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941.
Masanori Uno Kazuaki Shimada Yusuke Yamamoto Satoshi Nara Minoru Esaki Yoshihiro Sakamoto Tomoo Kosuge Hidenori Ojima 《Surgery today》2012,42(12):1189-1194
Purpose
This study was undertaken to elucidate the clinicopathological characteristics and surgical outcome of the periductal infiltrating (PI) type of intrahepatic cholangiocarcinoma (ICC), which is a distinct macroscopic type of ICC arising from the second-order of the intrahepatic bile ducts without apparent invasion of the surrounding liver parenchyma.Methods
All patients with the PI type of ICC were identified from a database of patients with intrahepatic cholangiocellular carcinoma that underwent surgical resection between 1983 and 2009. The clinicopathological data of these patients were analyzed retrospectively.Results
Sixteen of 203 patients (7.9%) had the PI type of ICC. The median survival was 7.7?years with 5-year survival rate of 62.1%. The PI type of ICC showed a significantly better survival than the mass-forming (MF) type (P?=?0.0293) or MF plus PI type of ICC (P?=?0.0001). Microscopic examinations showed intrahepatic metastasis to be absent in all the patients with PI type ICC. The incidence of intrahepatic metastases in patients with PI type was significantly lower in comparison to that of patients with MF type (P?=?0.0030) and MF plus PI type (P?=?0.0533), respectively.Conclusion
Surgery could therefore provide a favorable outcome in patients with the PI type of ICC, probably due to its lower incidence of intrahepatic metastases. 相似文献942.
943.
Kawahara T Ito H Terao H Yoshida M Ogawa T Uemura H Kubota Y Matsuzaki J 《BJU international》2012,110(4):588-590
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Retrograde nephrostomy was first developed by Lawson et al. in 1983, and Hunter et al. reported 30 cases of retrograde nephrostomy in 1987. This procedure uses less radiation exposure and has a shorter duration compared with the previous percutaneous nephrostomy techniques. Retrograde nephrostomy using Lawson's procedure was reported in the late 1980s by several authors. But since then, few studies have been reported about this procedure due to the development of ultrasonography assisted percutaneous nephrostomy. With the arrival and development of the flexible ureteroscope (URS) both observation and manipulation in the renal pelvis are now easily achieved. The present procedure provides less radiation exposure, less bleeding, and a shorter procedure than previous percutaneous nephrostomy techniques. Using this procedure, after the needle has exited through the skin, no further steps are required in preparation for dilatation. In the present study, we continuously visualised from puncture to inserting the nephron‐access sheath with the URS.
OBJECTIVE
- ? To describe a technique for ureteroscopy assisted retrograde nephrostomy.
PATIENTS AND METHODS
- ? Under general and epidural anaesthesia, the patient is placed in a modified‐Valdivia position. Flexible ureteroscopy is carried out, and a Lawson retrograde nephrostomy puncture wire is placed in the ureteroscope (URS).
- ? After the needle has exited through the skin, no further steps are required in preparation for dilatation.
RESULTS
- ? After informed consent was obtained, two patients (a 43‐year‐old man with left renal stones and a 57‐year‐old woman with right renal stones) underwent this procedure.
- ? The URS was positioned in the middle posterior calyx and punctured toward the skin.
CONCLUSIONS
- ? This procedure involves less radiation exposure and shorter surgery than the previous percutaneous nephrostomy technique.
- ? Our technique represents another new option for percutaneous nephrolithotomy in patients with a non‐dilated intrarenal collecting system.
944.
Yahiro M Kuragano T Kida A Kitamura R Furuta M Hasuike Y Otaki Y Nonoguchi H Nakanishi T 《Clinical and experimental nephrology》2012,16(3):448-455
Background
Hemoglobin (Hb) cycling in patients with renal anemia might be associated with a higher mortality rate. We investigated the association of factors relating serum ferritin and dose of erythropoiesis-stimulating agents (ESAs) with Hb levels.Methods
We measured Hb and ferritin levels every month in 266 hemodialysis (HD) patients for 12?months.Results
The standard deviation (SD) and residual SD (RSD) (liner regression of Hb or ferritin SD values) values of Hb were significantly correlated with ferritin SD or RSD values, respectively. The percentage achievement of target Hb in the target-ferritin group was significantly higher than in the high-amplitude fluctuation ferritin group. Ferritin SD and RSD values in patients with oral or no iron supplementation were significantly lower than those who received intravenous iron.Conclusion
Iron storage varies over a relatively wide range in HD patients, and this variation is closely associated with Hb cycling. The stability of iron storage and ESA dosage is important for maintaining stable Hb levels. 相似文献945.
Takahisa Yoshikawa Hiroya Takeuchi Koichi Suda Taku Miyasho Shingo Yamada Minoru Okamoto Yoshio Kawamura Ikuro Maruyama Masaki Kitajima Yuko Kitagawa 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2012,397(3):457-465
Purpose
The efficacy of intravenous immunoglobulin G in the treatment of patients with severe sepsis or septic shock is still being debated. We investigated the impact of high-dose immunoglobulin administration on the survival rate and serum high-mobility group box chromosomal protein 1 (HMGB1) level in a rat model of sepsis created by cecal ligation and puncture (CLP). 相似文献946.
