1.Modified Blumgart Anastomosis (Compressing the
Takehito Otsubo ; Shinjiro Kobayashi
Innovation 2014;8(4):102-103
Background: To minimize the risk of pancreatic fistula development after
pancreaticoduodenectomy, we perform a pancreaticojejunostomy procedure that
is characterized by compression of the pancreatic stump by the seromuscular
layer of the jejunum.
Methods: To suture the pancreatic parenchyma to the jejunal seromuscular layer,
we use 4-0 non-absorbent thread and double-ended needles. After insertion of
a needle from the posterior surface of the pancreatic parenchyma toward its
anterior surface, the serosa of the small intestine is stitched in the direction of the
minor axis of the jejunum to approximate the posterior surface of the pancreas. A
stitch is made in the posterior parenchymal surface to anchor the suture thread.
Two sutures are placed, one at the head of the main pancreatic duct and the other
at the bottom of the pancreas.During all-layer suturing of the pancreatic duct to
the jejunum, three support threads are placed at the three points of an imaginary
equilateral triangle, and sutures are added as needed, depending on the size of
the pancreatic duct. Generally, nine sutures are used, fewer when the pancreatic
duct is small in diameter. Note that there is a total of four needle tips/threads
coming through the anterior surface of the pancreas. After the all-layer suture of
the pancreatic duct to the jejunam is tied off, the 4-0 non-absorbent thread that
was used to stitch the pancreatic parenchyma to the jejunal seromuscular layer
is used to stitch the seromuscular layer of the small intestine in the direction of
the minor axis to approximate the anterior wall of the small intestine.Although it
appears as though pressure is being applied when the branch of the pancreatic
duct that is exposed to the pancreatic cut end is closed, ligation should be gentle.
Study Patients: We conducted a study of 222 patients who underwent
pancreaticojejunostomy. The patients comprised three groups treated during three
different time periods, and we compared pancreatic fistula rates between these
groups. The first group was treated between 2005 and 2009, the second group
was treated between 2010 and 2012, and fast-track perioperative management
was undertaken in this group, and the third group was treated between 2012 and
2014, and anastomosis was achieved in this group by serosal compression of the
pancreatic stump.
Results: The incidences of grade B/C pancreatic fistula were 27.8% (25/90) in the
first group, 10.3% (9/87) in the second group, and 2.2% (1/45) in the third group
(p<0.001).
Conclusion: The risk of serious pancreatic fistula at the pancreatic stump can be
markedly reduced by creation of a modified Blumgart pressure anastomosis.
2.Perioperative Care with Fast-Track Management in Patients Undergoing Pancreaticoduodenectomy
Shinjiro Kobayashi ; Takehito Otsubo
Innovation 2014;8(4):120-121
Background: It has been considered that allowing patients to return to daily
life earlier after surgery helps recovery of physiological function and reduces
postoperative complications and hospital stay. We investigated the usefulness
of Fast-Track management in perioperative care of patients undergoing
pancreaticoduodenectomy (PD).
Methods: Patients (n = 90) who received conventional perioperative management
from 2005 to 2009 were included as the ‘conventional group’ (historical control
group),
and patients who received perioperative care with Fast-Track management (n
= 87) from 2010 to 2013 were included as the ‘fast-track group’. To evaluate
the efficacy of perioperative care with fast-track management,the incidence
of postoperative complications and the length of hospital stay were compared
between the two groups (comparative study). For statistical analysis, univariate
analysis was performed using the v2 test or Fisher’s exact test.
Results: There was no significant difference between the two groups in sex, mean
age, presence/absence of diabetes mellitus, preoperative drainage for jaundice,
previous disease, operative procedure, mean duration of operation, or blood loss
(p=0.01). The incidence of surgical site infection in the conventional group and
fast-track group was 28.9 and 14.0 %, respectively, with a significant difference
between the two groups (p = 0.019). In addition, the incidence of pancreatic
fistula (grade B, C) significantlydiffered between the two groups (27.8 % in
the conventional group, 9.0 % in the fast-track group; p = 0.001). The mean
postoperative hospital stay was 36.3 days in the conventional group and 21.9
days in the fast-track group (p=0.001).
Conclusions: Perioperative care with fast-track management may reduce
postoperative complications and decrease the length of hospital stay in patients
undergoing PD.
