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1.
Int J Surg Pathol ; 28(4): 447-453, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31771368

RESUMO

Tenosynovial giant cell tumor (TSGCT) of localized type is a common disease occurring mostly in the hands. Diagnosis of this tumor is relatively easy to render with hematoxylin-eosin-stained sections as compared with that of TSGCT of diffuse type. However, very rare cases with chondroid metaplasia that have recently been reported mainly in diffuse type can make pathological differentiation from soft tissue cartilaginous tumors extremely difficult. In this article, the authors present the second reported case of TSGCT of localized type showing extensive chondroid metaplasia. Pathological interpretation was difficult without utilizing immunohistochemistry and fluorescence in situ hybridization. One must be careful not to misdiagnose this lesion as cartilaginous tumors of soft tissue, and we suspect at least some chondroblastoma-like chondroma could be reclassified as TSGCT of localized type with extensive chondroid metaplasia. Morphological, immunohistochemical, and molecular genetic characteristics are presented and discussed.

2.
Surg Case Rep ; 5(1): 191, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31811418

RESUMO

BACKGROUND: Synchronous and asynchronous multiple cancers have become more pervasive in recent years despite advances in medical technologies. However, there have been only six cases (including the present case) that underwent pancreaticoduodenectomy (PD) for pancreas head cancer following surgery for esophageal cancer. PD for treating pancreas head cancer is extremely challenging; thus, the confirmation of vessel variation and selection of surgical procedures are vital. CASE PRESENTATION: The patient was a 78-year-old Japanese male who was synchronously diagnosed with esophageal and cecal cancer 7 years previously at our hospital. He was admitted with densely stained and jaundiced urine and presented no remarkable family medical history. Following various examinations, surgery was performed due to the diagnosis of distal cholangiocarcinoma (pancreatic head cancer). Since the tumor was located far from the gastroduodenal artery (GDA) and no significant lymph node metastases could be found, subtotal stomach-preserving PD was performed instead of the resection of GDA with the right gastroepiploic artery (RGEA) for gastric tube blood flow preservation. The common hepatic artery (CHA) and GDA were confirmed, and RGEA diverged from GDA was identified. Subsequently, their respective tapings were preserved. The right gastric artery (RGA) was identified, taped, and preserved considering the gastric tube blood flow. The inflow area of the right gastroepiploic vein (RGEV) through gastric colic vein trunk in the superior mesenteric vein was exposed and preserved as the outflow of gastric tube blood flow. PD was completed without any complications on the shade of the gastric tube. CONCLUSIONS: This case report describes successfully preserved gastric blood flow without the resection of GDA, RGEA, RGEV, or RGA. To preserve the gastric tube, GDA inflow, RGEA, RGA, and RGEV outflow should be preserved if possible. When performing PD after tube reconstruction, it is essential to confirm the relative positions of the blood vessel, blood flow, and tumor through three-dimensional computed tomography angiography before surgery and to consider the balance between the invasiveness and optimal curability of the surgery.

3.
Tokai J Exp Clin Med ; 44(4): 108-112, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31769000

RESUMO

OBJECTIVE: This study of 45 patients aimed to retrospectively examine whether the relationships among the postoperative to preoperative body weight ratio (BWR), meal intake as a good indicator of quality of l ife (QOL), and absorptive kinetics from the small intestine could be expressed by the acetaminophen (AAP) concentration. METHODS: The postoperative/preoperative BWR and meal intake ratio (MIR) were evaluated in 30 patients who underwent open distal gastrectomy for advanced gastric cancer (ODG group) and 15 patients who underwent laparoscopic proximal gastrectomy for early gastric cancer (LPG group). In addition, all patients underwent functional evaluation using the AAP method. Correlation coefficients of the BWR and MIR with the plasma AAP concentration after meal intake were evaluated. RESULTS: There was a negative correlation between the AAP concentration at 15 min and the BWR in all patients (r = -0.438, P = 0.00259, n = 45) and a weak negative correlation between the AAP concentration at 15 min and the MIR (r = -0.309, P = 0.0368, n = 45). CONCLUSIONS: There were some relationships between slow intestinal absorption in the early postprandial phase and the maintenance of postoperative body weight and meal intake. Namely, operative methods that maintained preoperative slow intestinal absorption were thought to be better for maintaining postoperative QOL.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Gástricas/cirurgia , Acetaminofen/sangue , Idoso , Peso Corporal , Ingestão de Alimentos , Feminino , Humanos , Absorção Intestinal/fisiologia , Intestino Delgado/fisiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários
4.
J Thorac Dis ; 11(9): 3776-3784, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31656650

