Hideki Asakawa - Academia.edu (original) (raw)
Papers by Hideki Asakawa
Surgical Endoscopy, 2016
The aim of this study was to identify factors associated with perioperative morbidity among patie... more The aim of this study was to identify factors associated with perioperative morbidity among patients who underwent laparoscopic gastrectomy while receiving antithrombotic therapy (ATT). This retrospective cohort study included 46 patients (14 females and 32 males) who underwent laparoscopic gastrectomy, including 12 (26.1 %) who received perioperative ATT, between January 2012 and November 2015 in our institution. Among patients receiving only aspirin as antiplatelet therapy, none were on anticoagulation therapy. All patients took aspirin as antiplatelet therapy for cardiac indications. The clinical findings and surgical outcomes of patients who did (ATT group) and did not (control group) receive ATT were compared. The intraoperative mortality was 0 % for both groups. There was no significant difference in the incidence of postoperative morbidity by univariate analysis between the control and ATT groups (8.8 vs. 8.3 %, p = 0.39). The risk of postoperative morbidity of laparoscopic gastrectomy can be equivalent between the ATT and non-ATT (control) groups.
Surgery Today, Jun 1, 1998
Localization of the parathyroid glands is not necessarily easy before surgery and can also be tro... more Localization of the parathyroid glands is not necessarily easy before surgery and can also be troublesome during surgery. This study focuses on the identification of pathologic parathyroid glands. The records of 32 patients who underwent parathyroidectomy at our institution in the past 14 years for primary hyperparathyroidism were reviewed. Twenty-three patients had a single lesion while 9 had multiple-gland involvement. Localization studies identified 17 of 23 patients with a single lesion. All patients with multiple lesions were diagnosed with an enlargement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored unilaterally. Solitary enlarged glands were resected, and a subtotal parathyroidectomy was performed for multiple-gland involvement. The intraoperative serum intact parathyroid hormone (PTH) level dropped after resection of the largest gland. The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered.
The Journal of Nutrition, Dec 1, 2001
We examined the effect of daily consumption of dietary diacylglycerol (DG) oil on serum lipid con... more We examined the effect of daily consumption of dietary diacylglycerol (DG) oil on serum lipid concentrations in patients with diabetes whose serum triacylglycerol (TG) levels were persistently increased despite continuous nutritional counseling at the outpatient clinic. Patients (n ؍ 16) were divided into DG and control groups (n ؍ 8 each). DG was incorporated (target dose 10 g/d) by substituting DG oil (80 g DG/100 g oil) for the ordinary TG cooking oil used at home for 12 wk. The control group continued consuming ordinary TG cooking oil. Dietary records indicated that there were no differences between groups in total energy intake or percentage of energy from fat. In the DG group, TG intake decreased from 26.8 ؎ 9.3 to 15.7 ؎ 8.9 g/d, whereas DG intake increased from 0.3 ؎ 0.1 to 10.6 ؎ 3.9 g/d. No differences between groups were observed in body weight, total fat intake or total oil consumption throughout the study period. In the DG group, serum TG levels decreased 39.4% from 2.51 ؎ 0.75 mmol/L to 1.52 ؎ 0.28 mmol/L. Serum glycohemoglobin A 1c (HbA 1c ) concentration also decreased 9.7%. In contrast, there were no changes in these variables in the control group. Serum total and HDL cholesterol were not affected in either group. These results indicate that DG oil may be useful as an adjunct to the standard diet therapy of fat restriction in the management of diabetics with hypertriglyceridemia. J. Nutr. 131: 3204 -3207, 2001.
