腹腔鏡下に摘出し得た後腹膜ミュラー管嚢胞の1例

　ミュラー管嚢胞は泌尿生殖器系嚢胞の一種であり、後腹膜腔に発生することは非常に稀と言われている。今回、右後腹膜腔に発生した15cm大のミュラー管嚢胞を、腹腔鏡下に摘出し得た症例を経験したので報告する。　術前の画像診断では、腫瘍が後腹膜腔に位置していることが示唆された。嚢胞は単房性で壁が薄く、内部に充実成分を認めず、良性腫瘍の可能性が高いと判断し、腹腔鏡下手術を選択した。腫瘍は後腹膜脂肪織内に位置しており、周辺臓器との交通は認めなかった。腫瘍内容液の除去および核出操作にはダブルバルーンカテーテルの一種であるS.A.N.D.バルーンカテーテルを使用した。今回の方法を用いることで、腫瘍内容液の漏出を防ぎながら、嚢胞壁を残存させることなく摘出することが可能であった。術後の病理組織学的診断はミュラー管嚢胞であった。本症例の術後経過は良好で、現時点で再発徴候を認めていない。　後腹膜ミュラー管嚢胞では、嚢胞径が10cmを超える場合においても、内容液の除去方法や剥離操作を工夫することで腹腔鏡下手術が選択肢の一つになり得ることが示唆された

Clip Blade Scissoring With Titanium Bayonet Clip in Aneurysm Surgery - Two Case Reports

Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 52(2):84-86 (2012)journal articl

Early Changes in Tissue Perfusion After Tissue Plasminogen Activator Administration in Hyperacute Ischemic Stroke: Initial Experiences With Arterial Spin Labeling Perfusion Magnetic Resonance Imaging-Two Case Reports

Cerebral perfusion monitoring is an important component of hyperacute stroke treatment. Arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging provides a noninvasive method of cerebral perfusion observation. Rapid changes in cerebral perfusion were demonstrated in two patients admitted one hour after onset of hyperacute stroke who underwent recombinant tissue plasminogen activator (rt-PA) treatment. Serial MR images and ASL images were taken on admission and after rt-PA administration. Cerebral blood flow (CBF) values were obtained using the CBF workstation and analysis software. Interpretable ASL images were taken in both patients. Perfusion deficits were consistent with symptoms and/or MR angiography imaging abnormalities. Delayed arterial transit effect was present in one patient; serial imaging showed improvement of CBF after rt-PA treatment in both patients. ASL perfusion MR imaging can provide rapid noninvasive multislice imaging in hyperacute ischemic stroke, and can depict early perfusion deficit and quantify regional CBF concomitantly.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 53(4):213-216 (2013)journal articl

Clip Blade Scissoring With Titanium Bayonet Clip in Aneurysm Surgery

Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 52(2):84-86 (2012)journal articl

Early Changes in Tissue Perfusion After Tissue Plasminogen Activator Administration in Hyperacute Ischemic Stroke: Initial Experiences With Arterial Spin Labeling Perfusion Magnetic Resonance Imaging

Cerebral perfusion monitoring is an important component of hyperacute stroke treatment. Arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging provides a noninvasive method of cerebral perfusion observation. Rapid changes in cerebral perfusion were demonstrated in two patients admitted one hour after onset of hyperacute stroke who underwent recombinant tissue plasminogen activator (rt-PA) treatment. Serial MR images and ASL images were taken on admission and after rt-PA administration. Cerebral blood flow (CBF) values were obtained using the CBF workstation and analysis software. Interpretable ASL images were taken in both patients. Perfusion deficits were consistent with symptoms and/or MR angiography imaging abnormalities. Delayed arterial transit effect was present in one patient; serial imaging showed improvement of CBF after rt-PA treatment in both patients. ASL perfusion MR imaging can provide rapid noninvasive multislice imaging in hyperacute ischemic stroke, and can depict early perfusion deficit and quantify regional CBF concomitantly.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 53(4):213-216 (2013)journal articl