki, Katsuhisa Matsuura, Kyoji Ito, and Tatsuya Shimizu
- Subjects
0301 basic medicine ,Carcinogenesis ,Induced Pluripotent Stem Cells ,Cell ,Cell Culture Techniques ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,Regenerative medicine ,Cell Line ,03 medical and health sciences ,chemistry.chemical_compound ,Methionine ,Tissue engineering ,Neoplasms ,medicine ,Humans ,Myocytes, Cardiac ,Induced pluripotent stem cell ,Cell sheet ,Tissue Engineering ,Chemistry ,Temperature ,Fibroblasts ,021001 nanoscience & nanotechnology ,Cell biology ,030104 developmental biology ,medicine.anatomical_structure ,0210 nano-technology - Abstract
Pluripotent stem cells, including induced pluripotent stem (iPS) cells, are promising cell sources for regenerative medicine to replace injured tissues, and tissue engineering technologies enable engraftment of functional iPS cell-derived cells in vivo for prolonged periods. However, the risk of tumor formation is a concern for the use of iPS cells. Bioengineered tissues provide a suitable environment for cell survival, which requires vigorous efforts to eliminate remaining iPS cells and prevent tumor formation. We recently reported three iPS cell elimination strategies, including methionine-free medium, TRPV1 activation through 42°C cultivation, and dinaciclib, a cyclin-dependent kinase 1/9 inhibitor. However, it remains unclear how many iPS cells in bioengineered tissues can be eliminated using these strategies alone or in combination, as well as the mode of subsequent tumor prevention. In the present study, we found that 2 days of cultivation at 42°C sufficiently eliminated 1 × 102 iPS cells in fibroblast sheets and prevented tumor formation. After screening for suitable combinations of these strategies based on Lin28 expression in co-cultures of fibroblasts and 1 × 104 iPS cells, we found that 1 day of cultivation at 42°C in methionine-free culture medium with or without dinaciclib remarkably decreased Lin28 expression and prevented tumor formation. Furthermore, these culture strategies did not affect spontaneous beating or the cell number of human iPS cell-derived cardiomyocytes. These quantitative findings may contribute to decreasing tumor formation risk and development of regenerative medicine using iPS cells.
- Published
- 2018
38. The Impact of MDCT and Endoscopic Transpapillary Mapping Biopsy to Predict Longitudinal Spread of Extrahepatic Cholangiocarcinoma
- Author
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Nobuhisa Akamatsu, Kiyoshi Hasegawa, Tetsuo Ushiku, Y. Nakai, Norihiro Kokudo, Hiroyuki Isayama, Yoshihiro Sakamoto, Junichi Arita, Junichi Kaneko, Takeyuki Watadani, Mariko Tanaka, and Kyoji Ito
- Subjects
Male ,medicine.medical_specialty ,Biopsy ,Cholangiocarcinoma ,Extrahepatic Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Bile Ducts, Extrahepatic ,Multidetector Computed Tomography ,medicine ,Humans ,Neoplasm Invasiveness ,Endoscopy, Digestive System ,cardiovascular diseases ,Aged ,Retrospective Studies ,Biliary drainage ,medicine.diagnostic_test ,Bile duct ,business.industry ,Gastroenterology ,Margins of Excision ,Cancer ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Depth of invasion ,030220 oncology & carcinogenesis ,cardiovascular system ,Female ,030211 gastroenterology & hepatology ,Surgery ,Histopathology ,Radiology ,business ,Wall thickness ,Cholangiography - Abstract
We aimed to investigate the diagnostic accuracy of multidetector-row computed tomography (MDCT), mapping biopsy, and other imaging modalities to predict the longitudinal extension and depth of invasion of extrahepatic cholangiocarcinoma at possible surgical ductal margins. Of 102 patients with surgical resection of extrahepatic cholangiocarcinoma between January 2010 and October 2015, 32 evaluated by multidetector-row computed tomography (MDCT) performed before biliary drainage and mapping biopsy were enrolled. Mapping biopsies were performed at 74 sites to determine the resection point of the bile duct (at 74 possible surgical ductal margins). Diagnostic accuracy was evaluated by histopathology. The diagnostic accuracy of MDCT for longitudinal cancer spread was 79.7%, that of biopsy was 73.0%, and combining the two modalities showed highest accuracy (83.8%). The depth of tumor invasion could be predicted by combination of the ductal wall thickness and contrast enhancement on MDCT, that is, at 11 of 13 sites (84.6%) with submucosal invasion, ductal wall thickness was > 2.5 mm with high contrast enhancement. MDCT demonstrated highest accuracy of diagnosing longitudinal extension at possible surgical ductal margins in patients with extrahepatic cholangiocarcinoma. The depth of tumor invasion could be predicted by ductal wall thickness and contrast enhancement of MDCT.
