Acute eosinophilic appendicitis simulating uncomplicated appendicitis.

Acute appendicitis is one of the most common abdominal emergencies worldwide. Uncomplicated appendicitis (UA), which does not involve perforation or peritonitis, has recently been treated with antibiotic therapy. Here, we report a case of acute eosinophilic appendicitis (AEA) that simulated UA and did not respond to antibiotic therapy. A 20-year-old Japanese woman emergently presented with the chief complaint of pain at the right iliac fossa. CT showed only swelling of the appendix. She was diagnosed with UA, and she received antibiotic therapy initially. However, the treatment was not effective and appendectomy was performed. The final histopathological diagnosis was AEA. The findings of this case suggest that AEA is likely to be diagnosed as UA. As AEA can simulate UA, the possibility of AEA should be considered when antibiotic therapy is not effective.

Effect of hospital volume on long-term outcomes of laparoscopic gastrectomy for clinical stage I gastric cancer.

BACKGROUND: This study aimed to examine the effect of hospital volume on long-term outcomes of patients who underwent laparoscopic gastrectomy for clinical stage I gastric cancer. PATIENTS AND METHODS: A total of 420 patients with clinical stage I gastric cancer who underwent laparoscopic gastrectomy at our university hospital (high-volume group) and affiliated hospitals (low-volume group) were included in this study. Overall survival (OS) and cause-specific survival (CSS) rates were analyzed. RESULTS: No significant differences were observed in the number of lymph nodes retrieved (29.9 vs. 27.7, p=0.21) and CSS between the high- and low-volume groups (p=0.92), although the OS rate in the low-volume group was significantly less than that in the high-volume group (p=0.045). CONCLUSION: These results indicate no clinical impact of hospital volume on prognosis of patients who underwent laparoscopic gastrectomy for clinical stage I gastric cancer when performed by surgeons with sufficient experience in open gastrectomy.

Subtotal gastrectomy for cancer located in the greater curvature of the middle stomach with prevention of the left gastric artery.

BACKGROUND: A novel distal subtotal gastrectomy was performed in 5 patients with macroscopically node-positive gastric cancer located in the greater curvature of the middle stomach. In these patients, total gastrectomy or standard distal subtotal gastrectomy has been typically performed. In these typical gastrectomies, the hepatic and the coeliac branches of the vagi are removed en bloc with the left gastric artery and the whole of the lesser omentum because the lymphatics along the left gastric artery are in the lower stream-regions of lymph flow from the cancer and metastases exist potentially. METHODS: During novel distal subtotal gastrectomy the activated carbon method confirmed that the lymphatics along the ascending branch of the left gastric artery were not in the lower stream-region of lymph flow from the cancer. Then, we preserved the hepatic and coeliac branches of the vagi as well as the ascending branch of the left gastric artery and the upper part of the lesser omentum. The other arteries feeding the stomach were removed with the surrounding lymphatics. In novel distal subtotal gastrectomy the remnant stomach was fed only by the ascending branch of the left gastric artery, while in standard distal subtotal gastrectomy the remnant stomach was fed by the short gastric arteries. CONCLUSIONS: Although further examinations are necessary, novel distal subtotal gastrectomy may have superior merit such as good function of gallbladder because of the preservation of the vagal nerve system, compared with total gastrectomy or standard distal subtotal gastrectomy.