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.

The hospital records of 50 patients treated for ruptured abdominal aortic aneurysms during the past ten years were reviewed. Nine patients in cardio-pulmonary arrest on arrival at our emergency room and 3 resuscitated patients were included in this study. The patients were classified into four groups: the non-shock group (17 cases), shock group (21 cases), post-cardiac resuscitation group (3 cases) and the cardio-pulmonary arrest on arrival (CAPOA) group (9 cases). The mortality rates including preoperative death in each group were 5.9% (non-shock), 57.1% (shock), 66.7% (post resuscitation) and 88.9% (CPAOA). The overall mortality rate was 46%, although the mortality rate in patients receiving graft replacement was 35.6%. The mortality in the non-shock group was significantly lower than in the other three groups. Longer duration of shock, lower preoperative systolic blood pressure level, longer operative time, greater blood loss and greater amount of blood transfused were risk factors in cases of graft replacement. The risk factors associated with preoperative death were advanced age and acidosis due to severe shock. The correct initial diagnoses were made in prior hospital in 28 cases. Incorrect diagnoses, which were made more often in non-shock patients than in patients in shock, were abdominal pain of unknown origin in 6, ureterolithiasis in 4, lumbago, appendicitis and gastritis in 2 cases each. The delayed diagnosis might have resulted in more severe shock or cardiac arrest. In conclusion, to reduce the mortality of ruptured AAA, correct initial diagnosis and expeditious preoperative management are most important.

This study focused on the effect of pressure sensation from the each plantar surface of the feet on postural control. The plantar surfaces of the feet were made less sensitive by cooling, using a specially designed apparatus set on a force plate. Three areas were cooled: the plantar surface of the heel, the forefoot, and the entire plantar surface of the foot. And the non-cooling condition was the control. The subjects, seven healthy men, were asked to track a continuously moving target spot displayed on a visual monitor while standing on the force plate. This tracking was done by controlling the center of foot pressure (CFP) by leaning forward and backward at the ankles. The target was moving at 0.025 Hertz (once per 40 seconds) with a triangular waveform. The moving range of the target was from 30 to 70 percent (%) of the total foot length from the heel, and this range was divided into 10 percent (%) subranges. Postural controllability was evaluated by the difference between movements of the CFP and target for each subrange. When the entire surface of the foot was cooled, postural controllability of moving the CFP anteriorly was significantly worse than the control. Postural controllability of moving the CFP anteriorly for the anterior and the posterior moving subranges was significantly worse than the control when the heel was cooled. When the forefoot was cooled, postural controllability of moving the CFP anteriorly for the anteriorly moving subrange was significantly worse than that of the control. These results suggest that pressure sensation from the plantar surface definitely participates in moving the CFP anteriorly for postural control. When the CFP is situated on the heel, pressure sensation from the heel alone may play a necessary role for postural control. When the CFP is situated on the forefoot, however pressure sensation from the forefoot may need to be the supplemented by sensation from the heel for adequate postural control.