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Surgical Science 2020年第9期11卷 242-256页

作者： Takanori Ayabe Masaki Tomita Ryo Maeda Manabu okumura Kunihide Nakamura Shin Nakajima Kazue Nakajima Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Department of Patient Safety Management University of Miyazaki Hospital Miyazaki Japan Division of Cardiovascular Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan National Hospital Organization Osaka National Hospital Osaka Japan Department of Clinical Quality Management Osaka University Hospital Osaka Japan

Background: The implementation of resilience engineering for an operating room is difficult;however, its study would become important for the surgeon’s personal and surgical team in order to develop a new surgical safety management. An expert operator must perform an operation with his surgical team that includes an anesthetist, scrub nurse, and young assistant. However, there exist some gaps among these multi-professionals. Objective: From the viewpoint of an expert operator, to have an operation go well, we would describe how to reconcile their gaps. We will explain the gaps among the multi-professionals in a surgical team, such as hidden interactions between the operator and anesthetist, surgeon and scrub nurse, and expert operator and young assistant. Material and Methods: We assumed three types of interactions among the multi-professionals in the operating theater and we clarified how to bridge the gaps by revealing what the operator thinks, what the anesthetist thinks, what the scrub nurse thinks, and what the young assistant thinks in the surgical team, and by understanding how they perform during surgery. Outcomes: What the expert operator thinks and how he performs in surgery is summarized by the following three items: 1) safety is first, 2) achieving the operative purpose, and 3) fast surgery. We interviewed the surgical team members. In order for the surgery to go well, what the important thing is “safety first” for any surgical professionals. The sentence, “safety is first” is the magic words, such as “open sesame”. They can communicate with each other on the spot and build the team and system. To develop a strong and resilient surgical team, these four behaviors are important to improve the performance as a system: 1) sharing the same goal and same priority, 2) understanding gaps with clear verbal communication. Coming out from own professional boundaries (takotsubo), speaking in words,

关键词： Resilience Engineering Hidden Interactions Multi-Professionals Surgical Team

Risk of Major Hemorrhage in Bilateral Lung Transplantation for Chronic Thromboembolic Pulmonary Hypertension: A Case Report

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Open Journal of Organ Transplant Surgery 2013年第4期3卷 65-67页

作者： Tomoyuki Nakagiri Masato Minami Masayoshi Inoue Soichiro Funaki Yasushi Shintani Meinoshin okumura Department of General Thoracic Surgery Osaka University Graduate School of Medicine Osaka Japan

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the indications for lung transplantation. When patients with CTEPH undergo transplantation, massive bleeding can occur because of severe pleural adhesions and collateral vessels that develop from the thoracic wall to the lungs. However, there has been no previous case report that has discussed the bleeding risk in detail. We report the case of a patient having CTEPH who underwent bilateral lung transplantation with massive blood loss (11,730 mL) in the first operation and required repeat operations for hemostasis. The patient underwent left upper lobectomy because compromised blood flew to the left upper lobe. He recovered from the operations by postoperative day 9;however, he died from pyothorax from an intractable air leak 56 days after transplantation.

关键词： Lung Transplantation Chronic Thromboembolic Pulmonary Hypertension Massive Bleeding Control

Use of McGrath^(■) MAC Video Laryngoscope for Nasotracheal Intubation in Patients for Whom Intubation Was Expected to Be Difficult Due to the Limited Mouth Opening

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Open Journal of Anesthesiology 2018年第7期8卷 223-227页

作者： Aiji Sato Naoko Tachi Yoko okumura Mayumi Hashimoto Masahiro Yamada Tomio Yamada Department of Anesthesiology Aichi Gakuin UniversitySchool of DentistryNagoyaJapan

McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.

关键词： McGrath? MAC Video Laryngoscope Limited Mouth Opening Difficult Intubation Nasotracheal Intubation

Time-dependent closure and permeability of a hydraulic fracture under constant normal stress

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Time-dependent closure and permeability of a hydraulic fract...

Unexpected Postoperative Paraplegia after Thoracotomy in Lung Cancer: Incidental Migration of Oxidized Regenerated Cellulose Used for Hemostasis of Intercostal Space Bleeding

The 2001 ISRM International Symposium-2nd Asian Rock Mechanics Symposium(ISRM 2001-2nd ARMS)

作者： K.MATSUKI K.SAKAGUCHI K.okumura Tohoku University SendaiJapan

＜正＞Time-dependent closure and permeability of a small-scale hydraulic fracture created in granite and sandstone were measured under constant normal *** time-dependent closure increased to be constant at 50 to 70 hours for both *** ultimate time-dependent closure did not depend on the normal stress when the elastic closure curve obeyed the Goodman’s formula as for granite,while it increased with the normal stress when the elastic closure curve did not obey the Goodman’s formula as for sandstone. The hydraulic aperture decreased with time to be constant at about 50 hours for both *** hydraulic aperture produced by the elastic closure was very small（2.2 to 3.5μm）.and was finally 1.3 to 1.8μ*** larger the initial hydraulic aperture was,the more the hydraulic aperture decreased with time,regardless of the normal *** decrease in the hydraulic aperture was small in comparison with the increase in the time-dependent closure for both *** was because the fractures used in this study were all well mated and,accordingly,the contact area was developed well.

