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.

Background/Aims: Colorectal polyp detection during colonoscopy is influenced by the lesion location, size, morphology, and histology. However, no studies have systematically assessed the difficulty of detection along the short axis of the intestinal lumen. This study aimed to evaluate the colorectal polyp detection rates on this axis during colonoscopy. Methods: This retrospective study analyzed 1,169 polyps in 513 patients who underwent colonoscopy at Showa University Hospital between November 2022 and February 2023. The short-axis lumen was divided into: upper right, lower right, lower left, and upper left. Each polyp detected was assigned to a quadrant. Detection rates were compared across quadrants and analyzed for associations with clinicopathological factors including lesion size, location, macroscopic type, and examiner experience. Results: The lesion detection rates varied significantly by quadrant. The upper left quadrant had the lowest detection rate (17.5%) compared with the expected 25.0% per quadrant. Subgroup analyses consistently confirmed the lower detection rates in this quadrant across most lesion types and patient groups, except for lesions in the cecum and rectum. Conclusions The lower detection rate in the upper left quadrant suggests that this orientation poses a challenge and may increase the number of missed lesions. Enhanced examination of this area may improve detection; however, further prospective studies are required.

Background/Aims: There are few published registry studies from Asia on pediatric inflammatory bowel disease (IBD). Registry network data enable comparisons among ethnic groups. This study examined the characteristics of IBD in Japanese children and compared them with those in European children. Methods: This was a cross-sectional multicenter registry study of newly diagnosed Japanese pediatric IBD patients. The Paris classification was used to categorize IBD features, and results were compared with published EUROKIDS data. Results: A total of 265 pediatric IBD patients were initially registered, with 22 later excluded for having incomplete demographic data. For the analysis, 91 Crohn’s disease (CD), 146 ulcerative colitis (UC), and 6 IBD-unclassified cases were eligible. For age at diagnosis, 20.9% of CD, 21.9% of UC, and 83.3% of IBD-unclassified cases were diagnosed before age 10 years. For CD location, 18.7%, 13.2%, 64.8%, 47.3%, and 20.9% were classified as involving L1 (ileocecum), L2 (colon), L3 (ileocolon), L4a (esophagus/stomach/duodenum), and L4b (jejunum/proximal ileum), respectively. For UC extent, 76% were classified as E4 (pancolitis). For CD behavior, B1 (non-stricturingon-penetrating), B2 (stricturing), B3 (penetrating), and B2B3 were seen in 83.5%, 11.0%, 3.3%, and 2.2%, respectively. A comparison between Japanese and European children showed less L2 involvement (13.2% vs. 27.3%, P< 0.01) but more L4a (47.3% vs. 29.6%, P< 0.01) and L3 (64.8% vs. 52.7%, P< 0.05) involvement in Japanese CD children. Pediatric perianal CD was more prevalent in Japanese children (34.1% vs. 9.7%, P< 0.01). Conclusions Upper gastrointestinal and perianal CD lesions are more common in Japanese children than in European children.

PURPOSE: Patients with pathological stage T1N+ or T2–3N0 gastric cancer may experience disease recurrence following curative gastrectomy. However, the current Japanese Gastric Cancer Treatment Guidelines do not recommend postoperative adjuvant chemotherapy for such patients. This study aimed to identify the prognostic factors for patients with pT1N+ or pT2–3N0 gastric cancer using a multi-institutional dataset. MATERIALS AND METHODS: We retrospectively analyzed the data obtained from 401 patients with pT1N+ or pT2–3N0 gastric cancer who underwent curative gastrectomy at 9 institutions between 2010 and 2014. RESULTS: Of the 401 patients assessed, 24 (6.0%) experienced postoperative disease recurrence. Multivariate analysis revealed that age ≥70 years (hazard ratio [HR], 2.62; 95% confidence interval [CI], 1.09–7.23; P=0.030) and lymphatic and/or venous invasion (lymphovascular invasion (LVI): HR, 7.88; 95% CI, 1.66–140.9; P=0.005) were independent prognostic factors for poor recurrence-free survival. There was no significant association between LVI and the site of initial recurrence. CONCLUSIONS LVI is an indicator of poor prognosis in patients with pT1N+ or pT2–3N0 gastric cancer.

Papillary fibroelastoma is a rare benign cardiac tumor generally arising from the valvular endocardium. We describe the successful surgical management of a patient who had a papillary fibroelastoma attached to a false tendon of the left ventricle. A 71-year old man was admitted with a left ventricular tumor. Routine transthoracic echocardiography revealed a mobile, 6×8 mm mass, which was attached to a false tendon in the apical area of the left ventricle. Continuous intravenous heparin was commenced to avoid the embolism, and then an urgent operation was performed, consisting of left ventriculotomy following establishment of a standard cardiopulmonary bypass. A mobile gelatinous mass with a short stalk, 7 mm in diameter, was attached to the false tendon. The mass was excised including a part of the false tendon. The excised tumor changed its shape in saline to a sea-anemone like tumor. The histopathological findings were consistent with the diagnosis of papillary fibroelastoma. The patient made an uneventful recovery and was discharged from the hospital on postoperative day 12.

