Adherences to oral nutritional supplementation among hospital outpatients: An online cross-sectional survey in Japan.

Oral nutritional supplements (ONS) are multi-nutrient products used to increase the energy and nutrient intakes of patients. The aim of this study was to examine whether or not the adherence of patients varies according to their receiving prescription or over-the-counter ONS. Data were obtained from an online cross-sectional survey conducted with patients in Japan. A total of 107 patients who matched the inclusion criteria for the prescription ONS group and 148 who matched the criteria for the over-the-counter ONS group were further analyzed. In the prescription and over-the-counter ONS groups, the main medical reason for ONS consumption were "malnutrition" (48 patients [44.9%] vs. 63 patients [42.6%] p = 0.798], "frailty" (29 patients [27.1%] vs. 36 patients [24.3%] p = 0.663) and "aging" (25 patients [23.4%] vs. 30 patients [20.3%] p = 0.644). The proportion of "No particular disease" for prescription ONS consumption was significantly lower than that for over-the-counter ONS (6 patients [5.6%] vs. 24 patients [16.2%] p = 0.001). The body mass index of the prescription ONS group was significantly higher than that of the over-the-counter ONS group (21.1±4.38 kg/m2 vs. 19.9±3.75 kg/m2, p = 0.0161). In the prescription ONS group, all patients were given medical advice by doctors or registered dietitians. In contrast, in the over-the-counter ONS group, only 46 patients (31.1%) were given advice by doctors or registered dietitians (p<0.001). In the prescription ONS group, ONS was taken significantly more times and for a longer duration than in the over-the-counter ONS group (p<0.0001). However, among patients given advice by doctors or registered dietitians, there were no significant differences between the groups. Greater support by the medical team is still needed in order to maximize adherence to supplementation, especially concerning the calories, timing and period, so that benefits can be achieved and sustained

Non-traumatic testicular dislocation mimicking incarcerated inguinal hernia in a one-year-old boy

Testicular dislocation usually results from trauma to the scrotum or abdominoperineal area. We herein report a case of non-traumatic testicular dislocation in a one-year-old male patient. The patient was referred to our hospital due to intermittent irritability and a palpable mass with erythema at the left groin. The differential diagnosis was incarcerated inguinal hernia and testicular torsion. We could not discriminate the former from the later even with contrast-enhanced computed tomography, so we performed exploratory laparoscopy. Although patency of the processus vaginalis was found on the left side, protrusion of the intraabdominal organs was not found. The definitive diagnosis of testicular dislocation was made after the inguinal canal was opened via oblique incision at the left groin. The testis was excised because of complete necrosis, and orchidopexy on the contralateral testis was performed. Physicians should be aware of the possibility of testicular dislocation with a non-traumatic etiology. It is difficult to distinguish blood flow disturbance in an undescended testis from incarcerated inguinal hernia because of similarities in the findings of a clinical investigation. Exploratory laparoscopy is useful for making a definitive diagnosis and deciding on a surgical approach. Keywords: Testicular dislocation, Undescended testis, Orchiectomy, Incarcerated inguinal herni

Functional assessment of the patients with perineal and vestibular fistula treated by anterior sagittal anorectoplasty

Background: Anterior sagittal anorectoplasty (ASARP) has been a standardised operative treatment for anorectal malformation (ARM). This retrospective study was undertaken to evaluate patients with perineal fistula (PF) and vestibular fistula (VF) treated by ASARP in our institution. Patients and Methods: Twenty patients (PF, n = 14; male, n = 8 and female, n = 6 and VF, n = 6) were evaluated. Eighteen patients underwent primary ASARP without protective colostomy. Two patients underwent colostomy because of intestinal atresia and suspected of other type ARM. The age range of operation was from 4 months to 5.0 years. Sixteen patients (PF, n = 13; male, n = 7 and female n = 6 and VF, n = 3) over 3 years of age were evaluated according to the Krickenbeck classification. Results: Operative complications occurred in one patient. Minor wound dehiscence occurred in six patients. Mucosal prolapse occurred in two patients. According to the Krickenbeck classification, amongst male patients with PF, all patients had voluntary bowel movements (VBMs) and two patients had Grade 1 soiling, while four patients had Grade 2 constipation. Amongst female patients with PF, all patients had VBM and no soiling, one patient had Grade 1 and two patients had Grade 2 constipation. In patients with VF, one patient was continent with Grade 1 soiling. One patient had Grade 2 and two patients had Grade 3 constipation. Conclusions: ASARP without colostomy carried a risk of wound dehiscence. The ASARP technique provided normal or moderate outcomes for VBM and soiling. However, in about half of patients, defecation management with laxative therapy was required to achieve a normal condition

Wandering spleen associated with omphalocele in a neonate: An unusual case with non-operative management

Wandering spleen with a history of omphalocele is extremely rare. We encountered a male baby with wandering spleen associated with omphalocele. This case of wandering spleen in a neonate was diagnosed by ultrasound and computed tomography scans after surgery for omphalocele. Our case was able to be managed non-operatively due to the lack of any findings suggesting torsion of the spleen and its asymptomatic status. We herein report the clinical presentation as well as the treatment options regarding wandering spleen associated with omphalocele. Keywords: Wandering spleen, Omphalocele, Pediatric, Non-operative managemen

Fibrous hamartoma of infancy in the scrotum – Report of a case

Fibrous hamartomas of infancy (FHI) is rare benign tumors. FHI is typically present before the age of two years. We report a 13-month-old child with FHI, which presented as the growing scrotum mass clinically diagnosed rhabdomyosarcoma of the trunk. Right scrotal swelling was presented. The mass was irregular, solidly, and non-tender. Operative findings revealed a mass fixed to the scrotal fundus. FHI is differentiated from other malignant neoplasms in the scrotum

Blunt splenic injury in a child with situs inversus totalis treated with transcatheter arterial embolization

We report the first case of blunt splenic rupture in a child with situs inversus totalis treated with transcatheter arterial embolization (TAE). A 12-year-old girl fell roughly 4 feet onto the pavement while riding her bicycle. Contrast-enhanced computed tomography revealed situs inversus totalis, a massive hemorrhage in the abdominal cavity, and a ruptured spleen with extravasation. Arteriography showed that the internal organs were located opposite their normal positioning. TAE was carried out with gelfoam and a micro coils at the branch of the upper lobe of the splenic artery. TAE is effective for blunt splenic injury with extravasation in a child with situs inversus. In TAE, there is no technical difference about situs inversus excepted mirror image of abdominal vascular formation