小児胆管径の基準値からみた胆管拡張の定義の問題点

小児胆管径の基準値からみた胆管拡張の定義の問題点


全国集計からみた先天性胆道拡張症, 膵・胆管合流異常の胆道癌発生率とその特徴

全国集計からみた先天性胆道拡張症, 膵・胆管合流異常の胆道癌発生率とその特徴


Geranylgeranylacetone prevents acute liver damage after massive hepatectomy in rats through suppression of a CXC chemokine GRO1 and induction of heat shock proteins.

BACKGROUND AND METHODS: Acute liver failure after massive hepatectomy remains a challenging problem. In this study, using a microarray designed to monitor the side effects of drugs, we examined changes in gene expression in the remnant liver during the 24 h after hepatectomy and the effects of a nontoxic heat shock protein (HSP) 70 inducer, geranylgeranylacetone (GGA), after 90% hepatectomy in rats. RESULTS: A single oral administration of 100 mg/kg GGA significantly suppressed the release of aminotransferases and improved survival compared with vehicle administration. The hepatectomy upregulated 74 genes and downregulated 95. Interestingly, ten cytokine genes were upregulated, while no cytokine-related gene was downregulated. Among the ten cytokine genes, a potent chemoattractant for neutrophils, GRO1, was most rapidly and markedly upregulated after 90% hepatectomy. GGA effectively suppressed the up-regulation of GRO1 messenger ribonucleic acid, and this was validated by Northern hybridization. Microarray and immunoblot analyses showed that, in addition to HSP70 and HSP27, GGA preferentially induced an endoplasmic reticulum chaperone, BIP. CONCLUSION: Considering hemodynamic and metabolic overloading as a primary cause of acute lever failure, the ER stress response enhanced by GGA may also play an important role in the prevention of overload-induced liver damage.


Prevention of lethal hepatic injury in Long-Evans Cinnamon(LEC) rats by D-galactosamine hydrochloride

Repeated injections of D-galactosamine hydrochloride (GalN) increase the survival rate of Long-Evans Cinnamon (LEC) rats, an animal model of Wilson's disease. The aim of the present study was to investigate the mechanism of GalN for prevention of spontaneous lethal hepatic injury in LEC rats. Male LEC rats were given a single subcutaneous injection of 300 mg/kg of GalN or vehicle (0.9% NaCl) at 14 weeks, and killed at 28 weeks of age. Next, 6-week-old male LEC rats were given weekly subcutaneous injections of 300 mg/kg of GalN or vehicle for 3 or 12 weeks, and their hepatic 8-hydroxydeoxy-2'-guanosine (8-OHdG), glutathione peroxidase (GPX), and catalase activities were measured. None of GalN-treated rats died of hepatic injury (0/12), whereas the mortality rate of control rats given 0.9% NaCl was 17% (2/12). GalN administration for 12 weeks decreased the hepatic 8-OHdG, and GalN administration for either 3 or 12 weeks increased the glutathione peroxidase activity. GalN administration increased the serum level of alanine aminotransferase, and accelerated megalocytic degeneration of the hepatocytes. GalN treatment is effective in preventing lethal hepatitis in LEC rats and decrease of oxidative DNA damage by GalN plays an important role in increase of the survival rate.

The Journal of Medical Investigation : JMI


Effect of Follistatin on Rat Liver Regeneration and Tumor Growth after Portal Occlusion

Although follistatin is known to be a positive regulator in liver regeneration after hepatectomy, the effects of follistatin on regeneration following portal occlusion and on tumor growth are not known. In experiment 1, rats were injected with follistatin immediately following 70% hepatic resection (HR), ligation of the left portal vein (PVL), or ligation of the left hepatic artery (HAL). Hepatic regenerative activity then was determined. In experiment 2, rats were injected intraportally with AH130 tumor cells. At 7 days after injection, the same procedures were carried out as in experiment 1. In a third experiment, in vitro, AH130 cells were cultured with various concentrations of activin A or follistatin, and cell proliferation was assessed. In experiment 1, follistatin did not accelerate liver regeneration after PVL. In experiment 2, follistatin significantly increased liver weight after HR, but did not accelerate tumor growth in any group. In vitro, neither follistatin nor activin affected proliferation of tumor cells. The mechanism of liver regeneration after PVL appears to differ from that after HR. Follistatin acts as a growth promoter for hepatocytes, but not for cancer cells.


