We reviewed 15 cases of reconstruction of cervical esophagus by grafting with free jejunum, which has been performed in our hospital since 1987. Primary disorders were hypopharyngeal cancer (8 cases), cervical esophageal cancer (4 cases), mesopharygeal cancer (2 cases) and laryngeal cancer (1 case). Our team for this operation consisted of otolaryngologists, abdominal surgeons and a microvasucular surgeon. We took, on the average, 15 hours and a half for total operation and four hours and half for blood isolation of the jejunum. Postoperative troubles were as follows ; necrosis of the grafted jejunum (1 case), suture failure at the phyayngojejunal anastomosis (1 case), fistural formation at the pharyngoesophageal anastomosis (1 case), light dysphagia (3 cases), ileus (2 cases) and perforation of the jejunostoma (1 cace).

Objective : Serum albumin is important marker in all aspects of stroke care including rehabilitation. We examined the serum albumin level of stroke patients, and investigated the relation between their serum albumin level and their prognosis. Methods : The serum albumin levels of 295 patients enrolled from 2008 to 2014 were sequentially checked in our hospital and in subsequent rehabilitation hospitals. Functional outcome was measured by functional independence measure (FIM) at the time of discharge from the rehabilitation hospital. Results : In all types (cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage (SAH)) of apoplexy, serum albumin levels were the highest at the time of admission, temporarily declined after admission, and almost recovered at the time of discharge. In SAH, the serum albumin levels deteriorated at a greater rate than in other types of stroke. In cerebral infarction and cerebral hemorrhage, the lowest serum albumin level was positively correlated with FIM at the time of discharge from the rehabilitation hospital (p<0.001). But, in SAH, there was no significant correlation between the lowest serum albumin level and FIM at the time of discharge (p=0.844). Conclusion : Our data suggest that serum albumin level is associated with the outcome of stroke patients, except for SAH patients. Serum albumin level should be one of the prognostic factors used in stroke patients, but we should consider that SAH patients are exceptional because of other neurological complications.

PURPOSE: The neonatal mortality rate in Japan has currently been at the lowest level in the world. However, it is unclear whether there are still some potentially preventable neonatal deaths. We, therefore, aimed to examine the backgrounds of neonatal death and the possibilities of prevention in a region of Japan. MATERIALS AND METHODS: This is a population-based study of neonatal death in Shiga Prefecture of Japan. RESULTS: The 103 neonatal deaths in our prefecture between 2007 and 2011 were included. After reviewing by a peer-review team, we classified the backgrounds of these neonatal deaths and analyzed end-of-life care approaches associated with prenatal diagnosis. Furthermore, we evaluated the possibilities of preventable neonatal death, suggesting specific recommendations for its prevention. We analyzed 102 (99%) of the neonatal deaths. Congenital malformations and extreme prematurity were the first and the second most common causes of death, respectively. More than half of the congenital abnormalities (59%) including malformations and chromosome abnormality had been diagnosed before births. We had 22 neonates with non-intensive care including eighteen cases with congenital abnormality and four with extreme prematurity. Twenty three cases were judged to have had some possibility of prevention with one having had a strong possibility of prevention. Among specific recommendations of preventable neonatal death, more than half of them were for obstetricians. CONCLUSION: There is room to reduce neonatal deaths in Japan. Prevention of neonatal death requires grater prenatal care by obstetricians before birth rather than improved neonatal care by neonatologists after birth.
Cause of Death ; Female ; Humans ; Infant ; *Infant Mortality ; Infant, Newborn ; Infant, Premature ; Japan/epidemiology ; Male ; *Perinatal Death ; Perinatal Mortality ; Pregnancy ; Pregnancy Complications/epidemiology/*etiology

OBJECTIVE: To selectively visualize the left gastric vein (LGV) with hepatopetal flow information by non-contrast-enhanced magnetic resonance angiography under a hypothesis that change in the LGV flow direction can predict the development of esophageal varices; and to optimize the acquisition protocol in healthy subjects. MATERIALS AND METHODS: Respiratory-gated three-dimensional balanced steady-state free-precession scans were conducted on 31 healthy subjects using two methods (A and B) for visualizing the LGV with hepatopetal flow. In method A, two time-spatial labeling inversion pulses (Time-SLIP) were placed on the whole abdomen and the area from the gastric fornix to the upper body, excluding the LGV area. In method B, nonselective inversion recovery pulse was used and one Time-SLIP was placed on the esophagogastric junction. The detectability and consistency of LGV were evaluated using the two methods and ultrasonography (US). RESULTS: Left gastric veins by method A, B, and US were detected in 30 (97%), 24 (77%), and 23 (74%) subjects, respectively. LGV flow by US was hepatopetal in 22 subjects and stagnant in one subject. All hepatopetal LGVs by US coincided with the visualized vessels in both methods. One subject with non-visualized LGV in method A showed stagnant LGV by US. CONCLUSION: Hepatopetal LGV could be selectively visualized by method A in healthy subjects.
Abdomen ; Esophageal and Gastric Varices ; Esophagogastric Junction ; Healthy Volunteers ; Magnetic Resonance Angiography ; Methods ; Ultrasonography ; Veins

High-flow nasal cannula oxygen therapy (HFNC) in palliative care is mentioned in several guidelines, however, the indication for this procedure has not been established yet. At our department, HFNC has increasingly been adopted for end-stage cancer patients when their dyspnea needs to be alleviated. This is a case report on three patients treated with this procedure at our department. Although they had severe dyspnea with respiratory failure, their daily activities, such as enjoying meals and conversation with their families, were improved with HFNC. It can be a treatment of choice to maintain and improve patients’ quality of life (QOL) in palliative setting, where benefits and risks should be considered for each patient.