Treatment Strategy for Pancreatic Neuroendocrine Neoplasms (pNEN)

Article信州医学雑誌 68(5): 235-242(2020)journal articl

Tracheal reconstruction using s-shaped skin flaps and a conchal cartilage graft.

We have devised a technique of two-stage tracheal reconstruction using S-shaped skin flaps and an aural conchal cartilage graft. During the first operation, S-shaped skin flaps were elevated before resection of the trachea. A tracheocutaneous fistula was created at the tracheal defect using S-shaped skin flaps while placing the conchal cartilage graft underneath. During the second operation, a skin incision was made around the fistula to elevate the hinge flaps, including the cartilage. The edges of the hinge flaps were sutured to form the tracheal lumen, and the area of the skin defect was then closed with double-rotation skin flaps

A left thoracic approach in a prone position for thoracoscopic thoracic duct ligation in a patient with post-esophagectomy chylothorax: A case report

INTRODUCTION: We debate whether or not to approach from right thorax for the left chylothorax afteresophagectomy.PRESENTATION OF CASE: A 50 s-year-old female underwent right-sided thoracoscopic esophagectomywith three-field lymphadenectomy for esophageal carcinoma (type 0-IIa, 3.4 × 2.2 cm, T1bN0M0, StageIA), followed by reconstruction with esophagogastric anastomosis through the posterior mediastinum.The thoracic duct was excised and ligated. The left thoracic drainage increased to 2115 mL/day on thefifth postoperative day. Thoracic duct injury was diagnosed, and surgery was performed on sixth post-operative day. With the patient in a prone position, the thoracic duct was ligated successfully underthoracoscopy in the left thorax. The leakage point was found in the crushed duct by 8.8-mm tita-nium clips. Then, we performed mass ligation of the thoracic duct with 11-mm titanium clips belowthe leakage point after careful dissection. The surgery took 58 min, with an estimated total blood lossof 0 g.DISCUSSION: Although thoracic duct is anatomically located on the right side of the descending aorta,we employed a left-sided thoracoscopic approach due to the chylous leakage in the left thorax. With thepatient in the prone position, surgeons can easily convert from a left thoracic approach to a right thoracicapproach immediately without postural change if the thoracic duct cannot be found in the left thoraciccavity.CONCLUSION: This technique is useful and should be considered for patients with left chylothorax

Decomposition of skin conductance data by means of nonnegative deconvolution

Skin conductance (SC) data are usually characterized by a sequence of overlapping phasic skin conductance responses (SCRs) overlying a tonic component. The variability of SCR shapes hereby complicates the proper decomposition of SC data. A method is proposed for full decomposition of SC data into tonic and phasic components. A two-compartment diffusion model was found to adequately describe a standard SCR shape based on the process of sweat diffusion. Nonnegative deconvolution is used to decompose SC data into discrete compact responses and at the same time assess deviations from the standard SCR shape, which could be ascribed to the additional process of pore opening. Based on the result of single non-overlapped SCRs, response parameters can be estimated precisely as shown in a paradigm with varying inter-stimulus intervals

Frequency components of systolic blood pressure variability reflect vasomotor and cardiac sympathetic functions in conscious rats

In this study, after confirming the suppression of autonomic nervous function by isoflurane anesthesia using autonomic antagonists, we pharmacologically investigated the involvement of vasomotor and cardiac sympathetic functions in systolic blood pressure variability (SBPV) frequency components in conscious rats at rest and during exposure to low-ambient temperature (LT-exposure, 9°C for 90 min). Under unanesthesia, phentolamine administration (α-adrenoceptor antagonist, 10 mg/kg) decreased the mid-frequency component (MF 0.33–0.73 Hz) and inversely increased the high-frequency component (HF 1.3–2.5 Hz). The increased HF was suppressed by subsequent treatment with atenolol (β-adrenoceptor antagonist, 10 mg/kg), but not with atropine (muscarinic receptor antagonist, 10 mg/kg). Moreover, phentolamine administration after atenolol decreased MF, but did not increase HF. LT-exposure increased MF and HF; however, phentolamine pretreatment suppressed the increased MF during LT-exposure, and atenolol pretreatment dose-dependently decreased the increased HF. These results suggest that MF and HF of SBPV may reflect α-adrenoceptor-mediated vasomotor function and β-adrenoceptor-mediated cardiac sympathetic function, respectively, in the conscious state

Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality

Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyper-hidrosis as a compensatory response to an/hypo-hidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with well-demarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides