246 results on '"Koji Okuda"'
Search Results
2. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report
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Yoriko Nomura, Hisamune Sakai, Jun Akiba, Toru Hisaka, Toshihiro Sato, Yuichi Goto, Masanori Akashi, Shogo Fukutomi, Daisuke Muroya, Hiroki Kanno, Shusuke Okamura, Yuta Yano, Hirohisa Yano, Yoshito Akagi, and Koji Okuda
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Falciform ligament ,Hematogenous metastases ,Intrahepatic cholangiocarcinoma ,Liver ,Segment IV ,Surgery ,RD1-811 - Abstract
Abstract Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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- 2021
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3. Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma
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Hiroki Kanno, Toshihiro Sato, Ryuta Midorikawa, Satoki Kojima, Shogo Fukutomi, Yuichi Goto, Yoriko Nomura, Munehiro Yoshitomi, Ryuichi Kawahara, Hisamune Sakai, Toru Hisaka, Yoshito Akagi, and Koji Okuda
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epithelioid hemangioendothelioma ,hepatocellular carcinoma ,liver ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.
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- 2021
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4. Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report
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Hiroki Kanno, Yusuke Hirakawa, Masafumi Yasunaga, Ryuta Midorikawa, Shinichi Taniwaki, Yoshihiro Uchino, Shin Sasaki, Satoki Kojima, Yoriko Nomura, Goichi Nakayama, Yuichi Goto, Toshihiro Sato, Ryuichi Kawahara, Hisamune Sakai, Hiroto Ishikawa, Toru Hisaka, and Koji Okuda
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Penetrating pancreatic trauma ,Duct injury ,Nonoperative management ,Medicine - Abstract
Abstract Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.
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- 2021
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5. Central hepatopancreatoduodenectomy—oncological effectiveness and parenchymal sparing option for diffusely spreading bile duct cancer: report of two cases
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Kapil Nagaraj, Yuichi Goto, Satoki Kojima, Hisamune Sakai, Toru Hisaka, Yoshito Akagi, and Koji Okuda
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Hepatopancreatoduodenectomy ,Diffusely spreading bile duct cancer ,Central liver resection ,Liver parenchymal sparing ,Case report ,Surgery ,RD1-811 - Abstract
Abstract Background Hepatopancreatoduodenectomy (HPD) for diffusely spreading bile duct cancer (DSBDC) usually involves a major hepatectomy and a concomitant pancreatoduodenectomy, and is still challenging surgery because of postoperative liver failure. The present case report demonstrated two cases of DSBDC where we could achieve successful HPD with central liver resection (CHPD) as liver parenchymal sparing surgery. Case presentation In Case 1, endoscopic retrograde cholangiography (ERC) with multiple biopsies revealed that she had DSBDC with Bismuth-Corlette type IIIA. 3D integrated images reconstructed by contrast enhanced CT and CT with drip infusion cholecystocholangiography data revealed the right antero-ventral bile duct (RAVD) confluent to the right hepatic duct and the right antero-dorsal bile duct (RADD) independently confluent to the right posterior bile duct (RPD). Tumor extended common bile duct including intrapancreatic bile duct to the left hepatic duct and RAVD, but the RADD and RPD were spared. Because the future liver remnant (FLR) was assumed not to achieve desirable volume by preoperative portal vein embolization for left or right trisegmentectomy, CHPD including resection of the segments IV and I, and the right antero-ventral segment was done and achieved R0. This procedure is tailored to the anatomical extent of disease in the context of variable biliary anatomy as a modified CHPD, and to our knowledge, this is the first reported case of modified CHPD with antero-dorsal segment preservation. In Case 2, preoperative imaging revealed DSBDC with Bismuth Corlette type IIIA. FLR volume was assumed insufficient for major hepatectomy, CHPD including resection of the segments IV and I, and the right anterior sector was done with R0. The remnant liver volumes of these cases were spared by 55.1% and 25% respectively, and postoperative course was uneventful in both. Conclusion CHPD should be considered a valid option for well-selected cases of DSBDC. This is the first case report of modified CHPD with antero-dorsal segment preservation.
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- 2021
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6. A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
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Hiroki Kanno, Hisamune Sakai, Toru Hisaka, Satoki Kojima, Ryuta Midorikawa, Shogo Fukutomi, Yoriko Nomura, Yuichi Goto, Toshihiro Sato, Munehiro Yoshitomi, Ryuichi Kawahara, and Koji Okuda
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Reactive lymphoid hyperplasia ,Liver ,Autoimmune hepatitis ,Surgery ,RD1-811 - Abstract
Abstract Background Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically. Case presentation A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver. Conclusions The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered.
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- 2020
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7. Intrabiliary growth type of metastasis from colon cancer, 12 years after curative colectomy: a case report
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Shin Sasaki, Yoriko Nomura, Shogo Fukutomi, Nobuhisa Shirahama, Hironori Kusano, Jun Akiba, Hisamune Sakai, Toru Hisaka, Osamu Nakashima, Hirohisa Yano, Yoshito Akagi, Hiroyuki Tanaka, and Koji Okuda
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Intrabiliary growth type of metastasis ,IGM ,Metastasis ,Colorectal cancer ,Hepatectomy ,Liver ,Surgery ,RD1-811 - Abstract
Abstract Background Liver is a common location of colorectal metastasis, but intrabiliary growth of liver metastasis is not well recognized. Furthermore, intrabiliary metastasis that discovered over 10 years after excision has rarely been described. Case presentation An 80-year-old man was admitted due to the presence of a liver mass in segment 5 (S5) concomitant with elevated carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19–9. He underwent right hemicolectomy for colon cancer 12 years prior. Enhanced computed tomography (CT) showed dilated bile ducts with periductal enhancement in S5; hence, cholangiocarcinoma was suspected. Upon anterior segmentectomy, we observed that the cut surface of the specimen exhibited a yellowish-white tumor within the bile ducts. Histologically, the tumor formed within the papillary process, extended along the lumen, and replaced the normal bile duct epithelium. Immunohistochemical studies showed that the liver tumor and primary colon cancer were negative for cytokeratin (CK) 7 and positive for CK20 and Caudal-type homeobox transcription factor 2 (CDX-2). In addition, both tumors showed a same KRAS mutation. We diagnosed the liver tumor as liver metastasis recurrence from colon cancer. Conclusion Intrabiliary growth type of metastasis (IGM) is difficult to distinguish from cholangiocarcinoma, and sometimes develops long after surgery; thus, careful examination of a patient’s history is needed in such cases.
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- 2019
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8. Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall
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Yuichi Goto, Satoki Kojima, Yoriko Nomura, Daisuke Muroya, Syoichiro Arai, Hisamune Sakai, Ryuichi Kawahara, Toru Hisaka, Yoshito Akagi, Hiroyuki Tanaka, and Koji Okuda
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Hepatic artery ,Stenosis ,Atherosclerosis ,Hilar cholangiocarcinoma ,Pyogenic liver abscess ,Surgery ,RD1-811 - Abstract
Abstract Background We experienced a rare case of benign arterial stricture of the right posterior hepatic artery (RPHA) caused by atherosclerosis in a patient with hilar cholangiocarcinoma. Case presentation A 75-year-old man was referred to our hospital for the detailed investigation of serum hepatobiliary enzyme elevation. The patient had a history of hypertension, type 2 diabetes mellitus, and an operative history of coronary artery bypass grafting 10 years before. Endoscopic retrograde cholangiography found strictures of the right and left hepatic ducts with involvement of right anterior and posterior bile ducts. Adenocarcinoma was evident by brush cytology. We diagnosed these findings as hilar cholangiocarcinoma and planned left trisectionectomy including bile duct reconstruction. Although the tumor and RPHA were not adjacent, preoperative multidetector computed tomography revealed a stricture of the RPHA that was 5.6 mm in length. We suspected that atherosclerosis caused the stricture, and we performed digital subtraction angiography and intravascular ultrasonography that showed stricture of the RPHA accompanied by thick plaques in the arterial wall. We placed a bare-metal stent in the RPHA and then performed left trisectionectomy. Since this patient developed bile leakage postoperatively, percutaneous drainage was performed. The bile leakage was successfully controlled, and the patient was discharged 3 months after surgery. Unfortunately, 4 months after hepatectomy, he was re-hospitalized with multiple pyogenic liver abscesses. We performed intensive multimodal treatment for the liver abscesses and stabilized the disease; however, we eventually lost this patient due to liver failure 14 months after surgery. Conclusion To the best of our knowledge, there is no previous literature on atherosclerosis of the RPHA, which was evident preoperatively in our case. Because arterial complications may lead to critical biliary complications in patients who undergo left trisectionectomy, we first performed prophylactic arterial stent placement. We speculate that existing chronic microscopic injury of the peribiliary plexus might have caused the liver abscesses. We successfully diagnosed atherosclerosis of the RPHA preoperatively. However, further investigation of patients is warranted to determine if left trisectionectomy is contraindicated in these patients.
