Four cases of villous adenoma of rectum in our department : Comparative study of 88 cases of villous adenoma in Japan

We reviewed the charts of 4 patients with villous adenoma of the rectum seen at the First Dept. of Surg., Okayama Univ. Med. School between 1971 and 1990. This study included 2 men and 2 women, ranging in age from 52 to 83 years. Polypectomy was performed on 3 patients with villous adenoma and low anterior resection was performed on 1 patient. Recurrent tumors developed in one of the 3 patients who had undergone polypectomy. In addition, a series of 88 patients with villous adenoma of the rectum reported in Japan were also reviewed. The average age of the patients with villous adenoma was 62.9. There were 47 men and 41 women. The presenting symptoms of the 69 patients with tumor were mainly bleeding and watery or mucinous diarrhea. The tumor size and invasiveness of malignancy were also examined. The likelihood of malignancy correlated with size of tumor, and none of the lesions smaller than 2cm contained a malignant tumor site. Surgeons should consider the size, location and malignant change of the villous tumor with as much precise examination before and during operation so that unnecessary over surgery is avoided

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era