Acute myocardial infarction (AMI) is one of the leading causes of death in Japan. Immediate reperfusion therapy, including coronary intervention, improves patient prognosis. Despite this, females are said to be more prone to poor prognosis. A regional AMI registry in Nagasaki prefecture has been instituted recently that will evaluate whether female gender might predict short-term in-hospital death. Seventeen regional AMI centers enrolled all AMI patients from September 2014 through March 2016. A propensity score (PS) was derived using logistic regression to model the probability of females as a total function of the potential confounding covariates. Two types of PS techniques were used: PS matching and PS stratification. The consistency of in-hospital death was determined between PS matched patients of both genders. Based on PS, patients were ranked and stratified into five groups for the PS stratification. Out of 996 patients, 67 (6.7%) died during hospitalization: 31 (10.4%) out of 298 females and 36 (5.2%) out of 698 males (p < 0.0025). The proportion of cardiac and non-cardiac related death was almost same between genders (25 and 6 in female, 29 and 7 in male, respectively). Among 196 PS matched patients, there was a consistency between genders regarding in-hospital deaths (McNemar test, p = 0.6698). The 717 propensity scored patients had no significant differences between genders among propensity quintiles (Cochran-Mantel-Heanszel test, p = 0.7117). We found that gender alone is not an indicator of short-term in-hospital death in acute myocardial infarction patients.

View full abstract

After pancreaticoduodenectomy (PD), pancreatic duct-to-mucosa anastomosis (PDM) has been usually applied which may prevent risk of pancreatic fistula (PF). In cases with a small pancreatic duct, however, PDM is difficult to complete. Procedures involving the invagination (IV) or complete external tube drainage (CED) are supposed to be alternative options for anastomosis. We retrospectively compared clinical results between PDM and IV or CED in 104 patients with a tiny pancreatic duct who underwent PD. The 77 patients undergoing PDM (the control group) and 27 patients undergoing other procedures, including 19 for CED and 8 for IV, were comparatively examined. Fatty pancreas was commonly observed in CED group. Pancreaticojejunostomy was significantly more frequently applied in CED group, and the operating time in the IV group was significantly longer than in control group (p < 0.05). The anastomotic time in CED group tended to be shorter than those in control and IV groups (18 versus 29 and 37 min). The incidences of PF were not significantly different among groups (31% in control, 47% in CED and 14% in IV, respectively); however, a grade B or C level of PF was not observed in the IV group. PDM is often difficult to achieve and inadequate suturing may injure the pancreatic parenchyma in cases of very small pancreatic duct. Re-evaluation of the CED or IV procedure as an alternative option was suggested to be warranted

View full abstract

　Obesity is associated with personality. The Type A behavior pattern (TABP), which is characterized by hostility and competitive behavior, is related to psychological stress. However, the relationship between obesity and the TABP has not been examined. This study aimed to examine the relationship between obesity and the Type A behavior pattern in 3,099 Japanese workers. The Type A behavior pattern was measured via the Maeda Type A Behavior Checklist. Data were analyzed using multivariate logistic regression adjusted for age, being current smokers, heavy drinker, lack of exercise, occupation, and rapid eating. The multivariate odds ratio (95% confidence interval) for obesity associated with TABP was 1.55 (1.13 to 2.13) in men. Regarding other variables, age, lack of exercise, and rapid eating were associated with obesity in men. The multivariate odds ratio (95% confidence interval) for obesity associated with TABP was 1.27 (0.81 to 2.02) in women. Regarding other variables, age and rapid eating were associated with obesity in women. The findings suggest that the Type A behavior pattern was associated with increased obesity prevalence in Japanese men. People with TABP tend to eat larger portions during mealtimes repeatedly by rapid eating; it is possible that eating large portions may lead to an increase weight in men with TABP.

View full abstract

The Tokyo Guidelines 2013 (TG13) provides a simple criteria and management strategy for acute cholecystitis. The optimal interval between performing percutaneous transhepatic gallbladder drainage (PTGBD) and delayed elective laparoscopic cholecystectomey (LC) and the suitable period of PTGBD, is controversial. In this study, we evaluate the operative outcome of elective LC with PTGBD for the management of acute cholecystitis. We analyzed 21 patients who underwent elective LC following PTGBD. The diagnosis and severity grading for acute cholecystitis was based on TG13. All patients showed grade II/III acute cholecystitis by TG13. Median time interval from onset of acute cholecystitis to PTGBD was 1.5 days (range 0-6). In all patients, local inflammation of gallbladder was improved by PTGBD. Median time interval from PTGBD to elective LC was 46 days (range 12-74). Only one patient (5%) showed bile leakage, and median postoperative hospital stay was 5 days (range 4-15). In conclusion, delayed elective LC following emergent PTGBD is a safe and effective treatment strategy for patients with complicated acute cholecystitis.

View full abstract

Background: Gestational thrombocytopenia (GT) is detected in approximately 8% of healthy pregnant women and > 70% of pregnancy-associated thrombocytopenia cases. Diagnosed by exclusion, GT is primarily a benign disorder of unclear pathogenesis, although mechanisms have been proposed such as hemodilution. To better understand GT, we conducted retrospective longitudinal and cross-sectional analyses of variations in platelet count (PC) during gestation period. Methods: PC kinetics was assessed across a test group of 100 pregnant women, accurately representative of 341 in total, and in a control group of 200 non-pregnant women. Results: In the test group, median PC was comparable to the control group in early gestation but decreased by 8% by delivery day (DD). PC decreased by > 5% in 59 pregnancies and increased by > 5% in 19. 12 cases were thrombocytopenic. Median PC fluctuation, 2.5^th percentile, and 97.5^th percentile were each most extreme in final 5 weeks. Longitudinal analysis established five gestational pattern types defined by curvature and Change Ratio. The GT-type pattern (8 cases) showed relatively low PC in early gestation, mild downwards slope in the 2^nd trimester, one or more peaks or “lifts” in the final weeks, followed by a “V-shape” of decrease beyond 15 x 10⁴/μL to DD and sharp post-partum increase. Some of the GT-associated characteristics above appeared identifiable in a majority of pregnancies regardless of absolute PC value: Distinct PC “lift” occurring within the final ten weeks [later than in GT cases] followed by the V-shape [decrease to DD less pronounced than in GT], suggesting that diverse PC kinetics relate to the placental cytokine and receptor system. Conclusion: Our novel identification of diverse kinetic patterns in platelet count over gestational period suggests that, instead of a universal decrease caused by hemodilution alone, homeostatic conditions are affected by a diversity of varying factors such as the placental thrombopoietic system.

View full abstract

　It is said that the clinical results of cases with anterior cruciate ligament reconstruction (ACLR) who have knee osteoarthritis (OA) are not very good. A case of simultaneous medial opening wedge high tibial osteotomy (MOWHTO) and revision ACLR using a bone-patella tendon-bone (BPTB) graft for medial knee OA after re-tear of a reconstructed ACL graft is reported. 　The patient was a 49-year-old man who underwent surgery for a right knee ACL injury by ACLR using an ipsilateral hamstring tendon graft 7 years earlier. He sprained his right knee while he was skiing and injured his reconstructed ACL graft. He had knee instability and pain at the medial side of his knee. X-ray showed a tibia vara deformity and medial knee OA of KellgrenLawrence grade II. It was thought that the medial knee pain would remain if he were treated by revision ACLR alone. Therefore, simultaneous MOWHTO and revision ACLR using an ipsilateral BPTB graft were performed. The excellent clinical results and radiological findings 3 years after the operation indicate the usefulness of this approach.

View full abstract