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Surgical management of the cases with both biliary and duodenal obstruction
Yoshihiro Miyasaka,Takao Ohtsuka,Vittoria Vanessa Velasquez,Yasuhisa Mori,Kohei Nakata,Masafumi Nakamura 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.2
Endoscopic management is presently the recommended first-line of treatment for biliary strictures. However, surgery still has an important role especially for biliary obstruction (BO) with duodenal obstruction. Even though endoscopic treatment for concurrent BO and gastric-outlet obstruction has been proposed, it is still not widespread. Duodenal obstruction is often associated with malignant BO which makes endoscopic treatment more challenging. Biliary and gastrointestinal double bypass with Roux-en-Y hepaticojejunostomy and gastrojejunostomy is the most common surgical intervention for malignant biliary and gastric-outlet obstruction. A variety of procedures of biliary bypass and gastrointestinal bypass have been reported. According to several studies, mortality rates range from 0% to 7%, while morbidity rates range from 3% to 50%. Higher morbidity was observed in symptomatic patients caused by the disease. Most common morbidity after double bypass was delayed gastric emptying. Recurrence of BO and gastric-outlet obstruction was less frequently seen after surgical bypass compared to after endoscopic treatment. Minimally invasive approach has been applied to double bypass. Studies showed that laparoscopic double bypass has a shorter hospital stay and reduced postoperative pain; however, due to its technical demand, it is still presently an uncommon procedure. Robotic bypass surgery may resolve this issue in the future. Further analyses of outcomes of both surgical and endoscopic treatments are necessary to establish better and suitable palliation options for concurrent biliary and duodenal obstruction caused by unresectable malignant tumors.
Surgical management of the cases with both biliary and duodenal obstruction
Yoshihiro Miyasaka,Takao Ohtsuka,Vittoria Vanessa Velasquez,Yasuhisa Mori,Kohei Nakata,Masafumi Nakamura 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.2
Endoscopic management is presently the recommended first-line of treatment for biliary strictures. However, surgery still has an important role especially for biliary obstruction (BO) with duodenal obstruction. Even though endoscopic treatment for concurrent BO and gastric-outlet obstruction has been proposed, it is still not widespread. Duodenal obstruction is often associated with malignant BO which makes endoscopic treatment more challenging. Biliary and gastrointestinal double bypass with Roux-en-Y hepaticojejunostomy and gastrojejunostomy is the most common surgical intervention for malignant biliary and gastric-outlet obstruction. A variety of procedures of biliary bypass and gastrointestinal bypass have been reported. According to several studies, mortality rates range from 0% to 7%, while morbidity rates range from 3% to 50%. Higher morbidity was observed in symptomatic patients caused by the disease. Most common morbidity after double bypass was delayed gastric emptying. Recurrence of BO and gastric-outlet obstruction was less frequently seen after surgical bypass compared to after endoscopic treatment. Minimally invasive approach has been applied to double bypass. Studies showed that laparoscopic double bypass has a shorter hospital stay and reduced postoperative pain; however, due to its technical demand, it is still presently an uncommon procedure. Robotic bypass surgery may resolve this issue in the future. Further analyses of outcomes of both surgical and endoscopic treatments are necessary to establish better and suitable palliation options for concurrent biliary and duodenal obstruction caused by unresectable malignant tumors.
Establishment of "A-PPNS", A Navigation System for Regenerating the Software Development Business
Hirotake Sakai,Yoshihiro Waji,Mari Nakamura,Kakuro Amasaka 대한산업공학회 2011 Industrial Engineeering & Management Systems Vol.10 No.1
Currently, knowledge within the field of software development is largely implicit and is not formally disseminated and shared. This means that there is little improvement and regeneration of processes, and knowledge gained from previous projects is not necessarily applied to new ones. In order to turn this situation around it is necessary to take an organized approach to sharing job-related information. For this study, the authors constructed "Amalab-Project Planning Navigation System, or A-PPNS", a system for organizing accumulated knowledge related to the field of software development. More specifically, A-PPNS is a business process monitoring system and consists of the following four elements: (ⅰ) Optimized estimate support subsystem, (ⅱ) Schedule monitoring system, (ⅲ) QCD optimization diagnostic system, and (ⅳ) Strategic technology accumulation system. The effectiveness of this system has been demonstrated and verified at Company A, a system integration company.
On-cam operation of counter-rotating type hydroelectric unit
Tetsuro Kasai,Makoto Usui,Yoshihiro Nakamura,Toshiaki Kanemoto,Daisuke Tanaka 한국물리학회 2010 Current Applied Physics Vol.10 No.2
To cope with the warming global environments, the authors had proposed the counter-rotating type hydroelectric unit, which is composed of the tandem runners and the peculiar generator with double rotational armatures. This unit can be supplied to various water circumstances, for instance, the traditional large hydropower, the mini/micro hydropower, and the tidal power. The fundamental performances and the flow conditions around the runners have been investigated and the design materials for the runners have been presented. Continuously, this paper discusses the performances at the oncam operation, in the large tidal power station. The model unit was operated while keeping the relative rotational speed constant nT = 900 min-1, namely 60 Hz, irrespective of the hydropower circumstances. The output and the hydraulic efficiency are affected by the blade setting angles of the front and the rear runners. Resultantly, both optimum angles giving the maximum output and/or the maximum efficiency are presented at the various discharges/heads.