The ingenious drainage system controls persistent duodenal stump fistula due to pancreatic fistula after subtotal gastrectomy for advanced gastric cancer.

Duodenal stump fistula (DSF) is a dangerous complication after gastrectomy. There is no consensus on the management of DSF. Sometimes, emergency surgery may be necessary. We present the case who underwent subtotal gastrectomy with Roux-en-Y reconstruction for advanced gastric cancer. After that surgery, we diagnosed DSF due to pancreatic fistula, and performed reoperation because of hemodynamic instability due to diffuse peritonitis and sepsis. We resected the stump and closed with handsewn suturing and inserted three intra-abdominal drainage tubes, including a dual drainage tube around the duodenal stump. Although there was a recurrence of DSF, because of the continuous and absolute drainage, the patient improved and discharged on postoperative Day 59. From this experience, diligent debridement and a continuous suction dual drainage system, intraluminal drain of the duodenum, and biliary diversion may be an effective surgical management for DFS.

Prevalence of dry eye syndrome and risk factors in physical education and sports science graduates.

PURPOSE: There are only a few epidemiological studies of dry eye syndrome (DES) in populations with a common academic background. in this study, the prevalence of DES and associated factors were evaluated separately in men and women physical education and sports science graduates. STUDY DESIGN: Cross-sectional survey. METHODS: A questionnaire about the diagnosis of DES and associated factors was mailed to 9507 graduates of the Faculty of Health and Sports Science, Juntendo University. The questions covered subjective DES using Schaumberg et al.'s questionnaire and the prevalence of diagnosed DES. Associated factors, age, sex, smoking, alcohol consumption, body mass index, daily screen viewing time, and contact lens (CL) use were analyzed. RESULTS: A total of 2048 valid responses were received. The prevalence of diagnosed DES was 2.9% in men and 9.3% in women. For subjective DES, the prevalence was 14.8% in men and 39.8% in women. The odds ratio for DES was high in men and women who used CLs and women whose daily screen viewing time was ≥ 4 h. CONCLUSION: Both diagnosed and subjective DES were highly prevalent in men and women of all ages, particularly among those in their 20 and 30s. CL use was associated with DES in both men and women. Measures to deal with the factors that can be corrected might have a positive effect on the ocular health and quality of life of physical education and sports science graduates.

Sports and Kinetic Visual Acuity.

Kinetic vision acuity (KVA) is an index developed in Japan that refers to the capacity to recognize a moving object that moves back and forth against the observer. This review outlines the history of KVA and studies on KVA conducted at the Faculty of Health and Sports Science of Juntendo University, i.e. characteristics of KVA in athletes, factors associated with KVA, sports and age-dependent decline of KVA, and effects of docosahexaenoic acid (DHA) and astaxanthin on KVA. KVA was defined in the early 1960s, and the measurement device was invented in 1968. Studies at the Faculty of Health and Sports Science began in the 1990s. In track-and-field athletics and skeleton, a winter downhill event, higher-ranked athletes had higher KVA than lower-ranked athletes. Although KVA cannot be predicted from static visual acuity or reaction time, a significant correlation was found between KVA and the peak latency of visual-evoked potentials. KVA could not be improved by training and did not change between age of 8 and 17 years. In contrast, habitual practice in kendo may inhibit the age-dependent decline in KVA. DHA may also improve KVA in subjects with low KVA; however, astaxanthin did not improve KVA.

Mucinous Carcinoma of the Breast: Clinicopathological Features and Long-term Prognosis in Comparison with Invasive Ductal Cancer; A Single Hospital's 30+-Year Experience.

