Search

Shuji Suzuki,1 Mitsugi Shimoda,1 Jiro Shimazaki,1 Tsunehiko Maruyama,1 Yukio Oshiro,1 Kiyotaka Nishida,1 Jun Kuroda,1 Kenta Miyoshi,1 Nobusada Koike,2 Nobuhiko Harada21Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan; 2Department of Surgery, Hachioji Digestive Disease Hospital, Tokyo 192-0903, JapanBackground: Early recurrence of distal cholangiocarcinoma (DCC) may result in a poorer prognosis. This study aimed to evaluate the clinicopathological factors that predict survival and recurrence in patients with DCC.Methods: Fifty-five patients with DCC who underwent pancreaticoduodenectomy between 2005 and 2015 were studied retrospectively. The following clinicopathological parameters were analyzed as predictors of disease-free survival (DFS) and overall survival (OS): sex, age, body mass index, presence of biliary tract decompression, macroscopic type, histological type, tumor size, TNM classification, lymph node metastasis ratio, number of positive lymph nodes (PLNs), lymphatic invasion, venous invasion, perineural invasion, proximal bile duct margin, dissected margin, portal system invasion, arterial system invasion, stage, and residual tumor.Results: Univariate analysis showed that contiguous extension of the primary tumor, PLN, lymphatic invasion, venous invasion, perineural invasion, and stage were significant prognostic factors for DFS and OS. Multivariate analysis revealed that PLN and lymphatic invasion were prognostic for DFS and OS (P

Mitsugi Shimoda, Tsunehiko Maruyama, Kiyotaka Nishida, Kazuomi Suzuki, Tomoya Tago, Jiro Shimazaki, Shuji SuzukiDepartment of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, JapanBackground: Laparoscopic appendectomy (LA) has been increasingly adopted for its advantages over the open appendectomy, but there are possibilities of conversion from laparoscopic to open appendectomy (CA) if the patients had complicated appendicitis concurrently, or when the extent of inflammation prohibits successful procedure. In this retrospective study, we aimed to clarify the preoperative predictors for CA.Patients and methods: From January 2010 to April 2016, medical records of 93 consecutive patients who underwent LA for suspected appendicitis were reviewed retrospectively. Factors evaluated were age, gender, body mass index, C-reactive protein (CRP), white cell count, albumin, Neutrophil count, lymphocyte count, Neutrophil/lymphocyte ratio, preoperative CT imaging (abscess formation: yes/no, appendicolith: yes/no), operative factors (time to operation, amount of bleeding), length of hospital stay, period until oral intake after surgery, and period from initial symptoms to surgery.Results: CA occurred in nine patients (9.7%). The reason for conversion was severe dense adhesion in two cases, inadequate exposure of appendix in two cases, uncompleted appendectomy in two cases, perforated appendicitis in one case, gangrenous appendicitis in one case, and abscess formation in one case. Based on 93 patients evaluated by preoperative CT scan, significant factors in the final multivariate analysis associated with CA was CRP [odds ratio=1.13, 95% CI:1.00–1.28, p=0.04].Conclusion: Identifying the potential factors for conversion preoperatively may assist the surgeons in making decisions concerning the management of patients with appendicitis and in the judicious use of LA.Keywords: laparoscopic, conversion, appendectomy, C-reactive protein

Masahiko Yamaguchi,1 Takeshi Nishijima,2 Jun Shimazaki,3 Etsuko Takamura,4 Norihiko Yokoi,5 Hitoshi Watanabe,6 Yuichi Ohashi1 1Department of Ophthalmology, Ehime University School of Medicine, Ehime, 2Department of Safety Vigilance Group, Santen Pharmaceutical Co., Ltd., Osaka, 3Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, 4Department of Ophthalmology, School of Medicine, Tokyo Women’s Medical University, Tokyo, 5Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, 6Department of Ophthalmology, Kansai Rosai Hospital, Hyogo, Japan Purpose: To evaluate the efficacy and safety of diquafosol (DQS) ophthalmic solution in dry eye (DE) patients wearing contact lenses (CLs) or with concomitant meibomian gland dysfunction (MGD) or conjunctivochalasis in a real-world setting. Patients and methods: From a cohort of patients enrolled in a prospective observational study, DE patients who met the Japanese diagnostic criteria and who received DQS as a monotherapy were extracted and stratified according to the presence or absence of CL use, MGD, and conjunctivochalasis. Corneal and conjunctival fluorescein staining score, tear film break-up time, total symptom score (12 DE-related subjective symptoms), patient-reported outcomes, and adverse reactions were investigated. Results: DQS treatment resulted in significant improvement in total symptom score, corneal and conjunctival fluorescein staining score, and tear film break-up time without significant differences between patient subgroups with versus without CL use, MGD, or conjunctivochalasis. Comparable proportions of patients perceived symptomatic improvements in all subgroups. There were no adverse reactions specifically associated with the CL use or any comorbidity of MGD or conjunctivochalasis. Conclusion: DQS can be used effectively and safely as a monotherapy for the treatment of DE patients wearing CLs or with concomitant MGD or conjunctivochalasis. Keywords: clinical practice, dry eye syndrome, patient-reported outcome, Diquas®

Katsuya Yamazoe1,2, Seika Shimazaki-Den1, Isao Otaka3, Kazuki Hotta2, Jun Shimazaki1,4 1Department of Ophthalmology, Tokyo Dental College, Ichikawa, 2Department of Ophthalmology, Kameda Medical Center, Kamogawa, 3Yokohama Sotetsu Building Eye Center, Yokohama, 4Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan Background: Although pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare. Methods: A 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning. Results: Systemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted. Conclusions: SINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used. Keywords: scleritis, pterygium, pterygium surgery, conjunctival autograft, SINS

Br J Ophthalmol 2003;87:1279-1283 Aim: To determine the efficacy of using albumin tear supplements in the treatment of ocular surface disorders as a substitute for serum eye drops. Methods: The [...]

Aim: To test the short term efficacy and safety of an infrared warm compression device (IWCD, Eye Hot, Cept Co, Tokyo, Japan) as treatment for non-inflamed meibomian gland dysfunction (MGD). [...]