ヒキノウセイ ジョウヒ ショウタイ ノウホウ ノ イチレイ

Parathyroid cysts are rare lesions of the neck and superior mediastinum. A 32-year-oldwoman visited a physician complaining of slight dyspnea, which was attributed to a lump on her neck. Ultrasonography and computed tomography showed a cyst extending from the left lobe of the thyroid gland to the superior mediastinum; and X-ray images revealed right deviation of the trachea. The cyst disappeared after fine-needle aspiration. However, the cyst fluid reaccumulated subsequently and she was admitted to our department. No abnormalities were recognized by blood chemical examinations or thyroid and parathyroid function tests. The cyst was removedsurgically and was diagnosed as a non-functioning parathyroid cyst, on the basis of high intact parathyroid hormone (PTH) level in the cyst fluid. The patient has made a full recovery, and shows no evidence of recurrence after 30 months.Parathyroid cysts can be differentiated from thyroid cysts by criteria such as the color of the cyst fluid, intact PTH levels in the cyst fluid, and the concentration of calcium, phosphate and PTH in the serum. Parathyroid cysts are typically located in the neck, and are solitary andunilocular; 10 percent occur in the mediastinum and 10 to 25 percent are complicated with hyperparathyroidism. Parathyroid cysts are classified into functioning and non-functioningdepending on the presence of hypercalcemia. Not only functioning parathyroid cysts but also non-functioning one should be removed surgically in cases of cyst fluid reaccumulation or tracheal and esophageal constriction

Development of rapid daiagnosis of staphylocuccus aureus in blood.

科学研究費補助金研究成果報告書研究種目: 一般研究(B)研究期間: 1993～1995課題番号: 05454351研究代表者: 谷 徹（滋賀医科大学・医学部・助手）研究分担者: 遠藤 善裕（滋賀医科大学・医学部・助手

Resting energy expenditure in patients undergoing pylorus preserving pancreatoduodenectomies for bile duct cancer or pancreatic tumors

We measured the energy expenditure weekly in patients undergoing a pylorus preserving pancreatoduodenectomy for bile duct cancer or pancreatic tumors. Twelve patients (5 women and 7 men; mean age 70.1 years) were enrolled in this study, and their resting energy expenditure levels were determined by indirect calorimetry. In these patients, a significant correlation was observed between the measured resting energy expenditures and the predicted resting energy expenditures calculated by the Harris-Benedict equation. The resting energy expenditures measured before surgery were almost the same as the predicted resting energy expenditures (measured resting energy expenditure: 22.4 ± 3.9 kcal/kg/day vs predicted resting energy expenditure: 21.7 ± 2.0 kcal/kg/day). The measured resting energy expenditure/predicted resting energy expenditure ratio, which reflects the stress factor, was 1.02 ± 0.10. After the pylorus preserving pancreatoduodenectomy, a significant increase in energy expenditure was observed, and the measured resting energy expenditure was 25.7 ± 3.5 kcal/kg/day on postoperative day 7 and 25.4 ± 4.9 kcal/kg/day on postoperative day 14. The measured resting energy expenditure/predicted resting energy expenditure ratio was 1.16 ± 0.14 on postoperative day 7, and 1.16 ± 0.18 on postoperative day 14 respectively. In conclusion, patients undergoing a pylorus preserving pancreatoduodenectomy showed a hyper-metabolic status as evaluated by their measured resting energy expenditure/predicted resting energy expenditure ratio. From our observations, we recommend that nutritional management based on 30 kcal/body weight/day (calculated by the measured resting energy expenditure×activity factor 1.2–1.3) may be optimal for patients undergoing a pylorus preserving pancreatoduodenectomy

Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

This study was to assess the resting energy expenditure of patients with esophageal cancer using indirect calorimetry. Eight male patients with esophageal cancer and eight male healthy controls were enrolled in this study. All patients underwent transthoracic esophagectomy with lymph nodes dissections. The resting energy expenditure was measured preoperatively, and on postoperative day 7 and 14 using indirect calorimetry. Preoperatively, the measured resting energy expenditure/body weight in these patients was significantly higher than that of the controls (23.3 ± 2.1 kcal/kg/day vs 20.4 ± 1.6 kcal/kg/day), whereas the measured/predicted energy expenditure from the Harris-Benedict equation ratio was 1.01 ± 0.09, which did not differ significantly from the control values. The measured resting energy expenditure/body weight was 27.3 ± 3.5 kcal/kg/day on postoperative day 7, and 23.7 ± 5.07 kcal/kg/day on postoperative day 14. Significant increases in the measured resting energy expenditure were observed on postoperative day 7, and the measured/predicted energy expenditure ratio was 1.17 ± 0.15. In conclusion, patients with operable esophageal cancers were almost normometabolic before surgery. On the other hand, the patients showed a hyper-metabolic status after esophagectomy. We recommended that nutritional management based on 33 kcal/body weight/day (calculated by the measured resting energy expenditure × active factor 1.2–1.3) may be optimal for patients undergoing esophagectomy

Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model

ObjectivesTo compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs.MethodsWe performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann–Whitney U-test.ResultsWe successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations.ConclusionsOff-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs

Feasibility of Microwave-Based Scissors and Tweezers in Partial Hepatectomy: An Initial Assessment on Canine Model.

Purpose:This study aimed to assess the feasibility of partial hepatectomy (PH) simplified by using microwave-based devices in animal experiments.Methods:PH was performed on 16 beagles using either Acrosurg Scissors (AS) or Acrosurg Tweezers (AT) without hepatic pedicle (HP) control. Parenchymal transection time, Glissonean pedicle (GP) seal time, bleeding volume, bile leak, and burst pressure were recorded. Probable complications were investigated after 4 weeks.Results:Transection time (6.5 [6.0–7.6] vs. 11.8 [10.5–20.2] min, p < 0.001) with AT were significantly shorter than with AS. GP sealing times (60 [55–60] vs. 57 [46–91] s, p = 0.859) by both devices were nearly similar. Bleeding volume in the AT group was approximately one-fourth of that in the AS group (6.7 [1.4–22] vs. 28.8 [5.8–48] mL, p = 0.247). AT created higher burst pressure on the bile duct stumps (p = 0.0161). The two devices did not differ significantly in morbidity and mortality after four-week follow-up.Conclusion:Acrosurg devices achieved a safe PH without HP control owing to microwave-based sealing. AS could be used alone in PH, whereas the clamp-crushing function of AT seemed more advantageous in reducing the transection time and blood loss

Basic Research for Liver cell differentiation and regeneration from ES cell of Monkey

科学研究費補助金研究成果報告書研究種目: 基盤研究(B)研究期間: 2001～2003課題番号: 13470233研究代表者: 谷 徹（滋賀医科大学・医学部・教授）研究分担者: 鳥居 隆三（滋賀医科大学・動物生命科学研究センター・教授）研究分担者: 来見 良誠（滋賀医科大学・医学部・講師）研究分担者: 江口 豊（滋賀医科大学・医学部・講師）研究協力者: 犬伏 俊郎（滋賀医科大学・MR医学総合研究センター・教授）研究協力者: 森川 茂廣（滋賀医科大学・MR医学総合研究センター・助教授）研究協力者: 遠藤 善裕（滋賀医科大学・医学部・助手）研究協力者: 塩見 尚礼（滋賀医科大学・医学部・助手

Feasibility of Microwave Scissors-Based Off-Clamp Laparoscopic Partial Nephrectomy in a Porcine Model.

Objectives:To assess the feasibility of off-clamp laparoscopic partial nephrectomy using microwave scissors.Methods:We performed transperitoneal laparoscopic partial nephrectomy, without hilar clamping or renorrhaphy, using only microwave scissors for renal resection in a porcine model. For each kidney, 2 types of procedures were performed: a middle pole resection excising an area of 2-cm diameter and approximately 1-cm depth and a lower pole resection at the level of the lower polar line. The renal calyces exposed during renal resection were sealed and transected using microwave scissors. After 3 days of follow-up, the pigs were reoperated to inspect for postoperative complications. Euthanasia was performed to collect the remaining kidneys for histopathological examination.Results:Ten procedures were successfully performed, without hilar clamping or suturing of the renal calyces and parenchyma, in 5 kidneys from 3 pigs. The median resecting time, blood loss, and lateral thermal injury were 23.2 min, 47.1 mL, and 6.8 mm in the middle pole resection, and were 15.1 min, 26.5 mL, and 6.9 mm in the lower pole resection, respectively. No complications were noted during reoperation, such as postoperative hemorrhage and major urine leakage. Extravasation occurred in 2 middle pole resections and 3 lower pole resections during retrograde pyelogram. Hematoxylin and eosin staining revealed thermal injury characterized by tissue microwave fixation in the near zone and acute coagulative necrosis in the intermediate zone.Conclusions:Microwave scissors-based off-clamp laparoscopic partial nephrectomy is feasible in pigs and can be used for clinical applications

Clinical use of a robot with an automatic chasing capability of the target for MR image guided surgery

科学研究費補助金研究成果報告書研究種目: 基盤研究(B)研究期間: 2005～2007課題番号: 17300171研究代表者: 森川 茂廣（滋賀医科大学・MR医学総合研究センター・准教授）研究分担者: 犬伏 俊郎（滋賀医科大学・MR医学総合研究センター・教授）研究分担者: 来見 良誠（滋賀医科大学・医学部・准教授）研究協力者: 谷 徹（滋賀医科大学・医学部・教授）研究協力者: 仲 成幸（滋賀医科大学・医学部・講師