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J Kamiya

Publications and source records attributed to J Kamiya.

At least 55 records · Page 3Linked to original sources
PubMed1998

Aggressive surgical treatment of hilar cholangiocarcinoma.

Recent progress in surgical techniques for and the perioperative management of hilar cholangiocarcinoma has led to improved outcomes for aggressive liver and bile duct resections, which, however, still show considerable morbidity and mortality. In this article, the results of pioneers' attempts in hepatobiliary surgery for difficult hilar cholangiocarcinomas are reviewed. It is recommended that curative hepatobiliary resection should be performed for hilar cholangiocarcinoma, with careful preoperative management of patients complicated with several difficult conditions.

Bile Duct Neoplasms↗
PubMed1998

A new method to prevent wound infection: a controlled clinical trial in patients with combined liver and bile duct resection.

INTRODUCTION: Despite advances in antibiotic prophylaxis, postoperative wound infection remains a major source of morbidity after digestive surgery. Its prevention is a challenging problem, especially in high-risk patients. The authors introduced a new method to prevent surgical wound infections and evaluated its efficacy in a prospective, randomized trial in markedly high-risk patients. METHODS: Patients with biliary tract carcinoma who were scheduled to undergo combined liver and extrahepatic bile duct resection with biliary reconstruction were randomly assigned to one of two groups, well matched in terms of clinical characteristics at baseline. In one group the new treatment was employed (sealed group, n=31), and in the other the wound was treated in the usual fashion (open group, n=28). In the sealed group, povidone-iodine gel was administered to the subcutaneous tissue, and the skin and peritoneum were approximated with a continuous suture. Wound infection was registered up to 30 days after surgery. RESULTS: Wound infection occurred in 18 patients: 5 (16%) patients in the sealed group and 13 (46%) in the open group (P<0.05). All 18 underwent preoperative percutaneous transhepatic biliary drainage and had positive bile culture findings. In 13 of these 18 patients (72%) the microorganisms isolated from the infected wound were identical to those in the bile. CONCLUSIONS: Our results confirm the close association between infected bile and wound infection in hepatobiliary surgery. Our new method, "direct wound sealing," is simple, easy to perform, virtually cost-free, and has the potential to prevent wound infections even in markedly high-risk patients.

Anti-Infective Agents, Local↗
PubMed1998

Mucosal bile duct carcinoma with superficial spread.

We describe a case of mucosal bile duct carcinoma with superficial spread in a 69-year-old man with gallstone pancreatitis. The patient was seen at the hospital because of abdominal pain, fever, and jaundice. Endoscopic retrograde cholangiography (ERC) demonstrated a protruding lesion in the lower third of the common bile duct (CBD) showing wall irregularity suggestive of malignancy. Percutaneous transhepatic cholangioscopy (PTCS) disclosed a papillary tumor with granular mucosa extending continuously to the middle third of the CBD. Cholangioscopic biopsy specimens taken from both the papillary tumor and surrounding granular mucosa revealed papillary adenocarcinoma. After this assessment of extent of cancer by PTCS, we performed pancreatoduodenectomy with extrahepatic bile duct resection and regional lymph node dissection. Pathology examination revealed papillary adenocarcinoma limited to the mucosal layer. The resected margin of the bile duct was free of tumor. We also reviewed 25 cases of early mucosal bile duct carcinoma described in detail in the Japanese literature, and we discuss the diagnostic advantages of PTCS.

Adenocarcinoma, Papillary↗
PubMed1998

Primary lymphoma of the liver with bile duct invasion and tumoral occlusion of the portal vein: report of a case.

A 55-year-old woman presented to hospital with epigastric pain and jaundice. Diagnostic imaging studies revealed a biliary stricture of the hepatic confluence and a hepatic tumour of the left and caudate lobes with a portal tumour thrombus, which occupied the main portal trunk, the umbilical portion of the left portal vein, and the right anterior and posterior portal branches. Left hepatic trisegmentectomy, caudate lobectomy, portal tumour thrombectomy, bile duct resection and bilioenteric anastomosis were performed. There were no other lesions, and so it was diagnosed as a primary lymphoma of the liver (B-cell, diffuse, large cell type). The patient underwent postoperative chemotherapy and has remained well for 4.5 years after surgery. Primary lymphoma of the liver is very rare, and this is the first case report with bile duct invasion and tumoral occlusion of the portal vein.

Bile Duct Neoplasms↗
PubMed1998

Different gastric emptying of solid and liquid meals after pylorus-preserving pancreatoduodenectomy.

BACKGROUND: Transient gastric stasis immediately after pylorus-preserving pancreatoduodenectomy (PPPD) is a common complication, but the cause remains unknown. Changes in gastric emptying were investigated in patients undergoing PPPD for periampullary malignancy. METHODS: In 14 patients undergoing PPPD, liquid- and solid-phase gastric emptying were evaluated before and after operation (mean 38 (range 27-53) days after operation). Two pharmacological gastric-emptying tests were used: the acetaminophen test for liquid-phase emptying and the sulphamethizole capsule food test for solid-phase gastric emptying. RESULTS: All patients exhibited delayed solid emptying but fairly good liquid emptying. CONCLUSION: Gastric function in the early postoperative period after PPPD is characterized by delayed solid-phase but good liquid-phase emptying.

