Papers - NANASHIMA Atsushi
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Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi-institutional study by the Kyushu Study Group of Liver Surgery. Reviewed
Yamashita YI, Shirabe K, Beppu T, Eguchi S, Nanashima A, Ohta M, Ueno S, Kondo K, Kitahara K, Shiraishi M, Takami Y, Noritomi T, Okamoto K, Ogura Y, Baba H, Fujioka H
Annals of gastroenterological surgery 1 ( 2 ) 136 - 142 2017.6
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Salvage photodynamic therapy accompanied by extended lymphadenectomy for advanced esophageal carcinoma: A case report. Reviewed
Nishida T, Takeno S, Nakashima K, Kariya M, Inatsu H, Kitamura K, Nanashima A
International journal of surgery case reports 36 155 - 160 2017.5
Language：English Publishing type：Research paper (scientific journal)
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Significance of splenectomy for upper gastric carcinoma with invasion to the greater curvature
Nishida T., Nanashima A.
International Surgery 102 ( 5-6 ) 284 - 292 2017.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：International Surgery
© 2017 Nishida et al. This study aimed to clarify the significance of splenectomy (Sp) for upper gastric carcinoma with invasion to the greater curvature. The Japan Clinical Oncology Group (JCOG) conducted a phase III randomized clinical trial (JCOG 0110), where the significance of Sp in total gastrectomy (TG) for upper gastric carcinoma without invasion to the greater curvature was not proved because Sp did not contribute to an improved prognosis. From 1992 to 2010, 167 patients underwent TG for carcinoma of the upper stomach, except for patients with carcinoma of the residual stomach. Among them, 60 patients with tumor invasion to the greater curvature of the upper stomach (Gre group) were enrolled. Within the Gre group, the following factors were compared between the Sp group (n ¼ 30) and non-Sp group (n ¼ 30): patient background, postoperative staging, rate of neoadjuvant chemotherapy, surgical outcomes and rates of R0 resection, morbidity, adjuvant chemotherapy, and overall survival (OS). The Gre group patients were relatively younger, and tumor size and the numbers of Borrmann type 4 tumors, circumferential lesions, undifferentiated type lesions, and advanced cases were significantly larger than those in the non-Gre group. There were also significant differences in patient age and organs resected other than the spleen between the Sp group and non-Sp group. There was no significant difference in OS between the 2 groups. The significance of Sp for upper gastric carcinoma with invasion to the greater curvature was equivocal because the patients received no survival benefit by undergoing Sp.
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Tsuchiya, K., Nanashima, A., Ikeda, T., Minami, S., Nagano, M., Hamada, T., Yano, K. and Fujii, Y.
Clinical Journal of Gastroenterology 10 ( 2 ) 157 - 162 2017.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2017, Japanese Society of Gastroenterology.Colitis-associated colorectal cancer (CAC) is known to occur in long-standing and extensive ulcerative colitis (UC). Furthermore, UC is known to complicate primary sclerosing cholangitis (PSC), which subsequently results in an increased risk of developing cholangiocarcinoma. We report a case of colitis-associated rectal cancer (CARC) accompanied by intrahepatic cholangiocarcinoma (ICC) based on UC and PSC. A 73-year-old man had suffered from UC for 19 years. During surveillance colonoscopy, a tumor was found in the rectum that was pathologically diagnosed as CARC from the resected specimen. Abdominal computed tomography also revealed a localized dilation of the intrahepatic bile duct, and endoscopic retrograde cholangiography revealed a band-like stricture. This remarkable tumor lesion was not observed in the hepatic duct. Left hepatectomy was performed because of the suspicion of possible ICC at the stenosis of the hepatic duct. The presence of ICC was confirmed at the lesion causing the stricture. The pathological diagnosis from the resected specimen was ICC based on PSC. Adjuvant chemotherapy for ICC was performed for 6 months. Neither cancer has recurred for 2.5 years after hepatectomy. Patients with PSC concomitant with UC should be considered a high-risk group for CAC and ICC.
