Methods: In total, 76 patients participated in this case-control study (neurologically symptomatic adjacent canal stenosis, n=33; neurologically asymptomatic cases at follow-up, n=43). Their risk factors during surgery and magnetic resonance (MR) images before the surgery and at follow-up were evaluated. Data from the two groups (n=25 each) were matched using propensity scores for age, sex, time to MR imaging at follow-up, surgical procedure, and LF hypertrophy in adjacent segments before the surgery and analyzed. Results: Compared with the asymptomatic group, the symptomatic adjacent canal stenosis group had a significantly larger LF area/spinal canal area in the spondylolisthetic segments before the surgery. During the follow-up periods (in months), they had a larger LF area/ spinal canal area in the adjacent segments: the two values were significantly correlated. The sensitivity, specificity, and positive and negative predictive values for determining symptomatic adjacent canal stenosis were high compared with on the cutoff value for the LF area/spinal canal area at the spondylolisthetic segments before the surgery. These results were the same after matching. Conclusions Symptomatic adjacent canal stenosis is mainly caused by LF hypertrophy. Ligamentous stenosis at the spondylolisthetic segments before fusion surgery might be strongly associated with symptomatic adjacent canal stenosis at follow-up.

Methods: The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [−] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (−) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis. Results: Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (−) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching. Conclusions The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.

Objectives: Gastric endoscopic submucosal dissection (ESD) is currently astandard procedure. ESD enables en-bloc resection of large lesions, whileinducing larger artificial ulcers to a greater extent than conventional procedures.Several studies have reported that proton pump inhibitors (PPIs) prevent delayed bleedingand expedite the artificial ulcer healing process. Esomeprazole, anS-isomer of omeprazole, is reportedly one of strongest inhibitors ofgastric acid secretion. Previous studies have examined the effectiveness of esomeprazole.Our goal was to verify the effects of esomeprazole on artificial ulcers in a prospectivestudy.

Methods: A total of 185 patients underwent ESD for gastric neoplasms at ourhospital between January 2013 and June 2015. Among these 185 patients, 49 post-ESD scarlesions were included in this prospective trial. First, 20 mg esomeprazole was orallyadministered to all subjects before and after the procedure. We then evaluated the delayedbleeding rate and ulcer scarring rates at 4 weeks and 8 weeks after the procedure by usinga gastric ulcer stage system.

Results: There was one case of delayed bleeding (2.0%).Regardless of Helicobacter pylori infection status, ulcer scarring ratesat weeks 4 and 8 were respectively 28.6% (14/49) and 98% (48/49).

Conclusions: Our resultssuggest that oral administration of esomeprazole alone may be sufficient for prompthealing of artificial gastric ulcers induced by ESD (UMIN000009367).

Objective: The purpose of this study was to assess the treatment outcome in patients with chronic hepatitis C (CHC) using the current standard antiviral therapy when patient were treated in collaboration between hepatologists and primary care physicians (PCPs).Patients and Methods: One hundred and ten patients with CHC were treated with a combination therapy of peginterferon-alpha 2b and ribavirin. Among them, 25 patients were treated by a collaboration between hepatologists and PCPs (collaboration group), whereas 85 patients were treated with exclusively by hepatologists (noncollaboration group). The duration of the therapy was 48 weeks for 58 'difficult- to-treat' patients (genotype 1 with a high load of HCV-RNA; 1H patients) and 24 weeks for the remaining 52 patients (non-1H patients). In the collaboration group, antiviral therapy was initiated and adjusted, if needed, by hepatologists (visits every four weeks), whereas the weekly administration of peginterferon-alpha 2b was performed by PCPs. Clinical characteristics and the treatment outcome were compared between these two groups.Results: The two groups had similar baseline characteristics. By intention to treat, the two groups showed similar rates of treatment-related serious adverse effects (0% vs. 1%, respectively) and dropout rates for adverse effects (8% vs. 13%, respectively). Sustained virologic response rates were also similar between the two groups, being 42% vs. 39% in the 58 1H patients (NS) and 62% vs. 64% in the 52 non-1H patients (NS), respectively.Conclusions: Collaboration between hepatologists and PCPs may be a valid treatment alternative to treat patients with CHC using the current standard antiviral therapy.

Nosocomial infection management is one of the most important subjects in terms of risk management in a hospital. To achieve the nosocomial infection management appropriately, both public relations and information gathering are important. When it comes to publicity, it is desirable that information is offered quickly and efficiently and the personnel are able to access the information easily anytime and wherever they are. As for information gathering, it is also important to collect the information concerning the nosocomial infection promptly, and to tell it quickly to infection management persons including infection control team members. The infection control committee of our hospital has engaged in both publicity and information gathering by using the committee web site established in the LAN of the hospital since January 2004. The web site carries notifications, organization chart, list of committee members, various manuals, guidance of educational activities, infection management, etc. It is also used for questions and answers, and gathering information concerning nosocomial infection. The number of times the web site was accessed was about 200 every month, and was considerable at night and on holidays. This method of using the web site seems to be useful to promote nosocomial infection management.
Nosocomial Infections ; Infection as complication of medical care ; Information gathering ; Local Area Networks ; Hospitals

The whole spectrum of patients infected with hepatitis C virus (HCV) who visited hospitals has not been fully clarified. It is also unknown whether such patients have visited the hospitals regularly thereafter for a long period. We studied 844 consecutive patients with liver diseases who visited our outpatient clinic located in the southern region of Ibaraki Prefecture. Five hundred eighty-three patients were HCV-infected. Among them, three patients were HBsAg-positive and another patient was IgM anti-HAV positive. Thus, 579 patients (68.6%) were considered to have HCV solely as a hepatotropic virus.Of these HCV patients, 60 were asymptomatic carriers and 15 others were unclassified because of the absence of either biopsy or imaging test records of the liver. As to the rest of the HCV patients, acute hepatitis was diagnosed in one patients, chronic hepatitis in 332 patients, cirrhosis in 130 patients and cancer of the liver in 41 patients.About half of the patients undergoing liver biopsy showed F1 in the degree of liver fibrosis. The rate of virological response to interferon mono-therapy in patients infected with genotype 2 was worse than the national average. The poor response was considered to be due to high viral load. It was suggested that the distribution of patients with each genotype was uneven in this region. After five years, the rate of patients still visiting our clinic were 68.1% for those with chronic hepatitis, and 50% for the healthy carriers. We deemed that it was important to clarify whether patients not visiting our clinic are followed up closely in other hospitals.
Hepatitis C virus ; Liver ; Clinic ; Infection as complication of medical care ; biopsy characteristics

We encountered a case of far advanced hepatomas involving the lungs and portal veins. The patient was a 38-year-old woman. Chemoembolization had transient effects. Cachexia occurred. After repeated episodes of upper gastrointestinal bleeding, she died. An autopsy revealed a deep gastric ulcer to which a nodule of the hepatocellular carcinoma adhered. Histopathologically, the infiltration of the hepatoma was not evident. These findings suggested that circulatory distarbances of the gastric wall due to the adhesion of the growing hematoma had caused the ulceration.