The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted ...splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.
Vitamin B1 deficiency is well known as a possible complication following gastric restrictive surgery for morbid obesity; however, reduced vitamin B1 levels in patients who have undergone gastrectomy ...for gastric cancer have not been discussed previously.
Serum vitamin B1 levels were determined after the return to normal daily activity in 54 patients with distal gastrectomy for gastric cancer, 32 patients with total gastrectomy for gastric cancer, and 30 patients with radical surgery for colorectal cancer. Changes from serum vitamin B1 levels before operation to those after return to normal daily activity, without nutritional support, were investigated in 25 patients with gastrectomy for gastric cancer and 26 patients with radical surgery for colorectal cancer.
Decreased serum vitamin B1 levels, below the normal range, were recognized in 7 of the 54 distally gastrectomized patients and in 5 of the 32 totally gastrectomized patients, whereas no such decrease was recognized in any patient after colorectal surgery. Decreased serum vitamin B1 level was recognized within 6 months after the operation in 6 of the 7 distally gastrectomized patients showing a decreased vitamin B1 level and in 3 of the 5 totally gastrectomized patients showing a decreased vitamin B1 level. Postoperative serum vitamin B1 levels were significantly lower than those before operation in patients with gastrectomies, whereas there was no significant difference in serum vitamin B1 levels before and after the surgeries in patients with surgery for colorectal cancer.
Vitamin B1 levels may be reduced in gastrectomized patients, especially within 6 months after operation, even after their return to normal daily activity without nutritional support.
Congenital dilatation of the bile duct (CDBD), or choledochalcyst, is often complicated by recurrent pancreatitis. Reflux of pancreatic juice into the bile duct through pancreaticobiliary maljunction ...(PBM), an anomaly commonly associated with CDBD, and ensuing activation of pancreatic enzymes could be involved in the pathophysiologic mechanism of recurrent pancreatitis. A study was undertaken to follow the time course of the activity of phospholipase A2 (PLA2) in animal models of PBM. The assay procedures for PLA2 were evaluated, as were the conditions for separating the active enzyme from its inactive proenzyme (pro-PLA2) by immunoblotting. A rat model was designed according to Block's method with some modifications. The kinetics of prophospholipase A2 (proPLA2) activation in bile was examined by measuring PLA2 activity and by immunoblotting using anti-rat pancreatic enzyme antibody after separating PLA2 from its zymogen under nonreducing conditions. Experimental animals were divided into three groups: group 1 (PBM group) in which bile and pancreatic juice were mixed with occlusion of the papilla; group 2, in which the papilla and hepatic hillus were occluded without mixing the two juices; and group 3, in which simple laparotomy was done. In group 1 animals, pro-PLA2 in bile was activated to its active form. In group 2 animals, where proPLA2 was predominant, there was only slight elevation of PLA2 activity in bile. In group 1 an immunohistologic study demonstrated localization of PLA2 around necrotic foci in the pancreatic parenchyma. These results suggest the involvement of activated PLA2 in the pathogenesis of choledochal cystassociated pancreatitis.
The effectiveness of using an absorbable suture material for continuous closure of abdominal wounds, especially contaminated wounds, has not yet been determined. Thus, the present study was conducted ...to investigate the wound complications that developed following continuous closure of clean and contaminated abdominal wounds using polydioxanone (PDS), compared with those that developed following interrupted closure using braided silk. Running closure using PDS was performed in 152 patients (PDS group), while 280 patients who underwent interrupted closure using braided silk served as controls (SILK group). The occurrence rates of wound dehiscence, early wound infection, and incisional hernia did not differ significantly between the two groups; however, the incidence of late suture sinus formation in the PDS group (1.3%) was significantly lower than that in the SILK group (7.1%). Moreover, late suture sinus formation following PDS suturing healed within 1 week after percutaneous drainage alone without removal of suture strings, whereas late suture sinus following braided silk suturing took an average of 16 days to heal and required removal of the infected suture strings in all 20 patients. These findings indicate the potential usefulness of PDS as a suture material to achieve running closure of clean or contaminated abdominal wounds.
Solitary necrotic nodule of the liver Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung‐Eun ...