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Tokumitsu T., Sato Y., Sato Y., Yamashita A., Moriguchi-Goto S., Moriguchi-Goto S., Kondo K., Nanashima A., Asada Y.
Cytopathology 28 ( 2 ) 116 - 121 2017.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Cytopathology
© 2016 John Wiley & Sons LtdObjective: Biliary brush cytology is an important diagnostic tool in the evaluation of pancreatobiliary malignancies. However, it is difficult to distinguish between malignant and benign cells. The present study evaluated the utility of immunocytochemical expression of Claudin-18 and Maspin in brushing cytology specimens of pancreatobiliary lesions in the diagnosis of pancreatobiliary malignancies. Methods: The study retrospectively assessed biliary and pancreatic duct brushing cytology specimens of 43 patients whose pancreatobiliary lesions were histologically diagnosed at the University of Miyazaki Hospital. Scanty cellularity slides and cases with no histological confirmation were excluded. Alcohol-fixed and Papanicolaou-stained slides were immunostained with monoclonal antibodies to Claudin-18 and Maspin. Results: Of the 43 patients, 35 (81.4%) were finally histologically diagnosed with invasive adenocarcinomas. The sensitivity of routine cytology for the detection of malignancy was 63%, and the specificity was 100%. The sensitivity of cytology in combination with immunocytochemical expression of Claudin-18 (89%) or Claudin-18 and/or Maspin (97%) was significantly higher than that of cytology alone (P < 0.01). Conclusion: Immunocytochemical staining for Claudin-18 and Maspin improved the diagnostic sensitivity for pancreatobiliary adenocarcinomas.
DOI： 10.1111/cyt.12368
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Clinical Significance of Serum p53 Antibody in the Early Detection and Poor Prognosis of Gastric Cancer. Reviewed
Kunizaki M, Fukuda A, Wakata K, Tominaga T, Nonaka T, Miyazaki T, Matsumoto K, Sumida Y, Hidaka S, Yasutake T, Sawai T, Hamamoto R, Nanashima A, Nagayasu T
Anticancer research 37 ( 4 ) 1979 - 1984 2017.4
Language：English Publishing type：Research paper (scientific journal)
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Beppu T., Imai K., Okuda K., Eguchi S., Kitahara K., Taniai N., Ueno S., Shirabe K., Ohta M., Kondo K., Nanashima A., Noritomi T., Shiraishi M., Takami Y., Okamoto K., Kikuchi K., Baba H., Fujioka H.
Journal of Hepato-Biliary-Pancreatic Sciences 24 ( 3 ) 127 - 136 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
© 2017 Japanese Society of Hepato-Biliary-Pancreatic SurgeryBackground: This multi-institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH-HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH). Methods: From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH-HM (n = 104) and CRH (n = 202). Results: After one-to-one propensity score-matched analysis, 72 ARH-HM and 72 CRH patients presented comparable background factors. Patients in the ARH-HM group demonstrated significantly less intraoperative blood loss (480 vs. 1,242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5-year overall survival rate was significantly better in the ARH-HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence-free and overall survival of the ARH-HM group was significantly greater than those of the CRH group. Conclusion: In comparison with CRH, ARH-HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm.
DOI： 10.1002/jhbp.431
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Nanashima A., Nakashima K., Kawakami H., Ashizuka S., Kubota Y.
Photodiagnosis and Photodynamic Therapy 17 221 - 225 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Photodiagnosis and Photodynamic Therapy
© 2017 Elsevier B.V.The primary goal of nursing care in cases of endoscopic photodynamic therapy (PDT) for digestive tract carcinoma is to prevent phototoxicity by the intravenous administration of photosensitizers. The adequate protocol and management of patients should be conducted under the instruction of expert physicians. Our experiences of administering porfimer sodium and talaporfin sodium during clinical PDT provide insight regarding the specific management protocol of each photosensitizer during an in-hospital stay. We herein report our nursing protocol based on 15 years of experience. Under adequate management, PDT can be safely performed.
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Cytological findings and BCL10 expression in pancreatic acinar cell carcinoma: A Case Report Reviewed
Ohno A., Sato Y., Sato Y., Nakamura E., Nakamura E., Noguchi H., Tokumitsu T., Hiyoshi M., Nanashima A., Asada Y., Asada Y.
