Preoperative prediction of difficult laparoscopic cholecystectomy based on diffusion-weighted magnetic resonance imaging.

INTRODUCTION: Laparoscopic cholecystectomy is a common surgery with a varying difficulty level. Difficult laparoscopic cholecystectomy may be experienced by many surgeons. If difficult procedures are predicted preoperatively, surgeons may be able to plan the surgical approach and treatment accordingly. Studies have reported using blood and clinical imaging data to predict difficult cholecystectomy. However, to our knowledge, no studies have reported using MRI. The purpose of this study was to evaluate the usefulness of MRI as a predictor of difficult laparoscopic cholecystectomy. METHODS: We retrospectively evaluated 25 patients with cholecystitis or biliary colic who had undergone diffusion-weighted whole-body imaging before laparoscopic cholecystectomy. The apparent diffusion coefficient value of the cystic duct was measured and its relationship with operative time and blood loss was examined to assess the capacity of diffuse-weighted whole-body imaging to predict difficult cholecystectomy. Further, we collected blood data and compared its usefulness as a predictor. RESULTS: The apparent diffusion coefficient value of the cystic duct was significantly lower in patients with difficult laparoscopic cholecystectomy than in those with non-difficult procedures (P = .00007). White blood cell count and serum C-reactive protein level were significantly higher in patients with difficult cholecystectomy than in those with non-difficult procedures (P = .035, .030). In the receiver operating characteristic analysis, the apparent diffusion coefficient value was the best predictor. CONCLUSION: Our results suggest that the apparent diffusion coefficient value of the cystic duct is a predictor of difficult laparoscopic cholecystectomy. In the future, it may be useful to study changes in coefficient values over time to determine optimal surgical timing.

[A Case of Malignant Pleural Effusion Implanted Subcutaneous Pleural Port].

A 74-year-old man with malignant pleural effusion due to recurrent gastric cancer underwent a failed pleurodesis. He subsequently underwent subcutaneous implantable pleural port implantation surgery followed by outpatient chemotherapy for 1 month. His disease progressed and he was unable to go to the hospital. He requested home care, so a nurse practitioner visited his home and drained the pleural effusion from the subcutaneous implantable pleural port. About 3 weeks after starting home care, he died at home. Pleurodesis is a common treatment for malignant pleural effusion; however, if a patient does not respond, long-term hospitalization is required due to manage port drainage. The subcutaneous implantable pleural port may aid provision of effective home care.

[A case of gastric cancer responding to TS-1, with long survival of 16 months].

We report the case of a 47-year-old woman with Stage VI gastric cancer accompanied by p2 grade dissemination which responded to chemotherapy using TS-1. Treatment of the patient with daily oral administration of 80 mg TS-1 for 2 cycles resulted in partial regression in the size of the primary lesion. Side effects were only seen after administration of 1 month, as mild pigmentation easily controlled by white vaseline ointment. After 6 cycles of administration, the effect on the gastric mucosal lesion decreased, and the wall thickness and stenosis of the antrum were increased. The patient has been administered 10 cycles of chemotherapy with no myelosupression, and maintains a good quality of life.