Pectoralis Major and Serratus Anterior Muscle Flap for Diaphragmatic Reconstruction

We have reported a new reconstruction method using a pectoralis major and serratus anterior muscle flap for diaphragmatic defects after chondrosarcoma resection. The reconstruction of diaphragmatic defects is challenging. In diaphragmatic reconstruction with chest wall defects, strong chest wall reconstruction and diaphragmatic flexibility are important to avoid interference with respiration. The artificial material Gore-Tex is used as the first choice, but it has infection-, exposure-, and durability-related drawbacks. As an alternative method using artificial material, we have reported our new technique—diaphragmatic reconstruction using a reversed-combined pectoralis major and serratus anterior muscle flap

Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus

We aimed to investigate the characteristics of Parkinsonian features assessed by the unified Parkinson's disease rating scale (UPDRS) and determine their correlations with the computed tomography (CT) findings in patients with idiopathic normal pressure hydrocephalus (iNPH). The total score and the scores for arising from chair, gait, postural stability, and body hypokinesia in the motor examination section of UPDRS were significantly improved after shunt operations. Stepwise multiple regression analysis revealed that postural stability was the determinant of the gait domain score of the iNPH grading scale. The canonical correlation analysis between the CT findings and the shunt-responsive Parkinsonian features indicated that Evans index rather than midbrain diameters had a large influence on the postural stability. Thus, the pathophysiology of postural instability as a cardinal feature of gait disturbance may be associated with impaired frontal projections close to the frontal horns of the lateral ventricles in the iNPH patients

Natural history of Upshaw-Schulman syndrome based on ADAMTS13 gene analysis in Japan

Upshaw–Schulman syndrome (USS) is an extremely rare hereditary deficiency of ADAMTS13 activity, termed congenital TTP. The clinical signs are usually mild during childhood, often with isolated thrombocytopenia. But their symptoms become more evident when patients have infections or get pregnant. We identified 43 USS-patients in Japan, who ranged in age from early childhood to 79 years of age. Analysing the natural history of these USS patients based on ADAMTS13 gene mutations may help characterise their clinical phenotypes. Severe neonatal jaundice that requires exchange blood transfusion, a hallmark of USS, was found in 18 of 43 patients (42%). During childhood, 25 of 43 patients were correctly diagnosed with USS without gender disparity. These 25 patients were categorised as having ‘the early-onset phenotype’. Between 15 and 45 years of age, 15 were correctly diagnosed, and, interestingly, they were all female. The remaining three patients were male and were diagnosed when they were older than 45 years of age, suggesting that they were ‘the late-onset phenotype’. Two of these three males developed sudden overt TTP when they were 55 and 63 years old, respectively. These two men had two different homozygous ADAMTS13 gene mutations, p.R193W/p.R193W and p.C1024R/p.C1024R, respectively. Both of which were not discovered in the US or Western countries. In vitro expression studies showed that these two proteins were consistently secreted into the culture medium but to a lesser extent and with reduced activity compared to the wild-type protein. Our results indicate that ‘the late-onset phenotype’ of USS is formed with ethnic specificity.・The definitive version is available at " http://dx.doi.org/10.1111/j.1538-7836.2011.04341.x "・State of the Art 2011 : XXIII Congress of the International Society on Thrombosis and Haemostasis Invited Reviewhttp://dx.doi.org/10.1111/j.1538-7836.2011.04341.

トウカ ニオケル ダイチョウ センコウ 83レイ ノ リンショウテキ ケントウ

Introduction : Colon perforation easily causes septic shock and multiple organ failure, mortality rate is high. We studied prognostic factors with colon perforation. From January１９９９to December ２００８, ８３ patients with colon perforation underwent emergency surgery in this department. Methods : Subjects were retrospectively divided into survivors（n＝６７）and nonsurvivors（n＝１６）. We studied their clinical factors and compared mortality for each factors. Results : Overall mortality was１９％ １６／８３）. The mean age was７４years, and significantly higher mortality over ８０years. The cause perforation was idiopathic in２５cases, cancer in２１cases, diverticulitis in１９ cases, iatrogenic in８cases, trauma in２cases, others in８cases. The perforation site was the most sigmoid colon. Patients with SOFA score at least five points before surgery and preoperative shock and leucopenia and older than２４hours before surgery was significantly higher mortality. Each was no difference in complications before surgery. PMX-DHP was performed in ３９ cases １３％ mortality. Discussion : In patients with colon perforation, preoperative assessment SOFA score was trusted to reflect the outcome

スイビブガン ノ ゾウ オ シメシタ スイナイ フクヒ ノ 1レイ

Intrapancreatic accessory spleens exhibit the same computed tomography （CT） findings as the spleen itself. We experienced a case in which an intrapancreatic accessory spleen mimicked pancreatic tail carcinoma. A ５４-year-old female who had a medical history of splenectomy presented with a pancreatic tail tumor, which exhibited low density in the arterial phase and slightly high density in the portal and equilibrium phases on CT. In addition, an accessory spleen was present in the greater omentum. We initially diagnosed the tumor as a pancreatic carcinoma, and scheduled distal pancreatectomy（DP）combined with lymph node dissection（LND）. Intraoperatively, the tumor was found to be elastic-soft, which indicated that it might be benign. We changed the planned procedure from DP combined with LND to DP without LND. The cut surface of the tumor had the appearance of spleen tissue, and the pathological diagnosis was an intrapancreatic accessory spleen. Intrapancreatic accessory spleens can display the same imaging findings as pancreatic carcinomas. Intraoperative palpation and gross pathological examinations were useful for selecting the optimal surgical procedure in the present case. It is important to differentiate pancreatic tail tumors that exhibit low density in the arterial phase on CT from accessory spleens

