Hiroshima journal of medical sciences
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Hiroshima J. Med. Sci. · Mar 2017
Case ReportsHybrid Surgery for Portosystemic Encephalopathy in a Patient with Liver Cirrhosis: a case report.
Regarding the treatment for a portosystemic shunt, surgical or interventional radiological closure of the shunt was established. Interventional radiology including balloon-occluded retrograde transvenous obliteration can worsen portal hypertension and create a large thrombus close to the major venous system in the case of a huge portosystemic shunt. In contrast, it is also difficult to treat some cases through surgery alone when huge complicated shunts exist very deep in the body. ⋯ Intraoperative angiography provided detailed information about the portosystemic shunt, such as direction or volume of blood flow and collateral routes in real time. Her encephalopathy disappeared completely and she remains healthy with improved liver functional reserve to date. In conclusion, this is a successful case of a hybrid operation for an extremely large and complicated portosystemic shunt, providing for intraoperative angiography as a safe and reliable surgical treatment for portosystemic encephalopathy in patients with liver cirrhosis.
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Hiroshima J. Med. Sci. · Dec 2016
Review Case ReportsGanglioneuroma of Spinal Nerve Root: A Rare Case Mimicking Herniated Lumbar Disc and Lumbar Radiculopathy.
Ganglioneuromas are rare benign tumors arising from neuroepithelial cells. Even more rarely they involve lumbar spinal nerve roots. We report a 34-year-old male patient who presented with typical lumbar radiculopathy. ⋯ Subtotal resection was performed. Biopsy showed Ganglioneuroma. The main purpose of this article is to report such a rare case and also to review the literature.
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Hiroshima J. Med. Sci. · Dec 2015
Comparative StudyDiagnostic Performance of Positron Emission Tomography for the Presurgical Evaluation of Patients with Non-lesional Intractable Partial Epilepsy: Comparison among 18F-FDG, 11C-Flumazenil, and 11C-Flumazenil Binding Potential Imaging Using Statistical Imaging Analysis.
To compare the diagnostic performance of 18F-FDG PET, 11C-FMZ PET, and 11C-FMZ BP imaging for the evaluation of patients with intractable partial epilepsy whose MRI findings are normal by using statistical imaging analysis. Ten patients underwent comprehensive presurgical evaluation, including PET studies, to assess the epileptic foci. The extent of cortical resection was based on the results of intracranial video-electroencephalography (IVEEG) monitoring and brain mapping under stimulation. ⋯ In patients with Engel I post-treatment seizures the concordance scores were significantly higher for 18F-FDG PET than 11C-FMZ PET and 11C-FMZ BP images (p < 0.05). With respect to sensitivity and specificity, 18F-FDG PET was superior to 11C-FMZ PET and 11C-FMZ BP imaging. However, in some patients with normal MRI results, 11C-FMZ BP studies may complement 18F-FDG PET findings in efforts to identify the epileptogenic lobar regions.
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Hiroshima J. Med. Sci. · Sep 2015
Propofol for Anesthesia and Postoperative Sedation Resulted in Fewer Inflammatory Responses than Sevoflurane Anesthesia and Midazolam Sedation after Thoracoabdominal Esophagectomy.
Responses to surgical stress can be modulated by anesthetics. We prospectively compared the effects of two different anesthetic/sedative techniques on the peak postoperative bladder temperature (BT) and the postoperative C-reactive protein (CRP) level. Twenty patients who were scheduled to undergo elective thoracoabdominal esophagectomy were allocated to receive either propofol anesthesia followed by propofol sedation (PP group, n = 10) or sevoflurane anesthesia followed by midazolam sedation (SM group, n = 10). ⋯ The peak postoperative BT was positively correlated with the CRP level on POD 2 (R = 0.533, p < 0.05). There were no significant differences between the clinical course-related parameters in both groups. Propofol anesthesia and postoperative propofol sedation resulted in a reduced peak postoperative BT and lower CRP levels on POD 2 after esophagectomy than sevoflurane anesthesia followed by midazolam sedation.
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Hiroshima J. Med. Sci. · Dec 2014
Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients.
Loop ileostomy is widely employed after low rectal anastomosis to prevent pelvic sepsis from anastomotic leakage. However, stoma closure carries a risk of morbidity and even mortality in some cases. It is important to assess complications after stoma closure for maximizing the benefit of making loop ileostomy. ⋯ Our study showed that the majority of complications associated with ileostomy closure are ileus. A BMI > 24 kg/m2 is an independent risk factor for postoperative complications. Weight loss programs before stoma closure might reduce postoperative complications.