3. Modified Blumgart Anastomosis (Compressing the
Takehito OTSUBO ; Shinjiro KOBAYASHI
Innovation 2014;8(4):102-103
Background: To minimize the risk of pancreatic fistula development afterpancreaticoduodenectomy, we perform a pancreaticojejunostomy procedure thatis characterized by compression of the pancreatic stump by the seromuscularlayer of the jejunum.Methods: To suture the pancreatic parenchyma to the jejunal seromuscular layer,we use 4-0 non-absorbent thread and double-ended needles. After insertion ofa needle from the posterior surface of the pancreatic parenchyma toward itsanterior surface, the serosa of the small intestine is stitched in the direction of theminor axis of the jejunum to approximate the posterior surface of the pancreas. Astitch is made in the posterior parenchymal surface to anchor the suture thread.Two sutures are placed, one at the head of the main pancreatic duct and the otherat the bottom of the pancreas.During all-layer suturing of the pancreatic duct tothe jejunum, three support threads are placed at the three points of an imaginaryequilateral triangle, and sutures are added as needed, depending on the size ofthe pancreatic duct. Generally, nine sutures are used, fewer when the pancreaticduct is small in diameter. Note that there is a total of four needle tips/threadscoming through the anterior surface of the pancreas. After the all-layer suture ofthe pancreatic duct to the jejunam is tied off, the 4-0 non-absorbent thread thatwas used to stitch the pancreatic parenchyma to the jejunal seromuscular layeris used to stitch the seromuscular layer of the small intestine in the direction ofthe minor axis to approximate the anterior wall of the small intestine.Although itappears as though pressure is being applied when the branch of the pancreaticduct that is exposed to the pancreatic cut end is closed, ligation should be gentle.Study Patients: We conducted a study of 222 patients who underwentpancreaticojejunostomy. The patients comprised three groups treated during threedifferent time periods, and we compared pancreatic fistula rates between thesegroups. The first group was treated between 2005 and 2009, the second groupwas treated between 2010 and 2012, and fast-track perioperative managementwas undertaken in this group, and the third group was treated between 2012 and2014, and anastomosis was achieved in this group by serosal compression of thepancreatic stump.Results: The incidences of grade B/C pancreatic fistula were 27.8% (25/90) in thefirst group, 10.3% (9/87) in the second group, and 2.2% (1/45) in the third group(p<0.001).Conclusion: The risk of serious pancreatic fistula at the pancreatic stump can bemarkedly reduced by creation of a modified Blumgart pressure anastomosis.
4. Perioperative Care with Fast-Track Management in Patients Undergoing Pancreaticoduodenectomy
Shinjiro KOBAYASHI ; Takehito OTSUBO
Innovation 2014;8(4):120-121
Background: It has been considered that allowing patients to return to dailylife earlier after surgery helps recovery of physiological function and reducespostoperative complications and hospital stay. We investigated the usefulnessof Fast-Track management in perioperative care of patients undergoingpancreaticoduodenectomy (PD).Methods: Patients (n = 90) who received conventional perioperative managementfrom 2005 to 2009 were included as the ‘conventional group’ (historical controlgroup),and patients who received perioperative care with Fast-Track management (n= 87) from 2010 to 2013 were included as the ‘fast-track group’. To evaluatethe efficacy of perioperative care with fast-track management,the incidenceof postoperative complications and the length of hospital stay were comparedbetween the two groups (comparative study). For statistical analysis, univariateanalysis was performed using the v2 test or Fisher’s exact test.Results: There was no significant difference between the two groups in sex, meanage, presence/absence of diabetes mellitus, preoperative drainage for jaundice,previous disease, operative procedure, mean duration of operation, or blood loss(p=0.01). The incidence of surgical site infection in the conventional group andfast-track group was 28.9 and 14.0 %, respectively, with a significant differencebetween the two groups (p = 0.019). In addition, the incidence of pancreaticfistula (grade B, C) significantlydiffered between the two groups (27.8 % inthe conventional group, 9.0 % in the fast-track group; p = 0.001). The meanpostoperative hospital stay was 36.3 days in the conventional group and 21.9days in the fast-track group (p=0.001).Conclusions: Perioperative care with fast-track management may reducepostoperative complications and decrease the length of hospital stay in patientsundergoing PD.
