Laparoscopic intraoperative navigation surgery for gastric cancer using real-time rendered 3D CT images.

PURPOSE: Recent advances in laparoscopic surgical technology have made it possible to perform advanced high-level surgery, such as lymph node dissection for malignancy. Grasping the anatomy during such procedures is important for a safe operation. We have developed a new image information system that provides three-dimensional (3D) reconstructed CT images synchronized with the motion of the laparoscope. This study assesses this new navigation system. METHODS: Enhanced CT using a custom-made software program can provide 3D angiography images reconstructed as a laparoscopic view. A motion sensor mounted on the laparoscope can detect the direction angle of the laparoscope. The real-time rendered 3D CT images are synchronized with the laparoscopic video images according to the motion of the scope. These 3D CT images are projected on another monitor close to the laparoscopic video monitor. Lymph node dissection can be performed with the help of the real-time navigation system that provides a detailed 3D view of the vasculature. RESULTS: Ten laparoscopic gastrectomies were performed using this navigation system. Real-time intraoperative navigation of the vasculature was available, allowing for an excellent surgical outcome. No complications occurred in this series. CONCLUSION: Our intraoperative navigation system allows for safe laparoscopic gastric lymph node dissection.

Assessing Community Cancer care after insurance ExpanSionS (ACCESS) study protocol.

BACKGROUND: Cancer is the second most common cause of mortality in the United States. Cancer screening and prevention services have contributed to improved overall cancer survival rates in the past 40 years. Vulnerable populations (i.e., uninsured, low-income, and racial/ethnic minorities) are disproportionately affected by cancer, receive significantly fewer cancer prevention services, poorer healthcare, and subsequently lower survival rates than insured, white, non-Hispanic populations. The Affordable Care Act (ACA) aims to provide health insurance to all low-income citizens and legal residents, including an expansion of Medicaid eligibility for those earning ≤138% of federal poverty level. As of 2012, Medicaid was expanded in 32 states and the District of Columbia, while 18 states did not expand, creating a 'natural experiment' to assess the impact of Medicaid expansion on cancer prevention and care. METHODS: We will use electronic health record data from up to 990 community health centers available up to 24-months before and at least one year after Medicaid expansion. Primary outcomes include health insurance and coverage status, and type of insurance. Additional outcomes include healthcare delivery, number and types of encounters, and receipt of cancer prevention and screening for all patients and preventive care and screening services for cancer survivors. DISCUSSION: Cancer morbidity and mortality is greatly reduced through screening and prevention, but uninsured patients are much less likely than insured patients to receive these services as recommended. This natural policy experiment will provide valuable information about cancer-related healthcare services as the US tackles the distribution of healthcare resources and future health reform. TRIAL REGISTRATION: Clinicaltrails.gov identifier NCT02936609.

Two patterns of clinical recovery in Guillain-Barré syndrome with IgG anti-GM1 antibody.

OBJECTIVE: To investigate the prognostic value of anti-GM1 antibody. BACKGROUND: Whether anti-GM1 antibody is a marker of poor prognosis due to axonal degeneration in Guillain-Barré syndrome (GBS) is a matter of controversy. METHODS: The clinical recovery of 41 consecutive GBS patients was analyzed. RESULTS: The Hughes functional grading scores were similar at the peak, and 1, 3, and 6 months after onset for the groups of patients with (n=19) and without (n=22) immunoglobulin (Ig) G anti-GM1 antibodies. However, the anti-GM1-positive group included significantly higher proportions of patients with poor recovery (inability to walk independently at 6 months, 5 of 19 versus 0 of 22; p=0.01) and those with a markedly rapid recovery (improvement by two or more Hughes grades within a month, 9 of 19 versus 4 of 22; p=0.05). The positivity of IgG anti-GM1 antibody correlated well with the electrodiagnosis of the acute motor axonal neuropathy pattern but was not always associated with poor prognosis. Anti-GM1-positive patients showed two different patterns of clinical recovery-their conditions improved slower or faster than those of the anti-GM1-negative patients, most of whom had acute inflammatory demyelinating polyneuropathy. CONCLUSIONS: Anti-GM1 antibody is not always a marker of poor prognosis and, besides axonal degeneration, early reversible effects other than demyelination could be part of the pathophysiology of Guillain-Barré syndrome with IgG anti-GM1 antibody.

Laparoscopy-assisted surgery: a new technique for transhiatal esophageal dissection.

Esophageal dissection under laparoscopic monitoring is performed during total esophagectomy to treat patients with cervical esophageal carcinoma. Using this technique, a safe esophageal dissection can be made from the surrounding mediastinal tissues. Some of the disadvantageous consequences of a blunt dissection, including the blind maneuver, may thus be prevented and various intraoperative and postoperative complications may be avoided.

Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy.

PURPOSE: Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy. Interventions to minimize fatigue are needed. The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide, methotrexate, and fluorouracil (CMF) or doxorubicin and cyclophosphamide (AC) for breast cancer. METHODS: Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention. Measures of functional ability, energy expenditure, and fatigue were obtained at baseline and posttest. Subjects maintained daily records of four types of fatigue, and exercise duration, intensity, and type. RESULTS: Exercise significantly reduced all four levels of fatigue (P < 0.01). As the duration of exercise increased, the intensity of fatigue declined (P < 0.01). There was a significant carry-over effect of exercise on fatigue, but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in. CONCLUSIONS: The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy.

17alpha-hydroxylase deficiency accompanied by adrenal myelolipoma.

A 45-year-old woman was admitted because of hypertension and hypokalemia. Primary amenorrhea from birth was noted. Plasma renin activity (PRA), 17alpha-hydroxyprogesterone and androgen levels were low, but progesterone, 11-deoxycorticosterone, corticosterone and adrenocorticotropic hormone (ACTH) were elevated, resulting in a diagnosis of 17alpha-hydroxylase deficiency. Abdominal magnetic resonance imaging revealed a round mass in the left adrenal region, the specimen of which was diagnosed as myelolipoma. After removal of the tumor, the blood pressure, serum potassium and hormone levels were unchanged, indicating an adrenal non-functioning tumor. Excessive ACTH secretion over a long period may stimulate the development of adrenal myelolipoma.

[Analysis of children with tuberculosis in the past 20 years].

To characterize the clinical features of childhood tuberculosis, we analyzed the symptoms, signs, and laboratory findings of the 89 children with tuberculosis admitted to the Yokohama City University Hospital from 1975 to 1994. Compared with the numbers of patients admitted from 1975 to 1979, those of patients of the past 5 years (from 1990 to 1994) were reduced by half. Of the 89 subjects, 56.2% were below 3 years of age and 24.7% were under 1 year of age. 51.7% had primary complex and 20.2% had serious tuberculosis (tuberculous meningitis 14.6%, miliary tuberculosis 3.4%, and bone and joint tuberculosis 2.2%). Tuberculous children below 3 years of age consisted of primary complex (60.0%) and serious tuberculosis (32.0%). The majority (86.0%) of tuberculous children below 3 years of age had not received BCG vaccination. In 55 (61.8%) of 89 subjects, the sources of tuberculosis were clarified. Of these subjects, 83.6% were infected in the family. The rate of BCG inocluation tended to decrease with decreasing age, especially that of children below 3 years of age was 14.0%. Of the 89 subjects, only 16.9% proved to be smear-positive. Taken together, in order to eliminate tuberculous children below 3 years of age, the following is necessary; (1) BCG inoculation in early infancy, (2) early diagnosis of index cases with adult tuberculosis, and (3) prompt and appropriate family contact examination.

Effect of recombinant human granulocyte colony-stimulating factor on combination therapy with aztreonam and clindamycin for infections in neutropenic patients with hematologic diseases.

The present multicenter study was performed to evaluate the effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on combination therapy using aztreonam (AZT) and clindamycin (CLDM) to treat severe infection in neutropenic patients with hematologic diseases. Forty-three neutropenic patients with infections (rhG-CSF group) were treated with AZT (2 g) and CLDM (600 mg) 2-3 times daily as well as rhG-CSF (Lenograstim or Filgrastim: 2-5 mu/kg/day). The clinical efficacy of this regimen was compared to that obtained in 44 febrile neutropenic patients, with hematologic diseases, who received only AZT and CLDM in a previous study (historical control group). The overall efficacy rate was 69.8% (30/43) in the rhG-CSF group and 65.9% (29/44) in the historical control group. Although the neutrophil count was significantly increased and C-reactive protein tended to be lower in the rhG-CSF group, the daily maximum body temperature profiles of the 2 groups were nearly the same. These results suggest that rhG-CSF is of little benefit in the treatment of single infectious episodes in neutropenic patients, and that appropriate antibiotic therapy is more important.

