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991.
Yasuyuki Fukami Masaki Terasaki Kenji Sakaguchi Toru Murata Masayuki Ohkubo Kazumi Nishimae 《Surgery today》2009,39(3):265-268
This report describes the use of side-to-end anastomosis in a colostomy for an acute malignant large-bowel obstruction. A
59-year-old man presented with a colonic obstruction due to advanced descending colon cancer. The preoperative imaging studies
revealed a complete obstruction of the descending colon at the site of the splenic flexure, a remarkably dilated transverse
colon, and no other metastatic lesions. Side-to-end anastomosis was performed with the colostomy because of the high comorbidity
associated with such cases. When the patient’s general condition improved, a stoma closure was performed under local anesthesia.
In conclusion, a side-to-end anastomosis with a colostomy (STEC procedure) was found to be a simple, useful, and cost-effective
technique for an acute malignant large-bowel obstruction, particularly in a high-risk patient. 相似文献
992.
Go Wakabayashi Hiroyuki Nitta Takeshi Takahara Motohide Shimazu Masaki Kitajima Akira Sasaki 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(4):439-444
Introduction We have accumulated over 170 patients since 1995 who underwent laparoscopic partial liver resection, laparoscopic left lateral
sectionectomy, and laparoscopy-assisted hepatectomy. Bleeding control, which is a basic element of liver resection, needs
to be better managed by methods suitable for safer laparoscopic liver resection. The aim of this study was to standardize
the basic skills and to establish safer techniques for laparoscopic liver surgery in order to perform safe laparoscopic donor
hepatectomy.
Materials and methods We analyzed initial results from the viewpoint of operative techniques of laparoscopic liver resection in our series. Laparoscopic
liver resections have been successfully performed by the application of automatic suturing devices and the radiofrequency
method.
Results We have performed 105 laparoscopic partial liver resections, 26 laparoscopic left lateral sectionectomies, and 45 laparoscopy-assisted
major hepatectomies. A total of 176 patients underwent minimally invasive liver resections.
Conclusion For safer laparoscopic liver resection, efficient bleeding control techniques, such as radiofrequency pre-coagulation and
the liver hanging maneuver, are needed during parenchymal transection of the liver. Laparoscopy-assisted donor hepatectomy
can be safely performed without increasing operative risks with mini-laparotomy. 相似文献
993.
Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma 总被引:1,自引:0,他引:1
Kazuhisa Uchiyama Satoru Ozawa Masaki Ueno Shinya Hayami Seiko Hirono Shinomi Ina Manabu Kawai Masaji Tani Hiroki Yamaue 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):333-338
Background and aim A retrospective analysis was performed on 32 patients with histologically confirmed xanthogranulomatous cholecystitis (XGC)
and 21 patients with gallbladder carcinoma who underwent surgical treatment between 1998 and 2007.
Methods All patients underwent preoperative CT scanning. The CT features analyzed were: the presence of intramural hypoattenuated
nodules or bands, mucosal line, the patterns of wall thickening and enhancement, and the presence of stones in the gallbladder.
The variables of the CT findings with XGC were analyzed using multivariate logistic regression analysis.
Results Intramural hypoattenuated nodules were observed in 21 patients (65%) with XGC, but in only six patients (29%) with gallbladder
carcinoma (P < 0.01). The mucosal line was observed in 27 patients (84%) with XGC and in only four patients (19%) with gallbladder carcinoma
(P < 0.0001). Gallstones were noted in 24 patients (75%) with XGC and five patients (24%) with gallbladder carcinoma (P < 0.001). There was no significant difference in the pattern of gallbladder wall thickening (diffuse or focal) and the presence
of changes outside the gallbladder. Multivariate logistic regression analysis revealed from the CT features that the enhanced
continuous mucosal line (P = 0.0013) and the presence of gallstones (P = 0.0072) were independently correlated with XGC.
Conclusion CT features of the enhanced continuous mucosal line in a thickened gallbladder wall, together with gallstones in a patient
with chronic gallbladder disease, are highly suggestive of XGC. Accurate diagnosis of XGC may therefore indicate the need
to select a less aggressive surgical approach. 相似文献
994.