フククウキョウカ イ ゼンテキジュツゴ ニ 2ド ノ Petersen’s hernia シュウフクジュツ オ ヨウシタ 1レイ

Petersen’s hernia is a type of internal hernia that may occur after Roux-en-Y reconstruction. Some surgeons suture Petersen’s defect for prevention of Petersen’s hernia. We report a case of recurrent Petersen’s hernia. A fifty-something man underwent laparoscopic-assisted total gastrectomy with antecolic Roux-en-Y reconstruction for gastric cancer. Petersen’s hernia occurred ６ months later. We closed Petersen’s defect by absorbable suture. However, he experienced recurrence２months later. The defect had not been successfully closed and there was no adhesion ; thus, we sutured Petersen’s defect again, more tightly than before. Additionally, we investigated different approaches for closing Petersen’s defect due to our experience of recurrent Petersen’s hernia

ジコ メンエキセイ スイエン ニ タイスル ステロイド チリョウ コウカ ハンテイ ニ Ga scintigraphy ガ ユウヨウ デアッタ 1レイ

Some cases of chronic idiopathic pancreatitis associated with autoimmune disease havebeen reported. The autoimmune pancreatitis revealed a diffusely irregular and narrowedpancreatic duct and responded well to steroid treatment. We report a case of autoimmunepancreatitis with a significant role of Gallium scintigraphy in response to steroid therapy.A sixty seven-year-old male, with upper abdominal pain, appetite loss and thirst, presenteddiffuse pancreatic swelling on abdominal ultrasonography, and diffuse irregular narrowingof the pancreatic duct and stenosis of the distal common bile duct. Gallium-67 scitigraphyrevealed high uptake in the whole pancreas. The patient underwent pancreatic biopsy torule out pancreatic cancer and malignant lymphoma. The definitive diagnosis was autoimmunepancreatitis. The patient recovered quickly with steroid therapy after the biopsy

カン focal nodular hyperplasia ニ タイスル フククウキョウカ カン セツジョジュツ

Recently, laparoscopic hepatectomy of the liver has been reported to be safe, with possible advantages to the patients such as reduced postoperative pain and shorter hospital stay. We report successful laparoscopic partial liver resections for two cases of focal nodular hyperplasia. Two cases of 43-year-old male and 69-year-old male, with chronic hepatitis C and without any symptoms, presented in each other a solitary mass 1.5 and 1.0 cm in size at the edge of the liver on diagnostic imagings. The patients underwent laparoscopic partial hepatectomy to rule out well differentiated hepatocellular carcinoma. The histopathological diagnosis was focal nodular hyperplasia. Each patient had an uneventful postoperative recovery and had been free from recurrence during the 6 years follow-up period. Laparoscopic partial hepatectomy is indicated in patients with benign solid mass located at the edge of the liver

Superwind-Driven Intense H_2 Emission in NGC 6240

We have performed a long-slit K band spectroscopic observation of the luminous infrared galaxy NGC 6240. The peak position of the H_2 v=1-0 S(1) emission in the slit is located ~0.3" - 0.4" north of the southern nucleus. It is almost the midpoint between the southern nucleus and the peak position of the ^12CO J=1-0 emission. Based on the line-ratio analyses, we suggest the excitation mechanism of H_2 is pure thermal at most positions. In the southern region we find the following three velocity components in the H_2 emission: the blueshifted shell component (~-250 km s^-1 with respect to V_sys) which is recognized as a distinct C-shape distortion in the velocity field around the southern nucleus, the high-velocity blueshifted ``wing'' component (~-1000 km s^-1 with respect to V_sys), and the component indicating possible line splitting of ~500 km s^-1. The latter two components are extended to the south from the southern nucleus. We show that the kinematic properties of these three components can be reproduced by expanding motion of a shell-like structure around the southern nucleus. The offset peak position of the H_2 emission can be understood if we assume that the shell expanding to the north interacts with the extragalactic molecular gas. At the interface between the shell and the molecular gas concentration the cloud-crushing mechanism proposed by Cowie et al. (1981) may work efficiently, and the intense H_2 emission is thus expected there. All these findings lead us to propose a model that the most H_2 emission is attributed to the shock excitation driven by the superwind activity of the southern nucleus.Comment: 33 pages, 9 figures, accepted for publication in PAS

スイ カセイ ノウホウ ニ タイスル フククウキョウカ ノホウ イ フンゴウジュツ : イヘキ トノ ユチャク オ ゼンテイ ト シナイ アンゼンナ ジュツシキ

A forty seven-year-old male who had been in clinical follow-up for a pancreatic pseudocystunderwent a laparoscopic cystogastrostomy through the lesser peritoneal sac in 1996. Thisprocedure is performed by creating a cystotomy and posterior gastrotomy through whichan Endo GIATM is applied. The mouth of cystogastrostomy is closed using continuous suturesby Endo STITCHTM. This approach does not rely on adhesions between the pseudocyst andposterior wall of the stomach, and offers clear advantages over previously described techniquesin the management of pancreatic pseudocyst