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Roberto Civitelli M.D. Eturo Ogata Louis V. Avioli Gary Stein Samuel Edelstein John A. Eisman Yasuho Nishii Hajime Orimo Jane Lian Takuo Fujita Yasufumi Hayashi Shigeaki Kato Tadashi Kobayashi Hirotoshi Morii Rikushi Morita Toshitaka Nakamura Yoshiki Seino Masataka Shiraki Tatsuo Suda Naoyuki Takahashi Hideaki Takahashi Tastuhiko Tanisawa Akifumi Tokita 《Calcified tissue international》1995,57(6):409-414
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Diagnosis and treatment of thoracic outlet syndrome 总被引:2,自引:0,他引:2
Masataka Abe Tadashi Shimamura Jun Nishida Katsuaki Ichinohe 《Journal of orthopaedic science》1997,2(2):119-127
Patients who develop symptoms of thoracic outlet syndrome (TOS) have a predisposing anatomic abnormality. In most patients
with TOS, the symptoms are caused by entrapment of the brachial plexus and they do not arise from compression of the subclavian
artery, as was previously thought. The tests advocated for diagnosing this common syndrome (i.e., evaluating the positional
compression of the artery when the arms are raised, the neck is turned, or the shoulders are braced) cannot accurately diagnose
this syndrome. There are two reasons for this. The symptoms of TOS are not related to the compression of the artery in the
outlet in 98% of patients, and 75% of normal individuals without symptoms show diminished radial pulse on various provocation
tests. We employed four timed provocation tests (minute tests) to diagnose TOS: the timed Morley test, timed Wright test,
timed Eden test, and elevated arm stress exercise, all of which are very sensitive. In normal individuals without symptoms,
20% experience transitional symptoms such as slight pain and tiredness, on these tests indicating a subclinical state. TOS
is treated by keeping the thoracic outlet wide, this being done either conservatively or surgically. In 1993 and 1994, we
conservatively treated 418 of 422 patients with TOS by means of active exercise, a brace, and by block therapy. These measures
did not reduce the symptoms in 23 of these patients, so surgical treatment was indicated. In the remaining 4 of the 422 patients,
conservative treatment was not indicated and surgery was performed directly. All the patients showed significant clinical
improvement of varying degree.
Presented at the 69th Annual Meeting of the Japanese Orthopaedic Association, Tokyo, April 12, 1996 相似文献
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Hiroshi Ohuchi Masataka Hatanaka Keiko Abe Shogo Yatsu 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(6):302-304
Off-pump surgery was performed in a patient with post-infarction angina complicated with aneurysmal coronary-pulmonary arterial fistula. Epicardial echocardiography localized the artery feeding the fistula in the myocardium, which had not been revealed by visual inspection, palpation, or transesophageal echocardiography. The patient underwent off-pump coronary artery bypass grafting concomitant with aneurysmectomy. The feeding arteries were dissected easily using a Harmonic Scalpel and ligated. The flow in the aneurysm disappeared immediately and aneurysmectomy was performed without bleeding. 相似文献
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Naomi Seki Jun Mitsui Masataka Hoshino Masahiro Akishiro Yoshikazu Ugawa Jun Goto Shoji Tsuji 《Brain and nerve》2006,58(1):68-73
A 51-year-old male who showed severe ataxia, dysarthria, bilateral blepharoptosis, diplopia and nystagmus with the subacute onset was reported. The chest roentgenogram and CT scan revealed mass lesions at the hilus of the left lung. The tumor markers, NSE and ProGRP, were elevated; 12.8 ng/ml (< or = 10) and 140.7 pg/ml (< or = 46), respectively. The biopsy was performed surgically and the small cell carcinoma of the lung was confirmed pathologically. His cerebellar symptoms were considered to be caused by the paraneoplastc cerebellar degeneration. However, the blepharoptosis was peculiar. The electrophysiological studies were carried out The muscle strength test of the right APB muscle was 5. But the supramaximum stimulation of the right median nerve evoked only 2.0 mV of CMAP of the right APB muscle. The repetitive stimulation tests of the same nerve showed that 3 Hz stimulation resulted in 42% waning but 20 Hz stimulation evoked no waxing. The post-exercise test of the right APB muscle showed 73% increase of the CMAP. These findings indicated that he also suffered from Lambert-Eaton myasthenic syndrome. The titer of the antibody against the P/Q type voltage-gated calcium channel (VGCC) was remarkably elevated, 1,920 pM. None of the following antibodies were detected ; they included antibodies against acetylcholine receptor, Hu, Yo, Ri, Ma-2, CRMP-5, amphiphysin and glutamic acid dehydrogenase. The small cell carcinoma was treated with the combination of irinotecan hydrochloride and cisplatin, leading to the reduction of the mass lesions and the tumor markers. His cerebellar symptoms improved slightly but his blepharoptosis was unchanged. The titer of antibody against the P/Q type VGCC reduced remarkably to 451.8 pM. We reviewed reported cases associated with paraneoplastic cerebellar degeneration and Lambert-Eaton myasthenic syndrome and discussed the relation between the paraneoplastic syndromes and autoantibodies. 相似文献
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Yutaka Yonemura Masataka Segawa Hisashi Matsumoto Kouichirou Tsugawa Itasu Ninomiya Luis Fonseca Takashi Fujimura Kazuo Sugiyama Kouichi Miwa Itsuo Miyazaki 《Surgery today》1994,24(6):488-493
Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach. 相似文献