Monitoring fibrosis of the pancreatic remnant after a pancreaticoduodenectomy with dynamic MRI.

Background: The time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging closely reflects the histological degree of pancreatic fibrosis.

Materials And Methods: Seventy-six patients who had undergone a pancreatic TIC analysis prior to receiving a pancreaticoduodenectomy for various reasons were subjected to a yearly monitoring with pancreatic TIC for the pancreatic remnants. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas.

Torsion of the gallbladder in a 3-year-old infant.

A 3-year-old girl was admitted to hospital with complaints of severe upper abdominal pain and vomiting. On admission, a board-like rigidity in the right hypochondrium was noted, along with a high white blood cell count and a high C-reactive protein value. Abdominal ultrasonography (US) revealed a left-sided enlarged gallbladder with a thickened wall, without gallstones.

What is the real contribution of extrahepatic cells to liver regeneration?

Extrahepatic cells, especially bone marrow (BM) cells, might contribute to liver repair, but recent published evidence suggests that they do not play a role in the normally regenerating liver. The mechanism by which extrahepatic cells express a liver-specific function in the liver, whether by transdifferentiation or by cell fusion, remains unclear. In this review, we investigate the status of findings on this controversial subject and summarize the recent research.

Combined pancreatic resection and pancreatic duct-navigation surgery for multiple lesions of the pancreas: intraductal papillary mucinous neoplasm of the pancreas concomitant with ductal carcinoma of the pancreas.

When a branch-type IPMN of the uncinate process is concomitant with ductal carcinoma of the body of the pancreas, total pancreatectomy may be recommended. However, a decrease in quality of life becomes a serious problem after total pancreatectomy because of the abolition of endocrine and exocrine pancreatic function. We proposed the combined resection, which consists of resection of the uncinate process of the pancreas with distal pancreatectomy.

Multicentric occurrence and spread of hepatocellular carcinoma in whole explanted end-stage liver.

Aim: Hepatocellular carcinoma (HCC) arising from the end stages of liver cirrhosis is a fair indication for liver transplantation (LT). To pathologically investigate the multicentric occurrence of relatively early staged HCC in cirrhosis, we studied whole explanted livers.

Methods: Fourteen explanted livers from patients undergoing living donor LT (LDLT) were examined.

A secure taping technique for a liver hanging maneuver using a surgical probe.

A liver hanging maneuver is currently being applied for various types of hepatectomies. The most difficult and important step of this technique is to encircle the liver with tape that is passed between the liver and the inferior vena cava, using a blind dissection. This report describes a secure technique for taping utilizing a surgical probe.

Re-evaluation of lipiodolized transarterial chemoembolization therapy for intrahepatic recurrence of hepatocellular carcinoma after curative liver resection.

Background/purpose: While lipiodolized transarterial chemoembolization (lip-TACE) is effective for treating unresectable hepatocellular carcinoma (HCC), its effect for treating recurrent HCC after curative liver resection needs to be clarified.

Methods: Of 163 patients who had undergone curative liver resection between 1992 and December 2003, 65 patients (39.8%) had recurrent HCC in the liver without extrahepatic recurrence and were indicated for lip-TACE.

Gastroesophageal and laryngopharyngeal reflux symptoms correlate with histopathologic inflammation of the upper and lower esophagus.

Background: The presence of laryngopharyngeal reflux disease is controversial when abnormal sensation of the laryngopharynx is felt without heartburn.

Goals: The aims of this study were to investigate the relationship between abnormal sensation of the laryngopharynx and gastroesophageal reflux, and to elucidate the pathology of laryngopharyngeal reflux disease by investigating histopathologic findings of the upper and lower esophagus.

Study: Upper and lower esophageal tissues were biopsied by endoscopy in 300 consenting patients, excluding those with serious diseases.

Acute deterioration of idiopathic portal hypertension requiring living donor liver transplantation: a case report.

Case reports of severe idiopathic portal hypertension (IPH) requiring liver transplantation are very rare. We report the case of a 65-year-old woman who was diagnosed as having IPH. At the age of 60 years, her initial symptom was hematemesis, due to ruptured esophageal varices.

Annular pancreas causing localized recurrent pancreatitis in a child: report of a case.

Annular pancreas is a rare congenital anomaly. We report a case of relapsing acute pancreatitis localized in the annulus of an annular pancreas in a young child. A 6-year-old boy complained of abdominal pain and we made a diagnosis of acute pancreatitis based on blood biochemistry results.

Compressive stenosis of the inferior vena cava due to localized ascites after living-donor liver transplantation.

