Purpose: Surgical resection of remnant gastric cancer (RGC) is technically challenging and difficult. Minimally invasive surgery (MIS) has been adopted for various procedures, but reports of MIS for RGC remain limited. Herein, we report the surgical techniques and short-term outcomes of MIS for RGC. Methods: We conducted a retrospective cohort study involving 61 consecutive RGC patients who underwent open or minimally invasive (laparoscopic or robotic) total gastrectomy for potentially curable RGC at our institution (January 1999–August 2025). A propensity scorematched cohort was used for an exploratory evaluation of the safety and efficacy of MIS for RGC, focusing on feasibility rather than superiority over open surgery. Results: Of these 61 patients, 53 underwent open surgery and eight underwent MIS gastrectomy for RGC. The median age was 70 years. The cohort comprised 53 men and eight women. The initial procedure was open surgery in 58 patients and MIS in three patients.Propensity score matching showed significantly reduced intraoperative blood loss in the MIS group compared with the open surgery group (39 mL vs. 576 mL, p < 0.05), and significantly longer operation time in the MIS group (352 minutes vs. 297 minutes, p < 0.05). Postoperative hospital stay was significantly shorter in the MIS group (12 days vs. 17 days, p < 0.05). The incidence of postoperative pancreatic fistula was lower in the MIS group, although not significantly different (0% vs. 16.7%). Conclusion MIS, including robotic gastrectomy, is feasible and safe for RGC, with potential perioperative benefits requiring multicenter validation.

Introduction: Autonomic and psychiatric symptoms occur in opioid withdrawal syndrome. We report a case in which a patient treated with hydromorphone for cancer pain showed psychiatric symptoms similar to withdrawal syndrome and improved with divided administration of an extended-release tablet formulation. Case: A 60-year-old woman who underwent surgery for left breast cancer. She had been treated with hydromorphone, non-opioid analgesics, analgesic adjuvants, and nerve blocks for pain due to recurrence of lumbar metastases. However, before regular oral administration of hydromorphone extended-release, symptoms of anxiety, irritability and restlessness began to appear. Since these symptoms improved a few hours after the regular administration, we suspected the effects of opioids on blood concentration and changed the dosage to twice-daily divided doses of the same drug. As a result, symptoms decreased dramatically. Conclusion: When patients experience withdrawal-like psychiatric symptoms while taking opioids, it may be possible to alleviate these symptoms by considering the effects of decreased blood levels and adjusting the dosage of the drug, such as divided dosing.

Objective: This study aimed to clarify the current practices of occupational therapy (OT) in addressing the employment aspirations of individuals with advanced or terminal cancer. Methods: A web-based questionnaire survey was administered to occupational therapists (OTs) working at designated cancer care hospitals across Japan. Data were analyzed using descriptive statistics and a qualitative descriptive approach. Results: A total of 278 OTs responded to the survey, of whom 119 (43%) had experience supporting employment in this patient population. The purposes of employment aspirations were categorized as financial reasons, social roles and responsibility to others, and self-realization or self-fulfillment. Agreed-upon goals included full-time return to work (32 cases, 27%) and part-time or reduced-hours return to work (38 cases, 32%). In addition, some goals did not lead to actual employment but reflected patients’ wishes, such as life review (7 cases, 6%) and simulated activities (7 cases, 6%). Conclusion: Employment aspirations in patients with advanced or terminal cancer are rooted in diverse psychosocial factors beyond economic motivations. OTs play a vital role in supporting these patients by respecting their wishes and helping set realistic goals that enhance quality of life.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

