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71.
Heita Kitajima Yuichiro Oba Takahisa Ohira Tomohiro Asaoka Yoshihiro Atsumi Takahiro Nakajima Takayuki Okura 《Journal of infection and chemotherapy》2021,27(5):766-769
To date, only 26 cases of Mycobacterium wolinskyi infections have been reported in humans. We herein report a first case of prosthetic valve endocarditis due to this organism after cardiovascular surgery. An 82-year-old man presented with repeat episodes of syncope and fever after aortic valve replacement, mitral valve replacement, left atrial appendage closure, and pulmonary vein isolation. Blood cultures maintained in aerobic bottles were repeatedly positive after 90–100 hours, and Gallium scan revealed abnormal accumulations in the sternum and left testis. While colonies formed by culturing the fluid of the parasternal area and blood cultures revealed gram-positive rods, we could not analyze the colony using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF). M. wolinskyi was finally identified on 16S rRNA, hsp65, and rpoB gene sequencing. We treated the patient with multiple antimycobacterial drugs, i.e., amikacin, imipenem, and clarithromycin for 6 weeks, which was changed to oral ciprofloxacin and minocycline for 12 months. This case highlights the need to consider rapidly growing mycobacteria, including M. wolinskyi, if chronic fever persists from weeks to months after surgery, the blood culture is positive, and the organism is not identified. In addition, sequencing the 16S rRNA, hsp65, and rpoB genes is essential for diagnosis. 相似文献
72.
Eiji Oki Koji Ando Hiroshi Saeki Yuichiro Nakashima Yasue Kimura Yukiharu Hiyoshi Yu Imamura Kippei Ohgaki Shuhei Ito Masaru Morita Tetsuo Ikeda Yoshihiko Maehara 《International surgery》2015,100(6):979-983
The double-stapling technique using a circular stapler (CS) to create an end-to-end anastomosis is currently used widely in laparoscopic-assisted rectal surgery. However, a high rate of anastomotic failure has been reported. We report new side-to-side anastomosis creation using a CS, the so-called circular side stapling technique (CST). After excising the rectum at the oral and anal sides of the tumor with a linear stapler, a side-to-side colorectal anastomosis was made on the anterior wall of the rectosigmoid colon and the anterior or posterior wall of the rectum with a CS. Between 2012 and 2013, we recorded 30 serial cases of rectal-sigmoid or rectal cancer that were treated with laparoscopic-assisted surgeries using this method. In the 30 cases, the mean age was 68 ± 12 years, operating time was 288 ± 80 minutes, and blood loss was 66 ± 67 mL. None of the patients suffered from anastomosis leakage or postoperative anastomotic bleeding, and none complained of their stool habits. Three months after the last surgery in this cohort, no anastomosis strictures were reported. Based on these results, we propose an alternative method of side-to-side anastomosis for low anterior resection by using a CS to prevent staple overlap. Our experience indicates that the CST is easy and safe. Therefore, this method is a useful alternative to the current method used in laparoscopic surgery.Key words: Laparoscopy, Circular stapler, Colorectal cancer, Low anterior resectionLaparoscopic surgery for the treatment of colorectal disease has proven to be a safe and effective method compared with an open procedure.1–3 Laparoscopy has the advantages of reduced blood loss, hospital stay, and use of anesthetics as well as a better cosmetic outcome. Although many clinical studies have demonstrated the advantages and low complication rates of laparoscopic colectomy and low anterior resection,1–5 a high rate of anastomotic leakage has been reported in laparoscopic rectal surgeries. The reported incidence of leakage after laparoscopic surgery for the treatment of rectum varies from 6% to 17%.1–3 Additionally, anastomotic leakage might raise concerns about local recurrence and may limit the patients prognosis.6–8 Therefore, despite great advances in laparoscopic surgery, the risks of anastomotic complications persist to a greater extent than those for other colonic resections.6,7Recent reports have included proposed methods for reducing anastomotic leakage, and recently a transanal drainage tube has been recommended, because the high pressure experienced in the rectum could cause anastomotic failure.9 Another group reported the use of anti-traction sutures supporting the anastomosis to reduce anastomotic leakage.10 Despite these proposals, anastomotic failure has not been completely resolved.In typical laparoscopic rectal surgery, a double-stapling technique (DST) with a circular stapler is used to create the anastomosis. This method is thought to be the only method available to complete an intracorporeal anastomosis of the rectum. However, the DST requires the excision of the stump of the staple line created by the linear stapler. Our previous endoscopic experience with anastomotic leakage shows that leakage occurs frequently at the point where the staples overlap in the DST.11 In this study we demonstrate a new circular side stapling technique (CST), which does not require the excision of the linear staple line in a laparoscopic low anterior resection. 相似文献
73.
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75.
Yoshihisa Hirakawa Yuichiro Masuda Masafumi Kuzuya Akihisa Iguchi Kazumasa Uemura 《Geriatrics & Gerontology International》2007,7(1):34-40
Background: Data on the differences between older and younger elderly cancer patients dying at home is sparse. To clarify age-related differences in symptom experience and care receipt of elderly cancer patients at end-of-life, we conducted a subanalysis study of the Dying Elderly at Home (DEATH) project, a multicenter study of 240 elderly aged 65 and older dying at home.
