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Yasuoka H.,Gunma University | Maruyama H.,Kamimoku Spa Hospital | Koja A.,Ohhama Daiichi Hospital | Iida T.,Kiryu Kosei General Hospital
Journal of Japanese Society of Gastroenterology | Year: 2014

A 69-year-old man was involved in a road traffic accident wherein his car hit a telegraph pole and turned over. He reported wearing a seatbelt and denied any injuries or pain at that time. Six hours after the accident, however, he developed melena and hematemesis. Computed tomography performed on admission to our hospital revealed no evidence of traumatic pneumothorax, intra-abdominal bleeding, or pneumoperitoneum. However, there was evidence of contrast medium leakage from the stomach. Emergency endoscopy revealed a mucosal laceration on the lesser curvature in the cardiac region, with evidence of arterial hemorrhage from visible vessels. Hemostasis was achieved endoscopically by injection of hypertonic saline-epinephrine and clipping. Endoscopic treatment of gastric injury following blunt abdominal trauma is rare. Here we report a case and present a review of the relevant literature.

Kuwabara M.,Red Cross | Ninomiya H.,Red Cross | Yokobori Y.,Kiryu Kosei General Hospital | Chikamatsu K.,Gunma University
Practica Oto-Rhino-Laryngologica | Year: 2016

Although traumatic injuries caused by crossbows are rare in Japan, some of these may be lifethreatening. We describe herein a-22-year-old man who attempted to commit suicide with a crossbow. The patient shot himself in the neck with a crossbow and was taken to hospital by ambulance. Computed tomography (CT) scans revealed a crossbow bolt entering anterior border of the sternocleidomastoid muscle, involving the carotid space, and passing through the posterior region of the neck. The crossbow bolt had been shot into the neck, penetrated the internal jugular vein and worked as a tamponade so that further bleeding was prevented. We successfully removed the crossbow bolt using the purse-string suture technique and reconstructed the internal jugular vein. The postoperative course was uneventful other than a temporary vocal cord paralysis. In cases of neck injuries, careful evaluations of the vascular structures are indispensable to prevent unexpected bleeding.

Komaya K.,Nagoya University | Ebata T.,Nagoya University | Fukami Y.,Toyota Kosei Hospital | Sakamoto E.,Red Cross | And 4 more authors.
Journal of Gastroenterology | Year: 2016

Background: The aim of this study was to evaluate whether percutaneous transhepatic biliary drainage (PTBD) increases the incidence of seeding metastasis and shortens postoperative survival compared with endoscopic biliary drainage (EBD). Methods: A total of 376 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy following either PTBD (n = 189) or EBD (n = 187) at 30 hospitals between 2001 and 2010 were retrospectively reviewed. Seeding metastasis was defined as peritoneal/pleural dissemination and PTBD sinus tract recurrence. Univariate and multivariate analyses followed by propensity score matching analysis were performed to adjust the data for the baseline characteristics between the two groups. Results: The overall survival of the PTBD group was significantly shorter than that of the EBD group (34.2 % vs 48.8 % at 5 years; P = 0.003); multivariate analysis showed that the type of biliary drainage was an independent predictor of survival (P = 0.036) and seeding metastasis (P = 0.001). After two new cohorts with 82 patients each has been generated after 1:1 propensity score matching, the overall survival rate in the PTBD group was significantly less than that in the EBD group (34.7 % vs 52.5 % at 5 years, P = 0.017). The estimated recurrence rate of seeding metastasis was significantly higher in the PTBD group than in the EBD group (30.7 % vs 10.7 % at 5 years, P = 0.006), whereas the recurrence rates at other sites were similar between the two groups (P = 0.579). Conclusions: Compared with EBD, PTBD increases the incidence of seeding metastasis after resection for distal cholangiocarcinoma and shortens postoperative survival. © 2015, Japanese Society of Gastroenterology.

Yamada M.H.,Gunma University | Takazawa T.,Gunma University | Iriuchijima N.,Kiryu Kosei General Hospital | Horiuchi T.,Gunma University | Saito S.,Gunma University
Journal of Clinical Monitoring and Computing | Year: 2015

Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. This study investigated the effect of sevoflurane and propofol anesthesia on IOP in the LDP. A total of 28 patients undergoing surgery in the LDP were included. Patients were randomly allocated to sevoflurane or propofol groups. IOP in both eyes was recorded and compared between groups at five time points: after anesthesia induction, after endotracheal intubation, at 5 min and 1 h after a positional change to the LDP, and 5 min after returning to the supine position. In the sevoflurane group, IOP was significantly increased in both dependent and non-dependent eyes 1 h after changing to the LDP. In the propofol group, IOP decreased in both dependent and non-dependent eyes after tracheal intubation, but did not increase after changing to the LDP. The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications. © 2015 The Author(s)

Arai S.,Gunma University | Arai S.,Gunma Prefectural Cancer Center | Miyashiro Y.,ASKA Pharma Medical Co. | Shibata Y.,Gunma University | And 4 more authors.
Steroids | Year: 2011

The mechanism accounting for the development of castration-resistant prostate cancer (CRPC) remains unclear. Studies in CRPC tissues suggest that, after androgen deprivation therapy (ADT), the adrenal androgens may be an important source of testosterone (T) and 5-alpha dihydrotestosterone (DHT) in CRPC tissues. To clarify the role of adrenal androgens in the prostatic tissues (prostatic tissue adrenal androgens) during ADT, we developed a high sensitive and specific quantification method for the levels of androgens in prostatic tissue using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Human prostatic tissues were purified using mixed-mode reversed-phase, strong anion exchange Oasis cartridges (Oasis MAX). Analysis of steroids was performed using LC-MS/MS after picolinic acid derivatization. The validation tests showed that our method of quantitative analysis was precise and sensitive enough for the quantification of dehydroepiandrosterone (DHEA), androstenedione, androstenediol, T, and DHT in the prostatic tissue. The levels of adrenal androgens in prostate cancer tissues after ADT were similar to those in untreated PCa. Especially, DHEA was the most existing androgen precursor in PCa tissues after ADT. The levels of DHEA were high in PCa tissues, irrespective of ADT. We assumed that DHEA played a significant role in the synthesis of T and DHT in PCa tissues after ADT. © 2010 Elsevier Inc.

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