ABSTRACT
Background/Aims@#Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited. @*Methods@#We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC. @*Results@#A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees. @*Conclusions@#Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.
ABSTRACT
Background/Aims@#Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety. @*Methods@#Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. @*Results@#Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed. @*Conclusions@#Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).
ABSTRACT
A 36-year-old man underwent direct closure of an atrial septal defect through median sternotomy at the age of 14. He also underwent a mitral valve replacement with tricuspid annuloplasty using the same approach at the age of 18. The patient also presented with pretibial edema and congestive liver disease at the age of 27 and the pretibial edema progressed at the age of 35. Hypoalbuminemia (TP ; 3.6 g/dl, Alb ; 1.6 g/dl) was also observed. Further examinations were performed, which revealed that the right ventricular pressure curve presented a dip and plateau pattern by cardiac catheterization. Computed tomography of the chest additionally revealed thickened and calcified pericardium in the left ventricle. Abdominal scintigraphy showed tracer accumulation in the transverse colon hepatic flexure 4 h after intravenous administration of technetium-99m-labelled human serum albumin. The patient was diagnosed with a protein-losing gastroenteropathy caused by constrictive pericarditis. He underwent pericardiectomy via left anterior thoracotomy without cardiopulmonary bypass. No complications were present after the surgery, and he was discharged after 46 postoperative days. Following his discharge from the hospital, the pretibial edema disappeared, and serum albumin levels gradually increased and normalized within 3 months after the surgery (TP 7.1 g/dl, Alb 4.2 g/dl).
ABSTRACT
Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.
Subject(s)
Humans , Bone Neoplasms , Chondroblastoma , Chondrosarcoma , Durapatite , Epiphyses , Femur , Giant Cell Tumors , Hydroxyapatites , Methods , Osteosarcoma , Plastic Surgery Procedures , Recurrence , TibiaABSTRACT
<p>A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.</p>
ABSTRACT
A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Biopsy , Constriction, Pathologic , Diagnosis , Duodenal Ulcer , Duodenitis , Endoscopy, Digestive System , Eosinophils , Lung , Nausea , Rare DiseasesABSTRACT
The purpose of this study was to determine the effects of supine floating on rectal temperature and cardiac autonomic nervous system activity after exercise. Seven healthy males volunteered for this study. Subjects performed supine position for 30 minutes in both control condition (C-condition) and water condition (W-condition) after exercise with a cycle ergometer for 15 minutes. Exercise intensity was high (80%VO<sub>2</sub>max) and moderate (60%VO<sub>2</sub>max). Water temperature was 30 degrees Celsius. Rectal temperature of post exercise showed no significant differences under the W-condition, as compared to the C-condition. Delta rectal temperature (point 0-0 was end of exercise) was significantly reduced (p<0.05) under the W-condition, as compared to the C-condition. Log HF was significantly increased (p<0.05) under the W-condition, as compared to the C-condition. These data suggested that supine floating after high and moderate intensity exercise could promote recovery of rectal temperature and increased in cardiac parasympathetic nervous system activity.
ABSTRACT
Though preoperative autologous donation is not acceptable for all cases partly because some are preoperatively in a severe condition, intraoperative predonation is possible in almost all cases. We retrospectively evaluated the major factors related to the prevention of homologous blood transfusion by intraoperative predonation in 25 cases <i>following valvular surgery</i> without preoperative autologous donation. Homologous blood was not transfused in 18 cases {Group-(-)} but in 7 cases only after CPB {Group-(+)}. The male/female ratio, type of operation, body weight, CPB dilution, CPB duration, and perioperative change in hematocrit were comparable in the 2 groups. However, the autologous blood pooled before CPB in Group-(-) was significantly more than in Group-(+) (11.3±2.5 vs 7.3±1.8ml/kg, <i>p</i><0.001). In conclusion, homologous blood transfusion may be prevented by appropriate intraoperative predonation during surgery for valvular disease.