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1.
Circ J ; 85(7): 1083-1092, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-33208572

RESUMO

BACKGROUND: Although diabetes mellitus (DM) is a common comorbidity of aortic stenosis (AS), clinical evidence about the long-term effect of DM on patients with AS is insufficient.Methods and Results:Data were acquired from CURRENT AS, a large Japanese multicenter registry that enrolled 3,815 patients with severe AS. Patients without initial valve replacement were defined as the conservative group; among them, 621 (23.4%) had DM, whereas 1997 did not. The DM group was further divided into 2 groups according to insulin treatment (insulin-treated DM, n=130; non-insulin treated DM, n=491). The primary outcome was a composite of aortic valve (AV)-related death and heart failure (HF) hospitalization. Secondary outcomes were AV-related death, HF hospitalization, all-cause death, cardiovascular death, sudden death, and surgical or transcatheter AV replacement during follow up. As a result, DM was associated with higher risk for the primary outcome (52.8% vs. 42.9%, P<0.001), with a statistically significant adjusted hazard ratio (HR 1.33, 95% confidence interval: 1.14-1.56, P<0.001). All secondary outcomes were not significantly different between DM and non-DM patients after adjusting for confounding factors, except for HF hospitalization. Insulin use was not associated with higher incidence of primary or secondary outcome. CONCLUSIONS: In initially conservatively managed patients with AS, DM was independently associated with higher risk for a composite of AV-related death or HF hospitalization; however, insulin use was not associated with poor outcomes.


Assuntos
Estenose da Valva Aórtica , Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Insulinas , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/cirurgia , Diabetes Mellitus/epidemiologia , Humanos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
2.
Surg Endosc ; 34(12): 5384-5392, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31993811

RESUMO

BACKGROUND: Colorectal cancer is one of the most common malignant diseases worldwide. However, laparoscopic lymph node dissection is technically demanding and time-consuming in right-sided colon cancer surgery because of variable vessel anatomy. We evaluated whether the ileocolic artery (ICA) crossing anterior to the superior mesenteric vein (SMV) was associated with better intraoperative parameters and survival compared with the ICA crossing posterior to the SMV, following laparoscopic curative resection for right-sided colon cancer. METHODS: This was a propensity-score-matched retrospective study including data for 540 patients with right-sided colon cancer undergoing laparoscopic curative resection (299 with the ICA crossing anterior to the SMV (group A) and 241 with the ICA crossing posterior to the SMV (group B). We compared propensity-matched scores between the two groups to evaluate surgical and oncological outcomes. RESULTS: We found no significant difference in 5-year overall survival rates between groups for any disease stage (0-III). However, 5-year disease-free survival (DFS) rates did differ significantly between groups (p = 0.011), especially in patients with stage III disease (p = 0.013). We then performed univariate and multivariate analyses to determine the associations between DFS and ICA location and tumor-node-metastasis (UICC) stage. ICA location and UICC stage had a poor association with DFS on univariate analysis: ICA hazard ratio (HR) 2.52, CI 1.19-5.78, p = 0.014 vs HR 3.18, CI 1.08-9.46, p = 0.03, and on multivariate analysis: HR 2.48, CI 1.17-5.69, p = 0.016 vs HR 3.86, CI 1.90-7.96, p = 0.0002. CONCLUSION: Our results showed that an ICA crossing posterior to the SMV was associated with worse DFS compared with an ICA crossing anterior to the SMV. We recommend careful laparoscopic technique in patients with an ICA crossing posterior to the SMV, during lymph node resection in right-sided colon cancer surgery.


Assuntos
Neoplasias do Colo/cirurgia , Veias Mesentéricas/cirurgia , Veia Porta/cirurgia , Pontuação de Propensão , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
3.
Gan To Kagaku Ryoho ; 47(5): 831-834, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32408330

