144 results on '"Hiroyuki, Egi"'
Search Results
102. A CASE OF RENOVASCULAR HYPERTENSION AND RENAL DYSFUNCTION SECONDARY TO AORTITIS SYNDROME TREATED WITH AUTORENAL TRANSPLANTATION
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Tetsuo Ishikawa, Kazuhiro Kume, Kazuo Sumimoto, Toshimitsu Matsuzaka, Kenzo Wakasugi, and Hiroyuki Egi
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Bilateral renal artery stenosis ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Renal function ,urologic and male genital diseases ,Aortitis syndrome ,medicine.disease ,Plasma renin activity ,Nephrectomy ,Renovascular hypertension ,Transplantation ,Blood pressure ,Internal medicine ,medicine ,Cardiology ,business - Abstract
This case report describes renovascular hypertension and renal dysfunction secondary to aortitis syndrome treated with rt. autorenal transplantation and lt. nephrectomy. A 43-year-old female with aortitis syndrome was found to have renovascular hypertension and renal dysfunction due to bilateral renal artery stenosis. We performed rt. autorenal transplantation and lt. nephrectomy to conrol blood pressure and maintain renal function. Post operatively, the hypertension did not resolve completely. However, plasma renin activiyt decreased to normal range and renal function was salvaged. We discuss “autorenal transplantation” herein.
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- 1997
103. A case of paraneoplastic syndrome mimicking adult Still's disease caused by rectal cancer
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Mayumi Okamoto, Hiroyuki Egi, Keishi Kanno, Hideki Ohdan, and Susumu Tazuma
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Multimodal imaging ,Aged, 80 and over ,Pathology ,medicine.medical_specialty ,Adult Still's disease ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Paraneoplastic Syndromes ,Rectal Neoplasms ,Colonoscopy ,medicine.disease ,Multimodal Imaging ,Diagnosis, Differential ,Tomography x ray computed ,Positron-Emission Tomography ,medicine ,Humans ,Female ,Geriatrics and Gerontology ,Differential diagnosis ,business ,Tomography, X-Ray Computed ,Still's Disease, Adult-Onset - Published
- 2013
104. Improvement of tactile sensitivity by stochastic resonance effect - Applications to surgical grasping forceps
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Hiroyuki Egi, Yamato Sueda, Minoru Hattori, Jun Ueda, Yuichi Kurita, Hideki Ohdan, Toshio Tsuji, and Hiroyuki Sawada
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Male ,Neurons ,Stochastic Processes ,Engineering ,Hand Strength ,business.industry ,Acoustics ,Sensory system ,Stochastic resonance (sensory neurobiology) ,Tactile perception ,Hand ,Surgical Instruments ,Vibration ,Signal ,Young Adult ,Noise ,Touch Perception ,Touch ,Humans ,business ,Actuator ,Tactile sensor ,Simulation - Abstract
This paper reports experimental results on a surgical grasping forceps with a vibration actuator that enhances a tactile perception ability. A short-time exposure of tactile receptors to sub-sensory white-noise vibration is known to improve perception ability. This phenomenon, called stochastic resonance (SR) in the somatosensory system, is expected to enhance the sense of touch when the weak vibration is applied to a fingertip, and thereby improve associated motor skills. A lead zirconate titanate (PZT) actuator was attached on the grip of surgical grasping forceps. A passive sensory test has been conducted for healthy subjects to confirm the efficacy of the device. Statistical significance has been observed when appropriate noise is applied. To investigate the effect of the noise intensity, a summing network of FitzHugh-Nagumo model neurons was built. The simulation results showed that a network with relatively large units can improve the detection capability of the input signal.
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- 2013
105. Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome
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Hiroyuki Egi, Hideki Ohdan, Takao Hinoi, and Tomohiro Adachi
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Oncology ,medicine.medical_specialty ,Colorectal cancer ,Inguinal lymph nodes ,Inguinal Canal ,Kaplan-Meier Estimate ,Adenocarcinoma ,Group A ,Group B ,Metastasis ,Internal medicine ,medicine ,Rectal Adenocarcinoma ,Humans ,Lymph node ,business.industry ,Rectal Neoplasms ,Gastroenterology ,Hepatology ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Lymphatic Metastasis ,Lymph Node Excision ,Lymph Nodes ,business - Abstract
No consensus has been formed on the optimal treatment strategy for the prognosis of patients with inguinal lymph node (ILN) metastasis from lower rectal adenocarcinoma. We, therefore, retrospectively analyzed outcomes of patients with ILN metastasis from lower rectal adenocarcinoma. Of 323 patients with lower rectal adenocarcinoma treated at a single institution between November 1993 and March 2010, 10 had synchronous or metachronous ILN metastasis, as confirmed by curative resection (R0) of the primary lesion. Outcomes of these 10 patients were assessed. The 10 patients with ILN metastasis were divided into two groups: group A (two patients who did not undergo ILN resection surgery because of metastases at other sites) and group B (eight patients with no other metastases who underwent surgery). Both patients in group A, with median overall survival of 5.2 months, died due to the other metastases, whereas five out of eight patients in group B survived (P = 0.001). Group B patients were further subclassified into synchronous (group B1) and metachronous (group B2) metastasis (n = 4 each) groups. Two patients in group B1 died of other metastases, which was diagnosed later, whereas three patients in group B2 survived. Some patients with isolated inguinal lymph node metastasis show a good prognosis after lymph node excision and, therefore, should be treated surgically. Patients with metachronous metastases have a better prognosis than patients with synchronous ILN metastases. Nevertheless, assessment of additional patients for prognosis and treatment strategy is warranted.
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- 2013
106. Improving performance under mirror-image conditions during laparoscopic surgery using the Broadview camera system
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Masakazu, Tokunaga, Hiroyuki, Egi, Minoru, Hattori, Takahisa, Suzuki, Tomohiro, Kawahara, and Hideki, Ohdan
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Task Performance and Analysis ,Photography ,Video Recording ,Humans ,Laparoscopy ,Clinical Competence ,Learning Curve - Abstract
Under mirror-image conditions, surgeons often become confused and their task performance may deteriorate. This study aimed to quantitatively investigate the difficulty of performing laparoscopic surgery based on a mirror image and to find methods to improve performance under these conditions.Twelve medical students with no prior endoscopic surgical experience and 10 surgical residents, each with over 50 laparoscopic surgery experiences, participated in this study. Three measures were assessed using the Hiroshima University Endoscopic Surgical Assessment Device: the deviation with integrated time, the approaching time, and the peak velocity. The scope was placed at 0° (coaxial position), 180° (mirror-image condition), and 180° using the Broadview camera system. Each participant performed the Hiroshima University Endoscopic Surgical Assessment Device task 10 times.The deviation with integrated time, the approaching time, and the peak velocity were better for surgical residents than for novices at 0° (P 0.001, P = 0.001, P = 0.011). The deviation with integrated time, the approaching time, and the peak velocity at 180° were significantly worse than the corresponding values at 0° (P 0.0001) for both surgical residents and novices. All three types of Hiroshima University Endoscopic Surgical Assessment Device assessment at 180° were significantly better when the Broadview camera system was used than when it was not (P 0.0001).This study showed quantitatively the difficulty in manipulating laparoscopic instruments in mirror-image conditions. Using the Broadview camera system improved surgeons' performance under mirror-image conditions during laparoscopic surgery.
- Published
- 2013
107. Improvement of Tactile Sensitivity by Stochastic Resonance: Application to Vibrating Forceps
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Hideki Ohdan, Masakazu Tokunaga, Hiroshi Takemura, Yuichi Kurita, Toshio Tsuji, Jun Ueda, Hiroyuki Egi, Yamato Sueda, and Minoru Hattori
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Engineering ,InformationSystems_INFORMATIONINTERFACESANDPRESENTATION(e.g.,HCI) ,business.industry ,Acoustics ,Forceps ,Tactile sensation ,Stochastic resonance (sensory neurobiology) ,GeneralLiterature_MISCELLANEOUS ,Vibration ,InformationSystems_MODELSANDPRINCIPLES ,Control theory ,Invasive surgery ,Sensitivity (control systems) ,Actuator ,business - Abstract
The tactile information is crucial in the execution of precise and dexterous manipulations. The improvement of the tactile sensitivity is expected to assist tasks that require high-precision manual dexterity. In this paper, the improvement in tactile sensitivity based on stochastic resonance effect was demonstrated. A vibration actuator was attached on forceps for a minimally invasive surgery, and the improvement in tactile sensation when using the forceps was tested. The experimental results confirmed that appropriate vibration enhances the tactile sensitivity even when the vibration was transmitted via the forceps.
