1.An Elderly Case of Ruptured Aortic Arch Aneurysm with Hemorrhagic Cardiac Tamponade
Yasuyuki Yamada ; Yoshihiko Mochizuki ; Yoshiei Shimamura ; Kunihiro Eda ; Ikuko Shibasaki ; Yuhou Inoue ; Shinichiro Miyoshi
Japanese Journal of Cardiovascular Surgery 2007;36(3):153-156
An 82-year-old man was taken to a local clinic following the occurrence of syncope. Chest roentgenography and computed tomography (CT) findings led to a suspicion of a ruptured aortic aneurysm, and the patient was immediately transferred to our hospital. Upon admission, his consciousness was clear and blood pressure was 74/47mmHg. Enhanced chest CT images demonstrated pericardial effusion and a saccular aneurysm with a maximum diameter of 5cm, which was associated with a thrombus in the distal aortic arch. An emergency operation was performed under a diagnosis of a ruptured distal aortic arch aneurysm and hemorrhagic cardiac tamponade. During the procedure, a hole was found in the lesser curvature of the aneurysm, which had directly ruptured into the pericardial space, and a graft replacement of the aortic arch was performed using selective cerebral perfusion. The patient was discharged 19 days after surgery without any postoperative complications.
2. Recent refinements and advances for pancreatoduodenectomy
Yuji MORINE ; Mitsuo SHIMADA ; Satoru IMURA ; Tetsuya IKEMOTO ; Yusuke ARAKAWA ; Syuichi IWAHASHI ; Yu SAITO ; Shinichiro YAMADA ; Daichi ISHIKAWA
Innovation 2014;8(4):136-137
Background: The technique of pancreatoduodenectomy (PD) has evolved, andartery first’ approach was considered for the intraoperative early determinationof resectability for borderline resectable cases before the ‘point of no return’and avoidance of blood congestion resulted in the reduction of blood loss. Also,active application of energy device was useful for the reduced operative time andblood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has beenuseful and mandatory. In this presentation, we introduced our recent refinementsand advances for PD.‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approachwere considered as six different methods as follows; 1) Superior approach, 2)Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/medial uncinate approach and 6) Mesenteric approach. A while ago, wepreferably applied the mesenteric approach to PD, and also the combination ofthis approach with vessel sealing system (VSS) significantly reduced intraoperativeblood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approachwithout VSS, n=78; 320±174ml vs. 486±263ml, p<0.01).Modified de-rotation method as complete ‘Artery first’ approach: Most recently,for further refinement of operative procedure, we refined a right/medial uncinateand posterior approach as modified de-rotation method. Point of view in thismethod was the complete clockwise rotation of small intestinal mesenteryincluding ascending colon, in order to linearize from duodenum to jejunumand look at the direct front of superior mesenteric artery (SMA), vein (SMV) andsome branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, inthe posterior view, the easy dissection of all pancreatic branch originated fromSMA can be done. This modified de-rotation method was possible to achieve thecomplete ‘Artery first’ approach.Preoperative 3D simulation of arterial and venous anatomy:Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) aspreoperative simulation for hepatic resection. And recently, for evaluation of theposition relationship between arteries and veins surround pancreas head, weadopted this software before PD. As first step, arteries and veins are automaticallyidentified, and small vessels are manually traced on the axial CT view. Afterthat, 3D arterial and venous simulations are combined. Grasp of detailed vesselanatomy and its relationship using preoperative 3D simulation enable to safelyperform PD, even in young surgeons (operative time; young 512±49 vs. senior445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml,p=0.16).Conclusion: Those refinements and advances are possible to safely and easilyperform pancreatoduodenectomy.
3.Recent refinements and advances for pancreatoduodenectomy
Yuji Morine ; Mitsuo Shimada ; Satoru Imura ; Tetsuya Ikemoto ; Yusuke Arakawa ; Syuichi Iwahashi ; Yu Saito ; Shinichiro Yamada ; Daichi Ishikawa
Innovation 2014;8(4):136-137
Background: The technique of pancreatoduodenectomy (PD) has evolved, and
artery first’ approach was considered for the intraoperative early determination
of resectability for borderline resectable cases before the ‘point of no return’
and avoidance of blood congestion resulted in the reduction of blood loss. Also,
active application of energy device was useful for the reduced operative time and
blood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has been
useful and mandatory. In this presentation, we introduced our recent refinements
and advances for PD.
‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approach
were considered as six different methods as follows; 1) Superior approach, 2)
Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/
medial uncinate approach and 6) Mesenteric approach. A while ago, we
preferably applied the mesenteric approach to PD, and also the combination of
this approach with vessel sealing system (VSS) significantly reduced intraoperative
blood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approach
without VSS, n=78; 320±174ml vs. 486±263ml, p<0.01).
Modified de-rotation method as complete ‘Artery first’ approach: Most recently,
for further refinement of operative procedure, we refined a right/medial uncinate
and posterior approach as modified de-rotation method. Point of view in this
method was the complete clockwise rotation of small intestinal mesentery
including ascending colon, in order to linearize from duodenum to jejunum
and look at the direct front of superior mesenteric artery (SMA), vein (SMV) and
some branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, in
the posterior view, the easy dissection of all pancreatic branch originated from
SMA can be done. This modified de-rotation method was possible to achieve the
complete ‘Artery first’ approach.
Preoperative 3D simulation of arterial and venous anatomy:
Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) as
preoperative simulation for hepatic resection. And recently, for evaluation of the
position relationship between arteries and veins surround pancreas head, we
adopted this software before PD. As first step, arteries and veins are automatically
identified, and small vessels are manually traced on the axial CT view. After
that, 3D arterial and venous simulations are combined. Grasp of detailed vessel
anatomy and its relationship using preoperative 3D simulation enable to safely
perform PD, even in young surgeons (operative time; young 512±49 vs. senior
445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml,
p=0.16).
Conclusion: Those refinements and advances are possible to safely and easily
perform pancreatoduodenectomy.
4.Association between number of teeth present and mandibular cortical erosion in Japanese men and women aged 40 years and older: A cross-sectional study.
Mizuna TAKAHASHI ; Keiichi UCHIDA ; Shinichiro YAMADA ; Noriyuki SUGINO ; Yukihito HIGASHI ; Kazuhiro YAMADA ; Akira TAGUCHI
Osteoporosis and Sarcopenia 2016;2(4):250-255
Mandibular cortical erosion detected on dental panoramic radiographs is associated with increased risk of osteoporosis in older adults. Additionally, many reports have demonstrated an association between decreased number of teeth present and osteoporosis. However, whether mandibular cortical erosion is associated with a decreased number of teeth remains unclear. The purpose of this study, therefore, was to clarify the association between mandibular cortical erosion and number of teeth present in Japanese men and women aged 40 years and older. Among patients who visited our university hospital and underwent dental panoramic radiography for the diagnosis of dental diseases, 839 patients (293 men and 546 women) aged 40–89 years (mean [SD], 63.7 [10.6] years) participated in this study. Multiple regression analysis revealed that mildly to moderately eroded cortex (p = 0.007) and severe eroded cortex (p < 0.001) were significantly associated with a decreased number of teeth present. Analysis of covariance adjusted for covariates revealed a significant association between mandibular cortical erosion category and number of teeth present (p < 0.001). Subjects with a severely eroded cortex had significantly fewer teeth present than those with a normal cortex (mean [SE], 20.7 [0.5] vs. 23.4 [0.3], p < 0.001) or mildly to moderately eroded cortex (22.2 [0.4], p = 0.04). Subjects with a mildly to moderately eroded cortex had significantly fewer teeth present than those with a normal cortex (p = 0.033). Our results suggest the significant association between mandibular cortical erosion and number of teeth present in Japanese men and women aged 40 years and older.
Adult
;
Asian Continental Ancestry Group*
;
Cross-Sectional Studies*
;
Cytochrome P-450 CYP1A1
;
Diagnosis
;
Female
;
Humans
;
Male
;
Mandible
;
Osteoporosis
;
Radiography, Panoramic
;
Stomatognathic Diseases
;
Tooth*
5.Symptom analysis of 537 patients with neurogenic intrapelvic syndrome.
Takano MASAHIRO ; Ogata SHUNJI ; Nozaki RYOICHI ; Hisano SABURO ; Saiki YASUMITSU ; Fukunaga MITSUKO ; Takano SHOTA ; Tanaka MASAFUMI ; Magata SHINICHIRO ; Nakamura YASUSHI ; Sakata GENTARO ; Yamada KAZUTAKA
Chinese Journal of Gastrointestinal Surgery 2010;13(12):921-923
OBJECTIVETo characterize the symptoms of neurogenic intrapelvic syndrome and the pathogenic mechanisms.
METHODSA total of 537 patients with neurogenic intrapelvic syndrome were treated in the Takano Hospital between 2001 and 2005. Clinical data were analyzed retrospectively.
RESULTSThe mean age was 58.5 years old. There were 205 males and 332 females. There were 80 patients(14.9%) who presented with only one symptom with anorectal pain being the most common one (43.8%, 35/80). One hundred and fifty-six(29.1%) patients had two symptoms with anorectal pain and difficult evacuation being the most common combination (26.3%, 41/156). There were 144 patients (26.8%) complained of 3 symptoms and the most common combination was anorectal pain, difficult evacuation, and abdominal discomfort (30.0%, 43/144). A combination of 4 symptoms was reported in 105 patients(19.6%) with the combination of anorectal pain, incontinence, abdominal discomfort, and lumbar discomfort being the most often(65.7%, 69/105). In addition, there were 52 patients(9.7%) who had above 5 symptoms simultaneously. The frequencies of the 5 symptoms were 73.6% for anorectal pain, 27.9% for incontinence, 69.6% for difficult evacuation, 55.3% for abdominal discomfort, and 53.6% for lumbar discomfort.
CONCLUSIONSSymptomatology of neurogenic intrapelvic syndrome is complicated. The pathogenic mechanism may be related to concurrent dysfunction of sacral nerve and pelvic splanchnic nerve.
