Light guided procedure for congenital pyriform sinus fistula; new and simple procedure for impalpable fistula

Pyriform sinus fistula causes acute suppurative thyroiditis, and there is a risk of recurrence if the sinus tract is not excised completely. The tract should be dissected as high as possible toward the pyriform fossa. We report our devised technique “the light guided procedure” for the impalpable fistula. A bronchoscope was inserted into the pyriform sinus fistula with the help of a gastrofiberscope positioned at the larynx. The tract of the fistula was identified with the help of the light from the bronchoscope. We were able to reach the proximal end of the fistula, directly. This procedure is easy, safe, and minimally invasive.     

Pediatric surgery triage: Problems and improvements

Background: The Canadian Paediatric Triage and Acuity Scale (P‐CTAS) is used and modified at hospitals as a triage tool for pediatric patients before they are seen in emergency rooms. Pediatric surgery patients account for very few of the many patients in emergency departments, but they should be triaged as emergency or urgent because they might be candidates for surgery. Problems with and improvements for triaging pediatric surgery patients using the P‐CTAS were studied. Methods: This retrospective study evaluated all patients <16 years old who visited the emergency department of Kyorin University Hospital during an approximately 4 year period between 1 May 2005, and 11 February 2009. Pediatric surgery patients were divided into two groups to evaluate the efficiency of P‐CTAS triage. Patients who needed emergency treatment were in group A, and the others were in group B. Results: Most group A patients were level I, II, or III (97%, 111/114). In contrast, 60% (71/119) of group B patients were level IV or greater. Some problems with and suggestions for the P‐CTAS were identified. Many patients with trauma were under 1 year of age, and many with a foreign body were under 2 years of age. Age categories should be added for patients with trauma or foreign body aspiration. Patients with abdominal pain, and without anal bleeding or vomiting who are >2 years old are triaged as level IV and they accounted for 12% of patients with possible intussusception in this study. A category of ‘possible intussusception’ should be made for level II. Most patients with acute scrotum, whether operated on or not, were level III. ‘Red or purple color of scrotal skin’ and/or ‘within 6 h from onset’ could be added to level II for patients with acute scrotum. Conclusions: P‐CTAS worked well for pediatric surgery patients, and it needs to be modified and improved for such patients based on these results.     

Is a sense of community belonging associated with problem gambling in Canada?

Purpose

Despite the increasing demand for public health measures to prevent problem gambling, few studies have examined the association between community characteristics and problem gambling. The aim of this nationally representative cross-sectional study was to investigate the relationship between a sense of community belonging and problem gambling in Canada. We also examined whether this relationship was modified by sex and marital status.

Methods

Canadian Community Health Survey (2013–2014) data from 38,968 residents of Quebec, Saskatchewan, Manitoba, and British Columbia were analyzed. Problem gambling was assessed using the Canadian Problem Gambling Index. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for problem gambling.

Results

The prevalence of problem gambling was 1.4% (1.9% among males; 0.9% among females). We observed an inverse dose–response relationship between a sense of community belonging and problem gambling. Compared with those with a very strong sense of community belonging, the adjusted ORs for problem gambling were 1.07 (95% CI 0.65–1.76) for a somewhat strong sense, 1.27 (95% CI 0.77–2.11) for a somewhat weak sense, and 2.32 (95% CI 1.34–4.02) for a very weak sense of community belonging. The association was more prominent among females (except for those widowed/divorced/separated), whereas no clear association was found among males, irrespective of marital status.

Conclusion

When implementing public health measures to reduce problem gambling, it would be useful to account for possible differential impacts of a sense of community belonging by sex and marital status, which may reflect significant social contexts among residents.

     

Time changes, so do people

When one discusses the dynamic changes in human health over time, one innately conceptualizes time from the three different, but related perspectives--age, period, and cohort. To determine their separate contributions to health outcomes, age-period-cohort analyses have been used for the past 80 years. This commentary aims to provide some insight into this analytical method by distinguishing the concept of time in terms of composition and context. To demonstrate, the author uses hypothetical nested data structures of age-period-cohort analyses in the two types of individual-level data, i.e., repeated cross-sectional survey and longitudinal data on the same individuals. The conceptual distinctions between composition and context have profound implications of hypothetical interventions in age-period-cohort analyses. Age is a compositional variable, and a hypothetical intervention to change age is at the individual level. By contrast, both period and cohort are contexts, and thus two distinct types of hypothetical interventions can be envisaged to examine their contextual effects. On a related issue, the author also discusses manipulability of time. Although time is a significant context in biomedical science, it is not the only context. In this commentary, context is proposed to be classified into three fundamental dimensions--relational, spatial, and temporal. Inattention to the contextual triad leads to a biased and precarious knowledge base for public health action, and the continuing flow of performance over time is an intrinsic component of improving our understanding of multilevel causal inference in the new era of eco-epidemiology.     