- Published
- 2018
39. Title: Pheochromocytoma Crisis Rescued by Veno-Arterial Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy
- Author
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Toshihiro Nakayama, Kyoji Ito, Fuyuki Inagaki, Wataru Miyake, Daisuke Katagiri, Fuminori Mihara, Nobuyuki Takemura, and Norihiro Kokudo
- Subjects
General Medicine - Abstract
Pheochromocytoma is a rare catecholamine producing adrenal tumor. Pheochromocytoma crisis is a life-threatening condition inducing multiple organ failure and hemodynamic instability caused by too much catecholamines produced from pheochromocytoma. We report a 59-year-old woman with pheochromocytoma crisis rescued by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT), and interval tumor resection. In June 2020, the patient was taken to our institution complaining of headache and left lower back pain. The patient developed cardiopulmonary arrest while at the emergency department. After extracorporeal cardiopulmonary resuscitation, the patient required VA-ECMO for hemodynamic support, and subsequently CRRT for catecholamine removal and acute kidney injury. After 1 month of hemodynamic management, the patient underwent left adrenalectomy. The postoperative course was uneventful and she was discharged on postoperative day 23. CRRT would be a safe and feasible option for catecholamine control in patients with acute kidney injury in pheochromocytoma crisis.
- Published
- 2021
40. Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma
- Author
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Yoshikuni Kawaguchi, Kiyoshi Hasegawa, Kyoji Ito, Yoshihiro Sakamoto, Norihiro Kokudo, and Junichi Arita
- Subjects
Male ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Pancreaticoduodenectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Blood loss ,Risk Factors ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Gastric emptying ,business.industry ,Incidence (epidemiology) ,Ascites ,Middle Aged ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Female ,Hemoglobin ,business ,Body mass index ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
Background: Pancreaticoduodenectomy (PD) is performed for pancreatic ductal adenocarcinoma (PDA) located at the pancreas head/body. Non-chylous massive discharge after PD is frequently encountered and can cause a vicious cycle of complications associated with severe dehydration and protein loss. Methods: From August 2008 to June 2015, 102 patients who underwent PD for PDA were retrospectively reviewed. High non-chylous discharge was defined as postoperative daily serous discharge exceeding 10 mL/kg. Predictive factors for high non-chylous discharge were assessed using multivariable analysis. Results: Fifty-one patients (50%) developed high non-chylous discharge. Body mass index (BMI) and hemoglobin, total protein, and cholinesterase levels were significantly lower in the high-discharge group compared to the corresponding levels in the low-discharge group. The incidence of postoperative pancreatic fistula and delayed gastric emptying was significantly lower and higher in the high-discharge group than in the low-discharge group, respectively. Multivariable analysis revealed that BMI 2, hemoglobin Conclusions: Preoperative low levels of BMI and hemoglobin and intraoperative high blood loss were independent predictive factors for high non-chylous discharge. Improvement of preoperative general and nutritional condition may reduce the incidence of high non-chylous discharge.