Diagnostic Cytopathology 45 ( 3 ) 247 - 251 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Diagnostic Cytopathology
© 2016 Wiley Periodicals, Inc.BCL10 was recently demonstrated to be a biomarker for pancreatic acinar cell carcinoma, but whether altered BCL10 expression can be detected in cell block specimens is unclear. Here, we report a pancreatic acinar cell carcinoma with cytological findings that showed BCL10 expression in a cell block. A 72-year-old man presented with a pancreatic tumor and underwent endoscopic ultrasound-fine needle aspiration (EUS-FNA) with additional passes performed for cell block preparation. The EUS-FNA cytology showed loose cohesive clusters with focal acinar- or gland-like-structures and prominent nucleoli. The preoperative diagnosis was well differentiated adenocarcinoma, and he underwent a pancreaticoduodenectomy. Histological examination revealed an acinar tumor structure with tumor cells staining positive for BCL10 and trypsin. The cell block specimen also demonstrated strong and diffuse BCL10-positive staining. Based on these findings, this tumor was diagnosed as acinar cell carcinoma of the pancreas. This case demonstrates that BCL10 expression within cell blocks facilitates a differential diagnosis of acinar cell carcinoma. Diagn. Cytopathol. 2017;45:247–251. © 2016 Wiley Periodicals, Inc.
DOI： 10.1002/dc.23634
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Takeno S., Yamashita K., Noritomi T., Hoshino S., Yamauchi Y., Yamashita Y., Nanashima A.
International Surgery 102 ( 1-2 ) 58 - 63 2017.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Surgery
2017 Takeno et al.; Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P ¼ 0.043); wound classification (P ¼ 0.0005); peritonitis (P ¼ 0.019); prolonged operation time (P ¼ 0.0001); increased blood loss (P ¼ 0.019); transfusion (P ¼ 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P ¼ 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P ¼ 0.20), but it tended to be associated with a shorter hospital stay (P ¼ 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.
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A case of multiple synchronous quadruple cancers of the stomach, sigmoid colon, rectum, and pancreas Reviewed
Nanashima A., Tominaga T., Nonaka T., Wakata K., Kunizaki M., Tobinaga S., Sumida Y., Hidaka S., Kinoshita N., Sawai T., Nagayasu T.
International Journal of Surgery Case Reports 35 4 - 7 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The AuthorsIntroduction Multiple primary neoplasms are relatively rare, but their incidence has increased because of aging and improvements in diagnostic imaging. Presentation of case A 67-year-old man presented with epigastric pain. On upper gastrointestinal endoscopy, an ulcer was seen at the gastric angle, and biopsy showed moderately differentiated adenocarcinoma (AC). Colonoscopy demonstrated a 15-mm lesion in the sigmoid colon and a submucosal lesion in the lower rectum. The biopsy showed well differentiated AC and neuroendocrine tumor (NET). In addition, abdominal CT and MRI showed a 14-mm nodular lesion in the pancreatic body suggesting pancreatic duct cancer. Based on the above findings, four synchronous cancers, including the pancreas, stomach, sigmoid colon and rectum, were diagnosed, and surgery was performed. A midline incision was made in the upper abdomen, and a distal gastrectomy, pancreatic body and tail resection, and sigmoidectomy were performed. Trans-anal tumor resection was performed for the rectal lesion. Histopathology showed invasive pancreatic duct cancer, moderately differentiated AC of the stomach, moderately differentiated AC of the sigmoid colon, and NET G1 of the rectum. The patient had no postoperative complications, 4 years 3 months after resection, and he was disease-free from all of the cancers. Discussion The strategy of perioperative diagnosis and treatment for multiple primary tumors is usually difficult. This process was performed by consulting a cancer board, which could be useful as a practice guideline. Conclusion This patient in whom four tumors were completely resected at the same time and who has had a good clinical course was reported.
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Ishii M., Takeno S., Takeno S., Nishida T., Nishida T., Nanashima A., Nanashima A., Kubota Y., Kubota Y., Kawakami H., Kawakami H., Kawakami H., Umekita Y., Akiyama Y.
International Journal of Surgery Case Reports 34 49 - 55 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The AuthorsIntroduction We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature. Presentaion of case A submucosal tumor 45 mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good. Discussion The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation. Conclusion Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
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Imamura N., Nanashima A., Hiyoshi M., Fujii Y.
International Journal of Surgery Case Reports 31 132 - 138 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s)Introduction Large-cell neuroendocrine carcinoma (LCNEC) in the duodenal ampulla of Vater is a rare malignant tumor, with frequent postoperative recurrence and poor prognosis even following complete resection. Effective adjuvant chemotherapy is expected to offer longer survival. Presentation of case We present two patients with LCNEC accompanied by components of tubular adenocarcinoma/adenoma in the duodenal ampulla of Vater who underwent pancreaticoduodenectomy (PD), resulting in longer survival of 1 patient. The first patient was an 81-year-old man in whom a 14-mm protruding solid tumor of the ampulla was observed. Pylorus-preserving PD (PPPD) was performed for the diagnosis of adenocarcinoma of the ampulla, and the final histological diagnosis of the resected specimen was LCNEC with an adenoma component. The patient showed a liver metastasis 4 months after surgery and died of carcinoma after 11 months. The second patient was a 72-year-old man with a 24-mm ulcerative solid tumor of the ampulla. PPPD was also performed in this patient, and the final histological diagnosis was LCNEC with mixed adenocarcinoma component (21%). Adjuvant chemotherapy of cisplatin and etoposide was administered, and the patient survived without tumor relapse for 24 months after surgery. Conclusion In the surgical treatment of LCNEC of the ampulla showing malignant behaviour, an accurate preoperative diagnosis and effective adjuvant chemotherapy after curative resection are necessary for longer survival.
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Horizontal traumatic laceration of the pancreas head: A rare case report Reviewed
Nanashima A., Imamura N., Tsuchimochi Y., Hamada T., Yano K., Hiyoshi M., Fujii Y., Kawano F., MitsuruTamura
International Journal of Surgery Case Reports 31 119 - 123 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s)Introduction This case report is intended to inform acute care surgeons about treating rare horizontal laceration of the pancreas head caused by blunt trauma. Case presentation A 57-year-old woman who sustained blunt abdominal trauma during a car crash was transported to the emergency center of our hospital with unstable vital signs due to hemorrhagic shock. Computed tomography showed transection of the pancreas head and massive intra-abdominal hemorrhage. She was referred for emergency surgery because of a transient response. Laparotomy at five hours after the accident initially revealed consistent massive bleeding from branches of the superior mesenteric artery and vein, which we resolved by suturing the vessels without damaging the main trunks. A horizontal laceration and complete transection of the pancreatic head were then confirmed but the main pancreatic duct remained intact. The lower part of the pancreatic head including the uncus with the attached part of the duodenum was resected, and the pancreatic stump remaining after transection was fixed by suturing. The jejunal limb was attached to the remnant duodenum by side-to-side functional anastomosis. Although gastric emptying was delayed for one month after surgery, the postoperative course was good and the patient recovered at three months thereafter. The embryonic border of pancreas head accompanied with pancreatic divisum was considered for this laceration without disruption of the main pancreatic duct. Discussion Blunt pancreatic trauma usually causes vertical transection and thus, horizontal transection is considered rare. The embryological anatomical border between the ventral and dorsal pancreas due to pancreatic divisum was supposed to be transected and therefore the main pancreatic duct was not damaged. Conclusion Hemorrhagic shock and rare pancreatic head trauma were treated by appropriate intraoperative management.
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Frequency of CD4+CD161+ T cell and interleukin-10 expression in inflammatory bowel diseases Reviewed
Tsuchiya K., Ikeda T., Batmunkh B., Choijookhuu N., Ishizaki H., Hotokezaka M., Hishikawa Y., Nanashima A.