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- 2018
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9. Perioperative challenges and surgical treatment of large simple, and infectious liver cyst - a 12-year experience.
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Yuichiro Maruyama, Koji Okuda, Toshiro Ogata, Masafumi Yasunaga, Hiroto Ishikawa, Yusuke Hirakawa, Kenjiro Fukuyo, Hiroyuki Horiuchi, Osamu Nakashima, and Hisafumi Kinoshita
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Medicine ,Science - Abstract
BACKGROUND: Cystic lesions of the liver consist of a heterogeneous group of disorders that can present diagnostic and therapeutic challenges. METHODS: A retrospective review of all medical records of adult patients diagnosed with large (>7 cm) cystic lesions of the liver between January 2000 and December 2011, at Kurume University Hospital. Cases with polycystic disease were excluded. RESULTS: Twenty three patients were identified. The mean size was 13.9 cm (range, 7-22cm). The majority of simple cysts were found in women (females: males, 2: 21). In 19 patients, the cyst was removed surgically by wide deroofing (laparoscopically in 16 cases, combined with ethanol sclerotherapy in 13 cases). Infection of the liver cyst occurred in one patient, who later underwent central bi-segmentectomy. CONCLUSION: Simple large cysts of the liver can be successfully treated by laparoscopic deroofing and alcohol sclerotherapy. Large hepatic cyst considered to need drainage should be removed surgically to avoid possible infection.
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- 2013
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10. Quantification of hepatic iron concentration in chronic viral hepatitis: usefulness of T2-weighted single-shot spin-echo echo-planar MR imaging.
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Tatsuyuki Tonan, Kiminori Fujimoto, Aliya Qayyum, Takumi Kawaguchi, Atsushi Kawaguchi, Osamu Nakashima, Koji Okuda, Naofumi Hayabuchi, and Michio Sata
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Medicine ,Science - Abstract
OBJECTIVE: To investigate the usefulness of single-shot spin-echo echo-planar imaging (SSEPI) sequence for quantifying mild degree of hepatic iron stores in patients with viral hepatitis. METHODS: This retrospective study included 34 patients with chronic viral hepatitis/cirrhosis who had undergone histological investigation and magnetic resonance imaging with T2-weighted gradient-recalled echo sequence (T2-GRE) and diffusion-weighted SSEPI sequence with b-factors of 0 s/mm(2) (T2-EPI), 500 s/mm(2) (DW-EPI-500), and 1000 s/mm(2) (DW-EPI-1000). The correlation between the liver-to-muscle signal intensity ratio, which was generated by regions of interest placed in the liver and paraspinous muscles of each sequence image, and the hepatic iron concentration (µmol/g dry liver), which was assessed by spectrophotometry, was analyzed by linear regression using a spline model. Akaike information criterion (AIC) was used to select the optimal model. RESULTS: Mean ± standard deviation of the hepatic iron concentration quantified by spectrophotometry was 24.6 ± 16.4 (range, 5.5 to 83.2) µmol/g dry liver. DW-EPI correlated more closely with hepatic iron concentration than T2-GRE (R square values: 0.75 for T2-EPI, 0.69 for DW-EPI-500, 0.62 for DW-EPI-1000, and 0.61 for T2-GRE, respectively, all P
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- 2012
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11. Correction: Quantification of Hepatic Iron Concentration in Chronic Viral Hepatitis: Usefulness of T2-weighted Single-Shot Spin-Echo Echo-Planar MR Imaging.
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Tatsuyuki Tonan, Kiminori Fujimoto, Aliya Qayyum, Takumi Kawaguchi, Atsushi Kawaguchi, Osamu Nakashima, Koji Okuda, Naofumi Hayabuchi, and Michio Sata
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Medicine ,Science - Published
- 2012
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12. Linear irreversible heat engines based on local equilibrium assumptions
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Yuki Izumida and Koji Okuda
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linear irreversible thermodynamics ,local equilibrium assumptions ,finite-time Carnot cycle ,efficiency at maximum power ,Science ,Physics ,QC1-999 - Abstract
We formulate an endoreversible finite-time Carnot cycle model based on the assumptions of local equilibrium and constant energy flux, where the efficiency and the power are expressed in terms of the thermodynamic variables of the working substance. By analyzing the entropy production rate caused by the heat transfer in each isothermal process during the cycle, and using the endoreversible condition applied to the linear response regime, we identify the thermodynamic flux and force of the present system and obtain a linear relation that connects them. We calculate the efficiency at maximum power in the linear response regime by using the linear relation, which agrees with the Curzon–Ahlborn (CA) efficiency known as the upper bound in this regime. This reason is also elucidated by rewriting our model into the form of the Onsager relations, where our model turns out to satisfy the tight-coupling condition leading to the CA efficiency.
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- 2015
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13. Exploring Visual Augmentations for Improving the Operation of a Hydraulic Excavator using Expert Operation Replay.
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Mai Otsuki, Ryosuke Ichikari, Junji Ohyama, Hiroshi Watanabe 0004, Hiroshi Endo, Nobumasa Takamatsu, Koji Okuda, and Yukinori Matsumura
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- 2023
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14. Perception of Vestibular Sensation During Turning Operation of Construction Machine.
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Koji Okuda, Youjirou Ohbatake, and Daisuke Kondo
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- 2021
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15. Hematogenous Dissemination of Tumor Cells in Hepatocellular Carcinoma: Comparing Anterior and Non-anterior Approach Hepatectomy
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Shin, Sasaki, Yoriko, Nomura, Tomoya, Sudo, Hisamune, Sakai, Toru, Hisaka, Jun, Akiba, Osamu, Nakashima, Hirohisa, Yano, Masayoshi, Kage, Yoshito, Akagi, and Koji, Okuda
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Cancer Research ,Carcinoma, Hepatocellular ,Oncology ,Liver Neoplasms ,Hepatectomy ,Humans ,General Medicine ,Epithelial Cell Adhesion Molecule ,Neoplastic Cells, Circulating - Abstract
Studies have indicated that liver mobilization during hepatectomy could cause the dissemination of tumor cells. However, the data are still limited in terms of the relationship between circulating tumor cells (CTCs) and surgical procedures.Fifteen patients who underwent hepatectomy for primary hepatocellular carcinoma (HCC) were included in the study. Blood samples were collected from the portal vein, central vein, and peripheral artery at three time points, namely, before mobilization (BM) of the liver, during transection (DT) of parenchyma, and after resection (AR) of the tumor. To detect CTCs, a real-time PCR assay was performed using primers for the epithelial cell adhesion molecule, cytokeratin 18, and glypican 3. Patients were divided into anterior approach (AA) and non-AA (NA) groups. In the AA group, patients underwent an initial hilar vascular dissection followed by a liver hanging maneuver during transection.Seven patients were allocated to the AA group, and eight to the NA group. In the NA group, CTC levels in the portal vein were significantly increased at DT and AR compared to BM. In cases with large HCC (70 mm), CTC levels in central venous blood were significantly increased at DT and AR in the NA group.The AA liver resection technique may minimize CTC dissemination, improving the prognosis of patients with HCC.
