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Biomedical subjects

Naotaka Fujita

Publications and source records attributed to Naotaka Fujita.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopic biliary drainage for patients with unresectable pancreatic cancer with obstructive jaundice who are to undergo gemcitabine chemotherapy.

AIM: To assess optimum endoscopic biliary drainage (EBD) in cases with unresectable pancreatic cancer in the era of gemcitabine (GEM). METHODS: Thirty patients with unresectable pancreatic cancer, who presented with jaundice and underwent chemotherapy using GEM after EBD were included in this study (GEM group). Fifteen cases with the same clinical manifestation and stage of pancreatic cancer treated with EBD alone were also included as controls. A covered metallic stent (CMS) or a plastic stent (PS) was used for EBD. The mean survival time (MST) in each group, risk factors of survival time, type of stent used and associated survival time, occlusion rate of stent, patency period of stent, and risk factors of stent occlusion were evaluated. RESULTS: MST in the GEM group was longer than that in the control (9.9 mo vs 6.2 mo). In the GEM group, the survival time was not different between those who underwent metallic stenting and those who underwent plastic stenting. Stent occlusion occurred in 60% of the PS group and 7% of the CMS group. The median stent patency in the PS-GEM group and the CMS-GEM group was 5 mo and 7.5 mo, respectively. Use of a PS was the only risk factor of stent occlusion. CONCLUSION: A CMS is recommended in cases presenting with jaundice due to unresectable pancreatic cancer, since the use of a CMS makes it possible to continue chemotherapy using GEM without repetition of stent replacement.

Antimetabolites, Antineoplastic↗
PubMed2006

[Solid-pseudopapillary tumor with an elderly woman, showing an increase in size over a four-year follow-up period: report of a case].

Solid-pseudopapillary tumor (SPT) is considered to be a tumor showing an essentially benign biological behavior based on the results of histological examination of resected specimens and postsurgical follow-up. Little is known regarding the growing speed and pattern, and the process of cystic structure formation of this tumor due to a lack of reports describing its natural history. We herein report a case of SPT showing an increase in size in a four-year follow-up period, which underwent resection thereafter.

Aged, 80 and over↗
PubMed2005

Clinical study of choledochocele: is it a risk factor for biliary malignancies?

BACKGROUND: We aimed to clarify the clinical characteristics of choledochocele and to evaluate the possibility of choledochocele as a risk factor for biliary malignancies. METHODS: The clinical feature, the configuration of the pancreatobiliary ductal system, coexistent pancreatobiliary lesions, and amylase level in bile in 21 patients with choledochocele were reviewed. The correlation between the configuration, comorbid diseases, and amylase level in the bile was investigated. RESULTS: There was a female predominance, and 57% of the patients showed abdominal pain. Quite a few patients showed elevation of the levels of hepatobiliary enzymes. The configuration of the pancreatobiliary ductal system and choledochocele was classified into two categories: type I, where the choledochocele and pancreatic duct were visualized independently or simultaneously (90.5%); and type II, where the pancreatic duct was visualized after filling of the choledochocele (9.5%). Among coexistent bilio-pancreatic diseases, biliary stone diseases were the most frequent. Biliary malignancy was seen in 3 patients (14.3%). The amylase level in the bile was high in 50% (4/8) of the patients examined. The rate of abnormal elevation of amylase level in the bile in the two types of pancreatobiliary ductal system and choledochocele was 3/7 and 1/1, respectively. CONCLUSIONS: The prevalence of organic abnormal arrangement of the pancreatobiliary ductal system in which the choledochocele serves as a common channel is low. However, there are patients with suspected functional abnormal arrangement of the pancreatobiliary ductal system, who may possibly be a high-risk group for biliary malignancy.

Adult↗
PubMed2005

Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow-up by EUS.

BACKGROUND: We investigated the mode of progression of intraductal papillary-mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow-up in order to elucidate the characteristics of malignancy and to establish an effective treatment strategy. METHODS: Fifty-one patients with IPMN (branch-duct type, 47; main-duct type, 4) who had undergone follow-up study by endoscopic ultrasonography (EUS) were included (mean follow-up duration, 41.0+/-32.3 months; average number of EUS examinations performed during follow-up, 4.4). Chronological changes in EUS findings and histological findings of resected specimens were evaluated. RESULTS: Of the patients with the branch-duct type, only 2% showed enlargement of the dilated branches. In the main-duct-type group, an increase in size of the main pancreatic duct (MPD) was observed in 75% of the patients. In 14 patients with papillary protrusions, an increase in size and lateral spread was observed in 71% and 43%, respectively. No patients developed invasive cancer. In 15 patients who had thick septum-like structures (TSS), the development of papillary protrusions and that of invasive cancer were observed in 53% and 13%, respectively. Twenty-nine patients who had thin septum-like structures showed no change. Two patients with dense multilocular large cysts and TSS developed invasive cancer without change in the cystic lesions. One patient developed carcinoma with multifocal stromal invasion. CONCLUSIONS: Patients with branch-duct type IPMNs without papillary protrusions or TSS are not immediate candidates for surgery. Those who have small papillary protrusions have a benign course. It is recommended that patients with the large branch-duct type with TSS should undergo surgery. Attention should be paid to the entire pancreas when performing follow-up examinations in patients with branch-duct type IPMN, as invasive ductal adenocarcinoma can develop at a site in the pancreas different from that of the IPMN.

Adenocarcinoma, Mucinous↗
PubMed2005

Mucinous cystic neoplasm in a young male patient.

A 25-year-old Japanese man was admitted to our hospital with a history of recurrent pancreatitis and a pseudocyst of the pancreas. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed an encapsulated multilocular cystic mass 5 cm in diameter in the pancreatic tail. Endoscopic ultrasonography demonstrated a mural nodule, and endoscopic retrograde pancreatography showed a communication of the lesion with the main pancreatic duct. A neoplastic cystic tumor was suspected, and a resection of the body tail of the pancreas was performed. The lesion was a multilocular cyst having a common fibrous capsule and viscous content. Histologically, the cystic lesion was lined with a single layer of columnar cells with low-grade atypia. Ovarian-type stroma (OS) was confirmed, and it showed positive for antiestrogen receptor and antiprogesteron receptor staining. Based on these findings, the lesion was diagnosed as mucinous cystic neoplasm (MCN), an adenoma that shows extraordinarily high prevalence in women. Further study on the pathogenesis of MCN in male patients should be undertaken to elucidate the process of development.

Adult↗
PubMed2004

Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens.

PURPOSE: To prospectively determine the magnetic resonance (MR) signal intensity characteristics of structures of the ampullary region and to assess the potential use of MR imaging in evaluation of the extent of periampullary tumors in resected specimens. MATERIALS AND METHODS: Twenty-five specimens from the ampullary region obtained in four autopsy cases without periampullary tumors and in 21 patients with periampullary tumors were examined with a 1.5-T MR system and a circular surface coil with 5-inch (12.7-cm) diameter. High-spatial-resolution MR images were obtained with field of view of 100 x 100 mm, matrix of 256 x 256 or 512 x 256, and section thickness of 2 mm. MR imaging findings were compared with histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of high-spatial-resolution MR imaging for assessment of tumor invasion into surrounding tissues were evaluated by two radiologists. RESULTS: T1- and T2-weighted MR images clearly depicted normal structures in the ampullary region that included Oddi muscle, duodenal wall, common bile duct, and pancreas; these findings corresponded well with histologic findings. In 20 (95%) of 21 tumors, high-spatial-resolution MR imaging depicted location and extension of periampullary tumors precisely. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of high-spatial-resolution MR imaging for assessment of tumor invasion into surrounding tissue were 88%, 100%, 96%, 100%, and 94%, respectively. CONCLUSION: In this study, MR imaging correctly depicted location, extension, and origin of tumor. High-spatial-resolution MR imaging has potential for presurgical staging of tumors in this region.

Aged↗
PubMed2004

Endoscopic approach to early diagnosis of pancreatic cancer.

Since its development, endoscopic retrograde cholangiopancreatography (ERCP) has been playing a major role in the diagnosis of pancreatic diseases. The recent development of magnetic resonance cholangiopancreatography has accelerated the shift in the role of ERCP toward more therapy-oriented applications. In the diagnosis and treatment of curable pancreatic cancer, however, ERCP remains the mainstay of imaging modalities. ERCP is not simply a method with which to obtain x-ray images of the pancreatic duct. Collection of pure pancreatic juice, transpapillary biopsy/brush cytology of the pancreatic duct, intraductal ultrasonography, and peroral pancreatoscopy are all performed based on the ERCP technique. Endoscopic ultrasonography (EUS) has a high spatial resolution and provides tomographic images of the pancreas and its neighboring organs. EUS is now widely used in evaluation of the local extent of pancreatic cancer and the differential diagnosis of cystic lesions of the pancreas. EUS-guided fine needle aspiration biopsy/cytology is performed to obtain a histologic diagnosis before beginning chemotherapy. Although the number of pancreatic cancer patients who are candidates for surgery is limited at present, there is an increasing need for ERCP-based techniques in both the diagnosis and treatment of pancreatic neoplasms.

Carcinoma, Pancreatic Ductal↗
PubMed2004

Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial.

OBJECTIVE: This study was performed to determine and compare the effectiveness and incidence of complications of percutaneous cholecystostomy and gallbladder aspiration in cases of severe acute cholecystitis. SUBJECTS AND METHODS. Fifty-eight patients with severe acute cholecystitis who did not improve after antibiotic treatment were included in this study. The patients were randomized into either the percutaneous cholecystostomy group (n = 30) or the gallbladder aspiration group (n = 28). Under sonographic guidance, percutaneous cholecystostomy was performed in the usual manner using a 6.5- or 7-French catheter. Gallbladder aspiration was carried out with a 21-gauge needle under sonographic guidance. The technical success, clinical response, and complications in each group were evaluated. RESULTS: Percutaneous cholecystostomy and gallbladder aspiration were technically successful in 30 patients (100%) and 23 patients (82%), respectively (not statistically significant). In five patients (18%) of the gallbladder aspiration group, aspiration was unsuccessful because of replacement of bile with dense biliary sludge or pus. Good clinical response was obtained in 27 patients (90%) of the percutaneous cholecystostomy group and in 14 patients (61%) of the gallbladder aspiration group (p < 0.05). As for complications, dislodgment of the catheter occurred in one patient of the percutaneous cholecystostomy group and minor bleeding in one patient after gallbladder aspiration. No major complications or procedure-related deaths occurred in either group. CONCLUSION: For severe acute cholecystitis, percutaneous cholecystostomy was superior to gallbladder aspiration in terms of clinical effectiveness and had the same complication rate as gallbladder aspiration.

Acute Disease↗
PubMed2003

Serous cystadenoma of the pancreas associated with obstructive jaundice.

We herein report a case of pancreatic serous cystadenoma in a patient who presented with jaundice, and we provide a review of the literature. A 53-year-old man was admitted with complaints of jaundice and weight loss. With a preoperative diagnosis of pancreatic serous cystadenoma with obstructive jaundice, he underwent pylorus-preserving pancreatoduodenectomy. A cystic tumor partially protruding into the bile duct was observed in the pancreatic head. Histology verified serous cystadenoma of the pancreas. Histologically, no atypia was proven in the epithelium. There have been only eight case reports dealing with serous cystadenoma of the pancreas with obstructive jaundice. Although serous cystadenoma of the pancreas has essentially a benign nature, pylorus-preserving pancreatoduodenectomy is the treatment of choice when available to avoid the recurrence of obstructive jaundice.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2003

Abnormal arrangement of the pancreato-biliary ductal system associated with advanced gallbladder cancer diagnosed 3 years after follow-up ultrasonography.

We herein report a case of abnormal arrangement of the pancreato-biliary ductal system (AAPB) followed by advanced gallbladder cancer 9 years after the initial endoscopic retrograde cholangiopancreatography (ERCP) diagnosis and almost 3 years after follow-up ultrasonography (US). A 65-year-old woman was referred to our department from a private clinic because of difficulty in controlling her diabetes mellitus. The patient had no complaints, and physical examination revealed no jaundice in her skin or conjunctiva. ERCP demonstrated the presence of AAPB (bile duct-main type) without congenital dilatation of the bile duct or irregularity in the gallbladder wall. She did not wish to undergo cholecystectomy. Follow-up transabdominal US revealed no change in the gallbladder. Two years and 9 months after this US examination, she developed advanced gallbladder cancer involving the liver and bile duct, with paraaortic lymph node metastases confirmed by US, computed tomography, and ERCP. This case re-emphasizes the necessity for patients with AAPB to undergo intensive follow-up examinations or cholecystectomy when the diagnosis of AAPB has been established.

Aged↗
PubMed2003

Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial.

BACKGROUND: Endoscopic papillary balloon dilatation may be an alternative to endoscopic sphincterotomy in the treatment of bile duct stones. However, there is a controversy as to the effectiveness and safety of endoscopic papillary balloon dilatation. METHODS: Two hundred eighty-two patients with bile duct stones were enrolled and randomized to an endoscopic sphincterotomy or endoscopic papillary balloon dilatation group. The success rate for duct clearance as well as the frequency and types of complications were evaluated prospectively. Endoscopic sphincterotomy was performed in a standard manner. Endoscopic papillary balloon dilatation was carried out with gradual inflation of a 4-, 6-, or 8-mm diameter balloon. RESULTS: Complete duct clearance was achieved in 100% in the endoscopic sphincterotomy group and 99.3% in the endoscopic papillary balloon dilatation group (not significant). Complications occurred in 11.8% of patients in the endoscopic sphincterotomy group and 14.5% of those in the endoscopic papillary balloon dilatation group (not significant). No complication was severe; there was no mortality. The frequency of acute pancreatitis was higher in the endoscopic papillary balloon dilatation group than the endoscopic sphincterotomy group (respectively, 10.9% vs. 2.8%; p < 0.045). Hemorrhage occurred only in the endoscopic sphincterotomy group. CONCLUSIONS: Endoscopic sphincterotomy and endoscopic papillary balloon dilatation were approximately equal in terms of successful clearance of bile duct stones. They were also similar with respect to overall complications. Endoscopic papillary balloon dilatation is an alternative to endoscopic sphincterotomy as a treatment of bile duct stones.

Adult↗
PubMed2003

Pseudolesion of the bile duct caused by flow effect: a diagnostic pitfall of MR cholangiopancreatography.

OBJECTIVE: Our objective was to examine the influence of the shape of imaged structures and the velocity of flow on the appearance of flow artifacts seen on MR cholangiopancreatography (MRCP) in a phantom model. MATERIALS AND METHODS: Three types of phantoms representing the biliary system were constructed. The first phantom type was a straight tube; the second, a single tube in which the inlet and outlet diameters varied by a ratio of as much as 1:6; and the third, a tube that simulated a stricture in the biliary system and a gallstone. All experiments were repeated three times. RESULTS: We did not observe any flow artifacts in the experiments we performed with the straight tubes. A higher rate of flow resulted in decreased signal intensity in tubes simulating bile ducts; the decreased signal was most likely to be observed on images in which the speed of flow exceeded 5 mm/sec. Flow artifacts were seen only if the ratio between the inlet and outlet diameters was 1:4 or greater. Simulations of bile duct abnormalities--such as a 50% stricture or the presence of a gallstone--did not produce any flow artifacts. CONCLUSION: In our experiments, a flow artifact could be seen on images in which the ratio between the inlet and the outlet diameters in the phantom was equal to or greater than 1:4. This finding indicates that a flow artifact could be observed in dilated bile ducts on MRCP under clinical conditions. Knowing that a pseudo-filling defect can be caused by a flow artifact should help to prevent misinterpretation of MRCP images.

Aged↗
PubMed2003

Autoimmune pancreatitis and multiple bile duct strictures treated effectively with steroid.

We herein report a patient with strictures of the hepatic hilar and intrapancreatic bile duct associated with autoimmune pancreatitis, who responded well to corticosteroid therapy. Although this bile duct lesion resembled primary sclerosing cholangitis (PSC) morphologically,its dramatic response to corticosteroid therapy seems to indicate that it is a different entity. A review of the literature revealed 13 patients with multiple biliary strictures and chronic pancreatitis successfully treated with corticosteroid therapy. From the clinical point of view, knowledge of the existence of a patient group with autoimmune pancreatitis with morphology similar to that of PSC and which responds well to corticosteroid therapy is important.

Aged↗
PubMed2002

Diagnosis of pT2 gallbladder cancer by serial examinations with endoscopic ultrasound and angiography.

BACKGROUND: The prognosis of pT2 gallbladder cancer correlates with whether appropriate surgery for the spread of cancer has been performed. Therefore, accurate preoperative T staging is especially important. We carried out this study to evaluate the usefulness of serial examinations by endoscopic ultrasound (EUS) and angiography for the T staging of pT2 gallbladder cancer. METHODS: Forty-eight patients with gallbladder cancer who underwent both EUS and surgery between 1983 and 1998 were included in this study. The accuracy of serial examination by both EUS and angiography in T staging, based on previously established diagnostic criteria, was retrospectively evaluated. First, the presence or absence of subserosal tumor invasion was assessed by EUS alone. Second, in equivocal cases, the depth of tumor invasion was further evaluated by angiographic findings. RESULTS: Twenty-four patients were correctly diagnosed as having other than pT2 cancer by EUS alone. Angiographic findings were reviewed in 19 of the remaining patients, who had pT1, pT2, or a small number of pT3 lesions. The sensitivity, specificity, and overall accuracy in the T staging of pT2 gallbladder cancer was 81.8%, 90.6%, and 88.4%, respectively. CONCLUSIONS: Serial angiographic examination following adequate patient selection by EUS is effective and efficient for the diagnosis of pT2 gallbladder cancer.

Adult↗