Osaka city medical journal最新文献

{"title":"C-reactive Protein is a Useful Marker for Early Prediction of Anastomotic Leakage after Esophageal Reconstruction.","authors":"Eijiro Edagawa,&nbsp;Yasunori Matsuda,&nbsp;Ken Gyobu,&nbsp;Shigeru Lee,&nbsp;Satoru Kishida,&nbsp;Yushi Fujiwara,&nbsp;Ryoya Hashiba,&nbsp;Harushi Osugi,&nbsp;Shigefumi Suehiro","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Esophageal anastomotic leakage is one of the most fatal complications after esophagectomy and increases the hospitalization length. We aimed to identify a convenient clinical marker of anastomotic leakage in the early postoperative period.</p><p><strong>Methods: </strong>In total, 108 patients who underwent esophagectomy were retrospectively screened, and 96 were used to validate the overall results. All 108 patients underwent physical examinations and determination of their white blood cell count, C-reactive protein level, platelet count, fibrinogen level, fibrin degradation product level, and antithrombin III level until postoperative day 6.</p><p><strong>Results: </strong>Anastomotic leakage occurred in 21 of the 108 patients (median detection, 8 days). The C-reactive protein level on postoperative day 3 and fibrinogen level on postoperative day 4 in the leakage group were significantly higher than those in the nonleakage group. Receiver operating characteristic curves for detection of anastomotic leakage were constructed; the cutoff value of C-reactive protein on postoperative day 3 was 8.62 mg/dL, and that of fibrinogen on postoperative day 4 was 712 mg/dL. Anastomotic leakage occurred in 23 of the 96 patients in the validation group. There was a significant difference between the leakage and nonleakage groups when the C-reactive protein threshold on postoperative day 3 was set at 8.62 mg/dL. However, there was no difference between the groups when the fibrinogen threshold on postoperative day 4 was set at 712 mg/dL.</p><p><strong>Conclusions: </strong>The C-reactive protein level on postoperative day 3 is a valuable predictor of anastomotic leakage after esophagectomy and might allow for earlier management of this complication.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"61 1","pages":"53-61"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34127304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased annexin A2 expression in the placenta of women with acute worsening of preeclampsia.","authors":"Miho Sano,&nbsp;Makiko Matsumoto,&nbsp;Hiroyuki Terada,&nbsp;Haijiao Wang,&nbsp;Yasushi Kurihara,&nbsp;Natsuko Wada,&nbsp;Hiroko Yamamoto,&nbsp;Yukimi Kira,&nbsp;Daisuke Tachibana,&nbsp;Masayasu Koyama","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The aims of present study were to investigate the expression of Annexin A2 in the placenta of patients with preeclampsia (PE) and correlate these data with acute worsening of clinical symptoms.</p><p><strong>Methods: </strong>Placentas were collected from uncomplicated normal pregnancies (n = 9), PE cases without emergency termination of pregnancy (group 1, n = 6), and PE cases with acute worsening of symptoms necessitating immediate pregnancy termination (group 2, n = 7). Immunohistochemistry data were analyzed quantitatively, and placental mRNA expression was measured by Real-time PCR.</p><p><strong>Results: </strong>Group 2 had a significantly shorter interval between diagnosis and pregnancy termination compared with group 1 (p = 0.002). Birth weight and placental weight in group 2 were significantly lower compared with the normal group (p = 0.006 and p = 0.03, birth weight and placental weight, respectively), whereas there were no differences in gestational age at delivery between the three groups or the severity of high blood pressure and proteinuria between the PE groups. Placental expression of Annexin A2 as determined by immunohistochemistry was significantly higher in both PE groups compared with the uncomplicated pregnancy group (p < 0.001 and p < 0.001, groups 1 and 2, respectively). Placental Annexin A2 mRNA expression was significantly elevated in group 2 compared with the normal group (p = 0.002) but did not change in group 1.</p><p><strong>Conclusions: </strong>This study is the first to demonstrate increased placental Annexin A2 mRNA expression during the acute phase of PE. Immunohistochemical staining of placental Annexin A2 was high, regardless of PE phase. These findings suggest that worsening of PE might alter Annexin A2 expression at the transcription level.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the contributing factors to airway hyperresponsiveness by a forced oscillation technique in patients with asthma.","authors":"Yumiko Imahashi,&nbsp;Hiroshi Kanazawa,&nbsp;Naoki Ijiri,&nbsp;Naoko Yoshii,&nbsp;Gakuya Tamagaki,&nbsp;Kazuhisa Asai,&nbsp;Yoshihiro Tochino,&nbsp;Kazuto Hirata","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Forced oscillation technique (FOT) is increasingly used to obtain much information on the state of the respiratory system. However, there are little data about FOT parameters on methacholine provocation test in adult asthma. This study was designed to determine the physiological implications of FOT parameters during methacholine provocation and analyze the major contributing factors to airway hyperresponsiveness (AHR) in asthma.