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- 2022
16. Liberal Application of Portal Vein Embolization for Right Hepatectomy Against Hepatocellular Carcinoma: Strategy to Achieve Zero Mortality for a Damaged Liver
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Nobuhisa, Shirahama, Yuichi, Goto, Hisamune, Sakai, Shogo, Fukutomi, Masanori, Akashi, Toshihiro, Sato, Yoshito, Akagi, Koji, Okuda, and Toru, Hisaka
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Cancer Research ,Carcinoma, Hepatocellular ,Portal Vein ,Liver Neoplasms ,General Medicine ,Embolization, Therapeutic ,Postoperative Complications ,Treatment Outcome ,Oncology ,Preoperative Care ,Hepatectomy ,Humans ,Liver Failure ,Retrospective Studies - Abstract
Right hepatectomy and extended right hepatectomy (Rt-Hr) are identified as risk factors for the development of post-hepatectomy liver failure (PHLF). Although portal vein embolization (PVE) has made it possible to safely perform extended hepatectomy, to ensure safety, in our department, PVE is performed prior to Rt-Hr for hepatocellular carcinoma (HCC) regardless of the resection rate. This study aimed to retrospectively investigate the clinical course of PVE prior to Rt-Hr for HCC cases resected in our department and the appropriateness of our policy by clarifying complications and deaths.The target period was from 2005 to 2020. Among the HCC cases resected at our hospital, those in which PVE was performed prior to Rt-Hr were included in this study. For PHLF, the definition of the International Study Group of Liver Surgery was used. The Clavien-Dindo classification was used for postoperative complications. Perioperative mortality was defined as the overall mortality within 30 days following surgery and surgery-related deaths within 90 days following surgery.A total of 79 cases were included. Rt-Hr was possible in all cases after PVE and there were no cases in which serious complications occurred after PVE. PHLF was found in 14 cases (17.7%)/5 cases (6.4%)/0 cases (0%) of Grade A/B/C, respectively. Regarding postoperative complications, there were no Grade IV, and Grade IIIa/IIIb were found in 13 cases (16.5%). There were no perioperative deaths.Our department's policy of performing PVE prior to all Rt-Hr was considered to be a safe and reasonable treatment strategy.
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- 2022
17. Prognostic Factors for Distal Bile Duct Carcinoma After Surgery
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RYUICHI KAWAHARA, RYUUTA MIDORIKAWA, SHINICHI TANIWAKI, SATOKI KOJIMA, HIROKI KANNO, MUNEHIRO YOSHITOMI, YORIKO NOMURA, YUICHI GOTO, TOSHIHIRO SATOU, HISAMUNE SAKAI, HIROTO ISHIKAWA, TORU HISAKA, MASAFUMI YASUNAGA, TAKAHIKO SAKAUE, TOMOYUKI USHIJIMA, MAKIKO YASUMOTO, YOSHINOBU OKABE, MASAHIKO TANIGAWA, YOSHIKI NAITOU, HIROHISA YANO, and KOJI OKUDA
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General Medicine - Published
- 2023
18. On the Studies of the Disaster Recovery and the Business Continuity Planning for Private Sector Caused by Great East Japan Earthquake.
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Koji Okuda, Masakazu Ohashi, and Mayumi Hori
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- 2011
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19. Perception of Vestibular Sensation During Turning Operation of Construction Machine
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Youjirou Ohbatake, Daisuke Kondo, and Koji Okuda
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Vestibular system ,0209 industrial biotechnology ,medicine.medical_specialty ,General Computer Science ,Computer science ,media_common.quotation_subject ,02 engineering and technology ,Audiology ,020901 industrial engineering & automation ,Perception ,Sensation ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,020201 artificial intelligence & image processing ,Electrical and Electronic Engineering ,media_common - Abstract
A major challenge in remote control is the reduction in work efficiency compared with on-board operation. The factors of reduction in work efficiency include a lack of information (information such as perspective, realistic sensation, vibration, and sound) compared to on-board operations. One of the factors is the lack of vestibular/somatosensory information regarding rotation. To clarify the effect of the presence of input of vestibular/somatosensory information regarding rotation on the worker’s operation, we conducted a basic laboratory experiment of a horizontal turning operation. The experimental results indicate that a response appropriate for the input of information regarding rotation can be made only with visual information; however, the reaction is delayed in the case without the input of information regarding rotation in comparison with a case with the input of information regarding rotation.
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- 2021
20. Salvage PTBD With Chemotherapy Improves Survival in Patients With Unresectable Malignant Biliary Obstruction - A Single Center Retrospective Study
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DAISUKE MUROYA, HIROTOSHI TSURU, HISAAKI SHIMOKOBE, YUICHI NAGAO, YASUNORI YOSHIMOTO, YOSHITO WADA, KOUJI HAYASHI, SATOSHI TANIWAKI, RYUTA MIDORIKAWA, SHINICHI TANIWAKI, SATOKI KOJIMA, SHOICHIRO ARAI, TAKAHISA SHIRAHAMA, YUICHI GOTO, HISAMUNE SAKAI, MUNEHIRO YOSHITOMI, TORU HISAKA, YOSHITO AKAGI, and KOJI OKUDA
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Male ,Cancer Research ,Fluorocarbons ,Cholestasis ,Dioxolanes ,General Medicine ,Treatment Outcome ,Oncology ,Neoplasms ,Drainage ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Malignant biliary obstruction (MBO) is a life-threatening condition. We aimed to investigate the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in patients with unresectable MBO due to failure of management by endoscopic retrograde cholangiopancreatography (ERCP) and/or prior surgical bypass.Fifty-two consecutive patients (mean age, 69 years; 44.2% women) underwent salvage PTBD between 2013 and 2020.The median overall survival rate was 4.2 months, with a 95% confidence interval (CI) of 1.9-5.7. The median overall survival (OS) were 11.1 months and 1.9 months for patients who underwent chemotherapy (n=17) and best supportive care (n=35), respectively (p=0.0005). Independent factors predicting poor outcome were best supportive care, with a hazard ratio (HR) of 3.3 (95%CI=1.3-8.5), American Society of Anesthesiologists physical status classification (ASA) with a HR of 13.5 (95%CI=1.3-136.0) and Eastern Cooperative Oncology Group (ECOG) performance status of 4, with a HR of 3.3 (95%CI=1.0-6.2).Salvage PTBD with chemotherapy has the potential to achieve prolonged survival in patients with unresectable MBO, including those with failure of ERCP and/or surgical bypass.
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- 2022
21. Impact of Interferon on the Prognosis of Hepatitis C Virus-Related Hepatocellular Carcinoma Patients with a Sustained Virological Response –An Additional Comparison Between Preoperative and Postoperative Sustained Virological Response
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DAISUKE MUROYA, TARO NISHIMURA, HIROKI KANNO, SATOKI KOJIMA, SHOGO FUKUTOMI, MASANORI AKASHI, YORIKO NOMURA, YUICHI GOTO, TOSHIHIRO SATO, HISAMUNE SAKAI, TORU HISAKA, YOSHITO AKAGI, and KOJI OKUDA
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General Medicine - Published
- 2021
22. The Expression of PEDF and its Putative Receptors in Hepatocellular Carcinoma and Background Liver Tissue
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Kazuya Murata, Sho-ichi Yamagishi, Osamu Nakashima, Hironori Kusano, Eiji Sadashima, Takanori Matsui, Hirohisa Yano, Yoshiki Naito, Yoshinao Kinjou, Jun Akiba, Takafumi Yoshida, Koji Okuda, Shinji Mizuochi, Toru Hisaka, Yutaro Mihara, and Hisamune Sakai
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Male ,Receptors, Neuropeptide ,Cancer Research ,Carcinoma, Hepatocellular ,Receptors, Laminin ,PEDF ,Liver tissue ,Humans ,Medicine ,Neoplasm Invasiveness ,Nerve Growth Factors ,Eye Proteins ,Receptor ,Serpins ,Serum Albumin ,chemistry.chemical_classification ,business.industry ,Liver Neoplasms ,Lipase ,General Medicine ,HCCS ,Prognosis ,medicine.disease ,Immunohistochemistry ,digestive system diseases ,Liver ,Oncology ,chemistry ,Hepatocellular carcinoma ,Adipose triglyceride lipase ,Cancer research ,Female ,business ,Glycoprotein - Abstract
Background/aim Hepatocellular carcinoma (HCC) remains one of the biggest medical issues. Pigment epithelial-derived factor (PEDF) is a glycoprotein that belongs to the superfamily of serine protease inhibitors. PEDF interacts with its two receptors, adipose triglyceride lipase (ATGL) and laminin receptor (LR). Materials and methods We conducted immunohistochemical staining for PEDF, LR and ATGL in 151 resected HCCs and their background liver tissues. Results High expression of LR in HCC was associated with high histological grade and portal vein invasion, while high expression of PEDF in HCC was associated with absence of portal vein invasion. High LR expression in background liver was statistically associated with low serum albumin levels and was an independent prognostic factor of worse outcomes. No cases with more than 5% fatty degeneration in the background liver tissue showed high PEDF expression. Conclusion PEDF/LR/ATGL could be potential biomarkers in HCC and various chronic hepatic disorders.
