Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

The Basic Lecture Course (BLC) hands-on seminar has long been a core educational activity organized by the U-40 of the Japanese Society for Cardiovascular Surgery at the branch level. However, due to the COVID-19 pandemic, in-person seminars were suspended for an extended period. Since 2022, the seminars have gradually resumed, and in 2025, a branch-based hosting system was introduced. Nevertheless, several challenges unique to the post-pandemic era have become evident. In the Hokkaido Branch, BLC hands-on seminars were held in July 2024 and August 2025. This report presents the outlines and management processes of these two events, summarizes the results of participant surveys, and discusses future challenges and perspectives for the operation of BLC hands-on seminars.

A 27-year-old woman developed circulatory failure 4 days after birth and was diagnosed with mid-aortic syndrome (MAS) 10 days after birth. Despite repeated endovascular treatments, restenosis recurred, and descending aorta-abdominal aorta bypass surgery was performed at the age of 6. Since the age of 14, bilateral external iliac artery occlusion has been observed, but no ischemic symptoms were observed in the lower extremities, and the patient was followed up. From around the age of 26, significant claudication appeared in both lower extremities, and it was determined that surgical intervention was required. Bilateral common iliac artery-common femoral artery bypass surgery was performed. The bilateral common iliac arteries were used as the central anastomosis, and the common femoral artery just above the bifurcation of the bilateral superficial and deep femoral arteries was used as the peripheral anastomosis. No ischemic symptoms in the lower extremities have been observed up to now (2 years after the operation). Bilateral common iliac artery-common femoral artery bypass surgery was performed for abdominal aortic stenosis with hypoplasia of the bilateral external iliac arteries and lower extremity artery disease (LEAD). Since we experienced the case with favorable results, we will add a review of the literature and report it.

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

Methods: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain. Results: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group. Conclusions Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain.

Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.

Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.

Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses.

BACKGROUND/AIMS: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. METHODS: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. RESULTS: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). CONCLUSIONS: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.
Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Multivariate Analysis ; Needles ; Prospective Studies ; Punctures ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

BACKGROUND/AIMS: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. METHODS: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. RESULTS: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. CONCLUSIONS: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Needles ; Pancreas ; Prospective Studies ; Punctures ; Retrospective Studies ; Ultrasonography