</p><p><strong>Methods: </strong>Spirometry and FOT were performed in 22 asthmatic patients and 21 normal control subjects before and after provocation with a maximal dose of methacholine.</p><p><strong>Results: </strong>In asthmatic patients, the percent increase in resistance at 5 Hz (R5) and resistance at 20 Hz (R20) after the methacholine provocation was 70 [45-93] % and 16 [5-23] %. The percent change in R20 was not significantly correlated with the percent change in FVC or FEV1. Similarly, the percent change in R5 was not significantly correlated with the percent change in FEV1, but was significantly correlated with the percent change in FVC. Moreover, the percent change in R5 was significantly correlated with the closing index (r = 0.55, p = 0.01). In addition, AHR to methacholine was closely correlated with the percent change in R5 (r = -0.71, p = 0.001).</p><p><strong>Conclusions: </strong>Simultaneous measurement of FOT and bronchial challenge test provide meaningful information, and greater change in R5 may represent exaggerated response of small airways in asthmatic patients. This study will provide new insights into the physiological implications of each FOT parameter in asthmatic patients.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"53-62"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between right medial temporal lobe atrophy and persecutory delusions in patients with dementia of the Alzheimer's type demonstrated on VSRAD advance.","authors":"Ryo Tagawa,&nbsp;Hiroshi Hashimoto,&nbsp;Yasunori Matsuda,&nbsp;Kentaro Uchida,&nbsp;Atsushi Yoshida,&nbsp;Shigeaki Higashiyama,&nbsp;Joji Kawabe,&nbsp;Kai Toshihiro,&nbsp;Shiomi Shiomi,&nbsp;Hiroshi Mori,&nbsp;Koki Inoue","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The relationship between focal brain atrophy and delusions in patients with Dementia of the Alzheimer's Type (DAT) is not well understood. Few studies have been reported on the association between medial temporal atrophy (MTA) and persecutory delusions in patients with DAT. We investigated the relationship between MTA and persecutory delusions in patients with DAT using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) advance software, which allows us to quantify the laterality and the degree of MTA on magnetic resonance imaging (MRI) scans.</p><p><strong>Methods: </strong>Thirty-one patients diagnosed with DAT were recruited and scanned with a 1.5 tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z score (Z-score) on the target VOI, with higher scores indicating more severe. These DAT patients were divided into a group with (D group: n = 13) and without (ND group: n = 18) persecutory delusions.</p><p><strong>Results: </strong>In the D group, the mean the bilateral, right, and left Z-scores were 2.45, 2.69, and 2.19, respectively. These mean Z-scores of the ND group were 2.00, 2.00, and 1.95, respectively. The right Z-scores for the D group were significantly higher than those for the ND group (p < 0.05).</p><p><strong>Conclusions: </strong>These findings suggest that right MTA could contribute to the development of persecutory delusions in patients with DAT.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"73-80"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral infarction in the left hemisphere compared with the right hemisphere increases the risk of aspiration pneumonia.","authors":"Keiichi Yamamoto,&nbsp;Hideo Koh,&nbsp;Hiroyuki Shimada,&nbsp;Jun Takeuchi,&nbsp;Yoshihiro Yamakawa,&nbsp;Mayumi Kawamura,&nbsp;Takami Miki","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonia (AP) following cerebral infarction (CI) has been considered as one of its most serious complications. Nevertheless, there are no reports on the association between the type or location of CI and the incidence of AP. In addition, the association between dysphagia, which leads to aspiration, and the type or location of CI has never been investigated. Therefore we hypothesized that the laterality of CI affects the development of both dysphagia and AP.</p><p><strong>Methods: </strong>We performed a retrospective cohort study to examine the association between the laterality of CI and the incidence of dysphagia and AP in 133 patients.</p><p><strong>Results: </strong>AP was found in 6.0% of the group with left CI and in 0.8% of the group with right CI. A univariate logistic regression analysis revealed that left CI was a significant predictor of AP (hazard ratio, 8.81; 95% confidence interval, 1.07-72.59; p = 0.043). Left CI was a significant predictor of AP even after adjusting for age, sex, CI type, or presence of diabetes mellitus. In addition, although the frequency of dysphagia as the direct cause of AP did not differ according to laterality, the frequency of AP that ensued from dysphagia in the left CI group was greater than that observed in the right CI group.</p><p><strong>Conclusions: </strong>The group with left CI from the motor cortex to the internal capsule complicated by dysphagia exhibited a high risk of AP.