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.

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.

This study was designed to investigate the association between autonomic nervous activities and clinical symptoms of climacteric women with qi disturbance. Power spectral analysis of heart-rate variability (HRV) was performed in 55 climacteric patients with undefined symptoms (age;51.9±2.8). The total power of HRV in patients with hot flushes was significantly higher (529.6±529.9ms²) than that of patients without this symptom (295.4±260.8 ms²) (P<0.05). The sympathetic nerve system (SNS) index in patients with hot flushes and with jitters (2.81±2.93 and 3.16±2.78), was significantly higher than those of patients without them (1.03±0.78 and 0.87±0.72) (P<0.001 and P<0.0001, respectively). The parasympathetic nerve system (PNS) index of patients with hot flushes and patients with jitters (0.38±0.19 and 0.33±0.16) was significantly lower than those of patients without them (0.55±0.17 and 0.58±0.14) (P<0.001 and P<0.0001, respectively). These findings indicate that HRV-based assessment of the autonomic nervous system activity of climacteric women with hot flushes and jitters, which have been known as symptoms of qi counterflow in the Kampo medicine, is associated with an increase in sympathetic nerve system and a decrease in parasympathetic nerve system activity. It has been suggested that autonomic nervous activities be included in the part of pathological condition of qi in the Kampo medicine, and that evaluation of qi be used as one diagnostic tool in the practical Kampo medicine, or fusion of western and oriental medicine.