Japan has been speculated to have more than 10,000 bathing accidents per year, and the number increases annually. In particular, the number of bathing accidents in the elderly is increasing.   I investigated the bathing accidents that occurred in Noboribetsu City between April of 2014 and March of 2015 with the full cooperation of the Noboribetsu ambulance service. There were 52 accidents in total; 25 occurred in women with an average age of 64.4±20.5 years, and 27 occurred in men with an average age of 70.7±18.2 years.   In 11 cases, patients were transported via ambulance because of cardiopulmonary arrest (CPA). Eight of these patients were men, and three were women; 10 of the 11 CPA patients were brought to the hospital during the winter.   Although I was unable to clearly determine whether alcohol consumption influenced the increase in the number and seriousness of bathing accidents, I do not recommend heavy alcohol consumption because of the additional risk of consciousness disturbance and drowning.   The number of bathing accidents at the patient’s own home in Noboribetsu City increased significantly (P<0.05) in the winter, and I found no correlation between the season of the year and the number of accidents in public baths in Noboribetsu City and the number of accidents in hotels and inns in Noboribetsu hot springs.

  【Background and objectives】The visitors who suffered from skin diseases and underwent hot-spring cure at Toyotomi Hot Spring were speculated to have been affected by the vicious cycle of heavy stress and aggravation of skin conditions. I, in collaboration with the Toyotomi Fureai Center, investigated whether the hot-spring cure at Toyotomi Hot Spring reduced stress in these visitors.  【Methods and Results】This study was conducted from September 1, 2016 to August 31, 2018. The data were analyzed from the questionnaire that had been administered to the 115 visitors before and after hot-spring cure at Toyotomi Hot Spring.  A reduction in total stress was reported by 108 of 115 (93.9%) visitors. The average of the total stress scale after hot-spring cure had significantly reduced compared to the scale before cure (P < 0.001). The 108 visitors additionally rated the effect of the different factors contributing to stress relief. The effect of the Toyotomi Hot Spring water dominantly contributed to stress reduction (P < 0.001).  The visitors answered a questionnaire including 29 items in 6 categories (vigor, impatience, exhaustion, insecurity, depressive mood, and body complaints) of the stress check recommended by the Ministry of Health, Labor and Welfare, Japan. A reduction in stress levels after hot-spring cure was observed in all 6 categories (P < 0.001).   Of the 115 visitors, 105 (91.3%) had actually felt an improvement in their skin condition. The total stress scale of visitors whose skin condition improved after hot-spring cure was significantly lower than that of visitors whose skin condition had not improved (P < 0.01). The score for reduction in stress levels of visitors whose skin condition had improved was significantly higher in categories of vigor, depressive mood, and body complaints (P < 0.05).  【Conclusion】The stress of visitors with skin diseases was significantly reduced after hot-spring cure at Toyotomi Hot Spring by the dominant effect of the hot-spring water. Their stress reduction seemed to be closely associated with the improvement in skin condition. More studies with objective evaluations may help elucidate the mechanisms of the hot-spring cure, which can break the vicious cycle of heavy stress and aggravation of skin conditions.

Background/Aims: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. Methods: Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated. Results: Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching. Conclusions Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

Treatment of perianal and vulvar extramammary Paget disease (EMPD), rare intraepithelial malignancies, is often challenging because of its potential to spread into the anal canal. However, there is still no consensus regarding the optimal resection margin within the anal canal. Between 2004 and 2014, six patients (three with perianal EMPD and three with vulvar EMPD) in which the spread of Paget cells into the anal canal was highly suspected were referred to our department. To evaluate the disease extent within the anal canal, preoperative mapping biopsy of the anal canal was performed in five out of six patients. Two patients were positive for Paget cells within the anal canal (one at the dentate line and the other at 0.5 cm above the dentate line), whereas in three patients, Paget cell were present only in the skin of the anal verge. Using 1 cm margin within the anal canal from the positive biopsy sites, we performed anal-preserving wide local excision (WLE), and negative resection margins within the anal canal were confirmed in all five patients. The remaining one patient with perianal EMPD did not undergo mapping biopsy of the anal canal because preoperative colonoscopy revealed that the Paget cells had spread into the lower rectum. Therefore, WLE with abdominoperineal resection was performed. During the median follow-up period of 37.3 months, no local recurrence was observed in all patients. Our small case series suggest the usefulness of mapping biopsy of the anal canal for the treatment of perianal and vulvar EMPD.
Anal Canal* ; Biopsy* ; Colonoscopy ; Consensus ; Follow-Up Studies ; Humans ; Paget Disease, Extramammary* ; Rectum ; Recurrence ; Skin

Treatment of perianal and vulvar extramammary Paget disease (EMPD), rare intraepithelial malignancies, is often challenging because of its potential to spread into the anal canal. However, there is still no consensus regarding the optimal resection margin within the anal canal. Between 2004 and 2014, six patients (three with perianal EMPD and three with vulvar EMPD) in which the spread of Paget cells into the anal canal was highly suspected were referred to our department. To evaluate the disease extent within the anal canal, preoperative mapping biopsy of the anal canal was performed in five out of six patients. Two patients were positive for Paget cells within the anal canal (one at the dentate line and the other at 0.5 cm above the dentate line), whereas in three patients, Paget cell were present only in the skin of the anal verge. Using 1 cm margin within the anal canal from the positive biopsy sites, we performed anal-preserving wide local excision (WLE), and negative resection margins within the anal canal were confirmed in all five patients. The remaining one patient with perianal EMPD did not undergo mapping biopsy of the anal canal because preoperative colonoscopy revealed that the Paget cells had spread into the lower rectum. Therefore, WLE with abdominoperineal resection was performed. During the median follow-up period of 37.3 months, no local recurrence was observed in all patients. Our small case series suggest the usefulness of mapping biopsy of the anal canal for the treatment of perianal and vulvar EMPD.
Anal Canal* ; Biopsy* ; Colonoscopy ; Consensus ; Follow-Up Studies ; Humans ; Paget Disease, Extramammary* ; Rectum ; Recurrence ; Skin

  To evaluate the current state of the Onsen-Ryoho-Specialist (Broad Certified Fellow in Balneology, Climatology and Physical Medicine) training system, we surveyed the training facilities designated by the Japanese Society of Balneology, Climatology and Physical medicine (BCPM). Of the 24 facilities targeted by the survey, 21 responded (88%). Currently, the training curriculum for Onsen-Ryoho-Specialists consists of 8 units on diseases and 8 units on therapy methods. As shown in Figs. 1 and 2, it is difficult for a single facility on effectively cover all of these units. The most pressing need is to establish and implement a standardized curriculum across all facilities. Until now, each related academic society has selected training facilities based on its own criteria. Moving forwards, the review/accreditation body of the Japanese Medical Specialist Broad will make site visits to establish and review Onsen-Ryoho-Specialist training facilities. These efforts should lead to the development of fully qualified Onsen-Ryoho-Specialist training facilities.