根治的前立腺全摘例の臨床病理学的検討 : 少数例施設の妥当性

A total of 161 patients underwent radical retropubic prostatectomy at our 11 institutions in the three-year period from January 2001 to December 2003. The numbers per institution ranged from 1-36, with 5 institutions conducting 20 or more (131 cases), and 6 performing less than 15 (30 cases). Here we examined the differences in operation parameters and patient outcome between these two groups. Time for surgery, associated loss of blood, lymphadenectomy, preservation of neurovascular bundles, time for removal of indwelling catheters, post-operation complications, and subsequent urinary incontinence, were assessed. There were no differences between the two groups of hospitals, except with regard to surgery time and incontinence, where the period to 'pad-free' was an average of more than 40 days longer in institutions undertaking only a small number of operations. From our experience with radical retropubic prostatectomy, series of hospitals, there is no reduction in safety with such intervention performed by institutions undertaking only a small number of operations.われわれの関連病院における, 根治的前立腺全摘例での少数例施設の妥当性についてレトロスペクティブに検討した。2001年1月から2003年12月までの3年間に施行した11施設, 161例の根治的前立腺全摘例を対象とした。1施設あたりの症例数は1例から36例で, 20症例以上の5施設131例と, 14例以下の6施設30症例で2群間での比較検討を行った。手術時間, 出血量, リンパ節郭清の有無, 神経温存の有無, カテーテル留置期間, 術後合併症, 術後尿失禁の状態について検討した。その結果, 手術時間の有意な延長と, パットフリーになるまでの期間が少数例の施設において平均で40日以上長くかかった。他のすべての項目においては有意な差はなかった。以上の結果から, われわれの関連病院における根治的前立腺全摘術は, 少数例の施設においては術後尿失禁の程度はやや劣るものの, 安全に施行されていることが示唆された。(著者抄録

The left inferior phrenic artery arising from left hepatic artery or left gastric artery: Radiological and anatomical correlation in clinical cases and cadaver dissection

Background: The purpose of this study is to assess angiographic and CT appearance of left inferior phrenic artery (LIPA) arising from left hepatic or left gastric artery and to recognize its specific anatomical location with the help of cadaver dissection. Methods: We retrospectively reviewed 761 abdominal angiographies and found 13 patients (1.7%) with LIPA arising from left hepatic or left gastric artery. We classified those origins and assessed radiological features. We also presented a cadaver dissection to identify anatomical location of LIPA arising from left hepatic artery. Results: The origin of the LIPA was classified as follows: (a) left hepatic artery: four, (b) accessory left gastric artery: one, (c) accessory left hepatic artery: three, and (d) left gastric artery: five patients. The proximal portion was located in gastrohepatic ligament and its distal portion was located in front of esophageal hiatus. In a cadaver dissection, the proximal portion ascends along ligamentum venosum and distal portion courses along superior aspect of left hemi diaphragm in front of esophagus. Conclusion: The LIPA rarely arises from left hepatic or left gastric artery. The proximal portion was located in gastrohepatic ligament and the distal portion runs in front of the esophageal hiatus. © 2007 Springer Science+Business Media, LLC.Link_to_subscribed_fulltex

Positional relationships between the masticatory muscles and their innervating nerves with special reference to the lateral pterygoid and the midmedial and discotemporal muscle bundles of temporalis

For an accurate assessment of jaw movement, it is crucial to understand the comprehensive formation of the masticatory muscles with special reference to the relationship to the disc of the temporomandibular joint. Detailed dissection was performed on 26 head halves of 14 Japanese cadavers in order to obtain precise anatomical information of the positional relationships between the masticatory muscles and the branches of the mandibular nerve. After complete removal of the bony elements, the midmedial muscle bundle in all specimens and the discotemporal muscle bundle in 6 specimens, derivatives of the temporalis, which insert into the disc were observed. On the anterior area of the articular capsule and the disc of the temporomandibular joint, the upper head of the lateral pterygoid, the midmedial muscle bundle of temporalis and the discotemporal bundle of temporalis were attached mediolaterally, and in 3 specimens the posterosuperior margin of the zygomaticomandibularis was attached to the anterolateral area of the disc. It is suggested that these muscles and muscle bundles contribute to various mandibular movements. Although various patterns of the positional relationships between the muscles and muscle bundles and the their innervating nerves are observed in the present study, relative positional relationships of the muscles and muscle bundles and of nerves of the mandibular nerve are consistent. A possible scheme of the developmental formation of the masticatory muscles based on the findings of the positional relationships between the muscles and the nerves is presented

Anatomical study of the obturator internus, gemelli and quadratus femoris muscles with special reference to their innervation

The manner of innervation of the obturator internus, superior and inferior gemelli, and the quadratus femoris in humans (101 pelvic halves) and in rheus monkeys (Macaca mulatta: 8 pelvic halves) were investigated. In most specimens, the inferior gemellus originated from the lateral surface of the ischial tuberosity and also from the medial surface (intrapelvic origin) just beneath the obturator internus and was covered by the falciform process of the sacrotuberous ligament. The superior gemellus was frequently innervated by the nerve to the obturator internus and the nerve to the quadratus femoris (60.4%) qnd the inferior gemellus was innervated by the obturator internus nerve in two specimens. The quadratus femoris nerve originated from more cranial segments than the obturator internus nerve, however these nerves had various communication patterns inside and outside the muscles. According to the intramuscular nerve distribution, in some specimens the branches to the superior gemellus from the quadratus femoris nerve extended to the inferior gemellus, and the branches to the inferior gemellus were distributed to the obturator internus. The present findings revealed that the positional relationships among the branches to the obturator internus and gemelli muscles are relatively constant, although the branching patterns and innervation patterns were varied. The various patterns and routes are considered to reflect the variability of the differentiation patterns of the anlage of the muscles. A possible schematic model of the positional relationships between the muscles and the nerves is proposed. Key Words: obturator internus; quadratus femoris; gemelli muscles; innervation; sacral plexus; human gross anatomy; comparative morpholog

A case of an Aberrant branch from the posterior brachial cutaneous nerve to the latissimus dorsi: a vestigeal part of the dorsoepitrochlearis?

Summary: During dissection, an aberrant muscular nerve to the small part of the latissimus dorsi arising from the posterior brachial cutaneous nerve was found. Based on the findings of the form and the innervations, the small part is considered to be a vestige of the dorsoepitrochlearis in mammals. It is suggested that the posterior brachial cutaneous nerve is derived from the nerve to the dorsoepitrochlearis (Kasai et al., 1989, Acta Anat Nippon 64:255-266). This case may be indirect evidence indicating one of the patterns of development of cutaneous nerves in man

Posteromedial capsular anatomy of the tibia for consideration of the medial meniscal support structure using a multidimensional analysis

Abstract Medial meniscal extrusion (MME) is a structural abnormality that leads to early knee osteoarthritis; however, its formation remains debated. For anatomical consideration of the mechanism underlying MME formation, we examined the capsular attachment on the posteromedial tibia and its layered association with the semimembranosus. Fourteen knees of eight body donors were analyzed in this study; six knees were grouped for macroscopic analysis, whereas four knees each were grouped for histological and phosphotungstic acid-enhanced micro-computed tomography analyses. The capsular attachment varied in width according to location and was not distant from the articular cartilage and posterior root. A portion of the posteromedial joint capsule formed the semimembranosus tendinous sheath. The dense fibrous membrane superficial to the semimembranosus, which was continuous from its tendinous sheath, existed as one of the layers of the joint capsule. The aforementioned findings were confirmed in all specimens. Based on the capsular attachment and its layered association with the semimembranosus, the conventional posteromedial knee ligaments may be only a part of the joint capsule divided into two layers by the semimembranosus. If the coordinated action of the joint capsule and semimembranosus partially contributes to the medial meniscus stability, such a structural problem may affect MME formation