- Published
- 2017
41. Hepatectomy for metachronous colorectal liver metastases following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases: a report of three cases
- Author
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Tomomichi Kiyomatsu, Norihiro Kokudo, Nobuyuki Takemura, Fuyuki Inagaki, Hideaki Yano, Yoshimasa Gohda, Fuminori Mihara, Kyoji Ito, and Toshiaki Kurokawa
- Subjects
Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,lcsh:Surgery ,Adhesion (medicine) ,Case Report ,lcsh:RC254-282 ,Liver metastases ,03 medical and health sciences ,0302 clinical medicine ,Multi-modality treatment ,Surgical oncology ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Left Hemihepatectomy ,Hepatectomy ,Humans ,Cytoreductive surgery ,Peritoneal Neoplasms ,Aged ,business.industry ,Liver Neoplasms ,Neoplasms, Second Primary ,lcsh:RD1-811 ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Primary tumor ,Surgery ,Hyperthermic intraperitoneal chemotherapy ,Peritoneal metastases ,Oncology ,Chemotherapy, Cancer, Regional Perfusion ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis (PM) from colorectal cancer (CRC) has been reported to substantially improve the prognosis and the quality of life of patients in comparison to systemic chemotherapy or palliative approaches. This study aimed to demonstrate the safety and feasibility of hepatectomy for metachronous liver metastases from CRC following CRS and HIPEC for PM on the basis of three case reports. Case presentation We describe three cases involving patients who underwent hepatectomy for metachronous liver metastases from CRC after CRS and HIPEC for PM. All patients underwent CRS and HIPEC after primary tumor resection, and hepatectomy was performed for the metachronous liver metastases after CRS and HIPEC. The hepatectomy procedures for cases 1, 2, and 3 were left hemihepatectomy and partial resection of S5, posterior sectionectomy, and left-lateral sectionectomy and partial resection of S5 and S8, respectively. Although adhesion of surrounding organs to the liver surface was observed on a broad level, dissections and hepatectomy could be performed safely. No recurrence was detected in cases 1 and 2 after hepatectomy. In case 3, liver metastases were detected from the time of the initial diagnosis of the primary tumor, and complete remission was achieved once with systemic chemotherapy. Although we performed hepatectomy for the recurrence of liver metastases after complete remission, early re-recurrence was observed after hepatectomy. Conclusions Hepatectomy for metachronous liver metastases after CRS and HIPEC for PM could be a multi-modality treatment option for CRC recurrence.
- Published
- 2019
42. Arterial blood supply to the pancreas from accessary middle colic artery
- Author
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Fuminori Mihara, Kyoji Ito, Fuyuki Inagaki, Toshiaki Kurokawa, Norihiro Kokudo, and Nobuyuki Takemura
- Subjects
Male ,Colon ,Endocrinology, Diabetes and Metabolism ,Dorsal pancreatic artery ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Colon surgery ,Mesenteric Artery, Superior ,medicine.artery ,Multidetector Computed Tomography ,Medicine ,Humans ,Superior mesenteric artery ,Pancreas ,Aged ,Retrospective Studies ,Splenic flexure ,Aged, 80 and over ,Hepatology ,business.industry ,Gastroenterology ,Inferior pancreaticoduodenal artery ,Arteries ,Middle Aged ,SMA ,Middle colic artery ,medicine.anatomical_structure ,Regional Blood Flow ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Nuclear medicine - Abstract
Background An accessory middle colic artery (AMCA) is an aberrant artery feeding the splenic flexure of the colon. Little is known about the branching pattern of an AMCA. We aimed to evaluate the branching pattern of the AMCA from the superior mesenteric artery (SMA) with special reference to the pancreatic artery using multidetector-row computed tomography (MDCT) before surgery. Methods We investigated 112 patients who underwent contrast-enhancement MDCT before surgical resection of the pancreas between January 2015 and July 2018. The pancreatic branch from the AMCA was divided into the dorsal pancreatic artery (DPA) and the inferior pancreaticoduodenal artery (IPDA). The branching level and angle of the AMCA from the SMA were also evaluated. Results The AMCA was present in 27.7% of patients (n = 31/112). The AMCA branching pattern was classified into four types: type A, no branch from the AMCA (n = 20); type B, a common trunk with the DPA (n = 6); type C, a common trunk with the IPDA (n = 3); and type D, a common trunk with the DPA and IPDA (n = 2). The AMCA with the IPDA (types C and D) branched more proximally compared to the AMCA without the IPDA (P = 0.04). The AMCA branched vertically from the SMA in most cases (n = 24/31, 77.4%). Conclusions The AMCA had a pancreatic branch in 8.9% (10/112) of cases. Special attention should be paid to its branching pattern in pancreatic and colon surgery.
