Takayuki Aimoto - Academia.edu (original) (raw)
Papers by Takayuki Aimoto
Journal of carcinogenesis & mutagenesis, 2013
Introduction: The recent advances of surgical techniques and technology allow minimally invasive ... more Introduction: The recent advances of surgical techniques and technology allow minimally invasive surgery to be applied in patients with benign and malignant diseases of the pancreas. About malignancy, we still have concerns regarding the oncologic adequacy of laparoscopic pancreatectomy, with fewer studies reporting oncologic outcomes. We describe the surgical technique to improve the curability of laparoscopic pancreatectomy in the treatment of Pancreatic Adenocarcinoma (PDAC) and focuse on the oncologic outcomes and long-term outcomes of laparoscopic surgery for PDAC patients. Methods: From January 2004, patients who had been diagnosed with the tumor in the pancreas without suspicion for vascular involvement were eligible for laparoscopic pancreatectomy at Nippon Medical School. In Lap-PD for PDAC patients, we apply laparoscopic left mesenteric approach, which enables both accurate laparoscopic lymph node retrieval and complete pancreatic nerve plexuses dissection to achieve R0 resection. In Lap-DP for PDAC patients, we perform retroperitoneal tissue dissection, which often includes adrenalectomy Results: We have experienced laparoscopic pancreatectomies in 148 patients including 25 PDAC patients. In the 25 patients with PDAC, the mean number of lymph nodes dissected was 22.4 ± 12.6 (6-57). Metastasis to the lymph nodes was observed in 8 of the 25 patients (32%). R0 resection was performed in 22 patients (88%). The median follow-up period for the PDAC patients undergoing laparoscopic pancreatectomy was 16 months (1-71 months). Six of the 25 patients died, at 2.5 months (stage IV), 15 months (stage IA), 29 months (stage IIB), 33 months (stage IIB), 24 months (stage IIA), and 18 months (stage IIB). Surviving 19 patients had no recurrence. Conclusion: Laparoscopic pancreatectomy for pancreatic cancer seems to achieve similar oncologic and longterm outcomes to open approach.
Pancreatology, Jun 1, 2014
pancreatic surgery). Trainees were divided into 4 groups (level 1-4) according to the total score... more pancreatic surgery). Trainees were divided into 4 groups (level 1-4) according to the total score of A+B or C step. The following factors were examined:â' Time course of trainee's total score and the rate of a complete operation by trainees',â'¡Comparison of perioperative data between the trainees' group and experts group,â'¢Analysis of a questionnaire. Results: The total score of A+B step and the rate of a complete operation by trainees' were steadily increasing in most trainees while time course of the total score of C step was various. The mean operative time in the experts group was significantly shorter than that in the trainees' group (p<0.05). However, no differences were found with respects to the mean blood loss, incidence rate of complications and mean hospital stay. There were no surgery-related deaths in both groups. Conclusion: Stepwise surgical residency program with rating system for PD was an efficient tool for gastric and colonic surgery and also secured patient's safety during the procedure. F-105. The prevalence of pancreas abnormalities in patients with inflammatory bowel disease was screened by US and further examined by EUS: Not frequent, but also not rare!
Journal of Nippon Medical School, Aug 25, 2021
Background: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the ... more Background: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes. Methods: There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin). Results: From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. Conclusions: We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.
PubMed, 1993
NORs (Nucleolar Organizer Regions) are loops of DNA encoding ribosomal RNA, which reflect cellula... more NORs (Nucleolar Organizer Regions) are loops of DNA encoding ribosomal RNA, which reflect cellular activity. The Ag-NORs staining was applied to paraffin sections of 10 normal pancreas, 10 chronic pancreatitis and 23 pancreatic cancer, with 17 gastric and 18 colonic cancers. We calculated the mean Ag-NORs number and Ag-NORs index, and defined T/N ratio. The mean Ag-NORs number was compared with the data obtained by Flow cytometry (FCM) in pancreatic carcinoma. A significant difference in Ag-NORs index was found between benign (normal: 1.86 +/- 0.38, pancreatitis: 2.14 +/- 0.53) and malignant tissues (4.02 +/- 1.19) of the pancreas (p < 0.01). Compared with the data by FCM, there was a significant correlation between the mean Ag-NORs number and the percentage of S-phase cells in pancreatic carcinoma (r = 0.59, p < 0.01). Ag-NORs index in pancreatic carcinoma showed significantly lower value than that in cancer of stomach (6.35 +/- 1.32) and colon (7.66 +/- 1.35), but there was no difference in T/N ratio among them. In conclusion, the Ag-NORs staining is useful for analyzing proliferating activity in pancreatic carcinoma. The proliferating potential in pancreatic carcinoma is lower than that in gastric and colonic ones. This may be due to the low proliferating potential of the background mucosa from which pancreatic carcinoma will arise.