RESUMO

Background: Esophageal cancer is one of the most malignant gastroenterological cancers. To improve the treatment outcomes of patients with esophageal squamous cell carcinoma (ESCC), a biomarker capable of predicting the malignant potential of the cancer cells is needed. The aim of the present study was to investigate the relationship between the expression pattern of insulin-like growth factor II m-RNA-binding protein 3 (IMP3), a promising cancer testis antigen for peptide vaccine therapy, in ESCC tumors and the outcomes of patients with ESCC. Methods: One hundred and seventy patients with ESCC who underwent a radical transthoracic esophagectomy between 2003 and 2005 at Tokai University Hospital were investigated. IMP3 expression was immunohistochemically analyzed using sections from surgically resected tumor specimens and metastatic lymph nodes. Results: Of the 170 patients, 160 patients (94%) exhibited IMP3 positivity in the cytoplasm of their cancer cells (IMP3-positive group), while 10 patients (6%) were IMP3-negative (IMP3-negative group). No significant difference in the overall survival curves were observed between the IMP3-positive and IMP3-negative groups. When the survival analysis was confined to the 160 IMP3-positive patients, however, an invasive front-type IMP3 expression pattern (IF-type) was seen in 46 patients (29%) and a diffuse-type pattern (D-type) was seen in 114 patients (71%). A multivariate analysis also showed that an IF-type was a prognostic factor (HR =1.618, P=0.049). The overall survival curve for patients with an IF-type was significantly worse than that of D-type patients (P=0.001). Conclusions: An IF-type pattern of IMP3 expression might predict a poor outcome in patients with ESCC.

5.
Surg Today ; 49(1): 38-48, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30159780

RESUMO

PURPOSE: Functional outcomes were prospectively compared between two types of reconstruction [double tract (L-DT; n = 15) and jejunal interposition (L-JIP; n = 15)] following laparoscopic half-proximal gastrectomy (LPG), including laparoscopic total gastrectomy (L-TG; n = 30) as a control group, at 1 year after surgery. METHODS: Clinical investigations were performed in each patient, and functional evaluations, involving the swallowing of an alimentary liquid containing acetaminophen (AAP), followed by measurements of the concentrations of AAP and hormones in the sitting (n = 5) and in the supine positions (n = 5), were carried out in each group. RESULTS: The post-/preoperative body weight ratios were significantly higher in the L-DT and L-JIP groups than in the L-TG group. The AAP levels were significantly lower in the LPG group than in the LTG group. The AAP, insulin, and gastrin levels in the L-JIP group were markedly increased in the sitting position compared with the supine position, while those in the L-DT and L-TG groups were stable in both positions. CONCLUSIONS: L-JIP and L-DT are procedures that maintain gradual intestinal absorption and help improve the quality of life. Intestinal absorption and hormonal secretion were relatively unaffected by the posture of the meal intake after L-DT, so L-DT might be the procedure providing the most stable results.


Assuntos
Gastrectomia/métodos , Jejuno/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Acetaminofen/metabolismo , Idoso , Peso Corporal , Feminino , Gastrinas/metabolismo , Humanos , Insulina/metabolismo , Absorção Intestinal , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Postura/fisiologia , Estudos Prospectivos , Qualidade de Vida , Neoplasias Gástricas/metabolismo , Fatores de Tempo
6.
J Shoulder Elbow Surg ; 27(12): 2262-2270, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30446232

