Relationship between status of dentition and incident functional disability in an elderly Japanese population: prospective cohort study of the Tsurugaya project

Purpose

The purpose of this study was to examine whether the status of dentition is associated with incident functional disability in elderly people.

Laparoscopic anterior resection for rectal cancer in a patient with a ventriculoperitoneal shunt

Laparoscopic surgery has been relatively contraindicated in patients with ventriculoperitoneal shunts (VPS) because of concerns about the effect of the pneumoperitoneum on shunt function. However, there have been recent reports of laparoscopic surgery on the gallbladder and cecum. This is the first report of laparoscopic high anterior resection for rectal cancer without manipulation of the VPS catheter in a patient with VPS. We made a diagnosis of advanced rectal cancer in a 77‐year‐old man who had a VPS to treat hydrocephalus after a subarachnoid hemorrhage. We performed the procedure with the patient in a 15° head‐down tilt and with 10‐mmHg pneumoperitoneum pressure. There were no postoperative complications. We concluded that laparoscopic surgery for rectal cancer can be safely performed in patients with VPS.     

Novel mutations of MVK gene in Japanese family members affected with hyperimmunoglobulinemia D and periodic fever syndrome

Hyperimmunoglobulinemia D with periodic fever syndrome (HIDS) is a recessively inherited recurrent fever syndrome. We describe a family of eldest son and monozygotic twin younger sisters with characteristic syndrome of HIDS, but normal level of IgD. Mevalonate kinase (MK) activity was deficient in all of them, and analysis of the MVK gene revealed compound heterozygosity for 2 new mutations, one of which was the disease-causing splicing mutation and the other was a novel missense mutation. All the patients had the same compound heterozygous mutations c.227-1 G?>?A and c.833 T?>?C, which resulted in exon 4 skipping and p.Val278Ala. This is the first case in which exon skipping mutation of the MVK gene has been certainly identified at the genomic DNA level. In each case, in which HIDS is clinically suspected, despite normal IgD level, analysis of MK activity and the MVK gene should be performed.     

Time saving with narrow-band imaging for distinguishing between neoplastic and non-neoplastic small colorectal lesions

Background and Aims: For colonoscopic examinations, the narrow‐band imaging (NBI) system is more convenient and timesaving than magnifying chromoendoscopy (MCE). However, the time‐saving aspects of NBI techniques have not been assessed. The present study compared interpretation times between NBI and MCE techniques in distinguishing between neoplastic and non‐neoplastic small colorectal lesions. Methods: Between January and March 2010, 693 consecutive patients who underwent colonoscopy at the National Cancer Center Hospital, Tokyo, Japan, were enrolled. When the first lesion was detected by conventional white‐light observation, the patient was randomly assigned to undergo a sequence of NBI and MCE observations (group A: NBI–MCE, group B: MCE–NBI). The time to diagnosis with each modality (NBI, from changing to NBI until diagnosis; MCE, from the start of indigo carmine solution spraying until diagnosis) was recorded by an independent observer. The sensitivity, specificity, and diagnostic accuracy of the first modality used in each group (NBI or MCE) were assessed by referring to the histopathological data. Results: Seventy‐one patients with 137 lesions were randomized to group A, and 80 patients with 163 lesions to group B. The median interpretation times were 12 s (interquartile range [IQR]: 7–19 s) in group A, and 17 s (IQR: 12–24 s) in group B, the difference being significant (P < 0.001). No significant differences were observed between NBI and MCE in terms of sensitivity, specificity, and diagnostic accuracy. Conclusions: NBI reduces the interpretation times for distinguishing between neoplastic and non‐neoplastic small lesions during colonoscopies, without loss of diagnostic accuracy.