Hospital-based registry is an essential tool in the fight against cancer. We summarized the 2012 data of hospital-based cancer registries in eight cancer treatment hospitals in Nagano Prefecture and compared them with data from all over Japan, considering the ranking by registration frequency for colorectal, gastric, lung, breast and prostate cancers between Nagano Prefecture and the whole of Japan. Liver cancer in Nagano Prefecture showed a low frequency while uterine and bladder cancers showed high frequencies compared with the rest of the country. Pancreatic cancer in Nagano Prefecture received a rank of 10, which is higher than the national average. Compared with all over Japan the frequencies of gastric, lung, liver, and breast cancers in Nagano Prefecture were high for stage I and low for stage IV. Hospital-based cancer registries can be powerful tools for evaluating the epidemiology of cancer in Nagano Prefecture.

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Background : Omental torsion is a relatively rare disease. It occurs when the omentum is twisted around its axis, and leads to perfusion defects and vascular impairment of the omentum.
Case : A 44-year-old man was referred to our hospital with an initial diagnosis of acute appendicitis. Abdominal CT scan revealed a high density mass with spiraled vessels inside. The appendix was normal. Under the diagnosis of omental torsion, partial omentectomy was performed laparoscopically. Histological findings revealed the mass to be the omentum accompanied by congestion and hemorrhage. Tumor cells were not detected. The postoperative course was uneventful and the patient was discharged on postoperative day 5.
Conclusion : Some of the literature suggests that not every case of omental torsion needs operation, and conservative management is possible in selected cases. In our experience, because of reduced invasiveness, laparoscopic surgery for omental torsion is useful both for making a diagnosis and for treatment.

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Vaginal varices are common during pregnancy and are rarely troublesome during the perinatal period. However, we report a woman who presented with massive postpartum hemorrhage caused by the rupture of prominent vaginal varices. A 35-year-old primigravida woman was found to have extensive vaginal varices with a red color on the surface at 28 weeks of gestation. She delivered a healthy infant at term. Immediately after the delivery, massive hemorrhage from the torn varices occurred. We first tried surgical sutures, but bleeding points could not be clearly identified because of the massive hemorrhage. We performed vaginal gauze packing to reduce the bleeding. The estimated blood loss at delivery was 3,770ml. Two days after the delivery we removed the vaginal packing, but massive hemorrhage from the varices resumed immediately.The blood loss was approximately 2,000ml in a few minutes, and the vaginal packing was the only means to control the bleeding. Both seven and 21 days after the delivery, balloon occlusion of the bilateral common iliac arteries was performed, but sufficient hemostasis was not achieved and vaginal packing was performed again. Because vaginal hemorrhage slowly decreased during the packing, we started step-wise removal of the vaginal packing and performed complete removal on the 48th day of puerperium without notable hemorrhage. Although life-threatening postpartum hemorrhage caused by vaginal varices is very rare, the present case suggests the need for an appropriate indication to avoid vaginal delivery.

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