5.The Role of Low Protein Diet (LPD) in the Treatment of Chronic Kidney Disease (CKD)
Tatsuo SHIIGAI ; Yoshitaka MAEDA ; Takahiko KOBAYASHI ; Takehito TANASE ; Kimie KOBAYASHI
Journal of the Japanese Association of Rural Medicine 2003;51(6):928-932
There is such an opinion that low protein diet (LPD) is unnecessary for preventing progression of renal insufficiency in chronic kidney disease (CKD). However, three randomized control trials of nondiabetic nephropathy (NDN) with CKD, using a metaanalysis method, revealed the usefulness of LPD in preventing progression of renal insufficiency. It is thought that the usefulness of LPD may increase further, if we evaluate randomized control trials one by one and select only what has high quality.
WHO/FAO recommended 0.8 g/kg/day of daily protein intake (DPI) to healthy people from a viewpoint of illness prevention 30 years ago. As, in advanced nations, DPI is 1.1 to 1.3 kg/day/kg in every country, DPI of CKD will become the same level of healthy people if not regulated. It cannot be considered at all that protein restriction is not required for CKD who is more susceptive to cardiovascular diseases than healthy poeple.
In conclusion, we should monitor DPI of patients with CKD, and control DPI between 0.6 and 0.8 g/kg/day. Under the restriction of DPI, we should manage NDN with CKD to prevent progression of renal insufficiency by controlling blood pressure, suppressing rennin-angiotensin system, compensating acidosis and correcting renal anemia.
6.Sublingual Immunotherapy for Japanese Cedar Pollinosis Attenuates Asthma Exacerbation
Sayaka KIKKAWA ; Kazuyuki NAKAGOME ; Takehito KOBAYASHI ; Tomoyuki SOMA ; Atsushi KAMIJO ; Makoto NAGATA
Allergy, Asthma & Immunology Research 2019;11(3):438-440
No abstract available.
Asian Continental Ancestry Group
;
Asthma
;
Cryptomeria
;
Humans
;
Rhinitis, Allergic, Seasonal
;
Sublingual Immunotherapy
7.Exposure to H1 genotype measles virus at an international airport in Japan on 31 July 2016 results in a measles outbreak
Aika Watanabe ; Yusuke Kobayashi ; Tomoe Shimada ; Yuichiro Yahata ; Ayako Kobayashi ; Mizue Kanai ; Yushi Hachisu ; Munehisa Fukusumi ; Hajime Kamiya ; Takuri Takahashi ; Yuzo Arima ; Hitomi Kinoshita ; Kazuhiko Kanou ; Takehito Saitoh ; Satoru Arai ; Hiroshi Satoh ; Hideo Okuno ; Saeko Morino ; Tamano Matsui ; Tomimasa Sunagawa ; Keiko Tanaka-Taya ; Makoto Takeda ; Katsuhiro Komase ; Kazunori Oishi
Western Pacific Surveillance and Response 2017;8(1):37-39
8.Long-term Observation of Gastric Adenocarcinoma of Fundic Gland Mucosa Type before and after Helicobacter pylori Eradication: a Case Report
Keitaro TAKAHASHI ; Nobuhiro UENO ; Takahiro SASAKI ; Yu KOBAYASHI ; Yuya SUGIYAMA ; Yuki MURAKAMI ; Takehito KUNOGI ; Katsuyoshi ANDO ; Shin KASHIMA ; Kentaro MORIICHI ; Hiroki TANABE ; Yuki KAMIKOKURA ; Sayaka YUZAWA ; Mishie TANINO ; Toshikatsu OKUMURA ; Mikihiro FUJIYA
Journal of Gastric Cancer 2021;21(1):103-109
Gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM) was proposed as a new variant of gastric adenocarcinoma of the fundic gland type (GA-FG). However, at present, the influence of Helicobacter pylori and the speed of progression and degree of malignancy in GA-FGM remain unclear. Herein, we report the first case of intramucosal GA-FGM that was endoscopically observed before and after H. pylori eradication over 15 years. The lesion showed the same tumor size with no submucosal invasion and a low MIB-1 labeling index 15 years after its detection using endoscopy. The endoscopic morphology changed from 0-IIa before H. pylori eradication to 0-IIa+IIc and then 0-I after H. pylori eradication. These findings suggest that the unaltered tumor size reflects low-grade malignancy and slow growth, and that the endoscopic morphology is influenced by H. pylori eradication.