Objective: To assess the efficacy of the FIGO 2018 classification system for nodal-specific classifications for early-stage cervical cancer; specifically, to examine the impact of nodal metastasis on survival and the effect of postoperative treatments, according to histological subtypes. Methods: This society-based retrospective observational study in Japan examined 16,539 women with the 2009 FIGO stage IB1 cervical cancer who underwent primary surgical treatment from 2004 to 2015. Associations of cause-specific survival (CSS) with nodal metastasis and postoperative adjuvant therapy were examined according to histology type (squamous cell carcinoma [SCC], n=10,315; and non-SCC, n=6,224). Results: The nodal metastasis rate for SCC was higher than that for non-SCC (10.7% vs. 8.3%, p<0.001). In multivariable analysis, the impact of nodal metastasis on CSS was greater for non-SCC tumors (adjusted-hazard ratio [HR], 3.11; 95% confidence interval [CI], 2.40–4.02) than for SCC tumors (adjusted-HR, 2.20; 95% CI, 1.70–2.84; p<0.001). Propensity score matching analysis showed significantly lower CSS rates for women with pelvic nodal metastasis from non-SCC tumors than from SCC tumors (5-year CSS rate, 75.4% vs. 90.3%, p<0.001). The CSS rates for women with nodal metastasis in SCC histology were similar between the postoperative concurrent chemoradiotherapy/radiotherapy and chemotherapy groups (89.2% vs. 86.1%, p=0.42), whereas those in non-SCC histology who received postoperative chemotherapy improved the CSS (74.1% vs. 67.7%, p=0.043). Conclusion The node-specific staging system in the 2018 FIGO cervical cancer classification is applicable to both non-SCC tumors and SCC tumors; however, the prognostic significance of nodal metastases and efficacy of postoperative therapies vary according to histology.

Retrospective cohort study.

Retrospective cohort study.

OBJECTIVE: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. METHODS: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. RESULTS: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. CONCLUSION: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
Guideline Adherence ; Humans ; Insurance ; Japan* ; Methods ; Patient Care ; Platinum ; Proctoscopes ; Qi ; Standard of Care ; Uterine Cervical Neoplasms*

We experienced 8 cases of children who presented with somatic complaints and found it difficult to attend school successfully treated with Kampo medicine. We evaluated them objectively by using the evaluation scale in the guideline for medical care of school refusal. Four cases were orthostatic dysregulation, 2 cases were migraine, 1 case was involuntary movement in upper abdomen and the other case was autonomic dysfunction. Kampo medicines were selected according to conventional method, so-called sho. Among 8 cases, 5 cases had a major response, 2 cases had a minor response and one case had no beneficial response. These results suggest that Kampo therapy can be effective therapeutic means. Kampo therapy is quite personalized and beneficial especially for children who find it difficult to attend school and need individualized care. This is the first report evaluating many cases objectively by using the evaluation scale and there have been no reports similar to ours. We have to continue to enlighten general pediatricians about the effectiveness of Kampo therapy.

A 55-year-old man presented with exertional dyspnea. He was found to have an incomplete atrioventricular septal defect (AVSD), mitral regurgitation, a patent foramen ovale (PFO), atrial fibrillation, and pectus excavatum. A one-stage operation including thoracoplasty in addition to the intracardiac repair was preferred in order to obtain a good view of the operative field and control the postoperative hemodynamics. Therefore, we performed autologous pericardial patch closure of the AVSD, mitral valve plasty with closure of the mitral cleft, direct closure of the PFO, and a modified maze procedure, followed by sternal elevation (modified Ravitch procedure) during chest closure. Postoperatively, his respiratory status on a respirator improved slowly and he was extubated on the 17th postoperative day. Dysphagia developed because of the prolonged intubation, but improved with deglutition rehabilitation. The subsequent postoperative course was uneventful and he was discharged on the 59th postoperative day. We performed a modified Ravitch procedure, instead of sternal turnover, because the latter requires exfoliating a broad area, which could increase the total blood loss and the risk of infection, and make it difficult to maintain the blood flow of the plastron. We obtained a good view of the operative field and stable hemodynamics postoperatively with sternal elevation in pectus excavatum accompanied by heart disease.

Objective: To inquire about how evaluation of physician supervisors is performed, and whether or not incentives to guide comprehensive community-based clinical clerkship for them are provided, in hospitals outside Sapporo Medical University.

Methods: We conducted field surveys using questionnaires distributed to physician supervisors and hospital directors, focusing on the evaluation of physician supervisors and whether they are provided with incentives. From the survey, we examined the attitude toward educational awareness of the physician supervisors.

Results: The number of hospitals where evaluations for physician supervisors were performed and incentives were provided was limited. In addition, 54.2% of the physician supervisors responded that incentives were unnecessary. Many of them considered that incentives for a hospital are more preferable than for individual supervisors.

Conclusion: These results suggest that with respect to community-based clinical clerkship outside the university, an appropriate method for providing incentives, including whether or not they are necessary, should be considered.

We report a rare case of double outlet right ventricle (DORV) with sub-pulmonary type ventricular septal defect (VSD). The great arteries were almost side-by-side, and the ascending aorta was located slightly posterior to the right of the pulmonary artery. We performed complete repair at the age of 25 days. Intra-cardiac rerouting (VSD closure) was carried out through the tricuspid valve. Arterial switch procedure was performed without the Lecompte maneuver. His postoperative course was uneventful and he was discharged 19 days after the operation without any complications.

BACKGROUND/AIMS: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Age Factors ; Aged ; Aged, 80 and over ; Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Feasibility Studies ; Female ; Gallbladder/pathology/*surgery ; Humans ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Prospective Studies ; Sphincterotomy, Endoscopic ; Treatment Outcome

BACKGROUND/AIMS: Several studies have shown the usefulness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to evaluate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were excluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited success rate. Because of technical difficulties, ENGBD should be reserved for limited indications.
Age Factors ; Aged ; Aged, 80 and over ; Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Feasibility Studies ; Female ; Gallbladder/pathology/*surgery ; Humans ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Prospective Studies ; Sphincterotomy, Endoscopic ; Treatment Outcome