Objectives: Open radical cystectomy (ORC) is a highly invasive, but widely performed, standard treatment for muscle-invasive bladder cancer (MIBC). Robot-assisted radical cystectomy (RARC) is increasingly performed worldwide as a minimally invasive procedure that can replace ORC. In June 2011, we started performing RARC procedures in which urinary diversion is performed intracorporeally. We compared the safety and invasiveness of RARC and ORC procedures that were performed in the same period.
Methods: Sixteen patients who underwent RARC and intracorporeal ileal conduit urinary diversion (IC-ICUD) were included. Robot-assisted surgery was performed with a head-down tilt of 30° and radical cystectomy was performed transperitoneally. The head-down tilt was then adjusted to 10°–15° for performing IC-ICUD.
Results: All RARC+IC-ICUD procedures were completed without conversion to ORC. The median operation time was 373 min (276–497 min), median console time was 320 min (227–431 min), and median estimated blood loss volume was 200 ml (100–1500 ml). No ≥grade 3 complications as per the Clavien–Dindo classification were identified. RARC had lower blood loss and transfusion rates compared with ORC, thereby shortening the postoperative hospital stay.
Conclusions: We reported our experiences with RARC+IC-ICUD and describe the operative method. IC-ICUD accelerates postoperative recovery of intestinal function and decreases the rate of complications, such as intestinal obstruction and ureteral stenosis. Our findings suggest that RARC+IC-ICUD can be performed with minimal invasiveness and high safety in patients with MIBC.
IgA1 with galactose (Gal)-deficient hinge-region (HR) O-glycans (Gd-IgA1) plays a key role in IgA nephropathy (IgAN), and the serum level of Gd-IgA1 is elevated in the majority of IgAN patients. To characterize the involvement of IgA1 in the development and progression of IgAN, O-glycan micro-heterogeneity and attachment sites need to be analyzed, as each HR has nine potential sites for O-glycosylation.
We have developed an on-line liquid chromatography (LC) hybrid quadrupole mass filter/linear ion trap/orbitrap mass spectrometry (MS) protocol, which was used to analyze IgA1 from a patient with IgAN. LC-MS profiling provided the overall O-glycan micro-heterogeneity distribution of IgA1 HR O-glycoforms. The LC-extracted ion chromatogram (XIC) of HR O-glycoforms containing Gal-deficient O-glycans indicated that the Gal-deficient O-glycans attached at specific sites. Structural isomers based on changes in the amino acid position of the attached glycans were identified in relation to the IgA1 HR O-glycoforms containing Gal-deficient O-glycans. To identify the predominant O-glycoforms in the serum IgA1 from IgAN patients as candidate biomarkers, O-glycan micro-heterogeneity and attachment sites, including isomeric structures, need to be analyzed.
Our MS-based approach is useful in this respect and should prove a valuable tool for the development of biomarkers for IgA1 HR O-glycosylation in IgAN.
Objectives: The purpose of this study was to evaluate the incidence of and risk factors for postoperative nausea and vomiting (PONV) after cleft-related surgery.
Methods: Forty-six pediatric patients who underwent cleft-related surgery from March to August 2016 were evaluated. The following items were examined: the presence or absence of PONV, age at the time of surgery, body weight at the time of surgery, surgery time (ST), anesthesia time (AT), and method of anesthesia. The presence or absence of PONV was considered an objective variable, and all others were considered explanatory variables.
Results: In total, 10 and 36 patients did and did not develop PONV, respectively, for a 21.7% incidence of PONV. Among boys, 2 and 23 patients did and did not develop PONV, respectively, while among girls, 8 and 13 patients did and did not develop PONV, respectively. The incidence of PONV was significantly higher among girls (p=0.014). Significant differences in ST (p=0.011) and AT (p=0.015) were found between patients with and without PONV. In all patients, the method of anesthesia involved the use of sevoflurane, fentanyl, and remifentanil. Multiple logistic regression analysis showed that sex (odds ratio, 9.670; 95% confidence interval, 1.489–62.815; p=0.018) and ST (odds ratio, 0.955; 95% confidence interval, 0.919–0.993; p=0.020) were risk factors for PONV.
Conclusions: The incidence of PONV was 21.7%. All identified risk factors were inevitable, suggesting that preventive treatments using medications might need to be introduced.
Objectives: This study was conducted to investigate the detection rate of the Streptococcus milleri group (SMG) in sputum cultures and clarify its relevance to the clinical presentation of respiratory diseases.
Methods: Data from sputum specimens that were submitted for routine clinical bacterial testing since 1997 at our hospital and classified using the Miller and Jones sputum classification system were analyzed based on SMG bacteria detection, SMG streptococci identification, and antimicrobial susceptibility testing. The relationships between SMG detection and respiratory disease and between SMG detection and bacterial volume were also analyzed in 23 patients with respiratory diseases.
Results: SMG bacteria were most often detected in sputum samples that were macroscopically purulent (Miller and Jones classification P3) with a high number of leukocytes (Geckler classification G5). Some isolates also exhibited resistance to clindamycin and other antibiotics. SMG bacteria were detected in patients with pneumonia, pyothorax, and other respiratory diseases. Notably, an SMG-positive culture was observed in four patients with bronchial asthma.
Conclusions: To our knowledge, this is the first report on the detection of SMG bacteria in patients with bronchial asthma. Considering the complications of asthma and chronic obstructive pulmonary disease overlap syndrome, SMG bacteria could contribute to exacerbation of the symptoms of these diseases. Given these findings, SMG bacteria, a well-established component of normal flora of the human oral cavity, may also serve as pathogens, especially in respiratory diseases.
Objectives: The mean bilateral nasal resistance in normal Japanese adults is 0.25±0.12 Pa/cm3/s, but this value in children remains unknown. This study aimed to determine the mean nasal resistance values in Japanese children.
Methods: We measured nasal resistance in a normal rhinosinal status and rhinosinal morbidity in elementary school children by active anterior rhinomanometry. We used a nasal nozzle that has been recommended for the standard measurement of nasal resistance by the Japanese Standardization Committee on Rhinomanometry.
Results: The mean value of bilateral nasal resistance at ΔP 100 Pa in 1204 normal children was 0.35±0.13 Pa/cm3/s on inspiration and 0.37±0.14 Pa/cm3/s on expiration (ΔP is an abbreviation for the pressure gradient). Nasal resistance in children decreased with growth, making it difficult to determine a single value of nasal resistance in normal children. The mean value of bilateral nasal resistance at ΔP 100 Pa in 838 children with nasal problems, including marked adenoidal hypertrophy, was 0.56±0.87 Pa/cm3/s on inspiration and 0.55±0.47 Pa/cm3/s on expiration.
Conclusions: Bilateral nasal resistance is significantly greater in children with nasal morbidity than in normal children. Additionally, nasal resistance in normal children is best assessed according to the body height category.