Anticancer Research, 1999
Thyroid tumors exhibit a wide spectrum of histopathology and some thyroid carcinomas are reported... more Thyroid tumors exhibit a wide spectrum of histopathology and some thyroid carcinomas are reported to secrete various cytokines. However, it is obscure whether the differentiation of thyroid carcinoma is related to amount and variety of the secreted cytokines or how the secreted cytokines affect patients. We examined the secretion of cytokines and G-CSF in four anaplastic (K119, IAA, KOA2 and MSA) and two poorly differentiated (SMP and CTP) thyroid carcinoma cell lines and compared them with the clinical courses of patients. We collected conditioned medium from each of the cell lines and measured the release of cytokines (IL-1 alpha, IL-1 beta, IL-6, IL-8 and TNF-alpha) and growth factors (G-CSF, IGF-1) by each assay kits. IL-1 alpha, IL-8 and TNF-alpha were measured by ELISA. G-CSF was measured by one step sandwich EIA method. IL-1 beta and IGF-1 were measured by immunoradiometric assay. IL-6 was measured by chemiluminescent enzyme immunoassay. All four anaplastic and one poorly differentiated (SMP) thyroid cell lines secreted G-CSF and all examined cytokines except TNF-alpha. One poorly differentiated (CTP) thyroid cell line secreted IL-1 beta, IL-6 and IL-8. IGF-1 and TNF-alpha were not detected in all examined conditioned medium of cell lines. All four original patients with anaplastic thyroid carcinoma showed remarkable leukocytosis at terminal stage and in one of these patients, subfever without any infections was observed. Anaplastic and poorly differentiated thyroid carcinomas have the ability to secrete various cytokines and G-CSF, which may affect clinical symptoms of the patients at terminal stage.
Gan to Kagaku Ryoho Cancer Chemotherapy, Jun 1, 2014
We report a case of small intestinal cancer that arose in the upper intestine 16 years after pylo... more We report a case of small intestinal cancer that arose in the upper intestine 16 years after pylorus-preserving pancreaticoduodenectomy( PPPD). An 84-year-old man, who had undergone PPPD for benign biliary tract disease 16 years previously, was found to have a primary small intestinal tumor in the upper intestine by upper gastrointestinal endoscopy, and primary intestinal cancer in the upper intestine was finally diagnosed. We performed partial resection of the upper small intestine and stomach and partial colectomy of the transverse colon to account for direct invasion. Histopathologically, the primary lesion was diagnosed as a moderately to poorly differentiated adenocarcinoma. Small intestinal cancer in the upper intestine after PPPD is extremely rare.
Nippon Rinsho Japanese Journal of Clinical Medicine, Jul 1, 2007
Surgical Case Reports, 2015
Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic inflammatory syndrome, and an u... more Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic inflammatory syndrome, and an understanding of its characteristics is currently evolving. IgG4-related cholecystitis is a manifestation of IgG4-related sclerosing disease in the gallbladder. This case report describes the clinical, radiographic, and histopathological findings in a young male patient who presented with a synchronous mass in the gallbladder. Serum levels of IgG4 and the IgG4/IgG ratio were normal, and there was no associated autoimmune pancreatitis. Therefore, establishing a preoperative diagnosis of IgG4-related cholecystitis was very difficult, and a differential diagnosis of gallbladder cancer infiltrating the liver was suggested. Postoperative histopathological examination established a diagnosis of IgG4-related cholecystitis definitively. A preoperative diagnosis of IgG4-related cholecystitis, although possible, would have been highly challenging in this case. It is difficult to establish whether surgical intervention is necessary in IgG4-related cholecystitis. Because malignant tumors are frequently suspected with this clinical presentation, surgical intervention should be undertaken only after due deliberation.
Surgical innovation, Jan 26, 2015
Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this s... more Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative ...
Immunopharmacology, 1996
ABSTRACT
Nihon rinsho. Japanese journal of clinical medicine, Jan 28, 2007
Surgical innovation, Jan 9, 2015
Postoperative pancreatic fistula formation remains a source of significant morbidity following di... more Postoperative pancreatic fistula formation remains a source of significant morbidity following distal pancreatectomy. The aim of this study was to evaluate the rate of clinically significant fistulas (International Study Group on Pancreatic Fistula grade B and grade C) after distal pancreatectomy using a fibrinogen/thrombin-based collagen fleece (TachoComb, TachoSil) with a stapled closure. Seventy-five patients underwent distal pancreatectomy at our institution between January 2005 and March 2014. A fibrinogen/thrombin-based collagen fleece was applied to the staple line of the pancreas before stapling. Twenty-six patients (34.7%) developed a pancreatic fistula, 8 patients (10.7%) developed a grade B fistula, and no patients developed a grade C fistula. The duration of the drain was significantly different in patients with or without a pancreatic fistula (8.0 ± 4.5 vs 5.4 ± 1.3 days, P = .0003). Histological analysis showed that there was a tight covering with the fibrinogen/thromb...