Journal of Hepato‐Biliary‐Pancreatic Surgery,
2002, Letnik:
9, Številka:
1
Journal Article
Recenzirano
Solitary necrotic nodule of the liver is a rare benign lesion; only 22 cases have been reported to date. An unsolved problem in treating these lesions involves the difficulties in differential ...diagnosis; specific features of necrotic nodule of the liver in preoperative examinations have not been identified. Here, we report a patient with resected solitary necrotic nodule of the liver with preoperative features shown on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) examinations. A 48‐year‐old woman was referred to our hospital on December 13, 1999 because a hypoechoic lesion in Couinaud's segment VIII of the liver had been incidentally detected on US. A CT scan confirmed the presence of a round hypodense lesion, measuring 2 cm in diameter. No significant enhancement was recognized on dynamic MRI study. T1‐Weighted MRI examinations demonstrated a low intensity showing a triple‐layered pattern with low‐iso‐low intensity in the lesion, while T2‐weighted images demonstrated a slightly high intensity in the lesion. These features suggested fibrous tissue. Histological examinations following partial resection of the liver revealed a solitary necrotic nodule of the liver. Combination studies, including MRI examinations, would be useful for the preoperative diagnosis of a solitary necrotic nodule of the liver.
The purpose of the present study was to determine the recurrence rate of symptoms suggesting acute appen-dicitis following conservative therapy and feasible CT findings for prediction of recurrence ...from follow-up ofconservatively treated cases in which thediagnosis of acute appendicitis was confirmed by CT. Subjects and Methods: Between December 1997 and June 2002, we studied 233 patients diagnosed with acute appendicitisconfirmed by CT. Follow-up of at least 6 months was done in the 62 cases treated conservatively. Results: 1) Recurrent right lower abdominal pain was recognized in 14 (33%) of 43 patients treated conservatively andwhose follow-up was completed; appendectomy was done in 9 (21%) and histological examinations of surgi-cally resected specimens showed acute appendicitis in 8 (19%). 2) No significant difference was seen betweenrecurrent and non recurrent cases in the development of positive fecal stones or elevated CT values aroundthe appendix on CT at initial conservative treatment. Appendix enlargement exceeding 9mm in diameter orascites was recognized in CT at initial conservative therapy more often in recurrent than non recurrent cases. Summary: The recurrence rate of acute appendicitis diagnosed by CT following conservative therapy was19-33%. Caution must therefore be exercised regarding the possible recurrence of acute appendicitis afterconservative therapy in cases with enlarged appendix or ascites on CT at the initiation of conservative ther-apy.
We report a left‐hand‐assisted laparoscopic resection of hepatocellular carcinoma that developed in an accessory liver in a 47‐year‐old man. Preoperative assessment of the location of the tumor and ...the feeder vessels by combined selective angiography and computed tomography studies predicted the feasibility of laparoscopic procedures for complete removal of the tumor. In an attempt to avoid direct contact of the tumor capsule with rigid instruments during the operation, left‐hand‐assisted procedures were attempted. The encapsulated mass, 6 × 5 × 3 cm in size, was located on the posterior side of the left diaphragm, and a thin stalk between the tumor and the margin of the left lateral segment of the liver proper was recognized. Hand‐assisted procedures ensured the complete mobilization of the lesion with an adequate margin, without any unexpected capsular tear. Left‐hand‐assisted laparoscopic procedures would be feasible for the easy and safe resection of localized hepatocellular carcinoma developing in an accessory liver.
A study on light-cured resins SATO, Hikaru; MIYAZAKI, Masashi; SATO, Tomomi ...
Adhesive Dentistry,
2003/12/15, Letnik:
21, Številka:
3
Journal Article
Odprti dostop
The purpose of this study was to evaluate bonding abilities of two one-step bonding systems with the combination of different type of restorative materials. Bovine enamel and dentin surfaces were ...prepared and 5 different products of resin composites and a lightcured glass ionomer cement were bonded with the adhesives. Specimens were stored for 5, 60 min and 24 h in 37°C distilled water and then tested on a shear mode at a cross-head speed of 1.0 mm/min. After 24 h storage in water, no significant differences in bond strength were observed among the restorative materials tested. For the specimens measured at 5 or 60 min, significant differences in bond strength were observed. From the results of this study, it was indicated that the bonding ability of the bonding systems should be evaluated by bond strength obtained in the early stages.
The authors have developed a new longitudinal vibration analysis model of a tape transport system for VCRs containing a tension control mechanism. Using this analysis model, we have achieved an ...effective vibration control method.
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