Differential diagnosis between intraductal papillary mucinous neoplasm with an associated invasive carcinoma and pancreatic ductal adenocarcinoma on ultrasonography: the utility of echo intensity and contrast enhancement

Masato Saito,Naoki Hirokawa,Yoko Usami,Masanori Someya,Koh-ichi Sakata 대한초음파의학회 2017 ULTRASONOGRAPHY Vol.36 No.3

Purpose: The aim of this study was to investigate the utility of echo intensity and contrast enhancement in the differential diagnosis between intraductal papillary mucinous neoplasm with an associated invasive carcinoma (IPMN-IC) and pancreatic ductal adenocarcinoma (PDAC) on ultrasonography. Methods: This study included eight and 37 patients who had pathologically confirmed IPMN-IC and PDAC, respectively, and were enrolled for a comparative analysis of the sonographic features of the tumors. In the quantitative echo intensity evaluation, the two groups were compared with respect to the difference between the tumor intensity and the pancreatic intensity (TI-PI) and between the tumor intensity and the vascular intensity (TI-VI). In the quantitative contrast enhancement evaluation, the increase in echo intensity (ΔTI) and increase in echo intensity per unit of time (slope) were compared between the groups. The echo intensity and contrast enhancement were also compared between the two groups in patients with T3-T4 disease. In addition, the correlations of the histological type, tumor size, stromal type, and T factor with echogenicity and contrast enhancement were analyzed. Results: IPMN-IC had significantly greater echo intensity and contrast enhancement than PDAC (TI-PI, P=0.004; TI-VI, P=0.001; ΔTI, P=0.012; slope, P=0.002). In T3-T4 disease, IPMN-IC also showed greater echo intensity and faster enhancement than PDAC. Echo intensity and contrast enhancement were correlated with histological type (TI-PI, P=0.003; TI-VI, P<0.001; ΔTI, P=0.007; slope, P<0.001). Conclusion: IPMN-IC and PDAC can be differentiated by the quantitative evaluation of echo intensity and contrast enhancement.

Cervical conization with endoCUT mode applying gastrointestinal endoscopic polypectomy technique

Masato Tamate,Motoki Matsuura,Tsuyoshi Saito 대한산부인과학회 2023 Obstetrics & Gynecology Science Vol.66 No.6

Objective To show how endoCUT mode can be safely managed with cervical conization. Methods Demonstration of the technique and explanation of endoCUT and soft coagulation mode with narrated video footage. Cervical conization is a therapeutic and diagnostic procedure performed for the diagnosis of cervical intraepithelial lesions and cervical cancer. Specific methods include cold scalpel, ultrasonically activated device and laser, and loop electrosurgical excision procedure (LEEP), which involves transpiration and partial excision. The endoCUT mode and soft coagulation in VIO3® (ERBE, Tübingen, Germany) were used to perform cervical conical resection safely and at low cost. The endoCUT mode was originally developed for polypectomy in gastrointestinal endoscopy, where no counter traction can be applied. Results The endoCUT mode approach to cervical conization with several key strategies to minimize blood loss and ensure safety: 1) incisions can be made in close contact; 2) resection can be performed with minimal contact with the lesion; 3) control of bleeding from the resected transection by soft coagulation; and 4) low running cost of endoCUT mode. Conclusion Conventionally, cervical conical resection has been performed by using a device capable of making a close incision (cold scalpel, ultrasonically activated device and laser, and LEEP etc.), but there have been issues with bleeding control and cost. Here, we present a new technique using the endoCUT mode and several strategies for safe and effective resection.

