An Investigation of Early Death Following the Operation for Lung Cancer

In our clinic 212 patients with primary lung cancer had undergone lung resection during 12 years from April 1977 to March 1989. The authors reviewed 41 patients who died within a year after operation. Twenty-eight deaths were from cnacer ; 13 from other causes. We inquired, from the view-point of operative indication and postoperative measurement, what points should be payed attention to in order that the operation performed may indeed benefit the treatment for lung cancer. Conclusions are that the following measures are essential to take precaution against the early death after operation : (1) strict preoperative assessment of the stage of cancer ; (2) avoiding reduction surgery-absolutely non-curative resection ; (3) keeping the blood volume transfused during and after operation as minimum as possible ; (4) preventing atelectasis immediately after operation ; (5) and preventing postoperative aspiration and alimentary tract bleeding

Complications and Management of Hepatic Arterial Infusion Chemotherapy for Liver Metastasis

Complications and management of hepatic arterial infusion chemotherapy for 79 patients with liver metastasis were studied. Complications were observed in 20 cases (25.3%), who included 8 cases (88.9%) of lapalotomy group and 12 cases (17.6%) of left subclavian group. In lapalotomy group, they were 5 cases of system occlusion, 2 cases of catheter tip dislocation and catheter reinsertion through the left subclavian artery was performed in 4 cases. In left subclavian group, they were 4 cases of system occlusion, 3 cases of catheter tip dislocation, 2 cases of hepatic arterial occlusion and hepatic arterial infusion chemotherapy was continued with catheter reinsertion in 8 of the 9 cases. It was considered that positive anti-complication measures including catheter reinsertion would contribute to the improvement of therapeutic results

Mixed HCV Infection of Genotype 1B and Other Genotypes Influences Non-response during Daclatasvir + Asunaprevir Combination Therapy

Daclatasvir (DCV) + asunaprevir (ASV) combination therapy has become available for patients with hepatitis C virus (HCV) serogroup 1 infection. We studied the efficacy of this therapy by focusing on the factors associated with sustained virological responses (SVR) including resistance-associated variants (RAVs) and mixed infection of different HCV genotypes. We enrolled 951 HCV serogroup 1-positive patients who received this combination therapy at our hospital or affiliated hospitals. The presence of RAVs in non-structural (NS) regions 3 and 5A was analyzed by direct sequencing. HCV genotypes were determined by PCR with genotype-specific primers targeting HCV core and NS5B regions. SVR was achieved in 91.1% of patients. Female sex, age > 70 years, and RAVs were significantly associated with non-SVR (p<0.01 for all). Propensity score-matching results among the patients without RAVs regarding sex, age, and fibrosis revealed that mixed HCV infection determined by HCV NS5B genotyping showed significantly lower SVR rates than 1B-mono infection (p=0.02). Female sex and RAVs were significant factors associated with treatment failure of this combination therapy for patients with HCV serogroup 1 infection. Mixed HCV infection other than 1B-mono infection would be useful for predicting treatment failure

Application of double stapling technique after anterior resection for rectal cancer

Double stapling technique (DST) were applied in 22 cases who underwent low and high anterior resection of the rectum. Postoperative complications were encounted in six, three were mild strictures and the other three were minor leakages. All were not severe, demonstrating no correlation to the conditions of the anastomosis and subsided by conservative therapy in a short period. Anastomotic leakage occurred in three but these were based on technical problems and it is possible to avoid with careful surgical management. In conclusion, DST is of great benefit for the treatment of carcinoma of the rectum to reduce the consuming operation time and to lessen the risk of bacteriological and oncological contaminations

Prevalence and Outcomes of Acute Hepatitis B in Okayama, Japan, 2006-2010

Hepatitis B virus (HBV) is one of the major viruses causing acute hepatitis. Recently, the incidence of acute hepatitis with genotype A has been increasing in Japan. The aim of this study was to investigate acute hepatitis B (AHB) in Okayama prefecture, with special attention to HBV genotype A. AHB patients who visited one of 12 general hospitals in Okayama prefecture between 2006 and 2010 were retrospectively analyzed. Over the course of the study period, 128 patients were diagnosed with AHB. Sexual transmission was supposed in the majority of patients (78 patients, 61%), including 59 (76%) having sex with heterosexual partners. The genotypes of HBV were assessed in 90 patients (70%), of whom 27 patients were infected with genotype A, 5 with genotype B, and 58 with genotype C. The prevalence of genotype A was significantly higher among male patients (28.7%), aged 20-29 (35.6%, p＜0.01), among men who had sex with men (100%, p＜0.005), and among patients having sex with unspecified partners (44.8%, p＜0.005). Genotype A was not a significant factor associated with delayed HBsAg disappearance. Caution should be exercised with regard to sexually transmissible diseases in order to slow the pandemic spread of AHB due to genotype A

Surgery for Stage I Lung Cancer

The surgical outcome for 209 early lung cancers was clinically evaluated. 1) Most (93%) of Stage I cancers were composed of pT1N0 and pT2N0 while 6.3 % was pT1N0. 2) Even in early cancer, nodal involvement and distant metastasis occurred and these related closely to their prognoses. 3) Reoperation should be indicated for recurrence with a 10 month or more time interval from the first operation and should be recommended, if possible. Advances in diagnostic technique for lung cancer have been achieved. As a consequence, early lung cancer has become clinically detected and the surgical curability has been improved with time. This study was undertaken to evaluate surgical treatment for stage I lung cancer patients

Mortality rate of patients with asymptomatic primary biliary cirrhosis diagnosed at age 55 years or older is similar to that of the general population

Recent routine testing for liver function and anti-mitochondrial antibodies has increased the number of newly diagnosed patients with primary biliary cirrhosis (PBC). This study investigated the prognosis of asymptomatic PBC patients, focusing on age difference, to clarify its effect on the prognosis of PBC patients. The study was a systematic cohort analysis of 308 consecutive patients diagnosed with asymptomatic PBC. We compared prognosis between the elderly (55 years or older at the time of diagnosis) and the young patients (< 55 years). The mortality rate of the patients was also compared with that of an age- and gender-matched general population. The elderly patients showed a higher aspartate aminotransferase-to-platelet ratio, and lower alanine aminotransferase level than the young patients (P < 0.01 and P = 0.03, respectively). The two groups showed similar values for alkaline phosphatase and immunoglobulin M. Death in the young patients was more likely to be due to liver failure (71%), while the elderly were likely to die from other causes before the occurrence of liver failure (88%; P < 0.01), especially from malignancies (35%). The mortality rate of the elderly patients was not different from that of the age- and gender-matched general population (standardized mortality ratio, 1.1; 95% confidence interval, 0.6-1.7), although this rate was significantly higher than that of the young patients (P = 0.044). PBC often presents as more advanced disease in elderly patients than in the young. However, the mortality rate of the elderly patients is not different from that of an age- and gender-matched general population