Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence.

PURPOSE: Recently, bail-out cholecystectomy (BOC) during laparoscopic cholecystectomy to avoid severe complications, such as vasculobiliary injury, has become widely used and increased in prevalence. However, current predictive factors or scoring systems are insufficient. Therefore, in this study, we aimed to test the validity of existing scoring systems and determine a suitable cutoff value for predicting BOC. METHODS: We retrospectively assessed 305 patients who underwent laparoscopic cholecystectomy and divided them into a total cholecystectomy group (n = 265) and a BOC group (n = 40). Preoperative and operative findings were collected, and cutoff values for the existing scoring systems (Kama's and Nassar's) were modified using a prospectively maintained database. RESULTS: The BOC rate was 13% with no severe complications. A logistic regression analysis revealed that the Kama's score (odds ratio, 0.93; 95% confidence interval 0.91-0.96; P < 0.01) was an independent predictor of BOC. A cutoff value of 6.5 points gave an area under the curve of 0.81, with a sensitivity of 87% and a specificity of 67%. CONCLUSIONS: Kama's difficulty scoring system with a modified cutoff value (6.5 points) is effective for predicting BOC.

[Late recurrence of gastric cancer diagnosed 10 years after curative gastrectomy: a review of 30 Japanese case reports].

A woman in her 50s was referred to our hospital with intestinal obstruction. Ten years prior, she had been treated for gastric cancer, pathologically confirmed as stage IIIA poorly differentiated adenocarcinoma with signet-ring cell carcinoma. Intraoperatively, a 4-cm hard white tumor was found in the mesoileum and around the ileum. Pathological examination revealed poorly differentiated adenocarcinoma with signet-ring cell carcinoma and infiltration and fibrosis. Late peritoneal recurrence of gastric carcinoma was diagnosed. Recurrence of gastric carcinoma more than 10 years after curative gastrectomy is extremely rare. A review of 30 cases reported in Japan revealed recurrence was more frequent in females (60%) and the mean age was around 50 years at the time of primary surgery. Poorly differentiated adenocarcinoma and/or signet-ring cell carcinoma was the primary gastric cancer in 82% of cases and bone metastasis was the most frequent site of recurrence.

Modulation of prism adaptation by a shift of background in the monkey.

Recent human behavioral studies have shown that the position of a visual target is instantly represented relative to the background (e.g., a large square) and used for evaluating the error in reaching the target. In the present study, we examined whether the same allocentric mechanism is shared by the monkey. We trained two monkeys to perform a fast and accurate reaching movement toward a visual target with a square in the background. Then, a visual shift (20mm or 4.1°) was introduced by wedge prisms to examine the process of decreasing the error during an exposure period (30 trials) and the size of the error upon removal of the prisms (aftereffect). The square was shifted during each movement, either in the direction of the visual displacement or in the opposite direction, by an amount equal to the size of the visual shift. The ipsilateral shift of the background increased the asymptote during the exposure period and decreased the aftereffect, i.e., prism adaptation was attenuated by the ipsilateral shift. By contrast, a contralateral shift enhanced adaptation. We further tested whether the shift of the square alone could cause an increase in the motor error. Although the target did not move, the shift of the square increased the motor error in the direction of the shift. These results were generally consistent with the results reported in human subjects, suggesting that the monkey and the human share the same neural mechanisms for representing a target relative to the background.