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71.
Summary We have recently shown that the mechanical efficiency of the contractile machinery of the canine left ventricle is constant at 30%–50%, independent of its loading, heart rate, and inotropic conditions. In contrast, the conventional mechanical efficiency of the ventricle is known to vary between 0 and 30%, depending on these conditions. In this study, we derived an equation for the conventional mechanical efficiency as a function of ventricular preload, afterload, and contractility, based on the constant mechanical efficiency of the contractile machinery. In deriving this equation, we fully utilized our new concept of the total mechanical energy of the left ventricle, i.e., systolic pressure-volume area, and our recent findings of the linear relationship between left ventricular oxygen consumption and the systolic pressure-volume area as well as the dependence of this relation on the ventricular inotropic state. As a result, the conventional mechanical efficiency of the left ventricle was found to change between 0 and 25% as an explicit function of these cardiodynamic and inotropic conditions. Using this function, we obtained combinations of loading and inotropic conditions to maximize the conventional mechanical efficiency of the left ventricle. 相似文献
72.
Kanzaki G Tsuboi N Yokoo T Miyazaki Y Utsunomiya Y Hosoya T 《Clinical and experimental nephrology》2012,16(3):480-484
Tubulointerstitial nephritis (TIN) is histopathologically characterized by the infiltration of leukocytes, edema, and fibrosis of the renal interstitium with or without tubulitis and vasculitis. TIN is not usually accompanied by specific glomerular lesions. We herein report the case of a 65-year-old male with a diagnosis of non-small cell lung carcinoma that showed acute renal failure, together with proteinuria and microscopic hematuria. The renal biopsy findings showed severe and diffuse TIN, despite the fact that glomerulonephritis (GN) with cellular crescents was only focally identified. In this case, the GN was of the pauci-immune type, but the serum tests for anti-neutrophil cytoplasmic antibodies were negative. No disorders known to be associated with TIN were detected. The pathogenesis involved in this unusual presentation of a concomitant occurrence of TIN and pauci-immune GN is currently unclear. 相似文献
73.
Sugo H Ishizaki Y Yoshimoto J Imamura H Kawasaki S 《Annals of surgical oncology》2012,19(7):2238-2245
Background
The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear.Methods
We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n?=?23) or primary hepatectomy as the initial treatment (primary group; n?=?174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival.Results
The salvage group showed a significantly longer operation time (385 vs. 300?min; P?=?0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265?ml; P?=?0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P?=?0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P?=?0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P?=?0.115; and 96, 60, and 45%, P?=?0.524, respectively).Conclusions
The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy. 相似文献74.
Takanori Ochiai Taiki Masuda Masayuki Yagi Reo Kasai Takaki Furuyama Kanako Tsukamoto Hiromitsu Ito Kimihiro Igari Arihiro Aihara Yoichi Kumagai Michio Iida Hajime Odajima Shinji Tanaka Shigeki Arii Shigeru Yamazaki 《International surgery》2012,97(1):6-13
At the time of diagnosis, 20% to 25% of patients with colorectal cancer already have liver metastases, the presence of which is a most important prognostic factor. A 64-year-old man was admitted to our hospital for investigation of anemia and multiple liver tumors. Examinations revealed ascending colon carcinoma with more than 40 liver metastases and 2 lung metastases. We performed right hemicolectomy with lymph node dissection, which was followed by 5-fluorouracil/leucovorin, oxaliplatin, plus bevacizumab (FOLFOX-BV). After 4 courses of chemotherapy, the lung metastases were in complete remission and the liver metastases had shrunk. We suggested the option of radical liver resection, but the patient declined initially as he had not suffered any severe side effects of FOLFOX-BV. After 23 courses of the chemotherapy, he agreed to undergo hepatectomy. We performed extended right lobectomy with partial left and caudal lobe resection. All of the macroscopic metastatic lesions were resected. Histopathologically, viable cancer cells were recognized in 7 of the 43 liver metastatic lesions. Postoperatively, FOLFOX-BV was restarted and continued for 10 months. At the time of writing, 15 months after the hepatectomy, the patient was well without evidence of recurrence of the cancer. 相似文献
75.