Thyroid : official journal of the American Thyroid Association, 1997
Graves' disease (GD), myasthenia gravis (MG), and polymyositis (PM) are organ-specific autoim... more Graves' disease (GD), myasthenia gravis (MG), and polymyositis (PM) are organ-specific autoimmune diseases. The association between GD and MG is well known, and an association between MG and PM has been reported. However, only one patient with all three diseases has been reported. We describe a patient with GD and PM developing 6 and 29 years, respectively after the onset of MG. This case suggests that the expression of autoimmunity occurred over a prolonged period of time and these organ-specific autoimmune diseases may be induced by a similar mechanism.
Nutrition, 2006
ObjectiveCoronary arteriosclerotic heart disease frequently develops in patients with diabetes. D... more ObjectiveCoronary arteriosclerotic heart disease frequently develops in patients with diabetes. Decreased serum high-density lipoprotein cholesterol concentration and low-density lipoprotein (LDL) particle size, accompanied by hypertriglyceridemia, are associated with the onset of atherosclerosis. We recently reported that hypertriglyceridemia was significantly improved in patients with type 2 diabetes who ingested diacylglycerol (DAG) oil. The effect on variables, including LDL particle size related to lipid metabolism, however, was not examined. The present study investigated the effects on these variables in more detail.
The Breast, 2009
Breast cancer Sentinel lymph node biopsy Number of metastatic axillary nodes a b s t r a c t It r... more Breast cancer Sentinel lymph node biopsy Number of metastatic axillary nodes a b s t r a c t It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.
Surgery Today, 1999
We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in pati... more We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised intrathyroid nodule was diagnosed to be parathyroid adenoma postoperatively. In the second patient, preoperative localization studies suggested the possibility of an intrathyroid adenoma. When a pathological gland is not found during surgery for primary hyperparathyroidism, an ectopic parathyroid gland including an intrathyroid adenoma should thus be considered.
Surgery Today, 1999
Differentiated thyroid cancer grows slowly in general. But some patients repeat recurrence and pr... more Differentiated thyroid cancer grows slowly in general. But some patients repeat recurrence and progress finally to death. To clarify the difference of their prognosis and establish the appropriate thyroid surgery, we studied 105 patients with differentiated thyroid cancer who were treated with total or subtotal thyroidectomy, excluding those with small tumors, under uniform conditions regarding thyroidectomy. There were 77 women and 28 men aged 19 to 76 years (mean 54.7 years). More than 60% (alive) were followed up for longer than 10 years. Thirty-eight (36%) patients had recurrences. There were 19 deaths. Twelve of 31 patients with locoregional recurrence died and 7 of these 12 died of locoregional control failure (neck and mediastinum). Age at first operation, tumor size, and local tumor extension increased the rate of recurrence significantly. Multivariate analysis confirmed that age, locoregional recurrence, and distant metastasis significantly affected survival. Although lymph node metastases were not a prognostic factor, for patients at high risk for recurrence who are older, and have large tumors with invasion, complete resection of cervical lymph nodes is advised to prevent local recurrence and prolong the disease-free interval. Prolongation of the disease-free interval may lead to prolonged survival time.
Surgery Today, 1998
Localization of the parathyroid glands is not necessarily easy before surgery and can also be tro... more Localization of the parathyroid glands is not necessarily easy before surgery and can also be troublesome during surgery. This study focuses on the identification of pathologic parathyroid glands. The records of 32 patients who underwent parathyroidectomy at our institution in the past 14 years for primary hyperparathyroidism were reviewed. Twenty-three patients had a single lesion while 9 had multiple-gland involvement. Localization studies identified 17 of 23 patients with a single lesion. All patients with multiple lesions were diagnosed with an enlargement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored unilaterally. Solitary enlarged glands were resected, and a subtotal parathyroidectomy was performed for multiple-gland involvement. The intraoperative serum intact parathyroid hormone (PTH) level dropped after resection of the largest gland. The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered.
Pathology International, 2009
Carcinoma with a large central acellular zone (central acellular carcinoma, CAC) and matrix-produ... more Carcinoma with a large central acellular zone (central acellular carcinoma, CAC) and matrix-producing carcinoma (MPC) have been recently noted as basal-like-type breast cancers, but the two entities are often confused. To clarify their histological differences, the histopathological sections of 15 CAC and seven MPC were examined and the following features were compared by reviewing slides: (i) mode of invasion; (ii) alteration of cancer cell adhesion in the transitional area between cellular and acellular zones; (iii) staining of the stromal matrix; (iv) lymphocyte infiltration; and (v) tumor grade. Complete agreement was required between two observers for the assessments of these features. All CAC had relatively sharp margins but showed infiltrative growth accompanied by eosinophilic intercellular matrix. In CAC there was abrupt transition between peripheral cellular and central acellular zones without alteration of cancer cell adhesion. In contrast, all MPC showed expansive growth with a well circumscribed margin, accompanied by basophilic and myxoid intercellular matrix. In MPC there was gradual transition from cellular to acellular areas with gradual loss of cancer cell adhesion. Histological grade 3 and peripheral lymphocyte infiltration were common features. It is suggested that CAC and MPC are histologically distinct entities, and that the aforementioned features are helpful for differential diagnosis.