[A survey of the initial course of tuberculosis chemotherapy under compulsory hospitalization on the basis of the revised Tuberculosis Prevention Law--report of the 32nd C series of controlled trials of chemotherapy--Cooperative Study Unit of Chemotherapy of Tuberculosis of the National Sanatoria in Japan].

We studied 2247 patients with pulmonary tuberculosis who were hospitalized for the initial course of chemotherapy under the provision of the revised Tuberculosis Prevention Law issued by Japanese Ministry of Welfare. The results were as follows. 1) There were more males than females with a ratio of 2.6: 1. 2) There were two peaks in their ages, 20s and 60s. 3) The average admission periods were 5.2 +/- 2.7 months for men and 5.1 +/- 2.8 months for women. 4) The average compulsory admission periods were 6.8 +/- 2.5 months for men and 6.4 +/- 2.3 months for women, so that the actual admission periods were shorter in the majority of the patients. 5) The sputum cultures were converted negative in three months in about 80 percent of the patients who were smear and/or culture positive on admission. 6) The appearance rate of INH-resistant and RFP-resistant strains were 2% and 1.4% respectively. 7) Most of the death from tuberculosis was observed in the early stages of admission. 8) With regards to the cost, there seemed to be no difference whether treated under the new or the old provisions. 9) The newly approved extension of the admission periods for those who had complications such as diabetes mellitus or pneumoconiosis and those who had INH and/or RFP positive bacilli seemed to be appropriate.

[Study of optimal CHOP dose ranges for elderly patients with non-Hodgkin's lymphoma].

Two groups of intermediate-to high-grade non-Hodgkin's lymphoma patients aged 65 years and over were enrolled in a dose-range study of CHOP therapy utilizing 5 doses (1/2, 7/12, 2/3, 5/6, full CHOP): 11 patients 65-79 years of age (group A) and 9 patients 80 years or older (group B). The patients were enrolled consecutively; the study was designed so that if 3 patients completed 3 cycles of CHOP on schedule without major problems, the next highest dose was administered. If 2 patients experienced any major problems during 6 cycles at a given dose, treatment was discontinued and the dose prior to that particular dose was regarded as the optimal dose. The 6 treatment cycles were completed by 3 of 3 (2/3 CHOP), 3 of 4 (5/6 CHOP), and 1 of 4 (full CHOP) group A patients; and by 3 of 3 (1/2 CHOP), 2 of 3 (7/12 CHOP) and 1 of 3 (2/3 CHOP) group B patients. The results indicated that the optimal doses for group A and B were five-sixths and seven-twelfths of the standard CHOP dose, respectively.

[Health education and people's participation in health in Nicaragua: research on the profile, role and function of the "brigadistas populares" in health]. / Educazione sanitaria e partecipazione popolare in salute in Nicaragua: una ricerca su profilo, ruoli e funzioni dei brigadistas populares en salud.

The Nicaraguan democratic government has been building, since the defeat of somozism in 1979, a very extensive and uniform health system in the whole country, giving special attention to the problems of prevention and health education, promoting and utilizing a wide participation of the population. The most emblematic representative of the Nicaraguan model of participation is the Brigadista Popular en Salud, a voluntary figure in urban and rural areas, working along side the Sole National Health System. The work and role of the Brigadista is integrated in a health education action defined "Educaciòn Popular en Salud", intended as a dialogue through which the educator and educated, beginning with the specific political and economical social reality, accomplish work of observation, analysis and syntesis of the different phenomena that deal with health-sickness. The Brigadista is a member of the community that works voluntarily for the community to carry out health actions, in coordination with the "Puesto de Salud" of the community. The authors refer to a research study done in the field in 1987, geared to study the profile, role and activities of the Brigadista. The research was done in the "Las Segovias" Region, in the Northern part of the country, in two Health Areas, involving three urban centers and six rural communities: 73 Brigadistas were interviewed, of which 50 (predetermined) of urban centers and 23 (total population) in rural communities. The article represents in a comparative manner the operative Brigadista respectively, in urban areas on the one hand and in rural areas on the other. The article examines: sex; age; schooling; work activity; social-cultural background; collective systems background; participation in Literacy Campaigns; motivation; length and continuity of activities; relationship with the territory; activities done. The Brigadista that works in rural areas seems actually to be more attached, even to the formal image of his role, that the urban Brigadista. This is shown by the reduced turn-over, the wider span of functions, the closer relationship with collective systems that represent categories, a more intense relationship with colleagues of the health system as well as with other Brigadistas, the operative reference to specificity defined territories, more continuity in the functions of the Brigadista Popular en Salud.

