Pathophysiology and surgical outcomes of patients with fungal peritonitis from upper gastrointestinal tract perforation: a retrospective study.

PURPOSE: To compare the pathophysiology and surgical outcomes of emergency surgery for upper gastrointestinal tract perforation with and without fungal peritonitis and identify the risk factors for fungal peritonitis. METHODS: The subjects of this retrospective study were patients with upper gastrointestinal perforation and peritonitis who underwent emergency surgery at a single medical center in Japan. The patients were allocated to two groups according to the presence or absence of fungal peritonitis: group F and group N, respectively. RESULTS: At the time of surgery, ascitic fluid culture or serum ß-D glucan levels were available for 54 patients: 29 from group F and 25 from group N, respectively. The stomach was perforated in 14 patients (25.9%) and the duodenum was perforated in 40 patients (74.1%). Group F had a higher proportion of patients with low preoperative prognostic nutritional index scores (≤ 40) and C-reactive protein levels and a higher postoperative complication rate. The time to initiate food intake and the postoperative hospital stay were also significantly longer in group F. Multivariate analysis identified that the perforation site of the stomach was a risk factor for fungal peritonitis. CONCLUSION: Patients with fungal peritonitis from upper gastrointestinal tract perforation had higher postoperative complication rates, delayed postoperative recovery, and a longer hospital stay. Gastric perforation was a risk factor for fungal peritonitis.

Prognostic significance of preoperative osteopenia on outcomes after gastrectomy for gastric cancer.

Aim: Osteopenia, characterized by low bone mineral density, is a potential prognostic factor for patients with cancer. The aim of this study was to clarify the impact of preoperative osteopenia in patients with gastric cancer (GC) after gastrectomy. Methods: We included 224 patients with GC who underwent gastrectomy between August 2013 and May 2022. Osteopenia was evaluated by measuring the pixel density in the mid-vertebral core of the 11th thoracic vertebra using computed tomography. Results: Osteopenia was identified in 68 patients (30%). The osteopenia group had significantly worse overall survival (OS) and disease-free survival (DFS) than the non-osteopenia group (P < .01, P < .01, respectively). The postoperative hospital stay was significantly longer, and the occurrence of postoperative complications (Clavien-Dindo grade ≥ III) was significantly higher in the osteopenia group (P = .04, P < .01, respectively). In multivariate analysis, osteopenia (P < .01), stage ≥II (P < .01), and R1 or R2 curability (P < .01) were independent and significant predictors of DFS. Additionally, osteopenia (P < .01), intraoperative blood loss (P = .04), stage ≥II (P < .01), and R1 or R2 curability (P < .01) were independent and significant predictors of OS. Conclusion: Preoperative osteopenia was independently associated with a poor prognosis and recurrence in patients who underwent gastrectomy for GC.

Features of Microcalcifications on Screening Mammography in Young Women

Background: There is no decrease in the number of breast cancer deaths if screening mammography is performed in women aged <40 years. However, NCCN guidelines recommend screening mammography in young women at risk of hereditary breast cancer. Therefore, more accurate screening mammography for young women is needed. Objective: To evaluate the features of screening mammographic findings, particularly microcalcifications, in women aged <50 years to increase the positive predictive value of screening mammography in young women. Methods: We retrospectively reviewed the data of consecutive women who underwent opportunistic and organized breast cancer screening at the Sakuragaoka Hospital (Shizuoka, Japan) between April 2013 and March 2015. We compared the mammographic findings and features of microcalcifications between women aged <40 and 40­49 years and those aged 50­74 years. Results: The study included 3645 women. Of these 3645 women, 415 (11.4%) were aged <40 years, 1219 (33.4%) were aged 40­49 years, and 2011 (55.2%) were aged 50­74 years. Women aged <50 years were more likely to be recalled for microcalcifications than those aged 50­74 years (<40 years, 4.8%; 40­49 years, 4.3%; 50­74 years, 3.3%). Young women were more likely to be recalled for small round and segmental microcalcifications [<40 years, odds ratio (OR): 1.799 (95% CI: 0.751­2.846); 40­49 years, OR: 1.394 (95% CI: 0.714­2.074)] and less likely to be recalled for small round and grouped microcalcifications [<40 years, OR: 0.603 (95% CI: 0.181­1.025); 40­49 years, OR: 0.961 (95% CI: 0.496­1.428)] compared with women aged 50­74 years. Conclusions: On screening mammography, women aged <50 years had a higher tendency to be recalled for microcalcifications, particularly small round and segmental microcalcifications. False-positive results may be reduced by reflecting the characteristics of microcalcification findings among young women without breast cancer in the future.

