Intraductal oncocytic papillary neoplasm of the pancreas shows strong positivity on FDG-PET.
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Adenocarcinoma, Papillary↗
Biomedical subjects
Hiroyuki Katoh
Publications and source records attributed to Hiroyuki Katoh.
[Six cases of incarcerated obturator hernia preoperatively diagnosed by pelvic CT].
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Aged↗
[Indication and operative techniques of extended right hepatic lobectomy for advanced gallbladder cancer].
Gallbladder cancer extends directly to the hepatic hilum and/or the right portal pedicle in the hepatic hilum type and the bed and hilum type of disease. Extended right hepatic lobectomy (ERHL), caudate lobectomy, lymph node dissection, and biliary reconstruction are necessary for radical resection of the tumor. It was previously thought that this extensive surgery carried high risk, with a hospital death rate of 20%, and had little survival benefit. However, it is now feasible with lower risk due to improvement in biliary decompression techniques, prevention of intrahepatic segmental cholangitis, introduction of preoperative portal embolization, etc. Long-term survival has been achieved after surgery unless there is hepatic, peritoneal, or paraaortic metastasis. Hilar hepatic involvement is more advanced in gallbladder cancer than in bile duct cancer, and portal vein resection and reconstruction are inevitable. All six such patients in our department over the past two years underwent concomitant portal reconstruction and have survived postoperatively.
Gallbladder Neoplasms↗
Clinicopathologic features and outcomes of intraductal papillary-mucinous tumors of the pancreas.
BACKGROUND/AIMS: The authors reviewed their experience with resected IPMT (intraductal papillary-mucinous tumor) of the pancreas to clarify the characteristics and prognosis of this neoplasm. METHODOLOGY: Between 1983 and 1998, 30 consecutive patients with IPMT underwent operations at our institution. Their clinicopathological features and postoperative long-term outcomes were analyzed retrospectively. RESULTS: There were 22 males and 8 females, with a mean age of 64 years. Operations performed were duodenum-preserving pancreatic head resection in 12 patients, distal pancreatectomy in 8, segmental pancreatectomy in 6, conventional pancreaticoduodenectomy in 4. Malignancy was found in 10 of 30 (33%). Factors significantly associated with malignancy were tumor size or presence in main pancreatic duct. In 30 resected patients after a mean follow-up of 60 months, tumor recurrence had occurred in 2 cases of invasive carcinoma that infiltrated into the extrapancreatic organ. The overall actuarial 5-year and 10-year survival was 83% and 62%, respectively. CONCLUSIONS: IPMT has a favorable prognosis after adequate resection. Despite slow growth, IPMT has an obvious malignant potential and a poor prognosis when invasive carcinoma has developed. Early recognition and pancreatectomy is the mainstay of treatment for IPMT.
Adenocarcinoma, Mucinous↗
Staged hepatectomy following arterial embolization for ruptured hepatocellular carcinoma.
BACKGROUND/AIMS: While hemostasis by transcatheter arterial embolization is often the first choice in the initial treatment of ruptured hepatocellular carcinoma, post-transcatheter arterial embolization treatment has not fully been established. We studied the prognoses of ruptured hepatocellular carcinoma cases where hepatectomy was possible after transcatheter arterial embolization. METHODOLOGY: We retrospectively reviewed 10 cases of ruptured hepatocellular carcinoma which had been treated in our institution between 1989 and 1998. In all the 10 cases, emergency transcatheter arterial embolization was performed, which successfully achieved hemostasis. RESULTS: Following the achievement of hemostasis by transcatheter arterial embolization, hepatectomy was carried out in 5 cases after evaluation of general condition, functional liver reserve and extent of tumor spread. There was neither operative nor hospital death. One-year and 3-year survival rates were 100% and 40%, respectively, and 50% survival time was 36 months. In the other 5 patients, hepatectomy was decided to be impossible after evaluation of general condition, functional liver reserve and extent of tumor spread; all of them died within 0.5-10 months after transcatheter arterial embolization. CONCLUSIONS: Among the patients with ruptured hepatocellular carcinoma, those in which hepatectomy was decided to be possible after evaluation of general condition, functional liver reserve and extent of tumor spread, following successful hemostasis by transcatheter arterial embolization, had fairly good prognoses.
