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961.
Akihiro Hosaka Tetsuro Miyata Katsuyuki Hoshina Hiroyuki Okamoto Kunihiro Shigematsu 《Surgery today》2014,44(9):1771-1773
Primary iliac venous aneurysm is an extremely rare clinical entity. We report a case of primary external iliac venous aneurysm containing an intraluminal thrombus that caused pulmonary thromboembolism in a 22-year-old woman. The aneurysm and pulmonary emboli were detected during examination for sudden onset of dyspnea. After receiving anticoagulation and thrombolytic therapy, the patient underwent aneurysm resection. We devised venoplasty using a dual-row saphenous vein patch to cover the large defect of the vessel wall. Primary iliac venous aneurysms associated with pulmonary thromboembolism are uncommon and surgical repair is made difficult by the fragility of the affected vessel. We reviewed the clinical features of this unusual entity. 相似文献
962.
Norihito Ogawa Hideaki Iseki Hidefumi Tsunozaki Mikiko Hayashi Hironobu Baba Takatoshi Matsuyama Hiroyuki Uetake Kenichi Sugihara 《Surgery today》2014,44(11):2174-2179
Desmoid tumors are benign fibroblastic neoplasms with no metastatic potential, but a propensity for local recurrence even after complete surgical resection. These lesions can develop at any site in the body, and commonly occur in the intra-abdominal area. Intra-abdominal desmoid tumors usually occur at the mesentery or retroperitoneum, and may morphologically mimic gastrointestinal stromal tumors (GISTs). Distinguishing between these tumors is important, because the therapies differ substantially, but is often difficult even with the use of CD117 staining. We herein report the cases of two patients with sporadic intra-abdominal desmoid tumors that were differentiated from GIST by immunohistological examination using beta-catenin and CD34. Desmoid tumors specifically express nuclear beta-catenin, and show no expression of CD34. We recommend staining for beta-catenin and CD34 when an intra-abdominal desmoid tumor is suspected. 相似文献
963.
Sayaka Otake Norio Suzuki Atsushi Takahashi Fumiaki Toki Akira Nishi Hideki Yamamoto Minoru Kuroiwa Hiroyuki Kuwano 《Surgery today》2014,44(8):1400-1405
Background/purpose
To clarify the role of interval appendectomy (IA) in pediatric patients with acute appendicitis with an appendiceal inflammatory mass or abscess, we histologically analyzed the appendices removed during IA.Patients and methods
We treated 355 consecutive pediatric patients with acute appendicitis and reviewed the admission charts of patients who started conservative management (CM). The histology of the appendix removed during IA was also examined. The relationships among the clinical features, appendicolith formation at the time of IA and histological findings were analyzed by stepwise regression analyses.Results
(1) CM was started in 48 patients (13.5 %). Recurrence or a remaining abscess was observed in nine patients (18.8 %). (2) Histopathological changes, particularly foreign body reaction with fibrosis and infiltration of inflammatory cells, were observed in about half of the specimens. (3) In a stepwise regression analysis, the presence of an appendicolith at IA was correlated with an appendicolith at diagnosis, foreign body reaction in the appendix and a decrease in the inflammatory reaction at diagnosis.Conclusion
More than half the patients had strong histopathological changes in the appendix, suggesting a high possibility of recurrence. The presence of appendicolith formation at IA, which is a risk factor for recurrence, was influenced by the presence of an appendicolith at diagnosis, foreign body reaction in the appendix and the inflammatory status of patients at diagnosis. These clinical findings are indications for IA. 相似文献964.
Bibek Aryal Teruo Komokata Jun Kadono Hiroyuki Motodaka Yuichi Shimamoto Iwao Kitazono Toshihiro Nakazono Shunsuke Motoi Akira Furoi Yutaka Imoto 《Surgery today》2014,44(8):1584-1587
Parenchyma-sparing pancreatic resections have been reported increasingly in recent years; however, for multifocal diseases involving the head and the tail of the pancreas, total pancreatectomy is still the preferred procedure. The possible consequence of this procedure is loss of normal pancreatic parenchyma, resulting in insufficiency of pancreatic exocrine and endocrine functions. Various types of limited resection have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor. Even for multifocal diseases, if the pancreatic body is spared, a middle-preserving pancreatectomy (MPP) can be performed to assure maximal pancreatic function and uncompromised quality of life. Yet, few papers have introduced the feasibility of MPP for a better outcome. This report describes a new surgical technique for MPP using an alternative approach for the remnant pancreas anastomosis. We used this technique successfully to remove a bifocal neoplasm: adenocarcinoma of the distal bile duct and mucinous cyst adenoma in the tail of the pancreas. 相似文献
965.
