An Assessment Rubric for a Resident Training Program in Surgery: A Single-Institution Experience.

Using a Collaborative Action Research model, our research team established a one-month clinical resident training program for first- and second-year clinical residents. We created and implemented an assessment rubric to assess the residents' progress toward independent practice in surgery, and thereby, to evaluate the program itself. The program included training in three areas: basic techniques and procedures in the operating room, surgical ward management, and academic activities. The rubric measured the residents' performance according to three achievement levels: Level 1 (demonstration), Level 2 (active help) and Level 3 (passive help). The program and rubric implementation began in June 2019 and continued until March 2020, when the program outcomes and shortcomings were analyzed. Among nineteen clinical residents, a total of nine clinical residents participated in the study. Most participants reached achievement Level 3 for their performance of basic techniques in the operating room. Finally, we discussed ideas for improvement and drafted plans for an improved rubric to complete the action research cycle. Our research team found the rubric to be a useful tool in evaluating the status of the new clinical resident training program.

Expanding on the professional role of dental hygienists as key managers of medical-dental and hospital-dental clinic collaboration in a local Japanese hospital without a dentistry department: From a questionnaire survey after a web seminar.

INTRODUCTION: Perioperative oral management (POM) was introduced into the Japanese universal health insurance system in 2012. Collaboration with dental clinics is important for hospitals without a dentistry department. A dental hygienist newly assigned as a member of the patient flow management centre led a seminar to promote collaboration via the web. This study represents the first step to explore the possible role of the hospital-based dental hygienist in the field of regional medical-dental cooperation of POM by assessing their willingness to participate in providing this type of care by a survey. METHODS: The rate of attendees' satisfaction and the current problems of the collaboration for POM were evaluated through a questionnaire survey after the web seminar. RESULTS: All respondents reported satisfaction with the web seminar although it was the first experience of an online seminar for half of the respondents. All hospital dentists, but only 47.8% of dentists working at clinics, had participated in POM. Dental hygienist tended to show greater desire to participate in POM than dentists. All respondents appreciated the role played by the dental hygienist as a key manager of medical-dental collaboration between the hospital and local clinics. CONCLUSION: The hospital-based dental hygienist can play a role in planning and management of web seminars for POM, to raise awareness and promote regional medical-dental cooperation of POM.

Totally laparoscopic colectomy with intracorporeal anastomosis for colonic liposarcoma: A case report.

Liposarcoma is a type of soft tissue sarcoma. Primary colonic liposarcomas are extremely rare. An 86-year-old man with diarrhea and anorexia visited our outpatient clinic at Okayama City Hospital. Colonoscopy and computed tomography imaging revealed a large submucosal tumor in the descending colon with a maximum diameter of approximately 10 cm. He underwent totally laparoscopic left hemicolectomy with intracorporeal anastomosis. The histopathological diagnosis was a well-differentiated liposarcoma without lymph node metastases. The patient's postoperative course was uneventful. We herein report a rare case of totally laparoscopic colectomy with intracorporeal anastomosis in an elderly patient with colonic liposarcoma.

An experience of total laparoscopic partial colectomy with intracorporeal triangulating anastomosis in an obese patient with descending colon cancer.

A 68-year-old woman was transferred to the emergency room of Okayama City Hospital because of worsening epigastric pain. After the examination, she was diagnosed with descending colon cancer, and laparoscopic colectomy was planned. However, exteriorization of the bowels to produce anastomosis was difficult because the rich adipose tissue of the mesocolon hardly stretched, and the abdominal wall was thick as the patient was obese. Therefore, an intracorporeal triangulating end-to-end anastomosis was performed. The colon was divided at 10 cm either side from the tumor using an endoscopic linear stapler. After the resection of the stumps with staples, the posterior walls were tied with stay sutures and then stapled with an endoscopic linear stapler. The anterior wall was stapled twice in the same manner, and the intracorporeal anastomosis was completed. The patient's postoperative course was uneventful. This technique provided an alternative intracorporeal anastomotic technique as troubleshooting in laparoscopic colectomy.

[Experiences and Problems Related to the Acceptation of Terminal Cancer Patients in the Regional Hospital of a Depopulated Area].

We provided palliative care for 2 patients with terminal rectal and esophageal cancer in the regional hospital of a depopulated area. Insufficient health resources, utilization of healthcare support services, lack of opportunities among medical staff for receiving education about palliative care, the building of relationships with concerned medical traders, and the building of trust with patients were found to be the problems that need to be addressed in the future.

Incarcerated Amyand's Hernia.

A 76-year-old Japanese man was transferred to our hospital to undergo rehabilitation after traffic accident-related injuries. Seven days post-admission, he presented with abdominal pain and an 8-cm lump in the right inguinal region. He was diagnosed with an incarcerated inguinal hernia and underwent elective surgery the day after manual reduction. He had a normal vermiform appendix which was observed to have adhered to the right indirect hernia sac. An appendectomy and hernia repair using lightweight mesh were performed. We discuss the surgical management of this rare incarcerated Amyand's hernia and the relevant literature.