- Published
- 2012
108. Overexpression of hypoxia inducible factor-1 alpha is an independent risk factor for recurrence after curative resection of colorectal liver metastases
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Hirotaka Tashiro, Hiroyuki Egi, Shintaro Kuroda, Takao Hinoi, Hideki Ohdan, Tomohiro Adachi, Tatsunari Sasada, Masazumi Okajima, Takashi Nishizaka, Yasuo Kawaguchi, Manabu Shimomura, and Yuji Takakura
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Liver tumor ,Colorectal cancer ,medicine.disease_cause ,Metastasis ,chemistry.chemical_compound ,Young Adult ,Surgical oncology ,Internal medicine ,medicine ,Biomarkers, Tumor ,Hepatectomy ,Humans ,Neoplasm Invasiveness ,Survival rate ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Hypoxia-Inducible Factor 1, alpha Subunit ,Prognosis ,Primary tumor ,Vascular endothelial growth factor ,Survival Rate ,chemistry ,Mutation ,Surgery ,Female ,KRAS ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms ,Follow-Up Studies - Abstract
Hypoxia inducible factor-1α (HIF-1α) is a major regulator of tumorigenesis in hypoxic conditions and therefore represents a potential therapeutic target in colorectal cancer (CRC). Clinical significance of HIF-1α expression in liver metastases has not been elucidated. Therefore, this study aimed to clarify the clinical significance of HIF-1α expression in colorectal liver metastasis (CRLM). We retrospectively analyzed 64 patients who underwent curative resection of CRLM from 2000 to 2008. We evaluated HIF-1α expression by immunohistochemical staining and analyzed its association with several clinicopathological characteristics, including vascular endothelial growth factor (VEGF) expression. We analyzed the mutation status of genes involved in CRC (p53, KRAS, BRAF, and PIK3CA). Finally, we compared HIF-1α expression between the primary tumor and the corresponding liver metastases. We found a significant positive correlation between HIF-1α expression in liver metastases and PIK3CA mutation status (p = 0.019). A significant correlation was also observed between the expressions of HIF-1α and VEGF in liver metastases and primary tumors (p = 0.015, 0.024, respectively). High HIF-1α expression in liver metastases was an independent risk factor for recurrence (p = 0.031). Our results suggest a possible induction of HIF-1α expression by mutant PIK3CA. The expressions of HIF-1α and VEGF in liver metastases significantly correlated with those in the corresponding primary tumor. Overexpression of HIF-1α was an independent risk factor for recurrence after curative resection of CRLM, suggesting that HIF-1α represents an important candidate for the treatment of CRLM in a subset of patients with high HIF-1α expression.
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- 2012
109. Skill assessment based on automatic classification of forceps manipulations
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Yuya Hayama, Yuichi Kurita, Tsukasa Ogasawara, Tomohiro Kawahara, Hiroyuki Egi, Masazumi Okajima, and Hideki Ohdan
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Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,education ,Forceps ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,behavioral disciplines and activities ,Simulation training ,Atmospheric measurements ,Invasive surgery ,medicine ,Medical physics ,business ,Residency training ,Simulation ,ComputingMethodologies_COMPUTERGRAPHICS ,Haptic technology - Abstract
Haptic information is crucial in the execution of precise and dexterous manipulations. During minimally invasive surgery, medical doctors are required to indirectly sense force-related information from body organ tissue via forceps because they cannot directly touch the tissue. The evaluation of force-based skill is critical in the judgment of whether a person has adequate manipulation skills to conduct surgery procedures. Currently, simulation training in minimally invasive surgery is a required component of general surgery residency training. This paper addresses the challenge of skill evaluation during laparoscopic surgery by measuring the force applied to forceps.
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- 2012
110. The integrated deviation in the HUESAD (Hiroshima University Endoscopic Surgical Assessment Device) represents the surgeon's visual-spatial ability
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Masakazu Tokunaga, Tomohiro Kawahara, Takahisa Suzuki, Minoru Hattori, Hideki Ohdan, and Hiroyuki Egi
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Peak velocity ,business.industry ,Medicine ,Optometry ,Visual spatial ability ,business ,Simulation - Abstract
This institution developed the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). HUESAD is a reliable system for objectively assessing a surgeon's skill on the basis of the direction and movement of laparoscopic long instruments. Previous studies calculated the integrated deviation, the peak velocity and the approach time from the HUESAD. However, what these three dexterity parameters (the integrated deviation, the peak velocity, the approaching time) in the HUESAD represent concerning the surgeons' ability remain unclear. The purpose of this study was to determine whether the three dexterity parameters in the HUESAD are associated with the surgeon's visual-spatial ability.
- Published
- 2012
111. Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery
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Manabu Shimomura, Tatsunari Sasada, Masazumi Okajima, Takao Hinoi, Tomohiro Adachi, Masakazu Tokunaga, Hideki Ohdan, Hiroyuki Egi, Satoshi Ikeda, Kazuaki Tanabe, and Yasuo Kawaguchi
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Laparoscopic surgery ,Male ,Pathology ,medicine.medical_specialty ,Transcription, Genetic ,medicine.medical_treatment ,Cautery ,Tissue Adhesions ,Andrology ,chemistry.chemical_compound ,Pneumoperitoneum ,Gastrectomy ,Laparotomy ,Fibrinolysis ,Plasminogen Activator Inhibitor 1 ,medicine ,Animals ,Humans ,Prospective Studies ,RNA, Messenger ,Cecum ,Aged ,business.industry ,digestive, oral, and skin physiology ,Middle Aged ,medicine.disease ,Rats, Inbred F344 ,Rats ,chemistry ,Plasminogen activator inhibitor-1 ,Tissue Plasminogen Activator ,Cauterization ,Surgery ,Female ,Laparoscopy ,Peritoneum ,business ,Plasminogen activator ,Pneumoperitoneum, Artificial ,Mesothelial Cell - Abstract
Background Postoperative adhesion formation is regulated by peritoneal fibrinolysis, which is determined by tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). This study compared peritoneal fibrinolysis and adhesion formation after laparoscopic surgery (LAP) and open surgery (OP). Methods We divided 154 male rats into 3 groups after cecal cauterization: Control, no treatment; LAP, CO 2 pneumoperitoneum at 5 mmHg for 60 minutes; and OP, laparotomy for 60 minutes. Adhesions were quantified at day 7. The activity and mRNA level of tPA and PAI-1 were determined by enzyme-linked immunosorbent assay in plasma and peritoneal lavage and by real-time polymerase chain reaction in peritoneal mesothelial cells from omentum. We also examined peritoneal fibrinolysis in human gastric cancer patients treated with LAP ( n = 14) or OP ( n = 10). Results In the animal study, adhesion scores, PAI-1 activity in peritoneal lavage fluid, and PAI-1 mRNA levels in peritoneal mesothelium were significantly greater in the OP group than the control and LAP groups. In the human study, postoperative PAI-1 mRNA levels were significantly greater in the OP group than the LAP group. Additionally, PAI-1 mRNA levels and subsequent adhesion formation were induced by prolonged operative time in the OP group, but not the LAP group. Conclusion Preservation of peritoneal fibrinolysis owing to decreased PAI-1 expression at the transcriptional level in peritoneal mesothelial cells is associated with suppression of postoperative adhesion formation in LAP. PAI-1 mRNA levels and subsequent adhesion formation were not induced by prolonged operative time in LAP. These results highlight the less invasiveness nature of LAP.
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- 2012
112. Identification of patients likely to benefit from metastasectomy in stage IV colorectal cancer
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Manabu Shimomura, Masazumi Okajima, Tomohiro Adachi, Yuji Takakura, Masakazu Tokunaga, Takao Hinoi, Yasuo Kawaguchi, Hirotaka Tashiro, Hideki Ohdan, and Hiroyuki Egi
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Disease ,Young Adult ,Carcinoembryonic antigen ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Young adult ,Survival analysis ,Aged ,Neoplasm Staging ,Aged, 80 and over ,biology ,business.industry ,Gastroenterology ,Metastasectomy ,Hepatology ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Multivariate Analysis ,biology.protein ,T-stage ,Female ,business ,Colorectal Neoplasms - Abstract
The aim of the present study was to determine selection criteria for patients with stage IV colorectal cancer (CRC) who were likely to show survival benefits of metastasectomy. Clinicopathological data of 119 patients with stage IV CRC who underwent primary CRC resection were retrospectively reviewed. The prognostic factors were analyzed according to the disease resectability status, and patients likely to show survival benefits of metastasectomy were identified. Metastasectomy was performed in 63 patients. Among these patients, R0 resection was reported in 55 patients, who comprised the curable group. The other 64 patients comprised the noncurable group. For the noncurable group, postoperative chemotherapy was identified as the only significant prognostic factor. In the curable group, T stage, histological type, elevated serum carcinoembryonic antigen (CEA) level and the presence of extra hepatic disease were identified as independent prognostic factors. Patients within the curable group were further classified into a low-risk group (zero to two prognostic factors) and a high-risk group (three or more prognostic factors). The overall survival (OS) of the high risk patients in the curable group was as poor as that of the patients in the noncurable group. Stage IV CRC patients consisted of heterogeneous populations who had different prognostic factors, stratified by the disease resectability status. No prognostic benefit of metastasectomy was observed in high-risk patients undergoing curative metastasectomy. These results suggested that patients showing survival benefits of metastasectomy can be identified by considering the prognostic factors in patients undergoing curative metastasectomy.