RESUMO

A 74-year-old man with upper abdominal pain and anorexia was referred to our hospital in December 2013. Based on computed tomography(CT)and gastroendoscopy findings, the patient was diagnosed as having advanced gastric cancer with multiple liver metastases(S3, S5, and S6 lesions). Because of high pyloric stenosis, distal gastrectomy Roux-en-Y reconstruction was performed in mid-December 2013. Histopathological findings of the patient were L, Ant-Gre, 35×60 mm, type 2, pT4a(SE), tub2>tub1, int, INF b, ly2, v1(VB), pPM0(95mm), pDM0(15mm), pN0(0/2), HER2(IHC 3+). Postop- eratively, the patient received combined S-1/trastuzumab chemotherapy toward the end of January 2014. The clinical response was PR after 2 courses and clinical CR(cCR)after 4 courses. Because hand-foot syndrome caused by S-1 was prolonged, the dosage was completed in 11 courses. He remains alive 4.5 years after surgery without recurrence. Although ToGA examination showed that trastuzumab was effective for HER 2-positive unresectable gastric cancer, few reported cases showed progression to cCR after the treatment followed by a regimen of trastuzumab without CDDP, and they had good prognosis. Furthermore, in this case, the liver metastases showed complete response without CDDP. Thus, trastuzumab might be a chemotherapy option for patients who have difficulty using platinum analogs, including the elderly patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Hepáticas , Neoplasias Gástricas , Idoso , Cisplatino , Gastrectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Recidiva Local de Neoplasia , Neoplasias Gástricas/tratamento farmacológico , Trastuzumab
4.
Circ J ; 82(3): 874-885, 2018 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-29081473

RESUMO

BACKGROUND: Clinical profiles of acute heart failure (AHF) complicating severe aortic stenosis (AS) remain unclear.Methods and Results:From a Japanese multicenter registry enrolling consecutive patients with severe AS, 3,813 patients were categorized into the 3 groups according to the symptom of heart failure (HF); No HF (n=2,210), chronic HF (CHF) (n=813) and AHF defined as hospitalized HF at enrolment (n=790). Median follow-up was 1,123 days with 93% follow-up rate at 2 years. Risk factors for developing AHF included age, female sex, lower body mass index, untreated coronary artery stenosis, anemia, history of HF, left ventricular ejection fraction <50%, presence of any combined valvular disease, peak aortic jet velocity ≥5 m/s and tricuspid regurgitation pressure gradient ≥40 mmHg, and negative risk factors included dyslipidemia, history of percutaneous coronary intervention and hemodialysis. Respective cumulative 5-year incidences of all-cause death and HF hospitalization in No HF, CHF and AHF groups were 37.1%, 41.8% and 61.8% (P<0.001) and 20.7%, 33.8% and 52.3% (P<0.001). Even in the initial aortic valve replacement (AVR) stratum, AHF was associated with excess 5-year mortality risk relative to No HF and CHF (adjusted hazard ratio [HR] 1.64; 95% confidence interval [CI]: 1.14-2.36, P=0.008; adjusted HR 1.47; 95% CI: 1.03-2.11, P=0.03, respectively). CONCLUSIONS: AHF complicating severe AS was associated with an extremely dismal prognosis, which could not be fully resolved by AVR. Careful management to avoid the development of AHF is crucial.


Assuntos
Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/etiologia , Insuficiência Cardíaca/etiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/terapia , Feminino , Próteses Valvulares Cardíacas , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Fatores de Risco
5.
Surg Endosc ; 32(1): 358-366, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28656334

RESUMO

BACKGROUND: Laparoscopy assisted distal gastrectomy (LADG) for gastric cancer has been rapidly adopted for the treatment of both early and advanced gastric cancers which need lymph node dissection, but remains difficult procedure, especially in patients with obesity. We evaluated the impact of obesity on short- and long-term outcomes of LADG for gastric cancer. METHODS: We retrospectively investigated 243 patients who underwent LADG for gastric cancer between January 2007 and December 2014. The patients were classified based on their body mass index (BMI) into the Obese (BMI ≥ 25) and Non-Obese (BMI < 25) Groups. Patient characteristics, clinicopathologic and operative findings, and short- and long-term outcomes were investigated and compared between the groups. RESULTS: The groups did not differ in age, sex, American Society of Anesthesiologists score, the presence of comorbidities, or pathologic stage. Operative time (265 ± 46.6 vs. 244 ± 55.6 min; P = 0.007) and estimated blood loss (113 ± 101.4 vs. 66.5 ± 95.2 ml; P = 0.007) were greater in the Obese Group. Fewer lymph nodes were retrieved in the Obese Group (38 ± 23.7 vs. 47.5 ± 24.3; P = 0.004). No differences were evident in postoperative complication rate (20% vs. 17%; P = 0.688) or the duration of postoperative hospital stay (9 ± 8.5 vs. 9 ± 5.1 days; P = 0.283) between the two groups. In the Obese Group, the 5-year overall survival rate was significantly lower than in the Non-Obese Group (67.6% vs. 90.3%; P = 0.036). Furthermore, 5-year disease-specific survival was significantly lower in the Obese Group than in the Non-Obese Group (72.7% vs. 94.9%; P = 0.015). CONCLUSIONS: LADG in patients with obesity could be performed as safe as in patients without obesity, with comparable postoperative results. But obesity may be a poor prognostic factor in gastric cancer.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Obesidade/complicações , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
6.
Surg Endosc ; 32(10): 4277-4283, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29602987