Acta Histochemica et Cytochemica 50 ( 1 ) 21 - 28 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Histochemica et Cytochemica
© 2017 The Japan Society of Histochemistry and Cytochemistry.Mucosal immune dysregulation associated with T cells plays a critical role in the development of inflammatory bowel diseases (IBD). However, the definite significances of these cells in IBD still remain unclear. Therefore, we investigated the population and expression of CD4+CD161+ T cells in the colonic lamina propria mononuclear cells (LPMCs) in patients with IBD by analyses using flow cytometry and immunohistochemistry. Interleukin-10 (IL-10) mRNA levels in both LPMCs and CD4+ T cells in lamina propria (LP-CD4+ T cells) were measured using a real-time quantitative reverse transcription-polymerase chain reaction. IL-10 production was investigated with immunohistochemistry. The results revealed that the population of CD4+CD161+ T cells was significantly decreased in active ulcerative colitis (UC) compared with inactive UC (P < 0.05). The CD4+CD161+ T cell population was inversely correlated with disease activity in patients with UC (r = −0.6326, P = 0.0055), but there was no significant correlation in those with Crohn’s disease. Overexpression of IL-10 mRNA in both LPMCs and LP-CD4+ T cells were detected in active UC. Immunohistochemistry revealed decreased frequency of CD161+ cells and increased IL-10 positive cells in active UC. The frequency of CD4+CD161+ T cells and IL-10 expression was supposed to be associated with the pathological status of mucosal immunoregulation in IBD.
DOI： 10.1267/ahc.16035
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Nanashima A., Murakami G., Takagi K., Arai J., Sumida Y., Kodama T., Nagayasu T.
Acta Medica Nagasakiensia 61 ( 2 ) 55 - 60 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2017 Nagasaki University Library, All Right Reserved. Aim: Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. In the present clinical study, we examined the relationship between ghrelin level and physiology in patients who had undergone major liver and pancreas surgery. Methods: Serum ghrelin level was measured before and after hepatectomy and pancreatectomy. The relationships between nutritional status and postoperative alterations of parameters including the ghrelin level were examined. Results: In 32 patients, the preoperative plasm acyl-(AG) or des-acyl-ghrelin (DAG) and AG/DAG ratio were not significantly different based on gender, type of operation, age and each disease. AG tended to be correlated with the respiration quotient but this was not statistically significant (p=0.08). AG was significantly negatively correlated with hemoglobin and albumin levels. The postoperative plasma ghrelin level was significantly decreased at day 1 in comparison with preoperative levels (p < 0.05) and recovered to preoperative levels at day 3. There were no significant differences between hepatectomy and pancreatectomy groups, with no changes of postoperative metabolic parameters. Conclusions: Although serum ghrelin level was transiently decreased, this level was immediately recovered and not influenced by the surgical procedures or its invasiveness.
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Hepaticoplasty prevents cholangitis after pancreaticoduodenectomy in patients with small bile ducts Reviewed
Hiyoshi M., Wada T., Tsuchimochi Y., Hamada T., Yano K., Imamura N., Fujii Y., Nanashima A.
International Journal of Surgery 35 7 - 12 2016.11
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery
© 2016 IJS Publishing Group LtdBackground To reduce cholangitis after pancreaticoduodenectomy (PD), we perform ‘hepaticoplasty’, in which the left side of the bile duct is cut to widen the diameter of the bile duct wall before hepaticojejunostomy. The aim of this study was to clarify the usefulness of hepaticoplasty to reduce cholangitis after PD. Methods From January 2002 through December 2010, 161 patients underwent PD and were enrolled in this study. Patient demographics, surgical factors, and clinical and biochemical parameters were evaluated to examine the factors predictive of cholangitis after PD and confirm the usefulness of hepaticoplasty. Results Cholangitis after PD occurred in 13 patients (8.1%). Multivariate analysis revealed that the ratio of the postoperative bile duct diameter to that before surgery was the only independent risk factor for cholangitis after PD (p = 0.0012). In the small bile duct group, in which the diameter was ≤15 mm before surgery (n = 99), hepaticoplasty reduced the narrowing of the bile duct after PD, and no cholangitis occurred. There were no complications related to hepaticoplasty. Conclusions The ratio of postoperative reduction of the bile duct diameter to that before surgery was found to be the only risk factor for cholangitis after PD. Patients with a small bile duct of ≤15 mm in diameter preoperatively might benefit from hepaticoplasty to widen the bile duct diameter and prevent cholangitis after PD.
