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Ogino, Takashi ; Ohbayashi, Tamiyuki ; Kaneko, Tatsuo ; Satoh, Yasushi ; Hasegawa, Yutaka ; Koyano, Tetsuya ; Ohki, Satoshi ; Sakata, Kazuhiro ; Yamagishi, Toshiharu ; Hagiwara, Shuichi ; Ohshima, Kiyohiro ; Iino, Yuichi ; Takahashi, Toru ; Takeyoshi, Izumi ; Morishita, Yasuo
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Journal Article<br />A 61-year-old man with an aneurysm of the common and deep femoral arteries underwent successful vascular reconstruction.The patient presented with localized pain and a rapidly enlarging pulsatile mass in the
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femoral triangle.A graft was placed from the left common femoral artery to the left superficial and deep femoral arteries.No ischemic symptoms or thrombosis developed postoperatively.Successful reconstruction with a graft is rare in this situation,with less than 30 cases reported in Japan to date.This type of aneurysm is characterized by rapid enlargement and severe atherosclerotic changes.Ischemic complications may occur after surgical treatment of a ruptured deep femoral artery aneurysm.We recommend reconstruction using the saphenous vein or a vascular prosthesis,as there have been some reports of patients requiring leg amputation following ligation of the deep femoral artery.
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Ogino, Takashi ; Sakata, Kazuhiro ; Yamagishi, Toshiharu ; Hagiwara, Shuichi ; Ohshima, Kiyohiro ; Iino, Yuichi ; Ohki, Satoshi ; Takahashi, Toru ; Takeyoshi, Izumi ; Morishita, Yasuo
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Yoshida, Takashi ; Koibuchi, Yukio ; Horiguchi, Jun ; Iijima, Kotaro ; Kikuchi, Mami ; Takata, Daisuke ; Rokutanda, Nana ; Nagaoka, Rin ; Sato, Ayako ; Oyama, Tetsunari ; Iino, Yuichi ; Morishita, Yasuo
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application/pdf<br />Journal Article<br />We present a rare case of a 26-year old woman with diffuse sclerosing variant of papillary thyroid\ncarcinoma. The patient was referred to our hospital with diffuse enlargement of the thyroid
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accompanied\nwith palpable bilateral cervical lymph nodes. Ultrasonography showed a heterogeneous\npattern with ill-defined hypoechoic areas in both thyroid lobes. There were multiple small punctate\nechogenic foci. Fine-needle aspiration cytology revealed typical signs of papillary carcinoma. The\npatient underwent a total thyroidectomy using a bilateral modified neck dissection. Pathological\nfindings demonstrated diffuse involvement and continuous infiltration of the tumors to both thyroid\nlobes, lymph nodes and cervical soft tissue. Postoperatively, 100 mCi of 131I was administrated to the\nsmall amount of residual thyroid tissue. The patient is free from recurrence one year after the operation.
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Iijima, Kotaro ; Yoshimoto, Masataka ; Horiguchi, Jun ; Oyama, Tetsunari ; Morishita, Yasuo ; Kasumi, Fujio ; Sakamoto, Goi
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application/pdf<br />Journal Article<br />Background & Aims: The purpose of this study was to investigate the influence
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of pregnancy on breast\ncancer prognosis by analyzing clinical and pathological features of young patients with breast cancer in\nrelation to last birth. Method: A total of 622 young breast cancer patients under 35 years of age\nundergoing surgical treatment between 1960 and 1990 at Cancer Institute Hospital were included in this\nstudy. The patients were classified into four groups; group A patients who were diagnosed during\npregnancy or within one year after delivery, group B patients who were diagnosed from one to three years\nafter delivery, group C patients who were diagnosed three years or more after delivery, and group D\npatients who were nulliparous. All four groups were examined from the viewpoint of clinical and\npathological findings with regard to age, disease duration, first childbirth, clinical stage, histopathological\ntype, lymph node metastasis, and survival. Furthermore, nuclear grade and immunohistochemical\nstaining of both estrogen receptor (ER) and factor-VIII were examined in early-stage breast\ncancer patients. Result: The incidence of early-stage(0, I and II) breast cancer was significantly(p＜\n0.05) lower in group A (69％) than in groups C (88％) and D (85％). The incidence of nodal involvement\ndecreased from group A (61％), B (59％), C (51％) to D (43％) in that order. The incidence of\nnodal involvement in group D was significantly (p＜0.05) lower than that in groups A and B. The\npositive rate of estrogen receptor increased from group A (50％), B (56％) to C (72％) in that order. \nDisease-free survival was significantly (p＜0.05) more favorable in group D than in groups A and C. \nThe similar result was obtained in patients with clinically early-stage breast cancer. Conclusion:\nPatients who developed breast cancer during pregnancy or within less than one year postpartum have a\npoor prognosis among patients under 35 years old. Patients having no childbirth history generally have\na high risk factor of developing breast cancer, however, breast cancer patients without childbirth history\nunder 35 years old result in a favourable prognosis.
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Oshima, Kiyohiro ; Takahashi, Toru ; Hasegawa, Yutaka ; Ohki, Satoshi ; Nameki, Taro ; Morishita, Yasuo
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application/pdf<br />Journal Article<br />Purpose: The purpose of this study was to examine the incidence, clinical features, treatment and outcome of patients with gastrointestinal complications after cardiovascular surgery in our
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hospital. Patients and Methods: Between January 1992 to February 2004, 835 patients were operated with cardiopulmonary bypass (CPB) at Gunma University Hospital. Of these, 12 (1.4%) patients had postoperative gastrointestinal complications. The mean age of 12 patients was 59 years old ranging from 7 to 71. Valve replacements were performed in six patients, CABG in three, and others in three. Results: Gastrointestinal bleeding occurred in seven patients. Six of them recovered with non-surgical procedure, and one died of hemorrhagic shock following an emergency operation. Acute cholecystitis occurred in three patients and all of them were successfully managed by percutenous transhepatic gall bladder drainage (PTGBD). Two patients with gastrointestinal perforation underwent an emergent operation, however, both of them died of sepsis. The total mortality rate of 12 patients was 25%. Conclusion: The occurrence of gastrointestinal complications after cardiovascular surgery with cardiopulmonary bypass is low, however, is frequently fatal. Preoperative careful evaluation of patients is required for the postoperative management of those complications.
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Rokutanda, Nana ; Makita, Fujio ; Ohwada, Susumu ; Sakamoto, Ichiro ; Yoshimura, Sumihiko ; Togo, Nozomi ; Takeyoshi, Izumi ; Morishita, Yasuo
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application/pdf<br />Journal Article<br />A 64-year-old male with right upper abdominal pain had been treated with an H2
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-blocker for three months as a gastric ulcer recurrence with no response. An abdominal US identified a large cystic tumor in the left lobe of the liver. Tumor markers were all normal ; hepatitis serology tests were all negative, although liver function tests were elevated slightly. A CT scan showed a well-defined cystic tumor with a thick, heterogeneously enhanced wall. Selective celiac artery angiograms showed displacement of the common hepatic artery, and an avascular area. As a malignant tumor was suspected, a left lobectomy of the liver was performed. The tumor measured 17×15×12cm and contained central cystic degeneration filled with 280 ml of dark red fluid. Microscopic findings revealed anaplastic spindle cell proliferation, and immunohistochemical examination was positive for α-smooth muscle actin. A thorough survey did not detect a primary tumor in any other organ. Therefore, primary hepatic leiomyosarcoma was diagnosed. Only 80 cases have been reported. We reviewed the available literature.
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