In Japan, based on the Ministry of Health, Labour and Welfare’s “Pharmacy Vision for Patients” (2015), there has been a growing need to shift from “drug-centered, physical work” to “patient-centered, interpersonal work.” Medication counseling is one of the most important tasks of pharmacists. In the present study, we focused on the questions asked by patients during medication counseling, and statistically analyzed the content of the questions and the patient attributes obtained from the patient medication profile. The study was conducted from 2018 to 2019 on patients who visited two pharmacies. Data from a total of 3,300 patients was collected, of which 859 asked questions during medication counseling, accounting for about 26% of the total. Attributes that significantly influenced the asking of questions included gender, new prescriptions, and who was being instructed, especially for women and parents of infants. In terms of topic, questions about the duration and timing of taking the medication and about the medication itself were common in all departments. In terms of medication effects, there were many questions about topical and central nervous system medications, but there were also questions about non-medication matters such as tests. When providing medication counseling, it is expected that pharmacists will actively provide instructions to resolve patients’ questions based on the characteristics of each pharmacy and on patient demographics, as well as improve the quality of interpersonal services according to the patient’s background.

We report a case of chronic mesenteric ischemia associated with severe aortic valve regurgitation and stenosis (ASR). The patient was a 76-year-old man who had been given a diagnosis of ASR in his 40s. He gradually developed heart failure and chronic kidney disorder due to deterioration of ASR. He had started hemodialysis 1 year before admission and had complained of abdominal pain after meals and weight loss during that period. He was admitted to the Department of Cardiology in our hospital for evaluation of ASR. Severe ASR with low output syndrome (C. I. 2.00 L/min/m²) were confirmed by cardiac catheter examination. In addition, abdominal angiography revealed total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). We considered that low cardiac output due to severe ASR had exacerbated the mesenteric ischemia. We performed AVR and abdominal aorta-SMA bypass at the same time to prevent acute mesenteric ischemia in the perioperative period. The combination of valvular disease and CMI is very rare. This is the first report in Japan of simultaneous valve replacement and mesenteric artery revascularization.

We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.

BACKGROUND: Specific IgE antibodies against the low-molecular-weight carbohydrate antigen that does not bridge IgE molecules on mast cells are not associated with clinical symptoms. Cross reactivity can be determined in allergen-specific IgE detection assays when the carbohydrate structures between pollen allergens and plant derived food allergens are similar; in such cases, false positive results for grain or legume allergens can be reported for pollen allergic patients who are not sensitized to those allergens. This phenomenon arises owing to the presence of cross-reactive carbohydrate determinants (CCDs). OBJECTIVE: This study aimed to assess the impact of CCD interference on the results for pollen allergen-specific IgE antibodies in the general adult population and to perform CCD inhibition tests evaluating the involvement of CCD on samples positive to pollen allergens. METHODS: Serum samples from 322 subjects were tested for IgE antibodies to pollens and CCD. The research subjects were given questionnaires about pollen allergic symptoms to help assess the presence of allergies. Allergen IgE antibodies for Japanese cedar, Japanese cypress, orchard grass, ragweed, MUXF, bromelain, horseradish peroxidase (HRP), and ascorbate oxidase (ASOD) were analyzed. RESULTS: It was observed that among individuals who tested positive to any of the pollen allergens, the positive ratio of CCD-specific IgE antibody was the highest for HRP (13.5%–50.0%). The results from the inhibition tests revealed that CCD was marginally present. Although IgE antibodies for cedar pollen did not react with CCD, IgE antibodies for Japanese cypress, orchard grass, and ragweed might be detected by the presence of CCD. CONCLUSION: The results of the inhibition tests revealed the obvious presence of CCD suggesting its involvement. Considering these findings, careful evaluation of patient IgE results should be performed for Japanese cypress, orchard grass, and ragweed.
Adult ; Allergens ; Ambrosia ; Antibodies ; Ascorbate Oxidase ; Asian Continental Ancestry Group ; Bromelains ; Cryptomeria ; Cupressus ; Dactylis ; Fabaceae ; False Positive Reactions ; Horseradish Peroxidase ; Humans ; Hypersensitivity ; Immunoglobulin E ; Mast Cells ; Plants ; Pollen ; Research Subjects ; Rhinitis, Allergic ; Rhinitis, Allergic, Seasonal