イ ジョウコウ ケッチョウ チョクチョウ ノ 3 チョウフクガン ニ タイシテ イッキテキ ニ フククウキョウカ シュジュツ オ シコウ シタ 1レイ

A ５１-years-old man was admitted with anemia. The upper gastrointestinal endoscopy revealed ０-IIa＋IIc lesion in the middle body of the stomach. The colonoscopy revealed type ３ lesion by Borrmann classification with advanced stenosis. Computed tomography of the abdomen revealed the tumor in the ascending colon. We diagnosed a synchronous gastric, ascending colon, and rectal cancer. After neoadjuvant chemotherapy, we performed the laparoscopic operation for the synchronous cancer. There were no remarkable complications due to the collaboration. Laparoscopic approach for synchronous triple cancer is feasible as safety and minimally invasive surgery

Trastuzumab/Capecitabine/Cisplatin HXP リョウホウ ニヨル 2ジ チリョウ ガ ユウコウ デアッタ シンコウ イガン ノ 1レイ

The case was a ６９-year-old man, and gastric cancer （papillary adenocarcinoma） was diagnosed by a close inspection of the abdominal pain in ２００８, and it was our department introduction. Show the type ０‐IIa＋IIc like advanced lesion of gastric middle body gastrointestinal endoscope, and CT showed no regional lymph node and distant metastases, and we diagnosed it as c-T２ （MP）, N０, M０, stageIB. We performed laparoscopic distal gastrectomy with D２ dissection, and in pathology, acknowledgment of severe lymph node metastases was obtained, and diagnosed it as T３ （SE）, N２, M０, stageIIIB. We gave adjuvant chemotherapy with S-１and Cisplatin for ５ cycles, and maintenance S-１alone up to ２４ months after surgery. There was no recurrence for ３９ months after surgery. But multiple metastases to lung recurrence was acknowledged and we performed S-１/Docetaxel therapy for ６ cycles, which lead to progressive disease. Then we performed Trastuzumab/Capecitabine/Cisplatin chemotherapy （HXP）, the anti-tumor effect was good, and after １４ months later, showed a liver metastasis, but the tolerability was good. Generally, it is said that the chemotherapy is poor at an effect after the second line treatment, but HXP may be useful even in the second line chemotherapy

Mesh-Airtight-Preperitoneum : a simple method for confirming mesh placement in transabdominal preperitoneal repair of inguinal hernia

We devised a method for confirming the position of mesh placed during transabdominal preperitoneal repair (TAPP) of an inguinal hernia. The preperitoneum is sufficiently detached, and the mesh is fixed in place as usual. Before completely closing the peritoneum, pressure is applied from outside the body and inside the abdominal cavity to remove as much air as possible from the detached preperitoneum ; the peritoneum is then sutured using a V-LocTM closure device so that it does not constrict. By releasing the pressure all at once, the airtightness of the preperitoneum is maintained, and the position of the mesh can be observed through the translucent peritoneum. This method, called Mesh-Airtight-Preperitoneum (MAPP), could become widely used as a simple technique for confirming mesh position in TAPP

Short-Term Outcomes of Laparoscopic Distal Gastrectomy for Advanced Gastric Cancer

The purpose of this study was to investigate the oncologic outcomes of laparoscopic distal gastrectomy (LDG) for advanced gastric cancer (AGC). Between April 2003 and March 2014, LDG was performed for 392 patients, 91 patients (23.2%) had histopathologically diagnosed AGC beyond T2 depth. The clinicopathological features, postoperative outcomes, mortality, morbidity, recurrence rate, and survivals of those patients were reviewed. The TNM stages of the tumor were IB in 26 patients (28.5%), IIA in 20 (21.9%), IIB in 18 (19.7%), IIIA in 13 (14.2%), IIIB in 6 (6.5%), IIIC in 6 (6.5%), and IV in 2 (2.1%). Major morbidity occurred in 14 patients (15.3%), with no postoperative mortality. Median follow-up was 24.5 months ; 10 patients developed recurrence during the follow-up period, and 10 patients died, including 6 cancer deaths. The 5-year overall and disease-free survival rates were 76.8% and 72.6%, respectively. By stage, OS/DFS was 92.3%/91.8% in stage IB, 85.4%/85.4% in stage II, and 49.3%/26.9% in stage III. Oncologic outcomes were good in patients with AGC, especially with stage IB-IIB, who underwent LDG. LDG appears to be an effective approach for treating stage IB and II gastric cancer

Endometriosis of the ileum treated by laparoscopic ileocecal resection

A ２９-year-old female was admitted due to abdominal pain. Abdominal computed tomography showed a tumor in terminal ileum and expanded jejunum, and colonoscopy showed a collection of lymph follicles. Biopsy finding showed a lymphoid tissue hyperplasia and no malignant finding. Therefore, we performed a laparoscopic ileocecal resection for diagnosis and treatment. Histopathological findings showed endometrial tissue in the muscular layer, and we diagnosed endometriosis of ileum. We performed a laparoscopic ileocecal resection with lymph node dissection, because the possibility of malignant tumor could not be ruled out. Laparoscopic operation is useful for the diagnosis and treatment of intestinal endometriosis, because it prevents the adhesion and abdominal wall destruction possibly

キョウセン ヒテイケイテキ カルチノイド ノ 1セツジョレイ

Background. Thymic carcinoids are rare disease to account for ２-４％ of anterior mediastinal tumors. So, the clinicopathologic characters are not known enough. Case. A ６７ years old man was followed up old myocardial infarction, and he was taken chest CT scan for evaluate coronary artery. It revealed three anterior mediastinal tumors and we diagnosed thymoma by needle biopsy. We treated by neoadjuvant chemotherapy（CAMP therapy）, but it was ineffective. We performed thoracoscopic thymothymomectomy, and the pathological diagnosis was thymic atypical carcinoid. He is free of clinically event recurrence one year and a half after treatment. Conclusions. When we found an anterior mediastinal tumor, and if the clinical course is usually different, we should consider the possibility of a thymic carcinoid

ダイガク トショカン デ ジッシ スル ガクシュウ シエン ノ セイカ ト カダイ : Study Support Space ノ ジッセン カラ

我が国の大学教育において，学生の主体的な学習を促進することが求められる中で，大学図書館は，学習支援に貢献できる可能性を高めている。このような背景のもと，全国の大学図書館ではラーニング・コモンズの整備や学習支援サービスの実施が始まっている。徳島大学においてもラーニング・コモンズの整備に続き，学生の学習相談に対応するStudy Support Space (SSS)の取り組みが始まった。SSSは自主的はピア・サポート活動として実施しており，成果を出し，継続的に活動するためには，現状の成果や課題を検証することが必要であると指摘されている。本研究は，学習相談に対応するアドバイザー，徳島大学の学生に対するアンケート調査をもとに，SSSの成果と課題を明らかにすることで，今後の学習支援の充実につなげる示唆を与える。Universities are now required to encourage university students to take the initiative in studying. This phenomenon enhances the potential of university libraries to support student learning. Thus, university libraries in Japan are establishing learning commons or implementing learning support services. The University of Tokushima, as well, has established a learning commons, and implemented a learning support service called “Study Support Space (SSS)” for advising. SSS is a voluntary peer support activity, and its continuation depends on a verification of its present achivements and problems. Thus, results of a questionnaire completed by students and advisors are dissucced. The discussion is centered on the outcomes and future challenges of SSS in aim of bettering learning support in the future