Encopresis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pelvic Pain ; etiology ; Retrospective Studies ; Syndrome
6.Recent refinements of glissonean pedicle approach for liver resection
Yu Saito M.D. ; Mitsuo Shimada M.D ; Satoru Imura M.D ; Yuji Morine M.D ; Tetsuya Ikemoto M.D. ; Yusuke Arakawa M.D. ; Shuichi Iwahashi M.D. ; Shinichiro Yamada M.D ; Daichi Ichikawa M.D ; Masato Yoshikawa M.D. ; Hiroki Teraoku M.D.
Innovation 2014;8(4):142-143
Background: The glissonean pedicle approach was introduced by Couinaud
and Takasaki in the early 1980s. The key of the glissonean pedicle approach is
clamping the pedicle first, secondly confirming the territory, and finally dissecting
the liver parenchyma. In this presentation, we introduced our recent refinements
of glissonean pedicle approach for liver resection.
“Approach to the glissonean pedicles at the hepatic hilus” Couinaud described
three approaches to the hepatic hilus. 1) Intra-fascial access (Control method):
The conventional dissection at the hilus or within the sheath is referred to as intrafascial
access However, dissection performed under the hilar plate is dangerous
and surgeons have to consider any variations of the hepatic artery and bile ducts.
2) Extra-fascial access (Glissonean pedicle approach): The glissonean pedicle is
dissected from the liver parenchyma at the hepatic hilus before dissecting the
liver parenchyma. This procedure prevents intrahepatic metastasis of HCC, which
spreads along the portal vein and improves the overall survival after surgery.
3) Extra-fascial and transfissural access: If the main portal fissure or the left
suprahepatic fissure is opened after dissecting the liver parenchyma, the surgeon
can confirm the pedicles that arise from the hilar plate or the umbilical plate.
“Operative techniques” 1) Preoperative 3D simulation of the precise anatomy
of portal vein, hepatic artery and bile duct at hepatic hilus should be performed.
2) Right glissonean pedicle: The hilar plate is detached from the quadrate lobe.
The assistant pulls the liver parenchyma cranially and the operator conversely
pulls the hepatoduodenal ligament caudally. Mayo scissors are inserted along the
liver parenchyma between the liver parenchyma and glissonean capsule (Fig.1).
Then forceps are inserted in the same way and the right main pedicle is taped
(Fig.2). The right anterior and posterior glissonean pedicles are taped as well. 3)
Left glissonean pedicle: The hilar plate is detached from the liver parenchyma.
Then, the Arantius duct is confirmed and the left pedicle is dissected along the left
pedicle at the ventral side of the Arantius duct.
“Pitfall of glissonean pedicle approach” The right pedicle should be dissected
in the liver side as much as possible to prevent the injury of left hepatic duct.
If possible, the right pedicle is recommended to be dissected at the level of the
second branches separately (Fig.3). The right posterior hepatic duct sometimes
branches from the left hepatic duct and the Arantius duct is confirmed and the left
pedicle should be dissected along the left pedicle at the ventral side of the Arantius
duct because the right posterior hepatic duct branches from the left hepatic duct
at the dorsal side of Arantius’ duct. In addition, the intraoperative cholangiogram
should be used in the case with the abnormal anatomy of bile duct.
Conclusions: Any anatomical hepatectomy can be performed using “glissonean
pedicle approach” which allows simple, safe and easy liver resection.
7.Seven days triple therapy for eradication of Helicobacter pylori does not alter the disease activity of patients with inflammatory bowel disease.
Shinichiro SHINZAKI ; Toshimitsu FUJII ; Shigeki BAMBA ; Maiko OGAWA ; Taku KOBAYASHI ; Masahide OSHITA ; Hiroki TANAKA ; Keiji OZEKI ; Sakuma TAKAHASHI ; Hiroki KITAMOTO ; Kazuhito KANI ; Sohachi NANJO ; Takeshi SUGAYA ; Yuko SAKAKIBARA ; Toshihiro INOKUCHI ; Kazuki KAKIMOTO ; Akihiro YAMADA ; Hisae YASUHARA ; Yoko YOKOYAMA ; Takuya YOSHINO ; Akira MATSUI ; Misaki NAKAMURA ; Taku TOMIZAWA ; Ryosuke SAKEMI ; Noriko KAMATA ; Toshifumi HIBI
Intestinal Research 2018;16(4):609-618
BACKGROUND/AIMS: The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients. METHODS: IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians’ global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation. RESULTS: A total of 429 IBD (378 ulcerative colitis, 51 Crohn’s disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78–3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81–3.11; P=0.172]). Based on the physicians’ global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months’ observation period. The overall eradication rate was 84.0%–comparable to previous reports in non-IBD patients. CONCLUSIONS: H. pylori eradication therapy does not alter the short-term disease activity of IBD.
Clarithromycin
;
Cohort Studies
;
Colitis, Ulcerative
;
Helicobacter pylori*
;
Helicobacter*
;
Humans
;
Inflammatory Bowel Diseases*
;
Metronidazole
;
Multivariate Analysis
;
Retrospective Studies