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Laparoscopic liver resection (LLR) is possible in many patients, but pure LLR is sometimes difficult to complete, and unplanned intraoperative hand-assisted laparoscopic surgery (HALS) or open conversion is sometimes necessary. However, appropriate indications and timing for conversion are unclear. This study aimed to clarify the indications for HALS and open conversion from pure LLR.We collected data from 208 patients who underwent LLR from January 2010 to February 2021 in our department. We retrospectively examined these data between cases of unplanned intraoperative HALS conversion, open conversion, and pure LLR, and clarified risk factors and indications for HALS or open conversion.There were 191 pure LLRs, nine HALS conversions, and eight open conversions. In the HALS conversion group versus pure LLR group, body mass index (BMI) (27.0 vs. 23.7 kg/mRisk factors for considering HALS during LLR were patients with a history of upper abdominal surgery including repeat hepatectomy, BMI ≥ 25 kg/m

Purpose: For gallbladder carcinomas (GBCs), the only effective treatment is surgery. In this study, we aimed to determine the clinicopathologicalfeatures of T2 GBC and identify the optimal surgical strategies. Methods: This was a retrospectivestudy of 77 patients with histologically verified T2 subserosal GBC who underwent surgery at our institution between 1989 and 2021. Pathological data (tumor size, location, grade, lymph node status, and lymphovascular and perineural invasions) and demographic data were reviewed. The 5-year disease-specific survival (DSS) rates were determined and included in our analysis. Results: The 42 (55%) patients in our sample who were pathological invasion (PI)-positive had significantly lower 5-year DSS. PI was significantly correlated with lymph node metastasis but not with tumor location. Those with PI treated with radical cholecystectomies had better 5-year DSS rates than those treated with simple cholecystectomies (57% vs 25%, p = 0.04). However, different surgical procedures produced no significant differences in the 5-year DSS of PI-negative patients. Conclusions: PI-positive T2 GBC patients had poor prognoses and required radical cholecystectomy. However, PI-negative cases had low lymph node metastases rates and favorable prognoses. In these cases, simple cholecystectomy may be more appropriate.

Although intussusception in adults generally results from malignant tumors and polyps, intussusception caused by chronic diverticulitis is extremely rare. We present the case of a 59-year-old man treated with steroids and biopharmaceuticals at the Department of Dermatology for psoriasis vulgaris. Cecal diverticulitis frequently recurred, for which he was treated during follow-up. This time, endoscopy showed a circumferential stenosis in the ascending colon, and computed tomography showed the appearance of a target sign in the right colon. As a result, the patient was preoperatively diagnosed as having intussusception of the ascending colon triggered by diverticulitis of the cecum and underwent laparoscopic right colectomy. Pathological findings of the specimen revealed multiple diverticulitis of the cecum. Therefore, we thought that the intussusception was caused by chronic inflammation of the diverticula and surrounding fibrosis. Among intussusception in adults, chronic diverticulitis should be considered as a target of surgical treatment on rare occasions.

No consensus has been reached on the postoperative treatment and follow-up duration for high-risk malignant gastrointestinal stromal tumor (GIST). We herein report a case of recurrent liver metastasis from gastric GIST in a patient who had been receiving adjuvant chemotherapy with imatinib mesylate for 10 years. A 78-year-old woman underwent local gastrectomy for a 20-cm gastric GIST with a mitotic index of 25/50 high-power fields (HPF) 17 years before. Partial hepatectomy for recurrent liver metastases was repeatedly performed 14 and 12 years before. After the second hepatectomy, postoperative adjuvant chemotherapy with imatinib mesylate was given for 10 years, during which no recurrence was observed. Two years after the completion of adjuvant chemotherapy, computed tomography revealed a 2-cm hepatic tumor; thus, laparoscopic partial hepatectomy was performed. Histopathological findings revealed a liver metastasis of gastric GIST with a mitotic count of 20/50 HPF and MIB-1 labeling index of 20%. Mutation analysis of the KIT gene revealed an exon 11 mutation. The patient is currently undergoing postoperative adjuvant chemotherapy with imatinib mesylate. The combination of surgery and long-term adjuvant chemotherapy for high-risk malignant GIST and liver metastases may be effective to achieve a good prognosis.

Male Ilyoplax pusilla perform a waving display, a simple up-down movement of the claws during the reproductive season. Large males dedicated most of their surface activity to waving displays and gained higher mating success. On the other hand, small males infrequently performed waving displays and devoted their time exclusively to foraging. To examine female preference for the size of waving males, two female-release experiments were conducted. In the experiments, we recorded female choice between small- and large-waving claw models over short (10 cm) and long (25 cm) distances. In both the short- and long-distance choice experiments, significantly more females chose the large-claw model over the small-claw model. The following characteristics may produce obvious age-dependent sexual advertisement in I. pusilla, which grows throughout a life: (1) the strong female preference for large claws; (2) the short, 2-year lifespan that includes only two reproductive seasons; and (3) the lack of alternative mating strategies (e.g., surface mating).

Color M-mode Doppler echocardiography (CMD) has been utilized in assessing left ventricular (LV) filling dynamics. We tested a novel CMD index, the depth of the spatiotemporal maximum of early diastolic inflow (D-maxV) in the left ventricle, to clarify its significance in assessing LV diastolic function. In 26 normal subjects and 32 patients with ischemic heart disease, D-maxV was determined with CMD as the distance from the mitral valve opening point to the center of the aliasing area in early diastole. Transmitral flow velocity was measured with pulsed Doppler. During routine catheterization, high-fidelity LV pressure measurements yielded diastolic variables in patients. D-maxV was significantly lower in the patients than the normals (13.0 ± 7.0 vs 23.4 ± 6.8 mm, P < 0.0001). D-maxV exhibited significant linear correlations with the minimal first derivative of LV pressure (r = 0.72, P < 0.01), the time constant of isovolumic relaxation (r = −0.67, P < 0.01), and LV minimal pressure (r = −0.53, P < 0.02) in the patients with wide ranges of peak early to late inflow velocity ratio (0.43–3.9) and deceleration time of early filling (79–293 ms). D-maxV showed an inverse correlation with LV end-diastolic pressure (r = −0.53, P < 0.02) and no significant correlation with mean pulmonary capillary wedge pressure. Moreover, Kaplan-Meier analysis focusing on the patients with myocardial infarction revealed that the group with D-maxV < 10.4 mm (n = 13) exhibited a lower cumulative cardiac event-free rate than that with D-maxV ≥ 10.4 mm (n = 14) (49.4% vs 92.9% at 5 years, P < 0.05). The depth of the spatiotemporal maximum of early diastolic LV inflow velocity reflects LV relaxation and is free of pseudonormalization. Evaluation of the LV relaxation separately from preload may have a prognostic value for myocardial infarction.

Males of the dotillid crab, Ilyoplax pusilla, perform waving displays during the reproductive season. Unlike many fiddler crabs (genus Uca), however, the function of the waving display is unclear for this species. Experiments using waving and static claw models over short (10 cm) and long (25 cm) distances were conducted to investigate responses by wandering females to artificial waving signals. In long-distance choice experiments, presuming undirected waving to unseen females as broadcast waving, females were equally likely to approach the waving and static claw sections during the non-reproductive season, but significantly more females (65 %) chose the waving claw section during the reproductive season. In short-distance choice experiments, presuming directed courtship waving toward a particular female, there was no significant difference between the waving and static claw models during the non-reproductive season, but significantly more females (88 %) chose the waving claw during the reproductive season. These results suggest that one function of the waving display of I. pusilla is mate attraction and that waving from a short distance is more effective.