Laparoscopic hepatectomy for extrahepatic growing tumor. Surgical strategy based on extrahepatic growing index.

BACKGROUND: This article describes the operative procedures, varying difficulties, and required instrumentation for performing laparoscopic hepatectomy (LH) on the basis of a lesion's extrahepatic growing (EG) index, as calculated by computed tomography (CT). METHODS: Laparoscopic partial hepatectomy cases were divided into the following two groups: an EG tumor group (n = 11) and an intrahepatic tumor group (n = 8). The surgical procedures, operative results, and laparoscopic instrumentation for these two groups were compared based on the EG index (/cm2; maximum diameter of tumor pedicle/maximum vertical diameter of tumor/area of the tumor). RESULTS: The mean operative time was significantly shorter and the mean blood loss was significantly less in the EG tumor group than in the intrahepatic tumor group. In addition, in the EG tumor group, there were significant differences in mean operative time and mean blood loss related to the values associated with the EG index (p <0.05, P <0.01). The selection of laparoscopic instruments was based on the EG index, as follows: (a) lesions with an EG index >5/cm2 underwent resection in combination with a microwave tissue coagulator and an ultrasonic surgical aspirator (13 cases, including intrahepatic tumor cases); (b) lesions with an EG index of 5-15/cm2 underwent resection in combination with a microwave tissue coagulator and laparosonic coagulating shears (four cases); (c) lesions with an EG index <%15/cm2 underwent resection with a laparoscopic linear stapler (two cases). CONCLUSION: Our preliminary experience leads us to believe that it is useful to calculate the EG index by CT scan before formulating the technical strategy for a subsequent LH procedure.

Association between novelty seeking and dopamine receptor D4 (DRD4) exon III polymorphism in Japanese subjects.

In this study, we investigated the association between dopamine receptor D4 (DRD4) exon III polymorphism and novelty seeking in 69 Japanese women. The group of subjects with long allele (> or =5 repeats) exhibited significantly elevated novelty seeking scores in comparison with subjects lacking the long allele. By contrast, the scores for harm avoidance, reward dependence, and persistence were statistically indistinguishable in the two group of subjects. With regard to the subscales of novelty seeking, the scores for exploratory excitability and extravagance were significantly higher in subjects with the long allele than in subjects lacking the long allele. However, no significant associations with impulsiveness or disorderliness were recognized. Our results suggest that although long alleles of the polymorphic exon III repeats are low in the Japanese population, there is an association between long alleles of DRD4 exon III polymorphism and novelty seeking.

[Multiple myeloma with hemolytic anemia and thrombocytopenia].

We report a 59 year old female patient who was diagnosed as having IgG kappa myeloma with hemolytic anemia and thrombocytopenia simultaneously. Although M-protein was suspected to contribute to the hemolysis, the IgG purified from the patient's serum did not bind to red blood cells. Therefore, massive non-specific binding of M-protein to blood cells might contribute to high levels of red blood cell-associated IgG and platelet-associated IgG in the patient.