- Published
- 2019
43. Arterial blood supply from accessary middle colic artery to the pancreas
- Author
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Fuminori Mihara, Norihiro Kokudo, Nobuyuki Takemura, and Kyoji Ito
- Subjects
medicine.medical_specialty ,Middle colic artery ,Arterial blood supply ,medicine.anatomical_structure ,Hepatology ,business.industry ,Internal medicine ,medicine.artery ,Gastroenterology ,medicine ,Cardiology ,Pancreas ,business - Published
- 2021
44. Emergency Surgery for Severe Liver Injury Through the Inferior Vena Cava
- Author
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Fuminori Mihara, R. Hirooka, Norihiro Kokudo, Nobuyuki Takemura, and Kyoji Ito
- Subjects
Liver injury ,medicine.medical_specialty ,Hepatology ,Emergency surgery ,medicine.vein ,business.industry ,Gastroenterology ,Medicine ,business ,medicine.disease ,Inferior vena cava ,Surgery - Published
- 2021
45. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein
- Author
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Nobuhisa Akamatsu, Keigo Tani, Daisuke Ito, Junichi Kaneko, Kyoji Ito, Yoshihiro Sakamoto, Junichi Arita, Kiyoshi Hasegawa, and Norihiro Kokudo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Vena cava ,medicine.medical_treatment ,Inferior right ,Vena Cava, Inferior ,Hepatic Veins ,030230 surgery ,Liver transplantation ,Inferior vena cava ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Multidetector Computed Tomography ,Living Donors ,medicine ,Humans ,Vascular Patency ,Child ,Vein ,Aged ,Retrospective Studies ,Transplantation ,Hepatology ,business.industry ,Liver Diseases ,Ultrasonography, Doppler ,Middle Aged ,Plastic Surgery Procedures ,Liver Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Liver ,medicine.vein ,Female ,030211 gastroenterology & hepatology ,Radiology ,Right liver ,Living donor liver transplantation ,business ,Vascular Surgical Procedures ,Follow-Up Studies - Abstract
Special care must be taken in hepatic vein reconstruction to avoid outflow block in living donor liver transplantation (LDLT) with a right liver graft. We have used cryopreserved homologous veins to reconstruct the right hepatic vein (RHV), middle hepatic vein (MHV), MHV tributaries (V5 and V8), and inferior right hepatic vein (IRHV). The reconstruction of V5, V8, and IRHV was based on the estimated congestive volume, calculated by the computed tomography volumetry, to secure the functional graft volume of 40% of the recipient standard liver volume. Among 262 right liver LDLT recipients, the number of reconstructed RHVs, MHVs, V5s, V8s, and IRHVs was 262, 48, 110, 111, and 147, respectively, and the overall patency was 95%, 100%, 36%, 58%, and 86%, respectively. Although the patency of the RHVs and MHVs was satisfactory, that of the V5s, V8s, and IRHVs was suboptimal. Patency of the IRHVs (86%, 126/147) was significantly better than that of both V5s (36%, 40/110) and V8s (58%, 64/111; P
- Published
- 2016
46. Liver Transection with Clamp Crushing, Followed by Vessel Sealing, is Superior to Crushing by LigaSure in Terms of Early Local Recurrence after Hepatectomy: A Retrospective Cohort Study
- Author
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Fuyuki Inagaki, Kyoji Ito, Fuminori Mihara, Yoshihiro Edamoto, Nobuyuki Takemura, Toshiaki Kurokawa, and and Norihiro Kokudo
- Subjects
medicine.medical_specialty ,Clamp ,Oncology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,medicine ,Vessel sealing ,Surgery ,Retrospective cohort study ,Hepatectomy ,business - Published
- 2020
47. Ultra-Low-Standby Power 6T Single-port and 8T Dual-port SRAMs on 65 nm Silicon-on-Thin-Box (SOTB) for Smart IoT Applications
- Author
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Yoshiki Yamamoto, Shinji Tanaka, Hiroki Shinkawata, Yukiko Umemoto, Shiro Kamohara, Makoto Yabuuchi, Takumi Hasegawa, Kyoji Ito, Koji Nii, Yohei Sawada, and Yoshihiro Shinozaki
