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161.
BACKGROUND AND STUDY AIMS: Palliative treatment for duodenal stenosis with an enteral stent is effective in enhancing the quality of life of patients with duodenal obstruction. There have been no thorough comparisons of duodenal stent placement with standard surgical gastrojejunostomy. The present study evaluated the outcome of duodenal stent placement and surgical gastrojejunostomy for palliation of duodenal stenosis caused by pancreaticobiliary malignancies. PATIENTS AND METHODS: Medical records for patients who underwent palliative enteral stenting during the past 9 years were retrospectively reviewed, and the patients' clinical outcome was compared with that in patients who underwent open surgical gastrojejunostomy during the same period. Patients who underwent prophylactic gastrojejunostomy were excluded from the study. RESULTS: Twenty patients (11 men, nine women; mean age 71.8 years) with pancreaticobiliary malignancy underwent palliative enteral stenting (stent group). Nineteen patients (12 men, seven women; mean age 68.7 years) with pancreaticobiliary malignancies underwent surgical gastrojejunostomy (bypass group). In the stent group, the diagnoses were 12 pancreatic cancers, six gallbladder cancers, one bile duct cancer, and one ampullary cancer. In the bypass group, the diagnoses were 14 pancreatic cancers and five gallbladder cancers. There were no significant differences between the two groups with regard to clinical background. Both procedures were successful. There were no differences between the two groups with regard to the technical or clinical success rates, patient survival, possibility of discharge, need for parenteral nutrition, or incidence of complications. However, the time from the procedure to resumption of food intake was shorter in the stent group than in the bypass group (1 day vs. 9 days; P < 0.0001). Improvement in the performance score after the procedure was observed more frequently in the stent group (65 % vs. 26.3 %; P < 0.05). In terms of the median hospital stay from the time of the procedure to the time of initial discharge home (12 patients vs. nine patients), there was no statistical difference (15 days vs. 30 days) due to the small size of the sample. There was no procedure-related mortality in either group. CONCLUSIONS: Palliative stent placement was more beneficial than surgical gastrojejunostomy in enhancing the quality of life of patients with duodenal obstruction due to pancreaticobiliary malignancies. 相似文献
162.
K Takeda H Nakai H Hagiwara K Tada T B Shows M G Byers R Myerowitz 《The Tohoku journal of experimental medicine》1990,160(3):203-211
Tay-Sachs disease results from mutation in the gene encoding beta-hexosaminidase A alpha-subunit. Although some reports have suggested the locus on 15q, we tried to determine the finer gene locus using high resolution in situ hybridization. cDNA probe, p beta H alpha-5, containing the full-length sequence for the enzyme subunit, was 3H-labeled within 1-4 x 10(7) cpm/micrograms of cDNA by nick-translation. After molecular hybridization and autoradiography, prometaphases were G-banded by Hoechst 33258, UV-exposure and Giemsa. A total of 227 silver grains on chromosomes within 115 prometaphase spreads were analyzed. The region 15q23-q24 had 27 grains, corresponding to 11.9% of the total grains and to 77.1% of the grains on chromosome 15. 20.9% of prometaphases were observed with a grain at 15q23-q24. According to several previous reports, the shortest region of overlap (SRO) of the locus has been 15q22-q25.1. Here we have assigned the gene locus to the narrower region 15q23-q24 by high-resolution in situ hybridization, which is one of the most powerful strategy for the completion of human gene map. 相似文献
163.
