Extended resection for appendicitis

Background : Appendectomy can be challenging and occasionally converted to extensive resection for complicated appendicitis. However, optimal treatment strategies can be developed using preoperative risk assessment. Thus, we aimed to investigate the preoperative predictors of extensive resection in complicated appendicitis patients undergoing surgery. Materials and methods : In total, 173 complicated appendicitis patients undergoing surgery between 2014 and 2019 were classified into the appendectomy (n = 153) or extensive resection (n = 20) groups. Clinicopathological factors and surgical outcomes were compared between groups. Results : Extensive resection was performed in 20 of 173 complicated appendicitis patients (11.5%). The rates of having defects in the wall structure at the appendix root on computed tomography images were significantly higher, and the duration from onset to surgery was significantly longer in the extensive resection group. Significant differences were found in operative duration, blood loss and postoperative hospitalization, but none in the incidence of postoperative complications between groups. Multivariate analyses showed that defects in the wall structure at the appendix root and five days or longer from onset were identified as independent predictors of extensive resection. Conclusions : Defects in the wall structure at the appendix root and five days or longer from onset predict extensive resection performance in complicated appendicitis patients

多発潰瘍を伴うMTX-LPDによる小腸穿孔

A ８６-year-old woman who had been treated for rheumatoid arthritis（RA）with methotrexate （MTX）for５years, presented another hospital because of abdominal pain. An abdominal CT scan showed ascites and free air in the abdominal cavity. She diagnosed peritonitis due to gastrointestinal perforation, and emergency surgery was performed in our hospital on the day of admission. A ３ mm perforation of the ileum was identified, and there was multiple ulcer near the perforation. Small bowel partial resection was performed, including both lesions. Postoperative histopathological examination revealed the diagnosis of MTX-LPD, and MTX was discontinued after surgery. Currently,６months after surgery, the patient is still alive without any progression of the lymphoma. MTX-LPD is still uncommon side effect of MTX. So we have to consider MTX maybe occur gastrointestinal perforation with immunocompromised patient

Development of Subsea Creature Monitoring Station for AUV Exploration Assistance

In this paper, we introduce our recent result on developing a low cost monitoring station. This station is intended to monitor underwater images of subsea creatures wirelessly from a boat in advance before an exploration AUV is put into water. We describe the concept, the design and system integration of the station in the paper. We also present an experimental result that was carried out to test the implemented functions at Suruga bay at 65m water depth.The 2020 International Conference on Artificial Life and Robotics (ICAROB 2020), January 13-16, 2020, B-Con Plaza, Beppu, Oit

肛門管癌に対する腹腔鏡下骨盤内臓器全摘術

A 83-year-old man with chief complaints of anal pain and disability to take a seat was diagnosed as anal cancer (tub1) and visited our hospital. CT and MRI examinations show tumor, from anal canal to lower rectum, with invasion to levator ani muscle, external anal sphincter and prostate. Furthermore three lung metastases in the upper lobes of the lung were suspected. We diagnosed to be resectable lung metastases, and performed laparoscopic total pelvic exenteration with lymph node dissection D2. An ileal conduit was constructed extracorporeally via an umbilical incision. There were no conversion to laparotomy and intraoperative complications. The total operating time was 424 minutes, with an estimated blood loss of 140 ml. Postoperative complication was only ileus treated conservatively. Preoperative chief complaints promptly disappeared after operation. Opportunities to treat pulmonary metastasis of colorectal cancer have been increasing with a rise in primary diseases and advances in chemotherapy. To our knowledge, this is the first report of palliative laparoscopic total pelvic exenteration for advanced anal cancer with distant metastasis

Atypically large well-differentiated hepatocellular carcinoma with extensive fatty metamorphosis : Report of a Case

A large well-differentiated hepatocellular carcinoma (HCC) with fatty change is rare, and to date only a few cases have been reported. Herein, we present a 68-year-old man who developed a well-differentiated HCC with extensive fatty metamorphosis. The patient was referred to our institute because of a rapidly growing tumor in the left lobe of the liver. Ultrasonography showed a hyperechoic lesion with a peripheral hypoechoic area. Dynamic contrast-enhanced computed tomography (CT) scan in all three phases revealed the tumor which showed diffuse low attenuation with internal irregular enhancement. He underwent left lateral segmentectomy at the liver. Histological diagnosis confirmed well-differentiated HCC and the surrounding non-cancerous area was diagnosed as non-alcoholic steatohepatitis. The patient is still alive without recurrence after 17 months of follow-up

Prediction of POPF using CRP after LG

Purpose : Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. The purpose of this study is to identify the risk factor of POPF and evaluate C-reactive protein on postoperative day 1 (POD1) as the predictor for POPF after laparoscopic gastrectomy (LG). Methods : Between May 2013 and September 2016, 226 patients who underwent LG for gastric cancer were investigated. Patients were divided into 2 groups; POPF group (n = 17) and control group (n = 209). Clinicopathological factors were compared between 2 groups. Results : In POPF group, there are more male patients (p = 0.003) compared with control group. Preoperative factors, such as age, BMI, and prevalence of previous operation and comorbidity showed no significant difference between 2 groups. Regarding tumor factors and perioperative data such as blood loss and operative time, there were also no significant difference between 2 groups. POPF group showed longer postoperative hospital stay, and higher serum CRP level on POD1 (p < 0.0001). Multivariate analysis revealed that high CRP level on POD1 ( ≥ 3mg/dl) was independent risk factor of POPF. Conclusions : High serum CRP level on POD1 can predict the occurrence of POPF