Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan

Background

The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery.

Methods

We conducted a propensity score-matched case–control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant.

Results

LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups.

Conclusions

In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.

     

Comparison of visibility of circumscribed masses on Digital Breast Tomosynthesis (DBT) and 2D mammography: are circumscribed masses better visualized and assured of being benign on DBT?

Objective

To compare the visibility of circumscribed masses on digital breast tomosynthesis (DBT) images and 2D mammograms and determine the usefulness of DBT for differentiation between benign and malignant circumscribed masses.

Methods

Seventy-one (19 malignant and 52 benign) mammographic well-circumscribed masses were included. Visibility of the masses and halo signs on DBT images were retrospectively compared with 2D mammograms. The effects of mammographic breast density on mass visibility were also evaluated.

Results

For DBT, 83% were superior and 17% were equivalent in visibility of the masses to that of 2D, and superiority of DBT was significantly enhanced in the high breast density group compared with the low breast density group (91% vs 68%, respectively, p = 0.016). Three lesions were only detected on DBT. There was no significant difference in the superiority of DBT for lesion visibility between malignant and benign masses. The halo sign was detected in 58% lesions on DBT and in 4% on 2D (p < 0.001).

Conclusion

Circumscribed masses were better visualized on DBT than on 2D mammograms, particularly in high-density breasts. The halo sign often appeared on DBT and gave a clearer mass margin. However, circumscribed masses on DBT are not assured of being benign.

Key Points

? Circumscribed masses were better visualized on breast tomosynthesis than on 2D mammography. ? Tomosynthesis visualized circumscribed masses better than 2D for all breast density categories. ? Halo signs often appeared on tomosynthesis and contributed to detect circumscribed margins. ? Circumscribed masses on tomosynthesis images are not assured of being benign lesions.

     

Subconjunctival gas bubble Formation during LASIK flap creation using femtosecond laser

PURPOSE: To report a patient who developed subconjunctival gas bubble formation during creation of a LASIK corneal flap with the IntraLase femtosecond laser. METHODS: Case report of a 19-year-old-man with compound myopic astigmatism and a normal preoperative evaluation who underwent bilateral simultaneous LASIK. RESULTS: The IntraLase FS15 was used to create an 8.8-mm diameter superior flap. Laser settings were 110-microm depth, 1.70-mJ bed and side-cut energy, 12-microm spot separation, 10-microm line separation, 70 degrees side-cut angle, 240-microm pocket start width, and 200-microm pocket start depth. The procedure was uneventful in the right eye whereas subconjunctival air bubbles were observed along the corneal limbus in the left eye (no bubbles were seen in the peripheral cornea). The patient was examined 30 minutes later, and the subconjunctival bubbles could still be observed. By the next day, the bubbles had disappeared completely. Postoperative uncorrected visual acuity was 20/20 in both eyes. CONCLUSIONS: Subconjuctival bubbles can be found after LASIK flap creation with a femtosecond laser.     

Perception in relation to a potential influenza pandemic among healthcare workers in Japan: implications for preparedness

Due to the potential for an influenza pandemic, preparedness for infection control in healthcare settings is essential from the standpoint of occupational health for healthcare workers. We conducted questionnaire surveys among Japanese hospitals to assess preparedness at the individual and institutional levels and their inter-relationship. Questionnaires were administered at 7 tertiary hospitals in Japan during the spring of 2006. We analyzed 7,378 individual responses of the 10,746 questionnaires administered and all seven institutional responses by hospital infection control committees. Healthcare workers assigned low importance to personal protective equipment and showed mixed attitudes (anxious but accepting) to the potential risk. Institutional gaps existed in preparedness across hospitals and most hospitals lacked the specificity to cope with a pandemic. A higher level of institutional preparedness, as determined by expertise as well as general and specific countermeasures, was an important predictor of individual recognition of preventive measures, perception of institutional measures, and attitude toward coping with risk. A higher level of institutional preparedness stood out to be an important predictor of individual preparedness. Considering the risk of a future influenza pandemic, hospitals should improve preparedness at all levels.     

Prevalence of signs and symptoms of temporomandibular dysfunction in male adolescent athletes and non-athletes

Purpose

The aim of the study was to compare the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) in male adolescent athletes—basketball players and non-athletes and to examine the association between signs and symptoms of TMD in male adolescents in different Tanner stages.

Methods

The subjects were 46 male basketball players ages 10-13 years and 41 male adolescent non-athletes ages 10-18 years selected from the Department of Pediatrics (School of Medicine, Federal University of São Paulo) as a control group. A questionnaire was used to assess the signs and symptoms of TMD. According to the answers on the questionnaire the adolescents were classified in two categories: no signs or symptoms present (score A—absent), at least one sign or symptom present (score P—present). The ones who got score “P” were submitted to a standardized functional examination of the masticatory system by the same examiner. Pubertal status was assessed based on physical examination by physicians from our Division. The adolescents were classified according to Tanner stages into three subgroups: subgroup 1 (before the growth spurt), subgroup 2 (growth spurt period), subgroup 3 (end of growth spurt). Significant differences between athletes and non-athletes were assessed using non-parametric Wilcoxon test for continuous variables and the Fisher's exact test for categorical variables. The level of significance used was 5%.

Results

There was no significant difference between the athletes and non-athletes in exhibiting at least one sign or symptom of TMD (p = 0.1148). When comparing the adolescents who presented at least one symptom of TMD to the different subgroups of Tanner Stages no statistically significant differences were found (p = 0.8357).

Conclusion

The lack of significant differences among male adolescents athletes and non-athletes may be caused by the size of the sample, the age of the athletes or by a probable protective action of testosterone levels in male athletes. The lack of statistical difference comparing the adolescents who presented at least one sign or symptom of TMD to subgroups of Tanner is probably because estrogen is the risk factor hormone and the levels of estrogen in male adolescents are very low.     

Examination of three-detector high-speed-rotation SPECT acquisition under breathhold in body: clinical application of 99mTc-MAA

In traditional pulmonary perfusion single photon emission computed tomography (SPECT), respiratory lung motion and cyclically varying changes in lung volume during image acquisition inherently degrade the image sharpness of ill-defined perfusion defects. However, because of the lack of an adequate fast imaging technique, perfusion SPECT has never been acquired under breathhold conditions, whereas breathhold images are commonly used for pulmonary magnetic resonance (MR) and computed tomographic (CT) images. Although a high-speed imaging technique combined with a multidetector SPECT system may enable SPECT images to be obtained during a short period of breathholding, image quality would be degraded owing to decreased radioactivity counts and increased statistical noise. To resolve this problem, we developed an innovative SPECT imaging technique using a triple-head SPECT system and the high-speed-detector rotation-multiplied projection (HSRMP) technique, where a single SPECT image was reconstructed from multiple respiratory dimensional breathhold projection data obtained at the same angle. HSRMP provided noiseless high-quality perfusion SPECT images by compensating for decreased radioactivity counts caused by high-speed imaging, and significantly improved image quality and perfusion defect clarity compared with traditional non-breathhold SPECT images.     

Core Strategies to Increase the Uptake and Use of Potassium-Enriched Low-Sodium Salt

Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.