Makoto Iwahashi Mikihito Nakamori Masaki Nakamura Teiji Naka Toshiyasu Ojima Takeshi Iida Masahiro Katsuda Kentaro Ueda Hiroki Yamaue 《World journal of surgery》2009,33(9):1882-1888
Background The double tract (DT) method was compared with the Roux-en-Y (R-Y) method to identify the optimal reconstruction procedure
after total gastrectomy for patients with gastric cancer. The DT reconstruction is as simple as the R-Y, and it can be safely
performed even after total gastrectomy. However, these have been no studies evaluating the usefulness of DT reconstruction
in comparison to R-Y reconstruction.
Methods A group of 44 patients with gastric cancer were intraoperatively randomized for R-Y (n = 23) or DT reconstruction (n = 21) after total gastrectomy (TG). Body weight, food intake, nutritional conditions, and quality of life (QOL) were determined
at 3 and 12 months after the operation. This study is registered with ClinicalTrials.gov, no. NCT00746161.
Results Food intake significantly decreased soon after the operation. No differences were observed between the DT and R-Y groups.
The body weight decreased throughout the ensuing period (P < 0.05) and thereafter gradually recovered. However, no differences were observed between the two groups. Among the nutritional
laboratory parameters, serum prealbumin, retinol-binding protein, total cholesterol, and triglyceride were decreased soon
after the operation. The changes of those parameters were not substantially different between the two groups. The postoperative
QOL was evaluated, and no differences were observed between those groups.
Conclusions There were no particular advantages in the DT method after TG in comparison to the simple R-Y method in terms of body weight,
QOL, and nutritional conditions, suggesting that the DT method might not be recommended after TG for patients with gastric
cancer. 相似文献
995.
Masaki Ebara MD Ichiro Yuki MD Yuichi Murayama MD Takayuki Saguchi MD Yih-Lin Nien MD Harry V. Vinters MD Fernando Vinuela MD Toshiaki Abe MD 《Surgical neurology》2009,72(6):620-627
Background
To investigate biomaterials seeking for their possible use for aneurysm treatment, in vivo screening tests using a number of potential materials are required. However, there is no established animal model that is suitable for such purpose. Some models require special preparation of tested materials for transcatheter delivery and others are inappropriate in view of their cost-effectiveness. The purpose of this study is to establish an animal model that overcomes these limitations and help us select potential materials before the preclinical evaluation.Methods
Bilateral CCAs in a rabbit were surgically ligated, and a 2-cm segment of either a bare platinum coil or a polymeric coil (a platinum coil coated with PLGA 10/90) was implanted into each blind-ended arterial segment (n = 26). They were harvested at day 1, 7, 10, 14, or 30, respectively. Angiographic and histologic evaluations as well as quantitative analysis on the development of the organized thrombus were performed.Results
One day after the implantation, both platinum and PLGA coils were surrounded by immature thrombus that was induced by blood flow stagnation in the arterial segment. At day 7, minimal thrombus organization was observed around both types of materials. At postimplantation days 10 and 14, fibrocellular responses, the early findings of the thrombus organization process, were observed in both material groups. Such histologic findings were more prominent in the PLGA coil group as compared to the platinum coil group (day 10, P = .051; day 14, P = .011). Well-organized thrombus was observed in both material groups at day 30 without showing statistical difference (P = .12).Conclusion
Given the cost-effectiveness, the simple material preparation process, and its feasible histologic evaluation methods, this new animal model can be useful in screening other potential biomaterials for the development of new coil devices. 相似文献996.