Mucinous carcinoma (MC) of the breast is a rare and special type of malignancy, with a substantial amount of extracellular mucin. We compared the clinicopathological features and the long-term survival of MC patients with those of invasive ductal carcinoma-no special type (IDC-NST) patients, and we examined prognostic factors of MC. A total of 116 patients with mucinous carcinoma and 3,258 patients with IDC-NST who underwent surgery at our hospital (1977-2008) were enrolled. The 10-year overall survival rate and breast cancer-specific survival rate (BSS) of the MC patients (88.3%, 93.7%) were both significantly higher than those of IDC-NST patients (81.6%, 85.0%) (p=0.015, p=0.005, respectively). A Cox regression analysis demonstrated that MC tended to be an independent prognostic factor (hazard ratio 0.44, p=0.098). The BSS of the MC patients with positive lymph node (LN) metastasis was significantly poorer than that of the patients without it, by univariate analysis (p=0.002). The tumor size in the MC patients with positive LN metastasis (mean 3.2 cm) was significantly larger than that in the patients without it (mean 1.9 cm) (p=0.0004). Although a Cox regression analysis revealed no independent factor, MC patients with positive LN metastasis should be treated for advanced invasive ductal breast cancer.

Survival outcomes after sentinel node navigation surgery for early gastric cancer.

AIM: This study evaluated the prognosis after sentinel node navigation surgery (SNNS) for early gastric cancer. METHODS: For 100 patients who underwent SNNS (between August 13, 2003 and December 17, 2018) at our hospital, the survival outcomes were investigated. RESULTS: (a) SN were detected with a diagnostic accuracy of 0.98. (b) Of seven patients who had positive SN metastasis, three underwent standard gastrectomy with D2 lymph node dissection. Among them, one patient died of recurrence (bone) and the other two patients were alive 4.5 and 14.7 years after surgery. The remaining four patients with positive SN who underwent diminished gastrectomy with lymphatic basin dissection at their request are alive 2.8, 6.0, 6.9 and 10.8 years after surgery without recurrence. (c) No patients who underwent diminished gastrectomy died of gastric cancer after surgery. (d) In the period following diminished gastrectomy, one patient underwent total gastrectomy and five patients underwent endoscopic submucosal dissection, and they survived for longer than 5 years. (e) As a result of SNNS, the gastric cancer-specific cumulative 5-year survival rate was 98.5%. CONCLUSIONS: Diminished gastrectomy during SNNS resulted in a satisfactory prognosis. However, regular follow-up after surgery is needed to detect secondary cancer of the remaining stomach.

Significance of Microcalcifications on Mammography in the Surgical Treatment of Breast Cancer Patients with a Preoperative Diagnosis of Ductal Carcinoma in Situ by Core Needle Biopsy.

To clarify the surgical outcomes of breast cancer patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) (abbreviated as CNBDCIS), we retrospectively analyzed the cases of 131 patients with CNBDCIS who underwent surgery at Oomoto Hospital (32 total mastectomies, 99 conservative mastectomies). Our analysis of underestimation and predictors of invasive breast cancer of CNBDCIS revealed that the underestimation rate of CNBDCIS was 40.5% (53/131). A logistic regression analysis revealed that palpable tumors (yes to no, odds ratio [OR] 3.25), mammography (MMG) category group (category 4 or 5 to categories 1 , 2, or 3, OR 4.69) and MMG microcalcifications (no to yes, OR 0.24) were significant predictive factors for CNBDCIS invasion. In our analysis of the predictors of positive margins during CNBDCIS surgery, 36 (27.5%) of the 131 patients had positive margins after postoperative pathological examination. A logistic regression analysis revealed that the operative procedure (conservative surgery to total mastectomy, OR 21.4) and MMG microcalcifications (yes to no, OR 3.35) were significant factors related to positive margins during CNBDCIS surgery. Thus, MMG microcalcifications are a negative predictor of upgrading of CNBDCIS and a positive predictor of positive surgical margins for CNBDCIS.

Impact of the surgical modality for axillary lymph node dissection on postoperative drainage and seroma formation after total mastectomy.