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Surgical Science 2017年第8期8卷 365-374页

作者： Takanori Ayabe Masaki Tomita Shigeko Shimizu Etsuko Yokoyama Manabu okumura Koichiro Itai Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Division of Patient Safety Management University of Miyazaki Hospital Miyazaki Japan Division of Clinical Ethics University of Miyazaki Hospital Miyazaki Japan Division of Cardiovascular Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: We experienced a very rare complication, that is, an unexpected postoperative paraplegia due to the incidental migration of oxidized regenerated cellulose used for hemostasis of intercostal space bleeding. Patients and Methods: The objective is to analyze the cause and to take measures against the very rare complication from an empirical analysis and the literature. For a 78-year-old male with suspected lung cancer in the right upper lobe (S1), a thoracotomy was performed. For hemostasis of the bleeding from the 5th intercostal thoracotomy space, we used and placed oxidized regenerated cellulose at the continuous oozing bleeding sites. On the 3rd postoperative day, paralysis beneath thoracic vertebrae level 6 was observed. Immediate computed-tomographic (CT) scanning and magnetic resonance imaging (MRI) displayed a 17 × 9 × 14 mm epidural hematoma in the spinal canal at level 5 of the thoracic vertebrae. An emergent laminectomy for the thoracic vertebra was performed to remove the oxidative cellulose and haematoma, and the compression was released. The paraplegia gradually began to recover and maintain a standing position. After 1 year from the event, the patient can walk by himself with a crutch. Results: The causes were that the oxidative cellulose materials were used for the intercostal bleeding at the open thoracotomy. The migration of the oxidative cellulose materials into the epidural space and into thoracic spinal canal through the intervertebral foramen, or gradual penetration of the oxidative cellulose materials into the spinal canal due to respiratory costal movement. As a measurement of prevention, the hemostat materials should be completely removed after finishing of the hemostasis. In the case of a difficult hemostasis, consultation of an orthopedist or neurosurgeon to perform the appropriate hemostasis in good cooperation is required. Conclusion: If postoperative paraplegia is suspected, immediate CT scanning and/or MRI examination would be

关键词： Lung Cancer Incident Oxidized Regenerated Cellulose Migration Thoracotomy Intercostal Space Bleeding Paraplegia

Kirkendall空洞引起的铝丝—金层之间键合强度的退化

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微纳电子技术 1982年第4期 76-83页

作者： Katsuya okumura 丁奎章

研究了铝丝-镀金层系统的健合强度的退化。这种健合系统在高温贮存时,健合强度的退化为下列三种退化模式之一:(ⅰ)A模式—随热退火时间的增加,键合强度下降,直到某一确定值,(ⅱ)B模式—在一确定的退火时间以后,键合强度开始分成两个值,(... 详细信息

研究了铝丝-镀金层系统的健合强度的退化。这种健合系统在高温贮存时,健合强度的退化为下列三种退化模式之一:(ⅰ)A模式—随热退火时间的增加,键合强度下降,直到某一确定值,(ⅱ)B模式—在一确定的退火时间以后,键合强度开始分成两个值,(ⅲ)C模式—键合强度迅速降到零。在铝-金界面之间富金金属间化合物相处生成的Kirkendall空洞可圆满地解释这三种退化模式的物理机理,此时,富金金属间化合物相的生长速率对决定退化模式起着非常重要的作用。当金层含有大量的铅或铊时,这个生长速率减慢,退化是C模式或者是B模式。有时在金层中掺入银,能使键合强度的退化减弱。

关键词：键合强度生长速率 Kirkendall 金属间化合物金属互化物铝丝空洞

Expression Analysis of Aquaporin-1 (Aqp-1) in Human Biliary Tract Carcinoma

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Journal of Cancer Therapy 2016年第1期7卷 17-23页

作者： Shinichi Sekine Tomoyuki okumura Takuya Nagata Kazuto Shibuya Isaku Yoshioka Koshi Matsui Ryouta Hori Kazuhiro Tsukada Department of Surgery and Science University of Toyama Toyama Japan

