Search

Primary appendiceal cancer is rare, and difficult to diagnose pre-operatively because lack of specific symptoms. This report presents a rare case of synchronous colon and appendiceal cancer. A 50-year-old man was referred to our hospital due to endoscopic submucosal resection (ESD) for early cecal cancer. ESD was performed, and the pathological examination revealed tubular adenocarcinoma with deep submucosal invasion. Laparoscopic ileocecal resection was performed as additional resection after ESD of cecal cancer. There were no obvious abnormalities around the ileocecal region in the preoperative examination. Postoperative pathological examination incidentally revealed a mucosal papillary adenocarcinoma of the appendix, with no residual lesion in the ESD scar. The patient was discharged on the seventh postoperative day. Synchronous appendiceal and colon cancer is extremely rare in past reports. Here, we report the case details and review previous case reports.

Background Intraoperative ultrasonography is the golden standard method for evaluation of liver tumors during hepatectomy. However, in laparoscopic surgery, accurate assessment of tumors may be difficult, particularly if the lesion is located nearby the liver surface because of the challenges in handling the intraoperative ultrasound and the lack of tactile sensation. In this study, we demonstrate the preliminary results of examining the microvascular architecture of subcapsular hepatic tumors using laparoscopic narrow-band imaging (NBI) to distinguish between malignant and benign tumors. Materials and Methods Thirty-five lesions were examined by NBI during laparoscopic hepatectomy for the presence of abnormal microvasculature on the liver surface in relation to hepatic tumors from January 2016 to August 2018. The microvascular findings were correlated with tumor localization and pathological diagnosis. Results The 35 examined nodules included 11 hepatocellular carcinoma, 18 colorectal liver metastasis, and six benign nodules. The mean tumor diameter was 26.3 (3-70) mm, and the distance from the liver surface to the tumor was 0.5 (0-5) mm. Microvessels on the liver surface were clearly visualized by NBI, consistent with malignant tumor localization. The tumors were thoroughly examined for the presence of three pathological microvascular features (enlargement, tortuosity, and heterogeneity). Abnormal microvascular patterns were found in 90.9% of hepatocellular carcinoma and 77.8% of colorectal liver metastasis, whereas neither normal sites nor benign lesions displayed microvascular abnormality. Conclusions This study suggests that observing the microvessel image on the liver surface by NBI could be useful in tumor localization and differentiation between benign and malignant lesions.

BACKGROUND/AIM To evaluate complications and risk factors associated with transumbilical incision as an organ removal site in laparoscopic pancreatectomy (LP). PATIENTS AND METHODS In total, 52 patients who underwent LP between 2009 and 2017 were included in this study. The development of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia was recorded. RESULTS None of the patients had SSI. However, three (5.77%) presented with transumbilical incisional hernia. No variables were significantly associated with the risk of transumbilical incisional hernia. CONCLUSION No evident risk factors correlated with hernia formation. Hence, incisional hernia might have occurred at a certain probability. In some cases, it was caused by technical problems. However, the use of transumbilical incision as an organ removal site was feasible, and a new incision for organ removal alone was not required.

Background Decreased pancreatic volume (PV) is a predictive factor for diabetes mellitus (DM) after surgery. There are few reports on PV and endocrine function pre- and post-surgery. We investigated the correlation between PV and insulin secretion. Methods Seventeen patients underwent pancreaticoduodenectomy (PD) Pre- and post-surgery PV and C-peptide index (CPI) measurements were performed. Additionally, the correlation between PV and CPI was analyzed. Results The mean preoperative PV (PPV) was 55.1 ± 31.6 mL, postoperative remnant PV (RPV) was 25.3±17.3 mL, and PV reduction was 53%. The mean preoperative C-peptide immunoreactivity (CPR) was 1.39 ± .51 and postoperative CPR was .85±.51. The mean preoperative CPI was 1.29±.72 and postoperative CPI was .73 ± .48. Significant correlations were observed between RPV and post CPR (ρ = .507, P = .03) and post CPI (ρ = .619, P = .008). Discussion There was a significant correlation between RPV and CPI after PD. A smaller RPV resulted in lower insulin secretion ability, increasing the potential risk of new-onset DM after PD.

A 79-year-old man presented with malaise and jaundice at a local hospital. His blood tests showed severe inflammation, liver failure, and high expression of several tumour markers. Radiological findings revealed dilated common and intrahepatic bile ducts and a lower bile duct constricted by a soft tissue mass. Histological findings by endoscopy showed a suspected adenocarcinoma, which was determined as class IV by cytology. The patient was referred to our hospital for surgical treatment. He underwent pancreaticoduodenectomy and the final diagnosis was so-called carcinosarcoma of the bile duct. He had liver metastasis and died at 26 postoperative months.