Pathology, 2002
We previously established an anaplastic thyroid carcinoma cell line (KOA2) that had double mutati... more We previously established an anaplastic thyroid carcinoma cell line (KOA2) that had double mutations: an N-ras mutation and a p53 gene mutation. To clarify multistep carcinogenesis, we analysed surgical material from the patient from whom KOA2 was derived for abnormalities in the N-ras and p53 genes. The resected material had two histologically different lesions: a follicular neoplasm and an anaplastic carcinoma. The N-ras mutation was observed in both lesions, but the p53 gene mutation only in the anaplastic lesion. These facts indicate that an N-ras mutation may induce follicular neoplasm and a subsequent p53 mutation may have caused the follicular neoplasm to transform to anaplastic carcinoma in this patient. This report suggests direct evidence for multistep carcinogenesis in anaplastic thyroid carcinoma.
Oncology Reports, 1996
To clarify the factors affecting survival of the patients with differentiated thyroid cancer and ... more To clarify the factors affecting survival of the patients with differentiated thyroid cancer and pulmonary metastases, 46 patients treated at our hospital during the past 23 years were studied using statistical analysis. Nineteen patients died as a result of their thyroid cancer. The follow-up period ranged from 1 to 31 years with a median of 10.5 years. Age at primary surgery, interval between primary surgery and appearance of pulmonary metastases and RI therapy affected survival from primary surgery and age at pulmonary metastases and RI therapy determined survival after pulmonary metastases, as revealed by the Cox proportional hazard model. These results suggest that prognostic factor of patients with differentiated thyroid cancer and pulmonary metastases is the age at initial surgery and at appearance of pulmonary metastases. But RI therapy could change the course of pulmonary metastases of thyroid cancer.
Surgical Endoscopy, 2016
The aim of this study was to identify factors associated with perioperative morbidity among patie... more The aim of this study was to identify factors associated with perioperative morbidity among patients who underwent laparoscopic gastrectomy while receiving antithrombotic therapy (ATT). This retrospective cohort study included 46 patients (14 females and 32 males) who underwent laparoscopic gastrectomy, including 12 (26.1 %) who received perioperative ATT, between January 2012 and November 2015 in our institution. Among patients receiving only aspirin as antiplatelet therapy, none were on anticoagulation therapy. All patients took aspirin as antiplatelet therapy for cardiac indications. The clinical findings and surgical outcomes of patients who did (ATT group) and did not (control group) receive ATT were compared. The intraoperative mortality was 0 % for both groups. There was no significant difference in the incidence of postoperative morbidity by univariate analysis between the control and ATT groups (8.8 vs. 8.3 %, p = 0.39). The risk of postoperative morbidity of laparoscopic gastrectomy can be equivalent between the ATT and non-ATT (control) groups.
Surgery Today, Jun 1, 1998
Localization of the parathyroid glands is not necessarily easy before surgery and can also be tro... more Localization of the parathyroid glands is not necessarily easy before surgery and can also be troublesome during surgery. This study focuses on the identification of pathologic parathyroid glands. The records of 32 patients who underwent parathyroidectomy at our institution in the past 14 years for primary hyperparathyroidism were reviewed. Twenty-three patients had a single lesion while 9 had multiple-gland involvement. Localization studies identified 17 of 23 patients with a single lesion. All patients with multiple lesions were diagnosed with an enlargement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored unilaterally. Solitary enlarged glands were resected, and a subtotal parathyroidectomy was performed for multiple-gland involvement. The intraoperative serum intact parathyroid hormone (PTH) level dropped after resection of the largest gland. The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered.
