Risk factors for stroke after coronary artery bypass grafting (CABG) were assessed. We retrospectively investigated 681 consecutive patients who underwent isolated, first-time CABG at our institute between 1987 and 1998. Ninety-eight patients (14%) had a history of preoperative stroke. They tended to be older and with a higher incidence of peripheral vascular disease (PVD) than those without preoperative stroke. In spite of several techniques for prevention of postoperative stroke, such as the aortic non-touch technique, 14 patients (2.0%) suffered postoperative stroke. Postoperative stroke was diagnosed soon after surgery in 7 patients (50%), and the causes of stroke in these patients seemed to be intraoperative manipulation of the ascending aorta in 5, and hypoperfusion during cardiopulmonary bypass in two. Stroke in the remaining 7 patients occurred after normal awakening from anesthesia, and the cause was unknown. We then compared the patients with postoperative stroke (n=14) to those without postoperative stroke (n=667). Statistical analysis demonstrated no significant difference between the two groups in variables such as history of preoperative stroke, duration of cardiopulmonary bypass, and prevalence of PVD. Four (29%) of the patients with postoperative stroke died, due mainly to aspiration pneumonia. The morbidity and mortality of the patients who suffered postoperative stroke were very high.

BACKGROUND: Prior research indicates that patients with medically unexplained symptoms and doctorshopping behavior are more likely to have psychological distress. In patients with somatic symptoms, we hypothesized that high scores on COOP/WONCA Functional Assessment Charts, in addition to the presence of medically unexplained symptoms and doctor-shopping behavior, might have an important role in diagnosing psychological distress.
METHODS: Between November 2002 and March 2003, the patients who presented themselves to the hospital for the first time with somatic symptoms were enrolled in this study. In this study, we defined psychological distress as disease conditions, including Mood disorders, Anxiety disorders, Adjustment disorders, and Somatoform disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) . Symptoms that, in the doctor's judgment, could not be medically explained were regarded as medically unexplained symptoms. Doctor shopping was defined as those patients with a complaint of sustained and unsolved symptoms for more than one month who had visited two or more medical facilities prior to visiting our hospital and arrived without any physician's referral.
RESULTS: One hundred and six patients out of 496 were diagnosed as having psychological distress. Among these 106 patients, 49 (46.2%) had doctorshopping behavior, 86 (81.1%) had medically unexplained symptoms, and 95 (89.6%) showed high scores on COOP/WONCA charts. Odds ratios and 95% confidence intervals of medically unexplained symptoms and doctor shopping were 24.12 (11.91-48.84) and 4.18 (2.16-8.07), respectively. High scores on COOP/WONCA charts 2, 3 and 6 were significantly associated with the presence of psychological distress, and the odds ratios (95% confidence intervals) of these three items were 1.41 (1.01-1.98), 1.41 (1.02-1.94), and 2.88 (1.68-4.95), respectively.
Positive and negative likelihood ratios for 4 items (i.e., age of not less than 45 years; duration of symptoms of not less than 6 months, ; doctorshopping behavior; and, medically unexplained symptoms) were 1.16 and 0.85; 1.43 and 0.55; 3.16 and 0.63; and, 3.96 and 0.24, respectively. Positive and negative likelihood ratios for high scores on COOP/WONCA charts were 1.42 and 0.28. Under ROC curves for the diagnosis of psychological distress, the information of COOP/WONCA charts, in addition to that of clinical data, medically unexplained symptoms, and doctor shopping behavior, increased the accuracy in diagnosing psychological distress.
CONCLUSIONS: In patients with somatic symptoms, COOP/WONCA charts increased diagnostic accuracy in predicting psychological distress when patients showed sustained symptoms for more than 6 month, doctor shopping, and medically unexplained symptoms.

