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

Ti–Pd Alloys as Heterogeneous Catalysts for Hydrogen Autotransfer Reaction and Catalytic Improvement by Hydrogenation Effects

Ti−Pd alloys were investigated as heterogeneous catalysts for hydrogen autotransfer reactions. This is the first reported study of alloys as catalysts for hydrogen‐borrowing reactions using alcohols. We improved the catalytic activities of alloys by increasing their specific surface areas via a hydrogenation−powdering process. The reactivities and selectivities of hydrogenated Ti−Pd alloys [Ti−Pd (Hy) ] were higher than those of non‐hydrogenated alloy catalysts in N‐alkylation by hydrogen autotransfer using alcohols. A plausible catalytic cycle is proposed based on control studies and deuterium labelling experiments

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

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