Background: Alcoholic liver cirrhosis is a life-threatening condition, especially in patients who are unable to reduce their alcohol use. Alcohol abuse is closely linked to low socioeconomic status and social marginalization. In Japan, public assistance (PA) or Seikatsu-hogo ensures medical care for low-income populations. This study aimed to investigate the potential excess mortality among patients with alcoholic cirrhosis who were recipients of PA.

Methods: Patients diagnosed with alcoholic liver cirrhosis at a community hospital between 2006 and 2017 were included in this retrospective study. Baseline demographics and mortality data were extracted from the electronic health records. Cirrhosis severity at baseline was measured using the mean model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) scores. The primary outcome was the survival probability obtained using the Cox proportional hazards regression analysis.

Results: A total of 244 participants were included, of which 62 were PA recipients. Baseline cirrhosis severity scores did not differ between the PA group and non-PA groups. The overall mortality rates were 48.4% and 31.9% for PA and non-PA recipients, respectively (p=0.002). In the Cox regression model adjusted for age, ALBI score, HCV infection, and presence or absence of a designated key family contact, the hazard ratio for PA status was 1.75 [95%CI 1.03-2.98, p=0.039].

Conclusions: Being a PA recipient is a poor prognostic factor for overall mortality in patients with alcoholic liver cirrhosis after adjusting for age, cirrhosis severity, and social support.

Background: The objective of this study was to review the patient characteristics and operative results in patients with postinfarction ventricular septal rupture (VSR) based on infarct-related vessel.

Methods: We used patient files and registry data to perform a review of 20 consecutive patients with VSR associated with acute myocardial infarction surgically treated at our hospital. The patients were divided into two groups according to the vessel in which the culprit lesion was located: the right coronary artery (RCA) group (n = 9) and left coronary artery (LCA) group (n = 11).

Results: The median ages of the patients in the RCA and LCA groups were 74.2 and 73.0 years, respectively. Although the interval between VSR onset and operation was not different between the two groups, operation within 24 hours occurred more frequently in the RCA group than LCA group (p = 0.043). The choice of operative techniques was not significantly different between the two groups. Operative mortality was significantly higher in the RCA group versus LCA group (5/9 [55%] vs 0/11 [0%], p = 0.005). Low output syndrome and sepsis occurred more frequently in the patients with operative mortality than in the survivors, whereas the rate of surgery within 24 hours of VSR onset was comparable between the two groups.

Conclusions: The poorer operative outcomes of the patients in the RCA group versus LCA group were considered to be due mainly to the more deteriorated condition of the RCA group patients.

Objectives: Colonic stent insertion as a bridge to surgery (BTS) has the advantage of avoiding emergency colostomy and is reported to have a lower postoperative complication rate than emergency resection or resection after stoma construction. Nevertheless, there is no consensus on the long-term prognosis; moreover, there are reports of stent insertion adversely affecting pathological findings. To clarify the influence of colorectal stent insertion on short-term postoperative results, pathological findings, and prognosis, we conducted this study.

Methods: Patients who had undergone resection of the primary tumor for primary colorectal cancer at our hospital between January 2012 and December 2020 and had preoperative colorectal obstruction (Colorectal Obstruction Scoring System [CROSS]) 0—2 were included. Patient were divided into two groups: those with and without preoperative colonic stent insertion. The background, surgical course, histopathological findings, shortterm postoperative outcomes, and the prognosis of both groups were retrospectively examined.

Results: There were 197 cases, 55 with preoperative colorectal stent insertion (stent group) and 142 without stent insertion (non-stent group). The rate of open surgery was significantly higher and postoperative hospital stay was longer in the non-stent group. There were no significant differences regarding histopathology findings, 3-year overall survival, and recurrences.

Conclusions: The short-term postoperative results of patients with stent insertion were favorable, and it seems reasonable to continue stent insertion for the purpose of BTS; however, further study is required regarding prognosis.

Purpose: Several studies have reported the benefits of embolization with N-butyl cyanoacrylate (NBCA); however, few of them have been prospectively studied. This study aimed to prospectively evaluate the safety and feasibility of NBCA embolization, including cases of coagulopathy and/or unstable hemodynamics.

Materials and Methods: This study involved a sample of 20 cases treated with NBCA embolization. Cases were excluded from the study if other embolic substances were considered more suitable, if NBCA embolization was utilized for cerebral and coronary vessels, or if the operators determined that NBCA use was unsuitable.

Results: There were no cases of severe adverse events specific to NBCA and embolization was successful in all cases.

Conclusion: NBCA embolization is a safe and feasible treatment option, even for cases of coagulopathy and/or unstable hemodynamics.

Fulminant hepatic failure is a fatal complication of iron intoxication. Currently, there is no well-established treatment. A 23-year-old Japanese woman, with past medical history of iron deficiency anemia, presented with fulminant hepatic failure caused by iron intoxication. Multiple organ failure progressed despite plasma exchanges and deferoxamine therapy, and she subsequently developed acute respiratory distress syndrome. Even though Venous-Venous Extracorporeal Membrane Oxygenation was inserted, she expired. Early treatment for iron intoxication with whole bowel decontamination and deferoxamine infusion is crucial. Liver transplantation also remains a treatment option for patients with fulminant hepatic failure secondary to iron intoxication.

Remimazolam is an ultrashort-acting benzodiazepine whose action is not prolonged. It is rapidly hydrolyzed, mainly by hepatic carboxylesterase 1, resulting in a short duration of action and little metabolic activity, so its effects are not prolonged in patients with renal impairment. It is useful for anesthesia management in kidney transplantation because it causes little decrease in blood pressure. We report the use of remimazolam in the management of kidney transplantation in a patient with cognitive decline. The patient was a 46-year-old woman on maintenance hemodialysis. She had experienced cognitive decline after a subarachnoid hemorrhage. She was managed with combined epidural general anesthesia, which was induced with remimazolam, remifentanil, and rocuronium, and was maintained with remimazolam, remifentanil, and levobupivacaine. Intraoperatively, there is no decrease in blood pressure, remimazolam was discontinued after surgery, and she awoke immediately and was extubated in the operating room without postoperative delirium. In conclusion, remimazolam causes less hypotension than other agents and was useful for anesthesia management of kidney transplantation in a patient with cognitive decline. Remimazolam has little effect on metabolites, so even patients with renal failure and a history of postoperative delirium do not have prolonged effects and may experience rapid, mild awakening and extubation without postoperative delirium and no need for re-sedation.