Tetsuo Nozaki Yasuhiro Iida Akihiro Morii Yasuyoshi Fujiuchi Hikaru Suzuki Mitsuyo Okazawa Minoru Iwata Hideki Fuse 《Surgical Practice》2012,16(4):154-159
Adrenocorticotropic hormone (ACTH)‐independent bilateral adrenocortical macronodular adrenocortical hyperplasia (AIMAH) is a rare cause of Cushing's syndrome (CS). Traditionally, bilateral adrenalectomy with subsequent lifetime steroid replacement has been considered to be the treatment of choice. In the present study, we evaluated the long‐term results of unilateral adrenalectomy in subclinical CS (SCS) due to AIMAH, with regard to the main laboratory and clinical abnormalities. Two patients with confirmed SCS due to AIMAH underwent unilateral laparoscopic adrenalectomy to reduce the cortisol‐secreting tissue. These procedures were successfully conducted in both cases without open conversion, and no surgery‐related morbidity occurred. In both cases, the size of the remaining adrenal gland appeared quite stable, and neither of the patients showed a Cushingoid appearance. Unilateral adrenalectomy achieved satisfactory and prolonged control of cortisol secretion, and also reduced the risk of metabolic disorders and cardiovascular disease after surgery. It can be a safe and effective treatment for SCS due to AIMAH, while maintaining the patient's quality of life. 相似文献
947.
Hiroko Shindo Shinya Maekawa Kazuki Komase Ryota Sueki Mika Miura Makoto Kadokura Kuniaki Shindo Fumitake Amemiya Takatoshi Kitamura Yasuhiro Nakayama Taisuke Inoue Minoru Sakamoto Shun-ichi Okada Yasuhiro Asahina Namiki Izumi Masao Honda Shuichi Kaneko Nobuyuki Enomoto 《Hepatology International》2012,6(2):482-490
Background and aims
Protease inhibitor (PI)-resistant hepatitis C virus (HCV) variants may be present in substantial numbers in PI-untreated patients according to recent reports. However, influence of these viruses in the clinical course of chronic hepatitis C has not been well characterized.Methods
The dominant HCV nonstructural 3 (NS3) amino acid sequences were determined in 261 HCV genotype 1b-infected Japanese patients before pegylated interferon plus ribavirin (PEG-IFN/RBV) therapy, and investigated the patients?? clinical characteristics as well as treatment responses including sustained virological response (SVR) rate. HCV-NS3 sequences were also determined in 39 non-SVR patients after completion of the therapy.Results
Four single mutations (T54S, Q80K, I153V, and D168E) known to confer PI resistance were found in 35 of 261 patients (13.4%), and double mutations (I153V plus T54S/D168E) were found in 6 patients (2.3%). Responses to PEG-IFN/RBV therapy did not differ between patients with and without PI-resistance mutations (mutation group, SVR 48%; wild-type group, SVR 40%; P?=?0.38). On the other hand, two mutations appeared in two non-SVR patients after PEG-IFN/RBV therapy (I153V and E168D, 5.1%).Conclusions
PI-resistance-associated NS3 mutations exist in a substantial proportion of untreated HCV-1b-infected patients. The impact of these mutations in the treatment of PIs is unclear, but clinicians should pay attention to avoid further development of PI resistance. 相似文献948.
Ricardo Aurélio Carvalho Sampaio Priscila Yukari Sewo Sampaio Minoru Yamada Mihoko Ogita Hidenori Arai 《Journal of Clinical Gerontology and Geriatrics》2012,3(4):127-131
Background/PurposeAssessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities.MethodsThe Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ2 test, Independent-Samples t test and Mann Whitney U-test.ResultsRural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02).ConclusionOur findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location. 相似文献
949.
Rumiko Umeda Yuji Nakamura Yohei Masugi Masahiro Shinoda Naoki Hosoe Yoshihiro Ono Tomonori Fujimura Yoshiyuki Yamagishi Hajime Higuchi Hirotoshi Ebinuma Shigenari Hozawa Minoru Tanabe Subaru Hashimoto Michiie Sakamoto Yuko Kitagawa Toshifumi Hibi 《Clinical journal of gastroenterology》2012,5(3):189-194
A 58-year-old man was transferred to us from his local hospital because of failure to control his gastrointestinal bleeding by endoscopic hemostasis. Abdominal imaging suggested a hypervascular tumor of the pancreatic head (36?mm diameter), and laboratory testing showed an elevated serum gastrin level (17,800?pg/mL). Gastroduodenal endoscopy revealed multiple duodenal ulcers and active bleeding from the ampulla of Vater. The selective arterial secretagogue injection test suggested a gastrinoma in the pancreatic head, but no gastrinoma in the pancreatic tail. The patient was diagnosed with solitary pancreatic head gastrinoma complicated by hemosuccus pancreaticus, and pancreaticoduodenectomy was performed. Intraoperatively, the diagnosis was changed to primary peripancreatic lymph node gastrinoma without pancreatic involvement. The gastrointestinal bleeding stopped postoperatively and serum gastrin levels returned to normal. Histological examination of the surgical specimens revealed a small submucosal gastrinoma in the duodenum (7?mm diameter). The final diagnosis was microgastrinoma of the duodenum with peripancreatic lymph node metastasis. The cause of bleeding from the ampulla of Vater was initially obscure, but eventually a hemorrhagic erosion with moderate atypia was found in the common bile duct, indicating biliary intraepithelial neoplasia (BilIN). This is the first report of hemobilia due to BilIN with gastrinoma. 相似文献
950.
Matsuzaka Y Kikuti YY Izumi S Goya K Suzuki T Cai LY Oka A Inoko H Kulski JK Kimura M 《Environmental health and preventive medicine》2012,17(5):423-428