Masashi Uehara Jun Takahashi Shota Ikegami Keijiro Mukaiyama Shugo Kuraishi Masayuki Shimizu Toshimasa Futatsugi Nobuhide Ogihara Hiroyuki Hashidate Hiroki Hirabayashi Hiroyuki Kato 《European spine journal》2014,23(10):2189-2195
Study design
A cross-sectional study of the data retrospectively collected by chart review.Objectives
This study aimed to clarify screw perforation features in 129 consecutive patients treated with computer-assisted cervical pedicle screw (CPS) insertion and to determine important considerations for computer-assisted CPS insertion.Summary of background data
CPS fixation has been criticized for the potential risk of serious injury to neurovascular structures. To avoid such serious risks, computed tomography (CT)-based navigation has been used during CPS insertion, but screw perforation can occur even with the use of a navigation system.Methods
The records of 129 consecutive patients who underwent cervical (C2–C7) pedicle screw insertion using a CT-based navigation system from September 1997 to August 2013 were reviewed. Postoperative CT images were used to evaluate the accuracy of screw placement. The screw insertion status was classified as grade 1 (no perforation), indicating that the screw was accurately inserted in pedicle; grade 2 (minor perforation), indicating perforation of less than 50 % of the screw diameter; and grade 3 (major perforation), indicating perforation of 50 % or more of the screw diameter. We analyzed the direction and rate of screw perforation according to the vertebral level.Results
The rate of grade 3 pedicle screw perforations was 6.7 % (39/579), whereas the combined rate of grades 2 and 3 perforations was 20.0 % (116/579). No clinically significant complications, such as vertebral artery injury, spinal cord injury, or nerve root injury, were caused by the screw perforations. Of the screws showing grade 3 perforation, 30.8 % screws were medially perforated and 69.2 % screws were laterally perforated. Of the screws showing grades 2 and 3 perforation, 21.6 % screws were medially perforated and 78.4 % screws were laterally perforated. Furthermore, we evaluated screw perforation rates according to the vertebral level. Grade 3 pedicle screw perforation occurred in 6.1 % of C2 screws; 7.5 % of C3 screws; 13.0 % of C4 screws; 6.5 % of C5 screws; 3.2 % of C6 screws; and 4.0 % of C7 screws. Grades 2 and 3 pedicle screw perforations occurred in 12.1 % of C2 screws, 22.6 % of C3 screws, 31.5 % of C4 screws, 22.2 % of C5 screws, 14.4 % of C6 screws, and 12.1 % of C7 screws. C3–5 screw perforation rate was significantly higher than C6–7 (p = 0.0024).Conclusions
Careful insertion of pedicle screws is necessary, especially at C3 to C5, even when using a CT-based navigation system. Pedicle screws tend to be laterally perforated. 相似文献164.
Haruka Ouchi MD Yasuko Toyoshima MD PhD Mari Tada MD PhD Mutsuo Oyake MD PhD Izumi Aida MD Itsuro Tomita MD PhD Akira Satoh MD PhD Mitsuhiro Tsujihata MD PhD Hitoshi Takahashi MD PhD Masatoyo Nishizawa MD PhD Takayoshi Shimohata MD PhD 《Movement disorders》2014,29(2):238-244
The aim of this study was to investigate corticobasal syndrome with respect to underlying pathologies, the ability of current clinical criteria to detect early stages of disease, and symptoms and signs predicting background pathologies. We retrospectively analyzed the clinicopathological findings from patients with corticobasal syndrome. We also analyzed whether those findings fulfilled the diagnostic criteria for corticobasal degeneration (CBD). Finally, we investigated characteristic clinical features that are specific to each background pathology. Of 10 consecutive autopsied patients who had corticobasal syndrome (mean age ± standard deviation, 67.9 ± 9.3 years; male:female ratio, 6:4), three had corticobasal degeneration pathology, three had progressive supranuclear palsy, three had Alzheimer's disease, and one had atypical four‐repeat tauopathy. Nine patients fulfilled Mayo criteria, and all 10 patients fulfilled modified Cambridge criteria at the later stage, but only two patients fulfilled either clinical criteria within 2 years of disease onset. Five patients fulfilled the clinical criteria for possible CBD (p‐CBD), and one patient fulfilled the clinical research criteria for probable sporadic CBD (cr‐CBD) at the later stage. Only two patients fulfilled the criteria for either p‐CBD or cr‐CBD within 2 years of disease onset. Although we could not find any predictive characteristic clinical features that were specific to CBD pathology, only patients with progressive supranuclear palsy developed apraxia of eyelid opening and cerebellar ataxia. Myoclonus and memory impairment, especially if they appear at an early stage of the disease, may predict Alzheimer's disease pathology. Sensitivity of the available clinical criteria for corticobasal syndrome was poor within 2 years of disease onset. © 2013 International Parkinson and Movement Disorder Society 相似文献
165.
166.