Background Hepatectomy for liver cirrhosis patients requires skillful surgical technique and careful attention because of the fibrotic parenchyma, elevated portal pressure, and impaired coagulation. This report evaluated short- and long-term outcomes for liver cirrhosis patients receiving precoagulation therapy on the parenchymal transection plane, compared with noncoagulation cases. Methods Seventy-three patients diagnosed with cirrhosis via postoperative pathological findings were selected after reviewing 887 hepatectomy patient files. They were divided into a precoagulation group (n = 20) and a noncoagulation group (n = 53). There were no significant differences in patient and tumor factors between 2 groups. Results The precoagulation group had significantly less blood loss compared with noncoagulation group [282 vs 563g (P < 0.05)], shorter operative time [214 vs 276 min (P = 0.06)], and shorter postoperative hospital stays [14.5 vs 22.5 days (P = 0.12)]. The median recurrence free survival rates time in the pre-coagulation group (733 days) was significantly longer than that in the non-coagulation group (400 days) (P < 0.05). Overall survival rates showed rates showed no difference between the 2 groups (P = 0.62). Conclusions Precoagulation therapy may be the a preferred treatment application for hepatectomy patients with severe liver fibrosis.

Background/aim To evaluate the complication rates and risk factors associated with transumbilical wounds and investigate the usefulness of an incision for organ removal in laparoscopic hepatectomy (Lap-H). Patients and methods We enrolled 42 patients who underwent Lap-H excluding a small partial resection in our hospital between 2013 and 2018. The occurrences of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia were recorded. Results SSI was not observed, and hernia occurred in 3 patients (7.14%). Univariate analysis revealed that body mass index (BMI) (p=0.004) was significantly associated with the risk of hernia formation. Conclusion High BMI is a risk factor for hernia formation in patients undergoing Lap-H with transumbilical incision; hence, wound closure should be performed carefully. The construction of the transumbilical wound for organ removal was feasible with rationality, with no need to create a new wound.

Recently, virtual navigation system has been applied to hepatic surgery, enabling better visualization of intrahepatic vascular branches and location of tumor. Intraoperative ultrasonography (IOUS) is the most common form of image guidance during liver surgery. However, during laparoscopic hepatectomies (LH), IOUS has several limitations and its reliability has been poorly evaluated. The objective of this work is to evaluate VRCT (virtual real-time CT-guided volume navigation) during LH. This system aims to provide accurate anatomical orientation for surgeons enhancing the safety of LH. Twenty-seven hepatic neoplasms were resected laparoscopically at our institution under reference guidance of VRCT. During operation, electromagnetic tracking of the surgical instrument was used for navigating the direction of accurate liver transection. Twenty-six (96.3%) of the 27 lesions (mean diameter 11 mm) were successfully performed under VRCT guidance. Average registration time was

Background/aim This study investigated the use of near-infrared fluorescent imaging for securing safe margins during liver resection. Patients and methods This study included 125 patients who underwent liver tumor resection in 2014-2018. Indocyanine green testing was performed 2-14 days before surgery. Histopathological specimens of hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) were evaluated using fluorescent microscopy. Results Fluorescence microscopy identified signals in 26/53 (49.0%) and 36/72 (50%) cases of HCC and CRLM, respectively. HCC demonstrated total, partial, rim, and combined fluorescence patterns; CRLM uniformly demonstrated rim fluorescence. Although rim fluorescence was seen in both HCC and CRLM, no malignancy was confirmed pathologically in the peritumoral area demonstrating fluorescence. The median widths of fluorescence from the tumor edge in HCC and CRLM were 1227.5 μm and 1608 μm, respectively, with no significant difference. Conclusion Near-infrared fluorescent imaging can reliably detect safe surgical margins intraoperatively during liver resection.

Three-dimensional virtual endoscopy (3DVE) has the potential advantage of enhanced anatomic delineation and spatial orientation during laparoscopic procedures. In the present study, we aimed to evaluate the impact of 3DVE guidance in laparoscopic distal pancreatectomy (LDP). Thirty-eight patients presenting to our hospital with a variety of pancreatic tumors underwent preoperative computed tomography scanning to clearly define the major peripancreatic vasculature and correlate it with a 3DVE system (SYNAPSE VINCENT: Fujifilm Medical, Tokyo, Japan). This map served as the guide during preoperative planning, surgical education, and simulation and as intraoperative navigation reference for LDP. Operative records and pathological findings were analyzed for each procedure. Operative parameters were compared between the 38 patients in this study and 8 patients performed without 3DVE guidance at our institution. The 3DVE navigation system successfully created a preoperative resection map in all patients. Relevant peripancreatic vasculature displayed on the system was identified and compared during the intervention. The mean blood loss in LDP performed under 3DVE guidance versus LDP without 3DVE was 168.5 +/- 347.6 g versus 330.0 +/- 211.4 g, p = 0.008 while and the operative time was 171.9 +/- 51.7 min versus 240.6 +/- 24.8 min, p = 0.001. 3DVE in conjunction with a “laparoscopic eye” creates a preoperative and intraoperative three-dimensional data platform that potentially enhances the accuracy and safety of LDP.