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- 2021
23. Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma
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Munehiro Yoshitomi, Yoriko Nomura, Toru Hisaka, Yuichi Goto, Hiroki Kanno, Hisamune Sakai, Ryuichi Kawahara, Toshihiro Sato, Ryuta Midorikawa, Koji Okuda, Satoki Kojima, Yoshito Akagi, and Shogo Fukutomi
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CD31 ,Pathology ,medicine.medical_specialty ,Hepatocellular carcinoma ,Single Case ,CD34 ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Epithelioid hemangioendothelioma ,lcsh:RC799-869 ,Halo sign ,Tumor marker ,business.industry ,Gastroenterology ,medicine.disease ,Liver ,030220 oncology & carcinogenesis ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Epithelioid cell ,Calcification - Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.
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- 2021
24. Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report
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Yoshihiro Uchino, Hisamune Sakai, Ryuichi Kawahara, Shin Sasaki, Hiroki Kanno, Koji Okuda, Ryuta Midorikawa, Toshihiro Sato, Masafumi Yasunaga, Yusuke Hirakawa, Satoki Kojima, Goichi Nakayama, Shinichi Taniwaki, Yuichi Goto, Yoriko Nomura, Toru Hisaka, and Hiroto Ishikawa
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Male ,medicine.medical_specialty ,Percutaneous ,Nonoperative management ,Thoracic Injuries ,lcsh:Medicine ,Case Report ,Abdominal Injuries ,Wounds, Nonpenetrating ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine ,Humans ,Stab wound ,Pancreas ,Retrospective Studies ,Pancreatic duct ,medicine.diagnostic_test ,business.industry ,lcsh:R ,Pancreatic Ducts ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Contrast medium ,medicine.anatomical_structure ,Angiography ,Duct injury ,Drainage ,Pancreatic injury ,business ,030217 neurology & neurosurgery ,Penetrating pancreatic trauma - Abstract
Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.
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- 2021
25. Synthesizable HDL generation method for configurable VLIW processors.
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Yuki Kobayashi, Shinsuke Kobayashi, Koji Okuda, Keishi Sakanushi, Yoshinori Takeuchi, and Masaharu Imai
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- 2004
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26. Spontaneous regression of lung metastases in hepatocellular carcinoma: A case report
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Daisuke Muroya, Toru Hisaka, Yoshito Akagi, Toshihiro Sato, Hisamune Sakai, and Koji Okuda
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medicine.medical_specialty ,Hepatocellular carcinoma ,medicine.medical_treatment ,Case Report ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Dialysis ,Spontaneous regression ,Lung ,business.industry ,Cancer ,Hepatitis C ,Hypoxia (medical) ,medicine.disease ,digestive system diseases ,Lung metastasis ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Hemodialysis ,medicine.symptom ,business ,Kidney disease - Abstract
Highlights • The prognosis of patients with advanced HCC remains poor even if appropriate treatments are administered. • Spontaneous regression of lung metastases of hepatocellular is a rare condition. • We discuss the mechanism for spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma., Introduction Spontaneous regression of hepatocellular carcinoma (HCC) is a rare condition. However, although there have been multiple reports of spontaneous regression, the definitive pathogenic mechanism of this phenomenon is still unclear. Case presentation We encountered a case of a 78-year-old man who was undergoing dialysis for end-stage kidney disease with hepatitis C virus-associated chronic hepatitis presenting with HCC. The patient had previously undergone right lobectomy of the liver, but the cancer recurred with multiple lung metastases after 5 months. Approximately 13 months after the initial diagnosis of recurrence, the lung metastases decreased in size and eventually resolved without any anticancer therapy. The patient remains alive for over 41 months after recurrence. Discussion Based on our case and literature, Hypoxia with hypotension due to hemodialysis can reduce the blood and oxygen supply of the body, which may lead to the spontaneous regression of the metastatic tumors. Conclusion We herein reported a case of spontaneous regression of HCC undergoing dialysis.
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- 2021
27. Salvage Surgery for Initially Unresectable Locally Advanced Hepatocellular Carcinoma Downstaged by Hepatic Arterial Infusion Chemotherapy
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Koji Okuda, Hisamune Sakai, Toru Hisaka, Yoshito Akagi, Katsuaki Takagi, Yuichi Goto, and Shogo Fukutomi
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Male ,Cancer Research ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Locally advanced ,Disease-Free Survival ,Vascular invasion ,Antineoplastic Combined Chemotherapy Protocols ,Hepatic arterial infusion chemotherapy ,Overall survival ,Hepatectomy ,Humans ,Infusions, Intra-Arterial ,Medicine ,Aged ,Salvage Therapy ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,Oncology ,Hepatocellular carcinoma ,Female ,Salvage surgery ,Fluorouracil ,Cisplatin ,business - Abstract
BACKGROUND/AIM Recent studies have demonstrated the efficacy of salvage surgery following downstaging of hepatocellular carcinoma (HCC). The aim was to assess the outcomes of salvage surgery after successful downstaging using hepatic arterial infusion chemotherapy (HAIC). PATIENTS AND METHODS Patients whose diagnosis was unresectable locally advanced HCC and who were resected after conversion to a resectable status by HAIC were included. The overall survival (OS) rate, and disease-free survival (DFS) rate were analyzed by stratifying patients into those with Vp3/4, Vv2/3, and those without major vascular invasion (MVI). RESULTS Eighteen patients were censored. Among them, six patients had Vp3/4, four patients had Vv2/3, and eight patients had no MVI. The 5-year OS rates of patients with Vp3/4 and those without MVI were 83% and 73%, respectively, whereas those with Vv2/3 had 0% (p
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- 2020
28. Quercetin Suppresses Proliferation of Liver Cancer Cell Lines In Vitro
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Yoriko Nomura, Toru Hisaka, Sachiko Ogasawara, Koji Okuda, Yoshito Akagi, Osamu Nakashima, Tomoaki Mizobe, Kouta Nakashima, Yoshiki Naito, Masahiko Tanigawa, Yuichi Goto, Hirohisa Yano, Fumihiko Fujita, Toshihiro Sato, Shogo Fukutomi, Hisamune Sakai, and Jun Akiba
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Cancer Research ,Cell cycle checkpoint ,medicine.diagnostic_test ,Cell growth ,Chemistry ,General Medicine ,Cell cycle ,Flow cytometry ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Apoptosis ,Cell culture ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,heterocyclic compounds ,MTT assay ,Viability assay - Abstract
Background/aim We investigated the anti-proliferative effect of quercetin on liver cancer cell lines. Materials and methods Thirteen liver cancer cell lines were cultured followed by treatment with varying concentrations of quercetin (0-100 μM) or quercetin and 5-FU, and the cell viability was analysed by the MTT assay. Flow cytometry was also used to examine cell cycle progression after treatment with quercetin. Results The addition of quercetin resulted in a dose- and time-dependent suppression of cell proliferation. In some cell lines, treatment with quercetin and 5-FU caused an additional or synergistic effect. Most cell lines displayed cell cycle arrest at different phases of the cell cycle. Conclusion Quercetin inhibits the proliferation of liver cancer cells via induction of apoptosis and cell cycle arrest.
