原発性小腸癌の外科切除例における予後予測因子としてのゲノム解析

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Management of occult obscure gastrointestinal bleeding patients based on long-term outcomes

Background: There is no consensus regarding the management of occult obscure gastrointestinal bleeding (OGIB) patients without a confirmed bleeding source. This study aimed to consider the management of occult OGIB patients based on their long-term outcomes. Methods: We retrospectively enrolled 357 consecutive occult OGIB patients (203 men; mean age: 59.7 years) who underwent capsule endoscopy (CE) at Hiroshima University Hospital, Japan and were followed up for more than 12 months (mean follow-up period; 50.2 months). Patients were divided into three groups as follows: Group A consisted of 98 of 157 patients who had positive findings and indication for treatment, Group B consisted of 59 of 157 patients who had positive findings but no indication for treatment, and Group C consisted of 200 patients who had negative small-bowel findings. We examined the rate of positive CE findings, detection rate and details of bleeding sources, overt bleeding rate, the rate of anemia exacerbation, 5-year anemia exacerbation rate, and overall survival rate. Results: The positive CE findings rate was 44% (157/357) and detection rate of bleeding source was 27% (98/357). The details of Group A were as follows: angioectasia ( n = 61), nonspecific ulceration ( n = 10), nonsteroidal anti-inflammatory drug-induced ulcer ( n = 8), and others ( n = 19). The details of Group B were as follows: erythema ( n = 31), angioectasia ( n = 25), and others ( n = 3). There were no patients with overt bleeding in Group B. Although six patients had anemia exacerbation in Group B, they had angioectasia without a bleeding source. Conclusion: The long-term outcomes of occult OGIB patients were good. Occult OGIB patients without bleeding source lesions may not require follow-up CE

Surgical Resection of Twenty-Three Cases of Brain Meningioma

The aim of this study was to report the effectiveness of MRI scanning during brain meningioma resection surgery in the canine and feline. The subjects were 23 cases from 2006 to 2008 in canines and feline diagnosed with meningioma. All were between 8 and 16 years of ages. There were 12 males and 11 females. An appropriate craniotomy was performed for each case according to the initial MRI taken to diagnose meningioma prior to the surgery. Once the dura mater was exposed, an MRI biopsy needle was placed in the tumor as a guide. The first MRI sequence during the surgery was performed with this needle to confirm the location of the tumor. This MRI image was also processed and displayed by multi planar reconstruction to reveal the tumor extent in three dimensions. A Sonopet was applied to the middle of the tumor to destroy the inner part and release pressure from the entire tumor. Creating some space between the brain tissue and tumor, we treated blood vessels and carefully resected them. This procedure was repeated until complete removal of the tumor was confirmed by MRI. Sixteen of the 23 cases survived for more than 2 years postoperatively. The other seven died due to other disorders within 2 years. Our method with MRI navigation during the surgery improved our surgical performance and contributed to a prolonged survival time for the patients. In order to perform multiple MRI procedures smoothly during the surgery, it is necessary to have skillful assistants