[Uretero-fallopian fistula secondary to low anterior resection for rectal cancer].

A 71-year-old woman presented with lower abdominal pain and urinary incontinence 18 days after low anterior resection for rectal cancer. Computed tomography and magnetic resonance urography revealed right hydronephrosis, cystic mass in the right pelvic cavity and hydrometra. Positron emission tomography showed dilated right upper urinary tract communicating with dilated right fallopian tube and uterine body, and the finding was quite characteristic. Laboratory studies revealed that the serum and the fluid from hydrometra levels of creatinine were 1.06 mg/dL and 6.15 mg/dL, respectively. We diagnosed this case as uretero-fallopian fistula. Since the conservative management of uretero-fallopian fistula with ureteral stent was not accomplished, she underwent right ureteroureterostomy and adnexectomy. The intraoperative findings included dilated right ureter and fallopian tube adherent to the stenotic right ureteral segment ligated by suture during prior surgery. The histopathological findings showed endometriosis and inflammatory changes of uterine appendages. Follow-up at 3 months demonstrated resolution of the urinary incontinence and the ureteral obstruction and fistula.

Which categories of social and lifestyle activities moderate the association between negative life events and depressive symptoms among community-dwelling older adults in Japan?

BACKGROUND: Social and lifestyle activities may serve as potential moderators of the association between negative life events (NLEs) and depressive symptoms among older adults. In this study, we examined whether social and lifestyle activities moderate the association between NLEs and depressive symptoms among older adults, and which activities are significant moderators. METHODS: The data came from a community-based sample of non-institutionalized adults aged 65 years or older. Of the 731 eligible older adults, 682 completed the Japanese version of the 30-item Geriatric Depression Scale. We measured 15 specific negative life events as well as 17 social and lifestyle activities which were grouped into four categories. RESULTS: Specific NLEs pertaining to human relationships, physical condition and financial status were all or were mostly associated with depressive symptoms. Significant moderating roles of social and lifestyle activities on the association of NLEs with depressive symptoms were observed between "loss of a significant other" and "contact with family members and friends" (ß = -0.282, SE = 0.091, p = 0.002); "change in human relationships" and "contact with family members and friends" (ß = -0.270, SE = 0.137, p = 0.048); and "change in human relationships" and "community involvement" (ß = -0.344, SE = 0.133, p = 0.010). CONCLUSIONS: The most statistically significant variable moderating the associations between negative life events and depressive symptoms was "having frequent contact with family members". Depressive symptoms arising from troublesome interpersonal relationships in one's proximal network might be moderated by positive interpersonal relationships.

Fear of falling and falls self-efficacy and their relationship to higher-level competence among community-dwelling senior men and women in Japan.

AIM: This cross-sectional study examined the relationships of fear of falling and falls self-efficacy with higher-level competence among community-dwelling senior citizens in Japan. METHODS: Of the 822 registered senior citizens, 731 (89%) community dwellers were requested to participate in the survey using a mailed self-accomplished questionnaire. Data from 648 respondents with duly accomplished questionnaires were analyzed using R(2) , the coefficient of determination, based on a multivariate regression analysis. RESULTS: Fear of falling, low falls self-efficacy and higher-level functional disability were observed among respondents. Of the hypothesized relationships examined by sex, fear of falling was significantly associated with disability among male respondents and low falls self-efficacy among both sexes. Several confounding variables were strongly associated with competence. CONCLUSION: While the data underscore the strategic importance of promoting higher-level competence among the senior citizens, there is much to suggest that their competence is likely to be maintained if their fear of falling and falls self-efficacy were modified. Programs must also consider a wide array of intervening factors.

Cost-utility of living donor liver transplantation in a single Japanese center.

BACKGROUND/AIMS: Living donor liver transplantation is becoming increasingly important in the Western world, but the economic issues remain controversial. We conducted a cost-utility analysis to evaluate whether living donor liver transplantation is cost-effective. METHODOLOGY: Cost and utility analyses were performed in a longitudinal survey of a single center in Sapporo, Japan. Medical costs were derived from 11 patients who underwent living donor liver transplantation. Health utility was measured in quality-adjusted life year. Data for health utility scores were derived from 19 patients who underwent living donor liver transplantation. RESULTS: Median medical cost was U.S. dollars 154,626 from the first day of preoperative evaluation to 24 months post-transplantation. Cumulative quality-adjusted life years were 1.60 at 24 months after transplantation. Medical cost per quality-adjusted life year decreased progressively, leading to medical cost of U.S. dollars 605,131 per quality-adjusted life year at 3 months to U.S. dollars 94,169 at 24 months after transplantation. The results were sensitive to medical cost. CONCLUSIONS: Follow-up survey identified progressive increases in the cost-effectiveness of living donor liver transplantation for patients with end-stage liver disease. Living donor liver transplantation appears to represent a cost-effective medical technology.

Gender differences in the contributions of risk factors to depressive symptoms among the elderly persons dwelling in a community, Japan.

OBJECTIVE: To examine the relative importance of risk factors associated with depressive symptoms and gender differences in exposure to the risk factors among the elderly persons living in the community. METHODS: The data came from the Minamifurano-town Aging Study, a community-based sample of non-institutionalized elderly persons aged 65 years or older. Of the 731 eligible subjects, 665 were assessed for four domains of the potential risk factors (demographic characteristics, health and disability, stress, and social networks) and depressive symptoms according to the 30-item Geriatric Depression Scale (GDS). RESULTS: The mean overall GDS-score was 10.9 (SD 6.2), 10.2 (SD 6.0) in men and 11.6 (SD 6.4) in women. The stress domain in men and the health and disability domain in women contributed most to the explanation of the variation in the GDS-score. CONCLUSION: 'Stress' for men and 'health and disability status' for women were important factors associated with depressive symptoms. Future studies should determine whether modification of these factors may prevent depression among the elderly persons living in the community.

[A review of health economic assessment for liver transplantation--toward social acceptance of liver transplantation in Japan].

This paper reviews the literature on health economics assessment (HEA) for liver transplantation (LT) in Europe and USA, and considers prospects in Japan where HEA is currently rarely performed. LT is one of the most expensive health technologies but the health outcome is generally good. It provides the only well-established treatment for end-stage liver disease (ESLD) in the Western world, while in Japan it has yet to be fully implemented because public acceptance is still very low. MEDLINE and Japana Centra Revuo Medicina WEB version Ver. 2 (JCRM2) were systematically used for the literature search. As a result, 6 original papers in Europe and USA that employed accurate methods for HEA were identified through MEDLINE, indicating that LT is cost-effective on long term follow-up. In Japan, however, only one study could be good which tried to estimate it's cost-effectiveness, and the methodology was different from that used in Europe and USA. Through accurate HEA for LT in Japan, we hope that this procedure may become a well-accepted health technology in the future.