Keijiro Nakamura Takahito Takagi Norihiro Kogame Hikari Hashimoto Masako Asami Yasutake Toyoda Yoshinari Enomoto Hidehiko Hara Mahito Noro Kaoru Sugi Masao Moroi Masato Nakamura 《Journal of atherosclerosis and thrombosis》2021,28(6):590
Aim: Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated. Methods: We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure. Result: In univariate analysis, CAVI significantly correlated with atrial structural and electrical remodeling (LA volume index, r =0.297, P =0.001; RA volume index, r =0.252, P =0.004; LA conduction velocity, r =0.254, P = 0.003; LA mean voltage, r =−0.343, P =0.001, RA mean voltage; r =−0.245, P =0.015). Multivariate regression analysis revealed that CAVI and plasma levels of N-terminal B-type natriuretic peptide were independent determinants of LA and RA remodeling, respectively. On the other hand, age and LA conduction velocity were independent variables with respect to CAVI. Age-adjusted CAVI was highest in long-standing persistent AF when compared with measures of persistent or paroxysmal AF. Conclusion: CAVI was closely associated with biatrial remodeling in patients diagnosed with AF. These results suggest that arterial stiffness may play a significant role with respect to disease progression. 相似文献
167.
Hayato Tada Soichiro Usui Kenji Sakata Masayuki Takamura Masa-aki Kawashiri 《Journal of atherosclerosis and thrombosis》2021,28(4):305
Precision or personalized medicine is currently gaining a lot of attention. Clinical evidence for its effectiveness has been established based on randomized clinical trials accounting for classical risk factors, such as hypertension, diabetes, and serum lipids. However, besides such classical risk factors, the genetic background should be considered, at least for heritable traits, including atherosclerotic cardiovascular disease (ASCVD). Such classical risk factors are almost always incidents that have already occurred in which it may be too late to start treatment, instead of indicators of presymptomatic state. Human genome information is associated with most traits, including ASCVD. Two methods of implementing precision medicine for ASCVD using human genome information are currently being investigated: the use of rare genetic variations that have large effect sizes and polygenic risk scores that are composed of multiple common genetic variations. This review article emphasizes the importance of clinical as well as genetic diagnoses when implementing precision medicine. Precision medicine should be considered based on comprehensive genetic analyses, encompassing rare to common genetic variations. 相似文献
168.
169.
Hirokazu Saito Atsushi Fujimoto Kana Oomoto Yoshitaka Kadowaki Shuji Tada 《World journal of gastrointestinal endoscopy》2022,14(11):657-666
Prophylaxis is important for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), which is the most common and serious complication of ERCP. Although the current guidelines include independent patient- and procedure-related risk factors for PEP and available PEP prophylactic measures, the synergistic effect of these risk factors on PEP should also be considered, given that patients often harbor multiple risk factors. Furthermore, a combination of prophylactic measures is often selected in clinical practice. However, established methods estimating the synergistic effect of independent risk factors on PEP incidence are lacking, and evidence on the impact of com bining prophylactic measures on PEP should be discussed. Selection of appro priate candidate patients for ERCP is also important to reduce the incidence of PEP associated with unnecessary ERCP. ERCP indications in patients with asymptomatic common bile duct stones (CBDSs) and in those with suspected CBDSs with no imaging-based evidence of stones are controversial. Further studies are warranted to predict the synergistic effect of independent risk factors on PEP, determine the best prophylactic PEP measures, and identify appropriate candidates for ERCP in patients with asymptomatic CBDSs and those with suspected CBDSs. 相似文献
170.
Masahiko Noguchi MD Minoru Tabata MD Kotaro Obunai MD Kentaro Shibayama MD Joji Ito MD Hiroyuki Watanabe MD Fumiaki Yashima MD Yusuke Watanabe MD Toru Naganuma MD Motoharu Araki MD Futoshi Yamanaka MD Shinichi Shirai MD Hiroshi Ueno MD Kazuki Mizutani MD Akihiro Higashimori MD Kensuke Takagi MD Norio Tada MD Masanori Yamamoto MD Kentaro Hayashida MD 《Catheterization and cardiovascular interventions》2021,97(1):E113-E120