The Journal of Nutrition, Dec 1, 2001
We examined the effect of daily consumption of dietary diacylglycerol (DG) oil on serum lipid con... more We examined the effect of daily consumption of dietary diacylglycerol (DG) oil on serum lipid concentrations in patients with diabetes whose serum triacylglycerol (TG) levels were persistently increased despite continuous nutritional counseling at the outpatient clinic. Patients (n ؍ 16) were divided into DG and control groups (n ؍ 8 each). DG was incorporated (target dose 10 g/d) by substituting DG oil (80 g DG/100 g oil) for the ordinary TG cooking oil used at home for 12 wk. The control group continued consuming ordinary TG cooking oil. Dietary records indicated that there were no differences between groups in total energy intake or percentage of energy from fat. In the DG group, TG intake decreased from 26.8 ؎ 9.3 to 15.7 ؎ 8.9 g/d, whereas DG intake increased from 0.3 ؎ 0.1 to 10.6 ؎ 3.9 g/d. No differences between groups were observed in body weight, total fat intake or total oil consumption throughout the study period. In the DG group, serum TG levels decreased 39.4% from 2.51 ؎ 0.75 mmol/L to 1.52 ؎ 0.28 mmol/L. Serum glycohemoglobin A 1c (HbA 1c ) concentration also decreased 9.7%. In contrast, there were no changes in these variables in the control group. Serum total and HDL cholesterol were not affected in either group. These results indicate that DG oil may be useful as an adjunct to the standard diet therapy of fat restriction in the management of diabetics with hypertriglyceridemia. J. Nutr. 131: 3204 -3207, 2001.
Anticancer Research, 1999
Thyroid tumors exhibit a wide spectrum of histopathology and some thyroid carcinomas are reported... more Thyroid tumors exhibit a wide spectrum of histopathology and some thyroid carcinomas are reported to secrete various cytokines. However, it is obscure whether the differentiation of thyroid carcinoma is related to amount and variety of the secreted cytokines or how the secreted cytokines affect patients. We examined the secretion of cytokines and G-CSF in four anaplastic (K119, IAA, KOA2 and MSA) and two poorly differentiated (SMP and CTP) thyroid carcinoma cell lines and compared them with the clinical courses of patients. We collected conditioned medium from each of the cell lines and measured the release of cytokines (IL-1 alpha, IL-1 beta, IL-6, IL-8 and TNF-alpha) and growth factors (G-CSF, IGF-1) by each assay kits. IL-1 alpha, IL-8 and TNF-alpha were measured by ELISA. G-CSF was measured by one step sandwich EIA method. IL-1 beta and IGF-1 were measured by immunoradiometric assay. IL-6 was measured by chemiluminescent enzyme immunoassay. All four anaplastic and one poorly differentiated (SMP) thyroid cell lines secreted G-CSF and all examined cytokines except TNF-alpha. One poorly differentiated (CTP) thyroid cell line secreted IL-1 beta, IL-6 and IL-8. IGF-1 and TNF-alpha were not detected in all examined conditioned medium of cell lines. All four original patients with anaplastic thyroid carcinoma showed remarkable leukocytosis at terminal stage and in one of these patients, subfever without any infections was observed. Anaplastic and poorly differentiated thyroid carcinomas have the ability to secrete various cytokines and G-CSF, which may affect clinical symptoms of the patients at terminal stage.
Gan to Kagaku Ryoho Cancer Chemotherapy, Jun 1, 2014
We report a case of small intestinal cancer that arose in the upper intestine 16 years after pylo... more We report a case of small intestinal cancer that arose in the upper intestine 16 years after pylorus-preserving pancreaticoduodenectomy( PPPD). An 84-year-old man, who had undergone PPPD for benign biliary tract disease 16 years previously, was found to have a primary small intestinal tumor in the upper intestine by upper gastrointestinal endoscopy, and primary intestinal cancer in the upper intestine was finally diagnosed. We performed partial resection of the upper small intestine and stomach and partial colectomy of the transverse colon to account for direct invasion. Histopathologically, the primary lesion was diagnosed as a moderately to poorly differentiated adenocarcinoma. Small intestinal cancer in the upper intestine after PPPD is extremely rare.
