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141.
Kondo K Chijiiwa K Funagayama M Kai M Otani K Ohuchida J 《World journal of surgery》2008,32(10):2223-2229
BACKGROUND: Hepatic resection is one of the main treatment modalities for patients with hepatocellular carcinoma (HCC); however, surgery is generally stressful and often is avoided for elderly patients. This retrospective study was designed to determine whether the indications for hepatic resection in younger patients with HCC are applicable to elderly patients. METHODS: Subjects were 294 patients in whom 319 hepatic resections were performed for HCC (male/female ratio, 238/81; age range, 18-83 years). The patients were divided into two groups according to age at the time of surgery: 70 years or older (n = 109) and 69 years or younger (n = 210). Surgical strategy and postoperative follow-up methods did not differ between groups. The incidence and severity of postoperative complications classified by the Clavien system were compared between the two groups. Postoperative survival was compared between the two groups and between subgroups based on Japan Integrated Staging (JIS) scores. HCC-related death rates also were compared. RESULTS: No significant between-group difference was found in background liver function or type of hepatic resection. Differences were found in performance status and type of hepatitis virus infection. No difference was observed in the incidence or severity of postoperative complications. Postoperative survival was similar between the two age-based study groups and between the JIS-based subgroups. HCC-related death rates did not differ between groups. CONCLUSIONS: The absence of differences in postoperative outcomes between groups suggests that hepatic resection is justified for HCC in selected patients aged 70 years or older. 相似文献
142.
Shima Y Nakanishi K Togawa H Obana M Sako M Miyawaki M Nozu K Iijima K Yoshikawa N 《Pediatric nephrology (Berlin, Germany)》2009,24(3):605-608
A 6-year-old previously healthy Japanese girl was found to have dipstick 2+ proteinuria and a goiter based on the results
of a routine school medical examination. Her serum free-thyroxine level was 4.98 ng/dL (normal range 0.95–1.74 ng/dL), thyroid-stimulating
hormone (TSH) was less than 0.003 μU/mL (0.34–3.88 μU/mL), anti-microsomal (anti-thyroid-peroxidase) antibody was 1600 T (up
to 100), anti-thyroglobulin antibody was 400 T (up to 100), and TSH-receptor antibody was 84% (up to ±10%). These results
are consistent with a diagnosis of Graves’ disease. Electron microscopy examination of a renal biopsy specimen revealed electron-dense
deposits located in the subepithelial spaces, and immunofluorescence microscopy examination demonstrated bright granular stainings
of immunoglobulin G along the glomerular capillary walls. These findings are characteristic of membranous nephropathy. To
investigate the relationship between the membranous nephropathy and Graves’ disease, we carried out a second immunofluorescence
study, which revealed that the immunoglobulin G granular deposits corresponded to glomerular granular staining of thyroid-peroxidase,
whereas staining for thyroglobulin was absent. It was therefore assumed that the deposition of immune complexes mediated by
thyroid-peroxidase had caused the membranous nephropathy in this patient. This is the first report of membranous nephropathy
associated with Graves’ disease in which deposits of thyroid-peroxidase, rather than thyroglobulin, have been confirmed in
the kidney.
This study was presented in the 14th congress of International Pediatric Nephrology Association (IPNA), Budapest, Hungary,
2007. 相似文献
143.
Chikara Kunisaki Hirochika Makino Ryo Takagawa Kei Sato Mayumi Kawamata Amane Kanazawa Naoto Yamamoto Yasuhiko Nagano Shoichi Fujii Hidetaka A. Ono Hirotoshi Akiyama Hiroshi Shimada 《Surgical endoscopy》2009,23(9):2085-2093
Background Some studies have found high incidences of intraoperative and postoperative complications for patients with gastric cancer.
To determine the predictive factors for the surgical complications of laparoscopic gastric surgery, surgical outcomes were
evaluated.
Methods Between April 2002 and December 2007, 152 patients with preoperatively diagnosed early gastric cancer who underwent laparoscopy-assisted
distal gastrectomy (LADG) were enrolled. Visceral (VFA) and subcutaneous fat areas (SFA) were assessed by Fat Scan software.
The predictive factors for surgical complications of LADG were evaluated by univariate and logistic regression analyses.