Stroke leaves serious neurological sequelae, which require long-term medical and social care, imposing financial and mental burdens on the patients and their families, and causing enormous losses to society. It is currently required that medical resources be used efficiently and the cost-effectiveness of treatment be analyzed carefully. We conducted a follow-up survey of stroke patients admitted to the hospital attached to our university in order to build a picture of the current status of chronic-phase stroke medical treatment. In total, 330 patients were analyzed in this study. We evaluated utility and medical cost at one year after onset. To investigate the relationship between activities of daily living (ADL) classified according to the modified Rankin scale (mRS) and quality of life (QOL), utility was calculated for each ADL level. Utility at 1 year post-onset for each mRS level was: ADL0, 0.89; ADL1, 0.79; ADL2, 0.65; ADL3, 0.58; ADL4, 0.36; and ADL5, 0.09. A significant correlation was seen between utility and mRS. Direct monthly medical costs at 1 year post-onset were 61,536 yen in the ADL0 group and 383,444 yen in the ADL5 group, indicating that a worse ADL score required higher medical costs. Direct monthly costs were significantly different between ADL levels. This present study has clarified the QOL and medical costs of chronic-phase stroke patients, and many cost-utility analyses will be based on our data in the future in Japan. 相似文献
76.
Uozumi Y Sumitomo M Maruwaka M Araki Y Izumi T Miyachi S Kato T Hasegawa T Kida Y Okamoto S Wakabayashi T 《Neurologia medico-chirurgica》2012,52(5):343-345
A 30-year-old female developed moyamoya syndrome after gamma knife surgery (GKS) for cerebral arteriovenous malformation (AVM), and was treated with bypass surgery. She suffered from flittering scotoma, right transient hemianopsia, and headache for 1 year. Cerebral angiography revealed a Spetzler-Martin grade III AVM located in the left occipital lobe. After staged embolization, GKS was performed with a minimum dose of 20 Gy to the periphery of the nidus at the 50% isodose level of the maximum target dose. Gradual nidus regression was achieved, and the clinical symptoms disappeared completely. However, at 30 months after GKS, the patient suffered transient ischemic attack. Cerebral angiography showed left middle cerebral artery occlusion with moyamoya vessels. The patient underwent direct and indirect bypass surgery. After surgery, the patient was free from ischemic symptoms. Chronic inflammation and long-term changes in expression of cytokines and growth factors after GKS may have triggered this case. 相似文献
77.
Rosai-Dorfman disease presenting with multiple intracranial and intraspinal masses: a case report 总被引:2,自引:0,他引:2
Sato A Sakurada K Sonoda Y Saito S Kayama T Jokura H Yoshimoto T Nakazato Y 《No shinkei geka. Neurological surgery》2003,31(11):1199-1204
Rosai-Dorfman disease (RDD), a systemic histioproliferative disorder, was first described by Rosai and Dorfman in 1969. However, only 41 cases involving the central nervous system have been reported. The authors present a rare case of RDD with multiple intracranial and spinal lesions mimicking multiple meningioma. A 59-year-old woman was admitted to our hospital with a history of bilateral visual impairment. MRI demonstrated multiple central nervous system lesions in the suprasellar region, right temporal convexity, left frontal convexity, left cerebello-pontine angle and C5 level of the spinal cord. Preoperative neuro-imaging studies suggested multiple meningioma. Subtotal removal of the suprasellar lesion was performed, followed by gamma knife radiosurgery to the residual lesion and the other intracranial lesions. All intracranial lesions disappeared following gamma knife radiotherapy. The spinal lesion, however, was completely excised one year after the initial operation following the appearance of sensory disturbance. Both intracranial and spinal lesions were diagnosed as RDD on histological examination. No recurrences have been detected on MRI two years after the initial operation. Seeing the good results already achieved by surgical removal of RDD, this case suggests that the combination of surgery and gamma knife radiotherapy might improve further. 相似文献
78.