Clinical outcome of pancreas transplantation from marginal donors in Japan.

In Japan, absolute shortage of donors still continues even after the law allowing organ transplantation from deceased donors came into force in 1997. With the passage of the waiting period after registration for pancreas transplantation (PTx), both deaths and serious cases of diabetic complications necessitating withdrawal of the registration have undoubtedly increased. Therefore, so-called "marginal donor" (MD) has been considered as a potential solution for shortage of donors in Japan. The aim of the present study is to evaluate feasibility of MD in terms of post-PTx outcomes using data from Japan Organ Transplantation Network. A total of 148 PTx were performed from deceased donors in Japan from 2000 to 2012. MD was defined as follows: (1) >45 years old; (2) hemodynamically unstable at harvest using a high-dose dopamine or more than 2 vasopressors; or (3) non-heart-beating status. Postoperative outcomes after PTx were compared between the MD group and the non-MD group. Among the 148 PTx donors, 108 donors (73.0%) satisfied the criteria of MD. Early graft loss of pancreas graft during 3 months post-transplant was observed in 15 patients (10.1%), and the marginality (MD vs non-MD) was not significantly correlated with the early loss of pancreas graft. The overall patient survival of the MD group (1, 3, 5 years: 94.7%, 94.7%, 94.7%) was not significantly different from that of the non-MD group (1, 3, 5 years: 95.0%, 95.0%, 95.0%). Pancreas graft survival in the MD group (1, 3, 5 years: 80.9%, 73.2%, 66.0%) seemed to be slightly lower than that in the non-MD group (1, 3, 5 years: 92.5%, 85.2%, 77.4%), but no statistically significant differences were found between the 2 groups. These results suggest the feasibility of the use of MD for PTx.

Current and novel therapies for hepatitis B virus infection.

Many therapeutic reagents for hepatitis B virus infection have established efficacy in goals such as alanine aminotransferase normalization, hepatitis B virus DNA suppression, HBeAg seroconversion, histological improvement, and reduce disease progression. However, it is not established that the efficacy of these reagents for the long-term survival and prevention of hepatocellular carcinoma although recent meta-analyses have also shown antiviral therapy to be efficacious. This article reviews the current status and innovative new options for antiviral therapy for hepatitis B and also discusses the various mechanisms of action for each drug, the results of clinical studies for each therapy, and the problems yet to be solved with respect to hepatitis B treatment.

Living donor liver transplantation for congenital absence of the portal vein.

The congenital absence of the portal vein (CAPV) is a rare venous malformation in which mesenteric venous blood drains directly into the systemic circulation. Liver transplantation (OLT) may be indicated for patients with symptomatic CAPV refractory to medical treatment, especially due to hyperammonemia, portosystemic encephalopathy, hepatopulmonary syndrome, or hepatic tumors. Because portal hypertension and collateral circulation do not occur with CAPV, significant splanchnic congestion may occur when the portocaval shunt is totally clamped during portal vein (PV) reconstruction in OLT. This phenomenon results in severe bowel edema and hemodynamic instability, which negatively impact the patient's condition and postoperative recovery. We have successfully reconstructed the PV in living donor liver transplantation (LDLT) using a venous interposition graft, which was anastomosed end-to-side to the portocaval shunt by a partial side-clamp, using a patent round ligament of the liver, which was anastomosed end-to-end to the graft PV with preservation of both the portal and caval blood flows. Owing to the differences in anatomy among patients, at LDLT for CAPV liver transplant surgeons should seek to preserve both portal and caval blood flows.

