[Show abstract][Hide abstract] ABSTRACT: Even after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high. Identification of mortality markers using routinely available preoperative parameters is important.
We enrolled consecutive patients with colorectal perforation who underwent operations from January 2010 to January 2015. We divided them into a mortality and survivor group and compared clinical characteristics between the two groups. Additionally, we compared the mortality rate between different etiologies: malignant versus benign and diverticular versus nondiverticular. We used the χ (2) and Mann-Whitney U tests and a logistic regression model to identify factors associated with mortality.
We enrolled 108 patients, and 52 (48 %) were male. The mean age at surgery was 71 ± 13 years. The postoperative mortality rate was 12 % (13 patients). Multivariate logistic regression analysis showed that a high patient age (odds ratio [OR], 1.09; 95 % confidence interval [CI], 1.020-1.181) and low preoperative systolic blood pressure (OR, 0.98; 95 % CI, 0.953-0.999) were independent risk factors for mortality in patients with colorectal perforation. In the subgroup analysis, there was no significant difference between the malignant and benign group (11.8 % vs. 23.9 %, respectively; p = 0.970), while the diverticular group had a significantly lower mortality rate than the nondiverticular group (2.6 % vs. 17.1 %, respectively; p = 0.027).
Older patients and patients with low preoperative blood pressure had a high risk of mortality associated with colorectal perforation. For such patients, operations and postoperative management should be performed carefully.
World Journal of Emergency Surgery 06/2015; 10(1):24. DOI:10.1186/s13017-015-0020-y · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to investigate the effects of yogurt containing Lactobacillus gasseri OLL2716 (LG21) on autonomic nerve activities, peripheral blood flow, skin condition (skin pigmentations and moisture), saliva s-IgA and examination of quality of life (QOL). 20 healthy female volunteers (yogurt containing LG21 group: 10 people, yogurt containing Bifidobacterium (Bif) group: 10 people) were examined. The subjects ingested 100 g of yogurt twice daily for 4 weeks. Analysis was before and after 4 weeks dosage. By the effects for the autonomic nervous activity, parasympathetic increase was observed in the LG21 yogurt group, but was not significant increase. The LG21 yogurt was significantly increased on the peripheral blood flow. The LG21 yogurt was significantly increased on saliva s-IgA. The LG21 yogurt and Bif yogurt were significantly decrease on skin pigmentation. Also, LG21 yogurt was significantly increased on skin moisture. As a result of QOL questionnaire, incomplete evacuation, lower abdominal fullness, cold extremities and pimply or rough skin improved in LG21 yogurt and Bif yogurt after the administration period. These results suggest that the improvement effects of LG21 yogurt may be related to the activity of the parasympathetic nervous system.
Health 03/2015; 7(3):397-405. DOI:10.4236/health.2015.73045 · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For hepatocellular carcinoma (HCC) within a single subsegment, the superiority of anatomical subsegmentectomy over non-anatomical partial resection is still controversial. In this study, we assessed the potential benefit of subsegmentectomy.
We selected 44 patients with a single HCC lesion within one subsegment who had undergone anatomical subsegmentectomy or non-anatomical partial resection from among 173 patients who underwent hepatectomy in our hospital from August 2003 to May 2013. We compared the results following anatomical subsegmentectomy (Group A; n = 16) and non-anatomical partial resection (Group N; n = 28).
One- and two-year survival rates were 92.5% and 89.3%, respectively; 1- and 2-year recurrence-free survival (RFS) rates were 88.9% and 69.1%, respectively. There was no significant difference in overall survival or RFS between the groups. However, among HBV-positive patients, RFS was significantly better for Group A than Group N (p = 0.008).
For HBV-positive HCC within a single subsegment, we recommend subsegmentectomy.
[Show abstract][Hide abstract] ABSTRACT: A 7 1-year-old man presented to our hospital with constipation and abdominal pain. Computed tomography of the abdomen and colonoscopy revealed advanced cancer of the transverse colon. The biopsy specimen indicated a highly differentiated adenocarcinoma. The patient underwent extended right hemicolectomy with regional lymph node dissection. Pathological examination showed a neuroendocrine carcinoma(NEC)with concurrent adenocarcinoma of the transverse colon and regional lymph node metastases of the NEC and adenocarcinoma. The histopathological examination confirmed a diagnosis of mixed adenoneuroendocrine carcinoma(MANEC)in accordance with the 2010WHO Classification of Tumors of the Digestive System. Liver and lung metastases were identified 8 months after the surgery. We administered chemotherapy including 5-fluorouracil, Leucovorin, and oxaliplatin(mFOLFOX)plus bevacizumab, with limited therapeutic effect, as the disease progressed despite treatment. The patient chose best supportive care 13 months after the surgery. Several studies have reported that most patients with adenoendocrine cell carcinoma, including MANEC, experience relapse within 1 year after surgery, and few patients remain disease-free for long periods after surgery. The optimal strategy for the management of MANEC is variable owing to its rarity; only 2 cases of MANEC in the colon, including the present case, have been reported in Japan. It is thus important to gather more evidence on this disease and its management.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):1826-8.
