A case of severe hemorrhagic shock caused by traumatic avulsion of uterine fibroid.

Case Presentation: A 40-year-old woman was injured in a motor vehicle accident. Physician-staffed helicopter emergency medical service (HEMS) was dispatched, and after the HEMS physician performed thoracostomy and tracheal intubation to relieve the tension pneumothorax and hemorrhagic shock, her carotid artery became unpalpable. The physician then decided to perform prehospital resuscitative thoracotomy.

Emergent surgery for cardiac herniation coexisting with complex blunt cardiac injury: A case report.

A 38-year-old man was pressed on his trunk by a heavy object weighing about 100 kg. The patient was in shock status on arrival to the hospital. Circular collapse progressed rapidly during contrast computed tomography (CT) scanning.

Diagnostic accuracy of diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion for the detection of abdominal solid cancer.

Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) images show significant contrast for cancer tissues against non-cancerous tissues. Fusion of a DWIBS and a T2-weighted image (DWIBS/T2) can be used to obtain functional, as well as anatomic, information. In the present study, the performance of DWIBS/T2 in the diagnosis of abdominal solid cancer was evaluated.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion and positron emission tomography/computed tomography of upper gastrointestinal cancers.

Purpose: Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion (DWIBS/T2) strongly contrasts cancerous tissue against background healthy tissues. Positron emission tomography/computed tomography (PET/CT) applies the uptake of 18-fluorodeoxyglucose in the diagnosis of cancer. Our aim was to compare DWIBS/T2 and PET/CT in patients with upper gastrointestinal cancers.

Thoracoscopic hepatectomy for malignant liver tumor.

Background: Anatomical position of the liver poses a difficulty in approaching the lesions using a laparoscopic approach.

Methods: The patient was a 79-year-old man with a surgical history of laparoscopic sigmoidectomy for colon cancer and posterior segmentectomy of the liver for metastatic liver tumor. On admission, he presented with another liver tumor (diameter, 1.

Newly designed bioabsorbable substitute for the treatment of diaphragmatic defects.

Purpose: Earlier studies have investigated the suitability of various materials and autologous grafts for the repair of diaphragmatic defects. Our group investigated the feasibility of using an artificial diaphragm (AD) to repair wide diaphragmatic defects.

Methods: Twelve pigs were laparotomized and, in each pig, a defect was fashioned by resecting a round 8-cm diameter hole in the left diaphragm.

Adult with primary hyperoxaluria type 1 regrets not receiving preemptive liver transplantation during childhood: report of a case.

A 32-year-old male was suspected to have primary hyperoxaluria type 1 (PH1) and eventually underwent liver transplantation (LT). He was diagnosed with nephrolithiasis at 9 years of age. Right heminephrectomy was performed for a staghorn calculus.

An extrahepatic bile duct grafting using a bioabsorbable polymer tube.

Background: Thus far, no ideal substitutions have been developed for completely replacing the extrahepatic bile duct (EHBD).

Methods: We used a bioabsorbable polymer tube (BAPT) for the complete reconstruction of an EHBD in pigs. A 2-cm-long EHBD was resected from the duodenal side, and a 4-cm-long BAPT graft was implanted at that site.

Single-port laparoscopic hepatectomy: technique, safety, and feasibility in a clinical case series.

Background: The recent use of single-port-access surgery in cholecystectomy and other abdominal surgeries has confirmed its safety and validity as a treatment option. However, few reports have described the use of complete single-port access surgeries in hepatectomy for neoplasms.

Methods: The authors performed single-port laparoscopic hepatectomy (SLH) for eight patients (5 patients with hepatocellular carcinoma, 1 patient with metastatic liver tumor, 1 patient with endocrine liver tumor, and 1 patient with hemangioma).

Liver resection using a soft-coagulation system without the Pringle maneuver.

Background/aims: The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. We have developed a method to sufficiently control blood loss during hepatectomy without applying the Pringle maneuver. This study was performed to determine the safety and operative blood loss in hepatectomy performed by this new method.

Duct-to-mucosa pancreatojejunostomy for small main pancreatic duct by the parachute technique after pancreatoduodenectomy.

A duct-to-mucosa pancreatojejunostomy is technically difficult to perform for a small main pancreatic duct after pancreatoduodenectomy. Our group applied the parachute technique to reconstruct and attach a small pancreatic duct to the jejunal mucosa. This method makes it very easy to position stitches on the posterior row of the anastomosis.

Regeneration of extrahepatic bile ducts by tissue engineering with a bioabsorbable polymer.

With the widespread adoption of laparoscopic cholecystectomy and living-donor liver transplantation in recent years, complications involving the biliary system, stenosis in particular, are increasing. Various invasive and non-invasive techniques are now available for the treatment of biliary stenosis, but all are compromised by a high risk of recurrence and other problems. As a potential solution, our group has developed a bioabsorbable polymer (BAP) tube for implantation as a bypass graft.

Preoperative 18[F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts early recurrence after pancreatic cancer resection.

Background: An important step in deciding the treatment strategy for pancreatic cancer is to preoperatively predict the possibility of early recurrence. We reviewed whether 18[F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) before pancreatic cancer resection could predict tumor recurrence in the early postoperative period.

Methods: FDG-PET/CT was performed preoperatively on 56 patients with pancreatic cancer.

A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch.