RESUMO

BACKGROUND: Elderly patients are often considered as a high-risk population for major abdominal surgery due to reduced functional reserve and increased comorbidities. The aim of this study was to assess the safety and curability of laparoscopic gastrectomy in elderly patients with gastric cancer compared with short- and long-term outcomes in non-elderly patients. METHODS: We retrospectively investigated 386 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2007 and December 2015 at the Digestive Disease Center, Showa University, Northern Yokohama Hospital. We categorized the patients into two groups by age: the elderly patients (≥ 75 years old) and the non-elderly patients (< 74 years old). Patient characteristics, clinicopathologic and operative findings, and short- and long-term outcomes were investigated and compared between the two groups. RESULTS: The elderly group showed a significantly higher rate of comorbidities (73.1 vs. 49.2%, P < 0.001), and American Society of Anesthesiologists (ASA) scores ≥ 2 (76.3 vs. 43.7%, P < 0.001), and using anticoagulant agents (25.8 vs. 7.9%, P < 0.001) than the non-elderly group. The postoperative morbidity and mortality did not differ between the two groups (19.4 vs. 18.8%; P = 0.880, 2.2 vs. 0%; P = 0.058). In the multivariate analysis, male sex was the only risk factor for postoperative morbidity after laparoscopic gastrectomy. However, age was not found to be a risk factor. The 5-year overall survival ratio was significantly lower in the elderly group than in the non-elderly group (67.7 vs. 85.0%; P < 0.001). However, the 5-year disease-specific survival ratio was similar in the two groups (84.8 vs. 89.1%; P = 0.071). CONCLUSION: Laparoscopic gastrectomy for gastric cancer could be safely performed in elderly patients with acceptable postoperative morbidity and curability.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
7.
Circ J ; 81(8): 1213-1221, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28392546

RESUMO

BACKGROUND: There is a paucity of data on the sex differences in the prevalence, clinical presentation, and prognosis of aortic stenosis (AS).Methods and Results:A total of 3,815 consecutive patients with severe AS were enrolled in the multicenter CURRENT AS registry between January 2003 and December 2011. The registry included 1,443 men (38%) and 2,372 women (62%). Women were much older than men (79±10 vs. 75±10 years, P<0.0001), and the ratio of women to men increased with age. The cumulative 5-year incidence of all-cause death was significantly higher in men than in women (47% vs. 41%, P=0.003), although women were more symptomatic and much older. The 5-year mortality was similar between men and women at age <65 years (16% vs. 15%, P=0.99), whereas it was significantly higher in men than in women at age ≥65 years (65-74 years, 38% vs. 19%, P<0.0001; 75-84 years, 55% vs. 34%, P<0.0001; ≥85 years: 82% vs. 72%, P=0.03). CONCLUSIONS: A large Japanese multicenter registry of consecutive patients with severe AS included a much higher proportion of women than men, with the female:male sex ratio increasing with age. The 5-year mortality rate of women was lower than that of men. Lower 5-year mortality rates in women were consistently seen across all age groups >65 years.


