Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Methods: Consecutive patients diagnosed with OFs at Fujieda Heisei Memorial Hospital were divided into three groups: nonsurgical therapy, balloon kyphoplasty (BKP), and open surgery groups. The mOF score was calculated, and the levels of independence and posttreatment imaging data were compared between patients treated and not treated according to the mOF score-based treatment recommendation. Results: In total, 118 patients were included (nonsurgical therapy, n=57; BKP, n=48; open surgery, n=13), of whom 100 (85%) received treatment consistent with the mOF score-based treatment recommendation. In the BKP and open surgery groups, the mOF scorebased treatment recommendations were consistent with the actual treatment in 93% of the patients. However, in the nonsurgical group, the mOF score-based treatment recommendation was not consistent with the actual treatment in 25% of the patients. In this group, patients not treated according to the mOF score had significantly shorter vertebral body height, greater local kyphosis, and smaller sacral slope after treatment than patients treated according to the mOF score-based treatment recommendation. Conclusions In the BKP and open surgery groups, the mOF scores were consistent with actual clinical selection. In the nonsurgical therapy group, patients not treated according to the mOF score-based treatment recommendation exhibited severe vertebral body deformity and a less well-balanced spine shape after treatment. The mOF score may help in selecting suitable treatments for OFs.

A 46-year-old man had a 3-week history of persistent cough. Chest radiography showed a mass in the left pulmonary hilum and contrast-enhanced computed tomography (CT) showed an infiltrative mass extending from the main pulmonary trunk to the left hilar region into the lung. He was referred to our hospital for multidisciplinary treatments. Echocardiography showed that the proximal side of the tumor reached the pulmonary valve. CT revealed that the heterogeneous low-density tumor extended from the main pulmonary trunk to the left and right pulmonary arteries, and the left side of the tumor extended beyond the left pulmonary hilum into the left lung. A mass shadow of 54 mm in length was also seen in the lower lobe of the left lung along the pulmonary artery. Although the left bronchus was compressed by the tumor, there was no obvious intratracheal invasion. Direct invasion to the descending thoracic aorta was suspected. He underwent the resection of the main pulmonary trunk and the left pulmonary artery along with the tumor concomitant with total left pneumonectomy. Reconstruction of the pulmonary artery and right ventricular outflow tract were performed as follows: The right ventricular outflow tract was reconstructed by using a semilunar shaped bovine pericardial patch. The pulmonary artery was replaced by using a composite graft with a Dacron tube graft and an aortic bio-prosthesis. He was discharged on the 22nd postoperative day. The pathological diagnosis of the tumor was pulmonary artery intimal sarcoma. Although there are various reconstruction methods for pulmonary artery intimal sarcoma depending on the affected site, reconstruction of the pulmonary artery and the right ventricular outflow tract by using a composite graft are considered to be a useful method.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

Circadian rhythms have been shown to regulate several physiological functions including body temperature, sleep/wake cycle, physical activity, and cognition. These functions are controlled by circadian clock genes, and the circadian clock system in the body is classified into two clocks which are the central clock in the suprachiasmatic nucleus (SCN) of the hypothalamus and peripheral clocks in peripheral tissues such as the liver and skeletal muscle. Therefore, many researchers are conducting basic and applied research on the relationship between circadian rhythm in peripheral tissues and physiological functions including sports performance and effects of acute exercise and exercise training. On the other hand, it has been shown that abnormal circadian rhythms and disturbance of circadian rhythms can lead to the development of several diseases such as diabetes, cancer, sarcopenia, depression, and dementia. Thus, it is also important to regulate individual circadian rhythm by considering for timing of exercise and daily physical activity. Exercise and physical activity are found to have an influence on circadian rhythms regulation (Chrono-exercise) and accumulate evidences between timing of exercise and health outcomes. This review aims to introduce evidence for chrono-exercise and suggests the importance for considering the timing of exercise and physical activity.

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery.

Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum ; Endoscopy ; Hemorrhoids ; Humans ; Potassium ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Tannins

A 40-year-old man with a family history of Marfan syndrome was admitted to our hospital because of acute Stanford type A aortic dissection. He underwent a Bentall operation with an artificial vascular graft. Postoperative computed tomography revealed a low-density area around the graft in the ascending aorta and at the left subclavian artery cannulation site. He showed no symptoms and was discharged uneventfully. Five months after the operation, a pulsatile subdermal tumor appeared in the center of the median sternotomy. Computed tomography showed low- and high density fluid accumulation surrounding the ascending aortic graft, and this was connected with a subdermal tumor. We suspected collapse of the anastomotic site and performed an emergency operation. The fluid around the aortic graft was clear and diagnosed as perigraft seroma. To prevent recurrence, we filled the space around the aortic graft with an omental pedicle graft. After the operation, perigraft seroma did not recurr. In addition, with the disappearance of the seroma in the mediastinum, fluid accumulation at the left subclavian artery cannulation site also disappeared.

We performed aortic valve reconstruction (AVrC) using autologous pericardium for a patient with severe aortic stenosis and chronic renal failure, prior to kidney transplantation. The patient received kidney transplantation in the early phase after cardiac surgery. The case was a 61-year-old man with severe aortic valve stenosis who received dialysis due to chronic renal failure. We performed AVrC using autologous pericardium for the following reasons. Anticoagulant therapy is not desirable because of the need to perform kidney transplantation in the early phase after cardiac surgery. Implantation of prosthesis was not desirable because the patient requires oral immunosuppression therapy after kidney transplantation. There was no significant postoperative pressure gradient of the aortic valve orifice or aortic valve regurgitation (AR). The patient received kidney transplantation 113 days after surgery. AVrC using autologous pericardium was feasible for aortic stenosis patients in a patient waiting to receive kidney transplantation because anticoagulation therapy is not necessary after AVrC.