- Subjects
010302 applied physics ,Physics ,Silicon ,business.industry ,Electrical engineering ,chemistry.chemical_element ,Port (circuit theory) ,02 engineering and technology ,01 natural sciences ,020202 computer hardware & architecture ,chemistry ,Megabit ,0103 physical sciences ,0202 electrical engineering, electronic engineering, information engineering ,Static random-access memory ,Internet of Things ,business ,Standby power ,Sleep mode ,Access time - Abstract
In 65-nm Silicon-on-Thin-Box (SOTB) technology, we demonstrate fully functional embedded 6T single-port (SP) SRAM and 8T dual-port (DP) SRAM for Smart Internet-of-Things (IoT) applications. By using back-bias (BB) control in the sleep mode, 13.72 nW/Mbit (25.85 nW/Mbit) ultra-low standby power for SP (DP) SRAM is observed. Both are reduced to 1/1000 compared to the normal standby mode. The measured read access time of 128-kb SP (32-kb DP) SRAM with forward BB is 1.84 ns (1.64 ns) at 1.0 V overdrive and 25°C, which is over 2.5× (2.75×) faster than that of normal mode at 0.75 V with zero BB. Besides, inherent read/write disturbance issues in DP SRAM are also evaluated by test chips, confirmed there are no issues.
- Published
- 2018
48. Statin use is associated with a reduced risk of hepatocellular carcinoma recurrence after initial liver resection
- Author
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Daisuke Ito, Nobuhisa Akamatsu, Kiyoshi Hasegawa, Yoshihiro Sakamoto, Kyoji Moriya, Norihiro Kokudo, Junichi Arita, Junichi Kaneko, Yoshikuni Kawaguchi, and Kyoji Ito
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Health (social science) ,Statin ,Carcinoma, Hepatocellular ,medicine.drug_class ,Lower risk ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,Disease-Free Survival ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Biomarkers, Tumor ,Hepatectomy ,Humans ,cardiovascular diseases ,Survival rate ,Aged ,Proportional hazards model ,business.industry ,Hazard ratio ,Liver Neoplasms ,nutritional and metabolic diseases ,General Medicine ,Hepatitis B ,Middle Aged ,medicine.disease ,Prognosis ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,lipids (amino acids, peptides, and proteins) ,030211 gastroenterology & hepatology ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Neoplasm Recurrence, Local ,business ,Dyslipidemia ,Follow-Up Studies - Abstract
Effective adjuvant therapies have not been established for hepatocellular carcinoma (HCC). The study aimed to determine prognostic influence of statin against HCC recurrence after initial resection. From 2003 to 2013, 734 patients underwent initial HCC resection. Exposure to statins was defined as the use at the recommended daily dosage for > 90 days after surgery. Outcomes were compared between patients who did and did not receive statins. Of 734 patients, 31 (4.2%) received statins for dyslipidemia (statin group) and 703 (95.8%) did not (non-statin group). The proportions of hepatitis B (6.5% vs. 22.8%, P = 0.032), C (19.4% vs. 45.0%, P = 0.005), and a fibrosis score of F3-4 (16.1 % vs. 39.8%, P = 0.008) were significantly lower in the statin than non-statin group. The recurrence-free survival rate was significantly higher in the statin than non-statin group (P < 0.001), without significant difference of the overall survival rate (P = 0.142). A multivariable Cox proportional hazards model revealed that the use of statins (hazard ratio, 0.34; P = 0.005) was associated with a significantly lower risk of HCC recurrence. After one-to-two propensity score matching, the RFS rate was also significantly higher in the statin group (n = 31) than in the non-statin group (n = 62) (P = 0.008). IN CONCLUSION The statins use reduced the risk of HCC recurrence after initial resection. Statins may have protective influences on HCC recurrence in patients who undergo initial liver resection.
