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1.
World J Surg Oncol ; 21(1): 36, 2023 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-36747176

RESUMEN

BACKGROUND: Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. METHODS: This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. RESULTS: The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). CONCLUSIONS: This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.


Asunto(s)
Colon Transverso , Neoplasias del Colon , Laparoscopía , Humanos , Colon Transverso/diagnóstico por imagen , Colon Transverso/cirugía , Angiografía por Tomografía Computarizada , Colon/irrigación sanguínea , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/cirugía , Mesenterio/diagnóstico por imagen , Mesenterio/cirugía , Laparoscopía/métodos , Cadáver
2.
Surg Today ; 52(10): 1438-1445, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-35195766

RESUMEN

PURPOSE: Few studies have reported on the interactions between gastrectomy and antithrombotic therapy, especially the long-term prognosis. We aimed to clarify the short- and long-term prognosis of gastrectomy for patients on antithrombotic therapy. METHODS: We reviewed the perioperative data and survival rate of patients who underwent laparoscopic distal gastrectomy (LDG) at our institute between 2010 and 2013. RESULTS: There were 119 patients enrolled in this retrospective study: 31 who were taking antithrombotic drugs (antithrombotic therapy (ATT) group), and 88 who were not (non-ATT group). The mean age was significantly higher in the ATT group than in the non-ATT group. No significant differences were observed in the amount of intraoperative bleeding or blood hemoglobin level after surgery between the groups. Bleeding complications occurred in only one patient from the ATT group, and the postoperative complication rate was comparable between the groups. During follow-up, cerebrovascular or cardiovascular events developed in 19.4% of the ATT group patients and 4.5% of the non-ATT group patients; however, there were no significant differences in the 5-year overall survival rates between the groups (ATT group, 76.9%; non-ATT group, 82.9%). CONCLUSIONS: Antithrombotic therapy did not affect the short-term or long-term prognosis of patients after LDG.


Asunto(s)
Laparoscopía , Neoplasias Gástricas , Fibrinolíticos , Gastrectomía/efectos adversos , Hemoglobinas , Humanos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
3.
Gan To Kagaku Ryoho ; 45(1): 163-165, 2018 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-29362342

RESUMEN

Polysplenia syndrome is a rare congenital disease characterized by variable thoracic and abdominal anomalies. A man in his 70s was diagnosed with rectal cancer by close exploration for fecal occult blood. A barium enema revealed a type 1 rectal tumor andwith non-rotation of intestine. CT revealed multiple abnormalities: a polyspleen, preduodenal portal vein, congenital absence of the pancreatic tail, bilateral superior vena cava, andbilateral bilobedlung. Basedon these findings, the patient was diagnosedas having rectal cancer with polysplenia syndrome andtreatedwith robotic assistedlaparoscopic low anterior resection. At operation, the whole colon was located in the left side of the abdominal cavity. The whole colon adhered with each other. The ileocecum adheredto the front of the aorta andthe right iliac artery. In the pelvis, anatomical abnormality was not detectedandrectal mobilization andresection was performedas usual. The patient hadno signs of recurrence of the rectal cancer. This is the first case presentation of laparoscopic low anterior resection in a patient with rectal cancer and polysplenia syndrome.


Asunto(s)
Síndrome de Heterotaxia/complicaciones , Laparoscopía , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo , Humanos , Masculino , Neoplasias del Recto/complicaciones
4.
Surg Case Rep ; 10(1): 86, 2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38619647

RESUMEN

BACKGROUND: Complete mesocolic excision (CME) and central vascular detachment are very important procedures in surgery for colorectal cancer. Preoperative and intraoperative assessments of the anatomy of major colorectal vessels are necessary to avoid massive bleeding, especially in endoscopic surgery. A case with a rare anomaly in which the middle colic artery (MCA) and ileocolic artery (ICA) had a common trunk is reported. CASE PRESENTATION: The patient was a 73-year-old woman diagnosed with ascending colon cancer on colonoscopy. Preoperative abdominal contrast-enhanced computed tomography confirmed that the MCA and ICA had a common trunk. She underwent laparoscopic ileocecal resection for the ascending colon cancer with D3 lymph node dissection. Intraoperative indocyanine green fluorescence imaging was conducted. After confirming vessel bifurcation, the ICA was dissected at the distal end of the MCA bifurcation. The patient has been followed as an outpatient, with no signs of recurrence as of 2 years postoperatively. CONCLUSION: A case of an ascending colon cancer with a unique vascular bifurcation pattern was presented. Preoperative and intraoperative evaluations of the major colorectal vessels are very important for preventing perioperative and postoperative complications.

5.
Asian J Endosc Surg ; 17(3): e13313, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38631698

RESUMEN

There are many reports on the positional relationship between the ileocolic artery and superior mesenteric vein (SMV). However, there have been no reports of anomalous venous confluence in the ileocecal vessel area. A 69-year-old man was diagnosed with cecal cancer on a preoperative examination of a lung tumor. We planned to perform surgery for the cecal cancer. Computed tomography angiography revealed an anomalous vein confluence in the ileocolic region. We performed robot-assisted ileocecal resection. Although the small intestinal vein was misidentified as the SMV at first, we confirmed the misidentification, identified the SMV on the dorsal side of the ileocolic artery, and ligated the ileocolic vessels with precise forceps manipulation during robotic surgery. Especially for cases with vascular anomalies revealed by preoperative computed tomography angiography, robotic surgery may be useful, as flexible forceps manipulation prevents vascular injury.


Asunto(s)
Neoplasias del Ciego , Neoplasias , Robótica , Masculino , Humanos , Anciano , Ciego , Venas Mesentéricas/cirugía
6.
Sci Rep ; 14(1): 9029, 2024 04 19.
Artículo en Inglés | MEDLINE | ID: mdl-38641657

RESUMEN

Double-stranded RNA-activated protein kinase R (PKR) is highly expressed in colorectal cancer (CRC). However, the role of PKR in CRC remains unclear. The aim of this study was to clarify whether C16 (a PKR inhibitor) exhibits antitumor effects and to identify its target pathway in CRC. We evaluated the effects of C16 on CRC cell lines using the MTS assay. Enrichment analysis was performed to identify the target pathway of C16. The cell cycle was analyzed using flow cytometry. Finally, we used immunohistochemistry to examine human CRC specimens. C16 suppressed the proliferation of CRC cells. Gene Ontology (GO) analysis revealed that the cell cycle-related GO category was substantially enriched in CRC cells treated with C16. C16 treatment resulted in G1 arrest and increased p21 protein and mRNA expression. Moreover, p21 expression was associated with CRC development as observed using immunohistochemical analysis of human CRC tissues. C16 upregulates p21 expression in CRC cells to regulate cell cycle and suppress tumor growth. Thus, PKR inhibitors may serve as a new treatment option for patients with CRC.


Asunto(s)
Neoplasias Colorrectales , Inhibidores de Proteínas Quinasas , Humanos , Apoptosis , Ciclo Celular , División Celular/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/metabolismo , Regulación Neoplásica de la Expresión Génica , Inhibidores de Proteínas Quinasas/farmacología , Indoles/farmacología , Tiazoles/farmacología , eIF-2 Quinasa/antagonistas & inhibidores , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/efectos de los fármacos , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/metabolismo
7.
J Anus Rectum Colon ; 7(1): 25-29, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36743467

RESUMEN

Objectives: The diagnosis of patients with chronic constipation is very complicated. This study aimed to develop a simple imaging classification for the diagnosis of chronic constipation by abdominal computed tomography (CT). Methods: Sixty-two patients who underwent abdominal CT in our hospital between January and June 2022 were enrolled. The CT values of the stool in the rectum and cecum were measured in patients with chronic constipation (C group) and in those without (non-C group). Results: A strong correlation was observed between the Bristol Stool Form Scale (BSFS) and the CT value of rectal stool. Furthermore, the rectal stool CT value was significantly higher in patients with chronic constipation than in those without. The CT value of cecal stool did not differ between the two groups. The cecal stool CT value was significantly higher in patients with severe constipation (BSFS 1) than in those with BSFS 2-6. A cutoff CT value of 100 was selected as the optimal value for indicating chronic constipation. Conclusions: Abdominal CT was useful in the diagnosis of chronic constipation. If the patient had constipation, the optimal cutoff CT value was 100.