Possible endocrine control by follistatin 315 during liver regeneration based on changes of activin receptor after partial hepatectomy in rat

Activin A is an autocrine inhibitor of cell growth in the liver. The biological activity of activin A is mediated by a heteromeric receptor complex. Follistatin (FS) binds to activin and inhibits its biological effects, and acts as a negative regulator of muscle cells. The role of activin receptors during liver regeneration following a hepatectomy has not been fully assessed. This study investigates the mechanism underlying how activin receptors regulate hepatocyte growth, and the effects of intravenous administration of FS during liver regeneration. The expression of both activins and activin receptors in the liver after a 70% partial hepatectomy (HT) was assessed by RT-PCR and immunohistochemistry. FS 315 or 288 was infused for different periods of time based on changes in hepatocyte activin receptor expression after HT. Activin receptor expression peaked between 48 and 72 hours after HT. 72 hours after HT, an injection of FS 315 resulted in a more potent stimulation of DNA synthesis and produced a greater increase in body weight compared with the control rats. The expression of activin receptors after peak DNA synthesis might be a key component in the downregulation of DNA synthesis. Intravenous administration of FS 315 might promote liver regeneration and have anabolic actions.


Efficacy of only left side approach in a case of unsuccessful reconstruction of the right hepatic artery after left hepatic lobectomy with caudal lobectomy


Tumor-stroma interaction of human pancreatic cancer: acquired resistance to anticancer drugs and proliferation regulation is dependent on extracellular matrix proteins

Pancreatic cancer is one of the major causes of cancer-related deaths in industrialized countries. It is known that pancreatic cancer is resistant to chemotherapy and that cancer cells are surrounded by extracellular matrix (ECM) proteins including collagen I, collagen IV, fibronectin, and laminin. To examine the role of ECM proteins in acquired resistance to anticancer drugs and proliferation regulation in pancreatic cancers. We used an in vitro model of ECM-induced chemoresistance and cell proliferation of cancer cell lines (MIA PaCa-2, PANC-1, and Capan-1) with 3 different malignancy grades and found that resistance to cytotoxic drugs and proliferation regulation was dependent on ECM proteins. Pancreatic cancer cell lines, especially MIA PaCa-2 cells, adhering to any of the ECM proteins showed decreased cytotoxicity of anticancer drugs, except for gemcitabine. PANC-1 and Capan-1 cells adhering to fibronectin, collagen I, and collagen IV proliferated more than the controls. ECM proteins have important roles in acquired resistance to anticancer drugs and cell proliferation regulation of pancreatic cancer cells. Therefore, the expression of ECM proteins in pancreatic cancer specimens could provide valuable information to aid anticancer drug cytotoxicity, and gemcitabine would be useful for treatment of patients with pancreatic cancer.


特集 手術器械の使い方:膵臓の剥離と切離法

特集 手術器械の使い方:膵臓の剥離と切離法


特集 肝胆膵領域におけるエビデンスは?:胆嚢癌に対する肝SIVa SV切除の意義


Arterial infusion chemotherapy for the patient of unresectable pancreatic carcinoma with liver metastasis: a case report

Despite various treatment trials for unresectable pancreatic carcinoma with liver metastases, the outcome has not been satisfactory. This paper reports a case of pancreatic carcinoma with multiple liver metastases that responded well to arterial infusion chemotherapy. A 65-year-old male was diagnosed with multiple liver tumors, and needle biopsy revealed adenocarcinoma. With endoscopic ultrasonography, a tumor in the pancreatic head was detected, and pancreatic carcinoma with multiple liver metastases was diagnosed. He received arterial infusion chemotherapy: cisplatin at a dose of 10 mg/body/day and 500 mg/body/day of 5-fluorouracil After 14 days administration, liver metastases had decreased in number and size, but thereafter, because of hepatic arterial occlusion, the same dose of drugs was administered intravenously. The patient was discharged from the hospital and was given chemotherapy 3 days a week on an outpatient basis. Although the chemotherapy was effective, it was stopped because of severe general fatigue 5 months after discharge. His general status continued to gradually worsen, and he died 12 months after diagnosis. Prognosis of pancreatic carcinoma with liver metastases is poor; however, transarterial infusion chemotherapy may be effective to improve the prognosis and quality of life of the patients.