Surgery, Nov 1, 2007
Several reconstructive surgical techniques have been proposed for restoring pancreatico-jejunal c... more Several reconstructive surgical techniques have been proposed for restoring pancreatico-jejunal continuity. Little has been done, however, to evaluate the efficacy of tissue engineering on anastomotic healing. We examined the effects of basic fibroblast growth factor (bFGF) incorporated in gelatin hydrogel (GH) microspheres on the anastomotic healing of pancreaticojejunostomy. As a preliminary experiment, 20 female Wistar rats received a jejunal subserosal injection of 1 microg of bFGF-GH (n = 10), 1 microg of Free-bFGF (n = 5), or gelatin alone (n = 5) to study the effects of bFGF on the histology of normal jejunum on day 7 after the injection. Next, 12 beagle dogs received a jejunal subserosal injection of 100-microg bFGF-GH (n = 7) or gelatin alone (n = 5) at the anastomotic site of pancreaticojejunostomy. Four types of assessment were performed to compare the 2 groups: pancreatography, breaking strength test, pathologic examination, and calculation of the microvessel density (MVD). The bFGF-GH injection led to markedly increased levels of collagen and fibroblastic cellularity in the subserosal layer of the Wistar rats. In contrast, the rats treated by gelatin alone exhibited no such effects. No anastomotic failures were observed in the dogs treated by bFGF-GH. Histologic observations of this group revealed abundant granulation tissues. Treatment with bFGF-GH significantly increased the breaking strength and MVD over the levels measured in the control group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). bFGF-GH accelerates healing of pancreaticojejunal anastomosis during the early postoperative period. Basic FGF-GH may show promise as a new technique for preventing anastomotic failure of pancreaticojejunostomy.
Pancreatology, Aug 1, 2016
Pancreatology, Jun 1, 2014
Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a ... more Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a pylorus-preserving pancreatoduodenectomy. Between 1998 and 2008 retrocolic duodeno/gastrojejunostomies were applied in 151 cases. Since 2008 the antecolic duodeno/gastrojejunostomy has been used in 123 cases for reconstruction completed with a Braun anastomosis between the afferent and efferent jejunal limb about 25 cm off the duodeno/gastrojejunostomy. Results: The differences were statistically not significant, regarding the postoperative hospitalization time, reoperation rate and operative mortality. Similarly the pre-and intraoperative data were statistically identical. However the frequency of DGE was significantly lower (2%) after antecolic recostruction, compared to that of the retrocolic group (10,6%, p: 0,040). Conclusion: It can be concluded that during pancreatoduodenectomy the antecolic reconstruction with a Braun anastomosis is associated with an especially low occurrence of DGE. The presumed explanations are e besides other possible factors e the "straight" duodeno/gastrojejunostomy without angulation and the prevention of reflux of bile and pancreatic juice into the stomach.
Journal of Nippon Medical School, 2013
Journal of Nippon Medical School, 2006
Pancreatology, Mar 1, 2013
Pancreatology, Mar 1, 2013
s / Pancreatology 13 (2013) e1–e94 e53 of the mouse pancreas via laparotomy. Two weeks post-cance... more s / Pancreatology 13 (2013) e1–e94 e53 of the mouse pancreas via laparotomy. Two weeks post-cancer cell injection, a second laparotomy was performed to inject drug-loaded MPs or saline into the same tail section of the pancreas. Mouse tissue samples were taken to evaluate the local effects of constant drug release on the pancreatic tumors and to determine the extent of drug escape to the spleen and liver. Positive results of these combined studies will justify additional pre-clinical investigation in a transgenic mouse model of pancreatic cancer.