Assuntos
Estenose da Valva Aórtica/mortalidade , Sistema de Registros , Caracteres Sexuais , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais
8.
Dig Surg ; 34(5): 394-399, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28099959

RESUMO

BACKGROUND/AIM: Anastomotic leakage (AL) is a major complication after laparoscopic low anterior resection (Lap-LAR). Many surgeons encounter AL following severe postoperative diarrhea. However, little is known about the relationship between postoperative fecal volume and AL. This study determined whether postoperative fecal volume can predict AL. METHODS: A retrospective assessment was performed with data from 176 patients with rectal cancers who underwent Lap-LAR between April 2011 and August 2015. A transanal tube was routinely placed in all cases. The fecal volume from the transanal tube was measured daily. The total fecal volume for 3 days after surgery was compared between the AL and non-AL groups. RESULTS: AL occurred in 11 patients. There were 3 patients with a fecal volume ≥1,000 mL for 3 days after surgery. AL occurred in these 3 patients. In patients with a fecal volume <1,000 mL, the total fecal volume was significantly greater in the AL group than that in the non-AL group (p = 0.0003). The cut-off value of the total fecal volume in AL was 118 mL. CONCLUSIONS: The volume of fecal discharge for 3 days after surgery is associated with the incidence of AL, and a fecal volume ≥118 mL may be a reliable predictor for AL.


Assuntos
Fístula Anastomótica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Fezes , Neoplasias Retais/cirurgia , Idoso , Área Sob a Curva , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos
9.
Surg Endosc ; 29(4): 863-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25052128

RESUMO

BACKGROUND: Anastomotic leakage is one of the most serious complications following laparoscopic low anterior resection (LAR) for rectal cancers. The purpose of this study was to investigate whether transanal tube placement can reduce anastomotic leakage following laparoscopic LAR. METHODS: Retrospective assessment was performed on 205 patients with rectal cancers who underwent laparoscopic LAR. A transanal tube was placed after anastomosis in 96 patients (group A). Another 109 patients were operated on without a transanal tube (group B). Clinicopathological and operative variables, the frequencies of anastomotic leakage and re-operation after leakage were investigated. RESULTS: Patient age, gender, body mass index, tumor size, Dukes' stage, intra-operative blood loss, and the rate of left colic artery preservation were comparable between the two groups. Tumor location was lower and operative time was significantly longer in group A than group B (p < 0.001). Overall rate of leakage was 9.3 % (19/205). The frequency of leakage was 4.2 % (4/96) in group A and was 13.8 % (15/109) in group B. The rate of leakage was significantly lower in group A (p < 0.05). Furthermore, the re-operation rate for symptomatic anastomotic leakage was 0 % (0/4) in group A, while in contrast it was 73.3 % (10/15) in group B. The rate of re-operation was lower in group A than group B (p < 0.05) and all cases with symptomatic leakage in group A were cured by conservative treatment. CONCLUSIONS: Transanal tube placement was effective for prevention of anastomotic leakage following laparoscopic LAR and avoiding re-operation after symptomatic leakage.


Assuntos
Canal Anal/cirurgia , Fístula Anastomótica/prevenção & controle , Laparoscopia , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Grampeamento Cirúrgico , Resultado do Tratamento
10.
Dig Surg ; 32(5): 338-43, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26183549

RESUMO

BACKGROUND/AIMS: Adjuvant chemotherapy for stage II colorectal cancer (CRC) can generally be administered to high-risk subgroups. To better identify these patients, we aimed at assessing factors that affect recurrence. METHODS: In our hospital, 432 colon and 96 rectal stage II cancer patients who underwent surgical resection between 2001 and 2011 were divided into recurrence and non-recurrence groups. Age, sex, lymphatic vessel invasion, venous invasion, tumor diameter, tumor depth, histological type, preoperative carcinoembryonic antigen level, number of sampled nodes, adjuvant chemotherapy, morphology, surgical approach, anastomotic leakage, preoperative bowel obstruction, and preoperative perforation were retrospectively compared between the groups. RESULTS: For colon cancer, multivariate analysis revealed a significant association between tumor diameter ≥40 mm and recurrence (p = 0.039). For rectal cancer, multivariate analysis revealed that tumor diameter ≥50 mm (p = 0.001) and ≤12 sampled nodes (p = 0.021) were associated with recurrence. Tumor diameter in rectal cancer was associated with worse disease-free survival (p = 0.026). CONCLUSION: Tumor diameter is a significant predictor of recurrence in stage II CRC. This is an important finding because tumor diameter is easy to evaluate clinically and might help to identify candidates for adjuvant chemotherapy.


