Asymptomatic patent processus vaginalis is a risk for developing external inguinal hernia in adults: A prospective cohort study.

BACKGROUND: Inguinal hernia repair is common for children and adults across the world, but the mechanism behind hernia onset still requires elucidation. This prospective study aims to determine whether patent processus vaginalis (PPV) is a factor in the development of external inguinal hernias. METHOD: We enrolled 1008 patients who underwent laparoscopic surgery and in whom the inguinal region was observed. If processus vaginalis existed, we measured the diameter and length. Patients were followed for three years after surgery to investigate the incidence of external inguinal hernias. RESULT: No significant differences were found between age groups. Furthermore, no difference could be recognized in length or opening diameter of the PPVs between age groups. Three-year follow up was possible for 765 of 1008 patients enrolled in this study (76%), eight of whom, all male, developed external inguinal hernia during this period. Multivariate analysis for onset of inguinal hernia onset in male patients showed that PPV and length of the right PPV were independent risk factors for development of external inguinal hernia. CONCLUSION: The patency rate, length, and diameter of the processus vaginalis do not differ according to age. The patency of the processus vaginalis in male patients is an independent risk factor for development of external inguinal hernia in adults.

Optimal Assessment of Frailty Predicts Postoperative Complications in Older Patients with Colorectal Cancer Surgery.

OBJECTIVES: The increasingly elderly worldwide population has affected the incidence of colorectal cancer. Establishment of reliable assessment of frailty and proposals for multi-disciplinary interventions are urgently required in oncology practices. Kihon Checklist (KCL) was published by the Japanese Ministry of Health, Labor and Welfare originally to identify individuals ≥ 65 years old at probable risk for requiring care or social support. We investigate the validity of KCL for frailty assessment to predict postoperative complication in older patients with colorectal cancer. METHODS: Consecutive colorectal cancer patients aged ≥ 65 (n = 500) were prospectively examined between May 2017 and December 2018. Preoperative frailty assessment was conducted by the G8 questionnaire and KCL. The main outcome measures were correlation between frailty, other clinical variables, and postoperative complications within 30 days after elective surgery. RESULTS: Of the 500 patients, 278 (55.6%) and 164 (32.8%) patients were classified as 'frail' by G8 and KCL, respectively. Overall complications counted among 97 patients (19.4%), and they were significantly associated with KCL ≥ 8-frail (46/164, p = 0.001), as opposed to G8 ≤ 14-frail (56/278, p = 0.531). Multivariate analysis showed that KCL ≥ 8 (hazard ratio 1.88, 95% confidence interval 1.16-3.04, p = 0.011) was an independent risk factor for these complications. CONCLUSIONS: KCL assessment can identify frail older patients likely to suffer from postoperative complications after colorectal cancer surgery. Preoperative screening of frailty, particularly by KCL, would help older patients prevent their worse outcomes in colorectal cancer. TRIAL REGISTRATION: UMIN000026689.

Color and gloss evaluation of titanium dioxide coating for acrylic resin denture base.

PURPOSE: We examined the clinical appearance (color, gloss, and surface roughness) of TiO(2) coating on polymethyl methacrylate (PMMA) resin dentures. METHODS: A spraying method, using air brushes, was used to generate thin uniform TiO(2) coating. PMMA resin, primer-coated PMMA, and TiO(2)-coated PMMA (with primer) specimens were compared. RESULTS: The Commission Internationale de l'Eclairage (CIE) color system revealed color variations between the with/without coated samples. The TiO(2)-coated PMMA specimen displayed high levels of glossiness, highlighting the efficient self-cleansing actions of the denture. The measured surface roughness decreased upon primer coating, and increased following TiO(2) coating. CONCLUSIONS: The thin TiO(2) coating afforded high levels of glossiness while maintaining the color of the denture base material.

Perineal approach for a gastrointestinal stromal tumor on the anterior wall of the lower rectum.

BACKGROUND: Wide margins of resection and regional lymphadenectomy for GIST are not necessary. Several procedures for rectal GIST have been designed according to the location and size of the tumor to preserve the anal function and decrease the morbidity rate. CASE PRESENTATION: We report a 61-year-old-man with rectal bleeding. Proctologic examination revealed a small mass of approximately 2 cm in diameter on the anterior wall of the rectum at a distance of 4 cm from the anal verge. Histological examination of the biopsy sample via the rectum led to a diagnosis of GIST due to immunohistochemical positivity for C117 and CD34. Perineal resection was planned because abdominoperineal resection with sacrificing the sphincter function was excessive for this small tumor, and low anterior resection with the double stapling technique was difficult due to the lower position. A hemispheric incision was made from one mid-ischial tuberosity to the other with an apex of approximately 2 cm above the anus. The fascia band and muscles were successively transected in order to expose the anterior wall of the rectum, and excision of the tumor was performed. The postoperative course was uneventful, and the patient remained free from incontinence and recurrence. CONCLUSIONS: This perineal approach for a GIST on the anterior wall of the rectum is one option for preserving the anal function and decreasing the morbidity rate.

Adenocarcinoma arising from heterotopic pancreas in the duodenum.

We present a rare case of adenocarcinoma arising from a heterotopic pancreas in the duodenum, and review the associated literature. A 62-year-old woman was admitted to our hospital, complaining of vomiting and epigastralgia. Imaging studies revealed advanced gastric cancer with a gastric outlet obstruction. Whipple's operation and resection of the regional lymph node were performed because of a direct invasion to the pancreas. Histopathologic examination of the resected specimen demonstrated the malignant transformation of a hetrotopic pancreas in the duodenum. At the 12-month follow-up, there was no recurrence of symptoms. The prognosis of adenocarcinoma arising from a heterotopic pancreas is not known. Further accumulation of cases and investigation of this entity are necessary.