RESUMO

BACKGROUND: For treatment of advanced elbow osteochondritis dissecans (OCD), we have used surgical treatment. Although favorable treatment outcomes have been reported for centrally located OCD, treatment outcomes are generally questionable and the choice of surgical method is controversial for laterally located OCD. Our purpose was to evaluate the treatment outcomes based on lesion location. METHODS: The patients were 30 young (mean age, 14 years) male athletes who underwent surgical treatment of elbow OCD and were monitored for more than 1 year. Osteochondral autografts harvested from the knee were transplanted to centralized (13 patients) or lateral localized (9 patients) OCD lesions. For lateral widespread (8 patients) OCD lesions, a detached osteochondral fragment was fixed using small osteochondral plugs. When the remaining cartilage defect was large after fragment fixation, a large-sized osteochondral plug was transplanted to the defect. Treatment outcomes were evaluated by the Japanese Orthopaedic Association score, elbow range of motion (ROM), and radiographic findings. RESULTS: The Japanese Orthopaedic Association score significantly improved in patients with centralized, lateral localized, and lateral widespread types of OCD. ROM significantly improved in patients with centralized and lateral localized, and they returned to playing sports within 6 months. However, patients with lateral widespread OCD exhibited no significant ROM improvement, and returning to sports was difficult for 3 patients because of poor osseous integration of the fixed osteochondral fragment. CONCLUSIONS: Osteochondral autograft transplantation provided favorable outcomes for centralized and lateral localized elbow OCD lesions. However, for lateral widespread OCD lesions, reconstruction of the entire capitellar lesion area may be necessary.


Assuntos
Articulação do Cotovelo/cirurgia , Osteocondrite Dissecante/cirurgia , Adolescente , Autoenxertos , Cartilagem/transplante , Criança , Estudos de Coortes , Fêmur/transplante , Humanos , Masculino , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Volta ao Esporte
7.
Intern Med ; 57(5): 737-740, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29269641

RESUMO

We report a case of eosinophilic granulomatosis with polyangiitis (EGPA; formerly known as Churg-Strauss syndrome) complicated by perforation of the small intestine and necrotizing cholecystitis. A 69-year-old man with a history of bronchial asthma was admitted with mononeuritis multiplex. The laboratory findings included remarkable eosinophilia. He was treated with corticosteroids and his laboratory indices showed improvement; however, his functional deficits remained. His neuropathy gradually improved after the addition of intravenous immunoglobulin (IVIG). He was subsequently treated with oral prednisolone (40 mg/day) as maintenance therapy. Within a month after finishing IVIG, he developed perforation of the small intestine and necrotizing cholecystitis. Intestinal perforation has often been reported as a gastrointestinal complication of EGPA. In contrast, cholecystitis is a rare complication. We report this case because the manifestation of more than one complication is extremely rare. Gastrointestinal symptoms may be a complication of EGPA itself and/or immunosuppressive treatment.


Assuntos
Colecistite/etiologia , Granulomatose com Poliangiite/complicações , Perfuração Intestinal/etiologia , Intestino Delgado , Corticosteroides/uso terapêutico , Idoso , Asma/complicações , Colecistite/patologia , Humanos , Hipestesia/tratamento farmacológico , Hipestesia/etiologia , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/etiologia , Debilidade Muscular/tratamento farmacológico , Debilidade Muscular/etiologia , Necrose , Prednisolona/uso terapêutico
8.
Acute Med Surg ; 4(1): 135-139, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-29123851

RESUMO

Case: We report a lethal case of a mamushi (Gloydius blomhoffii) bite. An 84-year-old woman was bitten by a mamushi snake on her right elbow. She was initially treated at another hospital, however, because the swelling expanded and her renal function worsened, she was transferred to our hospital. Compartment syndrome, thrombocytopenia, respiratory arrest, and elevated creatinine kinase and lactose dehydrogenase levels were seen; renal failure progressed, and ileus and peritonitis due to colon perforation occurred. Outcome: The patient died 35 days after the bite. An autopsy revealed widespread necrosis of the ileum, colon, and liver. Conclusion: This report supplies useful clinical information on the treatment of severe mamushi bite cases, and severe abdominal symptoms, such as ileus and melena, may be a lethal sign.

9.
J Orthop ; 14(4): 544-547, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28878513

RESUMO

Fibroma of tendon sheath in the intra-knee joint is a very rare and benign soft-tissue tumour which has been reported unilaterally in the various aged people. To help distinguish it from other similar kinds of lesions and symptoms including osteoarthritis, we report the oldest case of fibromas arising from the posterior cruciate ligament tendon sheath in the bilateral knee joints within one year of each other confirmed with magnetic resonance imaging (MRI) features, operative findings and histological examination.