Estética em prótese dentária / Esthetics in prosthetic dentistry

A harmonia facial é vitalmente influenciada pela aparência bucal, sendo que a restauração das estruturas orais perdidas deve estar direcionada à beleza natural. As funções da dinâmica da estética natural devem ser utilizadas para a criação dos parâmetros estéticos naturais. Uma prótese estética deve manter os traços faciais típicos, o perfil, a forma e suporte dos lábios e a harmonia ao sorrir, o que resulta numa fisionomia do paciente rotulada como agradável. O sorriso é uma das mais belas e importantes expressões faciais, sendo, por isso, essencial nas expressões de felicidade, humor, amizade, concordância e apreciação. Seja qual for a emoção, o sorriso tem uma função importante para a sociedade e, por uma série de razões que envolvem à Psicologia, faz com que tanto o doador quanto o receptor do sorriso tenham sensações positivas. Nesse contexto, a reabilitação bucal realizada pelo Cirurgião-Dentista, com maior ou menor amplitude, é de extrema importância na obtenção desses resultados. Assim, o objetivo deste trabalho é de proporcionar ao clínico considerações sobre a estética dental, aliada à fisiologia do sorriso

Facial harmony is vitally influenced by oral appearance, the restoration of lost oral structures, should be directed to a natural beauty. The functions of the dynamics of natural aesthetics should be used for the creation of the natural aesthetic prosthesis parameters. An esthetic must keep the typical facial features, profile, shape and support of the lips and harmony in smiling, resulting in a patient's face labeled as enjoyable. The smile is one of the most beautiful and important facial expressions, and is therefore essential in expressions of happiness, humor, friendship, agreement and appreciation. Whatever the emotion, the smile has an important function for society and for a variety of reasons involving psychology and it makes both the giver and receiver of the smile have positive feelings. In this context, oral rehabilitation conducted by the dentist, has an extreme importance in obtaining these results The objective of this work is to provide clinical considerations on dental aesthetics combined with physiology smile

Lifestyle-related risk factors for total and cancer mortality in men and women.

We conducted a 14-year follow-up study to analyze the hazard ratio (HR) of mortality regarding lifestyle-related factors in Saga Prefecture, Japan. The subjects included 2,170 people, who were randomly selected from men and women aged from 40 to 69 years old, and who also completed the standardized questionnaire on lifestyle in 1983. Information about death and corresponding data were obtained either by mail and/or through the city offices in 1997. We found that a lower body weight, a lower physical fitness level, not consuming a balanced diet, and cigarette smoking to be significantly elevated risks for all-causes of death in males after adjustment by age and health status. In addition, these results did not change even after excluding subjects for early death. The HR of the female subjects who quit smoking was significantly high, although it changed to insignificant after excluding subjects for early death. These results suggested that being underweight might be an index of a positive risk of death, while maintaining a higher physical fitness level, being careful to consume a more balanced diet, and non smoking all appear to be indexes of a negative risk of death. In addition, these results might also be considered good evidence for improving poor health habits in health promotion activities.

[Familial Behçet's disease--a case report].

We reported a case of mother and child affected with Behçet's disease. Both had recurrent oral ulcer, erythema nodosum and arthralgia. Neither had gastrointestinal manifestation nor central nervous system involvement. The mother represented positive pathergy test, but the child did not. Laboratory data suggested no severe sign of inflammatory reaction and increased levels of immunoglobulin D. She was diagnosed as incomplete form, and he was diagnosed as suspicious form of Behçet's disease. On HLA examination, they had common haplotypes of HLA A24, B61, Cw1 and DR8. Additionally, haplotypes of HLA B7, Cw7, DR1, DQ1, were also detected in the mother, and HLA A2, Cw3, DR12, in the child. HLA-B51, which is primarily associated with Behçet's disease, was failed to be demonstrated. Familial involvement of Behçet's disease were described in only 20 cases, 11 of which had positive HLA B51. These findings suggest that molecular genetic examinations for both class I and II antigens will be necessary for a case of familial involvement.