Objective: To investigate whether establishment of surgeon-led multidisciplinary palliative care teams at our hospital has resulted in measurable benefits for patients with terminal-stage disease. Subjects and Methods: Subjects were 101 patients who visited the Department of Gastrointestinal and General Surgery at St. Marianna University Hospital during the 1-year period of August 2005 through July 2006. The chief complaint in all cases was oncogenic pain. Realizing that it would take time for our new system to have an effect, we divided these patients into an early-period group (August 2005–January 2006) and a late-period group (February 2006–July 2006), and we compared outcomes between the 2 groups and various subgroups. The length of patients’ hospital stay was taken as the main outcome of interest because we considered it to be the clearest measurable indicator of a direct effect of our team approach to palliative care. Results: Mean±SD hospital stay was 50.36±64.63 days for the early-period group and significantly shorter at 35.09±27.64 days for the late-period group. (p=0.044). The hospital stay also differed significantly between long-term in-patients (those hospitalized 60 days or more) in the early-period group and those in the late-period group (152.33±100.87 days vs. 82.75±23.12 days, respectively; p=0.016). The hospital stay of early-period patients who died was 64±82.87 days, and that of late-period patients who died was significantly shorter at 32±19.77 days (p=0.015). The positive outcomes of the team-based palliative care appeared to arise from the ability of the team specialists to alleviate patients’ symptoms and release them to home treatment. Conclusion: We conclude that establishment of specialized palliative care teams yields a significant benefit to terminal-stage cancer patients that is manifested by shortened hospital stays.
We investigated, in an animal model of skeletal muscle injury, whether microcurrent electrical neuromuscular stimulation (MENS) and hyperbaric oxygen (HBO) therapy used in combination (MENS and HBO) enhances the restorative benefits conferred by these treatments alone. Skeletal muscle injury was simulated in 40 7-week-old male C57BL/6J mice by injection of cardiotoxin (CTX) into the left tibialis anterior (TA) muscle of each mouse, which induced the necrosis-regeneration cycle. The mice were divided into 4 groups of 10 each and subjected to one of the following no additional treatment (X), HBO (XH), MENS (XM), MENS and HBO (XMH) groups. MENS was delivered at 10 µA intensity, 0.3 Hz frequency, and 250 msec pulse width for 60 minutes per day, 3 days per week for 2 weeks, and HBO was performed with 100% oxygen at 2 atmospheres absolute (ATA) for 60 minutes per day, 3 days per week for 2 weeks. One and 2 weeks after CTX injection, the TA muscle was dissected. Two weeks after CTX injection, both the mean fiber cross-sectional area (CSA) and percentage increase in the fiber CSA were significantly greater in the XMH group than in the X group (P <0.05). The fiber CSA increased without treatment and also under sole treatment with either MENS or HBO, but the values did not differ significantly. Our data indicate that combination MENS and HBO therapy enhances regeneration of injured skeletal muscle and that such combination therapy may be clinically beneficial.
Background: The purpose of this study was to investigate the prognostic factors of stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) to improve outcomes. Materials and methods: Between 2008 and 2016, 71 patients with medically inoperable stage I NSCLC were treated at our hospital with SBRT (48–55 Gy in 4–5 fractions for peripheral lesions or 60–64 Gy in 8–10 fractions for central lesions). Survival outcomes were analyzed using Kaplan-Meier and cumulative incidence methods. Factors including sex, age, tumor location, tumor size, BED (biologically effective dose) 10, and maximum standardized uptake value (SUVmax) were evaluated with regard to overall survival (OS) and disease-specific survival (DSS) using Cox proportional hazard regression. Results: The median follow-up duration of surviving patients was 33 months (range, 6–81 months). Two-year OS and DSS were 78.5% and 91.5%, respectively. Two-year cumulative local recurrence rate, regional recurrence rate, and distant metastasis rate were 6.8%, 10.9%, and 7.3%, respectively. Multivariate analysis revealed that BED10 and SUVmax were prognostic factors for DSS. Conclusion: Lower BED10 and higher SUVmax were predictors of significantly worse DSS. A higher SUVmax may be considered for intensive treatment to improve outcomes.
[Objective] We performed a prospective comparative study of early postoperative pain in adult patients with inguinal hernia treated by the transabdominal preperitoneal approach (TAPP) or the anterior approach (AA). [Patients and Methods] The participants comprised 89 adult patients with inguinal hernia operated on from August 2015 to March 2017. The patients were divided into two groups, the TAPP group (n=46) and the AA group (n=43). We assessed the intensity of postoperative pain using the current perception threshold (CPT) measured by a perceptual pain sensation analyzer (PainVision PS-2100; Sanyo Seiko, Yamanashi, Japan). We measured the minimum perceived current and pain-compatible current (PCC) preoperatively and calculated the innate pain intensity (IPI). Postoperatively, we measured the wound PCC, calculated the wound pain intensity (WPI), calculated the adjusted wound pain intensity (AWPI) from the IPI and WPI, and compared postoperative pain in the two groups based on the surgical technique used. [Results] The AWPI values were 193.2 ± 27.9 and 200.4 ± 32.9 in the TAPP and AA groups, respectively, on postoperative day (POD) 1 (P=0.86), then 160.0 ± 23.5 and 138.7 ± 17.1, respectively, on POD 2 (P=0.47), with no significant differences observed. [Conclusion] We observed no significant difference in the intensity of pain measured by PainVision between the TAPP and AA groups during early postoperative period.