10.
Tokai J Exp Clin Med ; 41(4): 227-229, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-27988922

RESUMO

We report a case of amoebic appendicitis without colitis symptoms. Acute appendicitis is commonly encountered by gastroenterologists in their daily practice. The number of cases of amoebiasis increases annually in Japan, and is thought to be associated with an increase in sexually transmitted disease or travel to endemic areas. However, acute amoebic appendicitis is rare and the prognosis is very poor compared to nonamoebic appendicitis. In our case, appendectomy was performed immediately after onset, and the patient was discharged without complications. It is difficult to differentiate between amoebic and nonamoebic appendicitis preoperatively, and the possibility of amoebic appendicitis should be kept in mind.


Assuntos
Apendicectomia , Apendicite/parasitologia , Apendicite/cirurgia , Disenteria Amebiana , Doença Aguda , Apendicite/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Tokai J Exp Clin Med ; 40(4): 161-4, 2015 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-26662667

RESUMO

OBJECTIVES: It is difficult to introduce laparoscopic surgery in institutions with a small number of patients, and surgical training relies heavily on mentors to produce well-trained surgeons. The aim of this study was to determine whether implementation of a hands-on mentorship model could provide safe skill transfer for transabdominal preperitoneal (TAPP) repair. METHODS: A trainee who had no experience with TAPP repair underwent operative tutorials until the mentor judged that the trainee could carry out the operation independently. Ten patients who underwent an elective TAPP repair were prospectively enrolled in this study. RESULTS: No cases had over 5 mL of bleeding, intraoperative/postoperative complications, or recurrence. There were significant differences in operation times between the first 4 cases and the later 5 cases, except for a bilateral inguinal hernia case. CONCLUSION: A prospective, single-arm, single-center, case series showed the feasibility of safe skill transfer for TAPP repair using a hands-on mentorship model.


Assuntos
Competência Clínica , Procedimentos Cirúrgicos do Sistema Digestório/educação , Educação de Pós-Graduação em Medicina/métodos , Herniorrafia/educação , Laparoscopia/educação , Mentores , Modelos Educacionais , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Surg Case Rep ; 1(1): 48, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26366345

RESUMO

We report a rare case of huge amebic intra-abdominal tumor with asymptomatic amebic colitis. This appears to represent the first report of amebic intra-abdominal tumor. A 31-year-old woman presented to a local doctor with only a sensation of abdominal fullness. Abdominal computed tomography (CT) showed a huge intra-abdominal tumor in the left abdominal cavity, and she was referred to our hospital. Colonofiberscopy for detailed examination showed multiple slight, discrete ulcers in the cecum. Ameboid trophozoites were identified from biopsy specimens, and asymptomatic amebic colitis was diagnosed. Oral metronidazole (MTZ) was administered at 1500 mg/day for 10 days. CT 14 days after starting MTZ showed no change in the intra-abdominal tumor, and resection of the tumor was therefore performed. Pathological examination revealed Entamoeba histolytica with engulfed erythrocytes complicated by hemorrhagic cyst. If an intra-abdominal tumor is present and colitis is observed, amebic intra-abdominal tumor should be considered among the differential diagnoses.

13.
Tokai J Exp Clin Med ; 40(3): 90-5, 2015 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-26369261

RESUMO

We report a 75 year old man in whom primary malignant melanoma of the esophagus (PMME) was detected on an upper gastrointestinal radiographic contrast study and upper gastrointestinal endoscopy during a regular medical checkup. An extensive black lesion with a 1.5 x 1.0 cm protrusion and diffuse 1 cm flat lesions were recognized. The results of radical surgery were PMME pT1a-MM ly1 v0 pN0 (0/86) multiple lesions (+). Adjuvant chemotherapy was not employed and he has survived almost 7 years with no evidence of recurrence. PMME is a very rare lesion and in the PubMed database only 85 cases in 73 reports accumulated in a 10 year period from 2005 to 2014. Until 2014 a total of 369 cases were reported. In the ICHUSHI database (a domestic medical literature database service provided by the NPO Japan Medical Abstracts Society), 65 lesions in 62 cases were reported in the same period. Also until 2014, 301 cases were reported. At present, surgery is the first choice of treatment for PMME extending to the submucosa or deeper, but with developments in molecular targeting agents, PMME is thought to likely become an expanded indication of this technique.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Melanoma/cirurgia , Neoplasias Primárias Múltiplas , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos , Bases de Dados Bibliográficas , Descoberta de Drogas/tendências , Endoscopia Gastrointestinal , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Humanos , Japão , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Terapia de Alvo Molecular , Estadiamento de Neoplasias , Sobrevida , Fatores de Tempo , Resultado do Tratamento
14.
Tokai J Exp Clin Med ; 40(3): 96-103, 2015 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-26369262

RESUMO

A 67-year-old man was pointed out mucosal irregularity on health check-up and was referred to our institution. Diagnostic examinations were performed and an aggregated type 0-IIa lesion having 3 small protrusions was recognized in the middle thoracic esophagus. Endoscopic biopsy led to diagnosis of esophageal cancer concomitant with adenocarcinoma and squamous cell carcinoma. Thoracic esophagectomy with 3-fields lymph node dissection was performed via a right thoracoabdominal approach and reconstructed with stomach roll. Three submucosal tumors like small protrusions were recognized in resected specimen. One of them was well differentiated tubular adenocarcinoma which occupied in mucosal layer. The other two were moderately differentiated squamous cell carcinoma. They existed very near but no connection was recognized by serial section. The adenocarcinoma existing in middle esophagus is very rare. Almost all of them were submucosal or advanced cancers. When we searched with the ICHUSHI database (a domestic medical literature database service provided by the NPO Japan Medical Abstracts Society) and the PubMed database, there was no report of mucosal adenocarcinoma occurred in middle thoracic esophagus in the past 10 years. Then this report was thought to be the first report of mucosal adenocarcinoma in middle thoracic esophagus in the world.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Neoplasias Primárias Múltiplas , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Esofagoscopia , Fluoruracila/administração & dosagem , Humanos , Excisão de Linfonodo/métodos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Tokai J Exp Clin Med ; 40(2): 36-9, 2015 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-26150181

RESUMO

We report a rare case of primary small cell type esophageal neuroendocrine carcinoma with a unusual endoscopic form similar to a submucosal tumor with the results of the histological and immunohistochemical analyses. A 57-year-old woman with dysphagia was referred to our hospital for further examination and treatment, and was diagnosed as type 1s esophageal carcinoma in the middle thoracic esophagus. Endoscopy revealed a protruding esophageal carcinoma resembling a submucosal tumor with an irregular and nodular surface covered by non-neoplastic epithelium stained with iodine. Analysis of the esophageal biopsy specimen revealed poorly differentiated squamous cell carcinoma. Based on a diagnosis of type 1s carcinoma in the middle thoracic esophagus that was 5 cm in size longitudinally, a radical esophagectomy with three-field lymph node dissection was performed. The pathological examination with histological and immunohistochemical analysis of the resected specimen revealed a small cell type neuroendocrine carcinoma overlaid by a non-neoplastic epithelium, extending into the adventitia without lymph node metastasis (T3, N0, M0, Stage II). However, multiple metastases in the brain and lung developed 3 months postoperatively, and the patient died of the cancer 7 months after the operation. This was a rare case of a highly malignant primary small cell type esophageal neuroendocrine carcinoma showing extremely rare form.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias Esofágicas/patologia , Neoplasias Encefálicas/secundário , Carcinoma Neuroendócrino/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/secundário , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias
16.
Tokai J Exp Clin Med ; 40(2): 63-8, 2015 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-26150186