Pancreatology, Nov 1, 2012
Introduction: In reference to our earlier publication, laboratory tests that reflect severe intra... more Introduction: In reference to our earlier publication, laboratory tests that reflect severe intravascular volume depletion (serum creatinine level, eGFR) can be used for predicting the severity of acute pancreatitis (AP). Aim: The aim of the study was to assess whether urine level of Neutrophil Gelatinase-Associated Lipocain (uNGAL) could represent a useful marker of AP severity. Patients and methods: We have observed a cohort of 100 prospectively enrolled patients. The study describes the entity: moderately severe acute pancreatitis (MSAP), characterized by local complications (LCs) without organ failure (OF). Severe acute pancreatitis (SAP) was defined by the presence of infectious (peri)pancreatic complication or an OF for more than 48 h. Urine 24h samples for uNGAL measurement by ARCHITECT assay were collected on 1st, 3rd and 7th hospital day. Utility of uNGAL for the prediction of clinical outcome was evaluated by receiver operator characteristic (ROC) curve analysis. Results: Usefulness of uNGAL for the prediction of OF and LCs was superior to CRP. Areas under the ROC curve of urinary NGAL for predicting MSAP and SAP were 0.885, 0.955, respectively. The cutoff points of 1 st day uNGAL that maximized the combined sensitivity and specificity for predicting MSAP and SAP were 40 ng/mL, 57 ng/mL, respectively. Moreover, elevated concentration of uNGAL was associated with longer average length of stay and higher risk of fatal AP. Conclusions: We strongly suggest using the uNGAL with cutoff value of >40 ng/mL as a simple indicator of severity in patients presenting with AP.
Pancreatology, Nov 1, 2012
Methods: 153 patients with chronic pancreatitis (CP) were included in the research in whom pancre... more Methods: 153 patients with chronic pancreatitis (CP) were included in the research in whom pancreas proximal resections were performed (pancreatoduodenal resection in 53 patients; Beger operation in modification of the clinicin 61 patients; Bern modificationin 39 patients). Criteria of treatment efficacy were the level of distant lethality, frequency of complications and repeated interventions, marked character of exocrine and endocrine insufficiency. The pain syndrome level and professional rehabilitation of patients were estimated. Results: Late lethality related to chronic pancreatitis progressing made up 2,61%. Firstly revealed diabetes mellitus developed in 15 (9,8%) patients after all surgical interventions; reliably smaller number of such cases in patients after Beger operation was noted in comparison with pancreatoduodenal resection. Exocrine insufficiency was revealed in 27 (17,65%) patients and it doesnt depend on the operative technique. High level of professional rehabilitation was marked at all techniques which was achieved in 137 (89,54%) patients. There was a reliable improvement of parameters of the pain syndrome elimination after Beger operation in modification of the clinic in comparison with pancreatoduodenal resection. Conclusions: The performed analysis of the distant results of surgical treatment of CP patients demonstrates advantages of the pancreas proximal resection with the duodenum saving.
Pancreatology, Jun 1, 2015
Introduction: Pancreatic brush cytology (PBC) by endoscopic retrograde cholangiopancreatography (... more Introduction: Pancreatic brush cytology (PBC) by endoscopic retrograde cholangiopancreatography (ERCP) may allow histological diagnosis of pancreatic adenocarcinoma (PA). It isn't regularly performed due to difficulty in traversing pancreatic strictures, potential for post-procedure pancreatitis and previous reports of inadequate sensitivity.