Contralateral inguinal hernias that occur after inguinal hernia repair may include so-called subclinical inguinal hernias (SIH). These latent hernias are not accompanied by symptoms such as swelling. However, few studies have investigated the prevalence and incidence of SIH using imaging. This paper documents a study of SIH incidence detected on hernia studies and risk factors for the clinical manifestation of SIH. These hernia studies comprised computed tomography images obtained prior to inguinal hernia repair with the patient in a prone position to decompress the inguinal region. Our subjects were 77 patients diagnosed as having a contralateral asymptomatic SIH before inguinal hernia repair between January 2006 and December 2015. Clinical manifestation occurred in 27.3% (21 patients), and the 5-year incidence was 23.3%. We investigated risk factors and found that the size of the hernia that was surgically repaired first was a significant factor (mean value of 157.6 cm3 in the incidence group and 77.8 cm3 in the non-incidence group; p=0.029). We also found that the cut-off value for hernia size on the symptomatic side was 44.5 cm3; above this value, the 5-year incidence was 32.5% (13 patients), whereas below it, the incidence was 13.5% (5 patients) (p=0.0205). SIH incidence is relatively high, and patients with large symptomatic hernias tend to experience clinical manifestation of contralateral SIH. We therefore believe that careful follow-up should be performed, and single-stage or early surgery should be considered.
Transplanting the ovaries of young mice into menopausal mice has been shown to extend their lifespan, suggesting that the reproductive organs may play an important role in combating aging. Preventing skin aging is an extremely important matter with respect to maintaining quality of life, but little basic research has been carried out on this issue. The effects of treatment with cryopreserved ovarian tissue, tissue hormone therapy (THT), and hormone replacement therapy on inhibiting skin aging in experimental animals were investigated. The effects on skin elasticity and body weight changes in 6-week-old mice resulting from the transplantation of cryopreserved ovarian tissue were evaluated, as were the effects on skin of estrogen administration after bilateral oophorectomy or transplantation. Estrogen was secreted by mouse ovaries that had been frozen, thawed, and transplanted, and the estrus cycle was restored, but this was insufficient to have any effect on skin elasticity. After oophorectomy, the body weight of the mice increased, and their skin elasticity decreased. Estrogen administration after these changes had occurred neither restored skin elasticity nor suppressed body weight gain. However, when estrogen was continuously administered from immediately after oophorectomy, skin elasticity decreased transiently and then improved. If techniques for THT using cryopreserved ovaries to maintain the blood estrogen concentration above a specific level can be established, this might help to prevent or improve the deterioration of skin appearance in young women who require oophorectomy due to gynecological disease and also in childhood, adolescent, and young adult cancer patients.
Background: The purpose of this retrospective study was to investigate the predictive ability of the Ki67 labeling index (LI) for relapse-free survival (RFS) of patients with stage I-II invasive breast cancer after breast-conserving therapy. Materials and methods: Between 2012 and 2016, 240 patients with stage I-II invasive breast cancer were treated at our hospital with breast-conserving therapy. Survival outcomes were analyzed using the Kaplan-Meier and cumulative incidence methods. Factors including T stage, N stage, estrogen receptor, HER2, and Ki67 LI were evaluated with regard to RFS using Cox proportional hazard regression. Results: The median duration of follow-up in the surviving patients was 36 months (range, 14–62 months). Rates of 3-year overall survival and RFS were 98.1% and 96.4%, respectively. Three-year cumulative rates of local recurrence, regional recurrence, and distant metastasis were 1.3%, 1.2%, and 2.1%, respectively. Multivariate analysis revealed that a Ki67 LI ≥33.3% was the only prognostic factor for RFS. Conclusion: A Ki67 LI ≥33.3% was a predictor of significantly worse RFS.
A Thai woman with lung lesions and her daughter with lung and brain lesions, both with a history of consuming raw freshwater crabs, were admitted to our institution. Based on the detection of worm eggs in the mothers’ sputum by serum enzyme immunoassay/DNA sequence analysis, both mother and daughter were diagnosed as having Paragonimus westermani infection (triploids). Praziquantel treatment resulted in the normalization of blood eosinophil counts and eosinophil cationic proteins. Although the total IgE and various specific IgE antibodies were elevated in both the mother and daughter, no increases were detected in their urinary levels of leukotriene E4.