A cross-sectional study was performed in the general medicine clinic of Saga Medical School Hospital to evaluate the humanistic quality of the clinical curriculum by assessing Patient satisfaction. The Patient Satisfaction Questionnaire (PSQ) developed by the American Board of Internal Medicine, was translated into Japanese, and 6 of 10 items were selected to evaluate the humanistic qualities of 123 fourth-year medical students who performed medical interviews of 442 patients. The patients rated each PSQ item with a 5-point scale from poor to excellent. The mean PSQ score was 3.38±0.66 (good to very good). The scores for “answering questions” and “giving clear explanations” were significantly lower than were scores for attitudinal aspects. The results suggest that the undergraduate curriculum at Saga Medical School for patient education skills requires further improvement.

We have established NICU (Neonatal Intensive Care Unit) in our hospital and concentrated our efforts on improving the contents of medical treatment since 1976 in order to accomplish a regionalization of neonatal medical treatment in our district.
Thereafter, the mortality rate of low birth weight infants at different weight have decreased markedly. During this period, we have gathered information by means of questinnaire concerning the prognosis of low birth weight (below 2, 000 g) infants whowere admitted in our hospital in the preimprovement period of five years (1971 through 1975, Group 1; N =110) and in the post-improvement period of five years (1976 through 1980, Group 2; N = 96).
The results were as follows:
1, In terms of height and weight, both groups revealed to be no less than those of normal infants.
2. The occurrence of cerebral palsy in Group 2 (2.2%) decreased to below one third of Group 1 (7.5%).
3. There were two infants with blindness resulting from retrolental fibloplasia in Group 1 and one in Group 2.
4. As regards the occurrence rate of epilepsy, there were two children with it in Group 1 (1.98%) and one in Group 2 (1.1%), whereas four children in Group 1 had episodes of afebrile convulsion.
5. Five (5.4%) of 92 grade-school pupils in Group 1 were attending a clss for handicapped.
From these results, it may be concluded that the improvement of neonatal medical treatment brought about a decrease of death rate of low birth weight infants and the improvement of theirprognosis as well.

Purpose: Maintenance therapy after oxaliplatin withdrawal is useful in patients with metastatic colorectal cancer (mCRC). This study aimed to investigate the timing of discontinuation or reintroduction of oxaliplatin and the optimal maintenance therapy regimen for survival. Materials and Methods: PubMed and conference abstracts were searched to select phase II and III trials of first-line oxaliplatin-containing therapy with or without bevacizumab using maintenance therapy for mCRC. Correlations of median overall survival (OS) with induction therapy regimens, induction therapy duration, maintenance therapy regimens (fluoropyrimidine plus bevacizumab [FP+Bev], FP/Bev alone, and no treatment), and oxaliplatin reintroduction were investigated using correlation and weighted multivariate regression analyses. Results: Twenty-two treatment arms were analyzed, including 2,581 patients. The maintenance therapy regimen FP+Bev showed the strongest correlation with a prolonged OS (Spearman’s partial correlation coefficient=0.42), and the other three variables correlated weakly with the OS. The maintenance therapy regimen significantly interacted with the induction chemotherapy duration (p=0.019). The predicted OS for FP+Bev crossed the lines of FP/Bev alone at 18 weeks of induction therapy, and of no treatment at 23 weeks. The corresponding OS at 12 and 27 weeks of induction therapies were 28.6 and 24.2 months for FP+Bev, 25.9 and 28.8 months for FP/Bev alone, and 20.5 and 27.5 months for no treatment. Conclusion The optimal maintenance therapy regimen for the OS is a continuous induction therapy as long as possible followed by FP/Bev alone and switching to FP+Bev within approximately 4 months if induction therapy is discontinued.

