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Kurashiki, Japan

Hada T.,Kurashiki Medical Center
Asian journal of endoscopic surgery | Year: 2011

Total laparoscopic hysterectomy has been reported as having a higher incidence of vaginal cuff dehiscence compared with the abdominal and/or vaginal hysterectomy. The cause of vaginal cuff dehiscence after total laparoscopic hysterectomy is not specified, but possible causes may be the use of thermal energy for vaginal incision, reduced suturing width due to magnification, low quality of laparoscopic suturing skills and early resumption of regular activities after surgery. We performed 677 cases of total laparoscopic hysterectomy for benign diseases, such as fibroids or adenomyosis, from January 2007 to December 2008 in our institute. We experienced four cases (0.6%) of vaginal cuff dehiscence. We checked the operative parameters for these cases, such as whether the retroperitoneum was sutured or not and intrapelvic adhesion, as well as examined operative duration, blood loss, weight of removed organs, and body mass index. Sexual intercourse was the triggering event for three cases (96 days, 103 days and 47 days after total laparoscopic hysterectomy) and the other case occurred during defecation (18 days and no sexual intercourse after total laparoscopic hysterectomy). There were no significant differences in vaginal cuff dehiscence with or without retroperitoneum suture and intrapelvic adhesion. After these four cases of vaginal cuff dehiscence, we recognized the need to review these cases carefully in order to discover the cause and how to prevent this from occurring in other patients. We do not have the answers to prevent this complication at present, but reducing the power-source and attempting different suturing techniques may be important steps. © 2010 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.

Kobayashi K.,Okayama University of Science | Mimaki N.,Kurashiki Medical Center | Endoh F.,Okayama University of Science | Inoue T.,Okayama University of Science | And 2 more authors.
Epilepsy Research | Year: 2011

Objective: To improve the interpretability of figures containing an amplitude-integrated electroencephalogram (aEEG), we devised a color scale that allows us to incorporate spectral edge frequency (SEF) information into aEEG figures. Preliminary clinical assessment of this novel technique, which we call aEEG/SEF, was performed using neonatal and early infantile seizure data. Methods: We created aEEG, color density spectral array (DSA), and aEEG/SEF figures for focal seizures recorded in seven infants. Each seizure was paired with an interictal period from the same patient. After receiving instructions on how to interpret the figures, eight test reviewers examined each of the 72 figures displaying compressed data in aEEG, DSA, or aEEG/SEF form (12 seizures and 12 corresponding interictal periods) and attempted to identify each as a seizure or otherwise. They were not provided with any information regarding the original record. Results: The median number of correctly identified seizures, out of a total of 12, was 7 (58.3%) for aEEG figures, 8 (66.7%) for DSA figures and 10 (83.3%) for aEEG/SEF figures; the differences among these are statistically significant (p= 0.011). All reviewers concluded that aEEG/SEF figures were the easiest to interpret. Conclusion: The aEEG/SEF data presentation technique is a valid option in aEEG recordings of seizures. © 2011 Elsevier B.V.

Yamamoto M.,Hayashibara Biochemical Laboratories Inc. | Kondo E.,Okayama University of Science | Kondo E.,Aichi Cancer Center Research Institute | Takeuchi M.,Hayashibara Biochemical Laboratories Inc. | And 7 more authors.
PLoS ONE | Year: 2011

MicroRNAs (miRNAs) play important roles in regulating post-transcriptional gene repression in a variety of immunological processes. In particular, much attention has been focused on their roles in regulatory T (Treg) cells which are crucial for maintaining peripheral tolerance and controlling T cell responses. Recently, we established a novel type of human Treg cell line, termed HOZOT, multifunctional cells exhibiting a CD4+CD8+ phenotype. In this study, we performed miRNA profiling to identify signature miRNAs of HOZOT, and therein identified miR-155. Although miR-155 has also been characterized as a signature miRNA for FOXP3+ natural Treg (nTreg) cells, it was expressed quite differently in HOZOT cells. Under both stimulatory and non-stimulatory conditions, miR-155 expression remained at low levels in HOZOT, while its expression in nTreg and conventional T cells remarkably increased after stimulation. We next searched candidate target genes of miR-155 through bioinformatics, and identified FOXO3a, a negative regulator of Akt signaling, as a miR-155 target gene. Further studies by gain- and loss-of-function experiments supported a role for miR-155 in the regulation of FOXO3a protein expression in conventional T and HOZOT cells. © 2011 Yamamoto et al.

Arai O.,Center for Gastroenterology and Research | Ikeda H.,Kurashiki Medical Center | Mouri H.,Kurashiki Central Hospital | Notohara K.,Kurashiki Central Hospital | Matsueda K.,Kurashiki Central Hospital
Journal of Japanese Society of Gastroenterology | Year: 2010

Inflammatory bowel disease (IBD), especially ulcerative colitis (UC), sometimes accompanies with primary sclerosing cirrhosis (PSC). Primary biliary cirrhosis (PBC) is also a chronic liver disease, but is attributed to an unknown immune abnormality. PBC frequently accompanies various autoimmune diseases, but rarely IBD. We report 2 rare cases of IBD which developed in the course of treatment for PBC. A 64-year-old man had blood in his stool 17 months after he was given a diagnosis of PBC. Colonoscopy revealed erosion and disappearance of the vascular network pattern in the rectum. UC (rectal type) was diagnosed and he received mesalazine, and following which his symptoms improved. A 40-year-old woman developed diarrhea, fever and arthralgia while receiving treatment for PBC. Colonoscopy revealed ileal erosion, a longitudinal ulcer in the ascending colon but only mild rectal inflammation. These findings were atypical of UC, and we therefore diagnosed indeterminate colitis. Her symptoms disappeared as a result of the administration of mesalazine.

Andou M.,Kurashiki Medical Center
Journal of Minimally Invasive Gynecology | Year: 2016

Study Objective: We describe our ultra-minimally invasive retroperitoneal lymphadenectomy using the extraperitoneal approach. This technique was developed to make traditionally invasive oncologic surgery more patient friendly and safer by eliminating the bowel from the operative field. Design: Description of a surgical technique. Canadian Task Force II-3. Setting: Urban general hospital in Japan. Patients: 320 Women undergoing endoscopic extraperitoneal paraaortic and pelvic lymphadenectomy for endometrial cancer from Jan 2001 to Dec 2013. Interventions: Patients underwent endoscopic extraperitoneal para-aortic and pelvic lymphadenectomy for endometrial cancer. We accessed the retroperitoneal space with a visual access cannula (Endotip). This device easily facilitates peritoneal tenting. After expanding the extraperitoneal space by blunt dissection with forceps, carbon dioxide was infused. The upper limit of our dissection was the renal vein and the lower limit was the iliac circumflex vein. The extraperitoneal approach naturally creates a bowel-free operative field, even when dissecting in the pelvis. This approach only requires a 5-mm access hole, making it the least invasive approach to this kind of surgery. Measurements and Main Results: The 5-year survival rates for this intervention combined with hysterectomy and bilateral adnexectomy are extremely favorable at 90% for patients with stage I to III disease, making this technique a viable minimally invasive approach for selected patients. Conclusion: We can achieve a total para-aortic and pelvic retroperitoneal dissection with this extraperitoneal approach without the bowel invading the operative field. This procedure is focused on the barrier-free nature of working in the retroperitoneal space, meaning a space that is not hindered by the invasion of the bowel or other intraperitoneal structures. © 2016 AAGL.

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