Pancreatology, May 1, 2013
Nippon Daicho Komonbyo Gakkai Zasshi, 1991
Background: Tumor angiogenesis is an important factor in the proliferation and metastasis of panc... more Background: Tumor angiogenesis is an important factor in the proliferation and metastasis of pancreatic ductal adenocarcinoma (PDAC). CD34, CD31 and factor VIII-related antigen are commonly used as endothelial cell markers for tumor vessels. However, these markers identify not only newly formed small tumor vessels, but also pre-existing large blood vessels. Nestin, a class VI intermediate filament protein, has been reported to be up-regulated in endothelial cells accompanying the process of angiogenesis. In an acute pancreatitis murine model, we have previously reported that nestin is strongly expressed in proliferating endothelial cells. Furthermore, we have reported that nestin-positive blood vessels correlated with a poor prognosis in colorectal cancer. In this study, we examined the effectiveness of nestin as an angiogenic marker and potent target for anti-angiogenic therapy in PDAC. Methods: Tissues from 45 patients with PDAC were immunostained with nestin and other common vascular endothelial markers including CD34, CD31 and factor VIII-related antigen. We measured the number and dimension of the nestin- and CD34-positive blood vessels using image analyzing software. In addition, we compared proliferation activity between nestin- and CD34-positive vessels as determined by PCNA-labeling indices. To clarify the roles of nestin in endothelial cells, we transfected siRNA targeting nestin transcripts to mouse endothelial TKD2cells, and performed cell growth and migration assays. Results: Immunohistochemically, CD34, CD31 and factor VIII-related antigen were localized in blood vessels of all sizes, while nestin was localized only in the small blood vessels in PDAC tissues. Nestin was also expressed in myofibroblasts and nerve fibers, but not in lymphatic vessels. In image analyzing software, nestin-positive vessels were small in number, and they formed small lumen compare with CD34-positive blood vessels. Nestin-positive vessels showed higher PCNA-labeling indices than those of CD34-positive vessels. Nestin was expressed in small and proliferating blood vessels in PDAC tissues, suggesting that nestin plays important roles in tumor angiogenesis in cancer. Knock down of nestin in mouse endothelial cells using siRNA inhibited the cell growth, but not cell migration in vitro. Conclusion: Nestin was specifically expressed in small and proliferating blood vessels in pancreatic cancer tissues, indicating that nestin is a useful angiogenic marker in cancer. Furthermore, nestin may be a novel therapeutic target for inhibition of tumor angiogenesis in pancreatic cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5145. doi:10.1158/1538-7445.AM2011-5145
Journal of carcinogenesis & mutagenesis, 2013
Introduction: Combination chemotherapy with gemcitabine and S-1 (GS) in metastatic advanced pancr... more Introduction: Combination chemotherapy with gemcitabine and S-1 (GS) in metastatic advanced pancreatic cancer patients is superior to gemcitabine alone in response rate and progression free survival. We investigated this combination chemotherapy as neoadjuvant therapy for resectable and borderline resectable pancreatic cancer. Methods: Eleven patients with resectable or borderline resectable pancreatic cancer were administered to neoadjuvant chemotherapy with GS (NeoGS) from June 2011 to March 2013 at Nippon Medical School, and shortterm outcome was evaluated. Results: The median age was 69.1 years. According to NCCN criteria, 6 patients were resectable diseases and 5 were borderline resectable diseases. All patients received Neo GS with a median cycle of 3.5 (range: 2-11). No serious adverse events including death or life-threatening complications happened. Grade 3 or 4 chemotherapyrelated toxicities included neutropenia (81.8%), anemia (18.2%), thrombocytopenia (18.2%), and febrile neutropenia (9.1%). Other non-hematological toxicities with grade 1 or 2 were anorexia (36.4%), constipation (36%), nausea (27.3%), diarrhea (18.2%), dysgeusia (9.1%), and stomatitis (9.1%). Radiologically, partial response was documented in 3 patients (27.3%), and the remaining 8 patients (72.7%) had stable disease. All patients underwent pancreatic resection with lymphadenectomy. An R0 resection was achieved in 10 of 11 (90.9%), and negative nodal involvement (N0) was found in 6 (54.5%). Pathologically, all specimens showed at least Evans grade I, while eight of eleven (72.7%) had Evans grade IIa. There was no mortality and severe morbidity including clinically relevant pancreatic fistula. All patients received adjuvant chemotherapy with either gemcitabine or S1. Conclusion: This pilot study suggests NeoGS is feasible in patients with resectable and borderline resectable pancreatic cancer and may be associated with a high R0 resection rate and a low lymph node metastasis rate, suggesting that further phase 2 and 3 trials are warranted.
International journal of pancreatology, 1994
Methods: Sere of 130 patients suffering from pancreatic carcinoma were tested for anti-p53-Ab via... more Methods: Sere of 130 patients suffering from pancreatic carcinoma were tested for anti-p53-Ab via ELISA and immunoblorting using recombinant p53-protein as a target. These patients were classified according to UICC-criteria: stage I: 14%, stage II: 5%, stage III: 48% and ...