Background/aim Thermo-reversible gelation polymer (TGP) can be converted into a gel state upon warming and liquid upon cooling. The present study aimed to demonstrate a new method for cryopreservation and encapsulation of rat hepatocytes using a TGP and their successful transplantation. Materials and methods The isolated rat hepatocytes were microencapsulated using TGP, and stored in liquid nitrogen. After cryopreservation, hepatocytes were cultured. Moreover, hepatocytes were transplanted into the spleen without a TGP capsule. Results The viability of hepatocytes that were cryopreserved in TGP was 71.2±2.3%. The hepatocytes demonstrated adequate survival, maintained their hepatic function in culture, and expressed albumin after transplantation to the rat spleen. Conclusion We demonstrated a cryopreservation method of rat hepatocyte encapsulation using a TGP gel in the hydrogel state which subsequently allowed successful transplantation of unencapsulated hepatocytes in a sol state TGP gel at low temperature.

Schwannomas occurring in the hepatoduodenal ligament are extremely rare, with only four cases reported. Here, we describe a case of a 30-mm schwannoma that originated in the hepatoduodenal ligament of a 38-year-old female found during a periodic medical check-up. Magnetic resonance imaging demonstrated a tumor in the hepatoduodenal ligament. Following an ultrasound-guided microbiopsy, histological examination showed solitary fibrous tumor or schwannomas in the liver or originating from the hepαtoduodenal ligament. The relationship between the tumor and associated organs was confirmed intraoperatively, and the tumor was removed safely in its entirety using indocyanine green. The postoperative histopathological examination revealed the presence of a schwannoma with typical characteristics. To our knowledge, this is the first case of hepatoduodenal ligament schwannoma treated by laparoscopic surgery using indocyanine green fluorescence imaging.

Background It is unclear how effective recombinant thrombomodulin (rTM) treatment is in disseminated intravascular coagulation (DIC) during the perioperative period of gastrointestinal and hepato-biliary-pancreatic surgery. The current study aimed to evaluate the therapeutic outcomes of rTM for perioperative DIC. Methods We enrolled 100 consecutive patients diagnosed with perioperative DIC after gastrointestinal surgery, and hepato-biliary-pancreatic including emergency procedures, between January 2012 and May 2021. Patients received routine rTM treatment immediately after DIC diagnosis. Then, the DIC, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated and used for evaluation. The outcomes of rTM treatment and the predictors of survival were evaluated. Results The causative diseases of DIC were as follows: perforated peritonitis, n = 38; intestinal ischemia, n = 23; intra-abdominal abscess, n = 13; anastomotic leakage, n = 7; pneumonia, n = 7; cholangitis, n = 4; and others, n = 6. The 30-day mortality rate was 18.0%. There were significant differences in the platelet count (13.78 vs 10.41, P = .032) and the SOFA score (5.22 vs 9.89, PConclusions Comprehensive and systemic treatment is fundamentally essential for DIC, in which rTM may play an important role in the treatment of perioperative DIC.

Indocyanine green fluorescence imaging (ICG-FI)—a sensitive tool for detecting tumor localization in laparoscopic surgery—produces false positive results for benign liver tumors. This report is the first case of hepatic angiomyolipoma (HAML) treated laparoscopically with ICG-FI. We present the case of a 31-year-old woman with a liver tumor that was a 13-mm mass in the anterior superior segment. Though a benign tumor was suspected, malignant potential could not be ruled out. Therefore, minimally invasive laparoscopic resection using ICG-FI was planned. ICG, intravenously injected preoperatively, revealed the tumor’s existence. Pure laparoscopic hepatectomy with ICG-FI was performed for excisional biopsy, during which the tumor was resected with adequate surgical margins, followed by histological confirmation of HAML. In conclusion, it is suggested that laparoscopic resection with ICG-FI is an effective minimal invasive surgery for tumors that are difficult to detect, such as HAML, leading to a safe surgical margin.