Adult↗
New technique to ligate enlarged cystic duct using a clip applier during laparoscopy: report of a case.
We developed a new technique to ligate an enlarged cystic duct under laparoscopy. First, the cystic duct was ligated with a large size Endoclip and cut halfway through with scissors. The rest of it was ligated by the clips and divided. This procedure does not require any special device or skill.
Adult↗
Surgical treatment of pulmonary recurrence after hepatectomy for colorectal liver metastases.
BACKGROUND/AIMS: Although pulmonary recurrence is frequent among the extrahepatic recurrences after hepatectomy, the efficacy of surgical treatment for pulmonary recurrence after hepatectomy has not been confirmed. Surgical resection of pulmonary recurrence after hepatectomy for colorectal metastases was reviewed retrospectively to evaluate the survival benefit. METHODOLOGY: From 1990 to 1995, 10 of the 17 patients with pulmonary recurrence after hepatectomy for colorectal metastases underwent surgical treatment. Ten patients underwent resection of pulmonary recurrence. RESULTS: Operative mortality was 0%, and a postoperative complication was observed in 1 patient after pulmonary metastasectomy. The overall 5-year survival rate after pulmonary metastasectomy was 10.0%, and the median survival was 21.7 (range: 2.4-77.9) months. One patient underwent resection two times for remnant lung recurrence after first lung metastasectomy, and is alive with no evidence of recurrence 77.9 months after the first pulmonary resection, and 50.7 months after the third pulmonary resection. In 3 patients with well-differentiated adenocarcinoma, the median survival time was 6.2 months (range: 2.4-9.7). The other hands, 7 patients with moderately differentiated adenocarcinoma have a longer median survival time of 29.2 months (range: 16.0-77.9). CONCLUSIONS: Pulmonary metastasectomy after hepatectomy for metastases from colorectal cancer is a safe treatment, and might offer prolonged survival for highly selected patients.
Adenocarcinoma↗
Primary sclerosing cholangitis associated with autoimmune pancreatitis.
We present 2 cases of primary sclerosing cholangitis complicated with autoimmune pancreatitis with narrowing of the pancreatic duct. In both cases, endoscopic retrograde cholangiography showed the characteristic findings of primary sclerosing cholangitis. In addition, positivity for autoantibody, hypergamma-globulinemia and narrowing of the pancreatic duct shown on endoscopic retrograde pancreatography were noticed in both. They were thu diagnosed as autoimmune pancreatitis. Whereas it is well known that primary sclerosing cholangitis is often complicated with chronic pancreatitis, it has rarely been studied whether the chronic pancreatitis is autoimmune pancreatitis or not. In English literature, possibly 7 equivalent cases have been reported so far. In those cases, the onset was in the post-prime of life, and the disease was frequently accompanied with Sjögren's syndrome, but not with ulcerative colitis; frankly the nature of the disease was slightly different from what has traditionally been thought as a typical primary sclerosing cholangitis. In primary sclerosing cholangitis complicated with autoimmune pancreatitis, the autoimmune mechanism seems to be much involved, and thus steroid therapy might be effective as in Case 2 in our series.
Adenocarcinoma↗
Mesenteric lymph nodes status influencing survival and recurrence pattern after hepatectomy for colorectal liver metastases.
BACKGROUND/AIMS: We retrospectively reviewed our results with curative hepatic resection of metastases from colorectal carcinoma, and analyzed several factors of the primary tumor and liver metastases. METHODOLOGY: From 1988 to 1995, 90 patients underwent curative resection of colorectal liver metastases. The total mortality rate was 1.1%. Overall 5-year survival rate after hepatectomy was 37.9%. RESULTS: Mesenteric lymph node metastases from the primary tumor and the prehepatectomy serum carcinoembryonic antigen level were significant. In multivariate analysis, positive mesenteric lymph node was an independent prognostic factor. In the recurrent patterns, mesenteric lymph node metastases were associated with extrahepatic recurrence after hepatectomy. CONCLUSIONS: The prehepatectomy carcinoembryonic antigen level and mesenteric lymph node metastases of the primary tumor were the most important predictive factors for long survival after hepatectomy. Patients with these risk factors should be closely followed up with regard not only to the remnant liver but also extrahepatic organs.
Adult↗
Middle colic artery-gastroepiploic artery bypass for compromised collateral flow in distal pancreatectomy with celiac artery resection.
BACKGROUND/AIMS: Radical distal pancreatectomy with en-bloc resection of the common hepatic, celiac, and left gastric arteries for pancreatic body cancer that involves these arteries does not routinely require arterial reconstruction because the collateral pathways via the pancreatoduodenal arcades from the superior mesenteric artery are recruited immediately. However, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and may lead to fatal complications. This article describes the middle colic artery-gastroepiploic artery bypass as an emergent salvage procedure for restoring collateral flow. METHODOLOGY: The inferior pancreatoduodenal artery was accidentally injured in 2 of 9 patients who underwent the radical procedure between 1997 and 2001. Microvascular anastomosis between the left branch of the middle colic artery and the gastroepiploic artery in an end-to-side fashion was employed. RESULTS: The pulsation of the gastroepiploic artery and the color of the stomach recovered immediately after completion of the middle colic artery-gastroepiploic artery bypass. No ischemia-related complication developed postoperatively. Postoperative angiography showed the middle colic artery-gastroepiploic artery bypass supplying arterial flow to the liver, stomach, duodenum, and pancreas. CONCLUSIONS: The middle colic artery-gastroepiploic artery bypass is an excellent alternative restoring compromised collateral flow via the pancreatoduodenal arcades when microsurgical technique is available.
Celiac Artery↗
Predictive value of uric acid in gastric mucosal damage in hemodialysis patients.
BACKGROUND/AIMS: Uric acid, which has an antioxidant effect, is present at very high serum levels in hemodialysis patients, but its effect has not yet been clarified. In this study we investigated whether or not serum uric acid levels could be associated with gastric mucosal damage in hemodialysis patients. METHODOLOGY: We performed endoscopy in 53 patients who were on dialysis for more than two months and determined the relationship between serum uric acid levels, clinical features and gastric mucosal damage. RESULTS: Of 53 patients, gastroduodenal ulcer was found in 13 patients (Ulcer group), gastritis lesions in 25 patients (Gastritis group) and no pathological findings in 15 patients (Normal group). Serum uric acid levels before the dialytic session were remarkably higher in the Ulcer group than in the Normal (P < 0.01) or Gastritis group (P < 0.05). There was also a significant difference between the Gastritis and Normal groups in the serum uric acid levels (P < 0.05). Alcohol intake and noncompliance resulted in a significant increase in both gastric mucosal damage (P = 0.009 and P = 0.010) and serum uric acid levels (P < 0.05 and P < 0.01). Serum uric acid levels were markedly decreased after treatment with a proton pump inhibitor or H2 blocker. CONCLUSIONS: In hemodialysis patients alcohol intake and noncompliance contribute to the increase in serum uric acid levels and gastric mucosal damage, and serum uric acid levels have predictive values in gastric mucosal damage.
Aged↗
New method for Billroth I reconstruction after distal gastrectomy.
Authors report a new technique for Billroth I reconstruction after distal gastrectomy using linear stapling devices, which is easier than conventional methods. The duodenum is divided 0.5 cm distal to the pyrolus ring, with a 55-mm linear stapler. The anterior wall of the duodenum is cut along the planned line of anastomosis with the gastric remnant. The anterior wall of the stomach is cut along the planned suture line having a length similar to that of the duodenum. The posterior walls of the stomach and the duodenum are placed back to back on the planned anastomotic line. End-to-end posterior anastomosis between the gastric remnant and the duodenum is simultaneously performed with gastrectomy using a 100-mm linear stapler. End-to-end anterior anastomosis is performed by hand. This technique has been used in 7 patients, and there have been no complications related to this procedure. Operative time was 152 +/- 16 min (range 130 to 180 min) on average. It is an economical and easy procedure for Billroth I reconstruction.
Anastomosis, Surgical↗
Helicobacter pylori infection in hemodialysis patients.
BACKGROUND/AIMS: Studies on the relationship between high serum urea nitrogen, creatinine and Helicobacter pylori infection in hemodialysis patients still give conflicting results. In the present study we investigated the prevalence of Helicobacter pylori positivity in patients with hemodialysis [HD(+)] and without hemodialysis [HD(-)] and assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels and Helicobacter pylori prevalence in these patients. METHODOLOGY: 117 patients with dyspeptic complaints were included in the study. They consisted of 36 HD(+) patients (31%) and 81 HD(-) patients (69%). Endoscopy was performed and gastric antral biopsies were obtained for immunohistochemical analysis for Helicobacter pylori in all patients. RESULTS: Helicobacter pylori was positive in 53(45%) of 117 patients [Hp(+)]. In univariate analysis Hp(+) patients received hemodialysis therapy significantly less often (P = 0.002) and had lower serum urea nitrogen (P = 0.0008) and creatinine (P = 0.003) levels than Hp(-) patients. There was no significant difference in age, gender, endoscopic findings or comorbid conditions (hypertension or diabetes mellitus) between these groups. Multivariate logistic regression analysis revealed that only the serum urea nitrogen level was significantly associated with Helicobacter pylori prevalence (P = 0.008). CONCLUSIONS: These results indicate that high serum urea nitrogen seems to correlate with a low prevalence of Helicobacter pylori infection and hemodialysis patients with high serum urea nitrogen may be protected against Helicobacter pylori infection.
Aged↗
Venous-drainage-guided selective hepatectomy: a novel approach to liver surgery.
Selective hepatectomy under the guidance of hepatic venous drainage has not yet been developed because hepatic venous occlusion alone produces no visible congested area. Now that this area can be identified by simultaneous occlusion of the hepatic vein and artery, venous-drainage-guided selective hepatectomy is considered feasible. Because the congested area becomes dysfunctional or atrophic due to the absence of portal blood supply, it can be regarded as a first candidate for preventive resection in livers that may bear latent tumors. We report here a novel approach to selective hepatectomy. Segment 4 hepatectomy and ventral hemisectorectomy of segments 5+8, with middle hepatic vein resection, was undertaken in a patient with hepatocellular carcinoma. After hepatic dissection between segments 2+3 and 4, the root of the middle hepatic vein was isolated. Test clamping of the middle hepatic vein and proper hepatic artery demonstrated a discolored area. Hepatic dissection was performed along the discolored border towards the hepatic hilum, exposing the right anterior portal pedicle with division of the ventral branches. The middle hepatic vein was finally divided. Selective hepatectomy was successfully performed without transfusion or complications. Venous-drainage-guided selective hepatectomy is feasible with acceptable perioperative results.
Aged↗
Pancreas-preserving biliary amputation with pancreatic diversion: a new surgical technique for complete resection of the intrapancreatic biliary system.
Pancreatoduodenectomy is not optimal for organ preservation in patients with mucosal carcinoma of the choledochus. When the lesion spreads near the papilla of Vater, pancreas-preserving biliary amputation may be indicated to achieve complete resection of the biliary system. The first successful case is reported here with technical considerations. First, the pancreatic neck was divided and a tube was inserted into the main pancreatic duct beyond the papilla. The choledochus was dissected downward with division of the posterior pancreatoduodenal vessels. The main pancreatic duct was isolated with the aid of palpation of the tube, and was then ligated and divided. Subsequent dissection was performed to the level of the duodenal mucosa, which was incised circularly. The duodenal defect was then closed. The elevated jejunum was interposed between the pancreatic stumps and bilateral pancreaticojejunostomies were created. The procedure was successfully performed in a patient with superficially spreading cholangiocarcinoma. Postoperative bile leak and pancreatic fistula were controlled with medical management. The patient is currently well without tumor recurrence 19 months after surgery. Her glucose tolerance, which was moderately impaired preoperatively, has been maintained. Pancreas-preserving biliary amputation has been developed as an organ-preserving procedure alternative to pancreatoduodenectomy. Indications, methods of pancreatic reconstruction, and long-term results require further study.