Journal of carcinogenesis & mutagenesis, 2013
Introduction: The recent advances of surgical techniques and technology allow minimally invasive ... more Introduction: The recent advances of surgical techniques and technology allow minimally invasive surgery to be applied in patients with benign and malignant diseases of the pancreas. About malignancy, we still have concerns regarding the oncologic adequacy of laparoscopic pancreatectomy, with fewer studies reporting oncologic outcomes. We describe the surgical technique to improve the curability of laparoscopic pancreatectomy in the treatment of Pancreatic Adenocarcinoma (PDAC) and focuse on the oncologic outcomes and long-term outcomes of laparoscopic surgery for PDAC patients. Methods: From January 2004, patients who had been diagnosed with the tumor in the pancreas without suspicion for vascular involvement were eligible for laparoscopic pancreatectomy at Nippon Medical School. In Lap-PD for PDAC patients, we apply laparoscopic left mesenteric approach, which enables both accurate laparoscopic lymph node retrieval and complete pancreatic nerve plexuses dissection to achieve R0 resection. In Lap-DP for PDAC patients, we perform retroperitoneal tissue dissection, which often includes adrenalectomy Results: We have experienced laparoscopic pancreatectomies in 148 patients including 25 PDAC patients. In the 25 patients with PDAC, the mean number of lymph nodes dissected was 22.4 ± 12.6 (6-57). Metastasis to the lymph nodes was observed in 8 of the 25 patients (32%). R0 resection was performed in 22 patients (88%). The median follow-up period for the PDAC patients undergoing laparoscopic pancreatectomy was 16 months (1-71 months). Six of the 25 patients died, at 2.5 months (stage IV), 15 months (stage IA), 29 months (stage IIB), 33 months (stage IIB), 24 months (stage IIA), and 18 months (stage IIB). Surviving 19 patients had no recurrence. Conclusion: Laparoscopic pancreatectomy for pancreatic cancer seems to achieve similar oncologic and longterm outcomes to open approach.
Pancreatology, Jun 1, 2014
pancreatic surgery). Trainees were divided into 4 groups (level 1-4) according to the total score... more pancreatic surgery). Trainees were divided into 4 groups (level 1-4) according to the total score of A+B or C step. The following factors were examined:â' Time course of trainee's total score and the rate of a complete operation by trainees',â'¡Comparison of perioperative data between the trainees' group and experts group,â'¢Analysis of a questionnaire. Results: The total score of A+B step and the rate of a complete operation by trainees' were steadily increasing in most trainees while time course of the total score of C step was various. The mean operative time in the experts group was significantly shorter than that in the trainees' group (p<0.05). However, no differences were found with respects to the mean blood loss, incidence rate of complications and mean hospital stay. There were no surgery-related deaths in both groups. Conclusion: Stepwise surgical residency program with rating system for PD was an efficient tool for gastric and colonic surgery and also secured patient's safety during the procedure. F-105. The prevalence of pancreas abnormalities in patients with inflammatory bowel disease was screened by US and further examined by EUS: Not frequent, but also not rare!
Journal of Nippon Medical School, Aug 25, 2021
Background: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the ... more Background: Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes. Methods: There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin). Results: From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. Conclusions: We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.
PubMed, 1993
NORs (Nucleolar Organizer Regions) are loops of DNA encoding ribosomal RNA, which reflect cellula... more NORs (Nucleolar Organizer Regions) are loops of DNA encoding ribosomal RNA, which reflect cellular activity. The Ag-NORs staining was applied to paraffin sections of 10 normal pancreas, 10 chronic pancreatitis and 23 pancreatic cancer, with 17 gastric and 18 colonic cancers. We calculated the mean Ag-NORs number and Ag-NORs index, and defined T/N ratio. The mean Ag-NORs number was compared with the data obtained by Flow cytometry (FCM) in pancreatic carcinoma. A significant difference in Ag-NORs index was found between benign (normal: 1.86 +/- 0.38, pancreatitis: 2.14 +/- 0.53) and malignant tissues (4.02 +/- 1.19) of the pancreas (p < 0.01). Compared with the data by FCM, there was a significant correlation between the mean Ag-NORs number and the percentage of S-phase cells in pancreatic carcinoma (r = 0.59, p < 0.01). Ag-NORs index in pancreatic carcinoma showed significantly lower value than that in cancer of stomach (6.35 +/- 1.32) and colon (7.66 +/- 1.35), but there was no difference in T/N ratio among them. In conclusion, the Ag-NORs staining is useful for analyzing proliferating activity in pancreatic carcinoma. The proliferating potential in pancreatic carcinoma is lower than that in gastric and colonic ones. This may be due to the low proliferating potential of the background mucosa from which pancreatic carcinoma will arise.