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- 2012
113. Approaching time is important for assessment of endoscopic surgical skills
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Tomohiro Kawahara, Masakazu Tokunaga, Daisuke Sumitani, Hiroyuki Egi, Hideki Ohdan, Masanori Yoshimitsu, Minoru Hattori, and Masazumi Okajima
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medicine.medical_specialty ,Analysis of Variance ,Time Factors ,business.industry ,General surgery ,Endovascular Procedures ,Skill level ,Endoscopic surgery ,Expert group ,Statistics, Nonparametric ,Short distance ,Surgery ,User-Computer Interface ,Japan ,Task Performance and Analysis ,Surgical skills ,Medicine ,Humans ,Learning ,Computer Simulation ,Clinical Competence ,Educational Measurement ,business ,Psychomotor Performance - Abstract
This study aimed to verify whether the approaching time (the time taken to reach the target point from another point, a short distance apart, during point-to-point movement in endoscopic surgery), assessed using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), could distinguish the skill level of surgeons. Expert surgeons (who had performed more than 50 endoscopic surgeries) and novice surgeons (who had no experience in performing endoscopic surgery) were tested using the HUESAD. The approaching time, total time, and intermediate time (total time--approaching time) were measured and analyzed using the trajectory of the tip of the instrument. The approaching time and total time were significantly shorter in the expert group than in the novice group (p0.0001). The intermediate time did not significantly differ between the groups (p0.05). The approaching time, which is a component of the total time, is very mportant in the measurement of the total time to assess endoscopic surgical skills. Further, the approaching time was useful for skill assessment by the HUESAD for evaluating the skill of surgeons performing endoscopic surgery.
- Published
- 2011
114. Adequate lymph node examination is essential to ensure the prognostic value of the lymph node ratio in patients with stage III colorectal cancer
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Masakazu Tokunaga, Manabu Shimomura, Masazumi Okajima, Satoshi Ikeda, Hiroyuki Egi, Takao Hinoi, Yuji Takakura, Hideki Ohdan, and Yasuo Kawaguchi
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Adenocarcinoma ,Metastasis ,Cohort Studies ,Surgical oncology ,Recurrence ,Internal medicine ,medicine ,Humans ,Lymph node ,Survival analysis ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Proportional hazards model ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,medicine.anatomical_structure ,ROC Curve ,Lymphatic Metastasis ,Multivariate Analysis ,Lymph Node Excision ,Surgery ,Female ,Lymph ,Lymph Nodes ,business ,Colorectal Neoplasms - Abstract
This study aimed to assess the prognostic value of the lymph node ratio (LNR), estimated by dividing the number of positive lymph nodes (LNs) by the number of LNs examined, for stage III colorectal cancer in comparison to the new tumor, nodes, and metastasis (TNM) system, and to evaluate the relationship between the number of LNs examined and the prognostic value of the LNR. We retrospectively reviewed the clinicopathological data of a cohort of 266 patients with stage III colorectal cancer. We assessed the impact of LNR on the prediction of cancer recurrence in comparison to the TNM system, as well as the prognostic value of LNR in patients with a low LN count. In multivariate analysis, the LNR was found to be an independent risk factor of cancer recurrence. The application of the LNR, in addition to the new TNM system, was more predictive of survival than the TNM system alone. A prognostic separation by LNR was observed in patients who had an adequate number of LNs examined, but not in patients with a low LN count. A stronger prognostic separation can be obtained by using the LNR together with the new TNM system. Adequate lymph node examination is important to ensure the prognostic value of LNR in patients with stage III colorectal cancer.
- Published
- 2010
115. The importance of stressing the use of laparoscopic instruments in the initial training for laparoscopic surgery using box trainers: a randomized control study
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Hiroyuki Egi, Masakazu Tokunaga, Masanori Yoshimitsu, Masazumi Okajima, Daisuke Sumitani, Hideki Ohdan, Minoru Hattori, and Tomohiro Kawahara
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Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,education ,Box trainer ,Training methods ,Surgery ,Task (project management) ,law.invention ,Initial training ,Randomized controlled trial ,law ,Improvement rate ,medicine ,Physical therapy ,Direct vision ,Humans ,Laparoscopy ,Clinical Competence ,business - Abstract
Background The goal of this study was to improve the efficiency of initial box training for laparoscopic surgery. Materials and Methods The study used the following task: suturing and knot tying task under a combination of four conditions. (1) The C (use of conventional instruments)-D (direct vision); (2) the C-V (indirect vision via a video monitor); (3) the L (use of laparoscopic instruments)-D; and (4) the L-V (the standard laparoscopic suturing and knot tying). The first study assessed 11 medical students undergoing L-V training. The time to complete each of the four assessment tasks was recorded pre- and post-training. The second study was a randomized, controlled trial involving 36 students grouped according to three types of training methods: the L-D, the C-V, and the L-V group. The improvement in the time to complete the L-V task was assessed and the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD) was used for assessment as well. Results In the first study, a significant improvement in the performance time between pre- and post-training for the L-D task was found, but not for the C-V task. The second study found that the improvement rate of the L-D trained group was significantly greater than that of the C-V and L-V groups. The HUESAD assessment also showed the similar results. Conclusions A training program stressing the use of laparoscopic instruments and compensating for the fulcrum effect is more effective for novices using box trainers in the initial laparoscopic surgery instruction than one emphasizing performing the tasks via a video monitor.
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- 2010
116. Scientific assessment of endoscopic surgical skills
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Masakazu Tokunaga, Daisuke Sumitani, Hiroyuki Egi, Haruka Takeda, Masazumi Okajima, Masanori Yoshimitsu, Toshiyuki Itamoto, Hideki Ohdan, and Tomohiro Kawahara
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Laparoscopic surgery ,medicine.medical_specialty ,Students, Medical ,business.industry ,medicine.medical_treatment ,Endoscopic surgery ,Endoscopy ,Expert group ,Task (project management) ,Surgery ,Physical medicine and rehabilitation ,Japan ,Peak velocity ,Assessment methods ,medicine ,Surgical skills ,Humans ,Computer Simulation ,Laparoscopy ,Clinical Competence ,Educational Measurement ,business ,Psychomotor Performance - Abstract
Recently, significant attention has been focused on training and education for safe endoscopic surgery. A new assessment method, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), has been designed at Hiroshima University to evaluate the smoothness of the movement of endoscopic instruments from velocity. Experts (with experience in performing more than 100 laparoscopic surgeries) and novices (with no experience in performing laparoscopic surgery) were recruited for this study. The aim of task 1 was to move the tip of the endoscopic instrument on the tops of poles from A to C, and task 2 was to move it from the right pole B to the left pole D. The peak velocity (Vp) and the time when peak velocity appears (Tp) were analyzed. Both the peak velocity (Vp) and the time when peak velocity appears (Tp) to perform task 1 and task 2 were significantly faster in the expert group than in the novice group. The peak velocity (Vp) and the time when peak velocity appears (Tp) in HUESAD, which indicate the smoothnes of the endoscopic procedure, are among the most important factors for assessing endoscopic surgical skills.
- Published
- 2010
117. [A case of advanced rectal cancer that responded to S-1 with an extended complete response]
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Hiroyuki, Egi, Masazumi, Okajima, Yuji, Takakura, Hideki, Nakahara, Yasuhiro, Matsugu, Toshihiko, Kohashi, Takayuki, Kadoya, Ichiro, Ohmori, Takashi, Urushihara, and Toshiyuki, Itamoto
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Antimetabolites, Antineoplastic ,Drug Combinations ,Oxonic Acid ,Rectal Neoplasms ,Lymphatic Metastasis ,Humans ,Camptothecin ,Female ,Irinotecan ,Antineoplastic Agents, Phytogenic ,Aged ,Tegafur - Abstract
A 78-year-old female underwent an abdomino-perineal resection for lower rectal cancer with para-aortic, right iliac artery and left inguinal lymph node metastasis. Two weeks later, an enlargement of para-aortic and right iliac artery lymph node metastasis was detected by CT. S-1 (100 mg/day for 2 weeks followed by a 1-week rest period) + CPT-11 (120 mg/m2, day 1)treatment was initially administered. However, the patient developed grade 2 anorexia so this treatment regimen was terminated. After complete recovery from the adverse reaction, the regimen was converted to S-1 administration at 100mg/day S-1 for 2 weeks followed by a 1-week rest period. Eventually, this schedule was modified to 100mg/day for 1 week followed by a 1-week rest period. A year after the operation, CT revealed the lymph node metastasis to have disappeared, and no relapse occurred for 32 months. This was a successful case in which S-1 yielded an extended complete response for advanced rectal cancer. Treatment with S-1 is an effective choice for patients who for various reasons can not tolerate the standard treatment for unresectable advanced colorectal cancer. Moreover, randomized controlled trials have to be started to evaluate the efficacy of S-1 treatment for advanced rectal cancer as soon as possible.
