Search

This study aimed to assess perioperative morbidity and mortality in elderly patients following colorectal cancer resection and to investigate risk factors for postoperative complications. This study reviewed 697 consecutive patients who underwent elective colorectal cancer resection between 2005 and 2013 at our institution. Patients were divided into 3 groups according to their age: ≤74 (n = 420), 75 to 89 (n = 261), and ≥90 years (n = 16). Clinical findings, morbidity, and mortality were compared among these groups. Univariate and multivariate logistic regression analyses were performed with clinically relevant variables for the complications that increased with aging. Postoperative delirium and pneumonia showed significant increases with aging. There were no significant differences in mortality and morbidity among the 3 groups, except for the 2 aforementioned diseases. Multiple logistic regression analysis showed that dementia and laparoscopic surgery were independent determinants of postoperative delirium and that age and American Society of Anesthesiologists (ASA) score were independent risk factors for postoperative pneumonia. Dementia, high ASA score, and age were the risk factors for higher postoperative morbidity in elderly patients. Our results demonstrated the effectiveness of laparoscopic surgery for the prevention of postoperative delirium after colorectal resection.

The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors.

Objective Previous studies have demonstrated that obesity is rare among those who consume the Japanese diet because of its lower caloric content compared with the American diet. Meanwhile, it has been reported that maternal caloric restriction, which induces antiobesity effects, during pregnancy and lactation increases the likelihood of a low birthweight infant, which increases the risks for obesity and diabetes later in life. The aim of this study was to examine the influence of maternal consumption of the Japanese diet during pregnancy and lactation on the risk for obesity and diabetes in the offspring later in life. Methods Pregnant mice were divided into three groups and fed either a control diet, Western diet, or Japanese diet, and their offspring were raised until 7 wk old. Results Examinations of 18-d-old and 7-wk-old offspring showed no effect of consistently eating a Japanese diet during pregnancy and lactation on the health conditions of 18-d-old offspring, but 7-wk-old offspring showed a decrease in visceral fat and liver triacylglycerol levels. In addition, 7-wk-old offspring from mothers who consumed the Japanese diet during pregnancy and lactation showed a decrease in the homeostatic model assessment of insulin resistance and a reduced risk for developing diabetes. This tendency was also confirmed in 18-d-old offspring. Evaluation of the mechanism revealed that fatty acid synthesis in the liver of the offspring was suppressed by the mother's consumption of the Japanese diet. Conclusion From these results, maternal consumption of the Japanese diet during pregnancy and lactation did not adversely affect the offspring, and continual intake of this diet reduced the risk for developing obesity and diabetes in the offspring later in life.

The purpose of this paper is to reveal the relationship between illuminance distributions of floor surface and travel speed and visibility. Subjective experiments were examined with a real-scale space, which is 25 m length by 1.8 m width by 1.8 m height. We set three kinds of installation intervals of lighting planes through five levels of average illuminance on the floor surface in order to set various inhomogeneous conditions. Five subjects participate in this experiment, who have good visual acuity more than 1.2. Their visual acuity is measured with Landolt ring (800 cd/m2 and contrast 0.9).

症例は83歳，男性．転倒による骨折を契機に入院し骨接合術を施行，リハビリテーション中であったが2週後に高熱と下血をきたした．絶食と抗生剤の投与を施行したが症状が改善せず，内視鏡検査でS状結腸に限局した全周性の浮腫，充血を認め，また生検で核内封入体が認められたためサイトメガロウイルス（以下CMV）腸炎と診断された．ガンシクロビルが投与されたが，下血が続き病変部の狭窄が進行したために当科で同部位の切除を行った．切除標本では明らかな虚血の所見はなく，粘膜下に核内封入体を認めた．術前血中のCMV antigenemiaは陽性だったが術後は陰性化した．元来健康な高齢者ではあったが一時的な免疫能低下によってCMV腸炎をきたしたものと考えられた．