BACKGROUND: The most common complications after total mastectomy with axillary lymph node treatment are prolonged drainage and seroma formation. The aim of this study was to find factors correlated with prolonged fluid discharge (prolonged drainage or seroma formation after 20th operative day or later), including surgical techniques or devices and clinical factors. PATIENTS AND METHODS: A total of 202 conclusive primary breast cancer patients underwent total mastectomy with axillary lymph node treatment between January 7, 2014 and June 20, 2018 at our hospital. The factors that correlated with the total fluid discharge volume and prolonged fluid discharge were examined statistically. The surgical modalities for total mastectomy with axillary treatment were classified into the following three groups:, Group A; skin flap formation by EC and axillary lymph node dissection by EC with ligation of the arteries and veins, Group B; skin flap formation by EC and axillary lymph node dissection by ultrasonic dissector (UD) without ligation of the vessels. Group D; skin flap formation by electrocautery (EC) and axillary lymph node dissection by picking up using forceps and ligation (PL). RESULTS: The total fluid discharge volume and prolonged fluid discharge after total mastectomy with sentinel node retrieval (33 patients) were significantly lower than those after total mastectomy with axillary lymph node dissection (169 patients). In patients treated without drainage, a high rate of seroma formation and prolonged fluid discharge were observed, and 1 patient developed seroma infection.In the total mastectomy with axillary lymph node dissection group, logistic regression analysis revealed that body mass index, 1-week drainage volume, and surgical modality were independently correlated with prolonged fluid discharge. CONCLUSIONS: The surgical procedure for axillary lymph node dissection should be considered to avoid prolonged fluid discharge, and the lymph vessels should be ligated in axillary lymph node dissection. An ultrasonic dissector was not effective in reducing the total fluid discharge volume. An optimal axillary lymph node dissection technique should be developed. For the patients without drainage, careful postoperative treatment should be given to avoid infectious seroma formation, even for patients who underwent total mastectomy with sentinel lymph node retrieval.

Effects of Batting Practice and Visual Training Focused on Pitch Type and Speed on Batting Ability and Visual Function.

This study aimed to examine the effects of batting practice and visual training focused on the pitch type and speed on batting ability and visual function. A total of 46 participants took part in 12 training sessions for 4 weeks. The participants were divided into six groups according to the training type as follows: Group 1, batting practice with a fastball at 100 km/h; Group 2, tracking (watching) a fastball at 100 km/h; Group 3, batting practice with a fastball at 115 km/h; Group 4, tracking a fastball at 115 km/h; Group 5, batting practice with a curve ball at 100 km/h; and Group 6, tracking a curve ball at 100 km/h. Dynamic visual acuity, depth perception, hand-eye coordination, and batting ability were measured before and after training. Group 1 showed significant improvement in batting ability in the tests with 100 km/h fastballs and curve balls, while Groups 3 and 5 showed significant improvement in batting ability with 100 km/h fastballs and curve balls, respectively. Group 6 also showed significant improvement in batting ability with 100 km/h fastballs. Moreover, Groups 2 and 4 showed significant improvement in Dynamic visual acuity and hand-eye coordination, respectively. The results of the present study suggest that batting practice and visual training improve batting ability for the same pitch types and speeds as those encountered in practice. Therefore, visual training may be an effective method for improving batting ability and visual function in coaching settings.

Diminished Gastric Resection Preserves Better Quality of Life in Patients with Early Gastric Cancer.

Using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, we compared the surgical outcomes and the quality of life (QOL) between patients undergoing limited gastrectomies and those undergoing conventional gastrectomies. In Oomoto Hospital between January 2004 and December 2013, a total of 124 patients who met the eligibility criteria were enrolled. Using the main outcome measures of PGSAS-45, we compared 4 types of limited gastrectomy procedures (1/2 distal gastrectomy [1/2DG] in 21 patients; pylorus-preserving gastrectomy [PPG] in 15 patients; segmental gastrectomy [SG] in 26 patients; and local resection [LR] in 13 patients) with conventional gastrectomy (total gastrectomy [TG] in 24 patients and 2/3 or more distal gastrectomy [WDG] in 25 patients). The TG group showed the worst QOL in almost all items of the main outcome measures. The 1/2DG, PPG, and SG groups showed better QOL than the WDG group in many of the main outcome measures, including the body weight ratio, total symptom score, ingested amount of food per meal, and the dissatisfaction for daily life subscale. The LR group showed a better intake of food than the 1/2DG, PPG, and SG groups. The body weight ratio of the LR group was better than that of the SG group. Diminished gastric resection preserved better QOL in patients with early gastric cancer.