Assuntos
Colectomia , Neoplasias Colorretais/patologia , Recidiva Local de Neoplasia/patologia , Reto/cirurgia , Carga Tumoral , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
World J Surg Oncol ; 13: 171, 2015 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-25943390

RESUMO

BACKGROUND: Carcinomas occurring at colostomy sites are rare, and most of these are metachronous colorectal cancers. The median time between colostomy and development of a carcinoma at a colostomy site is 22 years, which exceeds the length of the recommended follow-up period. We report a rare case of a carcinoma of the transverse colon occurring at a colostomy site in a patient without a history of colorectal cancer. CASE REPORT: An 89-year-old woman presented with a tumor occurring at a colostomy site. Thirty-five years previously, she had undergone a transverse loop colostomy for an iatrogenic colon perforation that occurred during left ureteral lithotomy. Upon physical examination, the patient had a hard nodule measuring 3 cm at the colostomy site. A biopsy of the nodule suggested adenocarcinoma, and the preoperative diagnosis was transverse colon cancer. A laparotomy was performed via a peristomal incision with 5-mm skin margins, and the tumor was covered by a surgical glove to avoid any tumor seeding. The colon was separated from the tumor by 5-cm margins, and the specimen was removed en bloc. An end colostomy was constructed to a new site on the right side of the abdomen. The deficit in the abdominal wall was repaired, and the skin was closed via a purse-string suture. The final diagnosis of the stoma tumor was transverse colon cancer (T2, N0, M0, stage I). One year and five months after surgery, there was no evidence of recurrence. CONCLUSIONS: The occurrence of carcinomas at colostomy sites in patients without a history of colorectal cancer is rare. It is important to train ostomates to monitor the stoma for possible tumor recurrence.


Assuntos
Adenocarcinoma/etiologia , Colo Transverso/patologia , Neoplasias do Colo/etiologia , Colostomia/efeitos adversos , Adenocarcinoma/diagnóstico , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico , Feminino , Humanos , Prognóstico , Tomografia Computadorizada por Raios X
12.
World J Surg Oncol ; 12: 112, 2014 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-24754918

RESUMO

BACKGROUND: We report an extremely rare case of resection of localized biphasic malignant peritoneal mesothelioma of the transverse colon. CASE REPORT: Computed tomography and magnetic resonance imaging in a 72-year-old man showed a tumor with enhanced borders consistent with the transverse colon. Colonoscopy showed ulcerative lesions in the transverse colon, but histological examination showed no malignancy. A gastrointestinal stromal tumor was strongly suspected, so an extended right hemicolectomy was performed. Histopathological examination showed that the tumor was a localized malignant peritoneal mesothelioma of the transverse colon. The patient did not receive postoperative chemotherapy and died 18 months after surgery. CONCLUSIONS: The number of patients with malignant mesotheliomas is predicted to increase in the future both in Japan and in western countries. We report this case due to its probable usefulness in future studies pertaining to the diagnosis and treatment of malignant mesotheliomas.


Assuntos
Colo Transverso/patologia , Neoplasias do Colo/patologia , Neoplasias Pulmonares/secundário , Mesotelioma/secundário , Neoplasias Peritoneais/secundário , Idoso , Colo Transverso/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Mesotelioma/cirurgia , Mesotelioma Maligno , Neoplasias Peritoneais/cirurgia , Prognóstico , Tomografia Computadorizada por Raios X
13.
Hepatogastroenterology ; 61(134): 1486-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25436330

RESUMO

In this study, we demonstrated the complete resection of untinate process that was performed by the hybrid laparoscopic surgery using our original new technique of Shuriken shaped umbilicoplasty with sliding window`s method. A 70-year-old weman was hospitalized for surgery of intraductal papillary mucinous neoplasm located in the uncinate process of pancreas. Under general anesthesia, a Shuriken shaped umbilical skin incision was made by 7 cm in horizontal and 4cm longitudinal width with 3cm round skin incision. The intermediate skin between outside and inside skin incision was removed. Subcutaneous tissue around the umbilicus and the upper abdominal subcutaneous region was dissected, and the 8cm of upper abdominal minilaparotomy was performed. The complete resection of untinate process was performed by hybrid laparoscopic procedure with the hand-assisted or the laparo-assisted manner. The umbilicoplasty of only 3cm round skin wound was made by the reefing of subcutaneous suture with 5-0 absorbable suture. The patient suffered from pancreas leakage from pancreas stump, however it was recovered spontaneously. Our new procedure could be used for PD, DP, and Major hepatectomy with the hybrid laparoscopic procedure. It might be considered that our method is good for both cosmetic and safety benefits in HPB surgery.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Laparoscopia Assistida com a Mão , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Umbigo/cirurgia , Idoso , Carcinoma Ductal Pancreático/patologia , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Neoplasias Pancreáticas/patologia , Técnicas de Sutura , Resultado do Tratamento
14.
Gan To Kagaku Ryoho ; 41(4): 499-502, 2014 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-24743369