Background: With the recent widespread use of laparoscopic cholecystectomy and living-donor liver transplantation, complications involving the biliary system, and stenosis in particular, are encountered frequently. Although various invasive and noninvasive techniques are now available for the treatment of biliary stenosis, recurrence and other problems limit their value and utility. Our group sought to investigate whether a bioabsorbable polymer (BAP) patch could serve as a novel treatment for biliary stenosis.

Development of a novel reflux-free bilioenteric anastomosis procedure by using a bioabsorbable polymer tube.

Background: Bilioenteric anastomosis allows reflux of bowel fluid into bile ducts, resulting in reflux cholangitis. We sought to develop a reflux-free procedure of bilioenteric anastomosis endowed using an artificial bile duct (ABD).

Methods: The study was performed in four groups of pigs.

Transport-mediated angiogenesis in 3D epithelial coculture.

Increasing interest has focused on capturing the complexity of tissues and organs in vitro as models of human pathophysiological processes. In particular, a need exists for a model that can investigate the interactions in three dimensions (3D) between epithelial tissues and a microvascular network since vascularization is vital for reconstructing functional tissues in vitro. Here, we implement a microfluidic platform to analyze angiogenesis in 3D cultures of rat primary hepatocytes and rat/human microvascular endothelial cells (rMVECs/hMVECs).

Extended left hepatic lobectomy for hepatic hilar bile duct cancer: a novel surgical procedure in which the right hepatic duct is transected before the hepatoduodenal ligament is skeletonized.

As a general principle, the procedure of isolating a cancer region from surrounding tissues (skeletonization) is not taken until the last stage of a cancer operation. This principle is often disregarded in surgery for cancers of the hepatic hilar duct, however, as it may be mandatory to skeletonize the region before resecting the liver. Our group invented 'extended left hepatic lobectomy', a new surgical procedure for hepatic hilar bile duct cancer, in which we isolate the liver and transect the right hepatic duct before skeletonizing the cancer region in the hepatoduodenal ligament.

Regeneration of extrahepatic bile duct--possibility to clinical application by recognition of the regenerative process.

The biliary epithelium is continuously exposed to highly cytotoxic bile acids and pathogens and thus is at persistent risk for injury. The monolayer mucosal epithelium protects the body from these dangers and once injured. The bile duct repair process essentially involves reconstruction of the bile duct with migrating cells, but there are many questions about the process.

Hepatocyte dynamics in a three-dimensional rotating bioreactor.

Background And Aims: The use of an artificial liver system with extracorporeal circulation or a three-dimensional bioreactor perfused with liquid culture medium inevitably exposes hepatocytes to fluid mechanical stress (MS). The expression of liver-specific hepatocyte functions seems to be modulated by the magnitude of MS. Nonetheless, few studies have focused on the direct effects of MS on hepatocytes.

Radiofrequency (RF)-assisted hepatectomy may induce severe postoperative liver damage.

Background: Radiofrequency (RF) ablation for the treatment of the section line prior to liver resection has been proposed as a way to reduce blood loss during hepatectomy. Our group compared hepatectomy with and without RF ablation to determine whether this technique actually reduces blood loss during liver resection and whether it affects the perioperative outcome.

Method: Of 151 patients who underwent a hepatectomy between January 2002 and October 2005 at the Division of Gastrointestinal Surgery in the Department of Surgery of Saitama Medical University, 48 who had a partial hepatectomy or resection of a portion of liver smaller than a single Couinaud segment were included in the study.

Regeneration of the inferior vena cava with a bioabsorbable polymer implant: a histological study.

Background: Cell implantation into ischemic regions has recently been introduced as a novel strategy for therapeutic angiogenesis. Little is known, however, about the process of blood vessel regeneration, particularly that of the inferior vena cava (IVC). The indicators of normal angiogenesis are also unestablished.

Alpha-fetoprotein-producing clear cell carcinoma of the extrahepatic bile ducts.

A 79-year-old woman visiting our hospital with chief complaints of epigastric pain and jaundice was emergently admitted. Her alpha-fetoprotein (AFP) level was as high as 2265 ng/mL at admission. Her abdominal computed tomography scan revealed dilation of the intrahepatic bile duct and a tumorlike lesion protruding into the cystic duct and gallbladder from the junction between the middle portion of the bile duct and the right and left hepatic ducts.

Extended right hepatectomy for hilar cholangiocarcinoma with resection of the left hepatic duct prior to hepatic resection.

Extended hepatectomy for hilar cholangiocarcinoma results in high operative or in-hospital mortality rates despite of the recent progress in perioperative management. As a new procedure to prevent postoperative hepatic failure in hilar cholangiocarcinoma infiltrating predominantly the right hepatic duct, we devised a combination of extended right lobectomy plus caudal lobectomy with resection of the left hepatic duct prior to hepatic resection by utilizing intraoperative cholangiography, and applied the procedure to a 70-year-old patient. He had a favorable postoperative course and remains recurrence-free at 4 years after operation.

A new laparoscopic-assisted hepatectomy (LAH) utilizing radiofrequency ablation and high-frequency electrocautery.

Compared to tumors located at the edge of the liver, tumors located directly on the liver surface are often difficult to resect, especially when the organ is cirrhotic. To remove tumors at this location, our group has developed a round high-frequency electrosurgical knife that allows hemispherical resection of the liver tissue. This study describes a new laparoscopic-assisted hepatectomy utilizing radiofrequency ablation of the tissue surrounding the tumor and high-frequency electrocautery.