Laparoscopic extra-abdominal suturing technique for the repair of Larrey’s diaphragmatic hernia using the port closure needle (Endo Close®): A case report

AbstractIntroductionMorgagni’s or Larrey’s diaphragmatic hernias are relatively uncommon. If the defect is too large for primary closure, the use of a mesh is inevitable. Although primary closure is adaptable for relatively small defects, it is difficult to suture the hernial orifice in which the anterior rim is absent. Herein, we present the case of a patient with Larrey’s diaphragmatic hernia that was easily and securely repaired using the recently developed laparoscopic extra-abdominal suturing technique via the port closure needle (Endo Close®; Medtronic, Minneapolis, USA).Presentation of caseAn 89-year-old woman complaining of vomiting was transferred to our hospital. Computed tomography scan showed Larrey’s diaphragmatic hernia. Laparoscopic repair was performed after gastric decompression. We diagnosed Larrey’s hernia on the left side of the falciform ligament. The transverse colon was herniated through the defect. Since the hernial defect was located below the substernal space, there was no tissue to stitch at the anterior rim of the hernial orifice. We performed the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using the port closure needle (Endo Close®) without the need for a mesh. The patient was discharged on the 8th postoperative day. There was no evidence of recurrence at 8 months postoperatively.DiscussionThe recently developed extra-abdominal suturing technique using Endo Close® to suture the full thickness of the anterior abdominal wall achieved secure mattress suture and easy extra-abdominal tying.ConclusionThis method may be useful in terms of easiness and security of suture

Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>It has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.</p> <p>Case presentation</p> <p>A 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.</p> <p>Conclusion</p> <p>Renal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.</p

Precise Measurement of Cosmic-Ray Proton and Helium Spectra with the BESS Spectrometer

We report cosmic-ray proton and helium spectra in energy ranges of 1 to 120 GeV and 1 to 54 GeV/nucleon, respectively, measured by a balloon flight of the BESS spectrometer in 1998. The magnetic-rigidity of the cosmic-rays was reliably determined by highly precise measurement of the circular track in a uniform solenoidal magnetic field of 1 Tesla. Those spectra were determined within overall uncertainties of +-5 % for protons and +- 10 % for helium nuclei including statistical and systematic errors.Comment: 12 pages, 4 figure

Relationships between Modus Vivendi, Stress Responses, and Scholastic attainments in Grade School: Dose Guidance to the Modus Vivendi Influence Children's QOL?

The purpose of this study was to investigate about the influence of modus vivendi on stress responses and scholastic attainments. 586 grade school students were asked by questionnaire. The first graders and the second graders were answered about modus vivendi. Third, fourth, fifth, and sixth graders did about modus vivendi and stress responses. Scholastic attainments of fourth graders were used for analysis. The following results were obtained: modus vivendi consists of three sub concepts; regular life, tooth brushing and facial cleansing, and guidance before going out. Stress responses consist of two sub concepts; low concentration and aggression. Differences in grades and sex were partially confirmed. The relations between the modus vivendi, stress responses, and scholastic attainments were partially shown. In conclusion, the guidance of the modus vivendi to the grade school student might decrease stress responses and improve scholastic attainments.本研究は586名の小学生を対象とした調査から、生活態度と不安・ストレス反応、学力の実態を把握し、これらの関連から、生活態度への指導が不安・ストレス反応と学力に与える影響を検討することを目的としたものである。分析の結果、生活態度は生活リズム、歯磨き・洗顔、家を出る前の指導という3つの下位概念からなっていること、不安・ストレス反応は集中力の低さ、攻撃性という2つの下位概念からなっていることが明らかにされた。生活態度と不安・ストレス反応については部分的に学年差と性差が確認された。生活態度と不安・ストレス反応、学力の関連より、小学生への生活態度の指導が不安・ストレス反応を低減し、学力を高める可能性が示唆された

Measurements of Cosmic-ray Low-energy Antiproton and Proton Spectra in a Transient Period of the Solar Field Reversal

The energy spectra of cosmic-ray low-energy antiprotons and protons have been measured by BESS in 1999 and 2000, during a period covering the solar magnetic field reversal. Based on these measurements, a sudden increase of the antiproton to proton flux ratio following the solar magnetic field reversal was observed, and it generally agrees with a drift model of the solar modulation.Comment: 4 pages, 4 figures, revised version accepted for publication in Phys. Rev. Let