A primary aortoesophageal fistula due to esophageal carcinoma successfully treated with endoluminal aortic stent grafting.
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Aorta, Thoracic↗
Biomedical subjects
Hideko Kurihara
Publications and source records attributed to Hideko Kurihara.
Are there significant benefits of minimally invasive endoscopic thyroidectomy?
Minimally invasive surgery using endoscopic vision is widely employed for the treatment of thyroid diseases. We have performed endoscopic thyroidectomy by the axillary approach (axillary approach) and video-assisted thyroidectomy via a 3 cm cervical incision (video-assisted approach). In this study, we evaluated the efficacy of these two procedures. Each procedure was performed in 20 consecutive consenting patients. The degree of invasiveness after surgery was compared using postoperative results. The amount of pain and satisfaction with surgery was evaluated by grade (1-5) using a patient questionnaire. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies occurred. Operating time for the video-assisted approach was significantly shorter than that for the axillary approach (p < 0.01). The amount of pain for the axillary approach on 1, 3, and 5 days after operation, respectively, was graded 3.2+/-0.7, 2.1+/-0.6, and 1.6+/-0.7 compared to 2.7+/-1.1, 1.7+/-0.7, and 1.1+/-0.2 for the video-assisted approach. The postoperative course was significantly less painful in patients undergoing the video-assisted approach on postoperative days 3 and 5 (p < 0.01). The degrees of satisfaction for the axillary approach and the video-assisted procedure were 1.2+/-0.4 and 2.4+/-1.0, respectively (p < 0.01). The video-assisted approach is less "invasive" than the axillary approach, but the axillary approach may be indicated for patients who are anxious about the visible cosmetic results.
Adult↗
Direct mini-incision thyroidectomy.
We recently developed a new surgical technique for carrying out thyroidectomy, to minimize surgical invasiveness and improve the cosmetic result. Our procedure differs from conventional thyroidectomy in requiring a 3-cm skin incision and no raising of the skin flap. Since this technique decreased tissue trauma by obviating unnecessary neck exploration, hypesthesia or paresthesia in the neck and discomfort while swallowing, related to a large skin incision and raising of the skin flap, are minimized. Since thyroidectomy is performed after delivering the thyroid gland through the small skin incision, sufficient exposure for dissection of the pretracheal and paratracheal space can be obtained. Therefore, injuring the recurrent laryngeal nerve and the parathyroid gland can be avoided. Although the number of patients that we have treated in this manner is still small, we believe that our new procedure constitutes a useful surgical treatment for patients with thyroid disease.
Adult↗
Direct mini-incision parathyroidectomy.
We describe our technique for performing a mini-incision parathyroidectomy in patients with hyperparathyroidism. Since our procedure differs from conventional parathyroidectomy in requiring a 2- or 3-cm skin incision and no raising of skin flap, this technique resulted in a good cosmetic status and less invasiveness. Hypesthesia or paresthesia in the neck and discomfort while swallowing related to a large skin incision and raising of skin flap are minimized. Although the cosmetic results of endoscopic techniques are better than those of our procedures, endoscopic instruments remain traumatic, can easily inflict iatrogenic lesions to parathyroid adenomas and enhance the risk of tumor cell exfoliation, especially if the parathyroid adenoma is manipulated by the instruments. Our surgical procedure can be less technically demanding and time-consuming. Although the number of patients whom we have treated in this manner is still small, we believe that our new procedure constitutes a useful surgical treatment for hyperparathyroidism.
Humans↗
Effective treatment with chemotherapy and surgery for advanced small cell carcinoma of the esophagus.
A 78-year-old man reported a persistent midthoracic pain, mild dysphagia, and an abdominal distention. An abdominal computed tomography scan showed massive ascites, extensive paracardial mass, a large mass which invaded the pancreas, and a mass of multiple para-aortic lymphadenopathies which involved the superior mesenteric artery. An upper gastrointestinal endoscopic study revealed an infiltrative, ulcerating tumor of the lower esophagus. Histological study of the biopsy specimens from esophageal tumor showed small cell carcinoma. After combination chemotherapy, an abdominal computed tomography scan showed a disappearance of asites, a partial response reduction of paragastric mass, peripancreatic mass and para-aortic lymphadenopathies. Histological study of the biopsy specimens from esophageal tumor showed a viable small cell carcinoma. In June 2001, the patient underwent lower esophagectomy and proximal gastrectomy combined with splenectomy and distal pancreatectomy through an abdominal approach. Histological findings of the resected specimen showed that the esophageal tumor was a small cell carcinoma which invaded into the submucosal layer, and both paracardial and peripancreatic tumors, and all lymph nodes had no cancer cells. The patient's postoperative recovery was uneventful and discharged without aggressive chemotherapy postoperatively. However, he eventually died of progression of the metastasis 21 months after first detection of the carcinoma. Patients with esophageal small cell carcinoma treated with surgery following chemotherapy and/or radiotherapy have been reported to survive longer than those treated with chemotherapy and/or radiotherapy. Therefore, surgical resection may be recommended as the second therapy that occasionally produces long-term remission and possibly long-term survival for patients with small cell carcinoma of the esophagus.
Aged↗
Esophageal intramural spreading from an adenocarcinoma of the esophagogastric junction.
Although intramural spreading from gastric carcinoma to the esophageal wall is occasionally reported, longitudinal intramural lesion of the esophagus is very rare. We herein report the case of a patient found to have a carcinoma of the gastric cardia with intramural spreading to the esophagus approximately 7.0 cm in length. A 65-year-old man was admitted to our department suffering from a persistent midthoracic pain and mild dysphagia during the previous 3 months. Upper gastrointestinal studies revealed an oval submucosal tumor of the lower esophagus and a flare irregular lesion on the esophagogastric junction. An endoscopic ultrasonography showed the main tumor was in the submucosal layer and invaded beyond the muscularis propria. Histopathological examination of the resected specimen confirmed a poorly differentiated adenocarcinoma, 7.0 cm in length, which penetrated through the gastric wall, and invaded the submucosal layer of the esophagus. When only a few scattered carcinoma cells infiltrate only the mucosa or submucosa, it is difficult to diagnose the extent of esophageal invasion. In treating patients with gastric cancer with esophageal invasion, it is important to determine the safety of the proximal margin for esophageal resection. Histological examination using frozen sections obtained during surgery is essential for deciding the operative safety margin.
Adenocarcinoma↗