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Iori Kisu,Kouji Banno,Asahi Tokuoka,Keigo Yamaguchi,Kunio Tanaka,Tetsuro Shiraishi,Kanako Nakamura,Hiroshi Senba,Kiyoko Matsuda,Nobumaru Hirao 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.3
ObjectiveTransvaginal removal of large specimens during laparoscopic hysterectomy can be a complex surgical procedure thatposes a risk of organ injury and tissue spillage into the abdominal cavity and is associated with extraction of thespecimen and manual morcellation. Our objective was to demonstrate a technique for transvaginal removal of largespecimens using the Alexis Contained Extraction System (CES) in laparoscopic hysterectomy. MethodsThe technique used for transvaginal removal of large specimens using the Alexis CES was presented in this video. Surgery was performed at a tertiary hospital. ResultsFollowing resection of the specimen during laparoscopic hysterectomy, the Alexis CES was inserted into the abdominalcavity through the umbilical trocar wound. The specimen was placed in a bag to prevent tissue spillage. The ringretractor was guided to the vagina and pulled out transvaginally. By repeatedly turning the ring retractor, tensionwas applied to the specimen bag, and the vaginal wall was unfolded all around to enable a secure surgical field. During manual morcellation of the specimen in the bag, the retractor was pulled and additionally turned to roll andre-tension the specimen bag when the bag was loosened. The specimen was pushed out of the vagina and safely andeffectively extracted without concerns about tissue spillage in the abdominal cavity or related organ injuries. ConclusionThe technique for transvaginal removal of large specimens using the Alexis CES enables simple, effective, and safetissue extraction with contained manual morcellation during laparoscopic hysterectomy. 영어
Optimizing Contrast Medium Injection for Coronary CT Angiography Using Myocardial CT Perfusion Data
Tomizawa Nobuo,Chou Shengpu,Matsuoka Satoshi,Yamamoto Kodai,Inoh Shinichi,Nojo Takeshi,Kumamaru Kanako Kunishima,Fujimoto Shinichiro,Nakamura Sunao 아시아심장혈관영상의학회 2019 Cardiovascular Imaging Asia Vol.3 No.4
Objective: To derive and validate a formula to predict the optimal amount of contrast medium for coronary CT angiography (CTA) from CT perfusion (CTP) data during comprehensive cardiac CT. Materials and Methods: The derivation and validation group consisted of 196 and 41 patients, respectively. Dynamic CTP was performed under adenosine triphosphate stress of 0.14 mg/kg/min, followed by rest coronary CTA. Time to peak (TTP) and peak enhancement (PE) in the left ventricle during CTP was recorded. The amount of contrast medium during CTA was 0.8×body weight (kg) in the derivation group. A formula to determine the amount of contrast medium needed to achieve an enhancement of 370 Hounsfield unit (HU) in CTA was derived using TTP, PE, body weight, and heart rate. The amount of contrast medium required during CTA in the validation group was determined by this formula. Results: The mean amount of contrast medium during CTA did not differ between the derivation and validation groups (49.3±8.0 mL vs. 47.9±12.9 mL, p=0.39). The mean coronary artery enhancement was slightly lower in the validation group (400±55 HU vs. 380±46 HU, p=0.03) with smaller interpatient variability (p=0.02) than in the derivation group. The proportion of patients with an optimal enhancement of 320 HU to 420 HU significantly increased from 54% to 75% (p=0.01) when the formula was used. Conclusion: Adjusting the amount of contrast medium using dynamic CTP data could reduce the interpatient variability of coronary enhancement during comprehensive cardiac CT.
Low Iodine Dose is Related with Overestimation of Extracellular Volume Derived from Cardiac CT
Hiroaki Arakawa,Nobuo Tomizawa,Shengpu Chou,Satoshi Matsuoka,Kodai Yamamoto,Shinichi Inoh,Takeshi Nojo,Kanako Kunishima Kumamaru,Shinichiro Fujimoto,Sunao Nakamura 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.2
Objective: To assess the relationship between the amount of injected contrast medium and the extracellular volume (ECV) value during cardiac CT and to propose a minimum amount of contrast medium necessary to correctly calculate ECV. Materials and Methods: A total of 95 patients who underwent comprehensive cardiac CT were included. Patients first underwent myocardial CT perfusion (CTP) with a contrast medium dose determined by the body weight (<70 kg: 50 mL; 70–89 kg: 55 mL; ≥90 kg: 60 mL). Coronary CT angiography (CTA) scan followed with a contrast medium dose of 0.8×body weight (kg). We defined the ECV value calculated after CTP as ECVCTP, and we used the ECV value calculated after the CTA exam as the reference standard (ECVref). We calculated the difference in ECV values (ECVdiff) as ECVCTP-ECVref. Results: The injected iodine doses during CTP and the entire exam were 284±50 and 559± 69 mg iodine/kg, respectively. There was a weak but significant negative relationship (R2 =0.07, p=0.01) between the injected iodine dose during CTP and ECVdiff. The ECVdiff of patients who received an injected iodine dose of <285 mg iodine/kg during CTP was significantly higher (2.7±4.1 vs. 0.8±3.4%, p=0.02) than that of the remaining patients. Conclusion: ECV derived from cardiac CT might be overestimated when a small amount of contrast medium is injected. Inj