Effect of yellow-tinted lenses on visual attributes related to sports activities.

The purpose of this study was to clarify the effect of colored lenses on visual attributes related to sports activities. The subjects were 24 students (11 females, 13 males; average age 21.0 ±1.2 years) attending a sports university. Lenses of 5 colors were used: colorless, light yellow, dark yellow, light gray, and dark gray. For each lens, measurements were performed in a fixed order: contrast sensitivity, dynamic visual acuity, depth perception, hand-eye coordination and visual acuity and low-contrast visual acuity. The conditions for the measurements of visual acuity and low-contrast visual acuity were in the order of Evening, Evening+Glare, Day, and Day+Glare. There were no significant differences among lenses in dynamic visual acuity and depth perception. For hand-eye coordination, time was significantly shorter with colorless than dark gray lenses. Contrast sensitivity was significantly higher with colorless, light yellow, and light gray lenses than with dark yellow and dark gray lenses. The low-contrast visual acuity test in the Day+Glare condition showed no significant difference among the lenses. In the Evening condition, low-contrast visual acuity was significantly higher with colorless and light yellow lenses than with dark gray lenses, and in the Evening+Glare condition, low-contrast visual acuity was significantly higher with colorless lenses than with the other colors except light yellow. Under early evening conditions and during sports activities, light yellow lenses do not appear to have an adverse effect on visual attributes.

Effects of thirty-times chewing per bite on secretion of glucagon-like peptide-1 in healthy volunteers and type 2 diabetic patients.

Glucagon-like peptide 1 (GLP-1) is secreted from the small intestine to the blood in response to glucose intake during a meal; however, it is not known whether mastication affects GLP-1 secretion. Here, we examined the relationship between mastication and GLP-1 secretion, along with postprandial blood glucose and insulin concentrations. We compared the levels of blood glucose, serum insulin, and plasma active GLP-1 concentrations after young healthy volunteers ate a test meal either by usual eating (control) or in one of three specified ways: 1. unilateral chewing, 2. quick eating, 3. 30-times chewing per bite. Ten volunteers participated in each of the three groups. Plasma active GLP-1 concentrations did not change by unilateral chewing or quick eating, but did increase by the third method, without affecting the concentrations of blood glucose or serum insulin. Next, we tested whether 30-times chewing per bite increased plasma active GLP-1 concentrations in 15 patients with type 2 diabetes mellitus, but there was no difference in results between usual eating and 30-times chewing per bite. This is a pilot trial with a small number of subjects, but is the first study to investigate the relationships between various styles of mastication and the GLP-1 secretion in young healthy volunteers and type 2 diabetic patients.