Results Of 152 patients, conversion to open surgery due to uncontrollable bleeding was observed in nine male patients, and postoperative
complications were detected in seven male and one female patient (four anastomotic leakage, two intraabdominal abscess, one
pancreatic fistula, and one lymphorrhea). High body mass index (BMI) and high VFA independently predicted conversion to open
surgery and postoperative complications. VFA was significantly higher, operation time was longer, blood loss was greater,
and SFA was lower in male than in female patients, whereas no significant difference was observed in BMI between male and
female patients.
Conclusions High BMI and high VFA can predict technical difficulties during laparoscopic gastric surgery and postoperative complications.
Particularly, LADG should be performed cautiously to prevent surgical complications for male patients with high VFA. Predictive
impact of VFA should be further determined in a larger set of patients. 相似文献
144.
Kazuhiro Kondo Kazuo Chijiiwa Mayumi Funagayama Masahiro Kai Kazuhiro Otani Jiro Ohuchida 《Journal of gastrointestinal surgery》2008,12(3):468-476
Long-term postoperative survival and prognostic factors were examined retrospectively in patients with hepatocellular carcinoma
(HCC) with serum hepatitis B surface antigen (HBsAg) or hepatitis C antibody (HCVAb) and in those without virus infection.
Subjects were 265 consecutive HCC patients treated surgically at one institution during the period 1990 to 2006. Postoperative
survival was analyzed and compared between HBsAg-positive (B-HCC), HCVAb-positive (C-HCC), and hepatitis B- and C-negative
(NBNC-HCC) patients. Prognostic factors for overall and recurrence-free survival were also analyzed. Overall and recurrence-free
survival rates were significantly higher in the NBNC-HCC group than in the C-HCC group. Significant prognostic factors for
overall survival identified by univariate and multivariate analyses were age, serum alkaline phosphatase (ALP) level, tumor
multiplicity, portal vein invasion (Vp), hepatic vein invasion (Vv), and operative blood loss in the B-HCC group; serum albumin
level, ALP level, tumor size, and Vv in the C-HCC group; and tumor multiplicity in the NBNC-HCC group. Significant factors
for recurrence-free survival were age, ALP level, tumor multiplicity, Vp, and operation time in the B-HCC group; ALP level,
prothrombin time, tumor size, Vv, and width of the surgical margin in the C-HCC group; and age, tumor size, tumor multiplicity,
and Vp in the NBNC-HCC group. Thus, postoperative survival and prognostic factors in cases of HCC differ according to the
presence of serologic viral markers. 相似文献
145.
Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines 总被引:2,自引:0,他引:2
Miura F Takada T Kawarada Y Nimura Y Wada K Hirota M Nagino M Tsuyuguchi T Mayumi T Yoshida M Strasberg SM Pitt HA Belghiti J de Santibanes E Gadacz TR Gouma DJ Fan ST Chen MF Padbury RT Bornman PC Kim SW Liau KH Belli G Dervenis C 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(1):27-34
Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis),
according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management
of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment
may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For
severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After
hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed.
For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic,
percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with
mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade
II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation,
elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy.
For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary
peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective
cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general
medical condition. 相似文献
146.
Gap junction protein beta 1 (GJB1) mutations and central nervous system symptoms in X-linked Charcot-Marie-Tooth disease 总被引:3,自引:0,他引:3
Takashima H Nakagawa M Umehara F Hirata K Suehara M Mayumi H Yoshishige K Matsuyama W Saito M Jonosono M Arimura K Osame M 《Acta neurologica Scandinavica》2003,107(1):31-37
OBJECTIVES: To clarify the clinical variability, including central nervous system (CNS) involvement, in X-linked Charcot-Marie-Tooth disease (CMTX) patients. MATERIAL AND METHODS: We clinically, pathologically and genetically studied six CMTX patients with distinct symptoms and four different GJB1 mutations. RESULTS: One patient with Val63Ile had deafness, low intelligence, saccadic eye movement, upper extremity distal dominant muscle weakness and normal sensation. Another patient with Glu186Lys had severe sensorineural deafness at the age of 6 years, but did not develop muscle weakness until the age of 20 years. Two patients with Arg22Gln had typical CMT1A-like clinical features, no CNS symptoms and obvious onion bulb formations. Two siblings with deletion of the entire GJB1 gene had mild to moderate lower extremity muscle weakness and sensory disturbance without CNS involvement. CONCLUSION: These findings suggest that some gain of function mutations of GJB1 may be related to CNS symptoms because the patients with GJB1 deletion only had peripheral neuropathy, although other unknown associated factors may contribute to their clinical phenotypes. 相似文献
147.
