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Kobayashi, Japan

Aimoto T.,Nippon Medical School | Uchida E.,Nippon Medical School | Matsushita A.,Nippon Medical School | Kawano Y.,Nippon Medical School | And 2 more authors.
Journal of Nippon Medical School | Year: 2013

Background: Frey's procedure might be a good alternative to pylorus-preserving pancreaticoduodenectomy (PPPD) for patients with an inflammatory mass of the head of the pancreas, because it is technically easy and associated with low morbidity and good pain relief. Purpose: To analyze the short-term and long-term outcomes of Frey's procedure in comparison with PPPD and to evaluate the efficacy of Frey's procedure against preoperative locoregional complications. Patients and Methods: From August 1997 through December 2007, 6 patients underwent Frey's procedure (as described by Frey and Smith), and 10 patients underwent PPPD. The mean follow-up times were 70.8 months (Frey's procedure) and 119.8 months (PPPD). Preoperative biliary stricture and duodenal stenosis were observed in 4 and 3 patients, respectively, of patients undergoing Frey's procedure. Pain intensity was assessed with a pain scoring system. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of-Life Questionnaire-Core 30. Exocrine and endocrine pancreatic function was measured during follow-up. Results: Significant reductions in total pain scores and all QOL scale scores were observed immediately after surgery in all patients (P<0.05). Frey's procedure was superior to PPPD with regard to physical status 7 years after surgery (P<0.05). One patient in the Frey group had a grade B pancreatic fistula, and 2 patients in the PPPD group had intra-abdominal bleeding and delayed gastric emptying. There were no re-operations or surgery-related deaths in either group. Diabetes developed postoperatively in 2 patients in the PPPD group. No patients with preoperative duodenal or biliary stricture or both had a relapse. Three patients in the PPPD group died during follow-up of diseases unrelated to chronic pancreatitis. Conclusion: Frey's procedure is safe and effective with regard to pain relief, preservation of pancreatic function, and improvement of QOL over the long term. Moreover, this procedure can also be used to treat preoperative biliary stricture and duodenal stenosis associated with an inflammatory mass of the pancreatic head.

Taniguchi M.,Shiga University of Medical Science | Taniguchi M.,Kyoto University | Fukumoto Y.,Kobe Gakuin University | Kobayashi M.,Kobayashi Hospital | And 4 more authors.
Ultrasound in Medicine and Biology | Year: 2015

The objective of the study described here was to compare lower extremity muscle quantity and quality between individuals with and those without knee osteoarthritis (OA). Twenty-one women with knee OA (mild, n = 8; severe, n = 13) and 23 healthy patients participated. Ultrasonography was used to measure muscle thickness (MT) and echo intensity (EI) of the rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, gluteus medius, gastrocnemius, soleus and tibialis anterior. MTs of the vastus medialis and vastus intermedius were smaller, and EIs of the vastus medialis, vastus intermedius, gluteus medius and tibialis anterior were larger, in the severe OA group compared than in the healthy group. Compared with the healthy group, the mild OA group had decreased MT and enhanced EI. Changes in quality and quantity occurring with knee OA progression differed among muscles. In the vastus medialis, change was observed from an earlier stage. © 2015 World Federation for Ultrasound in Medicine & Biology.

Shimoyama I.,Chiba University | Kobayashi Y.,Kobayashi Hospital
International Medical Journal | Year: 2012

Objective: To study constructional apraxia, a quantitative method was proposed to evaluate the cube drawing test. Design: Six correlation coefficients were obtained between 1) a sample figure and a drawn figure, 2) a drawn figure and a figure rotated 180 degree of the drawn figure, 3) the left half of the drawn figure and a figure rotated 180 degree of the right half of the drawn figure, 4) the upper half of the drawn figure and a figure rotated 180 degree of the lower half of the drawn figure, 5) the left upper quadrant of the drawn figure and a figure rotated 180 degree of the right lower quadrant of the drawn figure, and 6) the right upper quadrant of the drawn figure and a figure rotated 180 degree of the left lower quadrant of the drawn figure. Materials and Methods: Three patients of clinical constructional apraxia and 3 healthy volunteers participated in this study after informed consent. Subjects were asked to draw copying a sample figure of the Necker's cube on a digitizer. And the correlation coefficients were obtained for 6 types of symmetry for the drawn figures. Results: The symmetry was deteriorated for the patients and the correlation coefficients were lower than those for the volunteers. Conclusion: The quantitative analysis should be useful to evaluate the higher brain function as for one of the neurological examinations. © 2012 Japan International Cultural Exchange Foundation & Japan Health Sciences University.

Ikuta K.,Asahikawa Medical College | Fujiya M.,Asahikawa Medical College | Ueno N.,Asahikawa Medical College | Hosoki T.,Asahikawa Medical College | And 6 more authors.
Internal Medicine | Year: 2010

We herein present a quite atypical case of primary gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma in the transverse colon. Computed tomography and endoscopic ultrasonography revealed diffuse thickening of the wall, and colonoscopy showed a white-colored mucosa with reduced superficial vessels in the entire transverse colon. The lesion was diagnosed as MALT lymphoma by pathological examination of the biopsied specimen. Secondary macroglobulinemia of IgM-κ type was also found in the present case. After chemotherapy and radiation, the lesions in the transverse colon improved and the patient has been in good condition without any evidence of recurrence for more than 1 year. © 2010 The Japanese Society of Internal Medicine.

Aimoto T.,Nippon Medical School | Mizutani S.,Nippon Medical School | Kawano Y.,Nippon Medical School | Matsushita A.,Nippon Medical School | And 4 more authors.
Japanese Journal of Gastroenterological Surgery | Year: 2015

Purpose: To evaluate the efficacy, significance and safety of a ratings-based stepwise surgical training program to teach pancreaticoduodenectomy (PD). Materials and Methods: The target group consisted of twelve trainee doctors and three senior surgeons. Their surgical skills were assessed using a rating system based on structured objective assessment forms that evaluated basic surgical techniques and operative ability in stepwise PD. This stepwise PD comprised three stages: A - basic processes such as laparotomy, B - processes common to surgical procedures for gastric and colonic cancer and C - processes specific to PD. The trainees were ranked on their performance into one of four levels (1-4). Those ranked at level 3 or above were qualified to perform PD, and those at level 4 were qualified to perform PD in pancreatic cancer patients who require vascular resection. These levels were determined by the combined score of A+B or the score for C. The assessment process examined the following factors: 1. Change in a trainee's total score over time and the number of completed operations, 2. Comparison of surgical outcome between the trainee and senior surgeon groups, and 3. Analysis of questionnaire results. Results: The total score for A+B increased with each operation in the trainee group once the four doctors at level 2 or below were excluded, while the score for C varied. The number of completed operations also increased over time. The mean operative time was significantly shorter in the senior surgeon group than in the trainee group (P<0.05). However, no differences were found with respect to mean blood loss, incidence of complications or postoperative death. The questionnaire results indicated that the surgical procedures and staging need some improvement. Conclusion: The ratings-based stepwise surgical training program in PD was efficient in improving processes common to surgical procedures for gastric and colonic cancer, but it was not sufficient on its own to train doctors in processes specific to PD. There was no risk to patient safety in this program, regardless of the surgeon's skill level. © 2015 The Japanese Society of Gastroenterological Surgery.

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