Wedge resection of the adjacent liver as treatment for cancer of the gallbladder invading the subserosal layer --- 主として胆嚢床切除の立場から

胆嚢癌NOW:ss胆嚢癌の治療をどうする --- 主として胆嚢床切除の立場から


空腹時の血漿インスリン濃度は常に低値で，グルカゴンにより著明なインスリン分泌反応が誘導されたインスリノーマの1例


特集:術前・術後のサーベイランスプログラム 膵胆管合流異常

特集:術前・術後のサーベイランスプログラム 膵胆管合流異常


多臓器浸潤をきたした胃内分泌細胞癌の1例

多臓器浸潤をきたした胃内分泌細胞癌の1例


当科におけるStageIVb膵癌の治療成績

当科におけるStageIVb膵癌の治療成績


肝硬変患者に対する就寝前夜食(LES)療法の長期継続効果:エネルギー代謝および耐糖能異常の改善がみられた1症例


Central bisegmentectomy of the liver combined with caudate lobectomy for hilar cholangiocarcinoma

肝門部胆管癌に対する肝中央2区域+尾状葉切除


癌診療に役立つ最新データ:胆嚢癌の診断に関する最新のデータ

癌診療に役立つ最新データ:胆嚢癌の診断に関する最新のデータ


高度肥満による皮下埋め込み式CVポートの変位が原因となりカテーテル逸脱をきたした1例


膵管非癒合に合併した膵管内乳頭腫瘍の1切除例

膵管非癒合に合併した膵管内乳頭腫瘍の1切除例


膵体部非浸潤性膵管内乳頭癌に対し脾温存膵体尾部切除術を施行した1例

膵体部非浸潤性膵管内乳頭癌に対し脾温存膵体尾部切除術を施行した1例


膵頭部膵管内乳頭腫瘍に対し膵頭十二指腸第Ⅱ部切除術を行った1例

膵頭部膵管内乳頭腫瘍に対し膵頭十二指腸第Ⅱ部切除術を行った1例


左側胆嚢症に対し腹腔鏡下胆嚢摘出術を施行した3例の検討

左側胆嚢症に対し腹腔鏡下胆嚢摘出術を施行した3例の検討


急性胆嚢炎で発症し術前にDICとなった胆嚢腺扁平上皮癌の1例

急性胆嚢炎で発症し術前にDICとなった胆嚢腺扁平上皮癌の1例


肝切除のコツ 肝切離にsray suture は有効か

肝切除のコツ 肝切離にsray suture は有効か


Effect of intrahepatic omental implantation on angiogensis in rat liver with artery ligation

Despite early surgical intervention, the results of treating hepatic artery thrombosis remain poor. The use of omental flaps is well documented for its angiogenic potential in promoting neovascularization in ischemic tissues. This experimental study evaluated the formation of new blood-vessels after omental implantation (OI) in rats after ligation of the hepatic artery. Wistar rats were used and divided into the following groups: I OI with HAL, II OI without HAL, III hepatic artery ligation (HAL). For angiography, measurements were made of liver tissue blood flow by the laser Doppler method and of hepatic artery flow by the colored microsphere method (CMS), and immunohistochemical study was done for vascular endothelial growth factor (VEGF). The rats were killed at 1, 3, 7 or 30 days after laparotomy. Relative arterial hepatic blood flow in the implanted lobe of group I, as determined by CMS, reached 50% of control values 7 days after surgery. Angiography and microscopic studies of the excised liver revealed distinct angiogenesis surrounding the omental implant in the liver for 7 days postoperatively. The formation of new blood-vessels after OI was not observed in livers without HAL. Omental implantation appears to be useful in preventing organ anoxia after hepatic artery thrombosis.


最新の標準治療 胆嚢癌ー進行癌

最新の標準治療 胆嚢癌ー進行癌


結節浸潤型胆嚢癌との鑑別が困難であった黄色肉芽腫性胆嚢炎の1例

結節浸潤型胆嚢癌との鑑別が困難であった黄色肉芽腫性胆嚢炎の1例


Effects of alendronate on bone metastases and hypercarcemia after surgery for hepatocellular carcinoma

