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991.
Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach
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992.
Laparoscopy‐assisted full‐thickness resection of the duodenum for patients with gastrointestinal stromal tumor with ulceration
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993.
Laparoscopic subtotal proctocolectomy for synchronous triple colorectal cancers: a case report
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A 42‐year‐old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self‐expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patient's postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers. 相似文献
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996.
Yoshihiko Oishi Mitsunori Okamoto Takashi Sueda Masaki Hashimoto Shinji Karakawa Masayuki Kambe 《Circulation journal》2002,66(7):659-664
The effect of guidewire bias on angled-lesion ablation by rotational atherectomy (RA) was assessed by measuring the changes in vertical lumen diameter, horizontal lumen diameter and the intima-media thickness of the coronary artery, using intravascular ultrasound in 10 lesions with an angle greater than 10 degrees. The vertical and horizontal diameters significantly increased after RA. The intima-media thickness at the 4 orthogonal sites significantly decreased. There was a significant positive correlation between vertical diameter change and angle (r=0.642, p=0.045), but none between horizontal diameter change and angle. There was no correlation between intima-media thickness change at 0 degrees and angle; however, at 180 degrees there was a tendency to correlation with angle (r=0.602, p=0.066). These data suggest that in cases of angled lesions, the increase in vertical lumen diameter is caused more by ablation of the 180 degrees wall than by that of the 0 degrees wall, which is brought about by guidewire bias toward the vascular wall at 180 degrees. 相似文献
997.
Yosuke Adachi M.D. Masaki Mori M.D. Munetomo Enjoji M.D. Hiroaki Ueo M.D. Keizo Sugimachi M.D. 《Diseases of the colon and rectum》1987,30(12):962-966
Eighteen cases of mesenteric panniculitis of the colon collected from the literature, together with two cases from the authors'
source, were reviewed. The disease occurred most often in late adult life, with a male predominance. Symptoms were abdominal
pain, diarrhea, constipation, and a lower abdominal mass in most patients. Barium enema disclosed narrowing, shortening, and
poor extensibility of the colon, and ultrasonography and computed tomography showed thickening of the mesocolon and colonic
wall with soft-tissue density. Exploratory laparotomy was done in all patients, and colectomy, colostomy, or other surgical
treatments were performed in 17 (85 percent). Gross appearance at the time of surgery was characterized by a marked thickening
or a firm mass of the mesocolon with a puckered surface involving the appendices epiploicae of the colon. Microscopically,
degeneration of the adipose tissue, revealed by aggregates of lipid-laden macrophages, was diagnostic. Inflammatory infiltration
and fibrosis also were present in many patients. Mesenteric panniculitis of the colon seems to be a lesion more advaced than
the same condition of the small intestine, and colostomy or bypass surgery may be needed for alleviation of severe symptoms. 相似文献
998.
Predictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma 总被引:8,自引:0,他引:8
To accurately select patients with malignant colorectal polyps who are at high risk of adverse outcome, we examined the predictive
value of clinicopathological factors, with special attention paid to the histology at the invasive margin. We examined 75
submucosal carcinomas from 75 patients, initially resected by polypectomy, including endoscopic, trans-anal, trans-sacral,
and trans-sphincteric local excision. The associations between clinicopathological features such as sex and age; tumor size,
location, shape, depth of submucosal invasion, vascular invasion, histology at the central part, and histology at the invasive
margin; and the presence or absence of a residual adenomatous component and adverse outcome were examined by univariate and
multivariate logistic regression analyses. Lymph node metastases were found in 2 patients, local recurrence in 4, and distant
metastases in 2. Univariate logistic regression analysis showed that unfavorable histology at the invasive margin was significantly
associated with lymph node metastasis or local recurrence (P = 0.0373), whereas the association of lymphatic invasion and vascular (lymphatic or venous) invasion with lymph node metastasis
or local recurrence had marginal significance (P = 0.0785; P = 0.0990). Multivariate logistic regression analysis, with unfavorable histology at the invasive margin and lymphatic invasion
as independent variables, showed that unfavorable histology alone had significance (P = 0.0373) in predicting adverse outcome. Widely accepted criteria such as massive submucosal invasion, positive vascular
invasion, and poorly differentiated histology, were less useful in predicting adverse outcome. These results suggest that
unfavorable histology at the invasive margin is a useful risk factor for predicting lymph node metastasis or local recurrence
in patients with malignant colorectal polyps.
Received: March 23, 1999 / Accepted: August 27, 1999 相似文献
999.
Yosuke Adachi M.D. Masaki Mori M.D. Akinori Kido M.D. Reishi Shimono M.D. Taketoshi Suehiro M.D. Dr. Keizo Sugimachi M.D. 《Diseases of the colon and rectum》1992,35(2):197-200
We report on a 22-year-old man with congenital hypogammaglobulinemia who developed multiple colorectal neoplasms. An immunodeficiency had been diagnosed in the patient since two years of age, and this time many tumors of the sigmoid colon and rectum were detected by barium enema and fiberscopy. Abdominoperineal resection was performed, and the resected specimen revealed 29 polyps, including 9 adenocarcinomas and 20 adenomas. The carcinomas, measuring 0.8 to 11.0 cm in size, showed various depths of invasion, and the adenomas, measuring 0.2 to 1.5 cm in size, showed various degrees of epithelial atypia. DNA analysis demonstrated that the tumors were heterogeneous, showing different DNA index and ploidy patterns. The pathogenetic relation between malignancy and immunodeficiency is also reviewed. 相似文献
1000.
TAKESHI MACHINO M.D. HIROSHI TADA M.D. YUKIO SEKIGUCHI M.D. YASUAKI TANAKA M.D. SHIGETO NAITO M.D. HIRO YAMASAKI M.D. TAKANORI ARIMOTO M.D. MIYAKO IGARASHI M.D. KENJI KUROKI M.D. YOSHIHIRO SEO M.D. SHIGEYUKI WATANABE M.D. HIROSHI HOSHIZAKI M.D. SHIGERU OSHIMA M.D. KOICHI TANIGUCHI M.D. KAZUTAKA AONUMA M.D. 《Journal of cardiovascular electrophysiology》2010,21(3):284-289
AF Ablation and PTMC. Background: The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF. Methods: Twenty consecutive patients with drug‐resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF‐8, long‐lasting [>1 year] persistent AF‐2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF‐7, long‐lasting persistent AF‐3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5. Results: During a mean follow‐up period of 4.0 ± 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log‐rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow‐up period in either group. Conclusions: The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 284–289, March 2010) 相似文献