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991.
Masanori Nakanishi Yoshiki Demura Nobuyuki Kosaka Satoshi Nishikawa Takeshi Ishizaki 《European journal of radiology》2010,73(3):545-550
Background
To diagnose sputum smear-negative pulmonary tuberculosis (PTB) is difficult and the ability of high-resolution computed tomography (HRCT) for diagnosing PTB has remained unclear in the sputum smear-negative setting. We retrospectively investigated whether or not this imaging modality can predict risk for sputum smear-negative PTB.Methods
We used HRCT to examine the findings of 116 patients with suspected PTB despite negative sputum smears for acid-fast bacilli (AFB). We investigated their clinical features and HRCT-findings to predict the risk for PTB by multivariate analysis and a combination of HRCT findings by stepwise regression analysis. We then designed provisional HRCT diagnostic criteria based on these results to rank the risk of PTB and blinded observers assessed the validity and reliability of these criteria.Results
A positive tuberculin skin test alone among clinical laboratory findings was significantly associated with an increase of risk of PTB. Multivariate regression analysis showed that large nodules, tree-in-bud appearance, lobular consolidation and the main lesion being located in S1, S2, and S6 were significantly associated with an increased risk of PTB. Stepwise regression analysis showed that coexistence of the above 4 factors was most significantly associated with an increase in the risk for PTB. Ranking of the results using our HRCT diagnostic criteria by blinded observers revealed good utility and agreement for predicting PTB risk.Conclusions
Even in the sputum smear-negative setting, HRCT can predict the risk of PTB with good reproducibility and can select patients having a high probability of PTB. 相似文献992.
Hiroaki Shiba Yuichi Ishida Shigeki Wakiyama Tomonori Iida Michinori Matsumoto Taro Sakamoto Ryusuke Ito Takeshi Gocho Kenei Furukawa Yuki Fujiwara Shoichi Hirohara Takeyuki Misawa Katsuhiko Yanaga 《Journal of gastrointestinal surgery》2009,13(9):1636-1642
Background In perioperative management of hepatic resection for hepatocellular carcinoma, excessive blood loss and blood transfusion
greatly influence postoperative complications and prognosis of the patients. We evaluated the influence of blood products
use on postoperative recurrence and prognosis of patients with hepatocellular carcinoma.
Methods The subjects were 66 patients who underwent elective hepatic resection for hepatocellular carcinoma without concomitant microwave
or radiofrequency ablation therapy nor other malignancies between January 2001 and June 2006. We retrospectively investigated
the influence of the use of blood products including red cell concentration and fresh frozen plasma on recurrence of hepatocellular
carcinoma and overall survival.
Results In multivariate analysis, the dose of blood products transfusion was a significant predictor of disease-free and overall survival.
Both disease-free and overall survival rates of those who were given blood products were significantly worse than those who
did not receive. On the other hand, in univariate analysis of disease-free and overall survival after hepatic resection and
clinical variables, the amount of blood loss was not a significant predictor of recurrence or death.
Conclusion Transfusion of blood products is associated with increased recurrence rate and worse survival after elective hepatic resection
for patients with hepatocellular carcinoma. 相似文献
993.
994.
Yoshiaki?MurakamiEmail author Kenichiro?Uemura Yujiro?Yokoyama Masaru?Sasaki Masahiko?Morifuji Yasuo?Hayashidani Takeshi?Sudo Taijiro?Sueda 《Journal of gastrointestinal surgery》2004,8(4):520-522
A rare case of intraductal papillary mucinous tumor of the pancreas associated with a replaced common hepatic artery and celiac
axis occlusion, which was treated by pancreatoduodenectomy, is reported. In this patient, the celiac trunk was occluded at
its root and the splenic and left gastric artery could be visualized serially via the enlarged collateral artery on superior
mesenteric arteriography. At surgery, the collateral artery was carefully preserved and pancreatoduodenectomy was successfully
performed without ischemia of the stomach, spleen, and remnant pancreas. Although celiac axis occlusion is an uncommon finding
for patients undergoing pancreatoduodenectomy, we recommend performing celio-mesenteric angiography before pancreatoduodenectomy,
and, at surgery, clamping of the gastroduodenal artery is required for patients with celiac axis occlusion. 相似文献
995.
Toda N Ohue T Nishimoto M Kitaura M Samuta T Koyama Y Ishimura A 《Masui. The Japanese journal of anesthesiology》2004,53(9):1051-1056
A 50-year-old woman underwent open reduction and internal fixation for bilateral lower extremity fracture under general anesthesia. During the surgery, arterial oxygen saturation and expired CO2 concentration dropped suddenly when the left limb was fixed. Immediately, we performed aspiration of the pulmonary thrombus and inserted a temporary infra-vena cava filter followed by heparinization. Ten days later, we carried out the surgery on the right limb uneventfully. The major cause of APTE is deep vein thrombosis (DVT), which is extremely common during perioperative period. Therefore, we must perform antithrombotic therapy for the patient at high risk for DVT. 相似文献
996.
Takeshi Oichi Hirotaka Chikuda Junichi Ohya Ryo Ohtomo Kojiro Morita Hiroki Matsui Kiyohide Fushimi Sakae Tanaka Hideo Yasunaga 《The spine journal》2017,17(4):531-537
Background Context
There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).Purpose
This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes.Study Design
This is a retrospective matched-pair cohort study.Patient Sample
Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.Outcome Measures
In-hospital mortality and occurrence of postoperative complications.Methods
For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data.Results
Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37–2.22; p<.001).Conclusions
Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication. 相似文献997.