Hideki Shibata, Takeshi Aoki, Tomotake Koizumi, Tomokazu Kusano, Tatsuya Yamazaki, Kazuhiko Saito, Takahito Hirai, Kodai Tomioka, Yusuke Wada, Tomoki Hakozaki, Yoshihiko Tashiro, Koji Nogaki, Kosuke Yamada, Kazuhiro Matsuda, Akira Fujimori, Yuta Enami, Masahiko Murakami Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, JapanCorrespondence: Takeshi AokiDivision of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, JapanTel +81-3-3784-8000Fax +81-3-3784-5835Email takejp@med.showa-u.ac.jpPurpose: Bile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries.Patients and Methods: We examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively.Results: There were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50– 197) minutes, and estimated blood loss was 43.2 (0– 400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3– 9) days, and no postoperative complications (Clavien–Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely.Conclusion: ICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.Keywords: indocyanine green fluorescent imaging, navigation surgery, near-infrared fluorescent cholangiography

Background Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate. Methods Twenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups. Results POPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group. Conclusions The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF. Trial registration The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.

Background There are no established standard criteria for choosing the most appropriate procedure of splenic artery dissection during laparoscopic distal pancreatectomy (LDP). The aim of this study was to evaluate the clinical benefits of individualized procedures for splenic artery dissection during LDP based on the variations in arterial structure visualized on preoperative three-dimensional computed tomography (3D-CT). Methods Patients who underwent LDP following 3D-CT at a single center were retrospectively evaluated. 3D-CT images were used to construct virtual 3D laparoscopic images for surgical planning. The splenic artery was classified into two major anatomic types: type S that curves and runs suprapancreatic and type D that runs straight and dorsal to the pancreas. Splenic artery dissection was planned according to these two variations, with type S dissected using an suprapancreatic approach and type D using a dorsal approach. Results Type-specific dissection was applied for 30 patients: 25 (83%) with type S and 5 (17%) with type D splenic artery anatomies. In 25 (83%) patients, the splenic artery was successfully dissected using the planned surgical procedure, whereas the surgical plan had to be altered in 5 cases (17%) due to difficulty in dissecting the splenic artery. Conclusion The individualized procedures for splenic artery dissection according to anatomic variations visualized on 3D-CT images can help improve the success and safety of LDP.

Laparoscopic liver resection is increasingly used to treat patients with hepatic tumor. However, during laparoscopic resection, information obtained by palpation using laparoscopic forceps or from intraoperative ultrasonography is extremely limited, which may pose a risk for positive surgical margins. This study aimed to investigate the feasibility and clinical application of near-infrared (NIR) fluorescence imaging to guide laparoscopic liver resection of a liver tumor and secure the surgical margins. A preliminary study in 25 patients was conducted. NIR imaging was used intraoperatively during laparoscopic liver resection. The liver tumors were preoperatively labeled by intravenously injecting the patients with indocyanine green dye (0.5 mg/kg), an NIR fluorescence agent. During the surgical procedure, the PINPOINT Endoscopic Fluorescence Imaging System was used to assess the surgical margin by using real-time endoscopic high-definition visible and NIR fluorescence imaging. All tumors were identified and resected laparoscopically by using the PINPOINT system, and all resections successfully secured the surgical margin. The pathological findings of all tumors indicated negative margins, defined as R0. This technique showed the potential to improve the intraoperative identification and demarcation of tumors. Its use could potentially reduce the number of positive resection margins.

Laparoscopic and thoracoscopic/laparoscopic hepatectomy is a safe procedure that has potential advantages over open surgery. However, deeply positioned liver tumors require expert laparoscopic and thoracoscopic/laparoscopic hepatectomy techniques. Using simulated preoperative three-dimensional virtual endoscopy (P3DVE) guidance, we demonstrate herein that a thoracoscopic approach (TA), thoracoscopic–laparoscopic approach (TLA), and laparoscopic approach (LA) are all feasible and safe routes for performing pure laparoscopic and thoracoscopic/laparoscopic resection of liver tumors located in the 4a, 7, and 8 liver subdiaphragmatic areas. Thirty-eight patients underwent laparoscopic and thoracoscopic/laparoscopic partial liver resection (TA 13 cases, TLA two cases, and LA 23 cases) of the subdiaphragmatic area at Showa University Hospital. All surgical approaches were preoperatively determined based on preoperative 3D virtual endoscopic simulation (P3DVES) visualization and findings using the image processing software SYNAPSE VINCENT®. Laparoscopic and thoracoscopic/laparoscopic liver resection was successfully performed for all cases under P3DVE instruction. The mean operative times using TA, TLA, and LA approaches were 193, 185, and 190 min, respectively. Mean blood loss during TA, TLA, and LA was 179, 138, and 73 g, respectively. No patients required conversion to open surgery, and there were no deaths, although there were three cases of Clavien–Dindo grade I in TA along with three cases of grade I and one case of grade II in LA. TA, TLA, and LA routes performed under P3DVE instruction are feasible and safe to perform for pure laparoscopic and thoracoscopic/laparoscopic liver resection in selected patients with lesions located in the hepatic subdiaphragmatic area.

