Clinical evaluation of complete solo surgery with the "ViKY®" robotic laparoscope manipulator.

BACKGROUND: Advancement in both surgical technique and medical equipment has enabled solo surgery. ViKY® Endoscope Positioning System (ViKY®) is a robotic system that remotely controls an endoscope and provides direct vision control to the surgeon. Here, we report our experience with ViKY®-assisted solo surgery. METHODS: We retrospectively examined 25 cases of solo surgery TAPP with ViKY®. ViKY® was setup by the surgeon alone, and the setup duration was determined as the time at which the side rail was positioned and that when the endoscope was installed. For assessing the control unit, the number of false movements was counted. We compared the operative results between ViKY®-assisted solo surgery TAPP and the conventional method with an assistant. RESULTS: The average time to set up ViKY® was 7.9 min. The average number of commands for ViKY® during surgery was 98.3, and the average number of errors and no response of control unit was 7.9. The mean duration of surgery was 136 min for the ViKY® group, including the setup time, and 117 min for the conventional method. No case required an assistant during the operation. There was also no difference between the two groups with regard to postoperative complications and the rate of recurrence. CONCLUSIONS: ViKY® proved reliable in recognizing orders with very few failures, and the operations were performed safely and were comparable to the conventional operations with assistants. Solo surgery with ViKY® was beneficial in this clinical evaluation.

A sewing needle in the liver: a case report and literature review.

Intrahepatic foreign bodies are rarely reported. Although rare, a few reports of swallowed foreign bodies straying into the liver from the gastrointestinal tract have been published. Herein, we report a case in which an asymptomatic intrahepatic needle was removed laparoscopically. An 81-year-old woman presented to our hospital with an abnormal shadow on her abdominal X-ray image. Abdominal computed tomography displayed a needle-like shadow obliquely lying in the lateral segment of the left lobe of the liver. No subjective symptoms were reported; however, the patient underwent laparoscopic extraction. The postoperative course was good, and the patient was discharged without any complications. We also present a literature review of 27 patients with intrahepatic foreign bodies, a sewing needle.

Conventional and Kampo Medicine Treatment for Mild-to-moderate COVID-19: A Multicenter, Retrospective, Observational Study by the Integrative Management in Japan for Epidemic Disease (IMJEDI Study-observation).

Objective Patients in whom coronavirus disease 2019 (COVID-19) was suspected or confirmed between January 1, 2020, and October 31, 2021, were enrolled from Japanese hospitals in this multicenter, retrospective, observational study. Methods Data on the treatment administered (including conventional and Kampo medicine) and changes in common cold-like symptoms (such as fever, cough, sputum, dyspnea, fatigue, and diarrhea) were collected from their medical records. The primary outcome was the number of days without a fever (with a body temperature <37°C). The secondary outcomes were symptomatic relief and the worsening of illness, defined as the presence of a condition requiring oxygen inhalation. The outcomes of patients treated with and without Kampo medicine were compared. Patients We enrolled 962 patients, among whom 528 received conventional and Kampo treatment (Kampo group) and 434 received conventional treatment (non-Kampo group). Results Overall, after adjusting for the staging of COVID-19 and risk factors, there were no significant between-group differences in the symptoms or number of days being afebrile. After performing propensity score matching and restricting the included cases to those with confirmed COVID-19 who did not receive steroid administration and initiated treatment within 4 days from the onset, the risk of illness worsening was significantly lower in the Kampo group than in the non-Kampo group (odds ratio=0.113, 95% confidence interval: 0.014-0.928, p=0.0424). Conclusion Early Kampo treatment may suppress illness worsening risk in COVID-19 cases without steroid use. Further randomized controlled studies are needed to confirm the clinical benefit of Kampo medicine for COVID-19.

Five-year blood pressure trajectories of survivors of the tsunami following the Great East Japan Earthquake in Iwate.

Whether tsunami survivors who suffered substantial damage experienced increases in blood pressure (BP) immediately after the disaster and in the medium to long term is unclear. We divided tsunami survivors into groups, those who relocated (substantial damage) and those who did not (little damage) and compared the BP trajectories between the groups over the first 5 years after the disaster. Of the 42,831 residents, 3914 were assessed from 2010 to 2015. Subgroup analysis was performed among the 2037 subjects with no information on antihypertensive medications between 2010 and 2015 (no antihypertensive medication group). The BP trajectories in the relocation and no relocation groups were compared using linear mixed models. The multivariate-adjusted mean systolic BP (SBP) values for all subjects significantly decreased after the disaster in both the group who relocated (2010: 130.6 mmHg, 2015: 124.8 mmHg) and the group who did not relocate (2010: 130.7 mmHg, 2015: 126.7 mmHg). The interaction between relocation and time points on SBP was significant (P = 0.017). In the no antihypertensive medication group, the SBP values in the subgroup who relocated were significantly lower in the second, third, and fifth years after the disaster than those in the subgroup who did not relocate. It was concluded that the SBP values of survivors of the tsunami caused by Great East Japan Earthquake decreased in the medium to long term after the disaster, and the group who relocated had a larger decrease in SBP than the group who did not relocate.

