One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent

瞄准：为了描述包含可扩充的金属的经皮的 transhepatic 插入的一个简单一步舞方法，在妨碍的黄疸的治疗使用的斯滕特氏印模膏(他们) 由 unresectable 恶意引起了。方法：由于 unresectable 恶意与妨碍的黄疸诊断的十四个病人在学习被包括。在这些病人的恶意是很先进的癌或老年的结果。经皮的 transhepatic 胆管造影术在 ultrasonographic 指导下面被执行。在有一个内部金属性的指南的一根导管是先进的进十二指肠以后，一他们被放在胆总管，在一个点之间在到肝的核的 Vater 和入口的乳头状的小突起以外的 1 厘米。在用就一个单身者跨越距离是困难的情况中他们，另外的斯滕特氏印模膏被放。一根排水导管在地方被离开充当一把止血钳子。在胆汁郁积和斯滕特氏印模膏明显的分辨率被证实以后，导管被移开 2 或 3 d 过程以后。结果：EMS 的一步舞插入与 24.4 min 的一过程平均数时间在所有病人被完成。从要求了 2 他们的病人， 4 需要一过程时间超过 30 min。导管的移动的吝啬的时间过程以后是 2.3 d。所有病人与 7.8 瞬间的一吝啬的后续时间死于恶意。没有 stent 相关的复杂并发症或斯滕特氏印模膏阻塞被遇到。结论：他们的一步舞经皮的 transhepatic 插入是为决定胆汁的阻塞和罐头有效地改进病人生命的质量的一个简单过程。

为胃的癌症的内视镜的 submucosal 解剖的支持的技术和设备

The indications for endoscopic treatment have expanded in recent years,and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection(ESD),even if they measure over 20 mm in size.However,ESD requires complex maneuvers,which entails a long operation time,and is often accompanied by complications such as bleeding and perforation.Many technical developments have been implemented to overcome these complications.The scope,cutting device,hemostasis device,and other supportive devices have been improved.However,even with these innovations,ESD remains a potentially complex procedure.One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection.Recently,countertraction devices have been developed.In this paper,we introduce countertraction techniques and devices mainly for gastric cancer.

Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy

AIM To evaluate the relationship between the location of hepatocellular carcinoma(HCC) and the efficacy of transarterial chemoembolization(TACE).METHODS We evaluated 115 patients(127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to m RECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center(mm)/liver diameter(mm) on multiplanar reconstruction images rendered(MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response(CR) and non-CR groups in Child-Pugh grade A and B patients.RESULTS The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients(0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups(0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.CONCLUSION Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

Host cellular micro RNA involvement in the control of hepatitis B virus gene expression and replication

A large number of studies have demonstrated that the synergistic collaboration of a number of micro RNAs(mi RNAs), their growth factors and their downstream agents is required for the initiation and completion of pathogenesis in the liver. mi RNAs are thought to exert a profound effect on almost every aspect of liver biology and pathology. Accumulating evidence indicates that several mi RNAs are involved in the hepatitis B virus(HBV) life cycle and infectivity, in addition to HBVassociated liver diseases including fibrosis, cirrhosis and hepatocellular carcinoma(HCC). In turn, HBV can modulate the expression of several cellular mi RNAs, thus promoting a favorable environment for its replication and survival. In this review, we focused on the involvement of host cellular mi RNAs that are directly and indirectly associated with HBV RNA or HBV associated transcription factors. Exploring different facets of the interactions among mi RNA, HBV and HCV infections, and the carcinogenesis and progress of HCC, could facilitate the development of novel and effective treatment approaches for liver disease.

Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma

Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

Estimation of Physiologic Ability and Surgical Stress Scoring System Appraises Laparoscopy-Assisted and Open Distal Gastrectomy in Treatment of Early Gastric Cancer

Laparoscopy-assisted distal gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC). The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system predicts the risk of fatal postoperative complications by quantifying the patient’s reserve and degree of surgical stress, but there have been a few reports of use of the E-PASS scoring system to assess the risk of mortality following special types of surgical procedures such as LADG. In this study we assessed the feasibility of LADG versus open distal gastrectomy (ODG) by the E-PASS scoring system. The subjects of this study consisted of 69 stage IA gastric cancer patients who underwent LADG (LADG group) and 69 stage IA gastric cancer patients who underwent ODG (ODG group). The mean age of the patients in the LADG group was 68.6 years, which was significantly higher than the mean age of 63.4 years in the ODG group. There were no statistically significant differences between the groups in operation time or preoperative risk score, but there were statistically significant differences in blood loss, surgical stress score, comprehensive risk score, and duration of postoperative hospital stay. We conclude that using the E-PASS scoring system, LADG appreciates a more beneficial procedure for the treatment of EGC than ODG.

Preoperative liver functional volumetry performed by 3D-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT: a preliminary study

Aim:The present study was designed to evaluate the feasibility of preoperative liver functional volumetry performed by 3D-technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin(99mTc-GSA)scintigraphy/vascular fusion imaging using SYNAPSE VINCENT and to examine the discrepancy between conventional and functional volumetry.Methods:The study group comprised 15 patients who underwent preoperative 3-dimensional(3D)-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT software before hepatectomy between July 2014 and August 2015.The diagnosis was hepatocellular carcinoma(n=4),metastatic liver tumor(n=10),or intrahepatic cholangiocarcinoma(n=1).Right hepatectomy was performed in 2 patients,left hepatectomy in 3 patients,right posterior sectionectomy in 3 patients,segmentectomy in 2 patients,and partial hepatectomy in 4 patients.99mTc-GSA scintigraphy and computed tomography(CT)were performed to construct 3D-99mTc-GSA scintigraphy/vascular fused images.The conventional volume ratio of the planned resection region without tumor(%CT),and the functional volume ratio of the planned resection region without tumor(%GSA)were calculated.The discrepancy ratio was calculated as follows:discrepancy ratio=100-%GSA/%CT×100(%).Results:The%GSA(17.9±16.7%)was significantly lower than the%CT(21.5±17.6%)(P<0.036).In all except 2 patients,the%GSA was lower than the%CT.The discrepancy ratio ranged from-4%to 75%(median,20.7%).Conclusion:3D-99mTc-GSA scintigraphy/vascular fused images constructed using SYNAPSE VINCENT were useful for noninvasively performing functional liver volumetry in patients scheduled to undergo various patterns of hepatectomy.In planned resection regions without tumor,the functional volume ratio was about 20%lower than the conventional volume ratio.