It is a big problem to cope with elderly patients who are increasing in a community in Niigata which has already been heavily populated by those people over 65 years of age. Aging is not a disease. However, the actual situation of patients with hematological and solid tumors in the aging community is little known. In this communication, we analyzed 293 patients (AML/ALL: 52, NHL: 112, MDS: 75, MM: 40, and others: 14) and 127 dead with hematological malignancies treated in our hospital for the past 10 years or 80 to clarify the actual changes in the trend of patients with hematological malignancies and compared them with those of patients who died of solid tumors. The population movements over the last 20 years in the Kashiwazaki area were also studied.Our analysis showed that the number of patients who died of solid tumors increased (1.6 times) in step with the increases in the aged population for there 20 years in the Kashiwazaki area. In addition, the incidence of gastric cancer markedly decreased for the past 20 years, while that of colorectal cancer rapidly increased (5 times). The incidence of hematological malignancies also increased with its peak shiftted to the latter haf of the 7th decade of age for the past 10 years. In addition to the increased incidence, patients with NHL and MDS increased in number by 1.5 times over the last 10 years. Especially, patients with MM showed an increase of 3 times, while the incidence of AML was not changed, even decreasing in number.In conclusion, the incidence of hematological malignancies as well as solid tumors has steadily been increasing with the increases in the aged population in the Kashiwazaki area, and the number of the aged patients over 70 years of age also increased. Such aged patients, however, are not available for hematopoietic stem cell transplantation. Therefore, it is urgently necessary for us to cope with the increases in the number of aged patients with hematological malignancies.
Malignant Neoplasms ; incidence of cases ; seconds ; Solid tumor ; Aging

Horseshoe kidney is a common renal anomalies, but coexistence with abdominal aortic aneurysm (AAA) is rare. Horseshoe kidney may cause various technical difficulties of aneurysm repair. A 76-year-old man was referred to our hospital for treatment of AAA with a horseshoe kidney. Preoperative 3-dimensional computed tomography (3D-CT) scans showed a pair of normal renal arteries and 3 accessory renal arteries from the anterior wall to abdominal aorta just proximal to an aneurysm. At operation, the aneurysm was exposed through a transperitoneal approach, and artificial graft replacement was performed with a woven Dacron bifurcated graft preserving the renal isthmus. The accessory renal arteries were not reconstructed. The postoperative course was uneventful. Postoperative 3-D CT showed minor infarction of renal isthmus, but renal function was not impaired.

Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD), and is clinically characterized by the progressive cognitive decline with fluctuations in cognition and alertness, recurrent visual hallucinations and Parkinsonism. Once these characteristic symptoms of DLB emerge, discriminating it from AD is relatively easy. However, in the early disease stages, the clinical symptoms of various types of dementias largely overlap and it is difficult to distinguish DLB from other neurodegenerative dementias based on clinical manifestations alone. To increase the accuracy of antemortem diagnosis of DLB, the latest diagnostic criteria incorporate findings from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, or from neuroimaging such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). In the present guidelines, decreased dopamine transporter uptake revealed by SPECT or PET receives the greatest importance among various neuroimaging findings and is listed as one of the suggestive features. Supportive features that commonly present but are not proven to have diagnostic specificity include relatively-preserved medial-temporal-lobe structures, occipital hypoperfusion, and abnormal MIBG myocardial scintigraphy. In this paper, we review the major findings on various neuroimaging modalities and discuss the clinical usefulness of them for the diagnosis of DLB. Although there is not enough evidence to reach the conclusion, considering the accessibility in clinical practice, in our personal views, we recommend the use of brain-perfusion SPECT and MIBG myocardial scintigraphy to improve the diagnosis of DLB.
3-Iodobenzylguanidine ; Alzheimer Disease ; Cognition ; Dementia ; Dopamine Plasma Membrane Transport Proteins ; Hallucinations ; Humans ; Lewy Bodies ; Magnetic Resonance Imaging ; Myocardial Perfusion Imaging ; Neuroimaging ; Parkinsonian Disorders ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD), and is clinically characterized by the progressive cognitive decline with fluctuations in cognition and alertness, recurrent visual hallucinations and Parkinsonism. Once these characteristic symptoms of DLB emerge, discriminating it from AD is relatively easy. However, in the early disease stages, the clinical symptoms of various types of dementias largely overlap and it is difficult to distinguish DLB from other neurodegenerative dementias based on clinical manifestations alone. To increase the accuracy of antemortem diagnosis of DLB, the latest diagnostic criteria incorporate findings from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, or from neuroimaging such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). In the present guidelines, decreased dopamine transporter uptake revealed by SPECT or PET receives the greatest importance among various neuroimaging findings and is listed as one of the suggestive features. Supportive features that commonly present but are not proven to have diagnostic specificity include relatively-preserved medial-temporal-lobe structures, occipital hypoperfusion, and abnormal MIBG myocardial scintigraphy. In this paper, we review the major findings on various neuroimaging modalities and discuss the clinical usefulness of them for the diagnosis of DLB. Although there is not enough evidence to reach the conclusion, considering the accessibility in clinical practice, in our personal views, we recommend the use of brain-perfusion SPECT and MIBG myocardial scintigraphy to improve the diagnosis of DLB.
3-Iodobenzylguanidine ; Alzheimer Disease ; Cognition ; Dementia ; Dopamine Plasma Membrane Transport Proteins ; Hallucinations ; Humans ; Lewy Bodies ; Magnetic Resonance Imaging ; Myocardial Perfusion Imaging ; Neuroimaging ; Parkinsonian Disorders ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: The diagnostic algorithms used for selecting patients with obscure gastrointestinal bleeding (OGIB) for capsule endoscopy (CE) or balloon-assisted enteroscopy (BE) vary among facilities. We aimed to demonstrate the appropriate selection criteria of CE and single balloon-assisted enteroscopy (SBE) for patients with OGIB according to their conditions, by retrospectively comparing the diagnostic performances of CE and BE for detecting the source of the OGIB. METHODS: We investigated 194 patients who underwent CE and/or BE. The rate of positive findings, details of the findings, accidental symptoms, and hemostasis methods were examined and analyzed. RESULTS: CE and SBE were performed in 103 and 91 patients, respectively, and 26 patients underwent both examinations. The rate of positive findings was significantly higher with SBE (73.6%) than with CE (47.5%, p<0.01). The rate of positive findings was higher in overt bleeding cases than in occult bleeding cases for both BE and SBE. Among the overt bleeding cases, the rate was significantly higher in ongoing bleeding cases than in previous bleeding cases. CONCLUSIONS: Both CE and SBE are useful to diagnose OGIB. For overt bleeding cases and ongoing bleeding cases, SBE may be more appropriate than CE because endoscopic diagnosis and treatment can be completed simultaneously.
Capsule Endoscopy* ; Diagnosis ; Hemorrhage* ; Hemostasis ; Humans ; Patient Selection ; Retrospective Studies

BACKGROUND/AIMS: The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the efficacy and safety of single-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis. METHODS: We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis due to choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016. RESULTS: Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients who underwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed during the same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomy during the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In the delayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences between the groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge. CONCLUSIONS: Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due to choledocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe and feasible.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystolithiasis ; Choledocholithiasis ; Hospitalization ; Humans ; Medical Records ; Operative Time ; Patient Outcome Assessment ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. METHODS: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. RESULTS: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. CONCLUSIONS: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.
Dental Arch ; Dental Models ; Facial Asymmetry ; Jaw ; Orthognathic Surgery* ; Splints

Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.
6-Mercaptopurine ; Adalimumab* ; Capsule Endoscopy ; Colitis, Ulcerative* ; Colon ; Enteritis* ; Gastrointestinal Tract ; Humans ; Ileum ; Inflammation ; Inflammatory Bowel Diseases ; Mesalamine ; Prednisolone ; Rectum ; Steroids ; Ulcer* ; Upper Gastrointestinal Tract ; Young Adult

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.
Colitis, Ulcerative ; Drug Compounding ; Humans ; Medication Adherence ; Mesalamine ; Patient Acceptance of Health Care ; Patient Compliance ; Prospective Studies ; Recurrence ; Tablets ; Ulcer ; Visual Analog Scale