RESUMO

A 77-year-old man underwent surgery for sigmoid colon cancer. He was diagnosed with Stage IIIa colon cancer; there- fore, we initiated oral administration of adjuvant chemotherapy comprising uracil/tegafur(UFT)plus Leucovorin(LV). However, chemotherapy was stopped after 21 days because of fatigue and diarrhea. He recovered after 3 weeks, and we administered the same regimen with a dose reduction. However, he again experienced fatigue and diarrhea after 20 days; therefore, chemotherapy was discontinued. Subsequently, he was hospitalized 8 times for conditions such as diarrhea, hypoalbuminemia, and fever. Computed tomography revealed thickening of the transverse colonic wall and colonoscopy revealed colitis, which we believe was induced by UFT plus LV. Twelve months after the last chemotherapy session, he was diagnosed with Clostridium difficile colitis. Therefore, we initiated the oral administration of vancomycin, which resulted in rapid recovery from colitis. However, he developed liver metastasis and died 29 months after the initiation of chemotherapy. We believe that this severe case of intractable colitis was caused by UFT plus LV. Therefore, we report this case with a review of the literature on enteritis induced by fluorouracil-based anticancer agents in Japan.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Enterite/induzido quimicamente , Neoplasias do Colo Sigmoide/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/efeitos adversos , Clostridioides difficile , Enterite/tratamento farmacológico , Enterite/microbiologia , Evolução Fatal , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Masculino , Estadiamento de Neoplasias , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Tegafur/administração & dosagem , Tegafur/efeitos adversos , Uracila/administração & dosagem , Uracila/efeitos adversos
15.
Cancer ; 118(11): 2813-9, 2012 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-21990070

RESUMO

BACKGROUND: Recently, a highly sensitive fluorescent imaging technique was developed for the real-time identification of hepatic tumors. The authors applied this procedure for the intraoperative detection of radiographically occult hepatic micrometastases from pancreatic cancer. METHODS: Forty-nine consecutive patients with pancreatic cancer who underwent surgical intervention were examined. Preoperative clinical images had not revealed any hepatic metastases. On the day before surgery, indocyanine green was injected intravenously. During the operation, the liver was observed with a near-infrared camera system, and abnormal fluorescent foci were examined by frozen-section histology. The patients with hepatic micrometastases were judged to have unresectable disease and underwent only palliative surgery followed by systemic chemotherapy using gemcitabine. RESULTS: Abnormal hepatic fluorescence at least 1.5 mm in greatest dimension without any apparent tumor was observed in 13 patients. Among them, histologic examination confirmed micrometastases in 8 of 49 patients (16%). All patients with hepatic micrometastases had clinical T3 or T4 disease and high serum CA19-9 levels (P = .042). On follow-up computed tomography images that were obtained within 6 months after surgery, the patients with hepatic micrometastases manifested hepatic overt metastases (7 of 8 patients; 88%) more frequently than the patients without hepatic micrometastases (4 of 41 patients; 10%; P < .001). Regardless of histologic confirmation, the positive predictive value of abnormal fluorescence for the manifestation of hepatic relapse within 6 months was 77% (10 of 13 patients), and the negative predictive value was 97% (35 of 36 patients). CONCLUSIONS: Indocyanine green-fluorescent imaging can detect hepatic micrometastases of pancreatic cancer during surgery. The hepatic micrometastases seem to have an adverse clinical impact identical to that of evident distant metastases.


