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Matsuda T.,Seirei Mikatahara General Hospital
Asian journal of endoscopic surgery | Year: 2013

Until now, no data have been available on the incidence of chylous ascites after laparoscopic colorectal surgery. From January 2007 to December 2011, 137 patients with colorectal cancer underwent laparoscopic surgery at our institution. The clinical data of the patients with postoperative chylous ascites were compared with those of the patients without chylous ascites. Chylous ascites developed in 9 of the 137 patients (6.5%). Blood loss, operative time, tumor location, and extent of lymph node dissection were not associated with postoperative chylous ascites. Mean postoperative hospital stay for patients with chylous ascites was significantly longer than that for patients without any complications (14 days vs 10 days; P < 0.001). Recurrence was observed in two of the nine patients with chylous ascites; it developed locally and in the liver in one patient, and peritoneal dissemination was seen in the other. The recurrence rate in the chylous ascites group (22.2%) was significantly higher than that in the non-chylous ascites group (3.9%; P = 0.016). The 3-year disease-free survival in the chylous ascites group (76.2%) was significantly lower than that in the non-chylous ascites group (93.4%; P = 0.020); however, the 3-year overall survival rates did not differ between the groups (87.5% vs 94.4%, respectively; P = 0.332). Chylous ascites are not a rare complication of laparoscopic colorectal surgery. It was managed conservatively in all cases but was associated with longer hospital stays. We recommend careful tissue dissection at a suitable plane and meticulous clipping during lymphadenectomy to prevent chyle leakage when lymphatic invasion is suspected. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Mao T.-L.,National Taiwan University Hospital | Ardighieri L.,Johns Hopkins Medical Institutions | Ayhan A.,Seirei Mikatahara General Hospital | Kuo K.-T.,National Taiwan University Hospital | And 3 more authors.
American Journal of Surgical Pathology | Year: 2013

ARID1A is a recently identified tumor suppressor that functions in chromatin remodeling. Inactivating mutations of ARID1A and loss of its expression most frequently occur in ovarian clear cell carcinoma, ovarian endometrioid carcinoma, and uterine endometrioid carcinoma. In this study, we performed a detailed immunostaining analysis of ARID1A in 246 cases including benign endometrium and endometrioid carcinoma at different stages of progression. Special attention was paid to recording intratumoral heterogeneity of clonal loss of ARID1A immunoreactivity. All normal endometria (n=51) and endometrial polyps (n=14) retained ARID1A expression. Among complex atypical hyperplasias (n=38), 16% exhibited clonal loss of ARID1A, but none showed complete loss. Among low-grade endometrioid carcinomas (n=88), 25% exhibited complete loss and 24% exhibited clonal loss. In contrast, 44% of high-grade endometrioid carcinomas (n=55) showed complete loss of ARID1A, and 9% exhibited clonal loss. We found that 19 high-grade carcinomas also contained concurrent low-grade carcinomas. In the high-grade areas, 63% exhibited complete loss and 11% exhibited clonal loss, whereas in the low-grade areas, 37% exhibited complete loss and 42% clonal loss. In 5 of these 19 cases, progressive loss of ARID1A from retention or clonal loss to complete loss was observed between the low-grade and high-grade areas. Overall, the percentage of complete ARID1A loss increased from 0% in complex atypical hyperplasia, to 25% in low-grade endometrioid carcinoma, to 44% in high-grade endometrioid carcinoma. These findings suggest that loss of ARID1A expression, presumably due to mutation, plays an important role in tumor progression of uterine endometrioid carcinoma. Copyright © 2013 by Lippincott Williams & Wilkins.

