Yorihisa Sumida

Nagasaki University, Nagasaki, Nagasaki, Japan

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Publications (81)109.24 Total impact

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    ABSTRACT: Nogo-B, located in the endoplasmic reticulum, is an isoform belonging to the reticulon protein family, which is expressed specifically in cholangiocytes and non-parenchymal cells in the liver. Nogo-B expression is down-regulated with the progression of liver fibrosis, but its distinct function in liver malignancies has not been fully clarified. We have hypothesized that Nogo-B expression may be altered in intrahepatic cholangiocarcinoma (ICC), a relatively rare type of primary liver cancer with highly malignant behavior. The present study aimed to investigate the relationship between Nogo-B expression, assessed by immunohistochemical staining, and clinicopathological factors and prognosis in 34 ICC patients. Positive expression was observed in 19 (56%) of 34 ICC specimens: 6 patients (18%) with positivity levels of 1+ (positive cells in 10-50% of cancer cells) and 13 patients (38%) with 2+ (positive cells over 50%). Importantly, the remaining 15 patients (44%) were categorized as negative expression (Nogo-B-positive cells, less than 10%). Conversely, the mass-forming type of ICC tended to express Nogo-B with the degree of 2+ positivity, compared to the periductal infiltration type (p = 0.064), and the mass-forming type showed a better 5-year survival rate (66% vs. 5%) after hepatectomy (p < 0.05). However, the degree of positivity was not associated with tumor relapse rate, disease-free and overall survival, although each of the periductal infiltration type, intrahepatic metastasis, larger tumor size, and lower microvessel counts was associated with lower survival rates. We propose that Nogo-B expression is down-regulated in ICC, the implication of which, however, remains to be investigated.
    Preview · Article · Jan 2016 · The Tohoku Journal of Experimental Medicine
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    ABSTRACT: A 66-year-old woman underwent barium gastrography as part of a medical check-up in 2010. After she took the laxative, passage of watery stools was observed but not of white stools. On day 4 after the examination, she visited a nearby clinic because of abdominal pain, and an abdominal CT showed ileus. When she developed persistent vomiting, the patient visited our hospital, and a repeat abdominal CT obtained at our hospital revealed free air around the sigmoid colon with leakage of barium. The patient was diagnosed as having perforation of the sigmoid colon, and an emergency Hartmann operation was performed.Perforation of the colon after a gastrointestinal barium series is rare ; while 2-4 cases per 10,000 have been reported following barium enema, there are scarce reports after gastrography. We suggest that as the number of subjects with constipation is likely to increase because of an aging society, it is necessary to monitor subjects undergoing gastrointestinal barium series very carefully, for example, ensuring excretion of the barium.
    Preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: We report a case of ileocecal intussusception due to Burkitt lymphoma. A 17-year-old male was admitted to the hospital for right lower abdominal pain. He was treated with antibiotics. The next day, he was transferred to our hospital and diagnosed as having an ileocecal intussusception by computed tomography.Ileocecal resection was then performed. Laparotomy showed intussusception due to an ileocecal tumor. The histological diagnosis was Burkitt lymphoma. A cytogenetic analysis showed a specific translocation of t (8 ; 22) (q24 ; q11). CODOX-M/IVAC chemotherapy was administered, and the patient achieved remission.Burkitt lymphoma is a rare disease, and the prognosis is poor. Recent developments in chemotherapy have introduced the possibility of a complete cure. Therefore, combined therapy including immediate surgery is needed for accurate diagnosis.
    No preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: The number of young surgeons in Japan has significantly decreased in recent years, which may lead to future problems in the medical field. Therefore, comprehensive training programs for young surgeons are needed. Retrospective study SETTING: We developed a specific education program called the "Recruitment of Young Medical Apprentices" (RYOMA) project. We performed this project between January 2008 and August 2013 on fourth- to sixth-year medical students and internship doctors. The RYOMA project included step-by-step surgical education programs on open and scopic procedures as dry, wet, and animal laboratory training. Our goal was to increase the number of young and specialist surgeons. Based on an interview questionnaire answered by 90 medical students, most young students were interested in surgical training and several chose to become surgeons in the future. The most positive opinions regarding the field of surgery were the impressive results achieved with surgery, whereas negative opinions included the difficulty of the surgical skill, physical concerns related to difficult work environments, and the severity of surgical procedures. The present program has begun to resolve negative opinions through adequate training or simulations. Of the 19 medical students and internship doctors who attended the RYOMA project in 2008, 17 trainees (90%) were satisfied with this special surgical program and 16 (88%) showed interest in becoming surgeons. The number of participants considering the field of surgery increased between 2008 and 2013. Of 23 participants, 19 (83%) had a positive opinion of the program after the training. Gaining experience in surgical training from an early stage in medical school and step-by-step authorized education by teaching staff are important for recruiting students and increasing the number of young surgeons.
    No preview · Article · Apr 2014 · Journal of Surgical Education
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    ABSTRACT: Objectives The number of young surgeons in Japan has significantly decreased in recent years, which may lead to future problems in the medical field. Therefore, comprehensive training programs for young surgeons are needed. Design Retrospective study Setting We developed a specific education program called the “Recruitment of Young Medical Apprentices” (RYOMA) project. Participants We performed this project between January 2008 and August 2013 on fourth- to sixth-year medical students and internship doctors. The RYOMA project included step-by-step surgical education programs on open and scopic procedures as dry, wet, and animal laboratory training. Our goal was to increase the number of young and specialist surgeons. Results Based on an interview questionnaire answered by 90 medical students, most young students were interested in surgical training and several chose to become surgeons in the future. The most positive opinions regarding the field of surgery were the impressive results achieved with surgery, whereas negative opinions included the difficulty of the surgical skill, physical concerns related to difficult work environments, and the severity of surgical procedures. The present program has begun to resolve negative opinions through adequate training or simulations. Of the 19 medical students and internship doctors who attended the RYOMA project in 2008, 17 trainees (90%) were satisfied with this special surgical program and 16 (88%) showed interest in becoming surgeons. The number of participants considering the field of surgery increased between 2008 and 2013. Of 23 participants, 19 (83%) had a positive opinion of the program after the training. Conclusions Gaining experience in surgical training from an early stage in medical school and step-by-step authorized education by teaching staff are important for recruiting students and increasing the number of young surgeons.
    No preview · Article · Jan 2014 · Journal of Surgical Education
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    ABSTRACT: A 20-year-old man visited a neighborhood clinic because of purpura and lower-extremity edema, afterwhich he complained of abdominal pain. He was diagnosed with Schönlein-Henoch pupura and was admitted to our hospital. He received steroid therapy. On the 2nd day, his abdominal pain was strong. Abdominal computed tomography (CT) showed a small bowel intussusception. He received antispasmoic drugs but, his pain did not diminish. We performed laparoscopic reduction of the intussusception. Laparoscopic findings showed edematous thickening of the small bowel and the hemorrhagic mesentery. Intussusception was not observed.After the operation, he did not experience any abdominal pain. A few days later the abdominal pain returned with tarry stool. We determined that the Schönlein-Henoch pupura conditions had deteriorated. We had trouble in differential diagnosis because Schönlein-Henoch pupura is similar to intussusception in symptoms of abdominal pain and tarry stool.If an operation was required, laparoscopy, which is less invasive, could be useful for both diagnosis and treatment.
    Preview · Article · Jan 2014 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: Background/aims: Pylorus-preserving pancreaticoduodenectomy (PPPD) has the advantage of achieving good nutritional status postoperatively, but delayed gastric empty (DGE) is a frequent complication leading to a longer fasting period. Subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) is an alternative option to preserve nutritional status and shorten the fasting period. We retrospectively compared clinical results between PPPD and SSPPD. Methodology: PPPD was performed in 28 patients and SSPPD in 27, between 2000 and 2009. Results: Pancreatic carcinoma was more frequent in the SSPPD group (p = 0.041). Operating time was longer in the SSPPD group (610 min) than in the PPPD group (540 min; p = 0.031). Blood loss was greater in the SSPPD group (1810 mL) than in the PPPD group (1306 mL; p = 0.048). Period of NG intubation and fasting period were shorter in the SSPPD group (6 days and 9 days, respectively) compared to the PPPD group (15 days and 19 days, respectively; p <0.01 each). Severe DGE was 7% in the SSPPD group and 46% in the PPPD group (p <0.01). Postoperative complications and nutritional status in the early period did not differ between groups, although incidence of fatty liver was higher in the SSPPD group (78%) than in the PPPD group (25%; p <0.01). Conclusions: SSPPD is a useful alternative for pancreaticoduodenectomy. Further prospective studies with longer follow-up are warranted to clarify the superiority and problems associated with this procedure.
    No preview · Article · Jun 2013 · Hepato-gastroenterology
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    ABSTRACT: A 55-year-old man who lived at a nursing-care facility for the mentally handicapped visited a local hospital for fever and vomiting in April 2012. Chest X-ray showed the incarcerated partial denture with clasp into the esophagus, and cervical and chest computed tomography (CT) revealed mediastinal emphysema around the esophagus. We diagnosed esophageal perforation by a foreign body, so we performed an emergent operation. At first, we tried to remove the clasp denture through a rigid scope ; however, although it moved from the thoracic esophagus, but became stuck in the cervical esophagus. Secondly, he underwent surgery to remove it using a cervical incision, to insert drain tubes into the bilateral mediastinal space, and for a tracheostomy and a enterostomy.Although it is possible to remove a foreign body from the esophagus by elimination spontaneously or by esophageal endoscope in some cases, it is very difficult to remove a partial denture with clasp.
    No preview · Article · Jan 2013 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

  • No preview · Article · Jan 2011 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

  • No preview · Article · Jan 2011 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

  • No preview · Article · Jan 2011 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: To identify predictors of changes in functional hepatic volumes after portal vein embolization (PVE) before hepatectomy, we examined the relationship between hepatic functional parameters and changes in functional volume of the embolized and non-embolized liver based on a previous volumetric analysis. Subjects were 24 patients who underwent PVE, which was performed through the trans-ileocolic vein (n = 4) or by percutaneous transhepatic puncture (n = 20). The RI liver volume parameter was measured by liver scintigraphy with technetium-(99m) galactosyl human serum albumin ((99m)Tc-GSA). Computed tomography (CT) volume parameter was also measured. Significant atrophy of the embolized liver and hypertrophy of the non-embolized liver (change of 72 ± 108 cm(3) and 111 ± 91 cm(3), respectively) (change of 7.8%) was observed after PVE. The change in these RI volume parameters (change of 173 ± 175 cm(3) and 145 ± 137 cm(3) , respectively) (16.5%) was significantly greater than CT volume parameters (P < 0.01). CT vol and RI vol in the embolized and non-embolized liver were well correlated (r = 0.75 and 0.69, respectively). However, the correlation between CT and RI volume parameters in the embolized and non-embolized liver after PVE was very weak (r = 0.17 and 0.03, respectively). Only alkaline phosphatase level correlated negatively with atrophic CT volume parameter of the embolized liver (r = -0.455, P < 0.05). When compared with CT volume parameter, more parameters were significantly correlated with changes of RI volume parameter in the embolized liver: pre-PVE pressure; ICGR15; and serum levels of hyaluronate, total bilirubin, albumin, and alkaline phosphatase. Only platelet count was significantly correlated with hypertrophy of the non-embolized liver. RI volume parameter might more accurately reflect functional changes in the embolized liver and non-embolized liver than CT volume parameter. Correlated parameters might allow us to predict the functional effect of PVE.
    No preview · Article · Dec 2010 · Journal of Surgical Research
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    ABSTRACT: Expert technique and special anatomical or physiological knowledge are needed in the field of pancreatic surgery. The establishment of basic policies and operative techniques for pancreaticoduodenectomy (PD) and stepwise training for young pancreatic surgeons are necessary. We scheduled PD for ampullar, biliary and pancreas carcinoma, and evaluated types of pancreatic anastomosis or results by each operator such as a chief, fellowship and resident doctors (> 5 years after graduation). Based on a questionnaire distributed to young residents (n = 30), only half of them have experienced PD or PPPD, which was related to operating volume at the hospital. Post-operative complications at the teaching hospital were observed in 50 of 88 patients (56%). Post-operative complications were not significantly correlated with the type of anastomosis; however, duct-to-mucosa anastomosis of the pancreas might decrease pancreatic fistula (0% vs. 26% in pancreaticogastrostomy and 13% in pancreaticojejunostomy without duct-to-mucosa anastomosis). Based on the stepwise education protocol of technique, patient demographics, the surgical records and the post-operative complications were not significantly different between experienced teaching surgeons, fellowship surgeons and senior residents, although the time of operation and anastomosis tended to be longer in resident surgeons (p = 0.22). Competent operative techniques for inexperienced surgeons and the achievement of safe resection at each stage are our educational goals for PD.
    Full-text · Article · Sep 2010 · Hepato-gastroenterology
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    ABSTRACT: Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (1CTP) is a sensitive serum marker for metastatic bone carcinomas and may also be associated with invasiveness of various carcinomas. To clarify the significance of 1CTP in hepato-biliary pancreas malignancies, we examined the relationship between clinicopathological features and serum level of 1CTP. The subjects were 75 patients who underwent surgical resections including 27 patients with liver carcinomas, 15 with extra-hepatic biliary carcinomas, 14 pancreatic carcinomas and 19 benign diseases. 1CTP level tended to be higher in the malignant diseases than in benign diseases but this difference was not significant (p = 0.065). Compared to benign adenoma, 1CTP level in the malignant diseases was significantly higher (p = 0.049). 1CTP level tended to be higher in patients with cholangitis compared to those with no inflammation or benign tumors (p = 0.065). 1CTP was not correlated with any tumor markers. 1CTP was not associated with node status and vascular infiltrations. 1CTP level tended to be lower in patients with poor differentiation. Serum level of 1CTP might be a predictive marker for hepatobiliary pancreas malignancies but also reflects the degree of co-existing cholangitis.
    Full-text · Article · Jul 2010 · Hepato-gastroenterology
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    ABSTRACT: To achieve complete resection of metastatic colonic carcinoma in the liver and lung, thoracolaparotomy-assisted simultaneous resection was attempted in a 60-year-old male patient who had previously undergone sigmoidectomy for primary sigmoid colon carcinoma. A solitary liver metastasis was observed in segment 7 and a solitary lung metastasis was located in segment 6 of the right lower lung. Simultaneous resection was attempted and, in the left lateral position, a thoraco-laparotomy with oblique incision was made in the right seventh intercostal space. Both tumors could be palpated under a good operative view. A partial hepatectomy was performed followed by a segmental resection of the lung. A chest drainage tube was inserted for two postoperative days. The patient had no remarkable complications including pulmonary complication after surgery and was discharged at day 20 post-operation. For metastatic tumors simultaneously located in the right subphrenic part of the liver and the lower part of the right lung, thoraco-laparoscopy-assisted complete resection is a safe and useful option to achieve curative treatment.
    Full-text · Article · Sep 2009 · Hepato-gastroenterology
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    ABSTRACT: A new prognostic staging system, the SLiDe (S, stage; Li, liver damage; De, des-gamma-carboxy prothrombin) score was recently proposed. We examined 207 HCC patients following hepatic resection to determine the usefulness of this staging system for HCC patients after surgery. Disease-free and overall survival rates were calculated according to the Kaplan-Meier method, and differences between groups were tested for significance using the log-rank test. Regarding disease-free survival, there were no significant differences in survival between SLiDe score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.01) and between 2-3 vs 4-5 (p < 0.01). Regarding overall survival, there were no significant differences in survival between score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.05) and between 2-3 vs 4-5 (p < 0.01). The SLiDe score, a staging system that combines tumor factors, a tumor marker and hepatic function, might be a better predictor of prognosis in HCC patients who have undergone hepatic resection.
    Preview · Article · Jul 2009 · Hepato-gastroenterology
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    ABSTRACT: To identify clinical significances of portal vein embolization (PVE) prior to major hepatectomy, we examined clinical parameters and outcome after right hepatectomy in patients who underwent PVE. The subjects were 30 patients who underwent PVE (PVE group), and 52 patients (non-PVE), in whom PVE was considered unnecessary, followed by right hepatectomy for hepatobiliary cancer. Total hepatic volume after PVE (1068+/-268 ml) tended to increase compared with before PVE (p=0.059). After PVE, the change in hemi-liver volume was 8.9+/-6.0%. Increases in hepatic volume of non-embolized left liver before and at 4 weeks after hepatectomy between the PVE and non-PVE groups were similar. Changes in hepatic volumes before and after PVE were not significantly influenced by background liver disease. After PVE, the functional liver volume (419+/-185 cm3) was significantly lower than morphological volume (564+/-165 cm3) in the embolized liver (p<0.05). Although preoperative liver function was worse in the PVE group compared with non-PVE, serious hepatic complications were rarely observed in the PVE group. Marked changes in hepatic volume were noted after PVE in patients with impaired liver function and those who need large-volume right hepatectomy, especially in functional volume, suggesting that PVE is a useful procedure to prevent postoperative liver failure.
    Preview · Article · May 2009 · Hepato-gastroenterology
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    ABSTRACT: Longitudinal tumor extension from the main tumor involves intramural or superficial spread along the bile duct, which influences surgical curability. Identifying the range of superficial extension is difficult by preoperative imaging. To clarify specific characteristics of bile duct carcinoma (BDC) with superficial extension of epithelium in the bile duct, we examined clinicopathologic features and patient outcomes in BDC patients with or without superficial extension who underwent surgical resection. Between 1994 and 2008, we retrospectively examined clinicopathologic findings and outcomes for 42 BDC patients who underwent surgical resection and divided them into two groups: (1) superficial extension (SE) group (n = 10); and (2) non-SE group (n = 32). In terms of macroscopic growth of the main tumor, the papillary type was more common in the SE group than in the non-SE group, whereas the nodular type was dominant in the non-SE group. The prevalence of cancer-positive findings at the cut end of the bile duct was higher in the SE group. Portal vein invasion was not observed in the SE group, and the prevalence of regional lymph node metastasis was significantly greater in the non-SE group than in the SE group. No patients died of cancer in the SE group, who tended to show better survival than the non-SE group. The present results suggest that a good prognosis may be achieved in BDC patients with SE when complete resection is accomplished.
    Full-text · Article · May 2009 · World Journal of Surgery
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    ABSTRACT: A C-arm equipped with a flat detector CT (C-arm CT) has been developed, which provides images with high spatial resolution that could facilitate effective 3D information during interventional procedures. The cone beam reconstructive method was applied for reconstruction of images. Time of reconstruction of 3D images was approximately one minute after the scan. The axial thin-slice images, the real-time volume rendering, maximum intensity projection, shaded surface display and multiplanner reconstruction images could be obtained from any direction in a single scan. We experienced 7 cases and present two informative cases with biliary obstruction caused by tumor that underwent C-arm CT. The First case shows gallbladder carcinoma invading the hilum. The C-arm CT provided precise images of the stenotic bile ducts that could be viewed in any direction. Multiple expandable metallic stent could be accurately placed in 3 stenotic bile ducts. The second case shows a hilar bile duct carcinoma. By using various pressure infusion of the contrast medium, severely stenotic hepatic duct was confirmed before surgery. C-arm CT provided useful information regarding the precise 3D status of the bile duct and the extent of tumor invasion.
    Preview · Article · May 2009 · Hepato-gastroenterology
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    ABSTRACT: Hepatocellular carcinoma (HCC) patients often have esophagogastric varices due to portal hypertension by chronic hepatitis or cirrhosis. Surgical treatment for gastric varices is necessary when the patient undergoes hepatic resection for HCC, simultaneously. We examined the clinical demographics, surgical records and outcome in 7 patients undergoing both hepatectomy and Hassab's operation (=decongestion of upper gastric veins and splenectomy) between 1994 and 2007. All patients had HCC, including chronic injured liver diseases. Preoperative liver functions were well preserved in all patients. Right hepatectomy was performed in two patients and limited resections in 5. Three patients had postoperative complications and the in-hospital death by hepatic failure was observed in one. Four patients had tumor recurrence within one year and 3 were dead, while, two patients had long-term survival with or without recurrence of HCC. Following Hassab's operation, gastric varices dramatically disappeared. Portal hypertension and hypersplenism were significantly improved. Simultaneous operation with Hassab's procedure and hepatectomy is useful and can be safely performed in HCC patients with gastric varices.
    Preview · Article · May 2009 · Hepato-gastroenterology