Medulloblastoma with myogenic differentiation showing double immunopositivity for synaptophysin and myoglobin 总被引:1,自引:0,他引:1
Mizue Kido Masaki Ueno Masayuki Onodera Kouichi Matsumoto Tadashi Imai Reiji Haba Takashi Tamiya Cheng-Long Huang Haruhiko Sakamoto 《Pathology international》2009,59(4):255-260
Reported herein is a case of medulloblastoma with myogenic differentiation in a 3-year-old girl who died 1 year after appearance of clinical signs. Magnetic resonance imaging indicated a mass lesion in the cerebellar vermis. She underwent total resection of the tumor, followed by chemotherapy and radiotherapy in the brain and spinal cord. The resected specimen mainly consisted of densely packed cells with round-to-oval highly chromatic nuclei surrounded by scanty cytoplasm and focally of long spindle-shaped cells with elongated nuclei and eosinophilic cytoplasm showing discernible cross-striations. Immunohistochemistry indicated partial expression of synaptophysin in the former area and focal expression of desmin in the latter area. The diagnosis was medulloblastoma with myogenic differentiation, also known as medullomyoblastoma. Autopsy indicated disseminated proliferation of immature neuroglial cells with highly chromatic nuclei and scanty cytoplasm showing partial expression of synaptophysin, neurofilaments, and GFAP, and focal proliferation of round-to-oval immature cells showing immunoreactivity of myoglobin. The tumor cells had large nuclei, frequent mitoses, apoptoses, nuclear molding, and cell wrapping, indicating moderate anaplasia. Their Ki-67 labeling index was 54%. In addition, some tumor cells had double immunopositivity for synaptophysin or neurofilament and myoglobin, suggesting that the neuroectodermal cells may undergo differentiation into rhabdomyoblasts. 相似文献
997.
We describe a strategy for the in vitro engineering of enamel tissue using a novel technique for culturing enamel organ epithelial (EOE) cells isolated from the enamel organ using 3T3-J2 cells as a feeder layer. These subcultured EOE cells retain the capacity to produce enamel structures over a period of extended culture. In brief, enamel organs from 6-month-old porcine third molars were dissociated into single cells and subcultured on 3T3-J2 feeder cell layers. These subcultured EOE cells were then seeded onto a collagen sponge in combination with primary dental pulp cells isolated at an early stage of crown formation, and these constructs were transplanted into athymic rats. After 4 weeks, complex enamel-dentin structures were detected in the implants. These results show that our culture technique maintained ameloblast lineage cells that were able to produce enamel in vivo. This novel subculture technique provides an important tool for tooth tissue engineering. 相似文献
998.
999.
1000.
Atsushi Nanashima MD Kenichiro Shibata MD Toshiyuki Nakayama MD Syuichi Tobinaga MD Masato Araki MD Masaki Kunizaki MD Hiroaki Takeshita MD Shigekazu Hidaka MD Terumitsu Sawai MD Takeshi Nagayasu MD Tsutomu Tagawa MD 《Annals of surgical oncology》2009,16(8):2123-2129
Background The present study aimed to elucidate the relationship between microvessel count (MVC) according to CD34 expression and prognosis
in intrahepatic cholangiocarcinoma (ICC) patients who underwent hepatectomy based on our preliminary study.
Methods Relationships between MVC and clinicopathological factors were examined in 37 ICC patients. CD34 expression was analyzed using
immunohistochemical methods.
Results Median MVC for ICC patients was 140/mm2, which was applied as a cutoff value. Lower MVC was significantly associated with larger tumor size, periductal infiltrating
type, and advanced Japanese tumor–node–metastasis stage (p < 0.05). Univariate survival analysis identified higher carcinoembryonic antigen level, periductal infiltrating type, poor
histological differentiation, and lower MVC as significantly associated with lower 5-year survival rates. The 5-year survival
rate in the higher-MVC group was significantly greater than that in the lower-MVC group (44% vs. 7%, p = 0.048). According to Cox multivariate survival analysis, only periductal infiltrating type on macroscopic examination was
identified as a significant independent risk factor for poor survival after hepatectomy (risk ratio 4.8; p = 0.006), not MVC (1.1; p = 0.82).
Conclusion Tumor MVC might offer a useful prognostic marker of ICC patient survival after hepatectomy and further investigation in a
larger series is warranted. 相似文献