A Rare Case of Gastrojejunocutaneous Fistula after Percutaneous Endoscopic Gastrostomy.

We report a rare case of fistulation to the jejunum after percutaneous endoscopic gastrostomy (PEG). An 85-year-old man with previous cerebral infarction and swallowing disturbance underwent PEG. Nine months later, he developed a high fever and discharge around the gastrostomy button. He was diagnosed with aspiration pneumonia, and administered antibiotic therapy. Examination showed digestive fluid around the gastrostomy button. Gastrointestinal contrast-enhanced CT revealed a gastrojejunocutaneous fistula. The button was removed, and the fistula closed naturally. PEG was performed again. The patient's postoperative course was uneventful. Gastrojejunocutaneous fistula should be considered in cases involving increased discharge from a gastrostomy fistula.

Effective management of an advanced gastric cancer patient by TS-1 combined chemotherapy using nasojejunal tube and successful transfer to home care after percutaneous transesophageal gastro-tubing (PTEG): a case report.

A 67-year-old woman with debilitation and massive ascites was admitted to our hospital and diagnosed with stage IV scirrhous gastric cancer with peritoneal dissemination. After successful nasojejunal tube feeding because of oral intake disability, TS-1 combined with paclitaxel chemotherapy was selected. TS-1 at 80mg/m2 was given daily via nasojejunal tube for 2 weeks, followed by a 1-week rest, and paclitaxel at 50mg/m2 was administered intravenously on day 1 and 8. There were no serious side effects. After 4 cycles, a partial response was observed and percutaneous transesophageal gastrotubing (PTEG) was placed. After the fifth cycle, she was transferred to her home and received chemotherapy in an outpatient clinic. After 7 cycles, the disease progressed, and TS-1 combined with low-dose cisplatin was administered for 3 cycles. However, the patient died 16 weeks after discharge. PTEG was useful not only for a route of TS-1 administration, but also for receiving chemotherapy at home to maintain her quality.

Efficacy and tolerability of weekly paclitaxel in combination with high-dose toremifene citrate in patients with metastatic breast cancer.

Toremifene citrate is expected to prevent drug resistance in cancer patients by inhibiting p-glycoprotein activity. The safety and efficacy of combination therapy with high-dose toremifene citrate and paclitaxel were investigated. Between December 2003 and June 2004, 15 women with a mean age of 53 years old with metastatic breast cancer were enrolled. The administration schedule was 80 mg/m2 of paclitaxel given on Days 1, 8, and 15, and 120 mg/day of toremifene citrate orally administered starting on Day 18. On Days 32 and 39, paclitaxel was concurrently administered again. Toxicities, response rate, and time to treatment failure were assessed. All patients had been treated with endocrine or chemotherapy. Grade 3 leukopenia occurred in 2 patients on the administration of paclitaxel alone, and grade 3 febrile neutropenia occurred in 1 patient given the combination therapy. There was no grade 3 or greater non-hematological toxicity. There was no complete response and 1 partial response, producing a response rate of 6.7%. Median time to treatment failure was 2.7 months. Combination therapy of paclitaxel and toremifene was safe and well tolerated with minimal toxicity. Further clinical trials targeting patients with functional p-glycoprotein are warranted.

Is the diameter or chirality distribution of single-walled carbon nanotubes selected in the synthesis process?

Based on recent theoretical photoluminescence intensity calculations, the population densities of sixteen semiconducting single-walled carbon nanotubes grown by alcohol catalytic chemical vapor deposition were estimated for two different temperatures. The profiles of population density merely as functions of tube-diameter or chiral angle are found to be widely scattered. However, systematic profiles are detectable when separately split into (2n + m), (n + 2m) and (n - m) family arrays. Apart from these well-knit family behaviors, the population densities of the group of nanotubes forming another three possible series [viz. constant-n, constant-m and constant-(n + m)] also show evidence of good correlations. Hence, a two-dimensional chiral-zone selective growth principle is hypothesized.

Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer.

PURPOSE: Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery. METHODS: Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications. RESULTS: There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance. CONCLUSIONS: Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.

Pharmacokinetic analysis of a combined chemoendocrine treatment with paclitaxel and toremifene for metastatic breast cancer.

