PTBDにおけるVirtual Fluoroscopic Preprocedural Planningの有用性の検討

Purpose: To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure. Materials and Methods: Twenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and 10 patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group. Results: The characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 seconds, P < 0.05; and 16.0 vs. 27.2 minutes, P < 0.05). Conclusion: Intraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct, and therebyshorten the X-ray fluoroscopy time and procedure 1 time while minimizing radiation exposure and complications

Prevalence of and Risk Factors for the Progression of Upper Cervical Lesions in Patients with Rheumatoid Arthritis

We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group’s final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA

Cancer of the Pancreas in 125 Patients

In this report, we did a retrospective study of 125 patients with cancer of the pancreas. Seventeen (36.2%) of the 47 patients with cancer of the pancreatic head underwent resection; 11.2% died within 30 days of surgery, 33.3 survived the first year, and 13.3 survived the first three years. The longest survival was for five years. Nine (23%) of the 39 patients with cancer of the pancreatic body and tail underwent resection; 11.1% died within 30 days, 37.5% survived the first year, and none survived more than three years. The longest survival was for 35 months. Important factors affecting the prognosis were invasion by the cancer of veins or lymph vessels in the surrounding tissues, and metastasis to regional lymph nodes. Lymphatic drainage of small cancers of the pancreatic head were established early. Invasion to the retroperitoneal tissue in cancer of the pancreatic body and tail was more common than in cancer of the pancreatic head. For the patient of early cancer of the pancreas, we strongly recommend total pancreatectomy over WHIPPLE\u27s pancreatoduodenectomy, based on results of our analysis of the outcome in our patients following these two operations. Key words: Cancer of the pancreas, Total pancreatectomy, WHIPPLE\u27s pancreatoduodenectom

A Retrospective Study in the Diagnosis of 301 Jaundiced Cases

In the past 12 years, 301 patients with a total serum bilirubin over 2 mg/dl (reference interval 0.2-0.8 mg/dl) were admitted to the Second Department of Surgery, Nagasaki University School of Medicine, Japan. The purpose of this paper is to analyse the jaundiced cases and to evaluate the diagnostic accuracy of the following imaging techniques: Computed Tomography (CT), Ultrasonography (US), Drip Infusion Cholangiography (DIC), Endoscopic Retrograde Cholangio- pancreatography (ERCP), Percutaneous transhepatic Cholangiography (PTC) and Selective Celiac Angiography (SCAG). Of the 301 patients, 63 had carcinoma of the bile duct, 48 carcinoma of the pancreas, 26 carcinoma of the gallbladder, 16 hepatoma, 8 carcinoma of the ampulla of Vater, 83 cholelithiasis, 27 parenchymal liver disease, 9 congenital bile duct disease, 5 chronic pancreatitis, 14 other diseases, and 2 had no final diagnosis. CT was attempted in 33 of 170 patients with malignancy, and 22 of 129 patients with benignancy. A correct finding was obtained in 23 (69.7%) of the 33 patients and 18 (81.8%) of the 22 patients, respectively. US gave a correct finding in 28 (59.6 %) of 47 patients with malignancy, and 36 (69.2%) of 52 patients with benignancy. DIC gave a correct finding in 1 (5.6%) of 18 patients with malignancy, and 16 (42.1%) of 38 patients with benignancy. ERCP gave a correct finding in 33 (76.7%) of 43 patients with malignancy, and 38 (74.5%) of 51 patients with benignancy. PTC gave a correct finding i

High Fracture Rate of AVANTA Silicone Implant Following Arthroplasty of the Thumb MCP Joint of Rheumatoid Arthritis Patients with Boutonniere Deformities

We retrospectively investigated the mid-term outcomes of arthroplasty using the AVANTA silicone implant for thumb metacarpophalangeal (MCP) joints with boutonniere deformity in patients with rheumatoid arthritis (RA). This study involved 36 thumbs of 33 RA patients with a mean follow-up period of 5.1 years (range, 2.0-13.3). Postoperatively, the mean extension was significantly increased and the mean flexion was significantly decreased (p<0.001, p<0.001, respectively), resulting in the mean arc of range of motion (ROM) shifting in the direction of extension after surgery. Implant fracture was observed in 10 thumbs (28%), and 4 of these (11%) underwent revision surgery. The survivorship with implant fracture and revision surgery as endpoints were 73.4% and 91.8% at 5 years, respectively. The preoperative arc of ROM and the postoperative flexion range of the implant-fracture group were significantly greater than those in the no-implant-fracture group (p=0.039, 0.034, respectively). These results suggest the importance of patient education and careful rehabilitation to prevent excessive flexion. Overall, the AVANTA silicone implant showed a relatively high rate of implant fracture at our institute