Biomedical subjects

Y Atomi

Publications and source records attributed to Y Atomi.

138 records · Page 8Linked to original sources

PubMedDate not supplied

Submucosal tumor (SMT)-like esophageal squamous cell carcinoma with gastric metastasis.

We present here a case of submucosal tumor-like esophageal cancer with metastasis to the stomach. A 60-year-old man, whose ability to swallow was impaired, was admitted to Kyorin University School of Medicine Hospital. Gastrointestinal endoscopy demonstrated a small bulging mass in the lower esophagus and a large submucosal mass in the gastric cardia. The gastric lesion was growing rapidly and becoming easily hemorrhagic. It appeared rich in blood flow by angiography. Surgical treatment was adopted after a diagnosis of esophageal cancer and a gastric submucosal tumor was made. However, in the end, the gastric mass was identified as a metastasis from the esophageal squamous cell carcinoma. Moreover, the primary esophageal lesion displayed quite a special type of histology, a so-called submucosal tumor-like pattern, which was covered by normal epithelium and grew mainly in the submucosal layer of the esophagus. Gastric metastasis from esophageal cancer is relatively rare, and it is quite rare that an esophageal squamous cell carcinoma grows as a submucosal tumor. Finally, the patient died of pneumonia and metastasis to the liver on the 110th day of hospitalization. Intramural metastasis to the stomach from esophageal cancer should be treated in its advanced stage, and poor prognosis can be expected from aggressive treatment. It is necessary to recognize this complication so that appropriate therapy can be carried out on patients with esophageal cancer, and the situation needs to be carefully evaluated, including the stomach, both before and after treatment.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Peroral jejunoscopy for treating stenosis of hepaticojejunostomy after pancreatoduodenectomy.

A 72-year-old woman suffered from relapsing cholangitis after pylorus-preserving pancreatoduodenectomy for chronic pancreatitis. The common hepatic duct had been anastomosed to the jejunum 8 cm distal to the duodenojejunostomy. Peroral jejunoscopy showed a severe stenosis of the hepaticojejunostomy, which was endoscopically enlarged by means of electroincision and balloon dilation, subsequently. No procedure-related complications occurred. The patient has been asymptomatic for 34 months. Most of the strictures of bilioenterostomy are reportedly treated by surgical revision, the percutaneous transhepatic approach, or the percutaneous transjejunal approach. Endoscopic treatment may be attempted in cases in which the postoperative anatomy potentially allows endoscopic access, because of its minimal invasiveness and effectiveness.

Aged↗

PubMedDate not supplied

Quantitative analysis of telomerase activity: a potential diagnostic tool for colorectal carcinoma.

BACKGROUND/AIMS: We describe the results of the application of the nonradioactive F-TRAP (fluorescence-based telomeric repeat amplification protocol) assay for the diagnosis of colorectal carcinoma(s). We also investigated whether the level of telomerase activity in colorectal carcinoma can be distinguished from that in normal colorectal tissue or benign colorectal tumors, in which the presence of telomerase activity has also been demonstrated. In addition, we also investigated whether it could be a potential tumor progression marker. METHODOLOGY: The F-TRAP assay was performed, using biopsy specimens obtained from colonoscopic examinations, including 20 colorectal carcinoma, 10 tubular adenoma and 20 adjacent colorectal normal tissue specimens. In 15 carcinoma cases, the correlation between telomerase activity level and clinicopathological parameters was analyzed. RESULTS: The results showed that the level of telomerase activity in colorectal carcinomas (88.71 +/- 92.1 units; mean +/- SD) was much higher than that in normal colorectal tissues (3.34 +/- 8.57 units) or adenomas (7.8 +/- 10.27 units). By quantifying the level of telomerase activity using the F-TRAP assay, colorectal carcinomas can be distinguished from normal colorectal tissue or colorectal benign tumors. However, no significant correlation was observed between telomerase activity levels and clinicopathological parameters such as depth of tumor invasion, lymphatic and/or venous involvement, and regional lymph node metastasis and Dukes' stage. CONCLUSIONS: Quantitative analysis of the level of telomerase activity using the F-TRAP assay provides a useful diagnostic tool for colorectal carcinoma, but it would not be useful as a tumor progression marker.

Adenoma↗

PubMedDate not supplied

Magnetic resonance cholangiopancreatography for diagnosing hepatolithiasis.

BACKGROUND/AIMS: Direct cholangiography with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography sometimes fails to adequately opacify the entire biliary tract, because of severe biliary obstruction caused by ductal stricture or lodged stones. We assessed the diagnostic accuracy of magnetic resonance cholangiopancreatography for hepatolithiasis. METHODOLOGY: Five patients with hepatolithiasis underwent ultrasonography, computed tomography, direct cholangiography, and magnetic resonance cholangiopancreatography, using a half-Fourier acquisition single-shot turbo spin-echo sequence. Surgical exploration or pathologic examination revealed stricture and dilatation of the intrahepatic ducts in all patients. Diagnostic accuracies for stones and ductal abnormalities were compared among the imaging studies. RESULTS: No complications occurred during magnetic resonance cholangiopancreatography studies. Magnetic resonance cholangiopancreatography fully depicted the biliary tract. Magnetic resonance cholangiopancreatography accurately detected and localized intrahepatic stones, as well as bile duct stricture and dilatation, in all patients. Intrahepatic stones were detected by endoscopic retrograde cholangiopancreatography in one of four patients and by percutaneous transhepatic cholangiography in all three who underwent this procedure. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography demonstrated ductal stricture in all patients but failed to completely demonstrate the biliary tree in three of four patients, and one of three, respectively. On ultrasonography and computed tomography, precise localization of stones was difficult. Ultrasonography and computed tomography failed to demonstrate ductal stricture in one and two of the five patients, respectively. CONCLUSIONS: Magnetic resonance cholangiopancreatography diagnoses intrahepatic stones and bile duct abnormalities less invasively and more accurately than endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

Adult↗

PubMedDate not supplied

Endoscopic biliary stenting for treatment of bile leakage after hepatic resection.

BACKGROUND/AIMS: Persistent bile leakage after hepatic resection may cause intraperitoneal sepsis and hepatic failure. Surgical treatment for bile leakage carries a high risk. Endoscopic treatment has only infrequently been documented. METHODOLOGY: Ten patients underwent endoscopic biliary stenting without sphincterotomy for persistent (9-138 days; median, 19 days) bile leakage after hepatic resection. Bile leakage was complicated by intraperitoneal sepsis in seven patients. RESULTS: ERCP showed bile leakage from the bile duct stump in nine patients. Stent placement was successful without complications in all 10 patients. Bile leakage disappeared within 1-17 days (mean, 5 days) in all patients. After 55-91 days, the stent was removed and ERCP confirmed disappearance of the leak. No patients have developed recurrent bile leakage for a mean of 4.1 years of follow-up after stent removal. CONCLUSIONS: Endoscopic biliary stenting is a safe and effective treatment for persistent bile leakage after hepatic resection. Endoscopic treatment may eliminate the need for difficult operations in high risk postoperative cases.

Adult↗

PubMedDate not supplied

Preoperative endoscopic pancreatic stenting for safe local pancreatic resection.

Local pancreatic resection and enucleation have the advantage of preserving pancreatic parenchyma but pancreatic fistula often occurs postoperatively. We describe a case in which preoperative endoscopic pancreatic stenting prevented pancreatic fistula formation following local pancreatic resection. A pancreatic stent seems to prevent leakage from small pancreatic branch ducts not identified or ligated intraoperatively, via the pancreatic decompression effect. The present case demonstrates a novel indication for endoscopic pancreatic stenting.

Carcinoma, Pancreatic Ductal↗

PubMedDate not supplied

Pancreatic carcinoma associated with anomalous pancreaticobiliary junction.

Anomalous pancreaticobiliary junction often leads to biliary tract carcinoma but only rarely to pancreatic carcinoma. We report three cases of pancreatic carcinoma associated with anomalous pancreaticobiliary junction. All three were female with a mean age of 68 years. Carcinomas were located in the pancreatic head (n = 2) or body (n = 1). None had choledochal cyst and one had experienced recurrent acute pancreatitis. All carcinomas were at an advanced stage with a poor prognosis. No unique imaging or histologic findings of the carcinomas could be identified. Attention should be paid to the possibility of pancreatic carcinoma in patients with anomalous pancreaticobiliary junction, particularly in aged patients. Early diagnosis and treatment of anomalous pancreaticobiliary junction may prevent development of pancreatic carcinoma.

Adolescent↗

PubMedDate not supplied

Ultrasonographic evaluation of pancreatic cancers: size, contour, echo texture, and ductal configuration.

To improve the detection rate of small pancreatic tumors, it is important to know the characteristic differences in echographic patterns that distinguish small tumors from larger ones. We have studied the echographic patterns of histologically confirmed pancreatic cancers, with special reference to tumor size. The tumor size in 243 cases of adenocarcinoma determined by measurement of the pathological specimen correlated with that determined by ultrasonography. The ultrasonographic pancreatic configurations, tumor echo patterns, and pancreatic duct size and configurations were reviewed in accordance with the size of the tumor. Many pancreatic cancers showed localized swelling of the pancreas, however, more than half of all T1 cases had normal pancreatic contour, suggesting that we cannot rely on abnormal findings in configuration for the early diagnosis of pancreatic cancer. The very low echo pattern of tumor was seen only in T1 tumors. In cases in which the tumors were not detected by ultrasonography, the detection of a dilated pancreatic duct and common bile duct were very important clues to diagnosing a small tumor in the pancreas.

Female↗

PubMedDate not supplied

Ultrasonography of small hepatic tumors.

The differential accuracy of ultrasonographic examinations of small hepatic tumours was analyzed by receiver-operating characteristics. Using only one image of a single hepatic tumor under 3 cm in diameter as revealed by real-time scanner, the readers were requested to select one out of five diagnoses (hepatocellular carcinoma, metastatic tumor, cavernous hemangioma, cyst, or miscellaneous) and to choose the credibility from five levels of confidence. The averaged diagnostic accuracy was 68% in hepatocellular carcinoma, 70% in metastatic tumor, and 77% in cavernous hemangioma. Hepatic tumors were classified retrospectively into eight ultrasonographic patterns, based on mutual consent. The mosaic and hypoechoic patterns were relatively characteristic of hepatocellular carcinoma (91% and 92% respectively). Except for these two patterns, ultrasonographic findings in small liver tumors were nonspecific, including frequently reported hyperechoic pattern for cavernous hemangioma.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Hepatic cavernous hemangioma in patients at high risk for liver cancer.

Cavernous hemangioma of the liver occurring in patients at high risk for liver cancer has been reviewed. Twenty-four patients with hemangioma were encountered during the past 4 years. Five lesions over 3 cm in diameter were correctly diagnosed with enhanced CT alone. Definite CT findings were however obtained in only 6 out of 19 lesions smaller than 3 cm in diameter. Ultrasonography was the most sensitive method for picking up small liver tumors even when compared with angiography, but the findings were non-specific (an echogenic mass was noted in 14 of the 19 lesions). Magnetic resonance imaging (MRI) had almost the same sensitivity as ultrasound in detecting small hemangiomas, and a prolonged T2 was highly suggestive of the diagnosis (T2 over 80 ms in 8 of 11 lesions). The results suggest that combined use of non-invasive diagnostic modalities has sufficient reliability to make a diagnosis of cavernous hemangioma even in small hepatic lesions, in patients at high risk for liver cancer.

Angiography↗

PubMedDate not supplied

Bile duct carcinoma without jaundice: clues to early diagnosis.

BACKGROUND/AIMS: Most bile duct carcinomas are diagnosed at an advanced stage, after the appearance of jaundice. The features of bile duct carcinomas without jaundice were analyzed with the aim of allowing early diagnosis in such cases. METHODOLOGY: Clinicopathological features, images and surgical outcomes were compared between 18 non-jaundiced and 85 jaundiced patients with extrahepatic bile duct carcinoma. RESULTS: Among the non-jaundiced patients, 13 were symptomatic. Abnormalities on hepatic function and tumor marker tests were seen in 56% and 44%, respectively. In all 18 cases, ultrasonography demonstrated biliary abnormalities including masses (9 patients) and strictures (5 patients). The diagnosis was confirmed histologically by transpapillary bile duct biopsy in eight of 10 non-jaundiced patients. The non-jaundiced patients (83%) had a higher rate of resectability than jaundiced patients (58%). Pathological findings of resected specimens showed no significant differences between the two groups. The non-jaundiced group had a significantly higher survival rate than the jaundiced group: 50% vs. 22% at 5 years. CONCLUSION: For early diagnosis of bile duct carcinomas not associated with jaundice, detailed ultrasonographic examination is useful, and subtle changes indicate a need for direct cholangiography. Non-jaundiced cases have the potential for curative resection.

Bile Duct Neoplasms↗

PubMedDate not supplied

Pancreatic trauma in patients with pancreatobiliary anomaly.

One patient with a choledochal cyst and anomalous pancreaticobiliary junction had pancreatic transection causing bile peritonitis. Intraoperative cholangiopancreatography revealed this anomaly. In another patient with pancreas divisum, cannulation of the minor papilla (ERCP) demonstrated focal stenosis of the dorsal pancreatic duct, corresponding to the site of the minor laceration. The possibility of a coexisting pancreatobiliary anomaly should be considered in the diagnosis of pancreatic trauma, particularly in terms of the interpretation of pancreatograms.

Adult↗