148.
Taizo Wada MD Yasuko Ishimoto MSc Mayumi Hirosaki MA Akiko Konno BSc Yoriko Kasahara MPH Yumi Kimura MPH Hiroaki Nakatsuka MD Ryota Sakamoto MD Masayuki Ishine MD Kiyohito Okumiya MD Michiko Fujisawa MD Kuniaki Otsuka MD Kozo Matsubayashi MD 《Journal of the American Geriatrics Society》2009,57(12):2369-2371
149.
Muthu Veeraputhiran Jerry Ware Judith Dent Joshua Bornhorst Ginell Post Michele Cottler‐Fox Gina Pesek John Theus Mayumi Nakagawa 《Transfusion》2011,51(5):1030-1036
BACKGROUND: Washed or volume‐reduced platelets (PLTs) are occasionally requested for patients with a history of allergic or anaphylactic transfusion reactions. However, conclusive data are not available as to which method is more suitable. STUDY DESIGN AND METHODS: A direct comparison of saline‐washed and volume‐reduced PLTs was performed by splitting 11 units of 6‐day‐old apheresis PLT units. PLT activation, aggregation, plasma protein, and PLT count were determined before and after each procedure. To assess whether washing using neutral, calcium‐free Ringer's acetate (NRA) would better preserve PLT function, 8 additional units of apheresis PLTs were split and were washed in saline or NRA. RESULTS: Saline washing resulted in significantly increased number of activated, P‐selectin–expressing PLTs compared to volume reduction (24.2% vs. 10.3%, p = 0.001). Aggregation was also significantly reduced (?40.6% vs. ?0.8%, p = 0.004). Plasma protein removal was significantly better for saline‐washed than volume‐reduced PLTs (96% vs. 51.1%, p < 0.001). PLT recovery was not significantly different for saline‐washed versus volume‐reduced PLTs (70.5% vs. 80.7%, p = 0.079). There was no difference between washing in saline or NRA with regard to PLT activation and loss of aggregation. CONCLUSIONS: PLT washing with saline or NRA significantly increases PLT activation and decreases PLT aggregability. On the other hand, volume reduction does not adequately remove plasma proteins. Therefore, PLT washing should be reserved for patients with a history of severe allergic or anaphylactic transfusion reactions. We suggest that fresher PLTs be selected to improve the functionality of washed PLTs. 相似文献
150.
Md. Shahidul Ahsan Manabu Yamazaki Satoshi Maruyama Takanori Kobayashi Hiroko Ida‐Yonemochi Mayumi Hasegawa Adeola Henry Ademola Jun Cheng Takashi Saku 《Journal of oral pathology & medicine》2011,40(7):552-559
J Oral Pathol Med (2011) 40 : 552–559 Objectives: The deposition of perlecan, a heparan sulfate proteoglycan, is enhanced within oral carcinoma in situ (CIS) foci, while it dynamically switches from CIS foci to the stromal space in squamous cell carcinoma (SCC). Because α‐dystroglycan and integrin β1 have been identified as two of the perlecan receptors, we wanted to determine their differential distributions before and after invasion of oral SCC. Methods: Eighty‐two surgical tissue specimens of oral SCC containing different precancerous stages were examined by immunohistochemistry for perlecan, α‐dystroglycan, integrin β1, and Ki‐67. In addition, α‐dystroglycan mRNA signals were localized by in situ hybridization. Results: In normal epithelia, α‐dystroglycan and integrin β1 were localized on the cell membrane of basal cells, while perlecan was faintly present in the intercellular spaces of parabasal cells. In epithelial dysplasia and CIS, α‐dystroglycan and perlecan were well co‐localized in the epithelial layer, especially in its lower half, and this co‐localization was mostly overlapped with Ki‐67‐positive (+) cell zones. However, in SCC, α‐dystroglycan was localized neither within carcinoma cell nests nor in the stroma, while perlecan disappeared from SCC foci but emerged in the stromal space, leaving integrin β1+ and Ki‐67+ cells only to the periphery of SCC foci. α‐Dystroglycan mRNA signals were basically identical to the α‐dystroglycan protein localizations. Conclusion: The findings suggest that α‐dystroglycan and integrin β1 act as perlecan receptors in oral precancerous lesions prior to invasion, and that the perlecan signals via the two different receptors function in cellular differentiation and proliferation of CIS cells, respectively. 相似文献