- Published
- 2009
118. Large-cell neuroendocrine carcinoma of the distal bile duct
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Hideki Nakahara, Toshiyuki Fukuhara, Takashi Nishisaka, Toshihiko Kohashi, Hiroyuki Egi, Takashi Urushihara, Yasuhiro Matsugu, Yasuhiko Fukuda, and Ichiro Ohmori
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medicine.medical_specialty ,Pathology ,Lung ,business.industry ,Bile duct ,medicine.medical_treatment ,General surgery ,Gastroenterology ,General Medicine ,Hepatology ,Percutaneous transhepatic cholangiography ,Pancreaticoduodenectomy ,medicine.disease ,Small-cell carcinoma ,medicine.anatomical_structure ,Surgical oncology ,Internal medicine ,medicine ,business ,Bile Duct Adenocarcinoma - Abstract
Large-cell neuroendocrine carcinoma (LCNEC) in the distal bile duct is very rare and different from common distal bile duct adenocarcinoma. A 77-year-old man was admitted with obstructive jaundice. Severe stenosis of the distal bile duct was revealed by percutaneous transhepatic cholangiography. Subtotal stomach-preserving pancreaticoduodenectomy was performed. A tumor measuring 1.8 cm in diameter was located in the distal bile duct. Both histopathological and immunohistochemical examination of the resected specimen revealed features of LCNEC of the bile duct. The patient developed multiple liver metastases, lung metastases, and local recurrence and died of disease 3 months after the operation. The clinical behavior of LCNEC in the distal bile duct appears to be highly aggressive with early metastases and a fatal outcome.
- Published
- 2008
119. A CASE OF ISOLATED ANEURYSM OF THE LEFT INTERNAL ILIAC ARTERY WITH NEUROFIBROMA
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Seiji Fujisaki, Tatsuhiko Yamanaka, Kouichi Okugawa, Yasuji Tabe, Akihiko Ohshita, Yuji Nakamura, and Hiroyuki Egi
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medicine.medical_specialty ,Ilioinguinal nerve ,business.industry ,education ,Internal iliac aneurysm ,medicine.disease ,Testicular artery ,Surgery ,medicine.anatomical_structure ,Aneurysm ,Left internal iliac artery ,medicine.artery ,cardiovascular system ,medicine ,Strangulated hernia ,Neurofibroma ,Radiology ,Vein ,business - Abstract
This case report describes isolated aneurysm of the left internal iliac artery with neurofibroma. A 72-year-old man was seen at the hospital because of a left inguinal mass, and was found to have a strangulated hernia and an isolated aneurysm of the left internal iliac artery. The patient was admitted to the hospital for treatment. At operation, the inguinal tumor so strongly adhered to the surrounding tissue that we were obliged to select resection of the ilioinguinal nerve, testicular artery, and vein in order to remove the tumor. Intraoperative frozen section diagnosis of the tumor was neurofibroma, and so the tumor was left intact. Then the left internal iliac artery was freed, its central side was ligated to its peripheral side, and the aneurysm was removed. This case of isolated internal iliac aneurysm coexisted with neurofibroma is relatively rare. The anatomical location of the aneurysm make the early detection difficult, and it is often found after rupture has occurred. We could resect the aneurysm before rupture. This patient has been in good condition for postoperative 12 months.
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- 1998
120. Objective assessment of endoscopic surgical skills by analyzing direction-dependent dexterity using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD)
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Masanori Yoshimitsu, Hirokazu Masugami, Makoto Kaneko, Toshimasa Asahara, Tomohiro Kawahara, Satoshi Ikeda, Yuichi Kurita, Hiroyuki Egi, Yoshihiro Miyata, and Masazumi Okajima
- Subjects
medicine.medical_specialty ,Students, Medical ,business.industry ,Endoscopic surgery ,Endoscopy ,General Medicine ,Equipment Design ,Spatial perception ,Hand ,Expert group ,Statistics, Nonparametric ,Task (project management) ,Surgery ,Objective assessment ,Physical medicine and rehabilitation ,Surgical skills ,Medicine ,Humans ,Computer Simulation ,Clinical Competence ,business ,Psychomotor Performance - Abstract
Purpose. We evaluated our system of objectively assessing endoscopic surgical skills. Methods. We developed the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), which records the movement of the tip of an endoscopic instrument precisely. The orbits of experienced surgeons (expert group) and those of medical students (novice group) were evaluated by measuring the deviation from the ideal course on horizontal and vertical planes. These data were integrated with the time taken to move the tip of an endoscopic instrument between a distal side pole (A) and a proximal side pole (C) (Task 1), and between a left side pole (D) and a right side pole (B) (Task 2). Results. The integrated deviation of the expert group was signifi cantly lower than that of the novice group on both the horizontal and vertical planes in Task 1 (P = 0.0004, P = 0.009) and Task 2 (P < 0.0001, P = 0.0002). Thus, the spatial perception of experts was signifi cantly better than that of novices. We also found that the direction of the scope and the movement of the endoscopic instrument were related to diffi culties in spatial perception for both experts and novices. HUESAD detected and resolved these differences based on the directions of the scope and movement of the endoscopic instruments. Conclusions. The HUESAD is a reliable system for assessing a surgeon’s dexterity, based on direction and movement. It helps us to attain a higher degree of accuracy and to create an ideal setting for optimal endoscopic surgery.
- Published
- 2006
121. [Laparoscopic surgery for colonic cancer: present status and evaluation]
- Author
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Masazumi, Okajima, Satoshi, Ikeda, Hiroyuki, Egi, Masanori, Yoshimitsu, and Toshimasa, Asahara
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Colonic Neoplasms ,Humans ,Laparoscopy ,Video-Assisted Surgery ,Clinical Competence ,Prognosis ,Randomized Controlled Trials as Topic - Abstract
It has been 15 years since laparoscopic surgery was first performed in colonic cancer. An inquiry-based analysis by the Japan Society of Endoscopic Surgery (JSES) in 2003 showed a steady increase in the number of laparoscopic colonic resections for cancer. This report also indicates that advanced cancer candidates exceeded early-stage patients in 2003. From the technical point of view, pure laparoscopic access and a medial dissection approach rather than hand-assisted laparoscopic surgery (HALS) and a lateral dissection approach is more likely to be selected as a standard procedure. In 2004, the Endoscopic Surgical Skill Qualification System was proposed by the JSES to promote safer laparoscopic surgery in Japan. For colonic qualification, a thorough videotape of colonic cancer resection is to be evaluated so that not only laparoscopic surgical skill but also oncologic handling is taken into account. In clinical research, based on the results of a multicenter, randomized, controlled study of open vs. laparoscopic-assisted colectomy in the USA and Europe, a Japanese trial has also now started to determine the optimum quality control of surgical skill. The results of this study arre expected to lead to less deviation in the level of surgical skill.
- Published
- 2006
122. A CASE OF THE COEXISTENCE OF NON-INVASIVE DUCTAL CARCINOMA WITH A PHYLLODESTUMOR
- Author
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Kazuhiro Kume, Tetsuo Ishikawa, Toshimitsu Matsuzaka, Hiroyuki Egi, and Kenzou Wakasugi
- Subjects
Oncology ,medicine.medical_specialty ,Axillary lymph nodes ,business.industry ,Non invasive ,Phyllodes tumor ,Frozen Section Diagnosis ,Ductal carcinoma ,medicine.disease ,Metastasis ,Dissection ,medicine.anatomical_structure ,Internal medicine ,medicine ,Radiology ,skin and connective tissue diseases ,Breast carcinoma ,business - Abstract
It is very unusual that non-invasive ductal carcinoma coexists with Pyllodes tumor. A 62-year-old woman was admitted to the hospital because of a large mass in the left breast. Simple mastectomy was performed with a diagnosis of phyllodes tumor and intraoperative frozen section diagnosis confirmed “Phyllodes tumor, borderline”. But, permanent section revealed the coexistence of non-invasive ductal carcinoma with Phyllodes tumor Axillary lymph nodes dissection was added. No recurrence or metastasis has been observed over the post operative period of 30 months. Though it is rare, phyllodes tumor of the breast can be associated with breast carcinoma like in this case and we have to entertain this possibility in the treatment of phyllodes tumor.
