We present a case of sigmoid colon to skin fistula following surgery for abdominal aortic aneurysm that was believed to have resulted from nonocclusive mesenteric ischemia involved in low cardiac output syndrome. A 65-year-old man underwent surgical treatment for an abdominal aortic aneurysm. Although the patient had operative risks of renal dysfunction and left ventricular dysfunction due to an old myocardial infarction, the abdominal aortic aneurysm was 6cm in diameter and threatened to rupture, thus prompting surgical removal. For the operation, the abdominal aorta was clamped above the renal arteries and the aneurysm was replaced with a Y-shaped prosthetic graft following the aneurysmectomy. Among the vessels supplying the sigmoid colon, both the inferior mesenteric artery and the left internal iliac artery had become obstructed and thus only the right internal iliac artery could be successfully reconstructed. The patient suffered from low cardiac output syndrome after surgery and subsequently experienced renal dysfunction, liver dysfunction and a disturbance of the peripheral circulation. On postoperative day number 7, the patient complained of watery diarrhea occurring several times a day and abdominal distension as a result of the ischemic colitis. On day number 16, the sigmoid colon to skin fistula developed. Oral intake was discontinued and nutritional support thereafter consisted of intravenous hyperalimentation. In addition, enteral nutrition using an elemental diet was begun. The fistula was successfully closed two weeks later and the patient recovered with no further complications.

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

A 78-year-old man with obstruction of the right common femoral artery due to arteriosclerosis obliterans underwent successful amputation of his leg. On the first postoperative day he received transfusion of three units of preserved blood. He continued to recover until postoperative day 7, when he developed a high fever, erythroderma and diarrhea. His condition gradually deteriorated and on postoperative day 15 he demonstrated severe and progressive leukopenia and thrombocytopenia. Although he underwent intensive treatment he died on postoperative day 20. A skin biopsy specimen revealed evidence of post-transfusion graft-versus-host disease.

Though the number of reoperative coronary artery bypass grafting procedures (re-CABG) is increasing, the operative results are still inferior to primary CABG. In the present study, we analyzed results of our two different procedures for re-CABG and estimated predominance of the LAST-MIDCAB (off-pump left anterior small thoracotomy minimally invasive direct coronary artery bypass) procedure in selected patients. From 1999 to 2001, 25 patients underwent re-CABG. The age of patients ranged from 56 to 82 years (mean 70 years). Re-CABG was performed due to the occlusion of existing grafts in 14 cases, progressive disease of previously ungrafted vessels in 6 and anastomotic stenosis of previously grafted vessels in 5. We performed off-pump LAST-MIDCAB in 15 patients, on-pump CABG via a median sternotomy in 9 and on-pump LAST-CABG in 1 which was converted due to RV injury during a re-sternotomy. In the LAST-MIDCAB group, the left internal thoracic artery was chosen as a graft to the LAD in 10 patients, the right gastroepiploic artery in 4 and the saphenous vein in 1. The operation time of the LAST-MIDCAB group was significantly shorter than that of the on-pump CABG group. Blood transfusion was necessary for only one patient in the LAST-MIDCAB group. Although many postoperative complications occurred in the on-pump CABG group, no major postoperative complication was seen in the LAST-MIDCAB group except one patient who sufferred from lung fibrosis, which led to shortness of the postoperative hospital stay. We conclude that LAST-MIDCAB is an alternative way to reduce operative morbidity in selected re-CABG cases.

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

Objective: We investigated the association between catastrophizing with regard to numbness and pain, subjective symptoms, upper extremity function, and disability in cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Method: We evaluated catastrophizing (pain catastrophizing scale [PCS] total score, rumination, helplessness, magnification), subjective symptoms of numbness and pain, upper extremity function, and disability in patients with hematological malignancy and gastrointestinal cancer who developed upper extremity CIPN. We calculated the Spearman’s rank correlation coefficient to determine the strength of the association. Result: A significant association was observed between catastrophizing and disability; however, upper extremity function was not significantly association with catastrophizing. Based on the PCS subscale scores, only rumination was significantly association with subjective symptoms. Conclusion: Functional assessment and approaches may not be sufficient to improve the activities of daily living in cancer patients with upper extremity CIPN, and assessment and approaches to cognitive aspects, such as catastrophizing, should also be considered.