Purpose: Maintenance therapy after oxaliplatin withdrawal is useful in patients with metastatic colorectal cancer (mCRC). This study aimed to investigate the timing of discontinuation or reintroduction of oxaliplatin and the optimal maintenance therapy regimen for survival. Materials and Methods: PubMed and conference abstracts were searched to select phase II and III trials of first-line oxaliplatin-containing therapy with or without bevacizumab using maintenance therapy for mCRC. Correlations of median overall survival (OS) with induction therapy regimens, induction therapy duration, maintenance therapy regimens (fluoropyrimidine plus bevacizumab [FP+Bev], FP/Bev alone, and no treatment), and oxaliplatin reintroduction were investigated using correlation and weighted multivariate regression analyses. Results: Twenty-two treatment arms were analyzed, including 2,581 patients. The maintenance therapy regimen FP+Bev showed the strongest correlation with a prolonged OS (Spearman’s partial correlation coefficient=0.42), and the other three variables correlated weakly with the OS. The maintenance therapy regimen significantly interacted with the induction chemotherapy duration (p=0.019). The predicted OS for FP+Bev crossed the lines of FP/Bev alone at 18 weeks of induction therapy, and of no treatment at 23 weeks. The corresponding OS at 12 and 27 weeks of induction therapies were 28.6 and 24.2 months for FP+Bev, 25.9 and 28.8 months for FP/Bev alone, and 20.5 and 27.5 months for no treatment. Conclusion The optimal maintenance therapy regimen for the OS is a continuous induction therapy as long as possible followed by FP/Bev alone and switching to FP+Bev within approximately 4 months if induction therapy is discontinued.

STUDY DESIGN: Retrospective case-control study, level 4. PURPOSE: To clarify the risk factors for late subaxial lesion after occipitocervical (O-C) reconstruction. We examined cases requiring fusion-segment-extended (FE) reconstruction in addition to/after O-C reconstruction. OVERVIEW OF LITERATURE: Patients with rheumatoid arthritis (RA) frequently require O-C reconstruction surgery for cranio-cervical lesions. Acceptable outcomes are achieved via indirect decompression using cervical pedicle screws and occipital plate–rod systems. However, late subaxial lesions may develop occasionally following O-C reconstruction. METHODS: O-C reconstruction using cervical pedicle screws and occipital plate–rod systems was performed between 1994 and 2007 in 113 patients with RA. Occipito-atlanto-axial (O-C2) reconstruction was performed for 89 patients, and occipito-subaxial cervical (O-under C2) reconstruction was performed for 24 patients. We reviewed the cases of patients requiring FE reconstruction (fusion extended group, FEG) and 26 consecutive patients who did not require FE reconstruction after a follow-up of >5 years (non-fusion extended group, NEG) as controls. RESULTS: FE reconstructions were performed for nine patients at an average of 45 months (range, 24–180 months) after O-C reconstruction. Of the 89 patients, three (3%) underwent FE reconstruction in cases of O-C2 reconstruction. Of the 24 patients, five (21%) underwent FE reconstruction in cases of O-under C2 reconstruction (p=0.003, Fisher exact test). Age, sex, RA type, and neurological impairment stage were not significantly different between FEG and NEG. O-under C2 reconstruction, larger correction angle (4° per number of unfixed segment), and O-C7 angle change after O-C reconstruction were the risk factors for late subaxial lesions on radiographic assessment. CONCLUSIONS: Overcorrection of angle at fusion segments requiring O-C7 angle change was a risk factor for late subaxial lesion in patients with RA with fragile bones and joints. Correction should be limited, considering the residual mobility of the cervical unfixed segments.
Arthritis, Rheumatoid ; Atlanto-Occipital Joint ; Case-Control Studies ; Decompression ; Follow-Up Studies ; Humans ; Joints ; Pedicle Screws ; Retrospective Studies ; Risk Factors