Surgery, Nov 1, 2007
Several reconstructive surgical techniques have been proposed for restoring pancreatico-jejunal c... more Several reconstructive surgical techniques have been proposed for restoring pancreatico-jejunal continuity. Little has been done, however, to evaluate the efficacy of tissue engineering on anastomotic healing. We examined the effects of basic fibroblast growth factor (bFGF) incorporated in gelatin hydrogel (GH) microspheres on the anastomotic healing of pancreaticojejunostomy. As a preliminary experiment, 20 female Wistar rats received a jejunal subserosal injection of 1 microg of bFGF-GH (n = 10), 1 microg of Free-bFGF (n = 5), or gelatin alone (n = 5) to study the effects of bFGF on the histology of normal jejunum on day 7 after the injection. Next, 12 beagle dogs received a jejunal subserosal injection of 100-microg bFGF-GH (n = 7) or gelatin alone (n = 5) at the anastomotic site of pancreaticojejunostomy. Four types of assessment were performed to compare the 2 groups: pancreatography, breaking strength test, pathologic examination, and calculation of the microvessel density (MVD). The bFGF-GH injection led to markedly increased levels of collagen and fibroblastic cellularity in the subserosal layer of the Wistar rats. In contrast, the rats treated by gelatin alone exhibited no such effects. No anastomotic failures were observed in the dogs treated by bFGF-GH. Histologic observations of this group revealed abundant granulation tissues. Treatment with bFGF-GH significantly increased the breaking strength and MVD over the levels measured in the control group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). bFGF-GH accelerates healing of pancreaticojejunal anastomosis during the early postoperative period. Basic FGF-GH may show promise as a new technique for preventing anastomotic failure of pancreaticojejunostomy.
Pancreatology, Aug 1, 2016
Pancreatology, Jun 1, 2014
Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a ... more Most commonly the tumours originated from the pancreatic head and thus we preferred to perform a pylorus-preserving pancreatoduodenectomy. Between 1998 and 2008 retrocolic duodeno/gastrojejunostomies were applied in 151 cases. Since 2008 the antecolic duodeno/gastrojejunostomy has been used in 123 cases for reconstruction completed with a Braun anastomosis between the afferent and efferent jejunal limb about 25 cm off the duodeno/gastrojejunostomy. Results: The differences were statistically not significant, regarding the postoperative hospitalization time, reoperation rate and operative mortality. Similarly the pre-and intraoperative data were statistically identical. However the frequency of DGE was significantly lower (2%) after antecolic recostruction, compared to that of the retrocolic group (10,6%, p: 0,040). Conclusion: It can be concluded that during pancreatoduodenectomy the antecolic reconstruction with a Braun anastomosis is associated with an especially low occurrence of DGE. The presumed explanations are e besides other possible factors e the "straight" duodeno/gastrojejunostomy without angulation and the prevention of reflux of bile and pancreatic juice into the stomach.
Journal of Nippon Medical School, 2013
Journal of Nippon Medical School, 2006
Pancreatology, Mar 1, 2013
Pancreatology, Mar 1, 2013
s / Pancreatology 13 (2013) e1–e94 e53 of the mouse pancreas via laparotomy. Two weeks post-cance... more s / Pancreatology 13 (2013) e1–e94 e53 of the mouse pancreas via laparotomy. Two weeks post-cancer cell injection, a second laparotomy was performed to inject drug-loaded MPs or saline into the same tail section of the pancreas. Mouse tissue samples were taken to evaluate the local effects of constant drug release on the pancreatic tumors and to determine the extent of drug escape to the spleen and liver. Positive results of these combined studies will justify additional pre-clinical investigation in a transgenic mouse model of pancreatic cancer.
