BACKGROUND: The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. METHODS: We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. RESULTS: We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). CONCLUSIONS: Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.
Asian Continental Ancestry Group* ; beta-Lactamases ; Carbapenems ; Cephalosporins ; Cohort Studies ; Critical Care* ; Disease Outbreaks ; Enterobacteriaceae* ; Epidemiology ; Feces ; Fluoroquinolones ; Humans ; Intensive Care Units* ; Length of Stay ; Mass Screening ; Mortality ; Retrospective Studies* ; Sputum

Between September 1972 and December 1987, 808 gastric cancer patients were treated at our hospital. The male/female ratio was 1.7. Gastric resection was performed on 88% of the patients, while curative resection was performed on 59.2%. The operative mortarity rate was 1.8%.
In patients undergoing surgery, the cumulative 5-year survival rates according to stage were 96.4% for stage 1, 68.6% for stage 2, 48.7% for stage 3 and 4.5% for stage 4.
With the spread of a mass screening, many cases of early gastric cancer have been detected recently. However, the incidence of advance cancer increased with age. This suggests the necessity of encouraging the aged to participate in the mass screening. Though gastrectomy is safety procedure of encouraging the aged to participate in the mass screening. Though gastrectomy is safety procedure in old patients over 75 years of age, its indications should be evaluated taking into consideration the quality of the patient's life.

We reviewed 338 cases of colorectal cancer treated in our clinic since 1973. On these patients, 62% were aged 60 years or older.
By location, the malignant tumor was found most frequenty in the rectum, followed by the sigmoid colon.
Resection was perforoed in 94.3%, of the patients with curative resection accounted for 68.3%. In the curative resection group the cumulative 5-year and 10-year survival rates were 77% and 65, 9%, respectively.
Early colorectal cancer was detected in only 26 patients. Mass screening for colorectal cancer using occult blood tests of feces had just recently started in our communities. Thus, further efforts to detect early colorectal cancer are needed.

BACKGROUND: The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. METHODS: We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. RESULTS: We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). CONCLUSIONS: Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.
Asian Continental Ancestry Group ; beta-Lactamases ; Carbapenems ; Cephalosporins ; Cohort Studies ; Critical Care ; Disease Outbreaks ; Enterobacteriaceae ; Epidemiology ; Feces ; Fluoroquinolones ; Humans ; Intensive Care Units ; Length of Stay ; Mass Screening ; Mortality ; Retrospective Studies ; Sputum

Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

INTRODUCTIONCandidaemia, recognised as a fairly common disease among intensive care unit (ICU) patients, carries a poor prognosis. However, as studies on the prognostic factors associated with candidaemia in ICU patients are limited, this study aimed to establish the best prognostic factor for ICU patients with candidaemia in a tertiary care hospital in Japan.

METHODSWe conducted a retrospective cohort study of patients with candidaemia in the emergency ICU at Fukuoka University Hospital, Fukuoka, Japan, from April 2010 to March 2015. Demographic and clinical data was collected from the patients' medical records and laboratory databases.

RESULTSA total of 25 patients were included in the study. However, 18 patients died during hospitalisation, resulting in an in-hospital mortality rate of 72.0%. The variables of Sequential Organ Failure Assessment (SOFA) score and cumulative number of risk factors for invasive candidiasis showed significant differences between patients in the survivor and non-survivor groups (p < 0.05). The areas under the receiver operating characteristic curves for the SOFA score and cumulative number of risk factors for invasive candidiasis were 0.873 (95% confidence interval [CI] 0.72-1.00) and 0.937 (95% CI 0.84-1.00), respectively.

CONCLUSIONOur results suggest that the cumulative number of risk factors for invasive candidiasis was the most useful prognostic indicator for candidaemia in ICU patients.