Postoperative hypoxia in 53 consecutively treat patients who underwent coronary artery bypass grafting (CABG) and who were weaned from mechanical ventilation were studied. The 29 patients who required high concentration oxygen (more than 70% H-group) were compared with the 24 patients who required lower concentration oxygen (less than 70% L-group). The preoperative body mass index (BMI) was significantly higher in the H-group (25.6±3.5) than the L-group (23.3±2.8). (p=0.012). Respiratory index (RI) decreased after extracorporeal circulation in all patients. The RI of the H-group during a stay in intensive care unit was significantly lower than that in the L-group. The RI in obese patients (BMI≥26.5) showed a significant reduction. Late deaths were seen in 3 obese patients in the H-group. These data suggested that careful postoperative respiratory managements is necessary in obese patients.

Case: The patient was a man in his 40s who had undergone proctocolectomy for familial polyposis coli and extensive resection of the small intestine for removal of an intra-abdominal desmoid tumor. He presented to our hospital with abdominal pain caused by residual desmoid tumor, and diarrhea associated with the short bowel syndrome. Adequate pain control could not be achieved even with simultaneous application of 5 sheets of 100 μg/h transdermal fentanyl patches. Subsequently, the patient was treated mainly with 270 mg/day of a slow-release morphine preparation; however, the pain control remained unsatisfactory. At our hospital, the pain treatment was switched to 240 mg/day of morphine solution, which yielded prompt reduction of the pain intensity from 9/10 to 1/10 on the numerical rating scale. Discussion: Morphine is mainly absorbed from the small intestine. The initially insufficient pain control in this patient may have been attributable to the short bowel syndrome and diarrhea causing rapid excretion of the morphine before it was absorbed. Morphine solution, in contrast, starts to be absorbed approximately 10 minutes after administration, allowing adequate absorption, leading to successful pain control, even in the present patient with the short bowel syndrome.

Objective: Spinal cord compression symptoms are complications that greatly reduce the quality of life of cancer patients. We report a retrospective study on the efficacy of and adverse reactions to high-dose dexamethasone therapy for patients with concomitant spinal cord compression symptoms. Subjects: This study included 8 patients with concomitant spinal cord compression symptoms who received high-dose dexamethasone therapy at our hospital between May 2009 and September 2011. Results: Only high-dose dexamethasone therapy was performed in 8 patients who could not undergo radiotherapy or surgery in combination. Among them, the results of manual muscle testing were improved in 4 patients (50.0%), and grades according to the modified Frankel Classification showed improvement in 5 patients (62.5%). Out of 7 non-ambulatory patients, one (14.3%) regained independent ambulation with highdose dexamethasone therapy alone and was discharged home. No serious adverse reactions were observed in any of the 8 patients. Discussion: This study suggested high-dose dexamethasone therapy to possibly be a useful option for relieving neurological symptoms in patients with spinal cord compression who cannot undergo radiotherapy or surgery in combination.

Background: We retrospectively compared endscopic gastroduodenal stenting with gastrojejunostomy as a means of palliating malignant gastric and duodenal obstruction. Methods: This retrospective study investigated patients treated for malignant gastric and duodenal obstruction from April 2011 to April 2015 at Shikoku Cancer Center. Results: Of the 40 patients in this study, 25 underwent gastroduodenal stenting and 15 had operative gastrojejunostomy. Comparing the stenting and operative patients, technical success rate was 100% in both group, clinical success rate was 84% in stenting patients and 93% in operative patients. The median time to fluid intake was significantly shorter in stenting patients than operative patients(0 day vs 2 days, p=0.0003), and the median time to intake of solids was also significantly shorter in stenting patients(1day vs 3 days, p<0.0001).The median hospital stay was significantly shorter in stenting patients(9 days vs 23 days, p=0.0116). Median cost of hospitalization is more expensive in operative patients than stenting patients(¥1,106,170 vs ¥752,290, p=0.0052). Conclusion: Our study suggested that gastoroduodenal stent was less length of time to fluid/solid intake, and less costly than gastrojejunostomy.

BACKGROUND/AIMS: The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and ¹³C-acetate breath test (¹³C-ABT) analyses. METHODS: ¹³C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the ¹³C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t(1/2), 90–170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t(1/2). RESULTS: The mean t(1/2) of all patients was 215.5 ± 237.2 minutes and the t(1/2) of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t(1/2) and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t(1/2) ≥ 140 minutes. CONCLUSION: The present study demonstrated that GE with t(1/2) ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.
Breath Tests ; Electric Impedance ; Esophagus* ; Gastric Emptying* ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration

Objective: The surgical workforce needs to at least double by 2030. To increase the workforce, training for non-physician healthcare professionals and community health workers (CHWs) in rural areas is promising to decrease the numbers of untreated surgical patients. Nevertheless, few studies have been conducted on surgical activities of non-physician healthcare professionals and CHWs in rural Cambodia. We sought to measure the level of knowledge of surgical symptoms, and identify factors associated with it. A questionnaire survey was administered to people in rural areas of Kratie Province to determine their knowledge of surgical symptoms, and to strengthen the surgical workforce among medical staff and CHWs.Patient/Materials and Methods: To evaluate the knowledge of surgical symptoms among medical staff and CHWs, a self-reported questionnaire was administered to medical staff, CHWs, and villagers in a rural area of Kratie province, Cambodia. The rating score of the number of correct answers among medical staff, CHWs, and villagers was set as the primary outcome.Results: A total of 91 participants, including 31 medical staff, 24 CHWs, and 36 villagers, completed the survey. The median scores for knowledge of symptoms indicative of surgery were 8 (7–8) [median (interquartile range)] in medical staff, 8 (7–8.5) in CHWs, and 8.5 (8–9) in villagers. There was no significant difference in the scores of surgical symptoms among each of the occupational groups. The group of people who recognized low subjective knowledge of surgical symptom by themselves had significantly higher objective score of knowledge of surgical symptom.Conclusion: Knowledge of surgical symptoms among medical staff and CHWs was inadequate. To at least double the surgical workforce by 2030 successfully, accurate evaluation and improvement of surgical symptomatic knowledge among medical staff in rural areas is crucial.

At our institution, various herbal medicines have been prescribed under the supervision of a herbal medicine supervisor for a wide range of clinical conditions in children with pediatric surgical diseases. At present, we continue to prescribe herbal medicines even in the absence of a herbal medicine supervisor. The aim of study is to continue and improve herbal medicines in pediatric surgery. A questionnaire survey was conducted among doctors prescribing herbal medicines in our department, and 14 doctors responded. All doctors agreed on their realization of the efficacy of herbal medicines and their willingness to study herbal medicines. Almost doctors obtained information on herbal medicine from the literature and decided on prescriptions based on the name of the disease and the symptoms. This survey showed that many doctors are aware of the effectiveness of herbal medicines and they prescribe herbal medicines to some extent in their own departments. As a result of this survey, three doctors from our department have received training in outpatient herbal medicine. Investigation of current problems through a fixed-point questionnaire survey would help to recognize the need for herbal medicine treatment in each department.