Safety ; Pharmaceutical Preparations

A 61-year-old man, who had previously undergone quadruple coronary artery bypass graft surgery, was successfully treated for proximal descending aortic aneurysm using hypothermic circulatory arrest via a left thoracotomy. Preoperative angiograms revealed that the left internal thoracic artery bypass graft to the LAD was patent, and that the aneurysm was located at the descending aorta just distal to the left subclavian artery. Operative procedures were as follows. A left thoracotomy incision was made through the 4th intercostal space. The common femoral artery and vein were cannulated, and the venous cannula was positioned in the right atrium. The patient was cooled by partial cardiopulmonary bypass until the EEG was isoelectric (24°C rectal temperature), and then circulation was arrested. Left ventricular decompression was not performed. After opening of the aneurysm, proximal anastomosis was performed first at the aorta just distal to the left subclavian artery. Another arterial cannula, connected to the Y-shaped arterial line, was inserted into the graft, and perfusion to the brain was restored through this cannula. Distal anastomosis was then completed, and routine cardiopulmonary bypass was reestablished. After the heart was defibrillated, the patient was rewarmed to 34°C before discontinuing the bypass. Circulatory arrest time and total cardiopulmonary bypass time were 17 minutes and 139 minutes, respectively. Postoperative recovery was uneventful.

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.

Suicide prevention programs at a national level in developed countries were briefly reviewed, and the community-based suicide prevention programs in Akita Prefecture, in the Tohoku Region of Japan, were also outlined. Suicide prevention programs were proposed in Western countries in the 1980s. A famous example is the national prevention program in Finland that was started in 1986. The national suicide prevention programs in Western countries share some common features such as their comprehensiveness and diversity. Typical policies of suicide prevention programs were categorized according to primary, secondary and tertiary prevention. Regarding community-based suicide prevention programs using a health promotion approach, the Akita prefectural government incorporated a suicide prevention program into the local health promotion strategy "Health Akita 21" in 2001. An outline of the four action programs was as follows: to raise awareness of suicide prevention, to increase opportunities for mental health consultation, to promote both primary and secondary prevention of depression, and to create a supportive environment for mental health promotion. Community-based suicide prevention programs were started in some communities of model projects that are financially supported by Akita Prefectural government. Efforts to evaluate the effectiveness of community-based suicide prevention programs are needed in the future.

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

Purpose: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear. Methods: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed. Results: Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE. Conclusion This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy.

BACKGROUND/AIMS: Despite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcers repeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at a high risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis. METHODS: We analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24 hours of arrival at the hospital. RESULTS: Durable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest types Ia, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysis indicated that age > or =70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI, 2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposed vessels with a diameter of > or =2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21; 95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis. CONCLUSIONS: Various factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is important for patients at a high risk for incomplete hemostasis.
Asian Continental Ancestry Group* ; Emergencies ; Endoscopy ; Hematemesis ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic* ; Humans ; Melena ; Mortality ; Multivariate Analysis ; Peptic Ulcer* ; Risk Factors ; Serum Albumin ; Shock ; Ulcer