Objectives: Exercise-induced bronchoconstriction (EIB) is a transient acute airway narrowing that occurs as a result of exercise. Approximately 80% of individuals with asthma experience exercise-related symptoms (ERS). The prevalence of EIB in the general population without a known asthma diagnosis has been estimated to be approximately 5%–20%, but there is no consensus on this. There have been previous studies on asthma patients, infants and athletes, but few studies have investigated general students, particularly in Japan. The purpose of our study was to investigate the prevalence of EIB with screening questionnaires and laboratory exercise challenge tests in Japanese medical students. Methods: This study included 233 potential participants. All participants completed an EIB screening questionnaire. The exercise protocol for the bicycle ergometer started at 25 W, and the participant remained in motion for 5 min in a multi-step load protocol that increased by 25 W per min. Spirometry was performed before and after all exercise challenge tests. The criterion for a positive test was a ≥10% decrease in forced expiratory volume in 1 s (FEV1) from the baseline measurement. Results: Twenty-six of 217 students (12.0%) had a self-reported a history of ERS. However, only six students (2.8%) were EIB-positive on an objective test. Moreover, all six students had no history of asthma, ERS or EIB diagnosis. Conclusions: Our data revealed EIB-positive participants in a generally healthy population. It is important that EIB diagnoses should not be made using only symptoms, a history of asthma, allergies or the baseline measurement of lung function. Objective tests should be used for the accurate diagnosis of EIB.
Objective: To determine whether Laparoscopy-Assisted Distal Gastrectomy (LADG) is suitable for treatment of gastric cancer in elderly patients, we conducted a retrospective study to examine the safety and outcomes of LADG performed in elderly patients at our hospital. Patients and Methods: Included in the study were 68 patients (15 aged ≥75 years and 53 aged <75 years) who underwent LADG at our hospital. We compared patients’ characteristics (age, sex, and body mass index [BMI]), physical status as defined by the American Society of Anesthesiologists (ASA-PS), medical history, whether endoscopic submucosal dissection (ESD) had been performed previously; surgical factors (operation time, blood loss volume, length of hospital stay, extent of dissection, number of lymph nodes dissected, anastomosis method, time to first flatus, time to first stool, complications); and pathologic factors (tumor location, tumor presence, invasion depth, lymph node metastasis). Results: Mean age of the elderly patients was 79.8 years (75–86 years). Mean BMI was 18.4 (14.3–22.2) kg/m2. Three elderly patients were classified into ASA-PS 3, and hypertension was common in the elderly group. The mean duration of surgery was 193.2 (125–290) minutes, and the mean blood loss volume was 52 (4–263) mL. Mean time to first flatus and first stool were 3.0 (2–5) days and 5.3 (4–8) days, respectively. The mean hospital stay was 18.4 (8–48) days. Complications included 1 pancreatic fistula and 1 stenosis associated with an anastomotic ulcer. The mean number of lymph nodes dissected was 33.1 (15–61), and there were 3 cases of lymph node metastasis. Only BMI and the incidence of previous ESD differed between the elderly patients and younger patients. Conclusion: We conclude on the basis of our study findings that laparoscopy-assisted distal gastrectomy can be perfomed safely in patients aged 75 years and older (just as it is in patients under 75 years of age), as long as patient selection is properly carried out.
To evaluate the outcomes of kidney transplantations performed by general urologists in collaboration with nephrologists by analyzing the clinical results. We retrospectively reviewed the medical records of 164 kidney transplantations performed at our center from July 1998 to December 2015. We obtained demographic data, anthropometric information, laboratory findings, and patient/graft survival data. The recipients included 99 (66.1%) men with a median ± standard deviation (SD) age of 41 ± 14.5 years, whereas the donors included 65 (40.1%) men with a median ± SD age of 59 ± 10.8 years. Among the recipients, chronic glomerulonephritis (non-biopsied glomerular injury, n = 42) was the most common primary disease that progressed to end-stage kidney disease, followed by IgA nephropathy (n = 33), and diabetic nephropathy (n = 20). Kaplan-Meier graft survival rate was 83.7% at 10 years after transplantation, which is comparable to the nationwide rate of 84.9% at 10 years after living-donor kidney transplantation. Graft survival rate in the ABO blood type incompatible subgroup was 90.5% at 10 years after transplantation, which was not significantly different from 82.2% rate in the ABO blood type compatible subgroup. Donors aged ≥60 years were defined as old-age donors. This old-age donor subgroup showed a significantly lower graft survival rate of 70.5% at 10 years after transplantation compared with 93.1% in donors aged less than 60 years ( p = 0.02 ). Although the number of kidney transplantations at our center was small, outcomes comparable to nationwide outcomes could be achieved through the collaboration of urologists with nephrologists.
