ヒドウジョウミャク オ オンゾン シタ ヒオンゾン ビソクスイ セツジョジュツ ショウカカン ニュウセン シュジュツゴ ノ ヒゾウ ノ タイセキ ヘンカ

Aim: There is a paucity of information about changes in splenic volume after surgery. The aim of this study was to investigate postoperative changes in splenic volume（SV）and the factors influencing SV after spleen-preserving distal pancreatectomy（SPDP）with conservation of the splenic artery and vein （CSAV）, and after surgery of the digestive tract and breast.Methods: We investigated 113 patients who underwent SPDP with CSAV（n=7）, breast surgery （n=24）, colorectal surgery（n=45）, distal gastrectomy（n=27）and total gastrectomy（n=10）. SV changes were determined for three years after surgery using volumetry based on computed tomographic imaging, and splenic vein diameter changes after SPDP with CSAV were also determined.Results: Splenic vein diameter after SPDP with CSAV did not change during 3 years. SV did not change significantly during 3 years after SPDP with CSAV and distal gastrectomy. After breast and colorectal surgery, and total gastrectomy, SV was decreased.Conclusions: Postoperative SV changes differed according to the type of surgery. SV did not change significantly during 3 years after SPDP with CSAV

Single-Incision Laparoscopic Surgery for Undiagnosed Small Bowel Obstruction in a Patient without a History of Abdominal Surgery

We herein report a 66-year-old female patient who developed an undiagnosed small bowel obstruction without a history of prior abdominal surgery and was successfully treated by single-incision laparoscopic surgery. A small bowel obstruction with unknown cause typically requires some sort of surgical treatment in parallel with a definitive diagnosis. Although open abdominal surgery has been generally performed for the treatment of small bowel obstructions, laparoscopic surgery for small bowel obstructions has been increasing in popularity due to its less invasiveness, including fewer postoperative complications and a shorter hospital stay. As a much less invasive therapeutic strategy, we have performed single-incision laparoscopic surgery for the treatment of an undiagnosed small bowel obstruction. We were able to make a definitive diagnosis after sufficient intra-abdominal inspection and to perform enterotomy through a small umbilical incision. Single-incision laparoscopic surgery appears to be comparable to conventional laparoscopic surgery and provides improved cosmesis, although it is an optional strategy only applicable to selected patients

Efficacy of the modified anvil grasper for laparoscopic intra-corporeal circular stapled anastomosis

The traditional anvil grasper may be difficult to use for connecting the stem of an anvil with the centre rod of a circular stapler because the grasper holds the anvil completely still. In addition, the head angle is fixed and cannot handle the anvil head delicately in a tight pelvic space. Many surgeons use a grasper designed for holding the bowel or a dissector for holding the anvil during intra-corporeal circular stapled anastomosis during low anterior resection, sigmoidectomy, left hemi colectomy and know that it is difficult to connect segments with these instruments due to slipping. A new modified anvil grasper was developed with curved blades that can easily grasp the stem of an anvil and smoothly connect it with the centre rod of the circular stapler. This grasper should be useful for surgeons performing laparoscopic intra-corporeal circular stapled anastomoses, which are the most challenging part of laparoscopic colorectal surgery

Serum big endothelin-1 as a clinical marker for cardiopulmonary and neoplastic diseases in dogs

【Aims】 Many studies of human subjects have demonstrated the utility of assessing serum levels of endothelin-1 (ET-1) and big ET-1 as clinical biomarkers in cardiopulmonary and neoplastic diseases. In this study we explored the feasibility of using serum big ET-1 as a reliable veterinary marker in dogs with various cardiopulmonary and neoplastic diseases. 【Main methods】 Serum big ET-1 levels were measured by ELISA in dogs with cardiopulmonary (n = 21) and neoplastic diseases (n = 57). Dogs exhibiting cardiopulmonary disease were divided into two groups based on the velocity of tricuspid valve regurgitation (3.0 > m/s) measured by ultrasound: without and with pulmonary hypertension. Big ET-1 levels for the dogs with the diseases were compared with levels in normal healthy dogs (n = 17). 【Key findings】 Dogs with cardiopulmonary disease (4.6 ± 4.6 pmol/l) showed a significantly (P < 0.01) higher level of big ET-1 than healthy control dogs (1.1 ± 0.53 pmol/l). Serum levels in the dogs with pulmonary hypertension (6.2 ± 5.3 pmol/l) were significantly (P < 0.01) higher than those without pulmonary hypertension (2.0 ± 0.6 pmol/l). Dogs with hemangiosarcoma (5.6 ± 2.2 pmol/l), adenocarcinoma (2.0 ± 1.8 pmol/l), histiocytic sarcoma (3.3 ± 1.9 pmol/l), chondrosarcoma or osteosarcoma (3.0 ± 1.6 pmol/l) and hepatocellular carcinoma (2.7 ± 1.8 pmol/l) showed significantly (P < 0.05) higher levels than healthy control dogs. 【Significance】These findings point to the potential of serum big ET-1 as a clinical marker for cardiopulmonary and neoplastic diseases in dogs