Laparoscopic Repair of a Ventral Hernia Using Composix E/X Dual Mesh at a Single Institution.

Introduction: Although abdominal ventral hernias are common, there is still no consensus regarding the most appropriatetechnique to be used for surgical repair. We herein present our initial experiences of laparoscopic ventral herniorrhaphy to repairabdominal ventral hernias.Patients: From April 2007 to March 2009, four patients were assigned to recieve laparoscopic ventral hernia repair. The operativetechnique was demonstrated. Additionally clinical factors, including operative time, length of hospital stay, complications,and recurrence rates, were evaluated.Results: All of the patients were successfully treated laparoscopically without conversion to open laparotomy. The median operativetime was 107.5 (range 75 - 130) minutes and the mean length of hospital stay was 13 (range 5 -19) days. There wereno significant complications or hernia recurrences during a follow-up period of 36 months ( median, 28 - 42 ).Conclusion: Laparoscopic repair of abdominal ventral hernias may therefore be a feasible option with a great potential to bothimprove treatment outcomes and reduce surgical morbidity

Small Mucinous Cystic Neoplasm of the Pancreas Successfully Detected and Resected by a Laparoscopic Approach: Report of a Case

Incidentally detected small pancreatic cyst is a therapeutic challenge. As these lesions include a spectrum of pathologies ranging from benignlesions to malignant mucinous tumors, it is important to differentiate potential malignant mucinous cystic neoplasms (MCN) from others.However, a definitive diagnosis might be difficult, since computed tomography (CT) and magnetic resonance imaging (MRI) cannot depict themorphologic features characteristic of small MCN.This report presents a case of a small pancreatic cyst incidentally detected during medical check-up for inguinal hernia. Although the preoperativediagnosis was uncertain with CT and MRI, the diagnosis of MCN was strongly suspected because the majority of MCN tend to oftenoccur in elderly women and the most common locations are in the pancreatic tail. Laparoscopic ultrasonography (LUS) was employed to obtaina correct diagnosis, and it showed a 16 mm cyst with characteristic features indicating a diagnosis of MCN. The patient underwent alaparoscopic distal pancreatectomy and the diagnosis of MCN was confirmed histopathologically. In conclusion, LUS allowed a timely curativeresection of a small MCN in this case

Laparoscopic Management of Omental Torsion Secondary to Inguinal Hernia: Report of a Case

Omental torsion is a rare cause of acute abdomen. The clinical symptoms can mimic other acute abdominal disorders, and therefore manypatients are often diagnosed during a laparotomy performed under a presumptive diagnosis of appendicitis, cholecystitis and so on. Recent advancesin diagnostic modalities has made it possible to determine the correct preoperative diagnosis of omental torsion, and the chances oftreating this rare condition are therefore expected to increase. Laparoscopic surgery has been used extensively for various emergent disorders;however, the laparoscopic management of omental torsion might be troublesome for most surgeons. A case of omental torsion secondary toinguinal hernia is herein reported, where a huge torted omentum was successfully managed laparoscopically. It was useful to hang up thepedicle of the congested and fragile omentum with polyester tape to manage it atraumatically. Moreover this device made it easy to removeof the specimen through a 4-cm minilaparotomy

Spontaneous Pneumomediastinum: Report of a Case and Review of Literature

Spontaneous pneumomediastinum, defined as the presence of free air in the mediastinal structures, is a rare disease that usually take a good course with conservative therapy. However, clinicians are usually unfamiliar with the disease because of its infrequency. We report herein a case of spontaneous pneumomediastinum following an episode of violent cough. The patient was treated conservatively after hospitalization and got well without any medical problems. In addition we reviewed characteristics of spontaneous pneumomediastinum reported so far in the Japanese literature. The result of our review suggests that the typical patient with spontaneous pneumomediastinum is a young man with a slender build. In most patients, spontaneous pneumomediastinum occurs in conjunction with condition causing high airway pressure. None of the patients described in the literature developed serious complications such as cardiac insufficiency or airway compromise, and none of the cases without concomitant pneumothorax required any medical care. In conclusion, familiarity with this rare disease is crucial to provide appropriate treatment

Positivity for cancer stem cell markers, CD44 and CD133, is a useful biomarker for predicting the outcomes of patients with advanced gastric cancer

Background; The CD44 and CD133 expressions have been identified to be putative cancer stem cell (CSC) markers. Some reports have revealed a correlation between these CSC markers and a poor prognosis in the clinical setting. However, clinical impact of combined use of these markers has not been determinated in advanced gastric cancer.Methods; Specimens were obtained from 73 patients with gastric cancer with invasion beyond the muscularis (T3/4a) who underwent curative gastrectomy. Immunohistochemically, tumors with more than 5% CD44-positive cells or at least one CD133-positive cancer cell were regard as being CSC marker-positive.Results; Forty patients were CSC marker-positive. There were significant correlations between the CSC marker expression and the extent of lymphatic (p=0.04) and vessel invasion (p<0.001). The CSC marker-positive patients exhibitedpoor prognoses in both the overall (p=0.006) and disease-free survival analyses (p=0.019). Based on the results of the univariate analysis, the peritoneal CEA value, the extent of lymph node metastasis and CSC marker positivity were analyzed in the multivariate analysis. The results revealed that the extent of lymph node metastasis (p<0.001) and CSC marker positivity (p=0.04) were significant risk factors.Conclusion; CSC marker positivity is an independent prognostic factor in patients with T3/4a gastric cancer

Study Protocol for Assessing the Efficacy of Compression Therapy Using Stockings and Sleeves to Prevent Docetaxel-Induced Peripheral Neuropathy in Breast Cancer Patients

Taxanes are key drugs for patients with breast cancer. A major adverse effect associated with the administration of the taxane docetaxel is chemotherapy-induced peripheral neuropathy (CIPN). We are conducting a singlecenter, single-arm, open-label historical control trial to evaluate the ability of compression therapy using stockings or sleeves to prevent CIPN due to docetaxel treatment. The primary endpoint is the incidence of all-grade CIPN according to patients’ records until 3 weeks after the fourth docetaxel administration. This study’s results will clarify whether compression therapy using stockings or sleeves can prevent CIPN in breast cancer patients

Aesthetic pectoral muscle flap repair for refractory enterocutaneous fistula after salvage esophagectomy in a female patient

Anastomotic leakage is a severe complication of esophagectomy. Development of an enterocutaneous fistula after anastomotic leakage often occurs after subcutaneous-route reconstruction at esophagectomy. Pectoralis myocutaneous flap (PMCF) repair has recently been performed when an enterocutaneous fistula was refractory to conservative treatment. However, this procedure requires a conspicuous incision and results in deformity of the breast especially in female patient. We performed pectoralis muscle flap (PMF) repair for a 50-year-old woman with a refractory enterocutaneous fistula after salvage esophagectomy. We made an oblique incision along the inframammary crease in order to avoid a conspicuous scar and moved the PMF under the mammary gland to the site of anastomosis. This method was effective for repairing a refractory enterocutaneous fistula, with especially good aesthetic results in a female patient

The preoperative thyroid function and perioperative course in patients with Graves\u27 disease

Graves\u27 disease is an autoimmune disorder that induces increase in thyroid hormone production and release. Although euthyroidshould be desirable to ensure a safe operation, some patients still undergo thyroidectomy with hyperthyroidism. The aimof this study was to evaluate our preoperative strategies in patients with Graves\u27 disease. A total of 186 patients underwent thyroidectomy for Graves\u27 disease between 2003 and 2017. We gave all of these patients potassium iodide (KI) in order todecrease their thyroid hormone levels. We compared the clinical factors among three groups defined by the value of serumfree triiodothyronine (FT3) after the administration of KI: (1) the good control group (n=126) with ?6.0 pg/mL, (2) the fair control group (n=35) with >6.0 but ?10.0 pg/mL, and (3) the poor control group (n=25) with >10.0 pg/mL. KI decreased the serumlevels of thyroid hormone. However, some patients still had hyperthyroidism, and the subsequent administration of corticosteroidreduced FT3 but not thyroxine. Regarding the intraoperative course, the heart rate at 1 h after beginning general anesthesiawas higher in the poor control group than in the good control group (p<0.05), and the proportion of patients givenadrenergic beta-blocker was higher in the poor control group than in the other groups (p<0.01 each). One patient in the faircontrol group experienced suspected thyroid storm after total thyroidectomy. The occurrence rate of other deteriorations wasidentical among the three groups. With preparative KI and corticosteroid administration, almost all patients with Graves\u27 disease were able to undergo thyroidectomy safely

Surgical assessment system reflexes and facilitates the developing the surgical skills of trainees for the Laparoscopic Distal Gastrectomy

Background: To assess laparoscopic distal gastrectomy (LDG) for gastric cancer (GC), the Japanese Operative Rating Scale (JORS) for LDG has been developed. This study evaluated the learning curve of the initial experience of LDG for GC using JORS-LDG.Methods: Thirty-one cases of LDG were performed by a trainee. The trainee and an instructor scored the surgical performance using JORS-LDG immediately after LDG. The 31 cases were evenly divided into early phase (EP), middle phase (MP), and late phase (LP).Results: The trainee successfully completed all cases of LDG without any complications. There were also no severe postoperative complications with Clavien–Dindo classification grade III or higher. The average JORS-LDG points were stable after 24 cases of experience in the CUSUM analysis. The median JORS-LDG points in EP were significantly lower than those in LP (EP: MP: LP = 43.5: 44.3: 45.5, P = 0.02). In operative data, procedure time, bleeding, and the drain fluid amylase level were correlated with the JORS-LDG points.Conclusion: The JORS-LDG scoring system is a practical tool to evaluate surgical performance in the initial LDG experience

Management of Spontaneous Portosystemic Shunts in 231 Patients Who Underwent Living Donor Liver Transplantation: A Retrospective Study from a Single Center in Nagasaki, Japan

The molecular mechanisms underlying the conspecific cue-mediated larval settlement in Crassostrea gigas is not yet fully understood. In this study, we described and compared the tran-scriptomes of competent pediveligers (Pedi) and conspecific cue-induced postlarvae (PL). A total of 2383 candidate transcripts were identified: 740 upregulated and 1643 downregulated transcripts, after settlement. Gene Ontology analysis revealed active chitin binding, calcium ion binding, and extracellular region processes in both stages. Results showed that the differential expression trend of six candidate transcripts were consistent between the quantitative real-time PCR and transcriptome data. The differential transcript expression related to shell formation showed closely linked dynam-ics with a gene regulatory network that may involve the interplay of various hormone receptors, neurotransmitters, and neuropeptide receptors working together in a concerted way in the Pedi and PL stages. Our results highlight the transcriptome dynamics underlying the settlement of oysters on conspecific adult shells and demonstrate the potential use of this cue as an attractant for wild and hatchery-grown oyster larval attachment on artificial substrates. It also suggests the possible in-volvement of an ecdysone signal pathway that may be linked to a neuroendocrine-biomineralization crosstalk in C. gigas settlement