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Review : EUS-Guided Biliary Drainage
( Kenji Yamao ),( Kazuo Hara ),( Nobumasa Mizuno ),( Akira Sawaki ),( Susumu Hijioka ),( Yasumasa Niwa ),( Masahiro Tajika ),( Hiroki Kawai ),( Shinya Kondo ),( Yasuhiro Shimizu ),( Vikram Bhatia ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1
Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fineneedle aspiration (EUS-FNA) using a curved linear- array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD. (Gut Liver 2010;4(Suppl. 1):S67-75)
Sagami Ryota,Yamao Kentaro,Minami Ryuki,Nakahodo Jun,Akiyama Hidetoshi,Nishikiori Hidefumi,Mizukami Kazuhiro,Yamao Kenji,Bhatia Vikram,Amano Yuji,Murakami Kazunari 거트앤리버 소화기연관학회협의회 2024 Gut and Liver Vol.18 No.2
Background/Aims: High-grade pancreatic intraepithelial neoplasia and invasive pancreatic ductal adenocarcinoma ≤10 mm are targets for early detection of pancreatic cancer. However, their imaging characteristics are unknown. We aimed to identify endoscopic ultrasound findings for the detection of these lesions. Methods: Patients diagnosed with high-grade pancreatic intraepithelial neoplasia (n=29), pancreatic ductal adenocarcinoma ≤10 mm (n=11) (who underwent surgical resection), or benign main pancreatic duct stenosis (n=20) between January 2014 and January 2021 were retrospectively included. Six features differentiating these lesions were examined by endoscopic ultrasonography: main pancreatic duct stenosis, upstream main pancreatic duct dilation, hypoechoic areas surrounding the main pancreatic duct irregularities (mottled areas without demarcation or round areas with demarcation), branch duct dilation, prominent lobular segmentation, and atrophy. Interobserver agreement was assessed by two independent observers. Results: Hypoechoic areas surrounding the main pancreatic duct irregularities were observed more frequently in high-grade pancreatic intraepithelial neoplasia (82.8%) and pancreatic ductal adenocarcinoma ≤10 mm (90.9%) than in benign stenosis (15.0%) (p<0.001). High-grade pancreatic intraepithelial neoplasia exhibited mottled hypoechoic areas more frequently (79.3% vs 18.9%, p<0.001), and round hypoechoic areas less frequently (3.4% vs 72.7%, p<0.001), than pancreatic ductal adenocarcinoma ≤10 mm. The sensitivity and specificity of hypoechoic areas for differentiating high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis were both 85.0%, with moderate interobserver agreement. Conclusions: The hypoechoic areas surrounding main pancreatic duct irregularities on endoscopic ultrasound may differentiate between high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis (Trial Registration: UMIN Clinical Trials Registry (UMIN000044789).
Hiroshi Nakagawara,Kenji Yamao,Takuji Gotoda,Daiichiro Kikuta,Akinori Takei,Kunio Iwatsuka,Toshimi Takahashi,Masahiro Ogawa,Akihiro Henmi,Makio Kobayashi,Mitsuhiko Moriyama 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.2
Background: Endoscopic-guided placement of metal stents for unresectable malignant hilar biliary obstruction (UMHBO) is performed using partial stent-in-stent or side-by-side (SBS) techniques. The latter involves placing sequential stents within the bile duct. Excessive dilation of the bile duct during stent placement can have serious effects on the surrounding organs.Methods: This study details seven cases of SBS placement of 8.0 mm metal stents for UMHBO. Histopathological examinations were performed to identify the effects on the bile duct and surrounding tissues.Results: The mean post-placement diameter of the bile ducts was 13.86 mm, and no compression necrosis or thrombi were observed in surrounding tissues. Cholangitis occurred in five cases, and death occurred as a result of cholecystitis in one case. Conclusion: The use of 8.0-mm stents for SBS is unlikely to have major negative effects on peribiliary tissues and blood vessels. However, post-placement cholecystitis can result in increased mortality; thus, gallbladder drainage should be considered.
Ultimate Strength and Ductility of Stiffened Steel Tubular Bridge Piers
Wang Zhanfei,Toshitaka Yamao 한국강구조학회 2011 International Journal of Steel Structures Vol.11 No.1
This paper presents the ultimate strength and ductility of steel tubular bridge piers with the inner cruciform plates, the stiffener plates, the concrete-filled sections and the outer tube subjected to monotonic and cyclic horizontal loads. Numerical analyses were carried out using the finite element package MARC. Firstly, to check the validity of the numerical analysis, the analytical results of the steel tubular columns with the inner cruciform plates, the concrete filled sections and the outer tube were compared with the previous experimental results. Secondly, the effects of the radius-to-thickness ratio parameter and the slenderness ratio parameter on seismic performance (the ductility, the ultimate strength etc.) of these steel tubular piers were examined. Numerical results indicated that the steel column with inner cruciform plates was able to improve the ultimate strength and ductility of the steel tubular piers.
Koike, Katsuaki,Mori, Kazuya,Yamao, Toshitaka,Fujimi, Toshio,Kim, Yun-Hae Korean Society for Engineering Education 2010 공학교육연구 Vol.13 No.5
As an activity of one working group for the Good Practice program at Kumamoto University, we proposed a questionnaire survey on the degree in which students understand the uppermost points of importance in their classes in addition to the usual type of class questionnaire. Each class lists three uppermost points of importance which are essential for understanding the class content. The degree of understanding is classified into four levels: full, most, insufficient, and not at all understandings. Through the analysis of questionnaire replies, the degree of understanding for bachelor students in the Department of Engineering was discovered to be meaningfully affected by the degree of difficulty, the effectiveness of audiovisual aids, self-study time, and class attendance.
Hiroshi Nakagawara,Kenji Yamao,Takuji Gotoda,Daiichiro Kikuta,Akinori Takei,Kunio Iwatsuka,Toshimi Takahashi,Masahiro Ogawa,Akihiro Henmi,Makio Kobayashi,Mitsuhiko Moriyama 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.2
Background: Endoscopic-guided placement of metal stents for unresectable malignant hilar biliary obstruction (UMHBO) is performed using partial stent-in-stent or side-by-side (SBS) techniques. The latter involves placing sequential stents within the bile duct. Excessive dilation of the bile duct during stent placement can have serious effects on the surrounding organs.Methods: This study details seven cases of SBS placement of 8.0 mm metal stents for UMHBO. Histopathological examinations were performed to identify the effects on the bile duct and surrounding tissues.Results: The mean post-placement diameter of the bile ducts was 13.86 mm, and no compression necrosis or thrombi were observed in surrounding tissues. Cholangitis occurred in five cases, and death occurred as a result of cholecystitis in one case. Conclusion: The use of 8.0-mm stents for SBS is unlikely to have major negative effects on peribiliary tissues and blood vessels. However, post-placement cholecystitis can result in increased mortality; thus, gallbladder drainage should be considered.
Water Rights Policymaking and the U.S. Congress, 1889 to 1997
Robert L. Perry,Kelly Tzoumis,Yoriko Yamao 한국공공정책학회 2003 공공정책연구 Vol.13 No.-
In this paper we examine congressional policy concerning water rights from 1889-1997. We examine both congressional committee hearings (n=appx. 280) and witnesses (n=appx. 3800) to determine what key issues are involved in water rights policy and how the participants and issue monopolies have changed over time. Through our coding of the tone of the hearings and witnesses, as well as public attention to water rights issues, we construct measures of dominance that track how congressional water policy has developed.