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- 2020
29. Differences in the immunosurveillance pattern associated with DNA mismatch repair status between right‐sided and left‐sided colorectal cancer
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Hiroaki Miyoshi, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Koichi Ohshima, Kazutaka Nakashima, Naohiro Yoshida, Masao Seto, Hiroyuki Tanaka, Hiroki Kanno, Mai Takeuchi, Koji Okuda, and Tomoya Sudo
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Male ,0301 basic medicine ,Oncology ,Cancer Research ,CD3 Complex ,Colorectal cancer ,tumor‐infiltrating lymphocyte ,DNA Mismatch Repair ,B7-H1 Antigen ,0302 clinical medicine ,Pathology ,Immunologic Surveillance ,Aged, 80 and over ,Hazard ratio ,FOXP3 ,Forkhead Transcription Factors ,General Medicine ,Middle Aged ,Immunosurveillance ,mismatch repair ,030220 oncology & carcinogenesis ,Original Article ,Female ,DNA mismatch repair ,Colorectal Neoplasms ,immune‐checkpoint molecule ,Adult ,medicine.medical_specialty ,Colon ,CD8 Antigens ,colorectal cancer ,Human leukocyte antigen ,Disease-Free Survival ,03 medical and health sciences ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,tumor location ,Aged ,business.industry ,Tumor-infiltrating lymphocytes ,Rectum ,Cancer ,Original Articles ,medicine.disease ,T-Cell Intracellular Antigen-1 ,030104 developmental biology ,business - Abstract
Tumor location and immunity play important roles in the progression of colorectal cancer (CRC). This study aimed to investigate the differences in the immunosurveillance pattern between right‐ and left‐sided CRC and analyze their association with clinicopathologic features, including mismatch repair (MMR) status. We included surgically resected stage II/III CRC cases and evaluated the immunohistochemical findings of HLA class I, HLA class II, programmed cell death‐ligand 1 (PD‐L1), PD‐1, CTLA‐4, CD3, CD4, CD8, TIA‐1, T‐bet, GATA3, RORγT, Foxp3, and CD163. A total of 117 patients were included in the analyses; of these, 30 and 87 had right‐ and left‐sided cancer, respectively. Tumor immunity varied according to the tumor location in the overall cohort. Analysis of the tumors excluding those with DNA mismatch repair (MMR) deficiency also revealed that tumor immunity differed according to the tumor location. In right‐sided colon cancer (CC), high expression of Foxp3 (P = .0055) and TIA‐1 (P = .0396) were associated with significantly better disease‐free survival (DFS). High CD8 (P = .0808) and CD3 (P = .0863) expression tended to have better DFS. Furthermore, in left‐sided CRC, only high PD‐L1 expression in the stroma (P = .0426) was associated with better DFS. In multivariate analysis, high Foxp3 expression in right‐sided CC was an independent prognostic factor for DFS (hazard ratio, 7.6445; 95% confidence interval, 1.2091‐150.35; P = .0284). In conclusion, the immunosurveillance pattern differs between right‐ and left‐sided CRC, even after adjusting for MMR deficiency., Comparison of Kaplan‐Meier curves of disease‐free survival (DFS) in each tumor location excluding DNA mismatch repair deficiency. In right‐sided colon cancer, high Foxp3 (P = .0055) and TIA‐1 expression (P = .0396) were associated with significantly better DFS. High CD8 (P = .0808) and CD3 (0.0863) expression showed a tendency towards better DFS. In left‐sided colorectal cancer, only high sPD‐L1 expression (P = .0426) was associated with better DFS.
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- 2020
30. A case of hepatic venous outflow obstruction caused by migration of the remnant liver into the subphrenic space after extended posterior sectionectomy of the liver
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Toru Hisaka, Yoshito Akagi, Hiroki Kanno, Atsushi Yoshida, Yuichi Goto, and Koji Okuda
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medicine.medical_specialty ,Liver tumor ,T.bil, total bilirubin ,medicine.medical_treatment ,MHV, middle hepatic vein ,HVOO, hepatic venous outflow obstruction ,AST, aspartate aminotransferase ,Article ,Abdominal wall ,03 medical and health sciences ,Hepatic venous outflow obstruction ,0302 clinical medicine ,ALT, alanine aminotransferase ,Laparotomy ,Hepatectomy ,Medicine ,Falciform ligament ,Vein ,POD, post operative-day ,US, ultrasonography ,business.industry ,Repositioning ,medicine.disease ,CT, computed tomography ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,cardiovascular system ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,business ,Left triangular ligament - Abstract
Highlights • Hepatic venous outflow obstruction (HVOO) is a rare complication of hepatectomy. • HVOO might occur irrespective of whether the left triangular ligament is divided. • The treatment for HVOO is repositioning and/or stenting into the hepatic vein., Introduction Hepatic venous outflow obstruction (HVOO) is a rare complication of hepatectomy. We report a case of HVOO caused by remnant liver migration into the subphrenic space after hepatectomy, which was successfully managed by repositioning of the remnant liver. Presentation of case A 55-year-old Japanese man was diagnosed with a liver tumor on ultrasound. Contrast-enhanced CT revealed early enhancement in the arterial phase, followed by a washout in the late phase. Preoperative diagnosis was hepatocellular carcinoma, and hand-assisted laparoscopic extended posterior sectionectomy was performed. On postoperative day 1, middle hepatic vein (MHV) flow was not detected on ultrasound, and the portal flow was hepatofugal. CT during arterial portography revealed absence of the portal flow to the medial and anterior sections, and remnant liver migration into the subphrenic space. Therefore, we suspected that HVOO was caused by the remnant liver migration and performed redo laparotomy to reposition the remnant liver with suturing of the falciform ligament to the anterior abdominal wall. Postoperatively, contrast-enhanced CT demonstrated that the remnant liver remained in the anatomical position, and the medial and anterior sections were well enhanced. Discussion HVOO might occur irrespective of whether the left triangular ligament is preserved. We believe that it is necessary to fix the remnant liver to the abdominal wall in cases with poor venous blood flow confirmed by intraoperative ultrasound. If kinking of the hepatic vein persists, stent insertion should be performed. Conclusion HVOO after hepatectomy is rare but potentially fatal, and prevention and countermeasures should be discussed.
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- 2020
31. [Laparoscopic Extirpation of Peritoneal Dissemination of Hepatocellular Carcinoma Using ICG Imaging]
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Hisamune, Sakai, Yuichi, Goto, Shogo, Fukutomi, Masanori, Akashi, Toshihiro, Sato, Yoriko, Nomura, Shoichiro, Arai, Hiroki, Kanno, Kazuaki, Hashimoto, Jun, Akiba, Toru, Hisaka, Yoshito, Akagi, and Koji, Okuda
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Indocyanine Green ,Male ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Hepatectomy ,Humans ,Female ,Laparoscopy ,Aged - Abstract
A 71-year-old man who underwent laparoscopic partial liver resection for local recurrence hepatocellular carcinoma (HCC)in segment 4 one year after percutaneous radiofrequency ablation(RFA)for HCC. About 3 years after treatment, the patient showed elevation of serum level of tumor marker and a mass lesion in the round ligament on CT and EOB-MRI. We made a diagnosis of peritoneal dissemination of HCC. Laparoscopic extirpation of peritoneal dissemination using indocyanine green(ICG)imaging was performed and no other tumors were observed in the peritoneal cavity. A lesion was diagnosed as peritoneal dissemination of HCC, and postoperative course was uneventful. This patient underwent repeated RFA and partial resection for recurrence of HCC. The patient was died for intrahepatic multiple recurrence of HCC without peritoneal dissemination 25 months after extirpation of peritoneal dissemination. In the field of hepatobiliary surgery, ICG imaging can be used for the intraoperative real-time visualization of hepatic malignancies. The ICG imaging is restricted to detection of fluorescence for liver tumors 5-10 mm from the liver surface. In the detection of peritoneal dissemination, however, there are no such limitations. Laparoscopic extirpation using ICG imaging is useful for the detection of peritoneal dissemination of HCC and may improve the prognosis in selected patients.
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- 2022
32. Fault detection based on Petri net models with faulty behaviors.
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Toshimitsu Ushio, Isao Onishi, and Koji Okuda
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- 1998
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33. Cholangitis after Hemobilia: A Brief Overview
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Daisuke, Muroya, primary, Koji, Okuda, additional, Shoichiro, Arai, additional, Masanori, Akashi, additional, Yoriko, Nomura, additional, Yuichi, Goto, additional, Toshihiro, Sato, additional, Hisamune, Sakai, additional, Yoshinobu, Okabe, additional, Toru, Hisaka, additional, Yoshito, Akagi, additional, Satoshi, Taniwaki, additional, Hironobu, Sou, additional, and Tetsuo, Imamura, additional
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- 2021
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34. Real-time fault diagnostics with multiple aspect models.
