職員の主観的苦痛度表を用いた業務量の把握

Article長野県透析研究会誌 29(1): 20-24(2006)journal articl

Clinical outcomes of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor

Background: Laparoscopic and endoscopic cooperative surgery (LECS) is a well-recognized surgical procedure for gastric gastrointestinal stromal tumor (GIST). In this report, we describe the clinical outcomes of LECS procedures for gastric GIST in our institution. Methods: We performed LECS procedures, including classical LECS, inverted LECS, closed LECS, and combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), in 40 gastric intraluminal and intramural type GIST patients, whose tumors were ≤ 50 mm in diameter, between September 2012 and December 2020. The patient background, surgical outcomes, postoperative morbidity and mortality, as well as the tumors' clinicopathological characteristics were analyzed retrospectively. Results: Pathological findings showed that most patients had a low or very low risk of tumor recurrence, while one patient had a high risk according to the modified-Fletcher's classification. The median length of postoperative hospital stay was 7 days. Only one patient had severe postoperative grade III complications according to the Clavien-Dindo (C-D) classification, after closed LECS, but was treated successfully with endoscopic hemostasis for postoperative hemorrhage. The remaining patients treated with LECS did not have severe complications. During the follow-up period (median, 31 months), all patients were disease-free, with no tumor recurrence or metastases. Conclusion: LECS is a safe surgical procedure for gastric intraluminal and intramural type GIST ≤ 50 mm in diameter, with good clinical outcomes

Lymphangiography in Cases of Chyluria : I. Findings of Lymphangiography and its Clinical Evaluation

Part 1 We have been studying the pathophysiological aspects of chyluria. In this part of the present paper, we have reported the findings of lymphangiography (LAG) in chyluria as follows: 1) Lymphangiography was done by Kinmonth\u27s method. Popiodole was used as the contrast medium. 2) Thirty-eight cases were classified into three groups by the periods between the onset and the application of LAG. Group A, under one years duration: Group C, three years or longer duration: Group B, the rest. Group A included 14 cases: Group B, 9 cases: Group C, 15 cases. Cases were fewer among the young generation and frequent among the middle-aged or old over 40 years of ages. 3) Lymph-backflow was demonstrated in all but two cases, in which the failure to visualize the change was most probably due to technical problems (94.7%). This backflow was almost specific for chyluria because only one case with a retroperitoneal tumor showed the backflow out of 240 cases with other diseases than chyluria. The backflow was observed to start from the Truncus lumbaris and to run up to the kidney. Chyle-reflux from the Cisterna chyli was not detected radiologically. 4) The abnormal changes of Truncus lumbaris were found in all cases of chyluria irrespective of patients\u27 past histories. The changes of lymph-vessels at this region appeared to be indispensable for and take a major role in the pathogenesis of chyluria. 5) Changes of pelvic lymph-vessels were severer in the cases of long duration. These seemed to be secondary changes than primary ones. 6) Distinct occlusion or stenosis of the thoracic duct was never found: It gave no evidence of obstruction of the lymphatic passage through the duct. 7) Based on the above-mentioned results, the pathogenetic mechanism of chyluria was discussed