Acetaminophen↗
PubMed1998

Cholangioscopy.

Explore the source record for details and available documents.

Biliary Tract Diseases↗
PubMed1998

The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases.

OBJECTIVE: To clarify the importance of different patterns of infiltration at the proximal border of hilar bile duct carcinomas. SUMMARY BACKGROUND DATA: There are few detailed pathologic studies on the proximal resection margins in patients with hilar bile duct carcinoma. METHODS: Serial sections of 62 specimens of resected hilar bile duct carcinoma were examined histologically to determine the involved layers and routes of invasion at the proximal border. The degree of cancer extension was determined, and the relation between the length of the tumor-free resection margin and postoperative anastomotic recurrences was analyzed. RESULTS: Mucosal extension was predominant in papillary and nodular tumors, but submucosal extension was predominant in diffusely infiltrating and nodular-infiltrating tumors. Submucosal extension usually consisted of direct or lymphatic invasion. The mean length of submucosal extension was 6.0 mm. Superficial spread of cancer, defined as mucosal extension of more than 20 mm from the main lesion, was seen in 8 specimens. No patient had an anastomotic recurrence when the tumor-free resection margin was greater than 5 mm. CONCLUSIONS: The pattern of infiltration at the proximal border of resected hilar bile duct carcinomas is closely related to the gross tumor type. The length of submucosal extension is usually less than 10 mm. Superficial spread of cancer is seen in more than 10% of cases. A tumor-free proximal resection margin of 5 mm appears to be adequate in hilar bile duct carcinoma.

Adult↗
PubMed1998

Islet cell tumor in von Hippel-Lindau disease.

We describe a 42-year-old man with von Hippel-Lindau disease and islet cell tumor of the pancreas. He had retinal and cerebellar hemangioblastomas. His sister had pheochromocytoma. A pancreatic tumor was detected by ultrasonography at his periodical medical checkup. Contrast enhanced computed tomography and abdominal angiography revealed a hypervascular tumor in the pancreatic head. Histological examination of the resected tumor revealed characteristics of islet cell tumor of the pancreas, which was positive for chromogranin-A, S-100 protein, and pancreatic polypeptide, but was negative for insulin, gastrin, glucagon, somatostatin, vasoactive intestinal peptide, serotonin, and adrenocorticotropic hormone.

Adenoma, Islet Cell↗
PubMed1998

Immediate increase in arterial blood flow in embolized hepatic segments after portal vein embolization: CT demonstration.

OBJECTIVE: This study was conducted to determine whether an immediate change occurs in the blood flow distribution in hepatic segments after segmental portal vein embolization. CONCLUSION: We found an immediate change in the distribution of blood flow in the liver after embolization; with portal vein embolization, we found an immediate increase in the hepatic artery blood flow in the affected segments.

Bile Duct Neoplasms↗
PubMed1998

[Differences in strategies for carcinoma of the pancreas between Japan and western countries].

Differences in surgical strategies for carcinoma of the pancreas, especially the head of the pancreas, between Japan and western countries are described. In Japan, pancreatoduodenectomy (PD) or pylorus-preserving PD, accompanied by extensive lymph node and extra-pancreatic nerve plexus dissection, is performed for this difficult disease. Combined resection of the portal vein is also done when needed (radical resection). In western countries, a standard PD does not include extensive lymph node dissection and portal vein resection (standard resection). Although some Japanese surgeons reported about 30% postoperative 5-year survival rates after radical resection and some American surgeons achieved about 20% 5-year survival rates after standard resection, there are some problems with comparison of these results. Surgeons in Japan and western countries use different staging systems, namely, the classifications of the Japanese Pancreas Society and the Union of Internationale Contre le Cancer (UICC). It is essential to establish a more accurate international staging system to scientifically evaluate the difference in surgical results between Japan and western countries.

Europe↗
PubMed1998

[Value of paraaortic lymphadenectomy for gallbladder carcinoma].

Seven reports of paraaortic lymphadenectomy for advanced carcinoma of the gallbladder were reviewed and positive paraaortic nodes were found in 20-40% of the resected patients and 10-15% of those with subserosal cancer invasion. The rate of patients with positive paraaortic nodes/all patients with positive nodes was 30-50%. Paraaortic lymphadenectomy did not improve the surgical outcome, and most of the patients with positive paraaortic nodes died within 1 year even after aggressive surgery with extensive lymph node dissection. Therefore it is important to clarify the value of paraaortic lymph node dissection for patients with possibly positive paraaortic node metastasis and those with histologically positive nodes excluding the paraaortic area. Although pancreatoduodenectomy for prophylactic lymphadenectomy around the head of the pancreas has been carried out in some institutions, the procedure does not seem to be effective because the main lymphatic route from the gallbladder has a direct connection with the paraaortic nodes via the pericholedochal, periportal, and/or the posterior nodes along the common hepatic artery. The present authors recommend a D2 plus paraaortic lymph node dissection (ext D2) as a standard surgical strategy for carcinoma of the gallbladder.

