自死による死別経験後の心理的過程 -悲嘆からの回復後の変化に着目して-

Interviews were conducted regarding psychological process after bereavement experiences. Changes after recovery from bereavement in four women that experienced grief caused by suicide were examined. Qualitative analysis using the modified grounded theory approach was used to generate a process model. The results indicated the following. (1) There was a cyclical process between loss-orientation, groping, and recovery- orientation. Moreover, through the process of grieving, their psychological state gradually changed from loss-oriented to recovery-oriented. (2) Encounter and turning point were extracted as factors that promoted recovery from grief and resulted in change-and-awareness. (3) The process after recovery from grief that lead to deepening of recognition via change-and-awareness

Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer.

Background: Hepatobiliary cancer invading the hilar bile duct often involves the portal bifurcation. Portal vein resection and reconstruction is usually performed after completion of the hepatectomy. This retrospective study assessed the safety and usefulness of portal vein reconstruction prior to hepatic dissection in right hepatectomy and caudate lobectomy plus biliary reconstruction, one of the common procedures for radical resection. Methods: Clinical characteristics and perioperative results were compared in patients who underwent right hepatectomy and caudate lobectomy plus biliary reconstruction with (ten patients) and without (11 patients) portal reconstruction from September 1998 to March 2002. Results: All ten portal vein reconstructions were completed successfully before hepatic dissection; the portal cross-clamp time ranged from 15 to 41 (median 22) min. Blood loss, blood transfusion during the operation, postoperative liver function, morbidity and length of hospital stay were similar in the two groups. No patient suffered postoperative hepatic failure or death. Conclusion: This study demonstrates that portal vein reconstruction does not increase the morbidity or mortality associated with right hepatectomy and caudate lobectomy with biliary reconstruction. This approach facilitates portal vein reconstruction for no-touch resection of hepatobiliary cancer invading the hilar bile duct. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd

Isolated paracaval subsegmentectomy of the caudate lobe of the liver.

Background The caudate lobe of the liver is divided into three subsegments based on the portal blood supply: the Spiegel lobe, the paracaval portion (S1r), and the caudate process. An isolated paracaval (S1r) subsegmentectomy is indicated for a small hepatocellular carcinoma localized within S1r. Because this challenging procedure has not been described, we report the details of successful surgical technique. Methods The portal pedicle isolation technique provides easy access to the S1r portal pedicle. A tape is passed along the midline of the anterior surface of the vena cava and its lower end is passed through the caudate parenchyma dorsoventrally to establish a landmark for the left border of S1r. A liver-splitting anterior approach is used to open the interlobar plane widely to the precaval tape. As exposing the vena cava and the root of the right hepatic vein, parenchymal dissection is advanced to the right and then, upward. Results The procedure was performed successfully in a 51-year-old man with hepatitis B who had a 2-cm hepatocellular carcinoma in S1r. Blood loss was 645 ml. Conclusions An isolated paracaval subsegmentectomy of the caudate lobe can be performed successfully, although it is likely to remain an uncommonly used procedure.Figure 1 is misse

Delayed esophageal reconstruction for aortoesophageal fistula caused by an aortic arch aneurysm with microvascular anastomosis of the left gastric artery and vein.

We report a case of aorto esophageal fistula (AEF) with delayed esophageal reconstruction employing microvascular anastomosis. We demonstrate here that our method is useful for delayed esophageal reconstruction following AEF

Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer : a propensity score-matched study

Purpose: We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler. Methods: We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared. Results: We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien-Dindo [CD] classification ≥ I; 21 vs. 26%, respectively; p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively; p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301; 9 vs. 8%, p = 0.753, respectively) were comparable. Conclusions: There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG