Laparoscopic mediastinal approach for retrosternal gastric conduit cancer after esophagectomy

The prognosis of esophageal cancer has improved, but the incidence of gastric conduit cancer has increased. Gastric conduit cancer is difficult to treat because current treatment options are highly invasive; in particular, surgical procedures have high mortality and modality. Treatment through the retrosternal route usually requires sternotomy, which often causes lethal osteomyelitis. To prevent lethal complications and reduce invasiveness, we used the laparoscopic mediastinal approach. Here, we report a successful case using the laparoscopic mediastinal approach for the treatment of gastric conduit cancer through the retrosternal route. Despite a few concerns, this approach can be a treatment option for gastric conduit cancer through the retrosternal route.     

Osteonecrosis and osteomyelitis of the jaw associated with tumour necrosis factor-alpha (TNF-α) inhibitors: a systematic review

Tumour necrosis factor-α (TNF-α) inhibitors are increasingly being used as immunomodulators to manage inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Reported serious side effects include an increased incidence of lymphoma and greater susceptibility to infections such as tuberculosis. The aim of this systematic review was to find out whether there is an associated risk of medication-related osteonecrosis of the jaw (MRONJ). Three authors independently searched PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials for published reports of oral osteonecrosis (ONJ) or osteomyelitis (OM) in patients who took anti TNF-α drugs and had no history of antiangiogenic agents or antiresorptive treatment. All types of studies on humans treated with TNF-α inhibitors were considered. Only six were eligible for analysis, and all were independently assessed for risk of bias. They included six patients with ONJ or OM that was attributed solely to TNF-α inhibitors. The most common site of ONJ was the posterior mandible (n = 5). The mean (SD) duration of anti-TNF-α treatment before the development of bony lesions was 62.5 (47.4) months. Invasive surgery was reported as a precipitating factor in five cases, and the ONJ/OM resolved with conservative management in five. Although all the studies were judged to be at high risk of bias, the limited data suggest that some patients will potentially develop ONJ/OM as a result of treatment with TNF-α inhibitors. Studies of higher quality are now needed to establish the relative risk of MRONJ in patients who take them.     

Developmental problems concerning children's oral functions,based on a questionnaire administered to dentists and guardians

ObjectivesThis study aimed to clarify the importance of dental support for eating problems of infants, young children and disabled children, based on a questionnaire survey administered to dentists and guardians.Materials and methodsThe respondents consisted of 1001 dentists, pediatric dentistry administrators randomly selected by each prefectural or municipal dental association, and 1031 guardians of preschoolers who attended kindergartens or children's day-care centers. Answers were received from 712 dentists and 844 guardians. We compared answers to question No. 16 for dentists and questions No. 23 & 26 for guardians. Furthermore, we compared free comments to question No. 16 for dentists and answers to No. 27 for guardians. Question No. 27 for dentists and question No. 21 for guardians similarly asked about children's eating problems, and we thus next compared the tendencies noted in answers to these questions. In addition, a componential analysis was conducted for free text answers to question No. 31 for dentists and question No. 34 for guardians to qualitatively examine “free comments to children's eating problems”. Free comments were statistically analyzed using a text-mining approach in IBM SPSS Text Analytics for Surveys.ResultsThe results revealed that guardians had more concerns about the following issues (relative to dentists): “vegetables” (23-fold) and “picky eating/fad eating/biased eating” (eight-fold). Issues of more concern to dentists (relative to guardians) were “mastication/chewing” (two-fold) and “dental caries/decay” (1.3-fold).ConclusionsThis study suggested that guardian's anxieties regarding children's eating problems have variable background factors.