Kim SW Kami M Urahama N Yamamoto R Hori A Imataki O Kanda Y Tanosaki R Mineishi S Takaue Y Honda O 《Transplantation》2003,75(4):566-570
Patients who require management in the intensive care unit (ICU) for complications after allogeneic hematopoietic stem-cell transplantation (HSCT) generally have a poor outcome. We retrospectively studied whether the risk-prediction stratification systems commonly used for patients admitted to the ICU, that is, the Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III systems, could be useful for identifying patients who should receive intensive care earlier. We reviewed the medical records of 210 patients who underwent allogeneic HSCT and found that 18 (8.6%) had been admitted to the ICU for acute respiratory failure (n=9), acute renal failure (n=7), and septic shock (n=2). The median APACHE II and III scores were, respectively, 16 (10-27) and 55 (22-87) at the onset of complications and 26 (15-43) and 101 (65-157) upon admission to the ICU. Thus, both the APACHE II and APACHE III scores at ICU admission were higher than those at the onset of complications (P <0.0001). Seventeen patients (94%) subsequently died, with a median ICU stay of 7.5 days (1-51 days), as a result of multiorgan failure (n=14), respiratory failure (n=2), and septic shock (n=1). The APACHE II and III scores of the sole surviving patient were, respectively, 21 and 71 at the onset and 24 and 86 upon transfer to the ICU. Thus, the APACHE scores in this study were lower than those reported for other surgical or medical patients treated in the ICU, despite their uniform poor prognosis. Although nine patients had developed grade III to IV acute graft-versus-host disease, which is the most common cause of morbidity and mortality after allogeneic HSCT, this was not fully evaluated in the current scoring systems. Application of these systems to HSCT will require adequate modification, with particular attention to organ dysfunction secondary to graft-versus-host disease. 相似文献
79.
Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure 总被引:11,自引:0,他引:11
Kawauchi A Fujito A Ukimura O Yoneda K Mizutani Y Miki T 《The Journal of urology》2003,169(3):890-894
PURPOSE: We report our initial experience with hand assisted retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma and compared our results to those of a contemporary series of open nephroureterectomy. MATERIALS AND METHODS: Clinical data on 34 consecutive patients who underwent hand assisted retroperitoneoscopic nephroureterectomy were reviewed and compared with those on 34 who underwent open nephroureterectomy. All specimens were extracted intact. RESULTS: Total operative time was similar in the 2 groups (233 versus 236 minutes). Estimated blood loss was significantly less in the hand assisted laparoscopy group (236 versus 427 ml.). During convalescence the frequency of parenteral analgesia postoperatively was significantly lower in the laparoscopy group than in the open surgery group. The former patients had a significantly shorter interval to oral intake and ambulation as well as a shorter hospital stay and convalescence compared with those who underwent open surgery. In each group the complication rate was 12% (4 of 34 cases). In the hand assisted laparoscopy group 1 conversion to an open procedure was due to bleeding. There was recurrence in 4 of the 34 patients (12%) in the laparoscopy group, including 2 with bladder recurrence and 2 with metastases, at an average followup of 13.1 months. CONCLUSIONS: Hand assisted retroperitoneoscopic nephroureterectomy is an effective and safe alternative to open nephroureterectomy for upper urinary tract transitional cell carcinoma. 相似文献
80.
Sumiya Ishigami M.D. Shoji Natsugoe M.D. Yoshikazu Uenosono M.D. Yoichi Hata M.D. Aikihiro Nakajo M.D. Futoshi Miyazono M.D. Masataka Matsumoto M.D. Shuichi Hokita M.D. Takashi Aikou M.D. 《Journal of gastrointestinal surgery》2003,7(6):735-739
The sentinel node (SN) is regarded as the first drainage lymph node, and tumor cells are considered likely to directly affect
the SN. However, few reports have identified differences between SNs and non-SNs in cancer patients. Subjects in this study
included 27 patients with gastric cancer who underwent curative operation and intraoperative detection of SNs by radioisotope
methods. The mean number of SNs was 3.2 (range 1 to 5). Degree of infiltration of natural killer cells, dendritic cells, MIB-1
labeling index, and CD3-ξ expression of lymphocytes in SNs and non-SNs were examined by means of immunohistochemical methods.
Degree of infiltration was compared according to depth of invasion and between SNs and non-SNs. Patients with early-stage
cancer displayed a greater degree of infiltration of MIB-1 labeling index and CD3-ξ expression than patients with pT2 or pT3
lesions (P<0.05). The MIB-1 labeling index in SNs was significantly lower than that in non-SNs (P<0.05). However, no significant difference was observed in infiltration of natural killer cells, dendritic cells, or CD3-ξ.
Morphologic changes of dendritic cells in SNs were not definite. Our results suggest that SNs in gastric cancer might not
be suppressed, unlike in breast cancer and melanoma. SN paralysis may depend on tumor- and organ-specific characteristics
or exogenous stimulation from the gastric mucosa. Studies in progress will help to identify immunologic paralysis of the SN
in various types of cancer. Attention must therefore be paid to organ specificity. 相似文献