Clinical use of a time-lapse system and the develpoment of continuous culture media have enabled the establishment of modern incubation systems which decrease stress on the embryo. Furthermore, the use of a time-lapse system allows the accumulation of successive images of embryonic development. Various embryo morphological kinetics are beginning to be analyzed by using the collected data. A time-lapse system is useful for the accurate evaluation of implantation ability and deciding which embryos should be transferred first. Also, a time-lapse system allows the elimination of embryos which shoud not be transferred because of abnormal cleavage, or a multinucleated blastomere after the 4-cell stage.

Mycoplasma Infectious Diseases (MID) are systemic illnesses that cause vasculitis and neuritis. MID not only includes pneumonia but also diseases such as asthma, arthritis, nephritis, meningitis, encephalitis, dermatitis, pancreatitis, hepatitis, and hematologic illnesses. The broader concept of MID encompasses acute to chronic phases with diverse symptoms. Therefore, it is often confusing and difficult to identify Mycoplasma-infected patients among those with incurable diseases, such as autoimmune diseases, rheumatic diseases, nervous system disorders, and hematological disorders. Regrettably, conventional diagnosis has only been available for pneumonia, although it is critical to identify MID at early stages for effective medical treatment. A cutting-edge technology has made it possible to measure the amount of specific antibodies to species-specific mycoplasma glycolipid-antigens. This new technology provides a reliable marker to follow the state of MID by monitoring antibody titer fluctuations. A novel therapeutic strategy based on new serological diagnostics is introduced in this review.

Nanoparticle albumin-bound paclitaxel (nab-PTX) has become a key drug used in chemotherapy for breast cancer, but it often causes adverse effects such as peripheral neuropathy (PN). No effective prophylactic management has so far been established. We have applied a "3S" approach to prevent and treat PN based on two concepts: compression therapy using stockings and sleeves, and medication therapy using selected prophylactic medications. We previously reported better CTCAE v4.0 PN grades and notably superior nab-PTX dose maintenance in a 3S group compared to a control group. However, little is known about the effects of compression therapy on a patient’s level of skin blood perfusion; it is also unknown whether any such effects might vary by 1) PN grade or 2) the number of nab-PTX cycles. To establish whether a compression therapy-skin perfusion relationship exists, the skin perfusion of the lower limbs was measured before and after stocking use in a 3S prophylactic treatment group for nab-PTX therapy (n=44), and in a control group of healthy volunteers (n=50). The skin perfusion was measured using a laser Doppler blood flow meter with an integrated probe (NL-101 Nahri Nexis Japan). To find how compression therapy affects skin perfusion by PN grade, the 3S group was subdivided into three PN grade subgroups (n = 12 for Grade 0, n = 20 for Grade 1, and n = 12 for Grades 2 and 3 combined). To find how compression therapy affects skin perfusion by number of nab-PTX treatment cycles undergone by patients, the 3S group was subdivided into the following three subgroups: 1 to 5 cycles of nab-PTX treatment (first period group; 1P, n=18), 6 to 10 cycles (second period group; 2P, n=16), and more than 10 cycles (third period group; 3P, n=12). In the control group of healthy volunteers, stocking use tended to increase the median skin perfusion level (mL/min/100g) from 10.9 ± 3.8 to 11.8 ± 4.3 (p=0.06). Interestingly, the median skin perfusion level for the 3S group as a whole significantly increased from 8.7 ± 3.3 before stocking use to 11.3 ± 3.8 after stocking use (p< 0.001). When examining the effects of stocking use on skin perfusion by PN grade, the increase in median skin perfusion level was significant in the Grade 0 subgroup (8.2 ± 2.7 to 12.4 ± 4.5, p=0.005), in the Grade 1 subgroup (8.3 ± 3.8 to 10.4 ± 4.0, p=0.0499), and in the Grades 2 and 3 subgroup (7.9 ± 2.3 to 10.6 ± 2.4, p=0.005). When examining the effects of stocking use on skin perfusion by number of treatment cycles, the increase in median skin perfusion level was significant in the 1P subgroup (7.9 ± 3.0 to 11.4 ± 4.8, p=0.007) and in the 2P (7.9 ± 2.9 to 10.8 ± 2.9, p=0.005), but not in the 3P (9.3 ± 3.5 to 10.8 ± 3.2, p=0.15). This study demonstrated that the skin perfusion of the lower limbs is decreased following nab-PTX chemotherapy, and also that the skin perfusion is improved by compression therapy. Compression therapy appeared to successfully restore the skin perfusion levels across every grade of chemotherapy-induced PN. Therefore, our 3S approach is suitable for alleviating CIPN by proactively maintaining skin perfusion from the beginning of nab-PTX therapy. Citation Format: Tsuyoshi Ohno, Takashi Mine, Hiroki Yoshioka, Mikiko Kosaka, Kazuhiro Matsuda, Maiko de Kerckhove, Charles de Kerckhove. Restoration by compression therapy of skin blood perfusion levels decreased during breast cancer chemotherapy, alleviating peripheral neuropathy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-13.