Suppression of exercise-induced neutrophilia and lymphopenia in athletes by cystine/theanine intake: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Intense exercise induces increased blood neutrophil counts and decreased lymphocyte counts, and leads to inflammation and immunosuppression. It was previously reported that cystine and theanine (CT) supplementation by long-distance runners before a training camp suppressed the changes of these blood parameters observed in un-supplemented control subjects after the camp. The purpose of the present study was to determine the effects of CT supplementation on the inflammatory response and immune state before and after intense endurance exercise in long-distance runners at a training camp. METHODS: Sixteen long-distance runners were allocated to one of two groups given CT supplements (700 mg cystine + 280 mg theanine daily) or placebo (8 in each group) for 7 days prior to and during a 9-day training camp. Daily run training averaged 19.9 km/day prior to the camp and 28.6 km/day during the camp. On the initial and final days of the camp, blood samples were collected before and after 15 km morning interval running workouts (1000 m x 15 times) and analyzed for neutrophil and lymphocyte counts and myoglobin. RESULTS: The relative change in exercise-induced blood neutrophil count (% of pre-exercise values) was significantly lower in the CT group than in the placebo group (163.3 +/- 43.2% vs. 200.4 +/- 19.6%, p = 0.044) on the initial day of camp, but not on the last day. The decline in lymphocyte count (% of pre-exercise values) was significantly less in the CT group than in the placebo group (60.2 +/- 19.2% vs. 36.2 +/- 12.0%, p = 0.010) on the initial day of camp, but not on the last day. In blood myoglobin, there was a trend toward lower % of pre-exercise values in the CT group (p < 0.09) on both measurement days. CONCLUSION: CT supplementation significantly attenuated the increase in neutrophil count and the reduction in lymphocyte count induced by intense endurance exercise. These results suggest that CT supplementation may suppress the exercise-induced fluctuation of the blood immunocompetent cells and may help to reduce the alteration of the immune state.

Effects of oral supplementation with cystine and theanine on the immune function of athletes in endurance exercise: randomized, double-blind, placebo-controlled trial.

Athletes become increasingly susceptible to infection with intense training that results in immune suppression. The immune state was investigated after administering cystine/theanine (CT), which has been reported to have an immune reinforcement effect, to athletes before training involving a prolonged period of intense exercise. Fifteen long-distance runners were each allocated to the CT or placebo group, and the test food was ingested for 10 d prior to the start of training. Clinical examinations were performed before and after the training. The results indicate a significant increase in the high-sensitivity C-reactive protein (hs-CRP) and neutrophil count in the blood, as well as a decreasing tendency for lymphocytes in the placebo group, but not the CT group. These observations suggest that the ingestion of CT contributed to suppressing the change in inflammatory response, prevented a decrease in the immune function, and prevented infection and reduced symptoms when infected associated with continuous intense exercise.

Primary osteosarcoma of the breast.

Presented herein is a case of primary pure osteosarcoma of the breast. A 59-year-old woman noticed a left breast tumor. Mammography showed a cluster of crushed stone-like calcifications, which gave the tumor a raw cotton-like appearance. Malignancy was suspected on fine-needle aspiration cytology of the tumor. An excisional biopsy was performed. The tumor was 2.0 x 2.4 cm in size. Histopathologically the tumor was composed of diffuse atypical cells with mitosis and a lot of bone. Atypical cells were thought to be neoplastic osteoblasts. Multinucleated osteoclastic cells were interspersed with osteoblasts. Spindle cells were found at the verge of the tumor. A few entrapped tubular structures were seen. Immunohistochemistry indicated that neoplastic osteoblastic cells of the tumor were stained positively for vimentin, but negatively for epithelial markers; which suggested that the tumor cell elements originated from epithelial cells. This tumor was diagnosed as primary extraskeletal osteosarcoma. Partial resection was additionally performed around the excisional biopsy without dissection of the axillary lymph nodes. Bone radionuclide scan after operation showed no abnormal uptake. At 5 years after surgery no recurrence was seen.

[Trial manufacture of a plunger shield for a disposable plastic syringe].

A syringe-type radiopharmaceutical being supplied by a manufacturer has a syringe shield and a plunger shield, whereas an in-hospital labeling radiopharmaceutical is administered by a disposable plastic syringe without the plunger shield. In cooperation with Nihon Medi-Physics Co. Ltd., we have produced a new experimental plunger shield for the disposable plastic syringe. In order to evaluate this shielding effect, we compared the leaked radiation doses of our plunger shield with those of the syringe-type radiopharmaceutical (Medi shield type). Our plunger shield has a lead plate of 21 mm in diameter and 3 mm thick. This shield is equipped with the plunger-end of a disposal plastic syringe. We sealed 99mTc solution into a plastic syringe (Terumo Co.) of 5 ml with our plunger shield and Medi shield type of 2 ml. We measured leaked radiation doses around syringes using fluorescent glass dosimeters (Dose Ace). The number of measure points was 18. The measured doses were converted to 70 microm dose equivalent at 740 MBq of radioactivity. The results of our plunger shield and the Medi shield type were as follows: 4-13 microSv/h and 3-14 microSv/h at shielding areas, 3-545 microSv/h and 6-97 microSv/h at non-shielding areas, 42-116 microSv/h and 88-165 microSv/h in the vicinity of the syringe shield, and 1071 microSv/h and 1243 microSv/h at the front of the needle. For dose rates of shielding areas around the syringe, the shielding effects were approximately the same as those of the Medi shield type. In conclusion, our plunger shield may be useful for reducing finger exposure during the injection of an in-hospital labeled radiopharmaceutical.

Foregut duplication cyst of the stomach with pseudostratified columnar ciliated epithelium.

Duplication cyst of the stomach with pseudostratified columnar ciliated epithelium is extremely rare. A 72-year-old Japanese woman visited Oomoto Hospital for examination of the stomach. Gastroendoscopy indicated a slightly depressed gastric cancer in the anterior wall of the middle third of the stomach. Adenocarcinoma was confirmed on endoscopic biopsy. Preoperative CT indicated a subserosal cystic lesion 2 cm in diameter on the lesser curvature of the stomach. The cystic lesion was resected through distal gastrectomy and systematic lymph node dissection. Histopathology showed that the cyst did not communicate with the gastric lumen, had pseudostratified columnar ciliated epithelium with circular muscle layers, and did not have gastric epithelium or cartilaginous tissue. The gastric cancer consisted of moderately differentiated adenocarcinoma with submucosal invasion and lymph node metastasis. Consequently, the present patient was diagnosed as having foregut duplication cyst of the stomach.

[Evaluation of combination therapy of high-dose toremifene and oral chemotherapy].

High-dose toremifene therapy (120 mg/day) is useful for the recurrence of receptor-positive breast cancer. However, some reports show that combination therapy of high-dose toremifene and chemotherapy exhibits additive effects. Twelve patients were given oral chemotherapy (capecitabine, 5'-DFUR+CPA, S-1) with high-dose toremifene. The overall response rate was 41.7%, in addition to 58.3% with no change beyond three months. Adverse events were restricted to headache, stomatitis and nausea. Average time to progressive (TTP) was 5.8 months. It was shown that high-dose toremifene and oral chemotherapy were useful for breast cancer recurrence without severe side effects.

Associations between white blood cell count and features of the metabolic syndrome in Japanese male office workers.

We assessed the association of white blood cell (WBC) count with different components of the metabolic syndrome (MS) in 5275 Japanese male office workers aged 23-59 years. There was a significantly crude correlation between WBC count and body mass index, systolic and diastolic blood pressures, total cholesterol, high-density lipoprotein cholesterol (negative), triglycerides, fasting plasma glucose, and uric acid (all P<0.001). After controlling for potential confounding factors, the adjusted means of WBC count were significantly higher in subjects with each feature of the MS (obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol levels, hypertriglyceridemia, high fasting plasma glucose levels, and hyperuricemia) (all P<0.005). The adjusted WBC count increments in subjects with 1, 2, 3, 4, and > or = 5 features of the MS were 0.28, 0.45, 0.68, 0.76, and 1.40 x 10(9) cells/l, respectively, compared with the subjects without features of the MS (P for trend<0.001). The adjusted means of WBC count increased significantly with the increasing number of features of the MS in both non-smokers and smokers (both P<0.001). These data indicate a strong association between WBC count and a number of disorders characterizing the MS independent of cigarette smoking among Japanese men.