BACKGROUND: Multidrug resistance protein could be a target for improving the efficacy of paclitaxel (PXL). Toremifene (TOR) may moderate P-gp-related drug resistance in vitro. Some P-gp moderators may change the pharmacokinetic parameters of PXL in vivo. A pharmacokinetic (PK) study in metastatic breast cancer patients (MBC) was conducted to determine the safety and efficacy of PXL and TOR. METHOD AND PATIENTS: Fifteen patients received 80 mg/m(2) PXL (i.v.) weekly and 120 mg/body TOR (p.o.) daily. For the pharmacokinetic study, PXL was administered on days 1, 8, 15, 32, and 39; TOR was given from day 18 to the end of study. On days 1, 8, 15, 18, 32, and 39, blood samples were collected from the patients who received either PXL alone or PXL + TOR, and these were analyzed by high-performance liquid chromatography. RESULTS: Among the 15 patients enrolled in the study, one showed a partial response, and eight had a stable disease. TOR caused no specific adverse events that were greater than grade 3, and its toxicity profile in combination with PXL was similar to that of PXL monotherapy. The PK profile of PXL was similar with or without TOR. The PK parameters of PXL indicated no inter- or intra-patient variability in previously treated patients with MBC. No increased PXL toxicity was observed. CONCLUSION: The PK profile of combined PXL and TOR was similar to that of PXL monotherapy. The addition of TOR to PXL in previously treated patients with MBC appears safe.

Unusual abscesses associated with colon cancer: report of three cases.

Three cases of colon cancer accompanied by unusual abscess formation are reported. Case I : A 77-year-old man was diagnosed with a paracolic abscess formation behind the cecum and a swollen appendix by computed tomography (CT) scan. Case II : An 85-year-old woman was diagnosed with an abscess formation of the right iliopsoas muscle, a swollen appendix, and a thickened right colon wall by CT scan. After antibiotic therapy failed, both patients underwent ileocecal resection urgently under suspicion of appendicitis, but cecal cancer around the entrance to the appendix caused secondary appendicitis in both cases. Case III : A 50-year-old woman was diagnosed with sigmoid colon cancer with an abscess formation in the pelvic cavity concomitant with ovarian tumor. A Hartmann procedure was performed, and a pathological examination revealed that a subserosal abscess behind the sigmoid colon cancer perforated the rectum with abscess formation. All cases were definitively diagnosed intraoperatively. The cancer recurred in cases I and III. We emphasize that precise surgical evaluation has an important role in the diagnosis of these complicated diseases. In addition, surgery affords the patient the best chance of recovery, and in these advanced cases radical treatment is recommended as early as possible.

[Retrospective evaluation of the safety of pamidronate administration at the dose of 90 mg/day/month in Japanese breast cancer patients with bone metastasis].

The Japanese Ministry of Health, Labor and Welfare approved the use of pamidronate in November 2004 at a dose of 90 mg/day/month especially for Japanese breast cancer patients with lytic bone metastasis. But no safety data have been shown for these Japanese patients thus far. Therefore, we evaluated the safety of pamidronate treatment for breast cancer patients with bone metastasis at the dose of 90 mg/day/month since July 1, 2004 until Dec 31, 2004, retrospectively, in our institute, the Shikoku Cancer Center. No definite severe side effects were detected in these patients, including renal dysfunction and thrombocytopenia. In addition, there were no definite alternations in hemoglobin titers, platelet counts, BUN, serum creatinine and potassium levels in one month and 3 months after beginning the treatment except for significant alternations in RBC counts in one month and in the serum calcium level 3 months later (p=0.03). Improvements of clinical symptoms or data due to bone metastases, i.e., bone pain or elevation of tumor markers, were obtained in 91% of patients. As a conclusion, pamidronate administration at the dose of 90 mg/day/month was safe for Japanese breast cancer patients with bone metastasis.

Thymidine phosphorylase and dihydropyrimidine dehydrogenase expression levels in tumor and normal tissue specimens of T3 human colorectal carcinoma.

PURPOSE: Thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) are important enzymes related to the metabolism of 5-fluorouracil and its derivatives. We evaluated the association between the clinicopathological factors and these enzymes in patients with T3 colorectal carcinoma. METHODS: The TP and DPD expression levels in 15 patients with T3 colorectal carcinomas were measured in tumor and adjacent normal tissue specimens by enzyme-linked immunosorbent assay. Correlations between each enzyme and clinicopathological factors were also statistically evaluated. RESULTS: The TP levels in tumor and normal tissue specimens were 77.9 +/- 33.6 and 24.7 +/- 10.3, respectively (P < 0.001). The DPD levels in tumor and normal tissue specimens were 44.1 +/- 18.2 and 53.1 +/- 24.1, respectively (P = 0.46). The TP/DPD ratios in tumor and normal tissue specimens were 1.84 +/- 0.52 and 0.53 +/- 0.26, respectively (P < 0.001). The tumor/normal ratios of TP level in patients with and without liver metastasis were 1.79 +/- 0.91 and 4.67 +/- 2.51, respectively (P = 0.024). CONCLUSION: The measurement of the enzyme expression levels of TP and DPD is considered to be useful for better understanding the conditions of tumor progression. The mechanisms of regulation of these enzymes thus require further evaluation.