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1.
Asian J Endosc Surg ; 16(3): 613-616, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37165303

RESUMO

For patients with perforated diverticulitis, many reports have focused on laparoscopic surgery without primary anastomosis. We performed laparoscopic surgery with primary anastomosis in three patients (two with Hinchey stage III, one with IV), with a median age of 53 years, all female, and no prior medical history. They all were hemodynamically stable. The median operation time was 91 minutes (range: 56-227 minutes) and the median blood loss was 50 mL (range: 0-200 mL). Their post-operative course was uneventful, and patients commenced oral intake at a median of 5 post-operative days and were discharged at a median of 12 post-operative days. This procedure may be an option for Hinchey stages III and IV diverticulitis.


Assuntos
Doença Diverticular do Colo , Diverticulite , Perfuração Intestinal , Laparoscopia , Peritonite , Humanos , Feminino , Pessoa de Meia-Idade , Doença Diverticular do Colo/cirurgia , Diverticulite/cirurgia , Colo Sigmoide/cirurgia , Laparoscopia/métodos , Anastomose Cirúrgica/métodos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Colectomia/métodos , Resultado do Tratamento , Peritonite/cirurgia
2.
Heart Vessels ; 38(6): 773-784, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36656354

RESUMO

The time-dependent changes in the natriuretic peptide families during sacubitril/valsartan (S/V) treatment remain obscure in the Asian heart failure (HF) cohort. Eighty-one outpatients with compensated HF were analyzed. The patients were divided into two groups based on the administration of S/V (n = 42) or angiotensin converting enzyme inhibitor (ACE-I; n = 39). Changes to the natriuretic peptide families and the daily dose of loop diuretics were evaluated 3 and 6 months after the intervention. The atrial natriuretic peptide (ANP) level was significantly increased (102 [63-160] pg/mL to 283 [171-614] pg/mL [3 months]; 409 [210-726] pg/mL [6 months]) in the S/V group but not in the ACE-I group. The dose of furosemide was significantly decreased during the six-month follow-up period in the S/V group (40 [20-40] mg to 20 [10-20] mg) but not in the ACE-I group. A multivariate logistic regression model showed that the presence of persistent atrial fibrillation (AF) and HF with a preserved left ventricular ejection fraction (HFpEF) was independently associated with a high delta-ANP ratio (≥ 4.5 ANP value on the start date/ANP value at 6 months; the mean value was used as the cutoff value) (odds ratio [OR]: 4.649, 95% CI 1.032-20.952 and OR: 7.558, 95% CI 1.427-40.042). The plasma level of ANP was increased, and the loop diuretic dose was decreased by the addition of neprilysin inhibitor therapy in patients with compensated HF. In patients with HFpEF and complicated persistent AF, neprilysin inhibitor therapy was associated with an increase in ANP.


Assuntos
Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico , Neprilisina , Tetrazóis/efeitos adversos , Função Ventricular Esquerda , Antagonistas de Receptores de Angiotensina/uso terapêutico , Valsartana/farmacologia , Valsartana/uso terapêutico , Peptídeos Natriuréticos/farmacologia , Peptídeos Natriuréticos/uso terapêutico , Combinação de Medicamentos , Vasodilatadores/farmacologia
3.
NMC Case Rep J ; 6(2): 61-64, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016103

RESUMO

Sarcoidosis is occasionally associated with malignant lymphoma. Cases of sarcoidosis associated with malignant lymphoma are called sarcoidosis-lymphoma syndrome. We report a 63-year-old man with sarcoidosis associated with primary central nervous system lymphoma (PCNSL). Definitive diagnosis by clinical and radiological findings was difficult. Finally, brain biopsy could produce the correct diagnosis. We could provide appropriate treatment for PCNSL and the patient has survived over 2 years. Thus, it is very important to make an early definitive diagnosis by biopsy for intracranial lesion, because it can prolong survival in patients with sarcoidosis.

4.
Cancer Sci ; 107(9): 1250-5, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27341700

RESUMO

High-linear energy transfer (LET) heavy ions have been increasingly employed as a useful alternative to conventional photon radiotherapy. As recent studies suggested that high LET radiation mainly affects the nonhomologous end-joining (NHEJ) pathway of DNA double strand break (DSB) repair, we further investigated this concept by evaluating the combined effect of an NHEJ inhibitor (NU7441) at a non-toxic concentration and carbon ions. NU7441-treated non-small cell lung cancer (NSCLC) A549 and H1299 cells were irradiated with X-rays and carbon ions (290 MeV/n, 50 keV/µm). Cell survival was measured by clonogenic assay. DNA DSB repair, cell cycle distribution, DNA fragmentation and cellular senescence induction were studied using a flow cytometer. Senescence-associated protein p21 was detected by western blotting. In the present study, 0.3 µM of NU7441, nontoxic to both normal and tumor cells, caused a significant radio-sensitization in tumor cells exposed to X-rays and carbon ions. This concentration did not seem to cause inhibition of DNA DSB repair but induced a significant G2/M arrest, which was particularly emphasized in p53-null H1299 cells treated with NU7441 and carbon ions. In addition, the combined treatment induced more DNA fragmentation and a higher degree of senescence in H1299 cells than in A549 cells, indicating that DNA-PK inhibitor contributes to various modes of cell death in a p53-dependent manner. In summary, NSCLC cells irradiated with carbon ions were radio-sensitized by a low concentration of DNA-PK inhibitor NU7441 through a strong G2/M cell cycle arrest. Our findings may contribute to further effective radiotherapy using heavy ions.


Assuntos
Cromonas/farmacologia , Quebras de DNA de Cadeia Dupla , Reparo do DNA/efeitos dos fármacos , Proteína Quinase Ativada por DNA/antagonistas & inibidores , Morfolinas/farmacologia , Radiossensibilizantes/farmacologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos da radiação , Reparo do DNA/efeitos da radiação , Pontos de Checagem da Fase G2 do Ciclo Celular/efeitos dos fármacos , Pontos de Checagem da Fase G2 do Ciclo Celular/efeitos da radiação , Humanos , Transferência Linear de Energia , Neoplasias Pulmonares
5.
Surg Today ; 44(1): 80-3, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23263446

RESUMO

PURPOSE: The aim of this study was to analyze the reasons and risk factors for intraoperative conversion from laparoscopic cholecystectomy to open cholecystectomy. METHODS: The study involved 407 patients in whom laparoscopic cholecystectomy was planned between January 1998 and July 2006. The patients were divided into two groups (the LC completed group and the conversion group), and the two groups were compared. RESULTS: Laparoscopic surgery was intraoperatively converted to open surgery in 47 cases (11.6 %). The reasons for the conversion consisted of adhesions (15 cases), inflammation (8 cases), adhesion plus inflammation (9 cases), bleeding (8 cases), common bile duct injury (4 cases), suspected common bile duct injury (1 case), injury of the duodenal bulb (1 case) and respiratory disorder (1 case). The group of patients who required conversion to open surgery had a significantly higher percentage of males (P = 0.042) and prevalence of acute cholecystitis (P < 0.001) than the group of patients for whom laparoscopic surgery could be completed. A multivariate logistic regression analysis of these significant predictors showed that male sex [odds ratio (OR) 1.95] and acute cholecystitis (OR 8.45) were significant. CONCLUSION: Particular attention is needed when laparoscopic surgery is considered for male patients with acute cholecystitis.


Assuntos
Colecistectomia Laparoscópica , Colecistectomia/métodos , Idoso , Perda Sanguínea Cirúrgica , Ducto Colédoco/lesões , Feminino , Humanos , Inflamação , Período Intraoperatório , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios , Fatores de Risco , Aderências Teciduais
6.
No Shinkei Geka ; 40(8): 711-6, 2012 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-22824577

RESUMO

A non-functioning paraganglioma is usually benign, however, it may cause distant metastases. There is no histological appearance for the diagnosis of malignancy or absolute criteria for predicting malignant potential. Bony metastases from paraganglioma are known to occur, but, skull metastases are very rare. We report a case of intracranial metastases from a renal paraganglioma. A 61-year-old male presented with temporal headache and exophthalmos on the left side. Seven years prior, he underwent surgery to remove a mass in the right renal hilum, which was diagnosed as renal cell carcinoma at that time. Computed tomography and magnetic resonance imaging showed a ring-like enhanced mass in the left middle fossa, which destroyed the sphenoid bone and the lateral wall of the orbit. Another osteolytic lesion was revealed in the occipital bone. The fragile tumor was totally resected. Histopathological study revealed the Zellballen pattern with extensive coagulation necrosis. No apparent nuclear atypia or mitosis were present. Immunohistochemistry showed reactivity for synaptophysin and chromogranin A in the tumor cells. Review of the surgical specimen of the previously resected renal tumor revealed the same pathological and immunohistochemical findings as those of chief cells in the middle fossa tumor. Thus, this tumor was diagnosed as a malignant paraganglioma metastasized from renal paraganglioma. After six cycle chemotherapy with cyclophosphamide and vincristine, his condition was stable for two years, however, he died four years after the diagnosis of malignancy.


Assuntos
Neoplasias Renais/patologia , Paraganglioma/patologia , Neoplasias Cranianas/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Ciclofosfamida/administração & dosagem , Evolução Fatal , Humanos , Imuno-Histoquímica , Neoplasias Renais/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraganglioma/terapia , Neoplasias Cranianas/terapia , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagem
7.
Artif Organs ; 31(2): 148-51, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17298404

RESUMO

An extracorporeal bioartificial liver (BAL) that could prevent death from hepatic encephalopathy in acute hepatic insufficiency was aimed to develop. A functional human hepatocellular carcinoma cell line (FLC-4) was cultured in a radial-flow bioreactor. The function of the BAL was tested in mini-pigs with acute hepatic failure induced by alpha-amanitin and lipopolysaccharide. When the BAL system was connected with cultured FLC-4 to three pigs with hepatic dysfunction, all demonstrated electroencephalographic improvement and survived. Relatively low plasma concentrations of S-100 beta protein, as a marker of astrocytic damage, from pigs with hepatic failure during BAL therapy were noted. BAL therapy can prevent irreversible brain damage from hepatic encephalopathy in experimental acute hepatic failure.


Assuntos
Reatores Biológicos , Encefalopatia Hepática/terapia , Fígado Artificial , Amanitinas , Animais , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Encefalopatia Hepática/sangue , Encefalopatia Hepática/induzido quimicamente , Lipopolissacarídeos , Masculino , Fatores de Crescimento Neural/sangue , Subunidade beta da Proteína Ligante de Cálcio S100 , Proteínas S100/sangue , Suínos , Porco Miniatura
8.
Surg Today ; 35(8): 639-44, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16034543

RESUMO

PURPOSE: Due to its recent clinical application, the results of Kugel herniorrhaphy have not yet been well documented. We analyzed our experience in performing 124 consecutive Kugel herniorrhaphies at a single institute. METHODS: Since the first introduction of Kugel herniorrhaphy in Japan in September 2001, a total of 117 patients (124 hernias) have undergone this procedure at our institute. The operative technique of Kugel herniorrhaphy was directly obtained through two hands-on training courses that were given by Dr. Kugel. The clinical results of the 124 hernias were analyzed, and to understand the feasibility of performing Kugel herniorrhaphy for various types of hernias, the operation time and the necessity for dividing the hernia sac were compared among each type based on the Nyhus classification. RESULTS: The operation times in types 2, 3A, 3B, 3C, and 4 were 48.5 +/- 19.5, 45.9 +/- 19.9, 54.2 +/- 24.8, 52.5 +/- 10.6, and 64.4 +/- 56.7 min, respectively, and the differences between each group were not statistically significant. In type 3A, no patient required a division of the hernia sac (0%), in contrast to 43% in type 3B. Peritoneal injury during operation and local hematoma/seroma were the most common complications (8.1% and 8.9%, respectively). Postoperatively the patients' quality of life factors, such as the analgesics needed, number of days before a return to normal activity, number of days before a return to work, and the recurrence rate of 0.9%, were comparable with other tension-free herniorrhaphy findings reported in the past. CONCLUSION: Our results suggest that Kugel herniorrhaphy is equally feasible for all types of Nyhus classifications, including femoral and recurrent hernias.


Assuntos
Hérnia Inguinal/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Resultado do Tratamento
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