Mutagenicity of water-soluble FePt nanoparticles in Ames test.

A mutagenicity test was conducted on water-soluble FePt nanoparticles capped with tetramethylammonium hydroxide in a bacterial reverse mutation assay using Salmonella typhimurium strains TA98, TA100, TA1535 and TA1537, and Escherichia coli strain WP2uvrA/pKM101, with and without metabolic activation by S9 mix in the preincubation method. Mutagenicity was weakly positive in the TA100 strain without S9 mix (maximum specific activity was 61.6 revertants/mg), but negative in other cases.

Diffusion properties of point defects in barium strontium titanate thin films.

The relationship between the diffusion behavior of hydrogen and the electrical properties of (Ba, Sr)TiO3 (BST) thin-film capacitors was investigated using thermal desorption spectroscopy and secondary ion mass spectroscopy analyses. It has been clearly shown that the frequency dependence of the complex impedance profile of the BST thin-film capacitors could be successfully represented by two parallel resistor-capacitor (RC) electrical equivalent networks in series correlated with the distribution of the hydrogen, namely, the Pt/BST interface region with the influence of hydrogen and the BST bulk region without the influence of hydrogen. However, the I-V properties of the BST thin-film capacitors could be determined almost from the hydrogen atoms existing at the Pt/BST interface.

Mesorectum amputation technique for laparoscopic anterior resection.

The objective of this study was to assess our original procedure, the cutting off method (COM), where the rectum and mesorectum are cut off with an autosuture device simultaneously in laparoscopic anterior resection. From 2001 to 2003, laparoscopic anterior resection was performed in 21 patients at our institution using the COM (n = 14) and trimming method (TM; n = 7). We reviewed the medical records for operative duration, intraoperative blood loss, and postoperative complications. The operation lasted 165 minutes (range, 140-215 minutes) in the TM group, but only 120 minutes (range, 95-135 minutes) in the COM group (P < 0.01). Intraoperative blood loss was 90 ml (range, 60-140 ml) in the TM group and 30 ml (range, 5-90 ml) in the COM group (P < 0.01). There were no postoperative complications in the COM group, although one complication of minor leakage was observed in the TM group.

Anastomosis Procedure through an Inguinal Hernia Incision in Simultaneous Laparoscopic Anterior Resection and Inguinal Hernia Repair.

For laparoscopic anterior resection, an additional small incision is usually placed in the left lower quadrant or the suprapubic portion. As a left inguinal hernia incision is close to both the left lower quadrant and the suprapubic portion, such an incision can be used for anastomosis in laparoscopic anterior resection, without additional incisions. We report a laparoscopic anterior resection using a left inguinal hernia incision for colorectal anastomosis, in a patient who underwent concomitant left inguinal hernia repair. After a total mesorectal excision was performed laparoscopically, the distal portion of the rectum was transected by a stapler. A 4 cm skin incision was made in the left inguinal region and carried down to the peritoneum through the hernia sac. The bowel resection was performed extracorporeally, and an anvil was placed at the proximal end of the colon over a purse-string suture. After colorectal anastomosis was performed using a circular stapler inserted through the anus, the inguinal hernia was repaired with a mesh. The inguinal wound healed without surgical site infection, and the patient was discharged ten days after surgery.