セイジン ソケイ ヘルニア ノ アプローチホウ ニヨル ビョウケイ シンダンノウ ニ ツイテ

Objective : To compare a laparoscopic transabdomina approach and anterior approach for inguinal repair regarding detectability of type Ⅳ hernia. Summary Background Data : Advantages of laparoscopic transabdominal preperitoneal（TAPP）inguinal hernioplasty, the accuracy of diagnosis is strongly emphasized, but this theory has not verified. Herein, we study this advantage retrospectively. Methods : A retrospective comparative study of８０７elective repairs of a inguinal hernia repair was performed : a control group ０f ３４１ patients undergoing anterior hernia repair with or without prosthesis and a study group of ４６６patients undergoing TAPP repair. Intraoperative diagnosis type of hernia was studied. Result : Fifty-five patients（１１．８％）detected type Ⅳ lateral hernia in the TAPP group as compared to seven（２．０％）patients in the anterior group. （p ＜０．０１）. Conclusions : laparoscopic transabdominal approach can be considered significantly（p＜ ０．０１）superior to anterior approach with regard to detectability of type Ⅳ hernia

ジャクネン セイジン ノ TAPP リョウホウゴ チョウキ ケイカレイ ノ バンキ サイハツリツ バンキ ガッペイショウ マンゾクド ニ タイスル ケントウ

Objective : This study evaluated the long-term outcome after laparoscopic transabdominal preperitoneal（TAPP）inguinal hernioplasty for young adults cases. The first goal is to measure recurrence rate. The second goals are late symptoms, complication, and patient’s satisfaction rate. Method : Young adults patients who underwent TAPP repairs between １９９５ and ２００４ were requested to fill in a postal questionnaire,１９patients are eligible to this study. Study participants ranged from ２０ to ４０ years, with an average age of ３２ years. One participant was female and eighteen participants were male. Follow up range was ５ to１３years, with a mean of ８．２years. Pt’s satisfaction scales ranging from １（not satisfied）to ５（very satisfied）were used. Participants checked yes or no about late symptoms, complications, and recurrence. Result : Of１９operated patients,１４patients（７３．６％）responded. One patient（７．１％）had symptomatic hernia recurrence. Long-term groin discomfort（occasional）occurred in ４ patients（２８．６％）. But there are no patient feeling groin discomfort interfered with daily activity. Pt’s satisfaction rates were５（very satisfied）：２８．６％,４：５０．０％,３：１４．２％,２：０％,１（very dissatisfied）：７．１％. None of them were required mesh removal. CONCLUSION : TAPP repair is a feasible procedure for young adult with acceptable rate of recurrence, no severe complication, late symptoms, and pt’s satisfaction rate

Preventive Effect of Proglumide on Erosive Gastritis in the Rat

The purpose of this study is to determine whether or not proglumide has a preventive effect on the erosive gastritis induced by sodium salt of taurocholic acid (TCA) in the rat. Its effect on the formation of gastric erosions, serum gastrin levels and secretion of acid and pepsin were also studied. The rats were given standard feed containing 0.25% proglumide and water containing 5mM TCA (experimental E group). The control rats were given standard feed and water containing 5mM TCA (TCA group). All rats were killed at the end of the 3 months. The tissue specimens of the resected gastric mucosa were stained with hematoxylin eosin for histopathology and with azan for evaluation of fibrous ploriferation. From microscopic observation of the stained specimens, the following results were obtained. TCA-group showed long mucosal surface injury (erosion), inflammatory cell infiltration, a reduction in the number of parietal cells, a decrease of mucosal thickness, and proliferation of collagenous fiber. In contrast, in the E group, these morphological and morphoquantitative changes were significantly small. The length of erosion and inflammatory cell infiltration were significantly reduced in the E group when compared with the TCA group. Furthermore, mucosal thickness was almost normal and fibrous proliferation was significantly scarce in the E group. Proglumide had an insignificant effect on pH on the mucosa, volume and pH of gastric juice, serum gastrin levels and tetragastrin-induced secretion of acid and pepsin. It is, thus, evident that proglumide has a preventive effect on the induction of erosive gastritis caused by TCA in the rats. Since it is difficult to explain its mechanism for the prevention of gastritis from only the already known facts that it has protective action on gastric mucosa and an inhibitory effect on secretion of acid and pepsin, unknown mechanisms are suspected to be involved

セイジン ソケイ ヘルニア ジュツゴ カンセン ニヨル prosthesis ジョキョレイ ノ ケントウ

Objective : Prosthesis removal is one of important complication in the hernia repair. A clinical investigation was made on cases of prosthesis removal following surgery for inguinal hernia. Methods : We performed ４６６ laparoscopic transabdominal preperitoneal （TAPP） inguinal hernioplasty for inguinal hernia and ２３２ open mesh inguinal hernia repair at our institution from March １９９５ to March ２０１０. These ６９８ cases were enrolled in this clinical study. Prosthesis removal was retrospectively assessed. Result : The five cases who underwent open mesh repair were required the removal of the prosthesis. These all cases were delayed onset infection. On the other hand, no patients who underwent TAPP repair were required removal of the prosthesis. Patients who underwent open mesh repair had high risk for the removal of the prosthesis compared to patients who underwent TAPP repair. Conclusions : Patients with inguinal hernia who undergo TAPP repair have fewer removal of the prosthesis than those who underwent open mesh repair

A Galanin-Like Peptide in the Colon of the Golden Hamster

Galanin-like immunoreactive peptide was studied in the colonic wall of the golden hamster using the immunoflurescent technique. Galanin-like immunoreactivity was observed mainly in cell bodies of the myenteric plexus and in fibers in the lamina propria mucosae and in the circular muscle layer. The submucosal plexus and submucosal connective tissue, however, contained very little galanin-like immunoreactive peptide. This peptide appears to be instrinsic mainly to the colon. The presence of the peptide indicates some possible biological roles in the colonic function

Preoperative Graft Volume Assessment with 3D-CT Volumetry in Living-Donor Lobar Lung Transplantations

To determine the effectiveness of living-donor lobar lung transplantation (LDLLT), it is necessary to predict the recipient's postoperative lung function. Traditionally, Date's formula, also called the segmental ratio, has used the number of lung segments to estimate the forced vital capacity (FVC) of grafts in LDLLT. To provide a more precise estimate of graft FVC, we calculated the volumes of the lower lobe and total lung using three-dimensional computed tomography (3D-CT) and the volume ratio between them. We calculated the volume ratio in 52 donors and tested the difference between the segmental volume ratios with a one-tailed t-test. We also calculated the predicted graft FVC in 21 LDLLTs using the segmental ratio pFVC(c) and the volume ratio pFVC(v), and then found the Pearson's correlation coefficients for both pFVC(c) and pFVC(v) with the recipients' actual FVC (rFVC) measured spirometrically 6 months after surgery. Significant differences were found between the segmental ratio and the average volume ratio for both sides (right, p＝0.03;left, p＝0.0003). Both pFVC(c) and pFVC(v) correlated significantly with rFVC at 6 months after surgery (p＝0.007 and 0.006). Both the conventional and the volumetric methods provided FVC predictions that correlated significantly with measured postoperative FVC

Bartter's Syndrome — Case Report —

A 26-year-old female with Bartter's syndrome associated with Graves' disease is reported. This patient had a history of Graves' disease from the age of 22 and anti-thyroid drug (Methimazole) had been administered for 2 years. Thyroid function returned to normal but general fatigue and polyuria continued. Hypokalemia was diagnosed at 25 years of age and she was referred to our hospital for evaluation. Blood pressure was normal and laboratory data revealed normal thyroid function, hypokalemic alkalosis, high plasma renin activity and high plasma aldosterone concentration. She showed normal pressor sensitivity to norepinephrine infusion, grossly diminished pressor sensitivity to exogenous angiotensin II infusion compared with the normal. A renal biopsy specimen showed juxtaglomerular cell hyperplasia. Electron microscopy confirmed lacis cell (agranular cell) proliferation.</p

Usefulness of right ventriculography compared with computed tomography for ruling out the possibility of lead perforation before lead extraction

Purpose High-risk patients can be identified by preprocedural computed tomography (CT) before lead extraction. However, CT evaluation may be difficult especially for lead tip identification due to artifacts in the leads. Selective right ventriculography (RVG) may enable preprocedural evaluation of lead perforation. We investigated the efficacy of RVG for identifying right ventricular (RV) lead perforation compared with CT in patients who underwent lead extraction. Methods Ninety-five consecutive patients who were examined by thin-section non-ECG-gated multi-detector CT and RVG before lead extraction were investigated retrospectively. Newly recognized pericardial effusion after lead extraction was used as a reference standard for lead perforation. We analyzed the prevalence of RV lead perforation diagnosed by each method. The difference in the detection rates of lead perforation by RVG and CT was evaluated. Results Of the 115 RV leads in the 95 patients, lead perforation was diagnosed for 35 leads using CT, but the leads for 29 (83%) of those 35 leads diagnosed as lead perforation by CT were shown to be within the right ventricle by RVG. Three patients with 5 leads could not be evaluated by CT due to motion artifacts. The diagnostic accuracies of RVG and CT were significantly different (p < 0.001). There was no complication of pericardial effusion caused by RV lead extraction. Conclusion RVG for identification of RV lead perforation leads to fewer false-positives compared to non-ECG-gated CT. However, even in cases in which lead perforation is diagnosed, most leads may be safely extracted by transvenous lead extraction

Existence of VIP and PHI-Like Immunoreactivities in the Amphibian Gut

The present paper provides the first definitive evidence on the presence and possible co-existence of VIP- and PHI-like peptides in the peripheral nervous system of the amphibian (bullfrog) gut wall. The possibility of co-existence of the peptides suggests that VIP- and PHI-like peptide may be synthesized from the same precursor protein in the amphibian