Here we review the prognosis of patients with unsuspected gallbladder carcinoma（GBC）, detected after laparoscopic cholecystectomy（LC）in a single institute. We reviewed the medical records of patients diagnosed with gallbladder stones on admission, who underwent LC. Carcinoma involving the gallbladder was found in 22 of 2,770 patients（0.9％）via postoperative pathological examination. This GBC group spanned 58-87 years of age（mean, 75 years; 13 females and 9 males）. The preoperative diagnosis was gallbladder stones with acute/chronic cholecystitis or adenomyomatosis of the gallbladder in all patients. We performed an additional surgery in 6 of 15 patients with pT2 and T3 disease; of these, 3 patients with pT2 disease and 1 with pT3 experienced bile spillage during the LC. The mean survival of patients with unexpected GBC was 21 months, with bile spillage occurring as a complication of LC identified as a potential risk factor for shorter survival（15.3 vs. 32.5 months）. We identified patients with pT2 and pT3 disease after LC, and two patients with pT2 and 1 with pT3 who had bile spillage during LC died of peritoneal dissemination within 28 months, despite additional surgery. Occasional seeding caused by bile spillage during LC should be carefully avoided to minimize the risk of developing unsuspected GBC after LC.

抄録全体を表示

A Special Needs Dental Center （hereafter referred to as the Center） was established at Showa University Dental Hospital in April 2012 to treat patients who need special care. In cooperation with the Division of Dentistry for Persons with Disabilities, the Division of Hygiene and Oral Health is mainly engaged in the treatment of patients with eating and swallowing disorders. It has been five years since the establishment of the Center. The present study was aimed to establish an effective medical support method through a comparative study of changes in patient trends. A total of 65 patients who visited the Center from April 2017 to March 2018 were examined and their statistics were compared with those of 60 previously reported patients who initially visited the Center for medical examination in 2012. In 2012, many visits occurred during the nursing period; however, in 2017, the number of patients who visited after the weaning period increased. Other noted trends were increased diversity in primary disease, more patient referrals, fewer patients with severe swallowing dysfunction, and more patients with oral dysfunction. The necessity of eating and swallowing practice is thought to increase when lifestyle and oral environment change. The treatment of eating and swallowing disorders is important in the dental profession. Due to the introduction of insurance coverage in Japan in 2018 for developmental insufficiency of oral function, more pediatric patients with eating and swallowing disorders will likely be treated in the future.

抄録全体を表示

This study retrospectively investigated the value of fusing a pre-ablation hepatobiliary phase（HBP）series and post-ablation unenhanced T1-weighted images（T1WIs）to evaluate the treatment effectiveness of radiofrequency ablation for hepatocellular carcinoma（HCC）. Predictors of local tumor progression（LTP）were also identified. Our study comprised 47 patients with 88 HCCs（＞2 years follow up）who underwent pre-ablation gadoxetate disodium-enhanced magnetic resonance imaging and post-ablation T1-weighted imaging. For the new assessment, pre-ablation HBP series and post-ablation T1WIs were fused using a rigid registration and manual correlation, and the ablation margin appearance was classified as ablation margin（＋）, ablation margin zero, ablation margin（−）, or indeterminate（index tumor was invisible）based on the post-ablation T1WIs and fusion images. The minimal ablation margin was measured and clinical factors were investigated to identify other risk factors for LTP, which was observed in 14 tumors. The mean minimal ablation margin was 1.9mm, excluding 5 indeterminate nodules without LTP, and 8 ablation margin-zero HCCs with LTP, with multivariate logistic regression analysis showing that the likelihood of ablation margin＋was inversely proportional to tumor size. The independent risk factors for LTP were not identified, but the cumulative LTP rates（0％ at 1, 2, and 3 years）in 41 ablation margin＋ nodules were significantly lower（P＝0.005）than those（8.8％, 17.6％, and 17.6％ at 1, 2, and 3 years, respectively）in 34 ablation margin-zero nodules. In conclusion, fusion images might show an early therapeutic response of the ablated tumors in the majority of HCC cases.

抄録全体を表示

The most common site of distant metastasis from colorectal cancer is the liver, and hepatectomy presents the best curative treatment for recurrence of colorectal liver metastasis （CRLM）. This study aimed to identify factors of prognostic value for repeat hepatectomy for CRLM and to determine whether a third such procedure could similarly produce favourable outcomes for CRLM. We analyzed data for 161 patients in our department with colorectal metastasis. Of these, 22 patients underwent repeat hepatectomy for recurrent metastasis, with 16 undergoing a second hepatectomy and 6 a third hepatectomy. We analyzed patient characteristics, tumor status, operation-related variables, and short- and long-term outcomes. Univariate analysis for repeat hepatectomy identified the following five prognostic risk factors: T factor （＞SE） of the primary cancer, number of tumors involved in the initial hepatectomy （＞5）, interval from first to second hepatectomy （＜1year）, number of tumors involved in second hepatectomy （＞3）, and post-operation time （＞30days）. By multivariate analysis, T factor （＞SE） of the primary cancer, number of tumors in the initial hepatectomy （＞5）, and number of tumors in the second hepatectomy （＞3） were independently associated with a worse survival after surgery for CRLM. Although surgical outcomes of the third hepatectomy were not compared with those of the first and second hepatectomy, there were no obvious differences, nor did the 1-, 3-, and 5-year survival rates differ significantly among the three groups. Repeat hepatectomy for CRLM could improve long-term survival. In addition, patients undergoing a third hepatectomy showed a similar survival benefit to those having one or two resections.

抄録全体を表示

Many studies have shown that gingival crevicular fluid （GCF） reflects the inflammatory state of local periodontal tissues. GCF has been collected from several types of teeth in previous studies. However, there is no report that characterizes GCF by the type of tooth. In the present study, the protein profiles of GCF from different sites were comprehensively compared with each other. GCF was sampled from six healthy adult men （21-31 years old） with healthy periodontal tissues. Three separate GCF samples were collected at the maxillary central incisor, canine, and first molar of each individual. The protein profiles of GCF were analyzed using sodium dodecyl sulfate polyacrylamide gel electrophoresis and liquid chromatogram-tandem mass spectrometry （LC-MS/MS）. The band patterns on the sodium dodecyl sulfate polyacrylamide gel electrophoresis from the set of three GCF samples from each individual were similar, regardless of the type of tooth. The proteins contained in each band were identified by LC-MS/MS analysis, and they were found to be the same among the three GCF samples. A comprehensive and quantitative analysis of proteins in the GCF samples was performed by LC-MS/MS using isobaric tag labeling. In total, 86 proteins were identified in GCF. A small number of proteins were increased or decreased in GCF from the first molars compared with the other types of teeth in one or two individuals. However, overall, no proteins were found to exhibit a reproducibly different composition in any of the individuals. These analyses show that the protein profiles of GCF in healthy periodontal tissues are similar, regardless of the type of tooth.

抄録全体を表示

Hepatocellular carcinoma（HCC）is the sixth most commonly diagnosed cancer worldwide. Sorafenib is an oral multikinase inhibitor used in the palliative treatment of advanced HCC. However, there were no reported cases of complete response（CR）from two previous large phaseⅢ clinical trials. Here, we report a case of CR in a patient with advanced HCC with multiple lymph node and bone metastases, treated with sorafenib monotherapy for 8 months. To our knowledge, this is the first evidence showing CR following sorafenib monotherapy for HCC with bone metastasis.

抄録全体を表示