PURPOSE: Due to adverse events, dose reduction or withdrawal of adjuvant chemotherapy is required for some patients. To identify the predictive factors for tolerability to postoperative adjuvant S-1 monotherapy in gastric cancer (GC) patients, we evaluated the predictive values of blood indicators. MATERIALS AND METHODS: We analyzed 98 patients with pStage II/III GC who underwent postoperative adjuvant S-1 monotherapy. We retrospectively analyzed correlations between 14 parameters obtained from perioperative routine blood tests to assess their influence on the withdrawal of postoperative adjuvant S-1 monotherapy, within 6 months after discontinuation. RESULTS: Postoperative adjuvant chemotherapy was discontinued in 21 patients (21.4%) within 6 months. Univariable analysis revealed that high preoperative albumin-bilirubin (ALBI) scores had the highest odds ratio (OR) for predicting the failure of adjuvant S-1 chemotherapy (OR, 6.47; 95% confidence interval [CI], 2.08–20.1; cutoff value, –2.696). The high ALBI group had a significantly shorter time to failure of postoperative adjuvant S-1monotherapy (hazard ratio, 3.48; 95% CI, 1.69–7.25; P=0.001). Multivariable analysis identified high preoperative ALBI score as an independent prognostic factor for tolerability (OR, 10.3; 95% CI, 2.33–45.8; P=0.002). CONCLUSIONS: Preoperative ALBI shows promise as an indicator associated with the tolerability of adjuvant S-1 monotherapy in patients with pStage II/III GC.
Chemotherapy, Adjuvant ; Drug Therapy ; Gastrectomy ; Hematologic Tests ; Humans ; Odds Ratio ; Retrospective Studies ; Stomach Neoplasms

Objectives: Postmenopausal women with osteoporosis are frequently underdiagnosed. In Japan, general dental practitioners have begun using the cortical shape of the mandible on dental panoramic radiographs (PRs) to identify and refer women at risk of osteoporosis to medical professionals. It remains unclear whether dental students, after relevant education, possess the ability to identify these at-risk individuals. This study evaluated the ability of dental students to screen for osteoporosis on PRs. Methods: A cohort of 113 fifth-year dental students participated in a lecture on osteoporosis screening using PRs.The students then categorized the mandibular inferior cortex on PRs from 30 postmenopausal women (11 with osteoporosis) as normal, mildly to moderately eroded, or severely eroded. Interobserver agreement between the students and an expert oral radiologist using two cortical groups (normal to moderately eroded and severely eroded) was assessed through kappa statistics. Screening ability for osteoporosis detection by identifying severely eroded cortices was calculated and compared with that of the Osteoporosis Self-assessment Tool for Asians (OSTA). Results: Twenty-one (18.6%) students demonstrated moderate to substantial agreement with the expert. The mean sensitivity, specificity, and positive and negative predictive values for these students in identifying osteoporosis were 60.2%, 88.0%, 76.3%, and 80.0%, respectively. For the OSTA, sensitivity, specificity, and positive and negative predictive values were 27.3%, 68.4%, 33.3%, and 61.9%, respectively. Conclusions Even with minimal education, approximately one-fourth of dental students may accurately identify postmenopausal women with osteoporosis on PRs, outperforming questionnaire-based screening tools.

Objectives: Postmenopausal women with osteoporosis are frequently underdiagnosed. In Japan, general dental practitioners have begun using the cortical shape of the mandible on dental panoramic radiographs (PRs) to identify and refer women at risk of osteoporosis to medical professionals. It remains unclear whether dental students, after relevant education, possess the ability to identify these at-risk individuals. This study evaluated the ability of dental students to screen for osteoporosis on PRs. Methods: A cohort of 113 fifth-year dental students participated in a lecture on osteoporosis screening using PRs.The students then categorized the mandibular inferior cortex on PRs from 30 postmenopausal women (11 with osteoporosis) as normal, mildly to moderately eroded, or severely eroded. Interobserver agreement between the students and an expert oral radiologist using two cortical groups (normal to moderately eroded and severely eroded) was assessed through kappa statistics. Screening ability for osteoporosis detection by identifying severely eroded cortices was calculated and compared with that of the Osteoporosis Self-assessment Tool for Asians (OSTA). Results: Twenty-one (18.6%) students demonstrated moderate to substantial agreement with the expert. The mean sensitivity, specificity, and positive and negative predictive values for these students in identifying osteoporosis were 60.2%, 88.0%, 76.3%, and 80.0%, respectively. For the OSTA, sensitivity, specificity, and positive and negative predictive values were 27.3%, 68.4%, 33.3%, and 61.9%, respectively. Conclusions Even with minimal education, approximately one-fourth of dental students may accurately identify postmenopausal women with osteoporosis on PRs, outperforming questionnaire-based screening tools.