Hiroyuki Tsujimoto Hideki Takamori Misaki Tsuji Maho Hayashi Junki Ikeda Taichi Orikasa Hiroko Torii Yuki Ozamoto Shuko Suzuki Shinichiro Morita Yoshito Ikada Akeo Hagiwara 《Surgery today》2014,44(2):391-394
To overcome the problems associated with sheet- or film-type anti-adhesive materials, we developed a new type of anti-adhesive material, gelatin flakes. We made two types of gelatin flakes with or without thermal cross-linking, and preliminarily examined their basic properties and the anti-adhesive efficacy using a rodent adhesion model. Both types of the gelatin flakes rapidly turned into gel and tightly attached the injured surfaces, absorbing the moisture and blood, when applied onto the abraded sites of rats. In addition, these flakes could be sprayed into the desired area by compressed air through a device with a long, thin tube, which could be used in laparoscopic surgery. The anti-adhesive effects of both types of gelatin flakes were similar, and both types were significantly superior compared to the non-treated group. Although further investigations are necessary, the gelatin flakes have unique and useful properties and satisfactory anti-adhesive effects, which indicate that they may be applicable in laparoscopic surgery. 相似文献
966.
Mitsuro Kanda Tsutomu Fujii Hideki Takami Masaya Suenaga Yoshikuni Inokawa Suguru Yamada Goro Nakayama Hiroyuki Sugimoto Masahiko Koike Shuji Nomoto Yasuhiro Kodera 《Surgery today》2014,44(9):1692-1701
Purpose
The aim of this study was to detect high-performance prognostic biomarkers of pancreatic cancer which would enable the identification of high-risk patients.Methods
The subjects were 324 patients who underwent radical surgery for pancreatic ductal adenocarcinoma without neoadjuvant therapy. We evaluated the prognostic impact of four perioperative serum tumor markers, including carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). We also evaluated the indices by multiplying the values of two tumor markers (e.g., CA19-9 × CEA).Results
The preoperative CA19-9 × CEA index had a strong correlation with the prognosis of patients with pancreatic cancer, even when the cut-off was set at the median value. CA19-9 × CEA ≥500 was an independent predictor of mortality (hazard ratio: 1.642, p = 0.021). In the ROC curve analysis of early mortality after surgery, the CA19-9 × CEA index had the highest goodness of fit. The presence of CA19-9 × CEA ≥500 had the largest attributable risk proportion because of its combined high predictive performance and prevalence. The postoperative CA19-9 × CEA index was also a significant predictive marker of mortality.Conclusion
The CA19-9 × CEA index is a strong prognostic biomarker that could help identify pancreatic cancer patients expected to have a poor prognosis so that they can be administered appropriate multidisciplinary treatment. 相似文献967.
Masaru Morita Hajime Otsu Hiroyuki Kawano Yuta Kasagi Yasue Kimura Hiroshi Saeki Koji Ando Satoshi Ida Eiji Oki Eriko Tokunaga Tetsuo Ikeda Tetsuya Kusumoto Yoshihiko Maehara 《Surgery today》2014,44(3):505-512
Purpose
The purpose of this study was to clarify the gender differences in the prognosis, as well as mortality and morbidity, of patients who have undergone esophagectomy for esophageal cancer.Methods
The clinical results of esophagectomy were compared between 975 male and 156 female patients with esophageal cancer.Results
The male to female ratios of cervical and thoracic esophageal cancer were 1.87 and 7.38, respectively (P < 0.01). The incidence of preoperative comorbidities was 32.4 and 17.4 %, respectively, and the rates of both tobacco and alcohol abuse were significantly lower in the females than in the males. The mortality rate was lower in the females (3.8 %) than in the males (5.7 %), although the differences were not significant. The overall survival was significantly better in the female than in the male patients (P = 0.039). The 5- and 10-year overall survival rates were 32.6 and 20.5 % in the males and 39.5 and 32.5 % in the females, respectively. A multivariate analysis revealed gender to be an independent prognostic factor. However, no significant differences were recognized in disease-specific survival.Conclusions
These results suggest that the prognosis of females with esophageal cancer is better than that of males after esophagectomy, most likely due to multiple clinical factors, such as a more favorable lifestyle and general status. 相似文献968.