Between December 1994 and December 2002, surgical repair of aneurysm of the abdominal aorta (AAA) was performed in 139 patients, 32 of whom had ruptured AAA. Thirty-nine patients were 80 years old or older (O) and 100 patients were younger (Y) than 80. The ratio between ruptured and unruptured AAA was significantly higher among older patients (O: 41.0% versus Y: 16.0%, p=0.002). Surgical mortality was identical in those receiving elective repair (O: 0% versus Y: 0%) and similar in those receiving repair following rupture (O: 13.3% versus Y: 28.5%, p=0.314). A diagnosis of AAA had been made before rupture in only 10 patients, whose survival rate was relatively higher (100%) than that of patients without known AAA (66.7%). Ten patients died of ruptured AAA without surgery. Four of them had intractable cardiopulmonary arrest despite attempts at resuscitation. Four other patients were debilitated due to other disease even before rupture of AAA. Another 2 patients were diagnosed as ruptured AAA at autopsy. In conclusion, elective surgical repair is safe in elderly patients with AAA. The survival rate of elderly patients following rupture of AAA is comparable to that of younger patients. Some patients, however, should be excluded from aggressive treatment because of associated conditions such as marked debilitation prior to rupture or uncorrectable cardiopulmonary arrest on arrival. Patient selection is a sensitive but important issue in the era of society being composed of many elderly people.

Stanford type B acute aortic dissection without complications has been considered to be an indication for medical rather than surgical treatment. To investigate the availability of medical treatment and early rehabilitation, we evaluated 90 cases treated between 1986 and 1999 with type B acute aortic dissection. These consisted of 79 nonruptured cases and 11 ruptured cases at the beginning of treatment in our medical center. No surgery was performed in any of the nonruptured cases but surgery was performed in 8 of 11 ruptured cases. Surgical mortality in the rupture type was 12.5% (1/8). During medical treatment of the nonrupture type, 3 patients died of sudden rupture (1 case) and bowel ischemia (2 cases). An early rehabilitation program in which the goal was for the patient to walk around the ward within 2 weeks was performed for 31 consecutive cases of nonrupture type without vascular complications. Mortality was not significantly different between the early and conventional rehabilitation groups. The incidence of pneumonia and ICU syndrome during medical treatment was 13.0% (6/46) and 37% (17/46), respectively in the conventional group and 0% and 12.9% (4/31), respectively in the early group. The incidence of ICU syndrome was significantly lower in the early group than in the conventional group. Despite the limitations of this study, medical treatment and early rehabilitation showed good results in cases of uncomplicated type B acute aortic dissection.

The internal mammary artery (IMA) has been widely used in CABG due to the excellent long-term results. However, the extensive use of bilateral IMA grafting has been believed to increase operative morbidity and mortality. This study was designed to determine if bilateral IMA grafting in diabetic patients increased the likelihood of mediastinitis. We analyzed the data of 386 consecutive patients who underwent isolated CABG in 1992 to 1996. The definitions of sternal wound complications are as follows, (1) mediastinal dehiscence and (2) mediastinal wound infection. Subtypes include superficial wound infection and deep wound infection (mediastinitis). Among these patients 97 received unilateral IMA grafts and 289 did bilateral IMA grafts. mediastinitis did not occur in any subjects. The occurrence rate of mediastinal dehiscence and superficial wound infection was 7.2% (7/97) for bilateral IMA grafting, 7.3% (21/289) for unilateral IMA grafting. No patients died of wound complications. The occurrence rate of mediastinal dehiscence and superficial wound infections were 12.0% (4/33) for bilateral IMA grafting in diabetic patients, 12.0% (14/117) for unilateral IMA grafting in diabetic patients. That of this complications was 4.7% (3/64) for bilateral IMA grafting in non-diabetic patients, 4.1% (7/172) for unilateral IMA grafting in diabetic patients, without significant differences in wound complication. Bilateral IMA grafting in diabetic patients carried no great risk of mediastinitis, but diabetes mellitus itself was a great risk for mediastinitis.

The hospital records of 59 patients treated for ruptured abdominal aortic aneurysms during the past eleven years were reviewed. The patients were classified into two groups: an elderly group aged 80 years old or wore (18 cases) and a control group aged under 80 years old (41 cases). Previous diagnoses of abdominal aortic aneurysm had been made more frequently in the aged group (44.4%) than in the control group (22%). Of the patients who fell into shock preoperatively, only 6 patients (60%) received graft replacements in the aged group, but all patients received graft replacements in the control group. Graft replacements were performed as safely in non-shock patients in the elderly group as in cases of non-ruptured abdominal aortic aneurysm. The overall survival rate including non-operative cases in the elderly group (38.9%) was lower than that in the control group (61%). The survival rates in patients receiving graft replacemes showed no significant difference between the elderly group (63.3%) and the control group (67.6%). Many of the aged patients who fell into shock due to aortic rupture died without receiving surgery. Hypovolemic shock which results in ischemia in vital organs is the most likely major cause of death in patients of advanced age. In conclusion, graft replacements should be performed electively and safely before aneurysmal rupture, particularly in elderly patients.