Mycoplasma pneumoniae expresses β-glycolipids (β-GGLs) in cytoplasmic membranes, which possess a unique β(1 → 6)-linked disaccharide epitope, which has high potential in biochemical and medicinal applications. In the present study, a series of β-GGLs homologues with different acyl chains (C12, C14, C16, and C18) were prepared from a common precursor. An ELISA assay using an anti-(β-GGLs) monoclonal antibody indicated that the synthetic homologues with long acyl chains had greater diagnostic potential in the order C18 > C16 > C14 > C12. Toward a simultaneous detection of natural glycolipids by mass spectrometry (MS), a deuterium-labeled C16 homologue (β-GGL-C16-d3) was prepared and applied as an internal standard for a high-resolution electrospray ionization MS (ESI-MS) analysis. The ESI-MS analysis was used to identify and quantify acyl homologues (C16/C16, C16/C18, and C18/C18) of β-GGL-C16 in cultured M. pneumoniae. A β-GGLs homologue with a 1,2-diacetyl group (C2) was also prepared as a “water soluble” glycolipid homologue and characterized by 1H NMR spectroscopy. We envisage that each of these chemosynthetic homologues will provide promising approaches to solve medical and biological problems associated with mycoplasma infectious diseases (MIDs).

〔目的〕転倒リスク管理における振動覚検査の有用性を検討することである．〔対象〕地域在住高齢者50名とした．〔方法〕振動覚検査，Timed “Up & Go” Test （TUG），膝伸展筋力測定，転倒恐怖感・活動性の調査を実施した．転倒の有無により転倒群と非転倒群に分け，各項目の2群の結果を比較した．また，転倒恐怖感・活動性とその他の各検査との関連性を調べた．〔結果〕振動覚検査，TUG，転倒恐怖感は，転倒群に比べ非転倒群の成績が有意に優れていた．転倒恐怖感・活動性は，運動能力と有意な相関を認め，振動覚との相関はみられなかった．〔結語〕振動覚は，転倒恐怖感や活動性と関連性がなく，運動能力の高い高齢者の転倒リスク評価に有用であると示唆された．

Technetium-99m-galactosyl human serum albumin (GSA) scintigraphy provides an accurate estimation of the hepatic functional reserve but is not applied after a hepatectomy. The aim of this study was to elucidate the natural course of the remnant hepatic functional reserve (RHFR) after hepatectomy by GSA scintigraphy. Eighty-six patients (partial hepatic resection, Hr0 = 46; sectionectomy, Hr1 = 21; bisectionectomy, Hr2 = 19) classified as Child–Pugh class A before the hepatectomy were enrolled, and GSA scintigraphy to detect HH15 (uptake ratio of the heart at 15 min to that at 3 min) and LHL15 (uptake ratio of the liver at 15 min to the liver plus the heart at 15 min) was performed periodically before and after the hepatectomy. HH15, LHL15, and the percentages of patients that recovered to the preoperative levels of these entities were estimated. In addition, hematobiochemical tests and the remnant liver volume were also periodically monitored. HH15 and LHL15 levels deteriorated until 2 months postoperatively (PO) after the procedure and subsequently recovered to the preoperative levels at 6 months PO in Hr0 patients. In Hr1 patients, but not in Hr2 patients, these levels also deteriorated until 3 months PO and had improved by 6 months after the surgery. Only 40% of the patients showed recovery to the preoperative levels by 6 months PO in the Hr0 group; furthermore, the percentage of patients who showed recovery to the preoperative levels by 6 months PO was under 40% in the Hr1 group and around 10% in the Hr2 group. However, the results of hematobiochemical tests and the remnant liver volume in all types of hepatectomies were rapidly normalized after the hepatectomy. Remnant hepatic functional reserve estimated by GSA scintigraphy revealed that a larger resected liver volume induced both more serious and continued remnant hepatic dysfunction in comparison to results shown by hematobiochemical tests, while the functional regeneration was also appreciably slower and more gradual in comparison to the volume regeneration.

Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation. The imaging technique for mapping liver segments and cholangiogram based on ICG fluorescence used an infrared-based navigation system. Eighty one patients with liver tumors underwent hepatectomy from 2006, January to 2009, March. In liver surgery, 1 ml of ICG was injected via the portal vein under observation by the fluorescent imaging system. Fourteen patients were underwent laparoscopic cholecystectomy for chronic cholecystitis with gallstones. In laparoscopic cholecystectomy, 5 ml of ICG was administered intravenously just before operation and the bile duct was observed using the infrared-based navigation system. This new technique successfully identified stained subsegments and segments of the liver in 73 of 81 patients (90.1%). Moreover, clear mapping of liver segments was obtained even against a background of liver cirrhosis. Fluorescent cholangiography clearly showed the common bile duct and cystic duct in 10 of 14 patients (71.4%). No adverse reactions to the ICG were encountered. Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery.

This paper proposes a seismic peak response evaluation method for slip-hysteretic structure having a viscous or viscoelastic damper. Formulations to estimate equivalent vibration period and equivalent damping ratio of the slip-hysteretic structure subjected to random excitation are presented. The peak response evaluation method is based on equivalent linearization as well as spectrum modification and reduction, reflecting increase in equivalent vibration period and equivalent damping ratio. Accuracy of the evaluation method is validated through numerous time history analyses, over a wide range of viscous damping ratio, elastic vibration period, post-yield stiffness, slip strength ratio, ductility ratio, and earthquake type.

Mycoplasma fermentans has been suspected as one of the causative pathogenic microorganisms of rheumatoid arthritis (RA) however, the pathogenic mechanism is still unclear. We, previously, reported that glycolipid-antigens (GGPL-I and III) are the major antigens of M. fermentans. Monoclonal antibody against the GGPL-III could detect the existence of the GGPL-III antigens in synovial tissues from RA patients. GGPL-III antigens were detected in 38.1% (32/84) of RA patient's tissues, but not in osteoarthritis (OA) and normal synovial tissues. Immunoelectron microscopy revealed that a part of GGPL-III antigens are located at endoplasmic reticulum. GGPL-III significantly induced TNF-alpha and IL-6 production from peripheral blood mononulear cells, and also proliferation of synovial fibroblasts. Further study is necessary to prove that M. fermentans is a causative microorganism of RA; however, the new mechanisms of disease pathogenesis provides hope for the development of effective and safe immunotherapeutic strategies based on the lipid-antigen, GGPL-III, in the near future.

In order to reduce seismic response and damage of wooden houses effectively, a series of so-called shear-link-type passive control systems, which include both velocity- and deformation-dependent dampers were proposed. In this study, a number of shaking table tests of the full-scale two-story wooden frame specimens were carried out. The specimens are composed of conventional post-and-beam with structural plywood, or K-brace and damper for structural element. Performance of specimens is discussed by referring to story drifts, base shear forces, damper deformations and forces, and ratio of story's stiffness. Dynamic properties of the structures such as equivalent periods and damping ratios are also discussed. Test results are compared with the prediction made by calculation of response and limit strength.

自己免疫性溶血性貧血において副腎皮質ステロイドにて治療中難治性のクリプトコッカス髄膜炎を発症した稀な症例を報告する．7年前より自己免疫性溶血性貧血にて副腎皮質ステロイド投与にて治療中の48歳の男性患者が4ヵ月前に頭痛，難聴，嘔気，嘔吐などを訴えクリプトコッカス髄膜炎を発症した．後に貧血の増悪のためにショック状態になり当科に紹介された．この間に視力障害，全盲，を合併した．貧血はm-PSLによるパルス療法により改善した．クリプトコッカス髄膜炎に対してはAMPH-B（注射用dAMPH-B，リポゾーム化剤，L-AMB），5-FC，アゾール剤であるFLCZおよびVRCZなどの投与により髄膜炎症状は消失した．抗真菌剤を1年半投与し，髄液中のクリプトコッカス抗原量は著明に減少したが陰性化せずまた墨汁染色ではクリプトコッカスの数は減少したが未だ完全には消失しておらず難治性であり視力障害，難聴は残存した．

A 69-year-old man complained of knee pain, subsequent polyarthralgia, and pains of the muscles of the pelvic girdle and thighs. At the same time, erythema of the face and hands appeared. Biopsy of the skin and muscle revealed non-caseating granuloma of epithelioid cells. The level of serum angiotensin-converting enzyme was normal, but that of lysozyme was elevated. Chest X-ray and CT did not show bilateral hilar lymphadenopathy (BHL) but revealed infiltrative ground glass appearance-like shadows of both lungs, and a Ga scintigram disclosed accumulation in the right hilar region, but not in the muscles. These complaints were quickly ameliorated by the administration of prednisolone. The present patient represented a rare case of acute musculoskeletal system involvement in sarcoidosis not typical of Löfgren's syndrome.

