Since the first introduction of laparoscopic cholecystectomy, the field of laparoscopic surgery has expanded rapidly to include surgery for other organs, and more complex and technically demanding abdominal surgery. The reduced invasiveness of laparoscopic surgery is seen clinically in the rapid recovery and return to normal activities that results from reduced patient pain, destruction of the abdominal wall, and damage to organs and peritoneum when exposed to air. However, the exact procedure being performed in the abdominal cavity is sometimes a more important factor affecting the invasiveness of the surgery. Complicated and technically demanding procedures, which often increase the operation time and bleeding, and alter organ function, are sometimes more invasive by their nature, which diminishes the merits of laparoscopic surgery.
For example, laparoscopic liver resections (LLR) under different settings have different results with or without the merits of laparoscopic surgery. In patients with hepatocellular carcinoma with the background chronic liver disease, LLR allows the surgeon to resect the tumor-bearing area with minimal damage to the liver and the surrounding environment, and to lower the risks of postoperative ascites and liver failure. However, these findings apply specifically to this setting and results differ for others.
As indications expand, the true advantages and disadvantages of specific procedures in laparoscopic surgery should be reconsidered depending on the setting of each procedure.

抄録全体を表示

Objectives: To modify the Stressor Scale for College Student (SSCS) by including extracurricular activity-related stressors and to examine the validity and reliability of the Modified SSCS (M-SSCS) to evaluate psychosocial stressors in medical and medical science students.
Methods: Third-year medical students (n = 103) and fourth-year medical technology students (n = 95) completed a cross-sectional questionnaire survey. We examined the factorial structure of the M-SSCS using factor analysis. Concurrent validity was assessed by examining the associations of M-SSCS scores with self-rated health status, K6 scale scores, and State–Trait Anxiety Inventory (STAI) scores. Cronbach’s alpha coefficient was calculated to evaluate the reliability of the M-SSCS.
Results: Factor analysis yielded seven factors. Stressors related to family, friends, part-time jobs, and extracurricular activity formed independent factors, but study- and fulfillment-related stressors were not distinct. High M-SSCS scores, indicating greater stressor levels, were significantly associated with poor self-rated health status (adjusted odds ratio [95% confidence intervals] = 2.80 [1.08, 7.25], p = 0.034), high K6 scale scores (2.99 [1.00, 8.96], p = 0.050), and high STAI state anxiety (3.32 [1.35, 8.20], p = 0.009) and trait anxiety scores (2.69 [1.31, 5.51], p = 0.007). Cronbach’ s alpha coefficient was 0.916.
Conclusions: The M-SSCS showed good concurrent validity and internal consistency in assessing psychosocial stressors in medical and medical technology students. However, further studies are necessary to fully determine the validity of the M-SSCS.

抄録全体を表示

Objectives: Functional brain mapping and precise localization are essential for the resection of centrally located tumors. We describe our initial experience with awake craniotomy for sensorimotor tumors in 15 patients using synthesized surface anatomy scanning (SSAS), intraoperative functional brain mapping, and an infrared-based navigation system (INS) without fixation of the patient’s head.
Methods: Craniotomy positioning was planned using the images created by SSAS. Fiducial markers were placed along the skin incision line for intraoperative registration of an INS. The resection of the tumor was performed under local anesthesia using both intraoperative functional brain mapping and an INS. In or near the motor cortex or the descending motor pathway, the extent of the resection was determined by the stimulation induced motor response and the intraoperative neurologic findings.
Results: Appropriately centered craniotomies were obtained in all cases using the presurgical planning images of SSAS. Reliable functional localization was identified with direct cortical and subcortical stimulation. The location of the tumors was detected within 3.5 mm of that predicted by the computation (target registration error). Postoperative computed tomography scans showed grossly total resection of the tumor in 13 of 15 cases and subtotal resection in 2 cases. Although 10 patients had mild to severe neurologic deficits in the immediate postoperative period, there were no permanent deficits.
Conclusions: Sensorimotor tumors can be resected effectively with the combined use of SSAS, stimulation cortical mapping and an INS with clinical acceptable morbidity.

抄録全体を表示

Objectives: Obstructive sleep apnea syndrome (OSAS) is an important cause of medical morbidity and mortality. Although adenotonsillar hypertrophy is linked to the pathogenesis of OSAS in children, the potential role of childhood adenotonsillar hypertrophy in the etiology of adult OSAS has not yet been examined.
Methods: We retrospectively evaluated 1,369 men aged ≥20 years with suspected OSAS who had undergone polysomnography at Fujita Health University Hospital in Japan. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated after adjusting for age and body mass index to evaluate the risk of development of OSAS in men with a history of adenotonsillar hypertrophy in childhood. The reference category for OSAS was non-OSAS.
Results: In total, 988 men were diagnosed with OSAS and 561 were diagnosed with severe OSAS (apnea–hypopnea index of ≥30). The adjusted ORs for a history of untreated adenotonsillar hypertrophy with OSAS and severe OSAS were 3.13 (95% CI, 1.18–8.27) and 4.31 (1.56–11.90), respectively. The adjusted ORs for a history of treated adenotonsillar hypertrophy with OSAS and severe OSAS were 1.31 (0.69–2.50) and 0.87 (0.41–1.90), respectively.
Conclusions: This study confirmed the risk of untreated childhood adenotonsillar hypertrophy in the development of adult OSAS. Our data also support the idea that abnormal dentofacial morphology induced by adenotonsillar hypertrophy in childhood is a critical factor in the pathogenesis of OSAS in adulthood.

抄録全体を表示

Fibroepithelial pharyngeal polyps are rare. We herein report a case of a 56-year-old Asian woman who presented with voice hoarseness and throat discomfort for several years because of a giant pharyngeal polyp. We resected the polyp under general anesthesia. It originated in the left hypopharyngeal wall. Postoperative recovery was uneventful. Her sore throat was diminished within 1 week after the operation. Pathological findings revealed a benign fibroepithelial polyp. At the time of this writing, the polyp had shown no regrowth. To our knowledge, this report describes the second largest fibroepithelial polyp among those reported previously.

抄録全体を表示