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"81-6"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory hypersensitivity in children with high-functioning pervasive developmental disorder.","authors":"Eri Futoo,&nbsp;Dai Miyawaki,&nbsp;Ayako Goto,&nbsp;Yu Okada,&nbsp;Nobuyoshi Asada,&nbsp;Yoshihiro Iwakura,&nbsp;Erika Yanagihara,&nbsp;Koki Inoue","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown that children with pervasive developmental disorder (PDD) have high rates of sensory hypersensitivity. In addition, a few recent studies suggested that sensory hypersensitivity was related to anxiety or depression. However, most studies had methodological limitations because they included children with mental retardation and did not examine broadband psychopathology. Therefore, the purpose of this study was to examine the prevalence of sensory hypersensitivity in children with high-functioning PDD (HFPDD) and the correlation among sensory hypersensitivity, various characteristics, and broadband psychopathology.</p><p><strong>Methods: </strong>We assessed 132 children with HFPDD (aged 6-15 years, 75% male) that were divided into sensory hypersensitivity (HS) and sensory non-hypersensitivity (non-HS) groups. A logistic regression model was used to examine correlations among sensory hypersensitivity, age, gender, PDD subtypes, socioeconomic status, and broadband psychopathology, including symptoms of anxiety and depression.</p><p><strong>Results: </strong>Of the 132 children with HFPDD, 65.9% (n = 87) were categorized as HS and 34.1% (n = 45) as non-HS. The most common sensory hypersensitivity was auditory. Logistic regression analyses revealed that sensory hypersensitivity in HFPDD was significantly associated with autistic disorder and symptoms of anxiety and depression.</p><p><strong>Conclusions: </strong>Majority of children with HFPDD exhibited sensory hypersensitivity. Our findings suggested that sensory hypersensitivity may be a core feature of HFPDD and is possibly correlated to symptoms of anxiety and depression. We propose that sensory hypersensitivity in children with PDD should be aggressively assessed.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"63-71"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrosing cholestatic hepatitis after successful interferon and ribavirin therapy for recurrent hepatitis C post living related liver transplantation: a case report.","authors":"Takatsugu Yamamoto,&nbsp;Shogo Tanaka,&nbsp;Takahiro Uenishi,&nbsp;Akishige Kanazawa,&nbsp;Shoji Kubo,&nbsp;Kazuhiro Hirohashi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 33-year-old Japanese man who had suffered from liver cirrhosis due to hepatitis C virus (HCV) underwent living related liver transplantation (LRLT). The allograft was given by his brother, who was healthy with no history of hepatitis or hepatic virus infection. After LRLT, the patient's hepatitis C recurred. Liver biopsy revealed chronic viral hepatitis and no allograft rejection such as shown by portal lymphocytic infiltration or mild bridging fibrosis. Interferon and ribavirin were administered, and sustained viral response (SVR) was obtained. Although serum hepatitis B virus (HBV)-DNA/HCV-RNA polymerase chain reaction found no presence of hepatic virus, the serum examination demonstrated liver dysfunction seven months after SVR. Liver biopsies histopathologically showed portal fibrosis invading to the sinusoids, cholestasis, mild hyperplasia of the cholangioles, and no features of allograft rejection. Fibrosing cholestatic hepatitis (FCH) was diagnosed. The FCH was resistant to treatment and advanced, and the patient died 17 months post-LRLT. Several serum examinations failed to demonstrate the existence of HBV/HCV during the patient's course. FCH is a type of viral hepatitis that is characterized by recurrent viral hepatitis after allograft transplantation. Because SVR obtained by anti-viral therapy commonly resolves FCH, we believe that this patient represented a rare case of FCH. The present case suggests that not only direct viral cytotoxicity, but other factors as well, promote the development of fibrosis and cholestasis. FCH sometimes progresses irreversibly despite the absence of serum viral load. The present case informed us that immediate anti-viral therapy should be initiated when recurrent allograft viral hepatitis is diagnosed.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 2","pages":"95-100"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of tricyclic antidepressants as analgesic adjuvants results in nonhazardous prolongation of the QTc interval.","authors":"Yusuke Funai,&nbsp;Tomoharu Funao,&nbsp;Kazutake Ikenaga,&nbsp;Ryota Takahashi,&nbsp;Ichiro Hase,&nbsp;Kiyonobu Nishikawa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tricyclic antidepressants (TCAs) are known to prolong QTc interval. However, little is known about the QTc lengthening effect of TCAs at analgesic dosages and the predictive factors for abnormal QTc prolongation.