Shintaro Iwai Tamon Kabata Toru Maeda Yoshitomo Kajino Shin Watanabe Kazunari Kuroda Kenji Fujita Kazuhiro Hasegawa Hiroyuki Tsuchiya 《Journal of orthopaedic science》2014,19(3):443-450
Background
Some reports indicate that one of major causes of clinical failure after periacetabular osteotomy is development of secondary femoroacetabular impingement (FAI). To assess the impact of range of motion (ROM) on the increase in FAI following rotational acetabular osteotomy (RAO), we performed FAI simulations before and after RAO.Methods
We evaluated 12 hips that had undergone RAO (study group), and 12 normal hips (control group). The study group was evaluated before and after surgery. Morphological parameters were evaluated to assess acetabular coverage. The acetabular anteversion angle, anterior CE angle, alpha angle, and combined anteversion angle were also measured. Impingement simulations were performed using 3D-CT. The ROM which causes bone-to-bone impingement was evaluated in flexion (flex), abduction, external rotation at 0° flexion, and internal rotation at 90° flexion. The lesions caused by impingement were evaluated.Results
Radiographic measurements indicated improved postoperative acetabular coverage in the study group. The crossover sign was recognized pre- and postoperatively in every case in the study group and in no cases in the control group. In the simulation study, flexion, abduction, and internal rotation at 90° flexion decreased postoperatively. Impingement occurred within 45° internal rotation at 90° flexion in two preoperative and nine postoperative cases. The impingement lesions were anterosuperior of the acetabulum in all cases. There were correlations between anterior CE angle, CE angle, acetabular anteversion angle, and hip flexion angle. There were also correlations between the anterior CE angle, combined anteversion angle, and angle of internal rotation at 90° flexion.Conclusions
In the postoperative simulation, there was a tendency to reduce the ROM in flexion, abduction, and internal rotation at 90° flexion due to impingement. Since there were more cases which caused impingement within 45° internal rotation at 90° flexion after RAO, we consider there is a potential for increased FAI after RAO. 相似文献969.
Hiroyuki Torisu Kyoko Watanabe Keiko Shimojima Midori Sugawara Masafumi Sanefuji Yoshito Ishizaki Yasunari Sakai Hironori Yamashita Toshiyuki Yamamoto Toshiro Hara 《Brain & development》2014
This paper documents the case of a female Japanese patient with infantile focal epilepsy, which was different from benign infantile seizures, and a family history of infantile convulsion and paroxysmal choreoathetosis. The patient developed partial seizures (e.g., psychomotor arrest) at age 14 months. At the time of onset, interictal electroencephalography (EEG) showed bilateral parietotemporal spikes, but the results of neurologic examination and brain magnetic resonance imaging were normal. Her seizures were well controlled with carbamazepine, and she had a normal developmental outcome. EEG abnormalities, however, persisted for more than 6 years, and the spikes moved transiently to the occipital area and began to resemble the rolandic spikes recognized in benign childhood epilepsy. Her father had paroxysmal kinesigenic dyskinesia, with an onset age of 6 years, and her youngest sister had typical benign infantile seizures. Genetic analysis demonstrated that all affected members had a heterozygous mutation of c.649_650insC in the proline-rich transmembrane protein-2 (PRRT2) gene. This case indicates that the phenotypic spectrum of infantile seizures or epilepsy with PRRT2-related pathology may be larger than previously expected, and that genetic investigation of the effect of PRRT2 mutations on idiopathic seizures or epilepsy in childhood may help elucidate the pathological backgrounds of benign childhood epilepsy. 相似文献
970.
Mikiya Inoue Kiminobu Sugito Taro Ikeda Hiroyuki Kawashima Manabu Hanada Takeshi Furuya Kensuke Ohashi Tsugumichi Koshinaga 《Journal of gastrointestinal surgery》2014,18(3):580-583