A rare case of xanthogranuloma of the stomach masquerading as an advanced stage tumor.

BACKGROUND: Xanthogranuloma of the stomach is an extremely rare disease, and this lesion has only been found to coexist with early gastric cancer in 2 cases in the literature. CASE PRESENTATION: We report a case of xanthogranuloma of the stomach combined with early gastric cancer that mimicked an advanced stage tumor. A 65-year-old female was referred to our hospital because of epigastralgia. During a physical examination, a defined abdominal mass was palpable in the region of the left hypochondrium. Imaging studies revealed an advanced gastric cancer, which was suspected of having infiltrated the abdominal wall. Total gastrectomy and resection of the regional lymph node and abdominal wall were performed. Histopathologic examination of the resected specimen demonstrated xanthogranuloma combined with early gastric cancer. CONCLUSION: Xanthogranuloma presenting as a form of SMT (submucosal tumor) of the stomach is an extremely rare disease, and diagnosing it preoperatively is difficult. Further accumulation and investigation of this entity is necessary.

Color differences between artificial and natural teeth in removable partial denture wearers.

The purpose of this study was to investigate differences between natural tooth color and that selected for artificial teeth in partial dentures at our department with a view to establishing criteria for obtaining greater harmonization between colors. The participants in this study comprised partial denture wearers visiting the Department of Prosthodontics, Tokyo Dental College Chiba Hospital, in whom both artificial teeth and natural teeth were present in the maxillary anterior tooth area. Natural tooth color was measured according to VITA classical shade guide number using a dental color measurement apparatus. Artificial tooth color in partial dentures produced at our department was investigated by referring to medical records. Color of 28 participants' natural teeth and 345 participants' artificial teeth was investigated. Differences in color distribution between the natural and artificial tooth were analyzed using the Fisher exact test. The most frequent color of natural tooth was C-type, accounting for 39%, followed by D- at 32%, A-at 22% and B-type at 7%. In terms of artificial tooth color, A-type was the most common (97%). The color distribution of natural teeth differed significantly from that of artificial teeth in partial dentures. These results suggest that artificial tooth color did not harmonize with the color of the natural teeth in partial denture wearers.

Risk factors and management for massive bleeding of an acute hemorrhagic rectal ulcer.

An acute hemorrhagic rectal ulcer (AHRU) is considered to be a potentially life-threatening illness requiring urgent identification and management because of massive bleeding. It is therefore important to clarify the factors associated with the massive bleeding of an AHRU and the best management. The factors associated with the massive bleeding of 14 patients with AHRU were determined by comparing the clinicopathologic features, laboratory data, and treatment between four patients with more transfusions (> or = 12 U) and 10 patients with less transfusions (< or = 3 U). Patients with AHRU of the more transfusion group had lower performance status (PS), more diabetes mellitus, more comorbid diseases, and lower serum albumin concentrate than those of the less transfusion group. More surgical treatment and the administration of hemostatic agents were necessary for the patients with AHRU of the more transfusion group than for those of the less transfusion group, and the duration from bleeding to hemostasis in patients with AHRU of the more transfusion group was larger than that of the less transfusion group. Patients with AHRU of the more transfusion group had a longer duration of no oral food intake, total parenteral nutrition, and hospital stay from bleeding day than those of the less transfusion group. Thus, the factors associated with the massive bleeding of AHRU were identified.

Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function.

BACKGROUND/PURPOSE: This study aimed to construct a formula for assessing liver function in order to prevent post-hepatectomy liver failure. METHODS: A formula was constructed by analyzing data from 28 patients with hepatocellular carcinoma (HCC) with liver cirrhosis operated on between 1981 and 1984. Next, we evaluated the validity of this formula in 207 hepatectomy patients operated on from 1985 to 1999. For 145 hepatectomy patients operated on from 2000 to 2006, this formula was calculated before surgery in order to assess their risk of hepatectomy. RESULTS: The formula for liver functional evaluation, constructed from preoperative hepatic function parameters, was: liver failure score = 164.8 - 0.58 x Alb - 1.07 x HPT + 0.062 x GOT - 685 x K. ICG - 3.57 x OGTT. LI + 0.074 x RW, where Alb is albumin (g/dl); HPT, hepaplastin test (%); GOT, glutamate oxaloacetate transaminase (U/l); K. ICG, K value of indocyanine green clearance test; OGTT. LI, 60-min/120-min glucose level in 75-g oral glucose tolerance test. linearity index of OGTT; and RW, weight of resected liver (g). We decided that a score below 25 would be safe for hepatectomy. CONCLUSIONS: The mortality rate decreased from 3.9% in 1985--1999 to 1.3% in 2000--2006. This finding allows us to conclude that the formula is valid for assessing the risk of post-hepatectomy liver failure.

Laparoscopic resection for gastrointestinal stromal tumors of the stomach.

BACKGROUND: We reviewed our experience with primary gastrointestinal tumors (GISTs) after surgical treatment. METHODS: Between 1998 and 2003, 56 patients who underwent surgical treatment for primary GIST of the stomach were enrolled in this study. Statistical analyses of the risk factors for recurrence were assessed. RESULTS: The proportion of cases undergoing laparoscopic surgery was 25 of 56 (44%) in these retrospective data. The site of recurrence was only the liver in all cases. These recurrent cases were defined as high-risk category. Tumors measuring over 2 cm in size tended to recur earlier, namely within 32 months. A statistical analysis showed a statistically significant correlation between the disease progression and the pathological phenotype. CONCLUSIONS: This retrospective study has shown that an initial laparoscopic resection of gastric GISTs is feasible even when the tumor size is relatively small (2-5 cm). The pathological phenotype (especially tumor mitosis) directly correlates to the patient's survival even if the resected tumor size was relatively small.