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Samir Padalkar, Gabor Karsai, Janos Sztipanovits, Koji Okuda, and Nobuji Miyasaka
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- 1991
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35. Fatty Liver Does Not Increase the Risk of Postoperative Liver Damage Following Hepatectomy
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Koji Okuda, Hisamune Sakai, Hirohisa Yano, Jun Akiba, Yoriko Nomura, Toru Hisaka, and Yoshito Akagi
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medicine.medical_specialty ,Text mining ,business.industry ,Internal medicine ,medicine.medical_treatment ,Fatty liver ,medicine ,Liver damage ,Hepatectomy ,business ,medicine.disease ,Gastroenterology - Abstract
Background The number of patients with fatty liver due to alcohol consumption, the metabolic syndrome, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis is increasing. Because there is no consensus on the risk of hepatectomy in patients with fatty liver, this study examined the clinical outcomes of hepatectomy in fatty liver patients by evaluation their transaminase levels. Methods Patients (n = 164) who underwent hepatectomy for primary liver tumors from January 2014 to March 2019 were included in the study. They were divided into the steatohepatitis (n = 19), steatosis (n = 20), and viral hepatitis (n = 30) groups. Serum values of aspartate aminotransferase (AST), alanine transaminase (ALT), total bilirubin (TB), white blood cells, and platelets level and the prothrombin time (PT) were compared before and immediately after surgery, and on postoperative days 1–5, 7, and 10. Results Overall, the AST and ALT elevation rates were higher in the control group than in the steatosis and steatohepatitis groups during postoperative days 2–7. There was no difference in postoperative hepatic dysfunction between the steatosis and steatohepatitis groups. Univariate analysis revealed significant differences in liver stiffness, operative time, mobilization, and the Pringle time. Multivariate analysis indicated low liver stiffness and a longer Pringle time as independent risk factors. Postoperative changes in the TB and albumin levels and the PT did not differ between the groups. There was no difference in the postoperative complications and hospital stay length between the groups. Conclusions Fatty liver does not increase the risk of postoperative liver damage following hepatectomy.
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- 2021
36. Neoadjuvant Chemotherapy with Gemcitabine Plus Nab-Paclitaxel Regimen for Borderline Resectable Pancreatic Cancer with Arterial Involvement: A Prospective Multicenter Single-Arm Phase II Study Protocol
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Kazuyoshi Nishihara, Susumu Eguchi, Hiroaki Nagano, Yoshihiro Miyasaka, Hirokazu Noshiro, Masafumi Nakamura, Koji Okuda, Masafumi Inomata, Hiroyuki Shinchi, Hideo Baba, Toshiharu Ueki, and Takao Ohtsuka
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Oncology ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,neoadjuvant ,gemcitabine ,Phases of clinical research ,Retrospective cohort study ,Institutional review board ,medicine.disease ,Gemcitabine ,Regimen ,nab-paclitaxel ,Internal medicine ,Pancreatic cancer ,medicine ,Clinical endpoint ,Protocol ,Surgery ,business ,borderline resectable pancreatic cancer ,medicine.drug - Abstract
Introduction: Although neoadjuvant treatment is recommended for patients with borderline resectable pancreatic cancer (BRPC), no standard neoadjuvant regimen has been established for BRPC with arterial involvement (BRPC-A), which is associated with a higher risk of margin-positive resection and poorer prognosis than BRPC with only venous involvement. Gemcitabine plus nab-paclitaxel (GnP) has been reported to significantly reduce tumor size in metastatic pancreatic cancer, and some retrospective studies suggested that neoadjuvant GnP for BRPC improved resectability and survival. Methods and analysis: A prospective multicenter single-arm phase II study is conducted to evaluate the safety and efficacy of GnP as neoadjuvant chemotherapy for BRPC-A. The primary endpoint is the R0 resection rate. The secondary endpoints are the neoadjuvant chemotherapy response rate, resection rate, pathological response rate, incidence rate of adverse events, and quality of life. Ethics and dissemination: This study protocol was approved by the institutional review board of Kyushu University (no. 181). The results will be published in a peer-reviewed journal and will be presented at medical meetings. Highlights: Strategy for borderline resectable pancreatic cancer involving arteries (BRPC-A). There is no standard regimen for neoadjuvant chemotherapy for BRPC-A. Gemcitabine plus nab-paclitaxel (GnP) shows significant tumor shrinkage. Neoadjuvant GnP for BRPC-A increases resectability and margin-negative resection.
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- 2021
37. Hepatocellular adenoma initially diagnosed as hepatocellular carcinoma with resistance to proton beam radiotherapy - A case report
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Yuichiro Maruyama, Hiroki Kanno, Toru Hisaka, Yoshito Akagi, Koji Okuda, and Toshihiro Sato
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medicine.medical_specialty ,Liver tumor ,business.industry ,medicine.medical_treatment ,Case Report ,Hepatocellular adenoma ,medicine.disease ,Gastroenterology ,Radiation therapy ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Proton beam radiotherapy ,030220 oncology & carcinogenesis ,Internal medicine ,Hepatocellular carcinoma ,medicine ,Immunohistochemistry ,Hepatectomy ,030211 gastroenterology & hepatology ,Surgery ,business ,Viral hepatitis - Abstract
Introduction and importance Hepatocellular adenoma (HCA) is a rare liver tumor. We report a case of a radio-resistant liver tumor that was removed surgically and found to be HCA. Case presentation A 37-year-old Japanese man was incidentally diagnosed with a liver tumor. He had no history of viral hepatitis nor metabolic disorders. MRI revealed a tumor enhancing in arterial phase, followed by washout in late phase, and hypointensity in hepatobiliary phase. A diagnosis of hepatocellular carcinoma (HCC) was made and surgery was advised. However, the patient chose proton beam radiotherapy. Although the tumor initially shrunk, it increased in size thereafter. Therefore, anterior sectionectomy was performed. Histology revealed proliferation of hepatocytes without cytologic atypia. On immunohistochemistry, CRP, SAA, GS, L-FABP, and nuclear expression of β-catenin were positive. A final diagnosis of mixed inflammatory and β-catenin activated HCA was made. Clinical discussion HCA is associated with obesity. The present case was a slightly obese man without history of viral hepatitis. In such cases, HCA should be considered. In the present case, proton beam radiotherapy was performed for a diagnosis of HCC. However, the tumor was radio-resistant. Conclusion HCA shows an almost equal male to female ratio in the Asian population. Molecular classification is vital in the management of HCA. HCC and HCA are often difficult to differentiate; tumor biopsy is necessary for patients with atypical imaging findings and in younger patients without underlying liver disease. Since the effectiveness of radiation therapy on HCA has not been reported, surgery should be preferred., Highlights • HCA is more prevalent in women in the western countries, while equal gender distribution in Asian countries • Subgroups show different imaging findings. I-HCA, atoll sign; b-HCA, iso-hyperintensity in the hepatobiliary phase • In the present case, the tumor showed resistance to radiation
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- 2021
38. Intelligent monitoring and diagnostics for plant automation.
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Janos Sztipanovits, Gabor Karsai, Samir Padalkar, Csaba Biegl, Nobuji Miyasaka, and Koji Okuda
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- 1990
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39. Control of Circularly Polarised Luminescence Using a Suitable Wired Structure Connecting a Binaphthyl with Two Pyrenes
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Nobuyuki Hara, Motohiro Shizuma, Nobuo Tajima, Koji Okuda, and Yoshitane Imai
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Circular dichroism ,chemistry.chemical_compound ,Materials science ,chemistry ,Pyrene ,General Chemistry ,Photochemistry ,Luminescence ,Fluorescence - Published
- 2019
40. Sarcomatous Component in Pancreatic Adenosquamous Carcinoma: A Clinicopathological Series of 7 Cases
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Yuichi Goto, Hirohisa Yano, Yoshiki Naito, Shinichi Taniwaki, Hisamune Sakai, Ryuichi Kawahara, Masafumi Yasunaga, Hiroto Ishikawa, Jun Akiba, Hiroyuki Tanaka, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, and Koji Okuda
- Subjects
Male ,Cancer Research ,Poor prognosis ,Pathology ,medicine.medical_specialty ,Vimentin ,Pancreatic Adenosquamous Carcinoma ,Malignancy ,Metastasis ,Carcinoma, Adenosquamous ,medicine ,Humans ,Aged ,biology ,business.industry ,General Medicine ,Middle Aged ,Cadherins ,Prognosis ,medicine.disease ,Sarcomatous Component ,Squamous carcinoma ,Gene Expression Regulation, Neoplastic ,Pancreatic Neoplasms ,Oncology ,biology.protein ,Adenocarcinoma ,Female ,business - Abstract
Background/aim The aim of this study was to examine the clinicopathological features of pancreatic adenosquamous carcinoma (PASC). Patients and methods Our study included seven patients who underwent resection of PASC. Results PASC is characterized by large tumors and strong infiltration into the major blood vessels and other organs, forcing many patients to undergo extended resections. In addition, all patients experienced liver metastasis recurrence following surgery, with a very poor prognosis. Histopathologically, a poorly differentiated sarcomatous component existed in all patients in addition to an adenocarcinoma component and squamous carcinoma component. Although P40 staining for the sarcomatous component was positive along with squamous carcinoma, E-cadherin expression disappeared while vimentin was expressed. It has been suggested that it is highly likely that these sarcomatous components are derived from squamous carcinoma and have an impact on prognosis. Conclusion The sarcomatous component may be related to the biological malignancy of PASC.
