Acta Medica Nagasakiensia Vol. 60(2015) No. 3
Acta Medica Nagasakieinsia

Constipation is a symptom-based disorder, and its definition is mainly subjective. Patients are more concerned with ease of passage and consistency rather than frequency of bowel movement. Studies on bowel movement frequency and stool texture in the general population are sparse, especially in young women. In this cross-sectional study, data obtained from self-administered questionnaires, including age, height, body weight, lifestyle, food habits, anxiety, depressive status, frequency of bowel movements, stool texture, and defecation-related symptoms were analyzed in 245 female Japanese university students. An established semiquantitative questionnaire available for clinical investigation (FFQg) was used to obtain a detailed assessment of food intake and physical activity levels. Of the participants, 21.4% had bowel movements ≤ 3 times per week and 33.3% had hard or lumpy stools ≥ 25% and loose (mushy) or watery stools ⟨ 25% of bowel movements. There was a positive association between infrequent bowel movements and hard or lumpy stools. These two situations both caused similar symptoms such as a sensation of incomplete evacuation and straining. There was no association of bowel movement frequency and stool texture with any specific nutrients and foods, dietary intake, mental status, or physical activity. Several lifestyle factors such as regular bowel movements and hesitation with evacuation were associated with bowel movement frequency and stool texture. Several lifestyle factors, but not mental, physical, or dietary intake factors, were associated with bowel movement frequency and stool texture in young Japanese women.

Bisphosphonates (BPs) are now widely used to treat various skeletal complications. Although the number of reported cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is rapidly increasing worldwide, therapeutic strategies remain controversial. Conservative treatments including antibacterial mouth rinses, the systemic administration of antibiotics, and superficial debridement in stage II BRONJ have been recommended by the American Association of Oral and Maxillofacial Surgeons position paper. However, these treatments are only partially successful. We performed a surgical intervention that consisted of osteotomy and primary wound closure in patients with stages II and III BRONJ. Forty-three out of 44 cases were treated effectively by this strategy, leading to improvements in quality of life. All BRONJ patients treated with oral BPs were treated successfully by the surgical intervention. We also proposed a surgical intervention for patients with stage II BRONJ.

An independent positive correlation between hemoglobin level and risk of hypertension has been reported for non-anemic non-overweight men and women. Additionally, serum hepatocyte growth factor (HGF) concentration in hypertensive subjects was reported to be significantly higher than in normotensive subjects. However no studies have reported on the correlation between hemoglobin and HGF. A cross-sectional study of 695 elderly non-overweight non-anemic Japanese subjects (231 men and 464 women; range 60-92 years old; Body mass index (BMI) < 25kg/m²; Hemoglobin (Hb) ≥ 13g/dL for men and Hb ≥ 12g/dL for women) who were undergoing general health checkups in 2014 was conducted. Multiple linear regression analysis adjustment for classical cardiovascular risk factors showed a significant positive correlation between hemoglobin and serum HGF concentration (parameter estimate (β) =31.8, P < 0.001) for men and (β=21.7, P < 0.001) for women. An independent positive correlation between hemoglobin and HGF was observed in elderly non-anemic non-overweight Japanese subjects. Since HGF level may become elevated in response to endothelial cell damage (vascular remodeling), these findings suggest that measuring hemoglobin level is clinically relevant for estimating the response to endothelial cell damage.

Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with hepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p ‹ 0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p ‹ 0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p ‹ 0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p ‹ 0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.

[Purpose] In order to clarify prognostic factors of recurrent oral cancer, [Patients and Methods] In 17 oral cancer patients with their age ranging from 28 to 86 years old, who underwent extensive resection accompanied by reconstruction for recurrence of a primary oral cancer, correlations between survival rate after salvage surgery and subsite, T classification and N classification of their initial and recurrent tumors, and time of recurrence were analyzed by using Kaplan-Meier method and kai-square analysis. [Results] Tongue cancer (10 patients) was found to have the poorest prognosis among all the subsites, and especially those who had recurrence within 3 months after previous surgery had extremely poor prognoses; 30% (3/10) of them died without being discharged from the hospital after salvage surgery, and in 40% of them QOL was remarkably impaired losing their voice and chance of peroral food intake, etc. While T classification and N classification of initial and recurrent tumors were found to have no correlations with the prognosis. [Conclusion] More appropriate and realistic information should be provided to those patients to assist them to make a fully informed decision prior to surgery.

Purpose: To describe the surgical technique and criteria for neonatal congenital diaphragmatic hernia (CDH) repair. Methods: CDH repairs were carried out by a thoracoscopic approach between February 2013 and April 2014. Preoperatively, the neonates were stabilized with high-frequency oscillatory ventilation and nitric oxide inhalation. They had no associated cardiac anomalies. Confirmation of the appropriateness of thoracoscopic repair was determined based on the patient’s stability in the decubitus position and no clinical signs of pulmonary hypertension. The operation was carried out with one optical and two operating trocars. The hernia defect was closed by interrupted nonabsorbable sutures. The more lateral portion of the defect was repaired with a U-shaped stitch using a laparoscopic percutaneous extraperitoneal closure needle. Results: Three neonates underwent repair via thoracoscopy. Two patients underwent primary CDH repair, and conversion to laparotomy was required in the other because of a large diaphragmatic defect. There was no intraoperative cardiorespiratory instability or postoperative complications. Conclusions: Thoracoscopic repair of neonatal CDH is a feasible and safe procedure for the patients who have respiratory stability in the decubitus position, no pulmonary hypertension and no intra-thoracic liver herniation.

Gingival enlargement is a prominent symptom in patients with myelomonocytic leukemia (AML-M4) and acute monocytic leukemia (AML-M5). Poor oral hygiene may aggravate the condition. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with the myelopoietic disorder. Here we report a case of a patient with AML-M4 in whom oral care intervention from an early stage improved the quality of life by relieving the pain associated with mucositis and gingival overgrowth aggravated by preceding periodontal lesions.