- Published
- 2017
49. An implementation of 2RW dual-port SRAM using 65 nm Silicon-on-Thin-Box (SOTB) for smart IoT
- Author
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Takumi Hasegawa, Makoto Yabuuchi, Shinji Tanaka, Kyoji Ito, Koji Nii, Hiroki Shinkawata, Shiro Kamohara, Yoshiki Yamamoto, Yohei Sawada, and Yoshihiro Shinozaki
- Subjects
Physics ,Silicon ,business.industry ,Electrical engineering ,Silicon on insulator ,chemistry.chemical_element ,Port (circuit theory) ,chemistry ,Megabit ,Static random-access memory ,business ,Standby power ,Sleep mode ,Access time - Abstract
An embedded 2-read/write (2RW) dual-port (DP) SRAM using 65-nm Silicon-on-Thin-Box (SOTB) is demonstrated. 25.85 nW/Mbit ultra-low standby power is observed by applying back-bias (BB) control in the sleep mode, reduced to 1/1000 compared to the normal standby mode. The measured read access time with forward BB is 1.64 ns at 1.0 V overdrive and 25°C, which is 2.75x faster than that of normal mode at 0.75 V with zero-BB, achieving over 380 MHz operation. Read/write disturbance issues in DP SRAM are evaluated by test chips, confirmed there are no issues.
- Published
- 2017
50. Outflow Reconstruction Using Cryopreserved Homologous Venous Grafts in Living Donor Liver Transplantation
- Author
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Junichi Togashi, Nobuhisa Akamatsu, Kyoji Ito, Yukiyo Sakamoto, Kiyoshi Hasegawa, S. Tamura, and Norihiko Kokudo
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Adult ,Male ,medicine.medical_specialty ,Inferior right ,030230 surgery ,Hepatic Veins ,Cryopreservation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Homologous chromosome ,Living Donors ,Humans ,Postoperative Period ,Vein ,Retrospective Studies ,Transplantation ,Right hepatic vein ,business.industry ,Middle Aged ,Plastic Surgery Procedures ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Liver ,cardiovascular system ,030211 gastroenterology & hepatology ,Outflow ,Female ,Vascular Grafting ,Radiology ,Right liver ,Living donor liver transplantation ,business - Abstract
Objectives The techniques and outcomes of outflow reconstruction in living donor liver transplantation (LDLT) using cryopreserved homologous veins at the University of Tokyo Hospital are presented. Methods We performed 540 LDLTs from January 1996 to March 2015. Graft types included right liver graft (n = 262), left liver graft (n = 196), left lateral sector graft (n = 53), and posterior sector graft (n = 28). We routinely use cryopreserved homologous vein grafts for the hepatic vein reconstructions to secure the large outflow of the graft. In addition to the presentation of our techniques, the cases with symptomatic outflow obstruction and the treatments were also investigated. Results The 1-, 3-, and 5-year graft survival rates were 90.6%, 86.1%, and 83.5%, respectively. The incidence of severe complications (Clavien-Dindo grade IIIb and more) was 38%. The overall incidence of outflow obstruction requiring invasive treatment was 1.9% (10/540), including 3 left liver grafts (1.5%, 3/196) and 7 right liver grafts (2.7%, 7/262). Regarding the patency of the reconstructed veins, the left hepatic vein, middle hepatic vein, and right hepatic vein achieved nearly 100% patency. On the contrary, venous tributaries such as V5, V8, and inferior right hepatic vein were frequently occluded in the postoperative course. Conclusions Outflow reconstruction is a key for the successful LDLT. Cryopreserved homologous vein graft is useful for the promising hepatic vein reconstruction.
- Published
- 2017
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