Association between hand muscle thickness and whole-body skeletal muscle mass in healthy adults: a pilot study.

[Purpose] Handgrip strength is a surrogate indicator for assessing disease-related and age-related skeletal muscle loss. Clinical utility as such a surrogate can be at least partially explained by the close relationship between handgrip strength and whole-body skeletal muscle mass. The handgrip strength is related to hand muscle size. Thus, the present study examined whether hand muscle thickness is associated with whole-body skeletal muscle mass. [Subjects and Methods] Thirty healthy male adults participated in this study. All subjects were right-hand dominant. Two muscle thicknesses (lumbrical and interosseous muscles) in the right hand were measured using ultrasonography. Whole-body and appendicular skeletal muscle masses were assessed using dual-energy X-ray absorptiometry. [Results] Although lumbrical muscle thickness was not correlated with whole-body skeletal muscle mass, there was a significant correlation with appendicular skeletal muscle mass. Furthermore, interosseous muscle thickness was significantly correlated with both whole-body and appendicular skeletal muscle masses. [Conclusion] The present findings suggest that two muscle thicknesses in the hand are related to whole-body and/or appendicular skeletal muscle mass in healthy adults. Therefore, we propose that despite being smaller than other limb muscles, hand muscle thickness may be useful as surrogate indicator for assessing disease-related and age-related skeletal muscle loss.

Laparoscopic treatment for inguinal hernia combined with cryptorchidism: Totally extraperitoneal repair with orchiectomy under the same operative view.

INTRODUCTION: Approximately 7% of child patients with inguinal hernias also present with cryptorchidism. On the other hand, combined adult cases are uncommon. Here we report two adult cases of inguinal hernia combined with intra-canalicular cryptorchidism who underwent totally extraperitoneal (TEP) repair with orchiectomy under the same operative view. PRESENTATION OF CASES: We treated two patients (49- and 38-year-old men) with right indirect inguinal hernias and cryptorchidism. Both patients underwent TEP repair with orchiectomy. In operative findings, an atrophic testis was drawn out with a hernia sac from the internal inguinal ring. After the testis was separated from the sac and cord structure was sheared, it was removed. The procedure did not require special techniques and devices. In both patients, the postoperative courses were satisfactory. DISCUSSION: To our knowledge, there has been only one such reported case till date which demonstrated the feasibility of TEP repair accompanied by orchiectomy. CONCLUSIONS: TEP repair with orchiectomy under the same operative view could be safely performed in adults with an inguinal hernia combined with extra-abdominal cryptorchidism. This procedure could be an option for the treatment of such adult patients.

Laparoscopy in the management of scirrhous gastric cancer.

BACKGROUND: Scirrhous gastric cancer frequently shows extensive tumor spread, and gastrectomy for cure of the disease is not possible in the presence of peritoneal dissemination, which is often overlooked by conventional computed tomography. The aim of this study was to evaluate our experience of 16 patients who underwent laparoscopy in the management of scirrhous gastric cancer, and to examine whether peritoneal dissemination could be diagnosed accurately by laparoscopy.METHODS: All patients had nonobstructed, nonbleeding scirrhous gastric cancer and had no evidence of metastatic disease by ultrasonography and computed tomography. Laparoscopy was performed under general anesthesia with CO(2) pneumoperitoneum. A Hasson trocar and two manipulating forceps were inserted, and the surfaces of the peritoneum, omentum, stomach, spleen, pancreas, liver, and diaphragm were examined.RESULTS: The mean time for laparoscopy was 20 min. Peritoneal dissemination was disclosed in 4 patients (25%), and systemic and intraperitoneal chemotherapy was done without laparotomy. In 12 patients, subsequent gastrectomy with a curative intent was successfully performed. Pathology revealed that the tumor diffusely invaded the whole thickness of the gastric wall; the mean size of resected tumors was 12 cm, and the mean number of positive nodes was 17. Nine patients died of the disease with a mean survival period of 10 months, and 7 patients were alive without recurrence during a mean follow-up period of 11 months.CONCLUSIONS: Laparoscopy is useful for the evaluation of peritoneal spreads of advanced gastric cancer, can avoid unnecessary laparotomy because of peritoneal dissemination, and is important for the choice of treatments in patients with scirrhous gastric cancer.

Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy.

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia.