Masatoshi Isogai

Pathophysiology of severe gallstone pancreatitis: A new paradigm

Masatoshi Isogai

Severe gallstone pancreatitis (GSP) refractory to maximum conservative therapy has wide clinical variations, and its pathophysiology remains controversial. This Editorial aimed to investigate the pathophysiology of severe disease based on Opie's theories of obstruction, the common channel, and duodenal reflux and describe …

Proposal of the term “gallstone cholangiopancreatitis” to specify gallstone pancreatitis that needs urgent endoscopic retrograde cholangiopancreatography

Masatoshi Isogai

Opie's "pancreatic duct obstruction" and "common channel" theories are generally accepted as explanations of the mechanisms involved in gallstone acute pancreatitis (AP). Common channel elucidates the mechanism of necrotizing pancreatitis due to gallstones. For pancreatic duct obstruction, the clinical picture of most …

Histological evidence of bile reflux in necrotizing pancreatitis

Masatoshi Isogai, Yuji Kaneoka, Yosuka Iwata

Rationale: Opie's postulate that bile reflux into the pancreas causes necrotizing pancreatitis because of impacted gallstone is debated because there is no clear evidence confirming bile reflux into the pancreas. We report a novel case wherein reflux into the pancreas was histologically …

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Positive surgical margins in surgically treated unifocal and multifocal IPMN

Junpei Yamaguchi, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama et autres

INTRODUCTION: Although treatment methods for the positive margins of surgically treated intraductal papillary mucinous neoplasms (IPMNs) are established, the significance of the positive surgical margins remains unclear. We aimed to clarify the risk factors of the positive margins and their impact on …

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Hepatectomy of segment 4b and 5 with extrahepatic bile duct resection for pT2 gallbladder carcinoma is valid: a single-institution result

Shunsuke Onoe, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama et autres

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Benefit of extended radical surgery for incidental gallbladder carcinoma

Junpei Yamaguchi, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama et autres

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Simultaneous resection for colorectal cancer and synchronous liver metastases

Yasuyuki Fukami, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama et autres

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One‐Stage Colectomy with Intraoperative Colonic Irrigation for Acute Left‐Sided Malignant Colonic Obstruction

Shimpei Otsuka, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama et autres

BACKGROUND: One-stage colectomy with intraoperative colonic irrigation (OCICI) may be useful in early resolution of acute left-sided malignant colonic obstruction (ALMCO). However, the clinical benefit of this technique has not been fully investigated. METHODS: Between January 2007 and July 2014, 451 patients …

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En Bloc Resection of the Hepatoduodenal Ligament for Advanced Biliary Malignancy

Yuji Kaneoka, Atsuyuki Maeda, Masatoshi Isogai

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Laparoscopic Resection of Schwannoma Arising from the Superior Mesenteric Plexus—A Case Report—

Tatsuro Yokoyama, Masatoshi Isogai, Yuji Kaneoka, Atsuyuki Maeda et autres

症例は49歳，女性．健診で異常を指摘され精査目的で当院を受診した．腹部造影CTで上腸間膜動脈（SMA）の右腹側に境界明瞭で造影効果を伴わない20×20mmの腫瘤を認めた．EUS-FNA検査ではわずかに末梢神経様の間質が認められた．MRI検査ではT1強調で低信号，T2強調で高信号，dynamic studyでは辺縁が早期に濃染し，後期相にかけて腫瘤が明瞭化した．以上の所見より後腹膜原発の神経鞘腫を第一に考え，腹腔鏡下腫瘍摘出術を施行した．術中所見では，腫瘍は脾静脈と下腸間膜静脈に接しており，SMA神経叢と連続していた．病理所見では，c-kit・CD34・α-SMAの免疫染色では染まらず，S-100蛋白で染まる紡錘形細胞の核や細胞質を認め，神経鞘腫と診断した．SMA神経叢に発生する神経鞘腫を腹腔鏡下に摘出しえたので報告する．

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A Case of IgG4-related Inflammatory Pseudotumor of the Spleen Resected by Laparoscopic Surgery

Shinpei Otsuka, Masatoshi Isogai, Yuji Kaneoka, Atsuyuki Maeda et autres

症例は63歳，女性．近医でフォローアップ中の脾嚢胞性病変が増大傾向のため当院を紹介受診した．自覚症状は認めず，腹部は平坦で軟，腫瘤は触知しなかった．血液生化学検査では特記すべき異常は認めなかった．造影CTで脾蔵に3.5×4cmの膨張性発育を呈し内部が不均一に造影される腫瘤を認めた．PET-CTではSUVmax 9.41と強い集積を認めた．MRIではdynamic studyで経時的な濃染の明瞭化を認めた．悪性リンパ腫を疑い腹腔鏡下脾臓摘出術を行った．腫瘍の大きさは3.5×4cm，病理組織学的検査では悪性所見はなく，広範な形質細胞とリンパ球の浸潤および線維化を呈していた．免疫染色にてIgG4染色で多数の陽性細胞を認め，IgG4関連の炎症性偽腫瘍と診断された．

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Clinical Evaluation of 61 Cases of Obturator Hernia

Tsutomu Iwata, Masatoshi Isogai, Tohru Harada, Yuji Kaneoka et autres

目的:1996年以降，急性腹症に対して積極的にCT検査を行うことで診断能の向上を認めた．今回，閉鎖孔ヘルニアについて検討した．対象および方法:1973年から2011年までに手術が施行された閉鎖孔ヘルニア61症例を対象に，1995年以前（前期群30例）と以降（後期群31例）に分けて患者背景・術前診断率・手術成績・術後経過を検討した．結果:平均病悩期間（日）（前期群:3.2，後期群:2.8）を含め患者背景に有意差を認めなかった．CT施行率増加（前期群:20.0％，後期群:96.8％）に伴い，術前正診率の向上（前期群:53.3％，後期群:93.5％）を認めたが，腸管切除率，術後合併症発生率の減少は認めなかった．平均入院期間は前期群26.1日，後期群20.0日と短縮した（P＜0.05）．結語:CT検査により術前正診率は向上したが，病悩期間に有意差はなく，それに付随してか腸管切除率は減少しなかった．

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