Aorta↗
PubMed1997

Clinicopathologic study on pancreatic cancer associated with pancreatic stones.

Four cases of pancreatic cancer associated with pancreatic stones were investigated clinicopathologically. In Case 1, pancreatic cancer was diagnosed 2 yr 9 mo after the diagnosis of pancreatolithiasis. Numerous large stones were present throughout the pancreas, and stones in the resected specimen were embedded in the tumor. Chronic inflammation, including inflammatory infiltration and fibrosis, were found around the pancreatic duct where the stones were present, both within and adjacent to the tumor, suggesting that chronic pancreatitis had been present for a protracted period. In Cases 2-4, a few small free stones were found in the dilated pancreatic ducts and a cyst upstream from the tumor, but there were no stones noted within the tumor. Microscopically, mild atrophy of the pancreatic parenchyma and fibrosis were seen. In each of these three cases, it was considered that the pancreatic cancer was the primary event, with the pancreatic stones arising as a secondary process. The pancreatic cancers associated with pancreatic stones were classified into two groups, one with pancreatic stones preceding the pancreatic cancer and the other three cases in which the reverse occurred.

Aged↗
PubMed1997

Distal pancreatectomy with en bloc resection of the celiac artery for carcinoma of the body and tail of the pancreas.

CONCLUSION: Combined resection of the celiac artery with a distal pancreatectomy (DP) increases the resectability and improves the overall prognosis of patients with locally advanced ductal cancer of the body and tail of the pancreas. BACKGROUND: Carcinoma of the body and tail of the pancreas is often unresectable because of invasion to adjacent organs. We evaluated a DP including an en bloc resection of the celiac artery ("extended"), for pancreatic cancer that had invaded the common hepatic and/or celiac arteries. METHODS: Six cases of an "extended" DP were compared with 19 cases of a "standard" DP for pancreatic ductal carcinoma in terms of clinical and pathologic findings, perioperative course, and long-term outcome. We also compared the survival rate of these two groups with a third group consisting of 22 patients with unresectable pancreatic ductal carcinoma. RESULTS: The mean operative time, postoperative serum aspartate aminotransferase concentration, and length of hospital stay did not significantly differ between the "extended" and "standard" DP groups. The cumulative 1- and 3-yr accumulated survival rates for the "extended," "standard," and unresectable groups were 40.0, 33.3, and 5.4, and 20.0, 16.6, and 0%, respectively. Statistically significant differences (p < 0.01) existed between the "extended" and unresected groups.

Adult↗
PubMed1997

Human hepatocyte growth factor in bile: an indicator of posthepatectomy liver function in patients with biliary tract carcinoma.

We measured the concentration of hepatocyte growth factor (HGF) in bile obtained from patients after hepatectomy. The HGF concentrations in the bile samples were quantified using an enzyme-linked immunosorbent assay (ELISA). By immunoblotting, using a monoclonal antibody raised against the HGF alpha-subunit, the bile HGF, which was purified on a Heparin-Sepharose column, showed a band of the same size as the recombinant HGF alpha-subunit (69 kd). Bile samples were obtained from 24 patients with biliary tract disease before and after hepatectomy by means of biliary drainage. Before surgery, the bile HGF concentrations were minimal (0.8 +/- 0.1 ng/mL); however, after hepatectomy on postoperative day 1 in patients without posthepatectomy liver failure (20 of 24), they increased severalfold (4.1 +/- 0.4 ng/mL, P < .05). The patients with posthepatectomy liver failure (4 of 24) showed no significant increase in bile HGF after hepatectomy (less than 2 ng/mL on postoperative day 1). The volume of the remnant liver correlated positively with the bile HGF concentration. The bile HGF concentration on postoperative day 1 exhibited a significant negative correlation with the maximum concentration of serum total bilirubin after hepatectomy. The concentration of bile HGF was generally higher than that in serum (2.1-fold). Thus, the bile HGF concentration after hepatectomy may be useful for the early assessment of posthepatectomy liver function.

Adult↗
PubMed1997

Preoperative transcatheter arterial embolization for giant cavernous hemangioma of the liver with consumption coagulopathy.

We describe a 40-yr-old woman with a giant hepatic hemangioma and consumption coagulopathy who underwent transcatheter arterial embolization (TAE) prior to liver resection. Post-contrast computed tomography showed a large mass in the right hepatic lobe with a peripheral, nodular enhancement pattern that enlarged on delayed-phase images. There was a low fibrinogen concentration and decreased platelet count. The patient received i.v. nafamostat mesilate and underwent selective embolization of the arteries feeding the hemangioma; consequently, the plasma fibrinogen concentration increased to 1.6-fold before surgery. Right hepatic lobectomy with partial resection of the caudate lobe was performed. The intraoperative blood loss was only 1380 g. This patient illustrates the usefulness of preoperative TAE for hepatic hemangioma with consumption coagulopathy; TAE appears to improve coagulopathy and increase the safety of surgery.

Adult↗