- Published
- 1997
123. Regulation of T helper type-1 immunity in hapten-induced colitis by host pretreatment with granulocyte colony-stimulating factor
- Author
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Fumio Shimamoto, Koichi Oishi, Keisuke Hayamizu, Hiroyuki Egi, Masanori Yoshimitsu, Toshimasa Asahara, Masazumi Okajima, and Ichiro Ohmori
- Subjects
Male ,medicine.medical_specialty ,Colon ,Immunology ,Inflammation ,Biology ,Granulocyte ,Biochemistry ,law.invention ,Th2 Cells ,Downregulation and upregulation ,Adjuvants, Immunologic ,law ,Internal medicine ,Granulocyte Colony-Stimulating Factor ,medicine ,Immunology and Allergy ,Animals ,Humans ,RNA, Messenger ,Colitis ,Molecular Biology ,Regulation of gene expression ,Wasting Syndrome ,fungi ,Hematology ,T-Lymphocytes, Helper-Inducer ,Th1 Cells ,medicine.disease ,Recombinant Proteins ,Granulocyte colony-stimulating factor ,Rats ,Endocrinology ,medicine.anatomical_structure ,Gene Expression Regulation ,Recombinant DNA ,Cytokines ,medicine.symptom ,Hapten - Abstract
Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is an immunoregulatory drug whose effects include modulation of antigen-presentation. We investigated the potential ameliorative effect of pretreatment with rhG-CSF in a hapten-induced colitis animal model. Sprague-Dawley rats were given rhG-CSF (125 microg/kg subcutaneously twice a day for 5 days) before a colonic instillation of 2,4,6-trinitrobenzene sulfonic acid (TNBS) in 50% ethanol. Consequent colonic damage was evaluated pathologically, and cytokine mRNA expression levels in macroscopically inflamed sites were measured by real-time quantitative reverse transcription-polymerase chain reaction. Pretreatment with rhG-CSF remarkably attenuated both the loss of body weight and colonic wall thickening due to progressive transmural inflammation. In the control, treatment with TNBS led to a statistically significant (p < 0.05) upregulation of IFN-gamma mRNA expression in the inflammatory sites measured at post-treatment day 7. In the experimental group, pretreatment with rhG-CSF abrogated transcription of IFN-gamma (p < 0.05), but was not, however, associated with an upregulation of IL-4 or the regulatory cytokines TGF-beta and IL-10. Furthermore, transcription of IL-12p35 (a rate-limiting factor for the production of IL-12) was significantly (p < 0.05) downregulated by rhG-CSF at 24h post-TNBS instillation, whereas IL-12p40 was not affected. Pretreatment with rhG-CSF drastically attenuated the degree of TNBS-induced colitis through selective downregulation of Th1-associated cytokines.
- Published
- 2003
124. Downregulation of interleukin-12p35 and upregulation of interleukin-12p40 mRNA expression in heart allografts by blood transfusion from granulocyte colony-stimulating factor-treated donors
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Ichiro Ohmori, Teruhiko Kitayama, Keisuke Hayamizu, Toshimasa Asahara, Hiroyuki Egi, and Xuehelati Aihaiti
- Subjects
Male ,Blood transfusion ,Time Factors ,Transplantation Conditioning ,medicine.medical_treatment ,Immunology ,Down-Regulation ,Enzyme-Linked Immunosorbent Assay ,Granulocyte ,Biochemistry ,Interleukin-12 Subunit p35 ,Tacrolimus ,Downregulation and upregulation ,Species Specificity ,In vivo ,Granulocyte Colony-Stimulating Factor ,Immunology and Allergy ,Medicine ,Animals ,Humans ,Blood Transfusion ,RNA, Messenger ,Molecular Biology ,business.industry ,Interleukin-12 Subunit p40 ,Reverse Transcriptase Polymerase Chain Reaction ,fungi ,Graft Survival ,Interleukin ,Hematology ,Interleukin-12 ,Granulocyte colony-stimulating factor ,Rats ,Up-Regulation ,Transplantation ,Protein Subunits ,medicine.anatomical_structure ,Heart Transplantation ,business - Abstract
Pretransplant treatment of recipients with recombinant human granulocyte colony-stimulating factor (rhG-CSF, 250 μg/kg/day s.c. for 5 days) facilitates heart allograft acceptance in tacrolimus-treated rat recipients. We examined effectiveness of transfusion of in vivo rhG-CSF-treated blood since rhG-CSF induces immunoregulatory cells in human blood. DA heart grafts were transplanted into tacrolimus (2 mg/kg i.m. on day 0)-treated Lewis recipients. Although graft survival prolongation by blood transfusion on day 0 from rhG-CSF-treated syngeneic Lewis was comparable to that in directly rhG-CSF-pretreated recipients ( p =0.22), transfusion of rhG-CSF-treated allogeneic DA blood was much more effective ( p =0.0016). Intragraft cytokine mRNA levels were measured by reverse transcription and real-time polymerase chain reaction at 24 h after transplantation. IL-12p35 expression was downregulated by both treatments. Notably, IL-12p40 was upregulated by rhG-CSF-treated DA blood transfusion but downregulated by transfusion of rhG-CSF-treated isogeneic blood. Differential expression of IL-12 subunits was associated with facilitation of graft acceptance by rhG-CSF-treated donor blood transfusion.
- Published
- 2003
125. Facilitation of tacrolimus-induced heart-allograft acceptability by pretransplant host treatment with granulocyte colony-stimulating factor: interleukin-12-restricted suppression of intragraft monokine mRNA expression
- Author
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Teruhiko, Kitayama, Keisuke, Hayamizu, Hiroyuki, Egi, Ichiro, Ohmori, Masanori, Yoshimitsu, and Toshimasa, Asahara
- Subjects
Transplantation Conditioning ,T-Lymphocytes ,Graft Survival ,Gene Expression ,Interleukin-12 ,Tacrolimus ,Rats ,Rats, Inbred Lew ,Granulocyte Colony-Stimulating Factor ,Animals ,Heart Transplantation ,Transplantation, Homologous ,RNA, Messenger ,Immunosuppressive Agents - Abstract
Because recombinant human granulocyte colony-stimulating factor (rhG-CSF) is known to modulate function of antigen-presenting cells, we examined effects of pretransplant host treatment with rhG-CSF on allograft survival.In DA-to-Lewis rat heart transplantation, hosts were given pretransplant injections of rhG-CSF (250 microg/kg/day subcutaneously from day -5-0) and/or posttransplant injections of tacrolimus (2 mg/kg/day intramuscularly from day 0-3). Cytokine mRNA levels in grafts were measured by real-time reverse-transcription polymerase chain reaction.rhG-CSF pretreatment was effective in prolonging allograft survival only in tacrolimus-treated hosts (P0.001). Intragraft mRNA expression of interleukin (IL)-12 subunits (p35, p40) at 24 hours after transplantation was significantly (P0.05) down-regulated by the addition of rhG-CSF and was associated with suppression of interferon-gamma levels on day 6, although other proinflammatory cytokines (tumor necrosis factor -alpha, IL-1beta, IL-6, IL-18) and anti-inflammatory cytokines (IL-10, transforming growth factor-beta) were not.rhG-CSF pretreatment down-regulates intragraft expression of the type-1 T-helper cell (Th1)-driving cytokine IL-12 and facilitates tacrolimus-induced graft acceptance.
- Published
- 2003
126. Downregulation of both interleukin-12 and interleukin-2 in heart allografts by pretransplant host treatment with granulocyte colony-stimulating factor and tacrolimus
- Author
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Ichiro Ohmori, Masazumi Okajima, Teruhiko Kitayama, Hiroyuki Egi, Keisuke Hayamizu, and Toshimasa Asahara
- Subjects
Interleukin 2 ,Male ,medicine.medical_treatment ,Immunology ,Down-Regulation ,chemical and pharmacologic phenomena ,Granulocyte ,Biochemistry ,Interleukin-12 Subunit p35 ,Tacrolimus ,law.invention ,Downregulation and upregulation ,law ,Granulocyte Colony-Stimulating Factor ,Immunology and Allergy ,Medicine ,Animals ,Humans ,Transplantation, Homologous ,RNA, Messenger ,Molecular Biology ,Heart transplantation ,business.industry ,fungi ,Hematology ,Interleukin-12 ,Recombinant Proteins ,Granulocyte colony-stimulating factor ,Rats ,Protein Subunits ,surgical procedures, operative ,medicine.anatomical_structure ,Rats, Inbred Lew ,Interleukin 12 ,Recombinant DNA ,Heart Transplantation ,Interleukin-2 ,business ,medicine.drug - Abstract
Since recombinant human granulocyte colony-stimulating factor (rhG-CSF) has been reported to induce immune deviation, we examined the effects of pretransplant treatment of recipients with rhG-CSF on heart allograft survival. Before heterotopic heart transplantation from DA to Lewis rats, recipients were given rhG-CSF (125microg/kg s.c. twice a day from day -5 to 0) and/or tacrolimus (2mg/kg i.m. on day 0). Combined treatment with both rhG-CSF and tacrolimus prolonged graft survival significantly (P0.05), while rhG-CSF or tacrolimus alone did not. At 24h after transplantation, cytokine mRNA levels in the grafts were measured by reverse transcription and real-time polymerase chain reaction. IL-12 p35 expression was highly inhibited by rhG-CSF treatment, but tacrolimus did not change the levels. Conversely, rhG-CSF treatment did not affect IL-2 levels, while tacrolimus completely blocked its expression. Combined pretreatment was effective for suppressing acute rejection reaction by downregulating these two key type-1 cytokines, IL-12 and IL-2, with unchanged levels of IL-10.