Laparoscopic excision of retroperitoneal tumors: report of three cases.

Retroperitoneal neural tumors are rarely excised laparoscopically, with fewer than ten cases reported in the literature. Between February 2005 and December 2007, we performed successful planned laparoscopic excision of retroperitoneal tumors using the four-trocar technique in three patients. All three patients were women, with a mean age of 40.7 years. The mean tumor size was 4.8 cm. The mean operative time was 126 min and the mean blood loss 14.3 ml. The postoperative pathological diagnosis was schwannoma in one patient and ganglioneuromas in two. There was no morbidity or mortality. Although difficult to diagnose preoperatively, neural tumors in the retroperitoneal space are most often benign, with a good prognosis. Laparoscopic surgical techniques for retroperitoneal tumors are safe, and their use is encouraged when an appropriate diagnosis is made, after exclusion of malignant subtypes.

[Local recurrence after surgical resection of pancreatic cancer effectively treated with combined chemoradiotherapy].

We report a patient for whom systemic chemotherapy using gemcitabine was effective against local recurrence of pancreatic cancer. A 59-year-old man underwent pancreatoduodenectomy for pancreatic head cancer. The diagnosis was moderately-differentiated tubular adenocarcinoma(tubular type, pT2, pN0, fM0, fStage II ). Ten months after surgery, the patient had a CT examination which revealed a mass at the cut-end of the pancreas. The serum CA19-9 level was found to be elevated 790(U/mL). Chemotherapy with GEM(1,000 mg/m2)was administered intravenously on days 1, 8, and 15. Courses were repeated every 28 days. The patient received 8 courses of chemotherapy by GEM, and the regimen was changed to every two weeks because of the adverse event, leucopenia(grade 2)and thrombocytopenia( grade 2). Twenty-one months after chemotherapy, CT examination revealed regrowth at the same location at the cut-end of the pancreas, and so radiotherapy was performed at a total 63 Gy. The serum CA19-9 level dropped to within the normal range. The patient had been receiving systemic chemotherapy as an outpatient for 48 months without deterioration of quality of life. Unfortunately, the patient died of bacteriogenous meningitis 56 months after recurrence. Our experience suggests that this chemotherapy is simple and possible to continue safely on an ambulatory basis while maintaining quality of life.

The serum concentration of soluble interleukin-2 receptor in patients with Kawasaki disease.

Kawasaki disease is a febrile disease of childhood that is associated with increased inflammatory cytokines and immunoregulatory abnormalities. While the serum concentrations of soluble IL-2 receptor can change under such pathologies, the relevance of the soluble IL-2 receptor concentration in patients with Kawasaki disease has not been specified. We aimed to summarize the existing studies that reported the soluble IL-2 receptor concentrations in patients with Kawasaki disease. Original articles that were published up to July 2016 were collected using a PubMed/Medline-based search engine. A total of nine articles that reported the serum soluble IL-2 receptor concentrations in acute-phase Kawasaki disease were eligible. All of the articles described a high soluble IL-2 receptor concentration in patients with Kawasaki disease relative to the level of controls or the reference range. Two of five articles on patients with coronary artery aneurysms described a significantly higher soluble IL-2 receptor concentration in patients with coronary artery aneurysms than patients without. Two articles on patients with intravenous immunoglobulin therapy described a significant decrease of the soluble IL-2 receptor concentration after the therapy. Accordingly, the serum soluble IL-2 receptor can be a potent marker of disease activity and therapeutic effects in patients with Kawasaki disease; further studies are thus warranted for its use in the clinical setting.

[Serum anti-lPS antibody production in an outbreak of enterohemorrhagic Escherichia coli O157 infection among schoolchildren].