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective observational study, and evaluated 87 patients (65 amitriptyline, 22 nortriptyline) who underwent 12-lead electrocardiogram (ECG) examinations both before and after receiving TCAs for herpes zoster pain or postherpetic neuralgia from May 2007 to January 2012. Data on QTc interval, age, gender, the type and daily dosage of TCAs, the medication period until the second ECG examination, and ECG findings were obtained from electronic medical charts.</p><p><strong>Results: </strong>The median daily dosages were 25 mg/day for amitriptyline and 10 mg/day for nortriptyline. The median medication period for all participants was 62 days. TCAs significantly prolonged the QTc interval (before, 413.2 +/-17.0 ms; after, 419.9 +/- 18.9 ms, p < 0.01). Three patients showed marked QTc prolongation, but it did not exceed 500 ms, or deltaQTc of 60 ms, and none had an episode of fatal arrhythmia. Univariate logistic regression analysis revealed left ventricular hypertrophy (LVH) to be the sole risk factor for abnormal QTc prolongation. The adjusted odds ratio was 4.09 (95% CI, 1.01-16.55, p < 0.05) by multivariate logistic regression analysis.</p><p><strong>Conclusions: </strong>TCAs as analgesic adjuvant significantly prolonged the QTc interval, but within an acceptable range. LVH was a significant predictor of abnormal QTc prolongation.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 1","pages":"11-9"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32711330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion-weighted magnetic resonance imaging findings in a patient with struma ovarii.","authors":"Tohru Takeshita,&nbsp;Teruhisa Ninoi,&nbsp;Tetunori Maebayashi,&nbsp;Kunihiko Doh,&nbsp;Shigeo Hashimoto,&nbsp;Yumo Mniki","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this report, the magnetic resonance imaging (MRI) appearance of struma ovarii (SO) in a patient who underwent diffusion-weighted imaging (DWI) of the pelvis and subsequent histological analysis is described. The solid portion of SO showed a high apparent diffusion coefficient (ADC) value, indicating unrestricted diffusion, and each loculus of SO showed different ADC values due to the different viscosity of the cyst contents in each loculus. These unique and characteristic DWI findings may serve as a helpful sign in making the correct diagnosis of SO when DWI findings are interpreted in conjunction with conventional MRI findings.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32711334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of single-incision laparoscopic appendectomy in adults and adolescents using an endolinear stapler.","authors":"Takatsugu Yamamoto,&nbsp;Yukiko Kurashima,&nbsp;Kazunori Ohata,&nbsp;Masato Okawa,&nbsp;Shogo Tanaka,&nbsp;Takahiro Uenishi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Some investigators recently introduced transumbilical single-incisional laparoscopic appendectomy (SILA), however, those SILA require expensive surgical instruments, or difficult technique. We uniquely propose performing SILA using with endolinear stapler, and compare the clinical results of the present SILA with those of conventional laparoscopic appendectomy.</p><p><strong>Materials and methods: </strong>In brief, the skin of the umbilical hollow is cut, the anterior layer of the rectus sheath and subcutaneous fat is exfoliated widely, and the linea alba is opened. Two low-profile 5-mm-diameter trocars are stabbed through the right rectus sheath, and a 12-mm-diameter trocar is inserted from the opened linea alba. Using a 5-mm laparoscope, and endolinear stapler, the appendix is dissected. Some clinical and operative data of 16 cases treated the present SILA are compared with those of 35 cases treated conventional laparoscopic appendectomy.</p><p><strong>Results: </strong>We performed the present SILA for 16 patients consisted of young women mostly, compared with cases treated conventional laparoscopic appendectomy (mean, 26-year-old vs 51-year-old, p < 0.0001). The results of the SILA we have proposed in adults and adolescents are good in terms of operation time (mean, 64 minutes vs 89.3 minutes, p = 0.049), duration of hospitalization (mean, 4.2 days vs 8.1 days, p = 0.0038), and low frequency of intra- and postoperative complications (one patient of postoperative umbilical granuloma).</p><p><strong>Conclusions: </strong>We assume that convenience of surgical procedure of the present SILA would affect the shortness of operation time, and that minimal invasive surgical stress of the present SILA would reduce perioperative stress of appendicitis, and ameliorate adolescents with appendicitis earlier. We believe that the SILA we have proposed offers advantages in diversion of conventional surgical instruments, similarity to conventional manipulation of laparoscopic forceps, usage of an endoscopic stapler able to cut cecum in cases of advanced appendicitis extending to the cecum, and obviation of extra-abdominal appendectomy demanding excessive traction of the appendix.</p>","PeriodicalId":19613,"journal":{"name":"Osaka city medical journal","volume":"60 1","pages":"21-7"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32711331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}