Noninvasive diagnosis of NAFLD

( Masato Yoneda ),( Kento Imajo ),( Satoru Saito ),( Atsushi Nakajima ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is an important cause of chronic liver injury in many countries around the world. The degree of liver fibrosis must be estimated to determine the prognosis, surveillance, and optimal treatment for NAFLD/NASH, similar to the situation for other liver diseases. Liver biopsy remains the gold standard for evaluating the degree of hepatic fibrosis. However, liver biopsy is an invasive and expensive method and is associated with a relatively high risk of complications. Furthermore it is impossible to enforce liver biopsy in all NAFLD patients, because the number of NAFLD patients has reached 80-100 million in the U.S. and about 5-10 million NAFLD patients are estimated to exist even in Korea. Thus, a rapid and noninvasive method of detecting fibrosis in patients with NAFLD is of major clinical interest. Several noninvasive investigations, such as serum biomarkers, scoring systems, imaging method have been developed to establish the diagnosis of NASH. First, we validated scoring systems (FIB4 index, AST/ALT ratio, AST to platelet ratio, Age-platelet index, NAFLD fibrosis score, BARD score) in biopsy-proven Asian population (n=576). Next, we investigated the clinical usefulness of ultrasound-based elastography such as transientelastography (Fibroscan) and Acoustic Radiation Force Impulse (ARFI) Elastography for detecting the advanced fibrosis in NAFLD patients. The major advantages of transient elastography and ARFI elastography, as compared with liver biopsy, are that these techniques are painless, rapid, and have no associated complications, and are, therefore, very easily accepted by the patients. It is not uncommon for patients to present with the complications of previously unrecognized cirrhosis despite being under long-standing medical care, because these patients often do not manifest the classic physical changes associated with cirrhosis. By using these noninvasive scoring systems and/or imaging methods, efficient recruitment of NASH patients with advanced stage may be facilitated.

Noninvasive diagnosis of NAFLD

( Masato Yoneda ),( Kento Imajo ),( Satoru Saito ),( Atsushi Nakajima ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is an important cause of chronic liver injury in many countries around the world. The degree of liver fibrosis must be estimated to determine the prognosis, surveillance, and optimal treatment for NAFLD/NASH, similar to the situation for other liver diseases. Liver biopsy remains the gold standard for evaluating the degree of hepatic fibrosis. However, liver biopsy is an invasive and expensive method and is associated with a relatively high risk of complications. Furthermore it is impossible to enforce liver biopsy in all NAFLD patients, because the number of NAFLD patients has reached 80-100 million in the U.S. and about 5-10 million NAFLD patients are estimated to exist even in Korea. Thus, a rapid and noninvasive method of detecting fibrosis in patients with NAFLD is of major clinical interest. Several noninvasive investigations, such as serum biomarkers, scoring systems, imaging method have been developed to establish the diagnosis of NASH. First, we validated scoring systems (FIB4 index, AST/ALT ratio, AST to platelet ratio, Age-platelet index, NAFLD fibrosis score, BARD score) in biopsy-proven Asian population (n=576). Next, we investigated the clinical usefulness of ultrasound-based elastography such as transientelastography (Fibroscan) and Acoustic Radiation Force Impulse (ARFI) Elastography for detecting the advanced fibrosis in NAFLD patients. The major advantages of transient elastography and ARFI elastography, as compared with liver biopsy, are that these techniques are painless, rapid, and have no associated complications, and are, therefore, very easily accepted by the patients. It is not uncommon for patients to present with the complications of previously unrecognized cirrhosis despite being under long-standing medical care, because these patients often do not manifest the classic physical changes associated with cirrhosis. By using these noninvasive scoring systems and/or imaging methods, efficient recruitment of NASH patients with advanced stage may be facilitated.

Nonalcoholic Fatty Liver Disease as a Systemic Disease and the Need for Multidisciplinary Care

Yoneda Masato,Kobayashi Takashi,Iwaki Michihiro,Nogami Asako,Saito Satoru,Nakajima Atsushi 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.6

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease, and there has been a rapid increase in cases worldwide. NAFLD is rapidly becoming the leading cause of hepatocellular carcinoma and is also associated with an increased risk of cardiovascular disease or exacerbation of other organ diseases, thus posing a significant health problem from both a medical and a socioeconomic perspective. NAFLD is a systemic disease and requires the involvement of numerous medical professionals. Multidisciplinary collaboration, in which different professionals within different specialties come together and work together toward a common goal, supports better patient care by integrating perspectives of multiple experts and facilitating the exchange of opinions. Due to the large number of potential patients, gastroenterologists and hepatologists cannot manage the patients alone, and collaboration between specialists in various fields, including family doctors, dentists, nutritionists, and pharmacists is required for treatment of NAFLD. This review will discuss NAFLD from the perspective of various specialties and introduce multidisciplinary collaboration.

Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future

Asako Nogami,Masato Yoneda,Michihiro Iwaki,Takashi Kobayashi,Yasushi Honda,Yuji Ogawa,Kento Imajo,Satoru Saito,Atsushi Nakajima 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.-

Non-alcoholic fatty liver disease is currently the most common chronic liver disease, affecting up to 25% of the global population. Simple fatty liver, in which fat is deposited in the liver without fibrosis, has been regarded as a benign disease in the past, but it is now known to be prognostic. In the future, more emphasis should be placed on the quantification of liver fat. Traditionally, fatty liver has been assessed by histological evaluation, which requires an invasive examination; however, technological innovations have made it possible to evaluate fatty liver by non-invasive imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging. In addition, quantitative as well as qualitative measurements for the detection of fatty liver have become available. In this review, we summarize the currently used qualitative evaluations of fatty liver and discuss quantitative evaluations that are expected to further develop in the future.

Estimation of Radiocesium In/out Flows in Paddy Fields in Fukushima, Japan

Seiko Yoshikawa,Eguchi Sadao,Itahashi Sunao,Igura Masato,Nobuharu Kihou,Shigeto Fujimura,Takashi Saito,Hideshi Fujihara,Shinichiro Mishima,Kazunori Kohyama,Noriko Yamaguchi,Ohkoshi Satoru 한국토양비료학회 2014 한국토양비료학회 학술발표회 초록집 Vol.2014 No.6

Effect of tranexamic acid on blood loss reduction in patients undergoing orthognathic surgery under hypotensive anesthesia: a single-center, retrospective, observational study

Keisuke Harada,Noritaka Imamachi,Yuhei Matsuda,Masato Hirabayashi,Yoji Saito,Takahiro Kanno 대한구강악안면외과학회 2024 대한구강악안면외과학회지 Vol.50 No.2

Objectives: Orthognathic surgery is a surgical procedure performed by intraoral approach with established and safe techniques; however, excessive blood loss has been reported in rare cases. In response, investigative efforts to identify methods to reduce the amount of blood loss have been made. Among such methods, the administration of tranexamic acid was reported to reduce the amount of intraoperative blood loss. However, few studies to date have reported the effect of tranexamic acid in orthognathic surgery under hypotensive anesthesia. The present study aimed to investigate the effect of the administration of tranexamic acid on intraoperative blood loss in patients undergoing bimaxillary (maxillary and mandibular) orthognathic surgery under hypotensive anesthesia. Patients and Methods: A total of 156 patients (mean age, 27.0±10.8 years) who underwent bimaxillary orthognathic surgery under hypotensive anesthesia performed by the same surgeon between June 2013 and February 2022 were included in this study. The following data were collected from the medical records of each patient: background factors (age, sex, and body mass index), use of tranexamic acid, surgical procedures, previous medical history, duration of surgery, American Society of Anesthesiology physical status findings before surgery, intraoperative blood loss as a primary outcome, in–out balance, and blood test results. Descriptive statistics were calculated for statistical analysis, and a t -test and the chi-squared test were used for between-group comparisons. Group comparisons were performed after 1:1 propensity score matching to adjust for confounding factors. Statistical significance was set at P<0.05. Results: Comparison between the groups based on the use of tranexamic acid revealed a significant difference in operation time. Propensity score matching analysis revealed that intraoperative blood loss was significantly lower in the tranexamic acid group. Conclusion: The administration of tranexamic acid was effective in reducing intraoperative blood loss in patients undergoing bimaxillary orthognathic surgery under hypotensive anesthesia.

Switching to systemic therapy after locoregional treatment failure: Definition and best timing

Sadahisa Ogasawara,Yoshihiko Ooka,Keisuke Koroki,Susumu Maruta,Hiroaki Kanzaki,Kengo Kanayama,Kazufumi Kobayashi,Soichiro Kiyono,Masato Nakamura,Naoya Kanogawa,Tomoko Saito,Takayuki Kondo,Eiichiro Suz 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.2

In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.