Hisako Katano Hideyuki Koga Nobutake Ozeki Koji Otabe Mitsuru Mizuno Makoto Tomita Takeshi Muneta Ichiro Sekiya 《Journal of orthopaedic science》2018,23(4):676-681
Background
Meniscus surgery is the most commonly performed orthopedic surgery, and despite recent emphasis on saving the meniscus, the current status of meniscus surgeries is little known in many countries, including Japan. The National Database of Health Insurance Claims and Specific Health Checkups of Japan and the Statistics of Medical Care Activities in Public Health Insurance track meniscus surgeries through health insurance claims. The National Database provides the numbers for 2014 and 2015, and the Statistics of Medical Care Activities provides the numbers from June 2011 to June 2016. Our aim was to analyze isolated meniscus surgery numbers and meniscus repair ratios by age group based on the National Database and evaluate trends of meniscus repair ratios for the latest six years from the Statistics of Medical Care Activities.Methods
Meniscus surgeries by age group were counted from the National Database for 2014–2015, and meniscus repair ratios (meniscus repairs/meniscus surgeries) were calculated. The numbers were also counted from the Statistics of Medical Care Activities in 2011–2016. For statistical analysis of annual trends of meniscus repair ratios, the Cochran–Armitage trend test was used. Meniscus surgeries with concomitant knee ligament surgeries were excluded.Results
According to the National Database, isolated meniscus surgeries totaled 34,966 in 2015, with peak ages of patients in their late teens and 60s. The meniscus repair ratio was 19% in 2014 and 24% in 2015. According to the Statistics of Medical Care Activities, the meniscus repair ratio was 9% in 2011 and significantly increased to 25% in 2016 (p = 0.0008). The ratio also increased significantly in each age group between the early 20s and late 70s.Conclusions
Approximately 35,000 meniscus surgeries are performed in Japan annually, with peak ages in the late teens and 60s. The number of meniscus repairs has increased over the past six years. 相似文献998.
A case of retroperitoneal dedifferentiated liposarcoma initially diagnosed as malignant fibrous histiocytoma: a case report 总被引:4,自引:0,他引:4
Nishizawa K Kanno T Takahashi T Nishiyama H Ito A Ito N Yamamoto S Kamoto T Ogawa O Kotani H Adachi Y Sakurai T Manabe T 《Hinyokika kiyo. Acta urologica Japonica》2006,52(1):11-14
We report a case of retroperitoneal tumor which turned out to be liposarcoma by the histological evaluation of its recurrent tumor, although the initial tumor was diagnosed as malignant fibrous histiocytoma (MFH). A retroperitoneal tumor in a 62-year-old man was removed and pathologically diagnosed as MFH. Five years after the initial surgery, computed tomography (CT) demonstrated a recurrent tumor near the spleen. The tumor was resected together with the spleen, tail of pancreas, and connective tissue due to adhesion and diagnosed as well-differentiated liposarcoma with sclerosing component. Generally dedifferentiated liposarcoma is difficult to distinguish from MFH and the presence of a well-differentiated liposarcoma component in the adjacent adipose tissue leads to the diagnosis of dedifferentiated liposarcoma. The clinical course of the present case indicated that the initial tumor was dedifferentiated liposarcoma and the recurrent tumor developed from the surrounding well-differentiated liposarcoma. 相似文献
999.
Prognostic Significance of Immunohistochemically Detected Blood and Lymphatic Vessel Invasion in Colorectal Carcinoma: Its Impact on Prognosis 总被引:6,自引:0,他引:6
Liang P Nakada I Hong JW Tabuchi T Motohashi G Takemura A Nakachi T Kasuga T Tabuchi T 《Annals of surgical oncology》2007,14(2):470-477
Background The prognostic significance of blood vessel invasion (BVI) and lymphatic vessel invasion (LVI) is unclear. Because of the
absence of specific markers for venous and lymphatic vessels, earlier studies could not reliably distinguish between BVI and
LVI.
Methods By immunostaining for podoplanin and CD34 antigen, we retrospectively investigated LVI and BVI in 419 tissue specimens of
colorectal carcinoma. We performed univariate and multivariate analysis of the clinicopathologic features, frequency of recurrence,
and outcome of patients with or without LVI and BVI.
Results The use of hematoxylin and eosin (H&E) staining to identify BVI and LVI yielded a false positive rate of 9.1% and false negative
rate of 12.6%. The incidence of BVI was significantly higher among tumors with LVI than tumors without LVI (P <.001). In logistic multivariate analysis, only LVI (P < .001) was associated with lymph node metastasis and BVI (P = .015) was associated with distant recurrence. Calculating the prognostic relevance, both two invasion types correlated
with decreased survival in univariate analysis (both P <.001). In multivariate analysis, BVI (P =.024), lymph node status (P =.003) and tumor stage (P <.001) remained statistically significant factors for survival.
Conclusions Our results suggest that immunohistologic evaluation of BVI and LVI could be useful in colorectal carcinoma indicating the
risk of lymph node metastasis and recurrence, thereby contributing to prognostic evaluation. 相似文献
1000.