Pancreatology, Nov 1, 2012
Introduction: In reference to our earlier publication, laboratory tests that reflect severe intra... more Introduction: In reference to our earlier publication, laboratory tests that reflect severe intravascular volume depletion (serum creatinine level, eGFR) can be used for predicting the severity of acute pancreatitis (AP). Aim: The aim of the study was to assess whether urine level of Neutrophil Gelatinase-Associated Lipocain (uNGAL) could represent a useful marker of AP severity. Patients and methods: We have observed a cohort of 100 prospectively enrolled patients. The study describes the entity: moderately severe acute pancreatitis (MSAP), characterized by local complications (LCs) without organ failure (OF). Severe acute pancreatitis (SAP) was defined by the presence of infectious (peri)pancreatic complication or an OF for more than 48 h. Urine 24h samples for uNGAL measurement by ARCHITECT assay were collected on 1st, 3rd and 7th hospital day. Utility of uNGAL for the prediction of clinical outcome was evaluated by receiver operator characteristic (ROC) curve analysis. Results: Usefulness of uNGAL for the prediction of OF and LCs was superior to CRP. Areas under the ROC curve of urinary NGAL for predicting MSAP and SAP were 0.885, 0.955, respectively. The cutoff points of 1 st day uNGAL that maximized the combined sensitivity and specificity for predicting MSAP and SAP were 40 ng/mL, 57 ng/mL, respectively. Moreover, elevated concentration of uNGAL was associated with longer average length of stay and higher risk of fatal AP. Conclusions: We strongly suggest using the uNGAL with cutoff value of >40 ng/mL as a simple indicator of severity in patients presenting with AP.
Pancreatology, Nov 1, 2012
Methods: 153 patients with chronic pancreatitis (CP) were included in the research in whom pancre... more Methods: 153 patients with chronic pancreatitis (CP) were included in the research in whom pancreas proximal resections were performed (pancreatoduodenal resection in 53 patients; Beger operation in modification of the clinicin 61 patients; Bern modificationin 39 patients). Criteria of treatment efficacy were the level of distant lethality, frequency of complications and repeated interventions, marked character of exocrine and endocrine insufficiency. The pain syndrome level and professional rehabilitation of patients were estimated. Results: Late lethality related to chronic pancreatitis progressing made up 2,61%. Firstly revealed diabetes mellitus developed in 15 (9,8%) patients after all surgical interventions; reliably smaller number of such cases in patients after Beger operation was noted in comparison with pancreatoduodenal resection. Exocrine insufficiency was revealed in 27 (17,65%) patients and it doesnt depend on the operative technique. High level of professional rehabilitation was marked at all techniques which was achieved in 137 (89,54%) patients. There was a reliable improvement of parameters of the pain syndrome elimination after Beger operation in modification of the clinic in comparison with pancreatoduodenal resection. Conclusions: The performed analysis of the distant results of surgical treatment of CP patients demonstrates advantages of the pancreas proximal resection with the duodenum saving.
Pancreatology, Jun 1, 2015
Introduction: Pancreatic brush cytology (PBC) by endoscopic retrograde cholangiopancreatography (... more Introduction: Pancreatic brush cytology (PBC) by endoscopic retrograde cholangiopancreatography (ERCP) may allow histological diagnosis of pancreatic adenocarcinoma (PA). It isn't regularly performed due to difficulty in traversing pancreatic strictures, potential for post-procedure pancreatitis and previous reports of inadequate sensitivity.