Tenryocha, rooibos, and guava teas are widely consumed as herbal beverages, especially as a therapy against pollen allergy. To investigate the possible herbal tea-drug interaction the effect of continuous ingestion of these teas on cytochrome P450 (CYP) 3A were studied. Rats (n = 6) were allowed free access to either tea (experimental groups) or water (control) for two weeks. Midazolam (MDZ) (20 mg/kg) was orally administered and the serum concentration was determined. The area under the serum concentration-time curve (AUC0–∞) and the maximum serum concentrations (Cmax) of MDZ were reduced by more than 60% after the treatment of tenryocha and rooibos tea (P

This study describes a novel technique for skeletonization and isolation of Glissonean and venous branches during liver surgery using a harmonic scalpel (HS). Hepatic resections with HS were performed with the skeletonization and isolation technique in 50 patients (HS group). Variables evaluated were blood loss, operative time, biliary leak, and morbidity. The results were compared with 50 hepatic resections that were performed using a previously established technique: Cavitron ultrasonic surgical aspirator with electric cautery, ligatures, and hemoclips (NHS group). The HS group had shorter total operative times (285 versus 358 minutes; P = 0.01), less blood loss (389 versus 871 mL; P = 0.034), and less crystalloid infusion (2744 versus 3299 mL; P = 0.027) compared with the NHS group. Postoperative liver function and complication rates were similar when comparing the two groups. These data demonstrate that HS is a simple, easy, and effective instrument for the skeletonization and isolation of vessels during liver transection.

Drewell ® (diphenhydramine: DPH) is a histamine H1 receptor antagonist and the first OTC sleep aid in Japan. There are few studies which objectively evaluate the sedative effects in elderly subjects. The aim of present study was to evaluate the sedative effects of Drewell ® in healthy elderly and to compare the results with data from young subjects on which we reported previously.A placebo controlled, double-blind, crossover clinical pharmacological study was performed. Eight Japanese healthy elderly male volunteers received 2 tablets of Drewell ®, containing 50mg DPH, or matched placebo orally. Plasma levels of DPH after administration were measured hourly up to 4 hours and every 2 hours up to 8 hours. The sedative effects after the dose were measured by using the saccadic eye movement analyzing system for objective assessment and visual analogue scale (VAS) for subjective assessment.After Drewell ® administration the saccadic peak velocity (SPV) was decreased and saccade inaccuracy (IAC) was increased compared with placebo. There were no significant differences in saccade latency and VAS. The onset of significant decrease of SPV in elderly was delayed compared to young subjects (90 min in elderly vs 30 min in young) although pharmacokinetic parameters were similar in elderly and young subjects. However, the available data of both pharmacokinetic and pharmacodynamic at the same time point until sedation onset was only 60 min. Therefore further investigation is necessary to precisely determine the differences of onset of the sedative effect up to 90 min after Drewell ® administration.

症例は61歳の女性で, 右側腹部痛を主訴にて当院を受診した. 特記すべき既往歴はなく来院時軽度の貧血を認めた. 右側腹部全体に筋性防御をともなう圧痛と, 著しい反跳痛を認めた.CTでは右後腹膜腔を中心に, 十二指腸から総腸骨動脈分岐部まで連続したlow～iso density areaを認めた. 上部内視鏡検査では上部消化管穿孔の所見は認めなかった. 以上の所見より, 後腹膜血腫をともなう下部消化管穿孔を否定できず同日緊急手術を施行した. 開腹にて右側中心に後腹膜血腫を確認したが, 腹腔内は淡々血性の腹水が少量のみであった. 後腹膜は開放せず, 洗浄ドレナージのみとした. 術後の3D-CT angiographyでは, 血管性病変は指摘できなかった. 第10病日に血腫による十二指腸狭窄を認めたが保存的に軽快し, 第31病日に軽快退院となった. その後, 再発は認められていない. 原因不明の後腹膜疾患を認めた場合, 後腹膜血腫も念頭に入れる必要がある.