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Ōtsu-shi, Japan

Kataoka K.,Otsu Municipal Hospital | Sakagami J.,Kyoto Prefectural University of Medicine | Hirota M.,Tohoku University | Masamune A.,Tohoku University | Shimosegawa T.,Tohoku University
Pancreas | Year: 2014

OBJECTIVE: Most patients with chronic pancreatitis develop intractable abdominal pain and malnutrition. A low-fat diet is one of the options used to manage intractable abdominal pain and malnutrition. However, few reports have examined the pain-suppression effect. To investigate the effects of oral ingestion of a low-fat elemental diet composed of purified amino acids on pain and nutritional status in patients with chronic pancreatitis, a multicenter prospective study was conducted. METHODS: Patients with chronic pancreatitis with symptoms of abdominal pain were enrolled. In addition to meals, patients ingested a low-fat elemental diet composed of purified amino acids for 12 weeks. Before and after treatment, patients were asked to indicate their pain grade using a 100-mm horizontal visual analog scale, and nutritional indices, including body mass index and blood levels of pancreatic enzymes, were measured. RESULTS: A total of 596 patients were eligible for analysis. Marked pain reduction was observed with a significant decrease of the mean visual analog scale score by 32.9 mm from 52.9 mm after 12 weeks (P < 0.001). There were also significant improvements in nutritional indices. CONCLUSIONS: An oral low-fat elemental diet composed of purified amino acids, which requires no special treatment procedures, may improve patients' quality of life. © 2014 by Lippincott Williams & Wilkins. Source

Imaizumi K.,Kyoto Prefectural University of Medicine | Imaizumi K.,Olympus Corporation | Harada Y.,Kyoto Prefectural University of Medicine | Wakabayashi N.,Otsu Municipal Hospital | And 5 more authors.
Gastrointestinal Endoscopy | Year: 2012

The mucosal layer of the colon contains metabolism-related fluorophores, such as reduced nicotinamide adenine dinucleotide (NADH), which might have the potential to serve as biomarkers for detecting neoplasia. To examine NADH fluorescence in human colonic adenoma while eliminating the effect of hemoglobin absorption and to develop a novel imaging technique for precise detection of adenomas. Cross-sectional study. A total of 66 endoscopically resected colonic polyps were investigated. After serial acquisition of autofluorescence images between 450 and 490 nm illuminated with dual-wavelength excitation at 365 nm (F 365ex) and 405 nm (F 405ex) on cross sections of the samples, ratio images were created by dividing F 365ex by F 405ex. The excitation-emission wavelength combinations in F 365ex and F 405ex were optimized for NADH fluorescence and reference fluorescence. The F 365ex/F 405ex ratio in the tumorous (T) and normal (N) mucosa. F 365ex/F 405ex ratio images showed a 1.81- and 1.12-fold higher signal intensity in the adenomas and hyperplastic polyps, respectively, than in the adjacent normal mucosa. The ratio between signal intensities in tumorous mucosa and normal mucosa in F 365ex/F 405ex ratio images for tubular adenomas was significantly higher than that for hyperplastic polyps. The signal intensity in F 365ex/F 405ex ratio images was not correlated with the hemoglobin concentration index evaluated by reflection images at 550 nm and 610 nm. Diminutive adenomas (<5 mm) and large adenomas were well discriminated in F 365ex/F 405ex ratio images. Ex vivo experiment. These results suggest that the precise measurement of NADH fluorescence intensity together with eliminating the influence of blood hemoglobin concentration serves as a method for visualizing colonic adenomas and that the dual-wavelength excitation method is a promising technique applicable to endoscopic detection of early colonic adenomas. © 2012 American Society for Gastrointestinal Endoscopy. Source

We report a case where "laryngospasm notch" technique was used in a patient to initiate spontaneous respiration during general anesthesia. The patient was a 43-year-old woman who underwent conization. A ProSeal laryngeal mask airway was inserted after induction of general anesthesia. General anesthesia was maintained with sevoflurane (1.7-2%) and fentanyl. Surgical course was uneventful until the patient became unable to breathe towards the end of surgery. Positive-pressure ventilation was applied, but the patient could not be ventilated. "Laryngospasm notch" technique was performed by applying digital pressure in front of the tragus of the ears, and the patient began to breathe spontaneously. We describe our experience with the "laryngospasm notch" technique applied to the front of the tragus of the ears to treat laryngospasm. Source

Glassy cell carcinoma of the uterine cervix (GCC) is a rare form of cervical carcinoma that is characterized by aggressiveness and poor prognosis. We reviewed a variety of clinicopathological features, treatment strategies, and outcomes in three women with GCC. The three patients were successfully treated by radical hysterectomy with pelvic/para-aortic lymphadenectomy. The patients had stage Ib1, stage IIa, and stage Ib2 tumors without lymph node metastases. A 44-year-old woman with stage Ib1 tumor did not undergo adjuvant chemotherapy or radiation therapy. She had recurrent pelvic tumors 12 months after surgery, and died 6 months after the recurrent disease. The histological findings of her cervix, which were different from the other two patients, did not show the marked infiltration of eosinophils. The other two patients with stage Ib2 and IIa tumors underwent adjuvant chemotherapy with paclitaxel and carboplatin, and had disease-free survival for 4.5 and 9 years. We think that all patients with GCC of stage Ib1 or more should undergo adjuvant chemotherapy of paclitaxel and carboplatin or other adjuvant therapies. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology. Source

Yamao Y.,Kyoto University | Takagi Y.,Kyoto University | Kawauchi T.,Kyoto University | Arakawa Y.,Kyoto University | And 2 more authors.
Spine | Year: 2015

Study design. A case report. Objective. We report a case of spontaneous spinal epidural hematoma with 3 bleeding episodes and discuss the surgical management of recurrent spontaneous spinal epidural hematoma. Summary of Background Data. Spontaneous spinal epidural hematoma is a rare condition that causes spinal cord compression and neurological deficits. However, the cause of bleeding remains unclear and recurrent bleeding is very seldom reported. Methods. A 39-year-old female patient was referred to Kyoto University hospital with sudden back and right upper extremity pain. She was also treated conservatively at the local hospital 19 and 4 months previously because of same episodes. Magnetic resonance images demonstrated right spinal epidural hematoma at the C6-T1 level. In the first 2 episodes, magnetic resonance images revealed spinal epidural hematomas at exactly the same level. Results. In the third episode, the patient's neurological condition was not worse than it had been in the first 2 episodes, and we initially managed her conservatively. To identify the cause of the hematoma, surgery was performed 15 days after the third onset. Microscopic examination revealed the development of a venous plexus around the old hematoma in the dorsal epidural space. The patient was discharged without any further neurological deficits, and recurrent bleeding has not occurred for 6 months after surgery. Conclusion. This is the first report of operative and histological observation of recurrent spontaneous spinal epidural hematoma caused by a posterior venous plexus. In a case of recurrent spontaneous spinal epidural hematoma, surgery might be necessary to prevent further hematomas. © 2015, Wolters Kluwer Health, Inc. Source

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