Aged↗
Appraisal of DSRS with SPGD for esophagogastric varices: a retrospective comparative study according to the underlying liver diseases.
BACKGROUND/AIMS: The differences in long-term results of distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for portal hypertension of different etiologies including non-cirrhotic portal hypertension have yet to be reported. The data are important to determine the indications and contraindications for this procedure. METHODOLOGY: Records of 54 patients of esophagogastric varices who survived 3 years or longer after DSRS with SPGD operation were reviewed. Patients were divided into three groups based on underlying liver disease; posthepatitic cirrhosis (HC) group, alcoholic cirrhosis (AC) group, and idiopathic portal hypertension (IPH) group. RESULTS: The only serious long-term complication of DSRS with SPGD was portal thrombosis in two patients in the IPH group. Postoperative bleeding occurred in two cases of each group; one in IPH group was the only variceal bleeding and others were bleeding from portal hypertensive gastropathy. Hepatocellular carcinoma (HCC) was developed in 28.6% patients in both the HC group and AC group. In all the cases, treatment for HCC was accomplished without aggravation of the varices. The cumulative survival rate was similar in the three groups, and no patient died of gastrointestinal bleeding. CONCLUSIONS: A favorable outcome was achieved by DSRS with SPGD operation both in the patients with cirrhosis or IPH. Underlying liver disease is not a factor when considering DSRS with SPGD for portal hypertension.
Dissection↗
Anicteric early bile duct carcinoma detection with magnetic resonance cholangiopancreatography.
The poor prognosis of extrahepatic bile duct carcinoma makes early detection and diagnosis essential for positive patient outcomes. We describe 2 cases of jaundice-free early extrahepatic bile duct carcinoma detected by magnetic resonance cholangiopancreatography. Extrahepatic bile duct carcinoma was discovered incidentally in patient 1 by magnetic resonance cholangiopancreatography during evaluation of a gallbladder stone. In patient 2, extrahepatic bile duct carcinoma was found during a routine health maintenance exam. Both patients underwent radical surgical intervention. Both patient 1 and 2 have remained in good health for over one year, 3.5 and one year, respectively, and have not exhibited any signs or symptoms of relapse or cancer recurrence. Based on these cases, it appears that magnetic resonance cholangiopancreatography can play a significant role in the early detection of extrahepatic bile duct carcinoma and improve disease prognosis.
Adenocarcinoma, Papillary↗
Clinical factors influencing CT findings in patients with acute appendicitis.
BACKGROUND/AIMS: CT has proven useful in diagnosing appendicitis, but it also has some disadvantages. In this study we investigated clinical factors influencing CT findings of acute appendicitis and identified the most appropriate patients for preoperative CT. METHODOLOGY: Enhanced helical CT scans were obtained preoperatively in 95 patients who underwent appendectomy. They were gangrenous in 52 (55%), phlegmonous in 38 (40%) and catarrhal in 5 (5%) and we usually indicated emergent surgery for phlegmonous or gangrenous appendicitis patients. 62 (69%) of 90 phlegmonous or gangrenous cases had both an enlarged appendix (> or = 6mm) and periappendiceal fat strand in CT, which strongly suggested the need for emergent operation (Positive group). We compared clinical factors in the positive group with those in the other 28 patients (Equivocal group). RESULTS: There was no significant difference between the positive and equivocal groups in age, gender, or white blood cell count. The depth of subcutaneous fat (SCF) at the umbilicus level in CT and the number of patients with gangrenous appendicitis were significantly increased in the positive group compared with the equivocal group by both univariate and multilogistic regression analysis. CONCLUSIONS: These indicated that the degree of inflammation and SCF were significantly associated with CT findings of appendicitis and CT should be routinely done in obese patients.
Acute Disease↗