Background: Aquaporins (AQPs) are important in controlling bile water secretion. AQP is related to the invasion and metastasis of cancer. However, the relationship of biliary tract cancer is not clear. The role of AQP-1 in cancer cell is also unknown. Methhods: We analyzed AQP-1 expression using tissue microarray (TMA) in 99 samples immunohistochemically (50 gallbladder carcinoma, 39 bile duct carcinoma and 10 Papilla Vater carcinoma patients who underwent surgery at our department from 1997 to 2011). Gene expressions were evaluated by the combination of the immunohistological intensity and distribution. The expression level is compared to the clinico-pathological data of the patients. Results: In the TMA, depth of tumor invasion and histological type are associated with AQP-1 expression. The group of patients with high AQP-1 expression is associated with higher rates of disease specific survival (log-rank p = 0.013). Cox’s proportional hazard model reveals that AQP-1 expression is an independent prognostic factor (RR, 0.324;p = 0.001) in multivariate analysis. There is a correlation between AQP-1 expression and tumor invasion. Conclusions: These observations of this study suggest that AQP-1 expression may be favorable biomarkers associated with prognosis and tumor invasion in biliary tract carcinoma.

关键词： Aquaporin Biliary Tract Carcinoma Tissue Microarray Immunohistochemistry

Repeated Resection for Pulmonary Metastatic Hepatocellular Carcinoma after Liver Transplantation— Case Reports and a Proposal of Negative Predictors for the Recurrence after the Operation

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Open Journal of Thoracic Surgery 2012年第4期2卷 94-98页

作者： Tomoyuki Nakagiri Soichiro Funaki Yasushi Shintani Masayoshi Inoue Noriyoshi Sawabata Masato Minami Meinoshin okumura Department of General Thoracic Surgery Graduate School of Medicine Osaka University Osaka Japan.

Background: Orthotropic liver transplantation (OLTx) is recognized as a radical therapy for unresectable hepatocellular carcinoma (HCC) without distant metastasis. Although the outcome depends on distant recurrence of HCC, the predictors for recurrence after repeat resection are unknown. Case 1: A 52-year-old man, who had suffered from hepatitis B and underwent repeat local ablation therapies since 50 years old, underwent living-donor OLTx because of multiple HCC recurrence with tumor marker (TM) elevation but without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. After the operation, he got TM normalization and was managed with cyclosporine A, without rejection. Although he underwent adjuvant chemotherapy, a pulmonary metastasis was found 1 year after the OLTx. He underwent wedge resection of the lung using video-assisted thoracoscopic surgery (VATS). Half a year after the operation, a recurrence was found in the transplanted liver with TM elevation. While a local ablation therapy was performed, TM was not normalized and new recurrence was found at the hilum of the right lung. Right upper sleeve lobectomy was performed, but he developed multiple recurrences, and died 4 months after the last operation. Case 2: A 32-year-old man, who has suffered from multiple HCC with hepatitis B and underwent hepatic resection and local ablation therapies since 28 years old, underwent living-donor OLTx because of multiple HCC recurrence without distant metastasis. Histopathological diagnosis was moderately differentiated HCC. He was managed using tacrolimus without rejection. Three years after the OLTx, a pulmonary recurrence was found without TM elevation. He underwent wedge resection using VATS. Four year after the last operation, a small recurrence was identified in the right lung without TM elevation, again. Wedge resection using VATS was performed. At the final follow-up visit, 3 years after the last operation, the patient was disease free w

关键词： Hepatocellular Carcinoma Liver Transplantation Recurrence Lung

Interaction between Primary Care Physicians and Specialists for Diagnosis and Management of Hypersensitivity Pneumonitis

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International Journal of Clinical Medicine 2011年第4期2卷 444-451页

作者： Keiko Morii Kozo Yoshimori Miyako Sudo Hideo Ogata Masao okumura Akihiko Gemma Shoji Kudoh Kozui Kida 不详

Objective: Hypersensitivity pneumonitis (HP) may be a complex syndrome rather than a single, uniform disease entity. The problems associated with HP treatment include a lack of awareness of primary care procedures and scarcity of recent information regarding HP. The main objective of this study was to investigate the problems in the interaction between primary care physicians and chest specialists. Data source: All available clinical records of cases at the Fukujuji Chest Hospital, Tokyo, between 1994 and 2005, supervised by specialists of a university hospital. Study selection: All cases suspected of HP during the period. Results: Nine cases were excluded because of insufficient records or because they did not satisfy the clinical criteria. Twenty-eight enrolled patients (14 men and 14 women;mean age, 53.0 years) were initially treated for respiratory infections by primary care physicians. The final HP types were summer-type (n = 18), bird fancier’s lung (n = 2), ventilation-related (n = 3), or undetectable antigen (n = 5). On the basis of the interval between the onset of initial symptoms and the time of referral to our hospital, the cases can be categorized into 3 groups, which may represent acute, subacute, and chronic HP. Conclusion: All patients initially received treatment on the basis of a different diagnosis at primary evaluation. We concluded that interaction between primary care physicians and chest specialists is essential for solving problems associated with the early diagnosis and adequate treatment of HP.

关键词： Biopsy Connection Computed Tomography Criteria Pneumonitis