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Nanashima A., Nanashima A., Sakamoto A., Sakamoto I., Hayashi H., Sumida Y., Murakami G., Arai J., Wada H., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 4 ) 135 - 140 2016.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.To evaluate pancreatic elasticity and tumor diagnosis, we preoperatively investigated the elasticity calculated by a new ultrasonography (US) technique, acoustic radiation force impulse (ARFI). Materials and Methods: We examined ARFI in non-tumorous and tumor regions by push pulse of probe in 30 patients with pancreatic malignancies undergoing pancreatectomy. Measurement of stiffness was indicated as the Vs (mm/sec). Results: The Vs in the non-tumor region was measured in the pancreas head in 17 and in the body in 13 patients. The Vs of pancreatic tumors was measured in 14 of 22 patients (64%). The Vs in pancreatic tumors (2.17±0.95 m/sec.) was significantly higher than that in the non-tumorous pancreas (1.41±0.47 m/sec.) (p<0.01). The Vs of the non-pancreatic regions in the pancreas head and body were not significantly different. The Vs of the non-tumorous pancreas was not associated with patient demographics, laboratory data, the hardness of the pancreatic tissue, or postoperative morbidity. The Vs of the resected pancreatic tumors was not associated with any tumor-related parameters. Conclusions: ARFI imaging elastography can be used to evaluate pancreatic malignant tumor lesion in comparison with the non-tumor lesion.
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Murakami G., Nanashima A., Nanashima A., Nonaka T., Tominaga T., Wakata K., Sumida Y., Akashi H., Okazaki S., Kataoka H., Nagayasu T.
Anticancer Research 36 ( 9 ) 4493 - 4501 2016.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Photodynamic therapy (PDT) is an effective laser treatment for locally treating advanced bile duct carcinoma (BDC). The study's objective was to evaluate the increased cytocidal effect by apoptotic PDT using a novel photosensitizer, glucose-conjugated chlorin, by irradiation of light-emitting diode laser (G-PDT) in comparison with conventional PDT using talaporfin sodium (T-PDT). Materials and Methods: The cytocidal effect of GPDT was compared to that of T-PDT as a control. Tumor viability was determined by an in vitro MTS assay. The percentage of apoptosis-positive cells was examined by triple stain flow cytometry (annexin V, ethidium homodimer III and Hoechst 33342) in the BDC cell line (NOZ cell) in vitro. The change in transplanted tumor volume in vivo (4-week-old male BALB/c mice) was examined 7 days after PDT. Results: Cell death was induced in a light dose-dependent manner by PDT. The laser power was set at 5 Jules/cm2 to obtain half maximal inhibitory concentration (IC50) in T-PDT and GPDT and the concentration of photosensitivity for G-PDT (2.02 g/ml) was lower than that for T-PDT (4.14 g/ml). Both T-PDT and G-PDT showed increased induction rates in comparison to the light only or G-chlorin only. Furthermore, the rate of apoptosis in the G-PDT (92.6%) was increased in comparison to that in the T-PDT (38.9%). The increased rates of tumor volume during the 7 days in both the G-PDT and T-PDT groups were significantly lower than that in the non-PDT group (p<0.01). At day 7, the increased rates of tumor volume in the G-PDT group were significantly lower than that in the T-PDT group (p<0.05). Conclusion: The new G-PDT treatment showed a high prevalence of apoptosis and inhibition of tumor growth in treatment of BDC cells.
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Nanashima A., Takagi K., Murakami G., Arai J., Sumida Y., Nagayasu T., Kodama T.
Acta Medica Nagasakiensia 60 ( 4 ) 153 - 159 2016.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However, adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mouse model. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 μg/kg or 30 μg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 μg/kg and 30 μg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 μg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 μg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also no remarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG did not induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery.