ヒト骨肉腫培養細胞におけるシスプラチン投与後のDNA損傷からの回復現象とカフェインによる抑制

取得学位 : 博士（医学）, 学位授与番号 : 医博乙第1206号, 学位授与年月日：平成4年11月4日,学位授与年：199

Difficulty in locking head screw removal

Background: Locking plates are an internal fixation material useful in the treatment of bone fractures, which provides effective stabilization between the plate and locking head screws (LHSs) via the locking mechanism. However, difficulty in removing LHSs is relatively common, and such cases can require long surgical procedures or use of special removal equipment. The purpose of this study was to report the incidence and risk factors for difficult removal of LHSs. Methods: During the 5-year-6-month period from April 2006 to September 2011, 83 locking plates containing a total of 482 LHSs were removed in 80 patients at our institution. Out of 482 LHSs, there were 118 LHSs with a 2.4-2.7 mm diameter, 308 LHSs with a 3.5 mm diameter and 56 LHSs with a 5.0 mm diameter. The incidence of removal difficulty was examined on the basis of screw diameter. In addition, the risk factors were assessed in only LHSs with a 3.5 mm diameter. LHSs with a 3.5 mm diameter were divided into 2 groups, the difficult removal group and the easy removal group, and the data were examined based on age, sex, time between insertion and removal, and screw position. The incidence of removal difficulty in LHSs with a 3.5 mm diameter was examined every 6 months between insertion and removal. Results: Difficulty in removal was encountered in none (0 %) of 118 LHSs with a 2.4-2.7 mm diameter, 15 (4.9 %) of 308 LHSs with a 3.5 mm diameter, and none (0 %) of 56 LHSs with a 5.0 mm diameter. In only LHSs with a 3.5 mm diameter, the mean ages of the patients in the difficult removal group and the easy removal group were 32.1 and 45.6 years, respectively. The average time between insertion and removal in the difficult removal group and the easy removal group was 529.2 and 389.2 days, respectively. There was a statistically significant difference in age and time between insertion and removal. Removal was difficult in 15 (9.1 %) of 165 LHSs with a 3.5 mm diameter in those with >1 year between insertion and removal. Conclusion: This study suggests that (1) the use of LHSs with a 3.5 mm diameter is a necessary condition for difficulty in screw removal, and that (2) longer time from internal fixation to removal, and (3) younger age, are risk factors for it. When removing LHSs with a 3.5 mm diameter, appropriate instruments and sufficient training are necessary. © 2013 The Japanese Orthopaedic Association

Cholecystitis caused by a fish bone.

The accidental ingestion of a foreign body is not uncommon. However, the presence of a foreign body in the gallbladder is extremely rare. Here, we present a case of cholecystitis due to a fish bone that may have penetrated through the stomach wall and into the gallbladder without causing peritonitis. A laparoscopic cholecystectomy was performed; a fish bone, measuring 4.0 cm in length, was found in the gallbladder. To the best of our knowledge, this is the first such case to be reported

Clinicopathology and prognosis of mucinous gastric carcinoma

Background/Aims: Mucinous gastric carcinoma (MGC) is a rare histopathological type of gastric carcinoma, for which the clinicopathological features and prognosis remain controversial. To clarify the clinical significance of mucinous histological type in gastric cancer, we studied clinicopathological characteristics of MGC tumors and prognosis of patients. Methodology: Forty-one patients with MGC and 1,407 patients with non-mucinous gastric carcinoma (NGC) were included in the study. Tumors were evaluated against patient gender and age, tumor location, size, and macroscopic type, depth of gastric wall invasion, lymph node metastasis, liver metastasis, peritoneal dissemination, distant metastasis, stage, and operative curability. Results: Compared with NGC tumors, MGC tumors were larger, showed more serosal invasion, were associated with a higher incidence of lymph node metastasis, and peritoneal dissemination, and tended to be at a more advanced stage. However, multivariate analysis demonstrated that the mucinous histological type was neither an independent prognostic factor nor an independent risk factor for lymph node metastasis in patients with gastric cancer. Conclusions: The mucinous histological type had no influence on patient outcome or the frequency of lymph node metastasis. MGC tumors are therefore biologically similar to those in NGC

Usefulness and limitation of laparoscopic assisted hepatic resections: a preliminary report

Background/Aims: We preliminarily examined the characteristics of patients who underwent laparoscopic assisted hepatic resection (LAPH) to clarify its advantages and limitations of this procedure. Methodology: We examined the demographics, surgical records and outcome in 9 patients undergoing LAPH between 2001 and 2007 by comparing results in 15 patients (control group) who did not undergo laparoscopy before 2000. Results: By comparing the control group, patient demographics were not different. Four patients underwent left lateral sectionectomy and others underwent partial hepatectomy. One patient needed combined resection of abdominal wall and left lateral sector because of direct invasion from a liver tumor. There was no remarkable morbidity or mortality in all patients. Mean operation time in the LAPH group was significantly longer than that in the control group (356+/-68 vs. 276+A59 minutes) (p=O.015), particularly in patients undergoing partial resection. Blood loss was not different between groups. Days of use of pain reliever and hospital stay in the LAPH group was significantly shorter than that in the control group (pO.OOl). These tendencies were similar in each operative procedure. Conclusions: LAPH can be safely performed even in patients with chronic liver injury and recovery of patients from operation was faster than that by conventional hepatectomy

Laparoscopy-Assisted Pancreaticoduodenectomy for Pancreatic Head Tumor at a Japanese Cancer Institute

Laparoscopic surgery is a less invasive treatment option for tumors in the intraabdominal organs; however, the safety and indication of laparoscopic or laparoscopy assisted pancreaticoduodenectomy (LPD) is still controversial. We attempted LPD in four cases for intraductal papillary mucinous neoplasm (IPMN) located in the pancreatic head and we report the surgical records and short-term outcome. LPD was carried out in four patients including three patients with the combined type IPMN and one with the branch type, based on the International Consensus Guidelines. None of the patients had invasive carcinoma based on preoperative imaging diagnosis. Laparoscopic procedures were performed until isolation of the pancreas head and duodenum, and final resection of PD and intestinal reconstruction were performed using small incision laparotomy (7-8cm). The mean total operating time was 882 minutes (820-932 minutes), mean blood loss was 925ml (610-1550ml) and red cell transfusion was not required in any patients. One patient underwent reoperation for bleeding at the pancreaticojejunostomy site at day 1. Mean duration until patients were able to walk was 3.5 days (2-6 days) and duration of use of analgesia was limited to within 7 days. Grade B pancreatic fistula was observed in one patient and jejunal ileus was observed in one patient. There were no deaths. LPD was safely performed and blood loss was limited, although the operating time was long. Postoperative recovery in patients without complications might be better than the conventional PD under laparotomy. Future study is necessary

Treatment of concomitant gastric varices in patients with hepatocellular carcinoma at a single Japanese Institute

Hepatocellular carcinoma (HCC) patients often have esophagogastric varices due to portal hypertension by chronic hepatitis or cirrhosis. Surgical treatment for gastric varices is necessary when the patient undergoes hepatic resection for HCC, simultaneously. We examined the clinical demographics, surgical records and outcome in 7 patients undergoing both hepatectomy and Hassab\u27s operation (=decongestion of upper gastric veins and splenectomy) between 1994 and 2007. All patients had HCC, including chronic injured liver diseases. Preoperative liver functions were well preserved in all patients. Right hepatectomy was performed in two patients and limited resections in 5. Three patients had postoperative complications and the in-hospital death by hepatic failure was observed in one. Four patients had tumor recurrence within one year and 3 were dead, while, two patients had long-term survival with or without recurrence of HCC. Following Hassab\u27s operation, gastric varices dramatically disappeared. Portal hypertension and hypersplenism were significantly improved. Simultaneous operation with Hassab\u27s procedure and hepatectomy is useful and can be safely performed in HCC patients with gastric varices

High Level Expression of Platelet-derived Endothelial Cell Growth Factor predicts Good Prognosis in Colorectal Cancer Patients

Platelet-derived endothelial cell growth factor (PD-ECGF) is one of the angiogenic factors. PD-ECGF expression is elevated in colorectal carcinoma, but its prognostic value does not reach a consensus. The aim of this study is to clarify the prognostic value of the PD-ECGF expression in colorectal carcinomas. PD-ECGF expression was measured by enzyme- linked immunosorbent assay in frozen materials from 71 colorectal cancer patients who had recived curative resection. Patients were divided into high expression and low expression groups based on cut-off value. Correlations among PD-ECGF expression, clinicopathologic features, and disease-free interval were studied by univariate and multivariate analysis. To evaluate the origin of PD-ECGF, serial sections of 71 tumors were stained for PD-ECGF and CD68. PD-ECGF expression in normal mucosa was 34.4 ﾂｱ 15.5 (Units/mg protein) and the cut-off value was 65.4 (mean+2SD). There were no significant correlations between clinicopathological features and PD-ECGF expression. The disease-free interval for high PD-ECGF expression group was significantly longer than that of low expression group (P=0.006). A multivariate Cox\u27s regression analysis revealed a high PD-ECGF expression as an independent factor for better outcome. In immunohistochemical study, almost all tumor cells were negative for PD-ECGF, but stromal macrophages were predominantly positive for PD-ECGF. In conclusion, the PD-ECGF expression measured in this study was derived from stromal macrophages. High PD-ECGF expression was a predictor for favorable outcome after curative resection for colorectal cancer

Evaluation of new prognostic staging systems (SLiDe score) for hepatocellular carcinoma patients who underwent hepatectomy.

BACKGROUND/AIMS: A new prognostic staging system, the SLiDe (S, stage; Li, liver damage; De, des-gamma-carboxy prothrombin) score was recently proposed. We examined 207 HCC patients following hepatic resection to determine the usefulness of this staging system for HCC patients after surgery. METHODOLOGY: Disease-free and overall survival rates were calculated according to the Kaplan-Meier method, and differences between groups were tested for significance using the log-rank test. RESULTS: Regarding disease-free survival, there were no significant differences in survival between SLiDe score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.01) and between 2-3 vs 4-5 (p < 0.01). Regarding overall survival, there were no significant differences in survival between score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.05) and between 2-3 vs 4-5 (p < 0.01). CONCLUSIONS: The SLiDe score, a staging system that combines tumor factors, a tumor marker and hepatic function, might be a better predictor of prognosis in HCC patients who have undergone hepatic resection

Prediction of Indocyanine Green Retention Rate at 15 Minutes by Correlated Liver Function Parameters before Hepatectomy.

Indocyanine green retention rate at 15 min (ICGR15) is a useful marker of liver function in deciding on the extent of hepatectomy. To determine ICGR15 regardless of liver condition, we sought to establish a formula for converted ICGR15 based on conventional blood tests and technetium-99 m galactosyl human serum albumin ((99m)Tc-GSA) scintigraphy