Alendronate, a bisphosphonate compound, lowers serum calcium in patients with cancer-associated hypercalcemia through its inhibitory effect on bone resorption and as a result symptoms associated with hypercalcemia improve. This study was carried out to investigate the effects of alendronate in patients with hypercalcemia due to bone metastasis of hepatocellular carcinoma (HCC). Two patients were evaluated. Their corrected serum calcium and alpha-fetoprotein (AFP) levels and their computed tomography (CT), bone scintigraphy and magnetic resonance imaging (MRI) findings were evaluated before and during alendronate treatment. After treatment, not only the corrected serum calcium levels but also AFP levels and bone pain decreased; in addition, the regression of the metastatic focus was noted in the MRI analysis. These tumor inhibitory effects of alendronate have not been reported in HCC before; and alendronate might serve to prevent bone metastases in patients with HCC. In conclusion, two patients who developed hypercalcemia associated with bone metastasis after surgery for HCC were treated with alendronate and they experienced alleviation of the pain due to bone metastasis, improvement of their quality of life and a marked decrease in AFP levels with tumor regression.


Hepatocelluar carcinoma with extension into the right atrium: report of a successful liver resection by hepatic vascular exclusion using cardiopulmonary bypass,

We report a successful liver resection using cardiopulmonary bypass with, total hepatic vascular exclusion (THVE) for hepatocellular carcinoma (HCC), with extension into the right atrium. A 61-year-old man with a cirrhotic liver was referred to our department with HCC in the medial segment of the left lobe of the liver, and tumor thrombus extending into the right atrium. During surgery, a left lobe and caudate lobe of the liver were transected leaving the left lobe of the liver connected to the inferior vena cava (IVC) by only the left and middle hepatic trunks, and then the intracaval tumor thrombus and the left lobe of the liver were removed en bloc using cardiopulmonary bypass with total hepatic vascular exclusion (THVE). Cardiac arrest was not performed during THVE, and the patient had an uneventful postoperative course and was discharged from the hospital 2 months following surgery. He died of multiple pulmonary metastases 4 years and 8 months after surgery; however, imaging showed no evidence of recurrence in the remnant liver during that period. In conclusion, by performing dissection of the hepatic parenchyma to the hepatic vein prior to removal of the tumor thrombus, the period of extracorporeal circulation, duration of warm ischemic time to the liver, and intraoperative blood loss were all reduced and a radical operation could be performed safely without scattering tumor cells during extirpation of the tumor.

The Journal of Medical Investigation : JMI


Expression of somatostatin receptor subtypes and growth inhibition in human exocrine pancreatic cancers.

The antiproliferative effects of somatostatin and its analogs on human pancreatic cancers were studied: (1) by evaluating the gene expression of somatostatin receptor (sstr) subtypes in human pancreatic cancer cell lines and cancer tissue specimens, (2) by evaluating the antiproliferative effects of somatostatin analogs, and (3) by evaluating the effect of sstr-2 cDNA transduction. Using a reverse transcriptase polymerase chain reaction (RT-PCR), the gene expression of five sstr subtypes (sstr-1 to -5) was examined in eight cell lines, and in ten pancreatic cancer tissues and in the normal surrounding pancreatic tissues. The antiproliferative effects of somatostatin (SS) -14 and its two analogs (SMS 201-995, RC-160) were examined by means of an MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (thiazolyl blue)) assay on three cell lines and Panc-1 transfectants with human sstr (hsstr)-2A cDNA. Sstr-2 was expressed in all samples tested. All examined cell lines simultaneously expressed sstr-2 and -5, while most of the examined pancreatic cancer tissues did not express both of these subtypes simultaneously. Somatostatin analogs inhibited epidermal growth factor (EGF)-stimulated pancreatic cancer cell proliferation. The cell proliferation was further and significantly inhibited by 14% in stable transfectants of Panc-1 cells with hsstr-2A. Based on these findings, it is concluded that somatostatin analogs with their antiproliferative effects mediated by sstr-2 could be potentially useful in the treatment of pancreatic cancers.

Journal of Hepato-Biliary-Pancreatic Surgery


Daily pattern of energy metabolism in cirrhosis.

The daily pattern of energy expenditure and the oxidation rates of carbohydrates, fats, and protein were evaluated by indirect calorimetry in 18 control subjects (Group 1) and 34 cirrhotic patients who were divided into Groups 2a and 2b showing indocyanin green retention rates at 15 min of <30% and 30% or more, respectively. The ratio of resting energy expenditure to basal energy expenditure (%REE) was higher in the cirrhotic patients than in the controls at 8:30 AM and 2:30 PM. The oxidation rates of carbohydrates and fats under fasting conditions in Group 2b patients were respectively lower, and higher than in Group 1 and 2a patients. After the subjects ate, glucose became the substrate preferentially metabolized, and the proportion of fat metabolized was reduced from 82.9+/-5.1% to 43.9+/-21.9% and from 70.7+/-14.1% to 46.8+/-13.9% in the patients with advanced and less advanced cirrhosis, respectively, and from 59.4+/-27.2% to 48.4+/-18.5% in the controls. The fasting concentrations of non-esterified fatty acids in Group 2b were also significantly higher than those in the Group 1 and Group 2a patients. After eating, these concentrations fell and reached similar levels in the patients and controls. These data indicated that the patients with cirrhosis developed the catabolic state of starvation in the morning because of a lack of glycogen stores. Therefore, frequent meal supplementation to prevent early-onset starvation and energy deficiency may be advisable in such patients to maintain a well-nourished condition.


Gastric function after pylorus-preserving duodenectomy in dogs

The purpose of this study was to delineate the alterations in gastric physiology after pylorus-preserving duodenectomy (PPD). The duodenum was transected 2 cm distal to the pyloric ring in five dogs. A patch graft around the papilla of Vater was preserved. Reconstruction was completed using an end-to-end duodenojejunostomy, anastomosis of the patch graft to the jejunum, and cholecystojejunostomy, in that order. Gastric acid analysis, serum gastrin and secretin concentrations, and gastric emptying were investigated before and one and three months after surgery. The postoperative mean basal and maximal acid outputs were not significantly increased. Fasting serum gastrin concentrations remained unchanged. The fasting serum secretin concentrations one month after surgery increased significantly as compared to the controls. There were no significant differences in meal-stimulated gastrin or secretin responses or gastric emptying after surgery. The acid output and gut hormone release after PPD were maintained at preoperative levels. Preservation of the duodenal bulb is postulated to be responsible for the maintenance of near-normal gastric physiology.


Effects of tacrolimus (FK506) on induction of glutathione S-transferase P-positive foci and liver cell regeneration after partial hepatectomy in F344 rats


下大静脈内腫瘍栓を伴う悪性腫瘍の外科治療

下大静脈内腫瘍栓を伴う悪性腫瘍の外科治療


下大動脈内腫瘍栓を伴う悪性腫瘍の外科治療

下大動脈内腫瘍栓を伴う悪性腫瘍の外科治療


悪性腫瘍による下大静脈症候群の検査，診断，治療方針，治療，予後

悪性腫瘍による下大静脈症候群の検査，診断，治療方針，治療，予後

静脈およびリンパ管疾患と外科

静脈およびリンパ管疾患と外科


Detection of Different Quasispecies of Hepatitis C Virus Core Region in Cancerous and Non-cancerous Regions.

Biochemical and Biophysical Research Communications


下大静脈・右心房への腫瘍栓を伴う肝細胞癌の手術

下大静脈・右心房への腫瘍栓を伴う肝細胞癌の手術


尾側膵切除における断端処理のピットフォール

尾側膵切除における断端処理のピットフォール


Surveillance and the Approach for the Proper Use of Antibiotics at Tokushima University Hospital

徳島大学医学部附属病院における抗菌薬適正使用の取り組みと使用状況

The working committee for the proper use of antibiotics was organized at Tokushima University Hospital in March 2002, and the institutional guidelines for the selection and use of antibiotics were established. The infection control team (ICT) also started monitoring the use of particular antibiotics, including third- and fourthgeneration cephalosporins, calbapenems and anti-MRSA antibiotics, and reported on their use in August 2002. To assess these activities, we examined the status of antibiotic use for injections and compared our findings with the previous data. The results were as follows : 1) the reports required were presented in 47% of the total antibiotics used ; 2) after starting the surveillance, the use of the third- and fourth-generation cephalosporins and calbapenems shifted to the first- and second-generation drugs, while the use of anti-MRSA drugs clearly decreased ; 3) these changes resulted in a savings of more than two million yen in medical expenditures in a month. These results suggest that closely monitoring the use of antibiotics may thus be beneficial not only for promoting the proper use of antibiotics but also for reducing overall medical costs.

Japanese Journal of Pharmaceutical Health Care and Sciences