ABSTRACT
Background/Aims@#Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. @*Methods@#Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated. @*Results@#Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching. @*Conclusions@#Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.
ABSTRACT
To report a case of severe and recurrent painless thyroiditis requiring thyroidectomy. A 47-year-old man who presented with severe thyrotoxicosis was found to have extremely low radioactive iodine uptake, negative TSH receptor antibodies, and normal C-reactive protein; these findings suggested a diagnosis of painless thyroiditis. Due to the severity and recurrence of thyrotoxicosis, surgical resection of the thyroid gland was performed to prevent a thyrotoxic storm. Histological examination revealed typical lymphoid infiltration of the thyroid gland. This case illustrates that a patient with painless thyroiditis was successfully treated with surgery
Subject(s)
Humans , Male , Thyroidectomy , Thyrotoxicosis , Thyroid Function TestsABSTRACT
Indications are that Japan is growing old at a faster pace than in any other nation. In 1993, people aged 65 years and over accounted for 13.5% of the nation's population, and in Nagano Prefecture the rate stood at 17.9%, far higher than the national average. In our district, Minamisaku, it was 22.0%, greater than the prefectural average. As aging goes on at a rapid clip, the number of the bed-ridden is on the upswing. The Saku Central Hospital has instituted a system of home-visit health care since 1988 with the Department of Internal Medicine playing a pivotal role. The Department of Dentistry and Oral Surgery has also commenced a home-visit dental care program since 1990 The patients to whom home-visit care is delivered have a variety of basic diseases. The attention has focused on their treatment. In many cases, their indifference to oral hygiene was responsible for the ailments. Since the mouth is an inlet for bacteria and other pathogenic microorganisms, it is important to keep the mouth clean so as to prevent the deterioration of basic diseases. That biting may be done with dentures and other prosthetic devices suggests a feasibility of improving quality of life and working for a better health? Because some reports argue that chewing stimulates the brain, thus helpful in preventing senile psychosis, and because eating is one of the pleasures for the bedridden, the role played by us, dentists, is large. Here we report the present status of home-visit dental care delivered by our department from 1990 to 1995
ABSTRACT
Indications are that Japan is growing old at a faster pace than in any other nation. In 1993, people aged 65 years and over accounted for 13.5% of the nation's population, and in Nagano Prefecture the rate stood at 17.9%, far higher than the national average. In our district, Minamisaku, it was 22.0%, greater than the prefectural average. As aging goes on at a rapid clip, the number of the bed-ridden is on the upswing.<BR>The Saku Central Hospital has instituted a system of home-visit health care since 1988 with the Department of Internal Medicine playing a pivotal role. The Department of Dentistry and Oral Surgery has also commenced a home-visit dental care program since 1990<BR>The patients to whom home-visit care is delivered have a variety of basic diseases. The attention has focused on their treatment. In many cases, their indifference to oral hygiene was responsible for the ailments. Since the mouth is an inlet for bacteria and other pathogenic microorganisms, it is important to keep the mouth clean so as to prevent the deterioration of basic diseases. That biting may be done with dentures and other prosthetic devices suggests a feasibility of improving quality of life and working for a better health? Because some reports argue that chewing stimulates the brain, thus helpful in preventing senile psychosis, and because eating is one of the pleasures for the bedridden, the role played by us, dentists, is large. Here we report the present status of home-visit dental care delivered by our department from 1990 to 1995