Pancreatology, May 1, 2013
Nippon Daicho Komonbyo Gakkai Zasshi, 1991
Background: Tumor angiogenesis is an important factor in the proliferation and metastasis of panc... more Background: Tumor angiogenesis is an important factor in the proliferation and metastasis of pancreatic ductal adenocarcinoma (PDAC). CD34, CD31 and factor VIII-related antigen are commonly used as endothelial cell markers for tumor vessels. However, these markers identify not only newly formed small tumor vessels, but also pre-existing large blood vessels. Nestin, a class VI intermediate filament protein, has been reported to be up-regulated in endothelial cells accompanying the process of angiogenesis. In an acute pancreatitis murine model, we have previously reported that nestin is strongly expressed in proliferating endothelial cells. Furthermore, we have reported that nestin-positive blood vessels correlated with a poor prognosis in colorectal cancer. In this study, we examined the effectiveness of nestin as an angiogenic marker and potent target for anti-angiogenic therapy in PDAC. Methods: Tissues from 45 patients with PDAC were immunostained with nestin and other common vascular endothelial markers including CD34, CD31 and factor VIII-related antigen. We measured the number and dimension of the nestin- and CD34-positive blood vessels using image analyzing software. In addition, we compared proliferation activity between nestin- and CD34-positive vessels as determined by PCNA-labeling indices. To clarify the roles of nestin in endothelial cells, we transfected siRNA targeting nestin transcripts to mouse endothelial TKD2cells, and performed cell growth and migration assays. Results: Immunohistochemically, CD34, CD31 and factor VIII-related antigen were localized in blood vessels of all sizes, while nestin was localized only in the small blood vessels in PDAC tissues. Nestin was also expressed in myofibroblasts and nerve fibers, but not in lymphatic vessels. In image analyzing software, nestin-positive vessels were small in number, and they formed small lumen compare with CD34-positive blood vessels. Nestin-positive vessels showed higher PCNA-labeling indices than those of CD34-positive vessels. Nestin was expressed in small and proliferating blood vessels in PDAC tissues, suggesting that nestin plays important roles in tumor angiogenesis in cancer. Knock down of nestin in mouse endothelial cells using siRNA inhibited the cell growth, but not cell migration in vitro. Conclusion: Nestin was specifically expressed in small and proliferating blood vessels in pancreatic cancer tissues, indicating that nestin is a useful angiogenic marker in cancer. Furthermore, nestin may be a novel therapeutic target for inhibition of tumor angiogenesis in pancreatic cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5145. doi:10.1158/1538-7445.AM2011-5145
Journal of carcinogenesis & mutagenesis, 2013
Introduction: Combination chemotherapy with gemcitabine and S-1 (GS) in metastatic advanced pancr... more Introduction: Combination chemotherapy with gemcitabine and S-1 (GS) in metastatic advanced pancreatic cancer patients is superior to gemcitabine alone in response rate and progression free survival. We investigated this combination chemotherapy as neoadjuvant therapy for resectable and borderline resectable pancreatic cancer. Methods: Eleven patients with resectable or borderline resectable pancreatic cancer were administered to neoadjuvant chemotherapy with GS (NeoGS) from June 2011 to March 2013 at Nippon Medical School, and shortterm outcome was evaluated. Results: The median age was 69.1 years. According to NCCN criteria, 6 patients were resectable diseases and 5 were borderline resectable diseases. All patients received Neo GS with a median cycle of 3.5 (range: 2-11). No serious adverse events including death or life-threatening complications happened. Grade 3 or 4 chemotherapyrelated toxicities included neutropenia (81.8%), anemia (18.2%), thrombocytopenia (18.2%), and febrile neutropenia (9.1%). Other non-hematological toxicities with grade 1 or 2 were anorexia (36.4%), constipation (36%), nausea (27.3%), diarrhea (18.2%), dysgeusia (9.1%), and stomatitis (9.1%). Radiologically, partial response was documented in 3 patients (27.3%), and the remaining 8 patients (72.7%) had stable disease. All patients underwent pancreatic resection with lymphadenectomy. An R0 resection was achieved in 10 of 11 (90.9%), and negative nodal involvement (N0) was found in 6 (54.5%). Pathologically, all specimens showed at least Evans grade I, while eight of eleven (72.7%) had Evans grade IIa. There was no mortality and severe morbidity including clinically relevant pancreatic fistula. All patients received adjuvant chemotherapy with either gemcitabine or S1. Conclusion: This pilot study suggests NeoGS is feasible in patients with resectable and borderline resectable pancreatic cancer and may be associated with a high R0 resection rate and a low lymph node metastasis rate, suggesting that further phase 2 and 3 trials are warranted.
International journal of pancreatology, 1994
Methods: Sere of 130 patients suffering from pancreatic carcinoma were tested for anti-p53-Ab via... more Methods: Sere of 130 patients suffering from pancreatic carcinoma were tested for anti-p53-Ab via ELISA and immunoblorting using recombinant p53-protein as a target. These patients were classified according to UICC-criteria: stage I: 14%, stage II: 5%, stage III: 48% and ...