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- 2019
41. Sinusoidal Obstruction Syndrome and Postoperative Complications Resulting from Preoperative Chemotherapy for Colorectal Cancer Liver Metastasis
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Masahiko Tanigawa, Hirohisa Yano, Yuichi Goto, Masaru Fukahori, Koji Okuda, Jun Akiba, Hiroto Ishikawa, Yoriko Nomura, Hisamune Sakai, Ryuichi Kawahara, Toru Hisaka, Yoshito Akagi, Tomoaki Mizobe, Yoshiki Naito, Masafumi Yasunaga, Hiroyuki Tanaka, Fumihiko Fujita, Osamu Nakashima, Tetsushi Kinugasa, and Keisuke Miwa
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Bevacizumab ,Colorectal cancer ,medicine.medical_treatment ,Hepatic Veno-Occlusive Disease ,Leucovorin ,Hemodynamics ,Gastroenterology ,Disease-Free Survival ,Metastasis ,Postoperative Complications ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Hepatectomy ,Humans ,Panitumumab ,Neoplasm Metastasis ,Aged ,Chemotherapy ,Cetuximab ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Chemotherapy regimen ,Oncology ,Preoperative Period ,Female ,Fluorouracil ,Colorectal Neoplasms ,business ,medicine.drug - Abstract
Background/aim The aim of this study was to investigate the effects of preoperative chemotherapy on the healthy, metastasis-free part of the liver in colorectal cancer patients with liver metastasis, and the relationship between chemotherapy and postoperative complications. Patients and methods Our study included 90 cases of colorectal cancer liver metastasis resected after preoperative chemotherapy. The patients were divided into three groups according to the received chemotherapy regimen: 20 cases received mFOLFOX6, 54 cases a combination of mFOLFOX6 with bevacizumab, and 16 cases a combination of mFOLFOX6 and cetuximab or panitumumab. Results The mean numbers of sinusoidal injuries for each chemotherapy type were compared. The group treated with the combination of mFOLFOX6 and bevacizumab showed a lower extent of sinusoidal injury relative to other groups; this intergroup difference became increasingly remarkable as the number of chemotherapy cycles increased. Complications of various extents were found in all three groups, but no significant differences were observed between the three groups. Conclusion In cases where preoperative chemotherapy was extended over a long period, combined use of bevacizumab was thought to be effective because of stabilization of disturbed liver hemodynamics resulting from sinusoidal injury suppression effects, allowing effective distribution of anti-cancer agents to tumors.
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- 2019
42. Spatial distributions of furan and 5-hydroxymethylfurfural in unroasted and roasted Coffea arabica beans
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Robert B. Cody, Koji Okuda, Kristen L. Fowble, and Rabi A. Musah
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0303 health sciences ,Hot Temperature ,Chromatography ,Food Handling ,Plant Extracts ,030309 nutrition & dietetics ,Coffea arabica ,Coffea ,04 agricultural and veterinary sciences ,Coffee ,040401 food science ,Gas Chromatography-Mass Spectrometry ,03 medical and health sciences ,chemistry.chemical_compound ,0404 agricultural biotechnology ,chemistry ,Furan ,5-hydroxymethylfurfural ,Seeds ,Furaldehyde ,Furans ,Food Science ,Roasting - Abstract
For the first time, the spatial distributions of the highly volatile compounds furan and 5-hydroxymethylfurfural (HMF) have been determined in cross sections of green and roasted Coffea arabica beans. The image maps were revealed by laser ablation DART imaging mass spectrometry (LADI-MS). The presence of these compounds was independently confirmed by GC–MS as well as argon DART-MS. Quantification of furan by GC–MS was completed with the final concentrations in roasted and unroasted beans determined to be 96.5 and 4.1 ng/g, respectively. Furan was observed to be distributed throughout the tissue of both green and roasted beans, while HMF was localized to the silver skin in green beans. Following roasting, the appearance of HMF was more diffuse. The implications of the broad distribution of furan on the one hand, and localization of HMF on the other, are discussed.
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- 2019
43. A Clinical Scoring System for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma Within the Milan Criteria
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Munehiro Yoshitomi, Hideki Saitsu, Yoshiyuki Wada, Koji Okuda, Masaki Tateishi, Seiya Momosaki, Kotaro Yasumori, Yuko Takami, Takanobu Hara, and Tomoki Ryu
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Adult ,Gadolinium DTPA ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Contrast Media ,Milan criteria ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Neoplasm Invasiveness ,Protein Precursors ,Risk factor ,Aged ,Retrospective Studies ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,Liver Neoplasms ,Area under the curve ,Odds ratio ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Confidence interval ,Tumor Burden ,ROC Curve ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Microvessels ,Female ,Prothrombin ,030211 gastroenterology & hepatology ,Surgery ,alpha-Fetoproteins ,Hepatectomy ,business ,Biomarkers - Abstract
Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment.One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors.MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24-56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of 55 mAU/mL (OR, 5.50; 95% CI, 2.09-15.4; P 0.001), tumor size of 2.8 cm (OR, 6.10; 95% CI, 2.07-20.0; P 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84-16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score.Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.
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- 2019
44. A Case Report of Synovial Sarcoma in the Abdominal Wall
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Tomonari Katayama, Takahiro Oshima, Yuka Oshima, Masao Sunahara, Kazuhito Misawa, and Koji Okuda
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Abdominal wall ,Pathology ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,General Engineering ,medicine ,General Earth and Planetary Sciences ,medicine.disease ,business ,Synovial sarcoma ,General Environmental Science - Published
- 2019
45. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report
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Toshihiro Sato, Shusuke Okamura, Yuichi Goto, Hirohisa Yano, Shogo Fukutomi, Yuta Yano, Hisamune Sakai, Koji Okuda, Masanori Akashi, Jun Akiba, Hiroki Kanno, Daisuke Muroya, Yoriko Nomura, Toru Hisaka, and Yoshito Akagi
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medicine.medical_specialty ,Liver tumor ,Hematogenous metastases ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,030218 nuclear medicine & medical imaging ,Metastasis ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Falciform ligament ,medicine ,Hepatectomy ,Humans ,Intrahepatic Cholangiocarcinoma ,Intrahepatic cholangiocarcinoma ,Aged, 80 and over ,Ligaments ,Round Ligament ,business.industry ,Liver Neoplasms ,Cancer ,lcsh:RD1-811 ,General Medicine ,Segment IV ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Liver ,030220 oncology & carcinogenesis ,Ligament ,Female ,Laparoscopy ,Radiology ,business - Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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- 2021
46. Geriatric Nutritional Risk Index Predicts Prognosis in Hepatocellular Carcinoma After Hepatectomy: A Propensity Score Matching Analysis
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Shin Sasaki, Shogo Fukutomi, Yuichi Goto, Koji Okuda, Toru Hisaka, Yoshito Akagi, Fumihiko Fujita, and Hiroki Kanno
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Carcinoma, Hepatocellular ,Science ,medicine.medical_treatment ,Nutritional Status ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Nutritional risk index ,medicine ,Hepatectomy ,Humans ,Propensity Score ,Geriatric Assessment ,Cancer ,Aged ,Retrospective Studies ,Aged, 80 and over ,Multidisciplinary ,business.industry ,Hazard ratio ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Survival Rate ,030104 developmental biology ,Nutrition Assessment ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Propensity score matching ,Medicine ,Female ,business ,Body mass index ,Follow-Up Studies - Abstract
The geriatric nutritional risk index (GNRI) is widely used for nutritional assessment in older inpatients and is associated with postoperative complications and cancer prognosis. We investigated the use of GNRI to predict long-term outcomes in hepatocellular carcinoma of all etiologies after hepatectomy. Overall, 346 patients were examined after propensity score matching. We dichotomized the GNRI score into high GNRI (> 98: N = 173) and low GNRI (≤ 98: N = 173) and evaluated recurrence-free survival (RFS) and overall survival (OS) between both groups. Clinicopathological characteristics between the low- and high-GNRI groups were similar after propensity score matching except for the components of the GNRI score (body mass index and serum albumin level), Child–Pugh score (comprising serum albumin level), and preoperative alpha-fetoprotein level (p p p = 0.0030, and p = 0.0007, respectively). High GNRI was associated with significantly better RFS and OS (p = 0.0003 and p = 0.0211, respectively; log-rank test). Multivariate analysis revealed that GNRI is an independent prognostic factor of RFS and OS (low vs. high; hazard ratio [HR], 1.8284; 95% confidence interval [CI] 1.3598–2.4586; p p = 0.0335, respectively). GNRI is an objective, inexpensive, and easily calculated assessment tool for nutritional status and can predict prognosis of hepatocellular carcinoma after hepatectomy.