Assuntos
Diagnóstico por Imagem/métodos , Neoplasias Hepáticas/secundário , Micrometástase de Neoplasia , Neoplasias Pancreáticas/patologia , Idoso , Sistemas Computacionais , Feminino , Fluorescência , Humanos , Verde de Indocianina , Período Intraoperatório , Masculino , Estudos Prospectivos
16.
Surg Case Rep ; 8(1): 102, 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35610493

RESUMO

BACKGROUND: Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair. CASE PRESENTATION: An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment. CONCLUSIONS: This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

18.
Gan To Kagaku Ryoho ; 37(3): 453-5, 2010 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-20332682

RESUMO

OBJECTIVES: Frequency of CVAPD-related complications in colorectal cancer patients is investigated to clarify the relationship to the clinical factors. METHODS: The subjects were 57 patients with unresectable or recurrent colorectal cancer who received interposition operation of CVAPD during the period from February 2006 to April 2009. The clinical factors including the insertion sites, the indwelling period of time, surgical operators, and the types of CVAPD products were analyzed in relation to the complications. RESULTS: The patients were 42 males and 15 females in the median age of 67 (28-82) years at insertion of CVAPD. The reasons for the introduction of CVAPD were liver metastasis in 25 patients, peritoneal metastasis in 12 patients, recurrent lymph node metastasis in 7 patients, lung metastasis in 18 patients, local factors in 8 patients, and other in 4 patients (multiple response). For CVAPD-related troubles, a total of 10 patients (17.5%) postponed the therapeutical treatment; for occurrence of infection in 4 patients (7.0%), thrombosis in 5 (8.8%), and fracture of a catheter in 1 (1.8%). The CV port device was removed in 9 patients. Analytical results showed that the frequency of CV port device-related complications was not affected by the puncture sites, surgical operators, indwelling period of time, and types of CVAPD products. CONCLUSION: Some troubles are often observed which require CVAPD removal, regardless of surgical operators and indwelling period of time, though the frequency of CVAPD-related complications is relatively lower. Review of the operational procedures of the CVAPD insertion and the types of the product to be used, early detection of the complications, and also understanding of the potential risks by the medical staff and patient are important for management of such clinical troubles related to CVAPD.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Trombose Venosa Profunda de Membros Superiores
19.
Eur Heart J Qual Care Clin Outcomes ; 6(2): 166-174, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31386103

RESUMO

AIMS: Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1 year after diagnosis in asymptomatic severe AS patients. METHODS AND RESULTS: We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1 year using a multivariable logistic regression model. The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, haemoglobin ≤11.0 g/dL, chronic lung disease (2 points), diabetes mellitus, haemodialysis, and any concomitant valve disease (1 point). The predictive accuracy of the model was good with the area under the curve of 0.79 and 0.77 in the derivation and validation sets (N = 425). In the validation set, the 1-year incidence of AS-related events was much higher in patients with score ≥2 than in patients with score ≤1 (Score 0: 2.2%, Score 1: 1.9%, Score 2: 13.4%, Score 3: 14.3%, and Score ≥4: 22.7%, P < 0.001). CONCLUSION: The CURRENT-AS risk score integrating clinical and echocardiographic factors well-predicted the risk of AS-related events at 1 year in asymptomatic patients with severe AS and was validated internally.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Valva Aórtica/cirurgia , Doenças Assintomáticas , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Sistema de Registros , Função Ventricular Esquerda/fisiologia , Idoso , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Ecocardiografia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
20.
Mol Clin Oncol ; 10(4): 425-429, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30931111

RESUMO

Positron emission tomography/computed tomography (PET/CT) is frequently used to detect colorectal cancer. The present retrospective study assessed the ability of PET/CT to identify synchronous colonic lesions in 72 patients with obstructive colorectal cancer. All patients had undergone surgical resection without undergoing preoperative total colonoscopy (TCS) at the Digestive Disease Center (April 2007 to September 2016), and subsequently underwent TCS of the proximal colon within 2 years post-surgery. A total of 11 patients exhibited 18F-fluorodeoxyglucose uptake during PET/CT of the proximal colon (4 invasive cancers, 3 advanced adenomas and 4 false-positive results), and 61 patients had no uptake in the proximal colon. Among these 61 patients, postoperative TCS revealed 2 invasive cancers and 4 advanced adenomas. The sensitivity of PET/CT for detecting synchronous invasive cancers was 66.6% (4/6), with a specificity of 89.4% (59/66), a positive predictive value of 36.4% (4/11), a negative predictive value of 96.7% (59/61), and an accuracy of 87.5% (63/72). Negative PET/CT results indicated a low probability of synchronous lesions in the proximal colon. Thus, PET/CT may be a useful tool for detecting synchronous colonic cancers in patients with obstructive colon cancer.

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