Fukuoka igaku zasshi = Hukuoka acta medica最新文献

Introduction: We evaluated the differences in instrument manipulation skills between expert laparoscopic surgeons and novices.

Methods: Six expert surgeons who had performed more than 500 laparoscopic surgeries and one skilled instructor at Kyushu University Training Center for Minimally Invasive Surgery, and 20 medical students who had experienced no laparoscopic surgery were enrolled. A new skill assessment task was designed using zippers on an unstable, mobile platform in a box trainer. The examinees were asked to close the zippers, while trying to avoid moving the platform. The path lengths of the tips of the instruments and of the platform were measured, and the performance time was also recorded. Surgical skill score was calculated from the correlation between the path lengths of the instruments and that of the platform, in addition to the performance time.

Results: The path lengths of the tips of both instruments and of the platform were significantly shorter in the experts than in the novices (all p < 0.05). The performance time was also significantly shorter for experts than novices (p < 0.05). The surgical skill score was significantly higher for experts than novices (p < 0.01).

Conclusion: The differences in the instrument manipulation skills between expert laparoscopic surgeons and novices could therefore be evaluated using our surgical skill scoring system.

We report a case of a 43-year-old man who presented with gradually intensifying abdominal pain of acute onset and was shown by contrast-enhanced computed tomography (CT) examination to have acute aortic dissection (Stanford type B). A diagnosis of gastrointestinal necrosis was made and he underwent emergency surgery. At laparoscopy, he was found to have no superior mesenteric arterial pulse and intestinal necrosis from the upper jejunum to the right transverse colon. Resection of the superior mesenteric artery (SMA) perfusion area was performed. Postoperatively, ischemia in the perfusion area of the celiac artery was also diagnosed, manifesting as gallbladder necrosis, portal vein gas accompanying gastric wall necrosis, perforation of the remaining upper jejunum, and hepatic and splenic infarction. However, development of a collateral circulation originating in the left colic branch of the inferior mesenteric artery (IMA) enabled retrograde provision of blood to the celiac artery through the SMA pancreaticoduodenal arcade. Thus, in this case, spontaneous development of a natural bypass created a new route for arterial perfusion, contributing to the patient's survival. When ischemia of the celiac artery and SMA perfusion areas occur, collateral circulation can develop from the IMA.

Avulsion fractures of the tibial tuberosity are uncommon injuries. A 16-year-old male sustained injuries to his right knee joint after jumping from stairs and landed on his feet with his right knee forced into flexion. X-ray photographs showed a type III avulsion fracture of the tibial tuberosity. On the next day of the injury, open reduction and internal fixation, followed by arthroscopy was performed. The fracture fragment was fixed with three 5.0mm cannulated cancellous screws. The torn anterior portion of medial meniscus was repaired with 3-0 Polydioxanone (PDS) using outside-in sutures and the torn midportion of medial meniscus was repaired using the FasT-Fix meniscal repair system. Eight months after the injury, removal of the screws and arthroscopy were undertaken. The medial meniscus was completely healed. The range of motion was full at the knee joint. Meniscal suture should be strongly considered for type III avulsion fractures of the tibial tuberosity in adolescents.

Zolpidem is a widely used ultrashort-acting non-benzodiazepine in clinical practice; compared with benzodiazepines, it does not have side effects such as daytime hangover, rebound insomnia, and development of tolerance. We report an autopsy case of abnormal behaviour induced by zolpidem. A man in his 60's had suffered from postherpetic neuralgia about 2 months ago and had been prescribed zolpidem for insomnia. According to his family, he had no memory of his actions such as striking a wall, taking his futon outside, and eating 5 times a day after he took zolpidem. Because his postherpetic neuralgia did not improve, he was hospitalized and treated with an epidural block. During hospitalization, he took off his clothes, removed the epidural block catheter by himself, and slept on others' beds. He disappeared from the hospital one day; the next day, he was found dead in a narrow water storage tank 10 km away from the hospital. He was thought to have driven a car by himself to reach the place. Forensic autopsy revealed that the cause of death was drowning. Zolpidem and several other drugs were detected by toxicological analysis of his blood; the concentrations of these drugs were within therapeutic range. There are several reports about somnambulism induced by zolpidem such as sleepwalking, sleep driving, and eating. Considering the strange episodes following zolpidem administration, his behaviour on the day of his death was considered abnormal behaviour induced by zolpidem.

Half-lives of blood levels of 2,3,4,7,8-Pentachlorodibenzofuran (PeCDF) are varied in Yusho patients. The objective was to evaluate a relationship between half-lives of PeCDF levels and types of SNP rs10249788 of aryl hydrocarbon receptor (AHR) gene in 93 Yusho patients. Based on physical symptoms, age, sex, body mass index and other factors, we set up suitable calculation formulas to fit the actual PeCDF levels thorough rates of change in PeCDF. We found that patients with C/T SNP had longer half lives than patients with C/C and T/T SNPs. Patients with T/T SNP are known to express higher amount of AHR mRNAs. However, detailed analysis could not be carried out in T/T group due to a limited number of patients (n = 11). Further research is warranted to determine the cause of the longer half-lives in C/T patients.