[Background] This study assessed the characteristics of right-sided colonic diverticulitis (RCD) and the optimal management of complicated RCD. [Methods] The present study enrolled 137 consecutive patients with colonic diverticulitis who were admitted to our institution over a 7-year period. The characteristics and treatment methods were compared between RCD and left-sided diverticulitis (LCD). Additionally, the difference between complicated RCD and LCD was investigated. [Results] The RCD patients were younger than the LCD patients (45.6±16.3 years vs. 61.2±16.7 years: P<0.001). The rate of complicated RCD was lower than that of LCD (15.3% vs. 50%: P<0.001）. In the subgroup analysis of patients with complicated colonic diverticulitis, such as those with modified Hinchey stage Ib, the size of the abscess did not differ between the RCD and LCD groups. Eleven of 13 cases with LCD (84.6%) required surgery. On the other hand, no patients with complicated RCD required surgery. One of 13 cases (7.7%) with complicated RCD developed recurrence with modified Hinchey stage Ia after discharge. [Conclusions] Conservative management may be effective for patients with complicated RCD, such as modified Hinchey Stage Ib, irrespective of the size of the abscess and degree of the inflammatory reaction.

Perforation of surgical gloves often occurs. Exposure of blood and body fluids pass through these perforation sites, resulting the risk of healthcare-associated infection for both the healthcare worker and the patient. To avoid these risks, double glove and intraoperative glove changes are recommended in many guidelines. The rate of glove perforation is reduced by double glove and glove exchange. However, there are no reports that have examined the exact degree of blood and body fluid exposure that pass-through glove perforations site. In this study, we investigated the frequency of exposure to blood and body fluids through glove perforations in gastrointestinal surgery using the forensic luminol blood tests. The results demonstrated that when glove perforation occurred, blood and body fluids exposure occurred at a high rate of 73.0％ in open surgery and 59.6％ in laparoscopic surgery. Double glove uses in gastrointestinal surgery, not only in open surgery but also in laparoscopic surgery, is thought to reduce the risk of blood and body fluid exposure and to prevent healthcare-associated infections.

【Background】Since April 2016, Kyorin University Hospital dental staff have checked the oral condition of all patients who underwent surgery under general anesthesia. Therefore, in this study, the authors’ aim was to determine whether an oral management intervention system, mainly characterized by oral mucosa stimulation contributed to a reduction in postoperative complications.【Methods】The authors performed a retrospective analysis of medical records of patients who underwent surgery from April 2014 to March 2018 at Kyorin University Hospital. They divided the patients in the study into 2 groups: an oral management intervention group which underwent surgery from April 2016 to March 2018 and was provided with guidance by dental staff before surgery, and a control group, without oral management direction, which underwent surgery from April 2014 to March 2016. In addition, our oral management procedure emphasized oral mucosa stimulation with a toothbrush to induce saliva discharge and assess presence or absence of mobile tooth, dryness of the mouth, and status of oral hygiene.【Results】This study demonstrated that our oral management system and practice were associated with a decline in the post-operative complications in lung surgery, and postoperative hospital stay duration in surgery of many clinical departments.【Conclusion】Our hospital recommends assessment all patients’ oral cavities before surgery under general anesthesia and proposes an innovative new strategy using our unique oral management procedure to reduce postoperative complications in the cases of many clinical departments.

This study was a retrospective study on 545 patients who referred for professional oral health care (POHC) to a dentist and dental hygienist by surgeon or physician. The relationship between comprehensive geriatric assessment (CGA) and oral condition on their admission was examined. The oral condition was evaluated by scores of Oral Assessment Guide by Eilers and Berger. The patients with 13 points or more were grouped in severe oral dysfunction. In the groups of cancer chemotherapy and a few outing weekly before this hospitalization, oral dysfunction was severe with significant differences (P ＜ 0.05). In the group of cancer chemotherapy, forgetfulness patients had severe oral dysfunction with significant differences (P ＜ 0.05). In the preoperative patients, a few outing weekly was a factor showed severe oral dysfunction without significant differences. It has been showed that POHC prior to surgery and cancer chemotherapy decrease the risk of complications caused by oral dysfunction. For patients with factors of CGA related severe oral dysfunction, especially in the groups of cancer chemotherapy and a few outing weekly, early POHC for the prevention of complications should be considered.

Most oral cancer surgeries are performed with clean-contaminated wounds, but the incidence of Surgical Site Infection（SSI）is higher than in other areas. In particular, oral cancer surgery with free flap reconstruction has a higher incidence of SSI compared to resection alone. There are various risk factors for SSI, such as host factors, cancer factors, and surgical factors, and these factors combine to cause SSI. Elucidating and improving these issues may reduce the incidence of SSI. In addition, if prophylactic antimicrobials are not used properly, SSIs caused by resistant bacteria or nosocomial infections may occur, making treatment difficult. Recently, the ERAS（Enhanced Recovery After Surgery）protocol has been recommended. This protocol aims to minimize pain, promote patient recovery, and reduce perioperative complications, including SSIs, and hospital stay. In Japan, perioperative oral function management, which aims to reduce postoperative complications including SSIs by providing oral care before and after surgery for cancer patients, has been covered by insurance since 2012 and is gaining importance.

In the surgery to detain artificial materials including prosthetic replacement and the artificial joint replacement in the body, bacteria possibly attach to the artificial body surface, and the risk of postoperative infection will increase. Once postoperative infection develops after surgery, the patients suffer a severe disadvantage. Those with periodontitis are more likely to allow bacteria to invade their blood vessel, hence the importance of oral management. Therefore, it is necessary to receive dentistry as soon as possible when operation is determined. The measures that increase the risk of developing bacteremia, such as the tooth extraction, should be done before surgery.

Postoperative pneumonia has a significant impact on the prognosis. It has been shown that oral care before and after surgery leads to the prevention of organ diseases unrelated to the oral cavity, such as pneumonia. At Hyogo Medical University Hospital, we work on oral management （OM） including oral care. OM emphasizes dental treatment and education for patients and medical staff as well as oral care. As dental treatment, we extract and fix loose teeth before surgery, and prepare the oral environment so that postoperative oral care can be performed easily. Furthermore, comprehensive efforts such as educating nurses on how to collect pharyngeal contaminants generated during oral care and moisturize, can increase the preventive effect of postoperative pneumonia more than mere oral care.

In recent years, it has been well known that oral care during the perioperative period is effective in controlling postoperative infections, and many hospitals introduce oral care to decrease postoperative infections. However, procedures of oral care for intubated patients differ depending on the background of each institution and the disparity in each nurse technique. We aim to verify the amount of water recovered in oral care by rinsing with water to standardize the oral care system for endotracheal intubated patients in ICU. As a result, we introduce aspiration-brushing wipe kit. In addition, dental care worker intervention and cooperation are important not only in oral care for intubated patients but also in the construction of general oral care systems.

Edwardsiella tarda (E. tarda) uncommonly infects humans. Although hepatic abscesses caused by E. tarda are rare, they can become severe if there is an underlying disease. A 69-year-old man was admitted to our hospital with chief complaints of general fatigue. The enhanced CT revealed multiple liver abscesses. His condition rapidly deteriorated with signs and symptoms of septic shock and disseminated intravascular coagulation syndrome. After recovery from the shock by treatment with intravenous vasopressors and fluids, ultrasonography-guided percutaneous transhepatic abscess drainage was performed. E. tarda was detected from blood and drainage specimens. The patient made an uneventful recovery and was discharged 63 days after admission. E. tarda infection may be rapidly exacerbated, necessitating immediate intervention.