Nippon Rinsho Japanese Journal of Clinical Medicine, Jul 1, 2007
Surgical Case Reports, 2015
Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic inflammatory syndrome, and an u... more Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic inflammatory syndrome, and an understanding of its characteristics is currently evolving. IgG4-related cholecystitis is a manifestation of IgG4-related sclerosing disease in the gallbladder. This case report describes the clinical, radiographic, and histopathological findings in a young male patient who presented with a synchronous mass in the gallbladder. Serum levels of IgG4 and the IgG4/IgG ratio were normal, and there was no associated autoimmune pancreatitis. Therefore, establishing a preoperative diagnosis of IgG4-related cholecystitis was very difficult, and a differential diagnosis of gallbladder cancer infiltrating the liver was suggested. Postoperative histopathological examination established a diagnosis of IgG4-related cholecystitis definitively. A preoperative diagnosis of IgG4-related cholecystitis, although possible, would have been highly challenging in this case. It is difficult to establish whether surgical intervention is necessary in IgG4-related cholecystitis. Because malignant tumors are frequently suspected with this clinical presentation, surgical intervention should be undertaken only after due deliberation.
Surgical innovation, Jan 26, 2015
Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this s... more Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative ...
Immunopharmacology, 1996
ABSTRACT
Nihon rinsho. Japanese journal of clinical medicine, Jan 28, 2007
Surgical innovation, Jan 9, 2015
Postoperative pancreatic fistula formation remains a source of significant morbidity following di... more Postoperative pancreatic fistula formation remains a source of significant morbidity following distal pancreatectomy. The aim of this study was to evaluate the rate of clinically significant fistulas (International Study Group on Pancreatic Fistula grade B and grade C) after distal pancreatectomy using a fibrinogen/thrombin-based collagen fleece (TachoComb, TachoSil) with a stapled closure. Seventy-five patients underwent distal pancreatectomy at our institution between January 2005 and March 2014. A fibrinogen/thrombin-based collagen fleece was applied to the staple line of the pancreas before stapling. Twenty-six patients (34.7%) developed a pancreatic fistula, 8 patients (10.7%) developed a grade B fistula, and no patients developed a grade C fistula. The duration of the drain was significantly different in patients with or without a pancreatic fistula (8.0 ± 4.5 vs 5.4 ± 1.3 days, P = .0003). Histological analysis showed that there was a tight covering with the fibrinogen/thromb...
Thyroid : official journal of the American Thyroid Association, 1997
Graves' disease (GD), myasthenia gravis (MG), and polymyositis (PM) are organ-specific autoim... more Graves' disease (GD), myasthenia gravis (MG), and polymyositis (PM) are organ-specific autoimmune diseases. The association between GD and MG is well known, and an association between MG and PM has been reported. However, only one patient with all three diseases has been reported. We describe a patient with GD and PM developing 6 and 29 years, respectively after the onset of MG. This case suggests that the expression of autoimmunity occurred over a prolonged period of time and these organ-specific autoimmune diseases may be induced by a similar mechanism.
Nutrition, 2006
ObjectiveCoronary arteriosclerotic heart disease frequently develops in patients with diabetes. D... more ObjectiveCoronary arteriosclerotic heart disease frequently develops in patients with diabetes. Decreased serum high-density lipoprotein cholesterol concentration and low-density lipoprotein (LDL) particle size, accompanied by hypertriglyceridemia, are associated with the onset of atherosclerosis. We recently reported that hypertriglyceridemia was significantly improved in patients with type 2 diabetes who ingested diacylglycerol (DAG) oil. The effect on variables, including LDL particle size related to lipid metabolism, however, was not examined. The present study investigated the effects on these variables in more detail.
The Breast, 2009
Breast cancer Sentinel lymph node biopsy Number of metastatic axillary nodes a b s t r a c t It r... more Breast cancer Sentinel lymph node biopsy Number of metastatic axillary nodes a b s t r a c t It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.
Surgery Today, 1999
We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in pati... more We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised intrathyroid nodule was diagnosed to be parathyroid adenoma postoperatively. In the second patient, preoperative localization studies suggested the possibility of an intrathyroid adenoma. When a pathological gland is not found during surgery for primary hyperparathyroidism, an ectopic parathyroid gland including an intrathyroid adenoma should thus be considered.
Surgery Today, 1999
Differentiated thyroid cancer grows slowly in general. But some patients repeat recurrence and pr... more Differentiated thyroid cancer grows slowly in general. But some patients repeat recurrence and progress finally to death. To clarify the difference of their prognosis and establish the appropriate thyroid surgery, we studied 105 patients with differentiated thyroid cancer who were treated with total or subtotal thyroidectomy, excluding those with small tumors, under uniform conditions regarding thyroidectomy. There were 77 women and 28 men aged 19 to 76 years (mean 54.7 years). More than 60% (alive) were followed up for longer than 10 years. Thirty-eight (36%) patients had recurrences. There were 19 deaths. Twelve of 31 patients with locoregional recurrence died and 7 of these 12 died of locoregional control failure (neck and mediastinum). Age at first operation, tumor size, and local tumor extension increased the rate of recurrence significantly. Multivariate analysis confirmed that age, locoregional recurrence, and distant metastasis significantly affected survival. Although lymph node metastases were not a prognostic factor, for patients at high risk for recurrence who are older, and have large tumors with invasion, complete resection of cervical lymph nodes is advised to prevent local recurrence and prolong the disease-free interval. Prolongation of the disease-free interval may lead to prolonged survival time.