A 54-year-old woman was admitted to our hospital following the diagnosis of decompensated liver cirrhosis with hepatitis C. She underwent living-donor liver transplantation, performed using the left hepatic lobe with the middle hepatic vein donated by her husband. After the transplantation, the patient suffered from massive ascites with liver dysfunction.

Surgical management for stenosis of the pancreaticojejunostomy.

The management of the stenosis of the pancreaticojejunostomy is dictated by the state of the anastomosis and the residual pancreas, endocrine, and exocrine pancreatic function. We report a case of a 23-year-old woman who presented with recurrent attacks of acute pancreatitis. Four years ago, she was diagnosed with pancreatic injury with a transection of the body of the pancreas.

A jejunal wall-covering method following central pancreatectomy for prevention of a pancreatic fistula: a novel technique.

To preserve pancreatic endocrine and exocrine function, various types of pancreatic resection, including central pancreatectomy, have been introduced as less invasive surgeries. However, postoperative pancreatic leakage has been demonstrated to be the most frequent complication following pancreas-preserving surgery. The authors' new surgical technique, a jejunal wall-covering method, helps to prevent pancreatic leakage following central pancreatectomy.

Significance of the serum level of soluble E-cadherin in patients with HCC.

Background/aims: E-cadherin (E-cad) is a type of adhesion molecule, and recent studies have demonstrated a correlation between its expression in tumor lesions and the recurrence of HCC. Serum levels of soluble E-cad are significantly elevated in patients with several types of cancer. The authors evaluated the significance of the serum level of soluble E-cad as a predictor of early recurrences (intrahepatic or extrahepatic metastasis) of HCC after a curative resection.

Lysophosphatidic acid stimulates the proliferation and motility of malignant pleural mesothelioma cells through lysophosphatidic acid receptors, LPA1 and LPA2.

Lysophosphatidic acid (LPA) is one of the simplest natural phospholipids. This phospholipid is recognized as an extracellular potent lipid mediator with diverse effects on various cells. Although LPA is shown to stimulate proliferation and motility via LPA receptors, LPA(1) and LPA(2), in several cancer cell lines, the role of LPA and LPA receptors for malignant pleural mesothelioma (MPM) has been unknown.

Evolution of living donor liver transplantation over 10 years: experience of a single center.

Purpose: To evaluate the changes in living donor liver transplantations (LDLTs) over the last 10 years, we analyzed our experience of performing LDLT in a single center.

Methods: We performed 73 LDLTs over the 10 years between 1997 and 2007 in Nagasaki University Hospital, Japan.

Results: Initially, from 1997 to 2003, LDLT was performed for pediatric patients; then, between 2004 and 2007, adult-to-adult LDLT was introduced, primarily for hepatocellular carcinoma (HCC) in liver cirrhosis.

Clinical images. Gallbladder torsion showing a "whirl sign" on a multidetector computed tomography scan.

An 82-year-old woman presented with a 5-day history of right upper quadrant pain. A physical examination showed a palpable tender mass in the right upper quadrant with Murphy's sign. The contrast-enhanced multidetector computed tomography (MDCT) scan clearly showed the twisted pedicle of the cystic duct and gallbladder mesentery on the right side of the gallbladder, thus showing a "whirl sign," and a definitive diagnosis of gallbladder torsion was made.

Prognostic impact of marginal adipose tissue invasion in ductal carcinoma of the breast.

This study aimed to investigate whether adipose tissue invasion (ATI) of cancer cells at the tumor margin influenced lymph node status and prognosis in patients with invasive ductal carcinoma of the breast. Data for 245 patients with breast cancer with marginal ATI were clinicopathologically compared with data for 65 patients without ATI. We also examined the value of the combination of ATI and peritumoral lymphatic vessel invasion (LVI).

The search for cancer stem cells in hepatocellular carcinoma.

Background: Recent evidence suggests that some solid cancers originate from cancer stem cells. We have identified a subset of candidate stem cells, which are termed side population (SP) cells, in the hepatocellular carcinoma cell line Huh7. Because most stem cells reside in the G0 phase of the cell cycle, G0 cells were isolated, and the relationship between SP cells and G0 cells was investigated to clarify the biological characteristics of G0 cells.

Two-surgeon technique using saline-linked electric cautery and ultrasonic surgical aspirator in living donor hepatectomy: its safety and efficacy.

Background: Saline-linked electric cautery (SLC) is introduced as an effective device to reduce blood loss in liver surgery. The aim of the current study was to evaluate the safety and efficacy of a 2-surgeon technique using SLC and the Cavitron Ultrasonic Surgical Aspirator (CUSA; Valleylab, Boulder, CO) in living donor hepatectomy.

Methods: Forty-three living donor right hepatectomy cases were enrolled in this study.