In the last decade, 78 patients received operations for abdominal aortic aneurysms with a transperitoneal approach (TP) while in 82 patients we used an extraperitoneal approach (EP). Forty-two patients in the TP group and 40 in the EP group who required no concurrent repair of the inferior mesenteric artery, renal artery or lower extremity arteries were compared. There was no difference between the two groups in mean operative time, mean amount of intraoperative bleeding or mean amount of required homologous blood transfusion. The mean interval after surgery to beginning peroral alimentation and the mean duration of postoperative fluid therapy were significantly shorter in the EP group than in the TP group. An extraperitoneal approach for abdominal aortic reconstruction is preferable for an early postoperative recovery.

Objective: To inquire about how evaluation of physician supervisors is performed, and whether or not incentives to guide comprehensive community-based clinical clerkship for them are provided, in hospitals outside Sapporo Medical University.

Methods: We conducted field surveys using questionnaires distributed to physician supervisors and hospital directors, focusing on the evaluation of physician supervisors and whether they are provided with incentives. From the survey, we examined the attitude toward educational awareness of the physician supervisors.

Results: The number of hospitals where evaluations for physician supervisors were performed and incentives were provided was limited. In addition, 54.2% of the physician supervisors responded that incentives were unnecessary. Many of them considered that incentives for a hospital are more preferable than for individual supervisors.

Conclusion: These results suggest that with respect to community-based clinical clerkship outside the university, an appropriate method for providing incentives, including whether or not they are necessary, should be considered.

We report two cases of an abdominal aortic aneurysm, one with congestive heart failure, and the other with a dissecting aortic aneurysm (type IIIb), who underwent an aorto-bifemoral bypass operation under a temporary external axillofemoral bypass. In one patient (Case 1, a 74-year-old male), who had an abdominal aortic aneurysm with congestive heart failure due to aortic valve insufficiency and stenosis, perioperative transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the regurgitant doppler signal was unchanged during the cross-clamping period of the abdominal aorta. In the other patient (Case 2, a 71-year-old male), who had a dissecting thoracoabdominal aortic aneurysm with the lower abdominal aorta having a true aneurysm formation, the transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the false lumen of the dissecting thoracic aneurysm had no change in size during the cross-clamping period of the abdominal aorta. Thus, a temporary external axillofemoral bypass might avoid any unfavorable hemodynamic effect during and after the abdominal aortic clamping in patients suffering from an abdominal aortic aneurysm with cardiovascular complications.

OBJECTIVE: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. METHODS: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. RESULTS: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. CONCLUSION: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Odds Ratio ; Ovarian Neoplasms ; Retrospective Studies ; ROC Curve

Low back pain is ranked number one burden of disease and a symptom that afflicts people worldwide. Although many cases of low back pain are considered non-specific, there is no unified agreement on the classification method. Furthermore, the biopsychosocial model is used as an interpretation model for understanding low back pain. Therefore, the effectiveness of acupuncture treatment for low back pain must be verified while clearly identifying the perspective from which low back pain is viewed and considering psychological factors. In this symposium, lectures were given by Akasaka, Inoue, Kikuchi, and Kondo. Akasaka explained specific and non-specific low back pain from the perspective of a physical therapist. Specifically, he presented the classification of low back pain based on structural anatomy of the musculoskeletal system such as facet joint, myofascial, and intervertebral discogenic pain as non-specific low back pain, and explained about the effectiveness of physical therapy. Inoue presented the results of randomized controlled trials of acupuncture treatment in patients with low back and lower limb pain that he had conducted. He also discussed the importance of needling at specific points such as the erector spinae group of muscles after carefully palpating these points. Furthermore, Inoue outlined the effects of needling along nerve pathways in patients with lower limb symptoms. Kikuchi reported the results of a retrospective observational study on the effectiveness of acupuncture in treatment of low back pain by classifying patients according to their movement reproducibility. He well stated that patients with movement reproducibility showed more improvement in low back pain-related quality of life. Kondo elaborated on how psychosocial factors in patients with low back pain could affect the effectiveness of acupuncture treatment. He also reported that the less catastrophic thinking about pain was, the greater effectiveness of acupuncture treatment was. In addition, Kondo also indicated that the lower risk on the Subgrouping for Targeted Treatment Back Screening Tool was, the more easily reduced pain was.We hope that the content of this symposium would serve as a valuable resource for clinical, research, and educational activities starting tomorrow.

BACKGROUND: Preventing the need for long-term care (LTC) by identifying physical function risk factors are important to decrease the LTC burden. The objective of this study was to investigate whether grip strength and/or walking speed, which are components of the frailty definition, are associated with LTC in community-dwelling older and oldest people. METHODS: The participants were 1098 community-dwelling older and oldest people who had not received LTC at the baseline. The endpoint was receiving LTC after the baseline survey. The independent variables were grip strength and walking speed, and participants were divided into two groups based on these variables. The confounding factors were age, sex, the Japanese version of the Montreal Cognitive Assessment (MoCA-J), hypertension, diabetes mellitus, stroke, joint diseases, living alone, body mass index, and serum albumin. We calculated the hazard ratio of receiving LTC using the Cox proportional hazard model. RESULTS: Among the 1098 participants, 107 (9.7%) newly received LTC during the follow-up. Regarding the physical function, only slow walking speed was significantly correlated with LTC after adjusting for all confounding factors except the MoCA-J score (HR = 1.74, 95% CI = 1.10-2.75, P = .018). However, slow walking speed was still a risk factor for LTC after adjusting for the MoCA-J score and other confounding factors (HR = 1.64, 95% CI = 1.03-2.60, P = .037). CONCLUSIONS The findings from this study may contribute to a better understanding of slow walking speed as a factor related to LTC, which might be a criterion for disability prevention and could serve as an outcome measure for physical function in older people.
Aged ; Aged, 80 and over ; Exercise ; Female ; Humans ; Independent Living ; statistics & numerical data ; Japan ; Long-Term Care ; statistics & numerical data ; Male ; Proportional Hazards Models