Objective: Pancreatic fistula (PF) occurs often after pancreatoduodenectomy (PD) and can lead to further, serious complications. To clarify important predictors of early post-PD PF, we compared clinical variables between patients in whom no or low-grade PF (no fistula or PF-A) developed and patients in whom PF-B or PF-C developed. Patients and Methods: Included were 54 patients (39 men and 15 women; mean age, 68.7±10.4 years) who underwent PD at our hospital between July 2011 and July 2016. We divided the patients between those in whom no PF or PF-A developed and those in whom PF-B or PF-C developed. We performed between-group comparisons of clinical factors, including especially body mass index; operation time; intraoperative blood loss volume; and C-reactive protein (CRP) concentrations, drain amylase (D-AMY) levels, and procalcitonin (PCT) levels on postoperative days (PODs) 1 and 4. We also compared clinical variables betwen the 2 groups of patients and performed an ROC analysis of laboratory factors shown to be significant by univariate and multiple regression analyses. Results: Significant between-group differences were found in overall complications, infectious complications, length of the hospital stay, pancreatic vs. non-pancreatic disorders, relative pancreatic stiffness (hard/soft), size of the pancreatic duct tube, and the CRP concentration on POD 4. Multiple regression analysis showed pancreatic disease (vs. non-pancreatic disease) to be significantly related to occurrence of PF-B. ROC analysis of CRP revealed a POD 4 concentration of 10.9 mg/mL to be predictive of post-PD PF. ROC analysis of the D-AMY levels on PODs 1 and 4, which were also found to be significant, showed levels of 2,257 U/L and 405 U/L, respectively, to be predictors of PF. Conclusion: PF is the most challenging early post-PD complication. The predictive factor PF-B was the only non–pancreatic disease in multivariate analysis. It appears that post-PD PF can indeed be predicted and that a CRP concentration of 10.9 mg/mL by POD 4 should be considered a signal for drain removal.
Metaplastic carcinoma accounts for only 1% of all breast cancer. Low-grade adenosquamous carcinoma (LGASCa) of the breast belongs to the family of metaplastic carcinomas. Here, we report on a case of LGASCa coexisting with sclerosing adenosis (SA). The patient was a 66-year-old woman. Eight years previously, she had an excisional breast biopsy in a hospital and was diagnosed with SA of her left breast. Three years ago, she presented to our hospital with deformity of the left nipple. We performed a core needle biopsy (CNB) and diagnosed SA. One year ago, a rebiopsy by CNB was performed because of the appearance of cysts in her left breast and worsening of the deformity of the left nipple. The diagnosis of the CNB was SA again. A third CNB was performed 4 months ago because the physical findings suggested malignancy; however, the CNB specimen was diagnosed as SA again. We decided to perform total mastectomy for the final diagnosis. Gross examination of the mastectomy material showed multiple cysts, the largest of which measured 3.3 × 2.2 × 2.0 cm. Histologically, the tumor was an irregularly shaped mass with duct proliferation and multiple cysts. The infiltrating tumor cells were scattered at the tumor periphery, and some infiltrating tumor cells resembled squamous cells. The tumor cells consisted of two types: one cell type was immunopositive for cytokeratin(CK)14 and p63, and the other cell type was immunopositive for CK14 and immunonegative for p63. Based on the histological and immunohistochemical findings, the diagnosis was LGASCa coexisting with SA and multiple cysts of the breast.