Although there have been many reports of the usefulness of serodiagnosis of enterohemorrhagic Escherichia coli (EHEC) O157, the serotype of the bacteria detected and the increase in anti-LPS antibody have not always been consistent. In this study we investigated the diagnostic significance of measurements of anti-LPS antibody by ELISA in an outbreak of O157 infection among schoolchildren in whom the bacteriological test findings were clarified and the age groups were uniform. The anti-LPS antibody titer was measured in 31 patients (77 serum samples) in an outbreak of EHEC O157 : H7 infection (220 children infected) that occurred in a primary school in Morioka in 1996. The anti-O157 LPS antibody positivity rates of IgM, IgG, and IgA were 98.7%, 85.7%, and 98.7%, respectively. Between the time the meal that caused the outbreak and 19 days later, anti-O157 LPS IgM antibody and IgA antibody were detected in all patients. The specificity was investigated using control serum, and the specificity of IgM, IgG, and IgA was 93.5%, 93.5%, and 97.2%, respectively. Some samples contained antibodies against O111 and O26 LPS, but the titers were lower than the anti-O157 antibody titer. The anti-O111 antibody titer and anti-O26 antibody titer were highly correlated, suggesting that they were crossreactive antibodies for O157 LPS. No significant correlation was found between differences in clinical manifestations and the anti-O157 LPS antibody titer in this O157 outbreak in schoolchildren. It was clarified that an increase in anti-LPS antibody was found to support the diagnosis of mild cases of 0157 infection infection as well as severe cases.

[Assessment of dihydropyrimidine dehydrogenase and thymidylate synthase expression in gastric carcinoma and colonic carcinoma].

We measured DPD activity and TS content in cancer and normal mucosa obtained from 23 patients with colorectal carcinoma and 7 patients with gastric carcinoma. DPD activity in colorectal carcinoma cases was significantly decreased in cancer tissues compared to those in adjacent normal mucosa (p<0.001), while TS content was significantly increased in cancer tissues (p<0.01). No significant correlation was found between cancer and adjacent normal mucosa in DPD activity and TS content of gastric carcinoma cases. Immunohistochemically, DPD and TS overexpression were found in 11 out of 23 patients (47.8%) and 3 out of 23 patients (13%) in colorectal carcinoma cases, respectively. In gastric carcinoma cases, DPD and TS overexpression were found in 3 out of 7 patients (42.9%) and 3 out of 7 patients (42.9%), respectively. No significant correlation was found between quantitative measurement and immunohistochemical overexpression in colorectal and gastric carcinoma cases. DPD and TS protein were partially overexpressed in some cases. Heterogeneity of the tumor is thought to be one of the reasons for the discrepancy between quantitative measurement and immunohistochemical overexpression.

Serous cystadenocarcinoma of the mesentery in a man: case report and review of literature.

In February 2007, a 41-year-old Japanese male was admitted to our hospital with increasing upper abdominal pain. A contrast-enhanced computed tomography (CT) scan of the abdomen demonstrated a well-demarcated, hypodense cystic mass with a thickened wall in the mesocolon. The laboratory results were within normal limits, except for increased carcinoembryonic antigen, carbohydrate antigen 19-9, DUPAN-2 and SPAN-1. The patient was diagnosed as having a mesenteric malignant cyst, and during a laparotomy, a right hemicolectomy with mesenteric cystectomy was performed without rupture in March 2007. In the microscopic findings, there was a well-differentiated adenocarcinoma in the inner surface of the cyst and in the fibrous connective tissue of the hypertrophic cystic wall. The tumor cells were immunohistochemically reactive to cytokeratin (CK) 7, CK18 and CK20. No remnant of the malignancy was detected in the resected margin of the colon, cyst, liver or peritoneum nor was an uptake detected in an 18[F]-fluorodeoxyglucose positron emission tomography/CT examination of other organs. Finally, the malignancy was concluded to be a serous cystadenocarcinoma of the mesentery. Nineteen months after the operation, the patient died from peritonitis carcinomatosa due to a small intestine rupture. This report suggests mesenteric cystadenocarcinomas originating in the ovary, oviduct and intestinal mucosa, but these were ruled out in our patient. In this report, we discuss a case of the malignant transformation of a cyst into adenocarcinoma, which to our knowledge has never been previously reported in a male patient.

Homologous and heterologous antibody responses to lipopolysaccharide after enterohemorrhagic Escherichia coli infection.

To evaluate antibody responses against lipopolysaccharide (LPS: O157, O26, and O111) in enterohemorrhagic Escherichia coli(EHEC) infection, sera of 24 schoolchildren associated with the Morioka outbreak in 1997 and of 74 sporadic patients suspected of having EHEC infection were examined. Using a positive standard serum, quantitative evaluation of LPS antibodies by an enzyme-linked immunosorbent assay (ELISA) was established. High levels of specific IgM and IgA antibodies against homologous E. coli LPS were present in the acute period and are characteristic of EHEC. This could be used for the serological diagnosis of EHEC infection, except for early infants and the elderly. In addition to the specific homologous response, multiple antibody responses against different serotypes other than those isolated were demonstrated in many cases by qualitative analysis using Western blotting.