8.
Asian J Endosc Surg ; 15(1): 197-200, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34318616

RESUMEN

The frequency of secondary perineal hernia after abdominoperineal resection has been reported as 0.83%-26%. The optimal surgery for secondary perineal hernia and surgical indication remains controversial. An 87-year-old woman diagnosed with lower rectal cancer underwent laparoscopic abdominoperineal resection. Follow-up computed tomography at 6 months postoperatively revealed secondary perineal hernia. She reported no discomfort and no incarceration was apparent, but she complained of perineal discomfort 3 months later. Laparoscopic repair surgery was performed using an intraperitoneal onlay mesh plus technique with VENTRALIGHT® ST mesh (Medicon, Osaka, Japan), a non-absorbable mesh with a biodegradable coating. No recurrence of peritoneal hernia was seen as of 3 months postoperatively. A time lag can exist between imaging findings and symptom appearance. This laparoscopic intraperitoneal onlay mesh plus technique might become the optimal treatment for perineal hernia.


Asunto(s)
Hernia Abdominal , Laparoscopía , Proctectomía , Anciano de 80 o más Años , Femenino , Hernia Abdominal/cirugía , Herniorrafia , Humanos , Mallas Quirúrgicas
9.
Asian J Endosc Surg ; 15(2): 432-436, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34672106

RESUMEN

Indocyanine green (ICG) fluorescence angiography has recently been reported useful as a method for predicting intestinal blood flow and may reduce anastomotic leakage. However, the quantification method for ICG fluorescence angiography has not been established. We usually measure the tissue oxygen saturation (StO2 ) in the intestinal tract via near-infrared spectroscopy, as it is able to measure the oxygen concentration accurately and immediately shows objective data. In this study, we propose that the time to reach the anastomotic site after intravenous ICG injection is an effective parameter for quantifying ICG fluorescence angiography from the comparison to the data of StO2 in the intestinal tract.


Asunto(s)
Verde de Indocianina , Saturación de Oxígeno , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/etiología , Angiografía con Fluoresceína/efectos adversos , Humanos , Proyectos Piloto
10.
Chem Commun (Camb) ; (2): 159-61, 2006 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-16372091

RESUMEN

A sterically congested tetraphenyl-substituted dibenzo-tetraaza-isobacteriochlorinato nickel derivative unexpectedly reacts with methanol at room temperature to release internal molecular strains, leading to the formation of a ligand having a skeleton bearing two cis-methoxy substituents.

11.
Surg Case Rep ; 2(1): 97, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27624553

RESUMEN

Endometriosis generally occurs in the ovary. Intestinal endometriosis is rare. About 1 % of all endometriosis cases become malignant. Malignant transformation of small intestinal endometriosis is very rare. A 55-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and omentectomy for endometriosis 7 years ago presented to her primary care doctor with melena. A tumor was detected in the right lower abdomen by ultrasonography. The doctor referred her to our hospital. Computed tomography demonstrated a lobulated tumor ventral to the right common iliac vessels. Magnetic resonance imaging demonstrated that the tumor had heterogeneous intensity on T2-weighted images. Several small cysts with high intensity were observed caudal to the tumor on T2-weighted images. We performed partial small intestinal resection for the lesion. The tumor was diagnosed as endometrioid adenocarcinoma of the small intestine. She has been relapse-free for 5 years after surgery. Only three cases of malignant transformation of small intestinal endometriosis have been reported previously. It is very rare for long-term survival to be obtained with surgery alone, as in our case. This case report highlights the imaging findings for malignant transformation of intestinal endometriosis.

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