Eosinophilic gastroenteritis associated with multiple gastric cancer

Eosinophilic gastroenteritis (EG) is an inflammation of the digestive tract that is characterized by eosinophilic infiltration. There are no specific symptoms, and are related to the layer in which eosinophilic infiltration is observed. A 69-year-old Japanese man presented to our hospital with a history of general malaise, diarrhea, and dysgeusia. Esophagogastroduodenoscopy showed reddish elevated lesions that were edematous all over the gastric mucosa. In addition, three tumors were also observed. The biopsies of the reddish elevated mucosa revealed eosinophilic infiltration and tubular adenocarcinoma from the tumors. Colonoscopy showed abnormal reddish elevated mucosa. The biopsies from the reddish elevated mucosa showed eosinophilic infiltration. From the abdominal contrast computed tomography scan, tumor stain was seen in the anterior wall of the gastric body. No ascites, intestinal wall thickening, or lymph node swelling were found. A slight elevation in the serum immunoglobulin E (IgE), 480 IU/ml, was found from the laboratory test results; other laboratory results were within normal limits including the number of peripheral eosinophils. No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative. He was diagnosed with EG associated with gastric cancer and underwent total gastrectomy, regional lymph node dissection with reconstruction by a Roux-en-Y method. He was prescribed prednisolone after the operation and showed a good clinical response. There are many case reports on EG, but none of them were associated with cancer. We encountered a case of EG associated with multiple gastric cancer; the patient underwent total gastrectomy.     

Effect of HEBP (1-hydroxyethylidene-1, 1-bisphosphonic acid) on inflammation-mediated osteopenia in the rat

Trabecular bone volume of rat leg bones decreased following the subcutaneous injection of talcum (magnesium silicate). The effect of HEBP (1-hydroxyethylidene -1, 1-bisphosphonic acid) on this osteopenia was investigated. Bone mineral content (σGs/D) of the tibia decreased at both metaphysis and diaphysis during 3 week observation period following the inflammatory stimulus, and HEBP inhibited the decrease of σGs/D at metaphysis when administrated together with talcum. Breaking stress at mid point of the femur decreased significantly and femur ash contents showed a significant percent decrease of ash weight and ash volume with talcum administration. HEBP did not improve these parameters. Talcum significantly increased serum concentration of P and alkaline phosphatase level, but HEBP had no remarkable change in these serum parameters. This type of osteopenia can serve as a working model for osteoporosis and HEBP protected the trabecular bone loss at metaphysis of this model.     

A CASE OF SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS WITH A HIGH TITER OF RNP ANTIBODY

A 30-year-old man developed severe erosive lesions in his oral cavity and transient Raynaud's phenomenon followed by discoid lupus erythematosus (DLE)-like lesions and non-scarring erythema. He had a high titer of RNP antibody as well. Widespread DLE (w-DLE), subacute cutaneous lupus erythematosus (SCLE) and mixed connective tissue disease (MCTD) were suspected as his condition. Finally we diagnosed him as having SCLE accompanied with a high titer of RNP antibody.     

Effects of Health Guidance on Outpatient and Pharmacy Expenditures: A Disease- and Drug-Specific 3-Year Observational Study Using Propensity-Score Matching

Background

Evidence is lacking on whether health guidance for metabolic syndrome reduces health care expenditures. The author used propensity-score matching to evaluate the effects of health guidance on health care expenditure.

Methods

Men who did and did not receive health guidance from a health insurance society (approximately 60 000 covered lives) were matched (n = 397 respectively) using propensity scores. Health insurance claims were compared using cumulative health care expenditures for metabolic syndrome-related outpatient medical care and drug costs for the period from the initial consultation to 3 years later.

Results

No difference was observed between intervention and control groups in cumulative outpatient charges or drug costs related to metabolic syndrome. However, regression analysis using the Tobit model showed that health guidance resulted in a small, nonsignificant reduction in health care expenditure.

Conclusions

Health guidance for metabolic syndrome did not reduce outpatient charges or drug costs related to metabolic syndrome during the 3-year period after the intervention. Findings from Tobit regression suggest that health guidance might eventually result in savings, but this hypothesis remains untested.Key words: health guidance, health insurance claims, propensity-score matching, PDM (proportional distribution method), metabolic syndrome     

Reduced bowel sounds in Parkinson’s disease and multiple system atrophy patients

Digital auscultation of bowel sounds was performed in newly diagnosed, drug-naïve patients with Parkinson’s disease (PD) (n = 10), multiple system atrophy (MSA) (n = 12), progressive supranuclear palsy/corticobasal degeneration (PSP/CBD) (n = 7), and control subjects (n = 18). The number of bowel sounds per minute and the integrated time of bowel sounds were significantly lower in PD and MSA patients than in control subjects. Reduced bowel sounds may herald compromised gastrointestinal motility in patients with PD and MSA.     

The usefulness of pre-radiofrequency ablation SUV(max) in 18F-FDG PET/CT to predict the risk of a local recurrence of malignant lung tumors after lung radiofrequency ablation

The aim of the present study was to assess the diagnostic usefulness of Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the prediction of local recurrence of malignant lung tumors by analyzing the pre-radiofrequency ablation (RFA) maximal standardized uptake value (SUV(max)). We performed a historical cohort study of consecutive malignant lung tumors treated by RFA from January 2007 to May 2008 at Okayama University Hospital. We selected only lung tumors examined by PET/CT within 90 days before RFA and divided them (10 primary and 29 metastatic) into 3 groups according to their tertiles of SUV(max). We calculated recurrence odds ratios in the medium group and the high group compared to the low group using multivariate logistic analysis. After we examined the relationship between SUV(max) and recurrence in a crude model, we adjusted for some factors. Tumors with higher SUV(max) showed higher recurrence odds ratios (medium group; 1.84, high group; 4.14, respectively). The tumor size also increased the recurrence odds ratio (2.67); we thought this was mainly due to selection bias because we excluded tumors less than 10mm in diameter. This study demonstrated the pre-RFA SUV(max) in PET/CT may be a prognostic factor for local recurrence of malignant lung tumors.