RESUMO

Metastatic tumors of the small intestinal tract from extra-abdominal sites are rare. We report herein a rare case of small intestinal metastasis from esophageal carcinoma that presented with perforated peritonitis. A 71-year-old man with dysphagia was referred to our hospital for further examination and treatment, and was diagnosed with type 3 advanced esophageal squamous cell carcinoma of the lower thoracic esophagus. Based on a diagnosis of Stage II cancer, a radical esophagectomy with three-field lymph node dissection was performed after neoadjuvant chemotherapy composed of 5-fluorouracil plus cisplatin. Pathological examination of the resected specimen revealed a moderately differentiated squamous cell carcinoma, extending into the adventitia with lymph node metastasis (T3, N2, M0, Stage III). During postoperative adjuvant chemotherapy, the patient complained of abdominal pain and was found to have perforated peritonitis. Emergency laparotomy was performed. A jejunal perforation with a submucosal nodule approximately 80 cm distal from the ligament of Treitz was detected, and completely resected by jejunal partial resection. Histopathology of the specimen showed a perforation of the small intestine due to metastasis of esophageal squamous cell carcinoma with mesenteric lymph node metastasis. The patient died of cancer 9 months after surgery. An extremely rare case of small intestinal metastasis from esophageal carcinoma presenting with perforated peritonitis was described.


Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Esofágicas/patologia , Neoplasias Intestinais/secundário , Perfuração Intestinal/etiologia , Intestino Delgado/patologia , Peritonite/etiologia , Idoso , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Neoplasias Esofágicas/cirurgia , Esofagectomia , Evolução Fatal , Humanos , Neoplasias Intestinais/patologia , Perfuração Intestinal/patologia , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática , Masculino , Mesentério , Terapia Neoadjuvante , Estadiamento de Neoplasias , Peritonite/patologia
17.
Anal Chim Acta ; 865: 39-52, 2015 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-25732583

RESUMO

The ion mobility behavior of nineteen chemical warfare agents (7 nerve gases, 5 blister agents, 2 lachrymators, 2 blood agents, 3 choking agents) and related compounds including simulants (8 agents) and organic solvents (39) was comparably investigated by the ion mobility spectrometry instrument utilizing weak electric field linear drift tube with corona discharge ionization, ammonia doping, purified inner air drift flow circulation operated at ambient temperature and pressure. Three alkyl methylphosphonofluoridates, tabun, and four organophosphorus simulants gave the intense characteristic positive monomer-derived ion peaks and small dimer-derived ion peaks, and the later ion peaks were increased with the vapor concentrations. VX, RVX and tabun gave both characteristic positive monomer-derived ions and degradation product ions. Nitrogen mustards gave the intense characteristic positive ion peaks, and in addition distinctive negative ion peak appeared from HN3. Mustard gas, lewisite 1, o-chlorobenzylidenemalononitrile and 2-mercaptoethanol gave the characteristic negative ion peaks. Methylphosphonyl difluoride, 2-chloroacetophenone and 1,4-thioxane gave the characteristic ion peaks both in the positive and negative ion mode. 2-Chloroethylethylsulfide and allylisothiocyanate gave weak ion peaks. The marker ion peaks derived from two blood agents and three choking agents were very close to the reactant ion peak in negative ion mode and the respective reduced ion mobility was fluctuated. The reduced ion mobility of the CWA monomer-derived peaks were positively correlated with molecular masses among structurally similar agents such as G-type nerve gases and organophosphorus simulants; V-type nerve gases and nitrogen mustards. The slope values of the calibration plots of the peak heights of the characteristic marker ions versus the vapor concentrations are related to the detection sensitivity, and within chemical warfare agents examined the slope values for sarin, soman, tabun and nitrogen mustards were higher. Some CWA simulants and organic solvents gave the ion peaks eluting at the similar positions of the CWAs, resulting in false positive alarms.


Assuntos
Amônia/química , Substâncias para a Guerra Química/análise , Temperatura , Substâncias para a Guerra Química/química , Espectrometria de Massas , Pressão , Volatilização
18.
Cell Transplant ; 24(10): 1931-43, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25396326

RESUMO

Patients with severe hypophosphatasia (HPP) develop osteogenic impairment with extremely low alkaline phosphatase (ALP) activity, resulting in a fatal course during infancy. Mesenchymal stem cells (MSCs) differentiate into various mesenchymal lineages, including bone and cartilage. The efficacy of allogeneic hematopoietic stem cell transplantation for congenital skeletal and storage disorders is limited, and therefore we focused on MSCs for the treatment of HPP. To determine the effect of MSCs on osteogenesis, we performed multiple infusions of ex vivo expanded allogeneic MSCs for two patients with severe HPP who had undergone bone marrow transplantation (BMT) from asymptomatic relatives harboring the heterozygous mutation. There were improvements in not only bone mineralization but also muscle mass, respiratory function, and mental development, resulting in the patients being alive at the age of 3. After the infusion of MSCs, chimerism analysis of the mesenchymal cell fraction isolated from bone marrow in the patients demonstrated that donor-derived DNA sequences existed. Adverse events of BMT were tolerated, whereas those of MSC infusion did not occur. However, restoration of ALP activity was limited, and normal bony architecture could not be achieved. Our data suggest that multiple MSC infusions, following BMT, were effective and brought about clinical benefits for patients with lethal HPP. Allogeneic MSC-based therapy would be useful for patients with other congenital bone diseases and tissue disorders if the curative strategy to restore clinically normal features, including bony architecture, can be established.


Assuntos
Transplante de Medula Óssea , Hipofosfatasia/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Osteogênese/fisiologia , Transplante de Medula Óssea/métodos , Diferenciação Celular/fisiologia , Células Cultivadas , Humanos , Lactente , Masculino , Transplante de Células-Tronco Mesenquimais/métodos , Transplante Homólogo/métodos , Resultado do Tratamento
19.
Hand Surg ; 19(2): 287-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24875521

RESUMO

Flexor tendon injuries in zone II were treated in 14 fingers of 13 patients with our method. Firstly, a 2-strand core suture was made by the side-locking loop technique using a USP 2-0-sized braided polyblend polyethylene suture, then 7-strand peripheral cross-stitches were added using a USP 5-0-sized monofilament nylon suture. Post-operative exercises included passive flexion and extension without external fixation on the next day of surgery. Average follow-up observation period was 18 months. As results, the Strickland method of assessment for surgical outcome showed excellent in eight digits and good in five digits, though there was a poor outcome in one digit. Our suture method enabled early post-operative mobilisation exercise without using a splint, while preventing adhesion between the repaired tendon and peripheral tissues, which is considered to provide far greater ultimate tensile strength and a smaller gap at the sutured site than by the conventional method.


Assuntos
Polietileno , Suturas , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Adolescente , Adulto , Materiais Biocompatíveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Resistência à Tração , Adulto Jovem
20.
Graefes Arch Clin Exp Ophthalmol ; 251(4): 1109-14, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23283484

RESUMO

BACKGROUND: To investigate the effect of using gelatin-microbial transglutaminase (gelatin-mTG) complex for treating experimental retinal detachment. METHODS: Vitrectomy with artificial posterior vitreous detachment (PVD) followed by induction of a retinal tear and detachment was performed in rabbit eyes. Gelatin-mTG complex or gelatin alone (control) was placed on the retinal tears. Fundus examination using optical coherence tomography (OCT) was performed after the surgery. Vitrectomy with PVD alone was also performed in additional rabbits. After application of the gelatin-mTG complex on the normal retinal surface, the electroretinogram (ERG) was measured 7 days after surgery. RESULTS: Gelatin-mTG complex covered the retinal tear for more than 7 days after the vitrectomy, with less prominent inflammation. Reattachment of the retina occurred in all treated eyes. In contrast, massive fibrin materials were observed at 1 day after the surgery in the control group. In addition, OCT showed that all of the gelatin disappeared by day 3. Local retinal detachment remained in three of the eyes. As demonstrated by the ERG, gelatin-mTG complex had no harmful effects on retinal function. CONCLUSIONS: The results indicate that gelatin-mTG complex continues to adhere and seal retinal tears for at least several days after administration without any inflammatory reaction.


Assuntos
Gelatina/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Perfurações Retinianas/tratamento farmacológico , Adesivos Teciduais , Transglutaminases/uso terapêutico , Animais , Modelos Animais de Doenças , Quimioterapia Combinada , Eletrorretinografia , Tamponamento Interno , Estudos de Viabilidade , Fluorcarbonetos , Coelhos , Retina/fisiologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/fisiopatologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/fisiopatologia , Tomografia de Coerência Óptica , Vitrectomia
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