Purpose: We compared laparoscopic and open surgical approaches in upper gastrointestinal tract perforation surgery in our hospital and examined the problems. Patients and Methods: Surgical factors were examined in 44 patients who underwent surgery for upper gastrointestinal perforation from September 2008 to August 2018, including 38 undergoing laparoscopic surgery (Lap group) and 6 undergoing laparotomy (Open group). Results: Mean patient age in the Open group was significantly higher at 76.8 (42–91) years (P=0.001), and significantly more patients (n=4) had a history of large laparotomy (P=0.0005). There were no significant between-group differences in operation time, amount of bleeding, postoperative length of hospital stay, and complications. The wash volume during operation was significantly less in the Lap group 5,060 (2,000–20,000) mL (P<0.001). A technically certified surgeon participated significantly more frequently (all 38 cases) in the Lap group (P=0.001). However, among the 6 patients in the Open group, even if they were not elderly, did not require advanced surgery, or had no history of surgery, some underwent laparotomy because of the absence a certified laparoscopic surgeon. Conclusions: Open surgery was often selected for elderly patients with a history of large open surgery, but in the future, less-invasive laparoscopic surgery will be performed on patients in good general condition.
Objective: Changes to swallowing function over time were investigated in patients with cortical cerebellar atrophy (CCA). Subjects and Methods: Forty-five CCA patients who underwent videofluorographic swallowing examinations (VF) at our hospital between June 2008 and March 2013 were divided into two groups (early group, ≤10 years; late group, ≥10 years) based on the time from appearance of the initial symptom. Years elapsed, total score on the International Cooperative Ataxia Rating Scale, diet consistency at the time of examination, and history of aspiration pneumonia were retrospectively examined in both groups based on medical records. Additionally, the presence of aspiration/laryngeal entry, oral transit time, pharyngeal transit time, pharyngeal delay time, and residual cooked rice in the oral cavity/epiglottic vallecula/pyriform sinus were examined with VF (10ml fluid and cooked rice). The t-test, Mann-Whitney U test, and Fisher’s exact test were used for statistical analysis. Results: The early group comprised of 25 patients (elapsed time, 7.2 years; normal meal, n=25), and the late group comprised of 20 patients (elapsed time, 15.3 years; normal meal, n=16; rice porridge, n=4). No patient had a history of aspiration pneumonia. The duration of each swallowing phase on VF was extended with the consumption of cooked rice in the late group. The percentage of patients with residual food in the epiglottic vallecula and pyriform sinus was significantly greater in the late group than that in the early group. Discussion: Many patients with CCA continue to eat normal meals even 10 years CCA onset. However, significant pharyngeal residue and extension of the swallowing phases were observed. These findings indicate that, it is necessary to be aware of the decline in swallowing function while maintaining the quality of the diet.
Vitamin B12 is a water-soluble vitamin mainly contained in animal foods and is essential for DNA synthesis, erythrocyte hematopoiesis and maintenance of nerve function. Normally, vitamin B12 in the fetus is stored in the liver. Therefore, childhood onset of megaloblastic anemia caused by vitamin B12 deficiency is rare, but its deficiency may cause developmental retardation in addition to anemia. We reported a case of an infant who was diagnosed as having vitamin B12- deficient megaloblastic anemia that triggered developmental retardation. A 10-month girl presenting with loss of smile and developmental retardation was admitted to our hospital. She had only received breast milk until the first visit and had not received sufficient baby food. Her mother was a foreigner and vegetarian. Blood tests showed macrocytic anemia and pancytopenia, and bone marrow examination showed megaloblasts. We diagnosed megaloblastic anemia caused by vitamin B12 deficiency because her serum vitamin B12 level was low. Pancytopenia improved with the administration of vitamin B12, but mild mental retardation remained. It is necessary to consider vitamin B12 deficiency in the differential diagnosis of the cause of developmental retardation. During pregnancy and breastfeeding, vegetarian mothers should be educated regarding the necessity of vitamin B12 intake.
A-76-year-old man with an abdominal aortic aneurysm measuring 55 mm in diameter underwent replacement of his abdominal aorta with a Y-shaped Gelsoft graft. His postoperative course was uneventful. Computed tomography performed five years after the operation showed no remarkable changes, and he subsequently was lost to follow-up. Seven years and eight months after the operation, he was referred to us because of huge seroma around the aortic graft associated with right hydronephrosis, which was detected by computed tomography performed at another hospital. Replacement of the graft with a Triplex graft resulted in remission of both the seroma and hydronephrosis. Although the resected graft was not structurally damaged, vascular wall organization around the graft was very poorly developed. We found a few other cases of the late onset of perigraft seroma after vascular graft implantation in the literature, so we emphasize the necessity of long-term follow-up in such patients.