- Published
- 2002
127. 2A1-A14 Improvement of tactile perception capability by stochastic resonance effect : Discussion based on a summing network model(Tactile and Force Sensing (1))
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Hiroshi Takemura, Hiroyuki Egi, Yuichi Kurita, Yamato Sueda, Minoru Hattori, Jun Ueda, Toshio Tsuji, and Hideki Ohdan
- Subjects
Engineering ,business.industry ,Electronic engineering ,Stochastic resonance (sensory neurobiology) ,Tactile perception ,business ,Network model - Published
- 2013
128. 1P1-C02 Improvement on tactile sensitivity by a stochastic resonance effect(Tactile and Force Sensing (3))
- Author
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Yuichi Kurita, Yamato Sueda, Masakazu Tokunaga, Minoru Hattori, Toshio Tsuji, Hiroyuki Egi, Hiroshi Takemura, and Jun Ueda
- Subjects
Physics ,Acoustics ,Stochastic resonance (sensory neurobiology) ,Sensitivity (control systems) - Published
- 2012
129. 7D13 Haptic display of biological tissue by using haptic augmented reality technique
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Minoru Hattori, Toshio Tsuji, Hiroyuki Egi, Kazuhiro Nagata, Hiroyuki Otsuka, Yuichi Kurita, and Masakazu Tokunaga
- Subjects
Haptic display ,Computer science ,Human–computer interaction ,Augmented reality ,Biological tissue ,Haptic technology - Published
- 2012
130. Malignant peripheral nerve sheath tumor arising from the greater omentum: Case report
- Author
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Masashi Miguchi, Manabu Shinomura, Hideki Ohdan, Takao Hinoi, Masakazu Tokunaga, Tomohiro Adachi, Yasuo Kawaguchi, Yuji Takakura, Masazumi Okajima, and Hiroyuki Egi
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Exploratory laparotomy ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,Malignant peripheral nerve sheath tumor ,Abdominal cavity ,lcsh:RC254-282 ,Nerve Sheath Neoplasms ,medicine ,Humans ,Peritoneal Neoplasms ,Pelvis ,Aged ,business.industry ,S100 Proteins ,Soft tissue ,Anatomy ,lcsh:RD1-811 ,Greater omentum ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.anatomical_structure ,Oncology ,Abdomen ,Surgery ,Desmin ,business ,Omentum - Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue tumors that arise from a peripheral nerve or exhibit nerve sheath differentiation. Most of these tumors arise on the trunk, extremities, or head and neck regions; they are very rarely located in the abdominal cavity. The patient was a 71-year-old man who was referred to our hospital for a mass and pain in the right lower abdomen. Abdominal computed tomography revealed a large (9 × 9 cm), well-circumscribed, lobulated, heterogeneously enhanced mass in the pelvis. Exploratory laparotomy revealed a large mass in the greater omentum, and the tumor was completely excised. Histopathological analysis revealed that the tumor was composed of spindle cells with high mitotic activity. On staining the tumor, positive results were obtained for S-100 but negative results were obtained for c-kit, cluster of differentiation (CD)34, α-smooth muscle actin, and desmin. These findings strongly supported a diagnosis of MPNST primarily arising from the greater omentum. To the best of our knowledge, this is the first reported case of an MPNST arising from the greater omentum. In this report, we have described the case of a patient with an MPNST arising from the greater omentum and have discussed the clinical characteristics and management of MPNSTs.
- Published
- 2011
131. Initial experiences of robotic versus conventional laparoscopic surgery for colorectal cancer, focusing on short-term outcomes: a matched case-control study.
- Author
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Hiroyuki Sawada, Hiroyuki Egi, Minoru Hattori, Takahisa Suzuki, Manabu Shimomura, Kazuaki Tanabe, Masazumi Okajima, and Hideki Ohdan
- Subjects
- *
COLON cancer , *LAPAROSCOPIC surgery , *SURGICAL robots , *RECTAL cancer , *SURGERY - Abstract
Background: Robotic surgery is a new technique with the benefits of a three-dimensional view, the ability to use multi-degree-of-freedom forceps, the elimination of physiological tremors, and a stable camera view. The aim of this study was to evaluate the feasibility and short-term outcomes of robotic surgery for colorectal cancer as initial cases, compared with conventional laparoscopic surgery. Methods: From July 2010 to June 2013, ten patients with left-sided colon and rectal cancer underwent robotic surgery, and 121 received conventional laparoscopic surgery. Both groups were balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), operative history, TNM staging, and tumor location. Moreover, in order to improve objectivity and approximate a randomized controlled study, we used the propensity score matching method. The matching was successful because the ROC analysis showed a well-balanced curve (C = 0.535). Results: Following propensity score matching, ten patients were included in the robotic surgery group and 20 patients were included in the conventional laparoscopic surgery group. There were no significant differences in the short-term clinicopathologic outcomes between the robotic surgery group and the conventional laparoscopic surgery group. However, the operative time was significantly longer in the robotic surgery group than in the conventional laparoscopic surgery group. Conclusions: There were no significant differences between the robotic surgery group and the conventional laparoscopic surgery group with respect to short-term clinicopathologic outcomes, with the exception of the operative time. Our early experience indicates that robotic surgery is a promising tool, particularly in patients with rectal cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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132. Avoiding restorative proctocolectomy for colorectal cancer in patients with ulcerative colitis based on preoperative diagnosis involving p53 immunostaining: report of a case.
- Author
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Haruki Sada, Manabu Shimomura, Takao Hinoi, Hiroyuki Egi, Koji Kawaguchi, Takuya Yano, Hiroaki Niitsu, Yasufumi Saitou, Hiroyuki Sawada, Masashi Miguchi, Tomohiro Adachi, and Hideki Ohdan
- Subjects
RESTORATIVE proctocolectomy ,RECTAL cancer ,ULCERATIVE colitis ,COLECTOMY ,LYMPHADENECTOMY ,IMMUNOSTAINING - Abstract
The standard operation for colitic cancer in ulcerative colitis (UC) is restorative proctocolectomy; however, sporadic colorectal cancer (CRC) can coincidentally arise in patients with UC and the optimal procedure remains controversial. Therefore, it is crucial to preoperatively determine whether the CRC in UC is a sporadic or colitic cancer. We report a case of avoiding proctocolectomy for sporadic CRC in a patient with UC based on preoperative diagnosis involving p53 immunostaining. A 73-year-old man with CRC in UC had undergone sigmoid colectomy with lymphadenectomy because of the submucosal deep invasion pathologically after endoscopic mucosal resection. The cancer was diagnosed sporadic cancer preoperatively not only based on the endoscopic, clinical, and histological patterns but also that the colon epithelium was unlikely to develop dysplasia as the circumference and unaffected UC mucosa did not detect p53 protein overexpression. Recent reports have shown that the immunohistochemical detection of p53 protein overexpression can be useful for a differential diagnosis and as a predictor of dysplasia and colitic cancer. The analysis of p53 mutation status based on immunostaining of p53 protein expression in the unaffected UC mucosa can be useful for the decision regarding a surgical procedure for CRC in patients with UC. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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133. The Challenge of Objective Assessment of Endoscopic Surgical Skill: Hiroshima University Endoscopic Surgical Assessment Device
- Author
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Hiroyuki Egi, Masanori Yoshimitsu, Makoto Kaneko, Masazumi Okajima, Tomohiro Kawahara, and Yuichi Kurita
- Subjects
business.industry ,Gastroenterology ,Medicine ,Surgery ,business - Published
- 2007
134. 2P1-N-121 Consideration on Dexterity Index for Manipulating Forceps(Medical and Welfare Robotics and Mechatronics 4,Mega-Integration in Robotics and Mechatronics to Assist Our Daily Lives)
- Author
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Yoshichika Iida, Makoto Kaneko, Tomohiro Kawahara, Hirokazu Masugami, Masazumi Okajima, Masanori Yoshimitsu, and Hiroyuki Egi
- Subjects
Engineering ,Index (economics) ,business.industry ,Forceps ,Mechanical engineering ,Robotics ,Artificial intelligence ,Mechatronics ,business ,Manufacturing engineering - Published
- 2005
135. The Neutrophil/Th1 Lymphocyte Balance and the TherapeuticEffect of Granulocyte Colony-Stimulating Factor inTNBS-Induced Colitis of Rat Strains.
