Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery.

Extensive gastrointestinal surgery surveillance data in Japan were analyzed to examine the differences in the risk factors for surgical site infection (SSI) between laparotomy and laparoscopic abdominal procedures. Surgical procedures investigated in the study were gastrectomy, cholecystectomy, colectomy, rectal resection, and appendectomy. A total of 32,629 patients were included in the study. The study participants were divided into two groups according to the year of surgery, 2003-2009 (first study period) and 2010-2015 (second study period), due to the increase in the number of laparoscopic surgeries in the second study period. The incidence of SSI was stratified by three SSI classifications (superficial incisional, deep incisional, and organ/space SSI). Multiple logistic regression analysis was performed to predict the risk factors for SSI. The percentage of laparoscopic surgeries performed has increased linearly since 2010. Patients in the second study period were significantly older and had a higher prevalence of SSI risk factors compared with those in the first study period. In addition, the predictive factors changed substantially in most surgical procedures between the two study periods. Wound class ≥ 3 was a ubiquitous risk factor for superficial incisional SSI (SI-SSI) and organ/space SSI (OS-SSI) in both open (laparotomy) and laparoscopic procedures in the first study period. Meanwhile, in the second study period, operative duration was a ubiquitous risk factor in both procedures. The risk factors for SI-SSI differed from those for OS-SSI in the five abdominal surgeries investigated in the study. Periodic examination of risk factors for SSI is recommended in an aging society.

Secular trend in skeletal growth among urban Japanese during the Edo period (1603-1867).

OBJECTIVE: The present study aims to investigate whether any secular change in growth occurred among the urban populations during the Edo period (1603-1867). During this time, the preconditions for industrialization were established through rapid urbanization, population increase, and economic development. MATERIALS: Ninety subadult and 189 adult skeletal remains were recovered from eight Edo-period burial sites in Tokyo were examined. METHODS: Maximum femoral lengths were measured and compared between the early and late Edo periods. RESULTS: While subadults of the late Edo period-especially of higher status-tended to have longer femoral lengths, the adult males tended to have slightly shorter femoral lengths. No clear difference was found among adult females. CONCLUSIONS: There was no clear or consistent secular change in growth patterns or in adult stature. The impact of social and economic transformations in 17th-century Japan on growth and on general health status remains unclear. SIGNIFICANCE: This is the first study to examine the impact of social changes on growth immediately before the industrialization of Japan. It will be helpfull to understand the complex relationship between human growth and social changes. LIMITATIONS: Changes in growth patterns may have been obscured by the small sample size, errors in estimating age and femoral lengths, temporary changes in growth in the late Edo period, or catch-up growth. SUGGESTIONS FOR FURTHER RESEARCH: Re-examining with a larger sample, introducing more precise dating of burials and more precise age estimation methods, and examining multiple physiological stress indicators are necessary.

Influences of industrial development and urbanization on human lives in premodern Japan: Views from paleodemography.

OBJECTIVE: This study tests the hypothesis that industrial development and urbanization negatively impacted the living circumstances and health of inhabitants. MATERIALS: The materials used in this study included 881 human skeletons aged 15 years and older from the Medieval (1185-1573), Edo (1603-1867), and Meiji (1868-1912) periods. The Meiji period corresponds to the period when the industrial revolution spread in Japan. METHODS: Age at death and sex were estimated for each skeleton, and demographic profiles of the Medieval, Edo, and Meiji periods were compared. RESULTS: The rate of young deaths was higher in the Meiji period than in preceding periods, and urban inhabitants had a higher proportion of young deaths than rural inhabitants in the Edo period. CONCLUSIONS: The results suggest that industrial development and urbanization led to a decline in human health. LIMITATIONS: The results produced through Bayesian methods are likely tentative, because they vary according to the priors and reference sample. SIGNIFICANCE: Paleodemographic approaches are a useful method to elucidate the impact of industrialization and urbanization on health. SUGGESTIONS FOR FURTHER RESEARCH: Decline of health associated with industrialization should be examined combining paleopathological and paleodemographic methods.

[A case of Henoch-Schölein purpura with acute pancreatitis].

We report a 11-year-old girl who had abdominal pain, hematemesis and melena. On admission, endoscopy revealed multiple duodenal ulcers and abdominal computed tomography showed dilatation and wall thickness of the jejunum. Because she showed purpura on the lower extremities and a decreased serum level of the XIII factor, she was diagnosed as having Henoch-Schönlein purpura (HSP). On the clinical course, she had acute pancreatitis. Following administration of XIII factor, nafamostal mesilate and predonisolone, the abdominal pain disappeared. Eventually the acute pancreatitis was improved with improvement of purpura. According to this course, this acute pancreatitis was associated with HSP.

A case of gastric adenocarcinoma arising from a fundic gland polyp.

A rare case of gastric adenocarcinoma arising on the surface of a fundic gland polyp is reported. A 36-year-old Japanese woman was referred to our hospital for examination and treatment of a polyp that had been detected in another hospital. She did not have a history of familial adenomatous polyposis (FAP). Endoscopic examination revealed a 10-mm-diameter fundic gland polyp in the body of the stomach. The polyp had an irregular depression on its top, suggesting the presence of malignancy. Endoscopic mucosal resection was done to make a histological diagnosis. This revealed a fundic gland polyp with a tiny superficial adenocarcinoma. Atrophic changes of the gastric mucosa were mild, although Helicobacter pylori infection was positive. It is suggested that fundic gland polyps have the potential for malignant transformation.