Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, and it needs complete surgical resection for cure. In addition, the reconstruction of IVC is necessary in many cases. Herein, we indicate the case of a 5...Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, and it needs complete surgical resection for cure. In addition, the reconstruction of IVC is necessary in many cases. Herein, we indicate the case of a 57-year-old female with leiomyosarcoma in segment I of the IVC, which grew deep into vascular lumen. She underwent complete en bloc resection of the tumor and IVC reconstruction by an artificial pericardium patch.展开更多
Perforation after endoscopic retrograde cholan- giopancreatography (ERCP) is a rare but severe complication. Management of ERCP-associated duodenal perforation remains controversial. Some recommend surgery, while othe...Perforation after endoscopic retrograde cholan- giopancreatography (ERCP) is a rare but severe complication. Management of ERCP-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. We describe the case who developed perforation of the duodenum and gas in the retroperitoneal cavity after ERCP. There was no sign of peritonitis, pancreatitis or sepsis. The patient was treated by conservative therapy without operation, and finally, fully re- covered from perforation.展开更多
Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and...Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and des-c-carboxy prothrombin are well-known and useful tumor markers for HCC.The positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local therapy.Although the normal ranges reported have differed by institution,the positivity of tumor markers is consistent and can easily be assessed.Kumamoto and Wakayama's group clearly demonstrated the following:1) Regardless of the degree of tumor stage,a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR;2) For RFA alone,HCC patients with double-and triple-positive status,having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes;3) For HCC patients with lesions ≤5 cm in Child-Pugh grade A,HR is preferred over RFA;4) Microvascular invasion rates increased even in the double-positive patients,while poorly differentiated HCC was frequently observed only in the triple-positive patients;and 5) RFA with chemoembolization,anatomical liver resection,and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor markers.However,the impacts of these therapies still need to be evaluated in prospective comparative studies.展开更多
Epithelial-mesenchymal transition(EMT)was first reported as an essential process in embryonic cells and later showed that cancer cells,regardless of the context,exhibited a similar phenomenon that was crucial for tumo...Epithelial-mesenchymal transition(EMT)was first reported as an essential process in embryonic cells and later showed that cancer cells,regardless of the context,exhibited a similar phenomenon that was crucial for tumor progression.Epithelial cells lose their adhesive characteristic capacity which is necessary for their functions but gain a mesenchymal phenotype.This change from epithelial to the mesenchymal phenotype of cancer cells makes it difficult to understand the mechanism underlying cancer biology and tumor progression.A number of transcription factors involved in tumor cell EMT and microRNA-regulated EMT have been reported.This review discussed recent findings and new players in EMT in gastrointestinal cancers.Since the molecular mechanisms of tumor progression are sometimes context-dependent,the recent findings of EMT have been reviewed in a context-dependent manner.展开更多
Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational st...Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital.The total score on the task checklist(21 parameters)for measuring technical performance during PD by self assessment and instructor assessment was compared between junior(JN)and hepatobiliary pancreatic(HBP)trainees at a university hospital.Surgical outcomes of 303 PDs(2007-2013)were also compared among JN trainees,HBP trainees,and instructors,and the present position of the trainees was investigated.This study was approved by the institutional review board of Kansai Medical University on May 26,2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD(P<.001).The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs.Although total score curves rose to the right in the JN group,scores in the HBP group were stable,at 70 or higher,which correlated with the instructor assessment.The 90-day and 30-day mortality rates were 1.6%and 0.3%,respectively.Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees.Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system.This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.展开更多
文摘Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, and it needs complete surgical resection for cure. In addition, the reconstruction of IVC is necessary in many cases. Herein, we indicate the case of a 57-year-old female with leiomyosarcoma in segment I of the IVC, which grew deep into vascular lumen. She underwent complete en bloc resection of the tumor and IVC reconstruction by an artificial pericardium patch.
文摘Perforation after endoscopic retrograde cholan- giopancreatography (ERCP) is a rare but severe complication. Management of ERCP-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. We describe the case who developed perforation of the duodenum and gas in the retroperitoneal cavity after ERCP. There was no sign of peritonitis, pancreatitis or sepsis. The patient was treated by conservative therapy without operation, and finally, fully re- covered from perforation.
文摘Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and des-c-carboxy prothrombin are well-known and useful tumor markers for HCC.The positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local therapy.Although the normal ranges reported have differed by institution,the positivity of tumor markers is consistent and can easily be assessed.Kumamoto and Wakayama's group clearly demonstrated the following:1) Regardless of the degree of tumor stage,a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR;2) For RFA alone,HCC patients with double-and triple-positive status,having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes;3) For HCC patients with lesions ≤5 cm in Child-Pugh grade A,HR is preferred over RFA;4) Microvascular invasion rates increased even in the double-positive patients,while poorly differentiated HCC was frequently observed only in the triple-positive patients;and 5) RFA with chemoembolization,anatomical liver resection,and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor markers.However,the impacts of these therapies still need to be evaluated in prospective comparative studies.
文摘Epithelial-mesenchymal transition(EMT)was first reported as an essential process in embryonic cells and later showed that cancer cells,regardless of the context,exhibited a similar phenomenon that was crucial for tumor progression.Epithelial cells lose their adhesive characteristic capacity which is necessary for their functions but gain a mesenchymal phenotype.This change from epithelial to the mesenchymal phenotype of cancer cells makes it difficult to understand the mechanism underlying cancer biology and tumor progression.A number of transcription factors involved in tumor cell EMT and microRNA-regulated EMT have been reported.This review discussed recent findings and new players in EMT in gastrointestinal cancers.Since the molecular mechanisms of tumor progression are sometimes context-dependent,the recent findings of EMT have been reviewed in a context-dependent manner.
文摘Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital.The total score on the task checklist(21 parameters)for measuring technical performance during PD by self assessment and instructor assessment was compared between junior(JN)and hepatobiliary pancreatic(HBP)trainees at a university hospital.Surgical outcomes of 303 PDs(2007-2013)were also compared among JN trainees,HBP trainees,and instructors,and the present position of the trainees was investigated.This study was approved by the institutional review board of Kansai Medical University on May 26,2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD(P<.001).The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs.Although total score curves rose to the right in the JN group,scores in the HBP group were stable,at 70 or higher,which correlated with the instructor assessment.The 90-day and 30-day mortality rates were 1.6%and 0.3%,respectively.Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees.Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system.This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.