Arai M.,Seirei Mikatahara General Hospital
Neuroendocrinology Letters | Year: 2011

OBJECTIVE: Several cases of syndrome of inappropriate antidiuresis induced by antiparkinson agents have been previously reported. However, the effect of antiparkinson agents on plasma arginine vasopressin (AVP) levels remains unknown in Parkinsons disease (PD) patients. The aim of the present study is to determine plasma AVP levels in PD patients and the effects of antiparkinson agents on these levels. METHODS: PD patients who visited our clinic between November 2008 and September 2009 were included in this study. Patients were excluded if they had at least one condition that could be associated with high AVP levels. PD patients who had been treated with antiparkinson agents participated in this study (treated PD group, n=76). De novo PD patients were also included (n=25). RESULTS: Mean plasma AVP levels were significantly higher in treated PD patients than those in treatment-naïve patients. Neither disease severity nor L-dopa dosage correlated with plasma AVP levels. Multiple linear regression analysis identified the male gender and pergolide dosage as weak independent predictors of high plasma AVP levels. While no difference in plasma AVP levels between genders in treatment-naive patients was observed, mean plasma AVP levels were significantly higher in male patients than in female patients administered antiparkinson agents. Mean plasma AVP levels in pergolide users were significantly higher than those in dopamine agonist nonusers with corresponding disease duration and L-dopa/carbidopa dosage. In some patients, plasma AVP levels appeared to be dependent on pramipexole dosage. CONCLUSION: Dopamine agonists may cause increased plasma AVP levels in some PD patients. ©2011 Neuroendocrinology Letters.

The author reviewed the clinical records and neuroradiologic examinations of 86 consecutive patients with orthostatic headache who visited our clinic between April 1995 and December 2014. Fifty-six patients were suspected to have spontaneous intracranial hypotension (SIH). The baseline characteristics of these patients were essentially similar to those reported in other published case series of SIH: female preponderance, mean age of approximately 40 years, and frequent association with nausea, hearing disturbances, or vertigo. In 43 patients who underwent gadolinium-enhanced MRI, 15 had partial dural enhancement and 15 had diffuse enhancement. Of 13 patients who underwent radionuclide cisternography, a direct finding of cerebrospinal fluid (CSF) leakage was demonstrated in six patients. Ordinal scales were formulated for regression of the extent of dural enhancement on cranial MRI (none: 0, partial: 1, diffuse: 2) and severity of orthostatic headache (not so severe: 1, severe: 2). Ordinal logistic regression analysis demonstrated that the extent of dural enhancement was negatively associated with the severity of orthostatic headache. A possible explanation was that patients suspected of having SIH who showed severe orthostatic headache may lack the ability to compensate for CSF loss. Epidural blood patch (EBP) is targeted at the CSF leak site or at the lumbar level when the site of CSF leak has not been determined. The interval from EBP to disappearance of orthostatic headache did not significantly differ in six patients treated with targeted EBP and five patients with lumbar EBP. Linear regression analysis demonstrated that the duration of orthostatic headache was associated with the interval from onset of headache to initial visit to our clinic, with the slope of the regression line 1.243 and intercept 14.8 days. Thus, early diagnosis of SIH appeared to correlate with earlier disappearance of orthostatic headache. No other factors were found to predict the outcome of SIH.

Nakamura T.,Seirei Mikatahara General Hospital | Nakamura T.,Tokyo Medical and Dental University | Fujishima I.,Hamamatsu City Rehabilitation Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

In Japan, ice massage is widely used as the prefeeding technique to facilitate dry swallowing, to improve swallowing apraxia for initiating the swallowing action, and in daily swallowing training. In a crossover study, we evaluated the usefulness of ice massage for eliciting the swallowing response. The subjects were 24 dysphagic patients with stroke and cerebrovascular disease. We measured the latency between the command of dry swallowing and the triggering of the swallow reflex by videofluoroscopic examination of swallowing, with and without ice massage. When a subject could not swallow all the 4 trials we recorded whether he or she could swallow or not. And we counted how many times he or she could swallow with and without ice massage. Our results suggest that ice massage significantly shortened the latency to triggering of the swallow reflex and often initiated swallowing even in those subjects who could not swallow without the massage. These results demonstrate that ice massage has an immediate effect on triggering of the swallow reflex. The effect of ice massage was especially remarkable in the 15 subjects who had supranuclear lesions compared with the subjects with nuclear lesions. Thus, ice massage could activate the damaged supranuclear tract and/or the normal nucleus and subnuclear tract for swallowing. Ice massage has proven useful in many clinical dysphagia training sessions. © 2013 by National Stroke Association.

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