Tetsuo Shinohara

Prospective Evaluation of Occlusive Hydrocolloid Dressing Versus Conventional Gauze Dressing Regarding the Healing Effect After Abdominal Operations: Randomized Controlled Trial

OBJECTIVE To compare occlusive hydrocolloid dressing (OHD; Karayahesive) and gauze dressing (GD) with regard to the cost and incidence of wound infection after abdominal surgery. METHODS A total of 134 patients who underwent incisions were randomized to have their wounds dressed with either OHD or GD. OHD was left on until the sutures were removed, and GD was changed everyday postoperatively. The cost calculations represent the number of dressings required for each treatment group as determined by the frequency of required dressing changes and cost per dressing. RESULTS There were no differences between the groups regarding the need for dressings to be changed or the incidence of infection. OHD was less expensive and complicated than GD, which needed to be changed everyday (p < 0.0001). CONCLUSION The results suggest that OHD is less expensive to use than GD, and the risk of wound infection is not increased compared to GD.

Surveillance Program for Recurrence after Curative Gastric Cancer Surgery

Background: It is not clear if more intense surveillance is associated with improved survival after curative resection for gastric cancer. Patients and Methods: A prospectively maintained gastric cancer database was used to identify 402 patients who underwent curative gastrectomy. Multivariate analysis was performed to identify the clinicopathological characteristics associated with long post-recurrence survival. Results: Of 402 patients, 62 patients showed documented recurrence. As shown by multivariate analysis, patients with lymph node metastases originating from primary cancer, symptomatic recurrence, peritoneal dissemination, multiple recurrences and supportive therapy showed a significantly shorter post-recurrence survival. Patients who suffered hematogenous metastases, locoregional recurrence, or recurrence in the remnant stomach had a significantly longer survival time when treated actively compared with those given supportive care. Conclusion: Active treatment is effective in patients with hematogenous metastases, locoregional recurrence, or recurrence in the remnant stomach. Intense surveillance is thus recommended for early identification of such patients.

Impact of short hepatic vein reconstruction in living donor adult liver transplantation using a left liver plus caudate lobe graft.

OBJECTIVE To investigate the impact of short hepatic vein reconstruction in the transplanted left liver plus caudate lobe graft. METHODS Six left liver plus caudate lobe grafts used for living donor adult liver transplantation were included in this study. The liver grafts were divided into two groups: those with (V1 group; n = 4) or without (control group; n = 2) short hepatic vein reconstruction. The changes in the transplanted left lobe (segments II-IV) and caudate lobe were compared between the two groups at 1 month after transplantation. RESULTS The addition of the caudate lobe increased the graft volume by 15 mL, which corresponded to a 4.3% gain of graft volume at the time of transplantation. Although the graft volume/standard liver volume ratio of the whole grafts after transplantation showed no difference between the two groups, the regeneration rate of the caudate lobe in the V1 group was significantly greater than that in the control group (p= 0.04). CONCLUSION Although no definite advantage from the V1 reconstruction was demonstrated, hepatic vein reconstruction with a significantly-sized short hepatic vein might provide an additional margin of safety for marginally-sized liver grafts during the early phase of graft regeneration.