Surgery Today, 1998
Localization of the parathyroid glands is not necessarily easy before surgery and can also be tro... more Localization of the parathyroid glands is not necessarily easy before surgery and can also be troublesome during surgery. This study focuses on the identification of pathologic parathyroid glands. The records of 32 patients who underwent parathyroidectomy at our institution in the past 14 years for primary hyperparathyroidism were reviewed. Twenty-three patients had a single lesion while 9 had multiple-gland involvement. Localization studies identified 17 of 23 patients with a single lesion. All patients with multiple lesions were diagnosed with an enlargement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored unilaterally. Solitary enlarged glands were resected, and a subtotal parathyroidectomy was performed for multiple-gland involvement. The intraoperative serum intact parathyroid hormone (PTH) level dropped after resection of the largest gland. The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered.
Pathology International, 2009
Carcinoma with a large central acellular zone (central acellular carcinoma, CAC) and matrix-produ... more Carcinoma with a large central acellular zone (central acellular carcinoma, CAC) and matrix-producing carcinoma (MPC) have been recently noted as basal-like-type breast cancers, but the two entities are often confused. To clarify their histological differences, the histopathological sections of 15 CAC and seven MPC were examined and the following features were compared by reviewing slides: (i) mode of invasion; (ii) alteration of cancer cell adhesion in the transitional area between cellular and acellular zones; (iii) staining of the stromal matrix; (iv) lymphocyte infiltration; and (v) tumor grade. Complete agreement was required between two observers for the assessments of these features. All CAC had relatively sharp margins but showed infiltrative growth accompanied by eosinophilic intercellular matrix. In CAC there was abrupt transition between peripheral cellular and central acellular zones without alteration of cancer cell adhesion. In contrast, all MPC showed expansive growth with a well circumscribed margin, accompanied by basophilic and myxoid intercellular matrix. In MPC there was gradual transition from cellular to acellular areas with gradual loss of cancer cell adhesion. Histological grade 3 and peripheral lymphocyte infiltration were common features. It is suggested that CAC and MPC are histologically distinct entities, and that the aforementioned features are helpful for differential diagnosis.
Pathology, 2002
We previously established an anaplastic thyroid carcinoma cell line (KOA2) that had double mutati... more We previously established an anaplastic thyroid carcinoma cell line (KOA2) that had double mutations: an N-ras mutation and a p53 gene mutation. To clarify multistep carcinogenesis, we analysed surgical material from the patient from whom KOA2 was derived for abnormalities in the N-ras and p53 genes. The resected material had two histologically different lesions: a follicular neoplasm and an anaplastic carcinoma. The N-ras mutation was observed in both lesions, but the p53 gene mutation only in the anaplastic lesion. These facts indicate that an N-ras mutation may induce follicular neoplasm and a subsequent p53 mutation may have caused the follicular neoplasm to transform to anaplastic carcinoma in this patient. This report suggests direct evidence for multistep carcinogenesis in anaplastic thyroid carcinoma.
Oncology Reports, 1996
To clarify the factors affecting survival of the patients with differentiated thyroid cancer and ... more To clarify the factors affecting survival of the patients with differentiated thyroid cancer and pulmonary metastases, 46 patients treated at our hospital during the past 23 years were studied using statistical analysis. Nineteen patients died as a result of their thyroid cancer. The follow-up period ranged from 1 to 31 years with a median of 10.5 years. Age at primary surgery, interval between primary surgery and appearance of pulmonary metastases and RI therapy affected survival from primary surgery and age at pulmonary metastases and RI therapy determined survival after pulmonary metastases, as revealed by the Cox proportional hazard model. These results suggest that prognostic factor of patients with differentiated thyroid cancer and pulmonary metastases is the age at initial surgery and at appearance of pulmonary metastases. But RI therapy could change the course of pulmonary metastases of thyroid cancer.