[Show abstract][Hide abstract] ABSTRACT: Glutamate plays an important role in skin barrier signaling. In our previous study, Yokukansan (YKS) affected glutamate receptors in NC/Nga mice and was ameliorated in atopic dermatitis lesions. The aim of this study was to assess the effect of YKS on skin and cultured human keratinocytes. Glutamate concentrations in skin of YKS-treated and nontreated NC/Nga mice were measured. Then, glutamate release from cultured keratinocytes was measured, and extracellular glutamate concentrations in YKS-stimulated cultured human keratinocytes were determined. The mRNA expression levels of NMDA receptor 2D (NMDAR2D) and glutamate aspartate transporter (GLAST) were also determined in YKS-stimulated cultured keratinocytes. The glutamate concentrations and dermatitis scores increased in conventional mice, whereas they decreased in YKS-treated mice. Glutamate concentrations in cell supernatants of cultured keratinocytes increased proportionally to the cell density. However, they decreased dose-dependently with YKS. YKS stimulation increased NMDAR2D in a concentration-dependent manner. Conversely, GLAST decreased in response to YKS. Our findings indicate that YKS affects peripheral glutamate signaling in keratinocytes. Glutamine is essential as a transmitter, and dermatitis lesions might produce and release excess glutamate. This study suggests that, in keratinocytes, YKS controls extracellular glutamate concentrations, suppresses N-methyl-D-aspartate (NMDA) receptors, and activates glutamate transport.
BioMed Research International 09/2014; 2014:364092. DOI:10.1155/2014/364092 · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Yokukansan (YKS) has been used in Japan as a remedy for neurosis, insomnia, and children with night crying. Recently, many studies on the central nervous system (CNS) in terms of the effect of YKS have been reported in Japan. Here, we introduce our studies of YKS effects in the dermatological field. Our first study showed that YKS controls scratching behaviors and inhibits the development of AD-like lesions in isolated NC/Nga mice. In the second study, we compared the efficacy of YKS and fexofenadine (anti-allergic drug) using the same experimental system. Both YKS and fexofenadine inhibit aggravation of AD-like symptoms in socially isolated NC/Nga mice with respect to TEWL and dermatitis scores. However, YKS decreases the scratching and grooming behaviors in socially isolated NC/Nga mice. Thus, we speculate that YKS inhibits the aggravation of AD-like skin lesions in isolated NC/Nga mice due to mechanisms different from fexofenadine. From the results for the central nervous system, we focused on glutamate signaling to evaluate the effect of YKS in the epidermis. Immunohistochemistry and RT-PCR revealed that N-methyl-D-aspartate (NMDA) receptor expression was increased in the skin of conventional control mice and was decreased in YKS-treated mice. Glutamate transporter-1 (GLT-1) mRNA levels were decreased in the skin of conventional control mice and were increased in YKS-treated mice. The results indicate that YKS ameliorates AD-like skin lesions in NC/Nga mice through a mechanism distinct from that of fexofenadine. Our latest experiment showed that the extracellular concentrations of glutamate increased as the cell density increased in cultured keratinocytes. We speculate that this increase originated from an outflow of glutamate from the keratinocytes. Furthermore, the effects of YKS are suggested to regulate epidermal glutamate signaling, notably NMDA receptors, in the epidermis.
[Show abstract][Hide abstract] ABSTRACT: This report concerns a 76-year-old obese man with postoperative bilateral diaphragmatic paralysis after esophagectomy. The paralysis was successfully managed by respiratory rehabilitation and weight control. The patient was diagnosed with abdominal esophageal cancer accompanied by metastasis of the right supraclavicular lymph node. We performed a lower esophagectomy via a left thoracotomy, as well as resection of the metastatic lymph node together with the right phrenic nerve. After extubation, the patient desaturated and was diagnosed with bilateral diaphragmatic paralysis, which we considered was caused by an incision of the left diaphragm in association with resection of the right phrenic nerve. Conservative management improved pulmonary function and the patient was weaned from mechanical ventilation. When metastatic lymph nodes may invade one-sided of the phrenic nerve, a surgery involving resection of the opposite side of the diaphragm should be avoided to prevent bilateral diaphragmatic paralysis.
Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 01/2014; 39(2):193-198. DOI:10.4030/jjcs.39.193