Methods: We assessed the frequency of symptom experience and end-of-life care receipt in home elderly patients during the last 2 days of their lives and evaluated the differences between younger elderly (aged 65–74) and older elderly (aged 75+) cancer decedents. The general practitioners were asked to fill out a questionnaire immediately after the death of study patients. A total of 66 younger and 51 older elderly cancer decedents were included in the analysis.
Results: Coma and dementia were common among younger and older elderly patients. Older decedents were less likely to experience anxiety, but, after adjustment for baseline characteristics, this age-related difference did not clearly appear. Older decedents were also less likely to receive opioids than younger decedents. There were no significant differences in volume of i.v. hydration between the two groups.
Conclusions: Our results suggested that there were no differences in symptom experience and care receipt among older and younger decedents, except in opioid use, at end-of-life. These findings imply a similar need of end-of-life care for younger and older elderly cancer patients who opt for home death. 相似文献
Methods: We assessed the frequency of symptom experience and end-of-life care receipt in home elderly patients during the last 2 days of their lives and evaluated the differences between younger elderly (aged 65–74) and older elderly (aged 75+) cancer decedents. The general practitioners were asked to fill out a questionnaire immediately after the death of study patients. A total of 66 younger and 51 older elderly cancer decedents were included in the analysis.
Results: Coma and dementia were common among younger and older elderly patients. Older decedents were less likely to experience anxiety, but, after adjustment for baseline characteristics, this age-related difference did not clearly appear. Older decedents were also less likely to receive opioids than younger decedents. There were no significant differences in volume of i.v. hydration between the two groups.
Conclusions: Our results suggested that there were no differences in symptom experience and care receipt among older and younger decedents, except in opioid use, at end-of-life. These findings imply a similar need of end-of-life care for younger and older elderly cancer patients who opt for home death. 相似文献
76.
Keiichi Tsuji Hiroyasu Ishida Kaori Oba Tsutomu Ueki Yuichiro Fujihashi 《Journal of Physical Therapy Science》2015,27(2):353-356
[Purpose] The present study aimed to determine changes in muscle activity while moving on
a treadmill at various speeds. [Subjects] The activities of the left vastus lateralis,
vastus medialis, hip adductors, lateral head of gastrocnemius, medial head gastrocnemius,
soleus, and tibialis anterior of 10 healthy male university students were analyzed.
[Methods] University students walked, jogged, and ran for 10 minutes each in random order,
and then myogenic potentials were measured 10 minutes later for 30 seconds. The flexion
angle of the lower limb upon initial contact, mid stance, and toe off were measured.
[Results] The average walking, jogging, and running speeds were 3.6 ± 0.4, 6.7 ± 0.6, and
10.4 ± 1.3 km/h, respectively. The average electromyographic activities of the vastus
medial, tibialis anterior, medial head of gastrocnemius, and lateral head of gastrocnemius
significantly differed. All muscles were more active during jogging and running than
walking. Only the soleus was more active during running than walking, and the activities
of the hip adductors and vastus lateralis did not significantly differ. [Conclusion]
Velocity is faster and the angles of the lower limbs and ground reaction force (GRF) are
larger during running than walking. The vastus medialis and soleus worked more easily
according to the angle of the knee joint, whereas the tibialis anterior worked more easily
at faster velocities and the medial and lateral heads of the gastrocnemius worked more
easily with an increased GRF.Key words: Walking, Running, Skeletal muscle 相似文献
77.
Takeshi Imura Yuki Nagasawa Tetsuji Inagawa Naoki Imada Hiroaki Izumi Katsuya Emoto Itaru Tani Hiroyuki Yamasaki Yuichiro Ota Shuichi Oki Tadanori Maeda Osamu Araki 《Journal of Physical Therapy Science》2015,27(5):1383-1386
[Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes
and activities of daily living function remains unclear. We evaluated the most appropriate
diffusion tensor parameters and methodology to determine whether the region of interest-
or tractography-based method was more useful for predicting motor outcomes and activities
of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor
imaging data within 10 days after stroke onset were collected and analyzed for 25
patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers,
and apparent diffusion coefficient were used as diffusion tensor parameters. Motor
outcomes and activities of daily living function were evaluated on the same day as
diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy
value of the affected corticospinal tract significantly correlated with the motor outcome
and activities of daily living function within 10 days post-onset and at 1 month
post-onset. Tthere were no significant correlations between other diffusion tensor
parameters and motor outcomes or activities of daily living function. [Conclusion] The
fractional anisotropy value of the affected corticospinal tract obtained using the
tractography-based method was useful for predicting motor outcomes and activities of daily
living function in stroke patients.Key words: Stroke, Diffusion tensor tractography, Activities of daily living function 相似文献
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79.
Norihiro Nishida Tsukasa Kanchiku Yoshihiko Kato Yasuaki Imajo Yuichiro Yoshida Syunichi Kawano Toshihiko Taguchi 《The journal of spinal cord medicine》2015,38(5):593-598