- Author
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Masanori Yoshimitsu, Keisuke Hayamizu, Hiroyuki Egi, Jiro Okiyama, Masazumi Okajima, Toshiyuki Itamoto, and Toshimasa Asahara
- Published
- 2006
136. Avoiding restorative proctocolectomy for colorectal cancer in patients with ulcerative colitis based on preoperative diagnosis involving p53 immunostaining: report of a case
- Author
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Hideki Ohdan, Hiroaki Niitsu, Takuya Yano, Hiroyuki Sawada, Yasufumi Saitou, Manabu Shimomura, Masashi Miguchi, Haruki Sada, Hiroyuki Egi, Takao Hinoi, Koji Kawaguchi, and Tomohiro Adachi
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Endoscopic mucosal resection ,Case Report ,Gastroenterology ,Diagnosis, Differential ,Immunoenzyme Techniques ,Intestinal mucosa ,Internal medicine ,Biomarkers, Tumor ,Medicine ,Humans ,Intestinal Mucosa ,Aged ,business.industry ,Proctocolectomy ,Proctocolectomy, Restorative ,Cancer ,p53 overexpression ,medicine.disease ,Prognosis ,Ulcerative colitis ,digestive system diseases ,Oncology ,Dysplasia ,Lymphadenectomy ,Colitis, Ulcerative ,Surgery ,Tumor Suppressor Protein p53 ,business ,Colorectal Neoplasms ,Sporadic cancer - Abstract
The standard operation for colitic cancer in ulcerative colitis (UC) is restorative proctocolectomy; however, sporadic colorectal cancer (CRC) can coincidentally arise in patients with UC and the optimal procedure remains controversial. Therefore, it is crucial to preoperatively determine whether the CRC in UC is a sporadic or colitic cancer. We report a case of avoiding proctocolectomy for sporadic CRC in a patient with UC based on preoperative diagnosis involving p53 immunostaining. A 73-year-old man with CRC in UC had undergone sigmoid colectomy with lymphadenectomy because of the submucosal deep invasion pathologically after endoscopic mucosal resection. The cancer was diagnosed sporadic cancer preoperatively not only based on the endoscopic, clinical, and histological patterns but also that the colon epithelium was unlikely to develop dysplasia as the circumference and unaffected UC mucosa did not detect p53 protein overexpression. Recent reports have shown that the immunohistochemical detection of p53 protein overexpression can be useful for a differential diagnosis and as a predictor of dysplasia and colitic cancer. The analysis of p53 mutation status based on immunostaining of p53 protein expression in the unaffected UC mucosa can be useful for the decision regarding a surgical procedure for CRC in patients with UC.
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- View/download PDF
137. Intrahepatic cholangiocarcinoma coinciding with a liver metastasis from a rectal carcinoma: a case report
- Author
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Masahiro Ohira, Kentaro Ide, Naoki Tanimine, Kohei Ishiyama, Shintaro Kuroda, Seiichi Shimizu, Hiroyuki Egi, Wataru Yasui, Tsuyoshi Kobayashi, Shintaro Akabane, Kazuaki Tanabe, Hiroyuki Tahara, Kazuhiro Sentani, and Hideki Ohdan
- Subjects
Chemotherapy ,medicine.medical_specialty ,Metastatic lesions ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Cancer ,Case Report ,medicine.disease ,Gastroenterology ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Colorectal carcinoma metastasis ,Rectal carcinoma ,Medicine ,030211 gastroenterology & hepatology ,Hepatectomy ,Metastatic liver tumor ,business ,Intrahepatic Cholangiocarcinoma ,Intrahepatic cholangiocarcinoma - Abstract
Background We experience many cases of liver metastasis from colorectal cancer, but synchronous occurrence of intrahepatic cholangiocarcinoma (ICC) and liver metastasis from a rectal cancer is extremely rare. We herein report a case of ICC coinciding with a liver metastasis from a known rectal carcinoma. Case presentation A 68-year-old man was referred to our hospital for investigation of multiple liver tumors. Total colonoscopy and computed tomography (CT) revealed a rectal carcinoma, coinciding with liver metastasis. He was planned to receive chemotherapy following rectal resection. During chemotherapy for the rectal cancer, one of the liver tumors gradually grew after first shrinking. The following hepatectomy revealed the presence of intrahepatic cholangiocarcinoma (ICC). Despite intensive chemotherapy for the ICC, he passed away 6 months after the hepatectomy. Conclusions We should also suspect the possibility of multiple primary cancers, even if the patient has a history of cancer that is likely to cause metastatic lesions. When simultaneous neoplasms are diagnosed, systematic treatment should be targeted to the tumor with the worst prognosis.
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138. Total colectomy for multiple metachronous colon cancers in a patient with Lynch syndrome
- Author
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Hiroaki Niitsu, Takuya Yano, Shoichiro Mukai, Manabu Shimomura, Masatoshi Kochi, Masashi Miguchi, Tomohiro Adachi, Yasufumi Saito, Hiroyuki Sawada, Hideki Ohdan, Yasuyo Ishizaki, Hiroyuki Egi, and Takao Hinoi
- Subjects
MSH2 mutation ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Case Report ,Gene mutation ,medicine.disease ,Gastroenterology ,Total colectomy ,Lynch syndrome ,Ileostomy ,MSH2 ,Internal medicine ,medicine ,Adenocarcinoma ,DNA mismatch repair ,Metachronous cancer ,Family history ,business - Abstract
Lynch syndrome (LS) is a disorder caused by mismatch repair gene mutations, which have been recognized to be associated with an increased frequency of colorectal and extracolorectal tumors. However, it remains controversial as to whether total or segmental colectomy should be performed to treat colorectal cancer in patients with LS. A 58-year-old male underwent total colectomy with ileostomy for advanced transverse colon cancer. He was also found to have LS based on his characteristic family history and the findings of a preoperative examination, including a microsatellite instability analysis of past multiple metachronous cancers. The postoperative histological findings showed mucinous adenocarcinoma without lymph node metastasis, and the loss of the MSH2 protein expression was confirmed on an immunohistochemical examination. The present case provided important information on the clinical management of multiple developing metachronous colorectal cancers in patients with LS.
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139. Up-front systemic chemotherapy is a feasible option compared to primary tumor resection followed by chemotherapy for colorectal cancer with unresectable synchronous metastases
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Hiroyuki Egi, Hiroaki Niitsu, Manabu Shimomura, Hiroyuki Sawada, Masashi Miguchi, Minoru Hattori, Yasuyo Ishizaki, Shoichiro Mukai, Masatoshi Kochi, Yasufumi Saito, Tomohiro Adachi, Hideki Ohdan, and Takao Hinoi
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Surgical oncology ,Unresectable metastases ,Laparotomy ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Chemotherapy ,Humans ,Medicine ,Neoplasm Invasiveness ,Stage IV ,Survival rate ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Research ,Liver Neoplasms ,Hazard ratio ,Neoplasms, Second Primary ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Primary tumor ,Survival Rate ,Lymphatic Metastasis ,Female ,Surgery ,Colorectal Neoplasms ,business ,Follow-Up Studies - Abstract
Background In stage IV colorectal cancer (CRC) with unresectable metastases, whether or not resection of the primary tumor should be indicated remains controversial. We aim to determine the impact of primary tumor resection on the survival of stage IV CRC patients with unresectable metastases. Methods We retrospectively investigated 103 CRC patients with stage IV colorectal cancer with metastases, treated at Hiroshima University Hospital between 2007 and 2013. Of these, those who had resectable primary tumor but unresectable metastases and received any chemotherapy were included in the study. We analyzed the overall survival (OS) and short-term outcomes between the patients who received up-front systemic chemotherapy (USC group) and those who received primary tumor resection followed by chemotherapy (PTR group). Results Of the 57 included patients, 15 underwent USC and 42 PTR. The median survival times were 13.4 and 23.9 months in the USC and PTR groups, respectively (P = 0.093), but multivariate analysis for the overall survival showed no significant difference between the two groups (hazard ratio, 1.30; 95% confidence interval (CI), 0.60 to 2.73, P = 0.495). In the USC group, the disease control rate of primary tumor was observed in 12 patients (80.0%), but emergency laparotomy was required for 1 patient. Morbidity in the PTR group was observed in 18 cases (42.9%). Conclusions The overall survival did not differ significantly between the USC and PTR groups. USC may help avoid unnecessary resection and consequently the high morbidity rate associated with primary tumor resection for stage IV CRC with unresectable metastases.
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140. Primary lung cancer presenting with metastasis to the colon: a case report
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Tomohiro Adachi, Hideki Ohdan, Hiroyuki Egi, Masakazu Tokunaga, Hiroshi Sakai, Manabu Shinomura, Koji Arihiro, Yasuo Kawaguchi, and Takao Hinoi
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Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Primary lung cancer ,Colorectal cancer ,lcsh:Surgery ,Case Report ,lcsh:RC254-282 ,Metastasis ,Squamous cell carcinoma ,medicine ,Carcinoma ,Humans ,Colonic metastasis ,Lung cancer ,Squamous-cell carcinoma of the lung ,Lung ,business.industry ,Sigmoid colon ,Chemoradiotherapy ,lcsh:RD1-811 ,Middle Aged ,respiratory system ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,medicine.anatomical_structure ,Oncology ,Colonic Neoplasms ,Carcinoma, Squamous Cell ,Female ,Radiography, Thoracic ,Surgery ,Radiology ,business - Abstract
Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary squamous cell carcinoma of the lung. A 60-year-old female with anorexia and fatigue was referred to the department of pulmonary surgery in our hospital. The patient was diagnosed with primary squamous cell carcinoma of the lung, T2b N3 M1b Stage IV, and chemoradiotherapy was initiated. This treatment led to a good partial response in the primary lung lesion without any new metastatic lesions. The patient developed left abdominal pain due to a bulky sigmoid colon tumor 6 months later, and was preoperatively diagnosed with primary colon cancer. She underwent colonic resection, and the pathology specimen demonstrated poorly differentiated squamous cell carcinoma that was suspected to be colonic metastasis from the primary lung cancer. The postoperative course was uneventful, and she was discharged. Chemotherapy for the lung cancer was scheduled in the department of pulmonary surgery. This report presented a rare case of colonic metastasis from lung cancer. When patients with advanced primary lung cancer complain of abdominal symptoms, we should consider gastrointestinal tract metastasis from lung cancer.
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141. Single-port laparoscopic colectomy versus conventional laparoscopic colectomy for colon cancer: a comparison of surgical results
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Hideki Ohdan, Manabu Shimomura, Takashi Urushihara, Takao Hinoi, Yuji Takakura, Minoru Hattori, Masakazu Tokunaga, Tomohiro Adachi, Yasuo Kawaguchi, Hiroyuki Egi, and Toshiyuki Itamoto
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Adult ,Male ,Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Statistics as Topic ,lcsh:Surgery ,lcsh:RC254-282 ,Laparoscopic colectomy ,Port (medical) ,Technical Innovations ,Surgical oncology ,Colon surgery ,Single-port laparoscopic surgery ,Health Status Indicators ,Humans ,Medicine ,Laparoscopy ,Colectomy ,Aged ,Aged, 80 and over ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,General surgery ,Conventional laparoscopic surgery ,lcsh:RD1-811 ,Gelport ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Colon cancer ,Surgery ,Oncology ,Single-incision laparoscopic surgery ,Case-Control Studies ,Female ,Colorectal Neoplasms ,business - Abstract
Background Single-port laparoscopic surgery is a new technique that leaves no visible scar. This new technique has generated strong interest among surgeons worldwide. However, single-port laparoscopic colon surgery has not yet been standardized. Our aim in this study was to evaluate the feasibility of single-port laparoscopic colectomy compared with conventional laparoscopic colectomy for colon cancer. Methods We conducted a case-matched, controlled study comparing single-port laparoscopic colectomy to conventional laparoscopic colectomy for right-sided colon cancer. Results A total of ten patients were included for the single-port laparoscopic colectomy (S-LAC) group and ten patients for the conventional laparoscopic colectomy (C-LAC) group. The length of the skin incision in the S-LAC group was significantly shorter than that of the C-LAC group. Conclusion Our early experiences indicated that S-LAC for right-sided colon cancer is a feasible and safe procedure and that S-LAC results in a better cosmetic outcome.
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142. Initial experiences of robotic versus conventional laparoscopic surgery for colorectal cancer, focusing on short-term outcomes: a matched case-control study
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Kazuaki Tanabe, Manabu Shimomura, Hideki Ohdan, Hiroyuki Egi, Hiroyuki Sawada, Minoru Hattori, Takahisa Suzuki, and Masazumi Okajima
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Laparoscopic surgery ,Male ,medicine.medical_specialty ,Propensity score ,medicine.medical_treatment ,Forceps ,Operative Time ,Postoperative Complications ,Robotic Surgical Procedures ,Technical Innovations ,medicine ,Humans ,Robotic surgery ,Prospective Studies ,Rectal cancer ,Prospective cohort study ,Laparoscopy ,Aged ,Neoplasm Staging ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Prognosis ,Surgery ,Colon cancer ,Oncology ,Case-Control Studies ,Propensity score matching ,Female ,business ,Colorectal Neoplasms ,Follow-Up Studies - Abstract
Background Robotic surgery is a new technique with the benefits of a three-dimensional view, the ability to use multi-degree-of-freedom forceps, the elimination of physiological tremors, and a stable camera view. The aim of this study was to evaluate the feasibility and short-term outcomes of robotic surgery for colorectal cancer as initial cases, compared with conventional laparoscopic surgery. Methods From July 2010 to June 2013, ten patients with left-sided colon and rectal cancer underwent robotic surgery, and 121 received conventional laparoscopic surgery. Both groups were balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), operative history, TNM staging, and tumor location. Moreover, in order to improve objectivity and approximate a randomized controlled study, we used the propensity score matching method. The matching was successful because the ROC analysis showed a well-balanced curve (C = 0.535). Results Following propensity score matching, ten patients were included in the robotic surgery group and 20 patients were included in the conventional laparoscopic surgery group. There were no significant differences in the short-term clinicopathologic outcomes between the robotic surgery group and the conventional laparoscopic surgery group. However, the operative time was significantly longer in the robotic surgery group than in the conventional laparoscopic surgery group. Conclusions There were no significant differences between the robotic surgery group and the conventional laparoscopic surgery group with respect to short-term clinicopathologic outcomes, with the exception of the operative time. Our early experience indicates that robotic surgery is a promising tool, particularly in patients with rectal cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12957-015-0517-6) contains supplementary material, which is available to authorized users.
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143. Hypertensive Cardiomyopathy with Congestive Heart Failure in an Infant with Unilateral Wilms Tumor: A Case Report.
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Jun Kuwabara, Satoshi Akita, Mitsunori Sato, Katsuya Watanabe, Takayasu Kawamoto, Kazufumi Tanigawa, Sayuri Matsui, Yusuke Matsuno, Yousuke Abe, Satoshi Kikuchi, Motohira Yoshida, Shigehiro Koga, Kei Ishimaru, Hiroyuki Egi, and Yuji Watanabe
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DILATED cardiomyopathy , *CONGESTIVE heart failure , *NEPHROBLASTOMA , *HYPERTENSION , *CARDIOMYOPATHIES , *PEDIATRIC surgeons , *HYPERTENSIVE crisis - Abstract
Wilms tumor (WT) is the most common malignant kidney tumor in children. High blood pressure is seen in up to 55% of children with WT. However, hypertensive cardiomyopathy with congestive heart failure due to WT is remarkably rare, with only several cases reported worldwide. In this report, a pediatric case of WT with hypertension causing hypertensive cardiomyopathy and congestive heart failure is presented. An 8-month-old male child with abdominal distension was seen by his primary physician. He was referred to our hospital for further examination and treatment. Abdominal contrast-enhanced computed tomography demonstrated a weakly enhancing, large abdominal mass, which was larger than 12 cm. Two-dimensional transthoracic echocardiography showed a diffuse hypokinetic left ventricle. The patient was diagnosed with cardiomyopathy caused by hypertension. Open surgical resection of the mass was successfully performed. His postoperative course was uncomplicated, and the patient was successfully discharged. The plasma renin activity was maintained at a high level even after left nephrectomy, suggesting that the right kidney was likely the source of renin secretion. Mechanical compression of the right renal blood vessels by a greatly enlarged left kidney can cause right renal ischemia, which activates renin excretion. Nephrectomy can be an effective treatment for a WT patient with hypertension causing hypertensive cardiomyopathy, and then cardiac function will be improved within several weeks. We recommend routine echocardiography surveillance in patients with WT. This report can help pediatric surgeons become more familiar with cardiomyopathy caused by WT. [ABSTRACT FROM AUTHOR]
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- 2021
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144. possible role of soluble fibrin monomer complex after gastroenterological surgery.
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Kochi M, Shimomura M, Hinoi T, Egi H, Tanabe K, Ishizaki Y, Adachi T, Tashiro H, and Ohdan H
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- Adult, Aged, Aged, 80 and over, Anticoagulants therapeutic use, Area Under Curve, Blood Coagulation, Female, Fibrin chemistry, Gastroenterology, Humans, Male, Middle Aged, Multivariate Analysis, Postoperative Period, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Treatment Outcome, Venous Thromboembolism etiology, Digestive System Surgical Procedures, Fibrin Fibrinogen Degradation Products chemistry
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Aim: To examine the role of soluble fibrin monomer complex (SFMC) in the prediction of hypercoagulable state after gastroenterological surgery., Methods: We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers., Results: A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five (28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7 (OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/mL (AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to high-SFMC patients who did not., Conclusion: The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers., Competing Interests: Conflict-of-interest statement: The authors have no potential conflicts of interest to disclose.
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- 2017
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