Tetsuto Takao

Resection of anterior mediastinal masses through an infrasternal approach

A video-assisted surgical technique for benign anterior mediastinal lesions is described. In 3 patients, the Laparolift system was used to lift the lower sternum before resection. This operation is less invasive and cosmetically more pleasing than median sternotomy. Unlike thoracoscopy, this procedure avoids opening the chest and can be performed in patients with pleural adhesions or pulmonary insufficiency in whom differential lung ventilation is impossible. At present, this technique is considered suitable only for benign lesions.

Interleukin-6 Levels in Colorectal Cancer Tissues

Abstract. Interleukin-6 (IL-6) levels in cancer tissues of 32 patients with colorectal cancer were measured and analyzed in relation to the clinicopathologic findings. The IL-6 level in cancer tissues was 81.1 ± 118.0 pg/mg protein, which was significantly higher than the 11.2 ± 20.8 pg/mg protein in normal colorectal tissues (p= 0.028). IL-6 levels in cancer tissues showed no correlation with the incidence of venous invasion, lymphatic invasion, lymph node involvement, or liver metastasis. The IL-6 level in cancer tissue tended to decrease as the cancer penetration extended. Our results suggest that IL-6 may play a role in human colorectal cancer growth.

Breast reconstruction after mastectomy without additional scarring: application of endoscopic latissimus dorsi muscle harvest.

Breast reconstruction with the latissimus dorsi muscle flap combinedwith a saline-filled implant was performed. Using an endoscope, additional operative scarring due to muscle harvesting was avoided. The operative techniques were easier than usual endoscopic surgery because most of the procedures were performed under direct vision. The procedures are presented in this article.

An appraisal of radical pancreatoduodenectomy based on insulin secretion.

The effect of pancreatoduodenectomy on insulin secretion was determined in seven patients with periampullary malignant tumors. As a uniform stimulus for secreting insulin, 100 gm of glucose was administered orally to all patients and glucose tolerance tests were carried out. Glucose intolerance and poor insulin secretion were obvious both pre- and postoperatively. Indexes of an initial insulin response, of a maximum insulin increment, and of total secretion of insulin responding to the stimulus of glucose were significantly lower in these patients before and after pancreatoduodenal resection, as compared with normal subjects. It was also observed that these three indexes, which express the ability of the pancreas to secrete insulin, decreased without exception after pancreatoduodenectomy. In light of these data it is postulated that radical pancreatoduodenectomy further diminishes the already insufficient secretion of insulin indicated by the oral glucose tolerance test in patients with periampullary malignant tumors.

Intra-abdominal venous pressure during laparoscopic cholecystectomy.

Superior vena cava (SVC) and inferior vena cava (IVC) pressures were measured serially during laparoscopic cholecystectomy in which the intra-abdominal pressure was maintained at 12mmHg. The influences of alteration of position from 15 degrees head-down to 15 degrees head-up and of the operative procedure of holding the gallbladder up to the right subphrenic space on SVC and IVC pressures were mild. IVC pressure was maintained almost equal to the intra-abdominal pressure during prolonged continuous pneumoperitoneum lasting longer than 60min, while SVC pressure did not change significantly during operation. The discrepancy between SVC and IVC pressures underwent no change during continuous pneumoperitoneum.

Indwelling Catheter Retraction Because of Pendulous Breast

Long-term home parenteral nutrition (HPN) is an established treatment for chronic intestinal failure. A reliable and safe vascular access is of fundamental importance to HPN patients. We have typically used a right atrial catheter attached to a subcutaneous port. We present a case of right atrial catheter retraction in a large-breasted woman with short bowel syndrome. The catheter was retracted and coiled around the reservoir in the subcutaneous pocket by motion of the patient with large breasts. Displacement of right atrial catheters is a rare but recognized complication. To avoid this complication in obese patients with large breasts, the positional changes of the breast should be determined. and the reservoir should be implanted in the area of least motion along the sternum.

Laparoscopic deroofing for symptomatic liver systs: Report of a case

We present herein the case of a 73-year-old woman with symptomatic liver cysts and cholelithiasis for whom successful deroofing of the liver cysts and cholecystectomy were performed via laparoscopy. Histopathological diagnosis of the resected cyst wall and direct observation of the inner surface of the remaining cyst wall confirmed that they were benign biliary cysts. The laparoscopic deroofing of liver cysts is therefore not only an effective means of treatment, but it also facilitates the establishment of an exact differential diagnosis.

Surgical Aspect of Cancer of the Distal Pancreas

A retrospective analysis was made of 115 patients who had undergone laparotomy for ductal cell carcinoma of the pancreas. The purpose of the analysis was to analyze the surgical statistics of patients

Biliary Level of Amylase in Gallstone Patients Associated with Bacterial Infection

To assess the role of pancreatic enzymes in the formation of gallstones, we examined bile and stones from 112 consecutive gallstone patients undergoing cholecystectomy and/or bile duct exploration. Th

Thoracic Esophagectomy for Lower Esophageal Cancer through Left Oblique Thoracolaparotomy and Right Posterolateral Thoracotomy

Radical operations for lower esophageal cancer, including lymph node dissection in the upper, middle and lower mediastinal and the upper abdominal regions were performed through a left oblique thoraco