- Published
- 2021
47. [A Case Report of Duodenal Ampullary Carcinoma with Annular Pancreas]
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Toshihiro, Sato, Hisamune, Sakai, Daisuke, Muroya, Hiroki, Kanno, Satoki, Kojima, Syogo, Fukutomi, Masanori, Akashi, Yoriko, Nomura, Yuichi, Goto, Hiroto, Ishikawa, Toru, Hisaka, Yoshito, Akagi, and Koji, Okuda
- Subjects
Ampulla of Vater ,Duodenal Neoplasms ,Humans ,Pancreatic Diseases ,Female ,Pancreas ,Aged - Abstract
Annular pancreas is a rare congenital anomaly that rarely occurs in parallel with malignancy. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 76-year-old woman presented with abdominal pain and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla. Preoperative computed tomography confirmed the presence of an ampullary tumor. During surgery, we found an anomaly consisting of a ring-like band of pancreatic tissue encircling the second part of the duodenum. Transduodenal papillectomy with preservation of the annular pancreas was subsequently performed. The patient was discharged without any postoperative morbidity.
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- 2021
48. Central hepatopancreatoduodenectomy—oncological effectiveness and parenchymal sparing option for diffusely spreading bile duct cancer: report of two cases
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Koji Okuda, Yuichi Goto, Hisamune Sakai, Kapil Nagaraj, Satoki Kojima, Toru Hisaka, and Yoshito Akagi
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Male ,medicine.medical_specialty ,Central liver resection ,lcsh:Surgery ,Context (language use) ,Diffusely spreading bile duct cancer ,Pancreaticoduodenectomy ,Bile duct cancer ,Case report ,Parenchyma ,medicine ,Hepatectomy ,Humans ,Aged ,Common bile duct ,Bile duct ,business.industry ,lcsh:RD1-811 ,General Medicine ,medicine.disease ,Central Liver Resection ,Surgery ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Concomitant ,Female ,Hepatopancreatoduodenectomy ,Liver parenchymal sparing ,business ,Left Hepatic Duct - Abstract
Background Hepatopancreatoduodenectomy (HPD) for diffusely spreading bile duct cancer (DSBDC) usually involves a major hepatectomy and a concomitant pancreatoduodenectomy, and is still challenging surgery because of postoperative liver failure. The present case report demonstrated two cases of DSBDC where we could achieve successful HPD with central liver resection (CHPD) as liver parenchymal sparing surgery. Case presentation In Case 1, endoscopic retrograde cholangiography (ERC) with multiple biopsies revealed that she had DSBDC with Bismuth-Corlette type IIIA. 3D integrated images reconstructed by contrast enhanced CT and CT with drip infusion cholecystocholangiography data revealed the right antero-ventral bile duct (RAVD) confluent to the right hepatic duct and the right antero-dorsal bile duct (RADD) independently confluent to the right posterior bile duct (RPD). Tumor extended common bile duct including intrapancreatic bile duct to the left hepatic duct and RAVD, but the RADD and RPD were spared. Because the future liver remnant (FLR) was assumed not to achieve desirable volume by preoperative portal vein embolization for left or right trisegmentectomy, CHPD including resection of the segments IV and I, and the right antero-ventral segment was done and achieved R0. This procedure is tailored to the anatomical extent of disease in the context of variable biliary anatomy as a modified CHPD, and to our knowledge, this is the first reported case of modified CHPD with antero-dorsal segment preservation. In Case 2, preoperative imaging revealed DSBDC with Bismuth Corlette type IIIA. FLR volume was assumed insufficient for major hepatectomy, CHPD including resection of the segments IV and I, and the right anterior sector was done with R0. The remnant liver volumes of these cases were spared by 55.1% and 25% respectively, and postoperative course was uneventful in both. Conclusion CHPD should be considered a valid option for well-selected cases of DSBDC. This is the first case report of modified CHPD with antero-dorsal segment preservation.
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- 2021
49. Achieving Carnot efficiency in a finite-power Brownian Carnot cycle with arbitrary temperature difference
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Kosuke Miura, Yuki Izumida, and Koji Okuda
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Statistical Mechanics (cond-mat.stat-mech) ,FOS: Physical sciences ,Condensed Matter - Statistical Mechanics - Abstract
Achieving the Carnot efficiency at finite power is a challenging problem in heat engines due to the trade-off relation between efficiency and power that holds for general heat engines. It is pointed out that the Carnot efficiency at finite power may be achievable in the vanishing limit of the relaxation times of a system without breaking the trade-off relation. However, any explicit model of heat engines that realizes this scenario for arbitrary temperature difference has not been proposed. Here, we investigate an underdamped Brownian Carnot cycle where the finite-time adiabatic processes connecting the isothermal processes are tactically adopted. We show that in the vanishing limit of the relaxation times in the above cycle, the compatibility of the Carnot efficiency and finite power is achievable for arbitrary temperature difference. This is theoretically explained based on the trade-off relation derived for our cycle, which is also confirmed by numerical simulations., Comment: 16pages, 8 figures
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- 2021
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50. Laparoscopic Liver Resection Using a Silicone Band Retraction Method (With Video)
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Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Toshihiro Sato, Koji Okuda, Yuichi Goto, and Hisamune Sakai
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medicine.medical_specialty ,Technical Reports ,Silicones ,silicone band retraction method ,silicone band uplift technique ,Resection ,chemistry.chemical_compound ,Silicone ,Blood loss ,Medicine ,Hepatectomy ,Humans ,Major complication ,Retrospective Studies ,posterosuperior segment ,one-surgeon technique ,business.industry ,Liver Neoplasms ,technology, industry, and agriculture ,laparoscopic liver resection ,Length of Stay ,Surgery ,chemistry ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Operative time ,Laparoscopy ,business ,Hospital stay - Abstract
Supplemental Digital Content is available in the text., Background: The success of laparoscopic liver resection (LLR) depends on stable and full exposure of the parenchymal transection plane. We evaluated the efficacy of LLR using a silicone band retraction method for lesions in the anterolateral and posterosuperior segments. Methods: We retrospectively analyzed 189 consecutive patients who had undergone LLR in our hospital between July 2010 and July 2020. They were divided into 2 groups according to whether LLR was performed before (conventional group; n=64) or after (silicone band group; n=125) the introduction of the silicone band retraction method. Results: The silicone band group demonstrated significantly less blood loss than that by the conventional group. The mean operative time and the hospital stay in the silicone band group were obviously shorter than that in the conventional group. The open conversion rate and the major complication rate were significantly lower in the silicone band group than that in the conventional group. Conclusion: The silicone band retraction method is a useful approach that results in a safe LLR.
- Published
- 2020
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