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Hashimoto, Japan

Oiwa Y.,Kishiwada Tokushukai Hospital | Hirohata Y.,Kishiwada Tokushukai Hospital | Okumura H.,Kishiwada Tokushukai Hospital | Yamaga H.,Saiseikai Wakayama Hospital | And 3 more authors.
Neurological Surgery

Microvascular decompression is now a standard surgical technique for the treatment of trigeminal neuralgia However, it is occasionally difficult to expose the trigeminal nerves because of the high anatomical variety of vascular or bony structures in the posterior fossa We reported the case of a 59-year-old woman with trigeminal neuralgia whose site of neurovascular compression could not be observed in microvascular decompression. On approaching the trigeminal nerve, the suprameatal tubercle was so prominent that it prevented adequate visualization of the nerve tract After drilling out the tubercle concealing the trigeminal nerve behind it, we exposed the nerve entirely and subsequently decompressed it from the superior cerebellar artery. Retrospectively, the suprameatal tubercle was found 3 mm high above the posterior surface of the petrous bone. Then, we analyzed the height of suprameatal tubercles in 106 patients who underwent three-dimensional CT of the skull. Mean values of the suprameatal tubercles were 1.4-1.7 mm in height, and 5.2% of them were higher than 3 mm The result suggested the high morphological variety of the petrous bone We emphasize the importance of presurgical evaluation of the petrous bone in trigeminal neuralgia, because the neurovascular compression site may not be exposed sufficiently by the suprameatal tubercle in approximately 5% of the patients. Source

Nakamura M.,Wakayama Medical University | Nakamori M.,Wakayama Medical University | Ojima T.,Wakayama Medical University | Iwahashi M.,Wakayama Medical University | And 6 more authors.
British Journal of Surgery

Background Patients' quality of life (QoL) deteriorates remarkably after gastrectomy. Billroth I reconstruction following distal gastrectomy has the physiological advantage of allowing food to pass through the duodenum. It was hypothesized that Billroth I reconstruction would be superior to Roux-en-Y reconstruction in terms of long-term QoL after distal gastrectomy. This study compared two reconstructions in a multicentre prospective randomized clinical trial to identify the optimal reconstruction procedure. Methods Between January 2009 and September 2010, patients who underwent gastrectomy for gastric cancer were randomized during surgery to Billroth I or Roux-en-Y reconstruction. The primary endpoint was assessment of QoL using the Functional Assessment of Cancer Therapy - Gastric (FACT-Ga) questionnaire 36 months after surgery. Results A total of 122 patients were enrolled in the study, 60 to Billroth I and 62 to Roux-en-Y reconstruction. There were no differences between the two groups in terms of postoperative complications or mortality, and no significant differences in FACT-Ga total score (P = 0·496). Symptom scales such as epigastric fullness (heaviness), diarrhoea and fatigue were significantly better in the Billroth I group at 36 months after gastrectomy (heaviness, P = 0·040; diarrhoea, P = 0·046; fatigue, P = 0·029). The rate of weight loss in the third year was lower for patients in the Billroth I group (P = 0·046). Conclusion The choice of anastomotic reconstruction after distal gastrectomy resulted in no difference in long-term QoL in patients with gastric cancer. Registration number: NCT01065688 (http://www.clinicaltrials.gov). © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd. Source

Hirabayashi Y.,Hashimoto Municipal Hospital
Nishinihon Journal of Urology

HoLEP (Holmium YAG laser Enucleation of the Prostate) is a new surgical technique for the treatment of Benign Prostatic Hyperplasia (BPH) that was first described by the medical team of Dr. Gilling in 1998. Fortunately I had the opportunity to abserve actual operations from a relatively early time. Since 2004 I have carried out more than 500 such operations. HoLEP is performed in more than 100 hospitals throughout Japan, and the number of operations has been increasing. However, the absolute technique has yet to be established. The procedure is entrusted to a technique based on the ability and the experience of each individual doctor. Various requirements are necessary so that HoLEP can replace TUR-P which is currently the most common surgical method for BPH. We need the establishment of the technique an assessment of its safety, an evaluation of long-term results, the purchase of equipment, an expansion of the number of hospitals where the procedure can be carried out the establishment of a training system. This time I would like to describe the measures and the reasoning of a point neglected by the original method of Dr. Gilling with the aim of establishment and the transmission of HoLEP. I would also like to refer to techniques for you to be when you are in a leading situation, in spite of this being simply my own personal opinion. Source

Ozawa S.,Minami Wakayama Medical Center | Tabata H.,Minami Wakayama Medical Center | Kinoshita I.,Minami Wakayama Medical Center | Tamaki T.,Minami Wakayama Medical Center | And 4 more authors.
Journal of the Wakayama Medical Society

Two cases with a past history of perforated sigmoid colon diverticulum treated by Hartmann's operation was admitted to our hospital due to vomit or/and abdominal pain. Case 1: A 89-year-old female, revealed by the computed tomography (CT) scan a parastomal hernia. Laparoscopic hernia repair operation was performed. The hernia defect and protruded omentum were located at the cephalad side of the stoma. Two different types of meshes were used to protect and fix the bowel to the abdominal wall. First, the polypropylene mesh (Soft Mesh®) was used for covering the hernia defect and the end of the colon. Moreover, polypropylene and expanded polytetrafluorethylene mesh (Composix® Mesh) was placed on the Soft Mesh® to prevent the conglutination. Case 2: A 71-year-old female was diagnosed incarcerated parastomal hernia with CT scan. We repaired the hernia by the same procedure as the first case. Neither of the cases showed parastomal hernia recurrence after the surgery. We conclude that the laparoscopic parastomal hernia repair with two different types of prosthetic meshes showed more safety and lower recurrence than single prosthetic mesh method. Source

Suzuki H.,Wakayama Medical University | Terai M.,Tokyo Womens Medical University | Hamada H.,Tokyo Womens Medical University | Honda T.,Tokyo Womens Medical University | And 14 more authors.
Pediatric Infectious Disease Journal

BACKGROUND: There are still no definite treatments for refractory Kawasaki disease (KD). In this pilot study, we evaluated the use of cyclosporin A (CyA) treatment in patients with refractory KD. METHODS: We prospectively collected clinical data of CyA treatment (4-8 mg/kg/d, oral administration) for refractory KD patients using the same protocol among several hospitals. Refractory KD is defined as the persistence or recurrence of fever (37.5°C or more of an axillary temperature) at the end of the second intravenous immunoglobulin (2 g/kg) following the initial one. RESULTS: Subjects were enrolled out of 329 KD patients who were admitted to our 8 hospitals between January 2008 and June 2010. Among a total of 28 patients of refractory KD treated with CyA, 18 (64.3%) responded promptly to be afebrile within 3 days and had decreased C-reactive protein levels, the other 4 became afebrile within 4 to 5 days. However, 6 patients (21.4%) failed to become afebrile within 5 days after the start of CyA and/or high fever returned after becoming afebrile within 5 days. Although hyperkalemia developed in 9 patients at 3 to 7 days after the start of CyA treatment, there were no serious adverse effects such as arrhythmias. Four patients (1.2%), 2 before and the other 2 after the start of CyA treatment, developed coronary arterial lesions. CONCLUSION: CyA treatment is considered safe and well tolerated, and a promising option for patients with refractory KD. Further investigations will be needed to clarify optimal dose, safety, and timing of CyA treatment. Copyright © 2011 by Lippincott Williams & Wilkins. Source

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