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Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

Few studies have investigated or verified the pressure resistance of anastomosis with circular staplers. We conducted end-to-end anastomoses with circular staplers and compared the pressure resistance with or without bioabsorbable material (Neoveil NanoⓇ). We conducted end-to-end anastomosis with or without Neoveil NanoⓇ (NN). Fresh pig small intestines were used. An end-to-end anastomosis was performed between two intestinal specimens using a circular stapler. The burst pressure of the anastomosis was recorded. The group with the highest pressure resistance was the group in which NN was attached only to the anvil, which was higher than the group in which NN was attached to the shaft and anvil. In contrast, no increase in pressure resistance occurred in the group using NN only for the shaft. Clinically, this method was used for various anastomoses using a circular stapler. In the absence of NN, a portion of the staple was often exposed at the anastomosis. When NN was used, however, only a small amount of the staple was exposed. There were no complications that were associated with NN. The usefulness of NN for pressure resistance of anastomosis with a circular stapler was demonstrated. The pressure resistance was highest by attaching NN only to the anvil of the stapler. Use of a circular stapler significantly reduces the complication associated with an anastomosis.

One of the complications in laparoscopic surgery is port-site hernia. It is a rare but potentially dangerous complication. Especially when using ports with a size 10 mm or more, it is required to securely close the port site. However, this procedure is often difficult especially for obese patients. We herein devised a new closure method by using a device developed for port site. These techniques are methods that can close the port site by a combination of putting in and out of thread and port rotation without removing a port. The port-site closure with these techniques was done for 53 port sites of 41 patients. The port site was closed horizontally or vertically, depending on the shape of the port site for two patients. Modified Z-suture was done for other 37 patients. To date, we have not noted any complications from this new method, including port-site hernia. With our technique, we could save operation time and reduce stress of us especially for obese patients. We would like to increase the number of patients and verify the safety and usefulness in further study.

The use of laparoscopic surgery has become widespread in recent years. One of its complications is port site hernia (PHS). It can be difficult to close the fascia at the time of laparoscopy, especially in obese patients, and there is a risk of herniation through a fascial defect with incomplete closure. It is important to ascertain closure of the defect when repairing PHS to prevent recurrence. We report a 47-year-old woman who developed a PHS at the superior aspect of the umbilicus. We repaired the defect using the VersaOneTM Fascial Closure System with laparoscopic guidance. This system allows the port site to be reliably closed while observing the suture from the abdominal cavity. The incision is the same size as a port site. If the abdominal wall is thick and the PHS has a diameter of ~10 mm, this method is considered to be indicated, regardless of the site.

Background: Few studies evaluated whether health care professionals accurately assess several symptoms for patients with cancer in palliative care units. We determined the agreement level for several symptoms related to quality of life (QOL) between patient-reported QOL assessment and health care professional-assessed symptoms based on the Support Team Assessment Schedule (STAS). Method: An observational study was performed with terminally ill patients with cancer hospitalized in the palliative care unit between June 2018 and December 2019. Patients and health care professionals independently assessed 7 symptoms at the time of hospitalization and after 1 week. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL). In examining the proportions of exact agreement, “exact agreement” referred to the pairs of the scores (QLQ-C15-PAL vs STAS) being (1 vs 0), (2 vs 1), (3 vs 2 or 3), or (4 vs 4). The relationships of physical functioning between QLQ-C15-PAL and Palliative Performance Scale (PPS) were examined. Results: Of 130 patients, approximately 60% had PPS scores from 40 to 60. The highest mean score on QLQ-C15-PAL was for fatigue (63.8). The exact agreement on symptoms between patients and health care professionals ranged from 15.4% (fatigue) to 57.7% (nausea and vomiting). The mean of the transformed QLQ-C15-PAL and proportions of exact agreement were negatively correlated ( R 2 = 0.949, P < .05). The physical function scores in QLQ-C15-PAL for each PPS group showed no differences. Conclusion: We expect patient-reported outcomes including QLQ-C15-PAL to be added to health care professionals’ assessment of serious symptoms such as fatigue in terminally ill patients with cancer.

The vulnerability of the crotch on a side-to-side anastomosis to leak has been widely recognized. However, countermeasures to prevent leaks from the crotch have not proven to be sufficient. A side-to-side anastomosis was performed between two intestinal specimens using a linear stapler. We analyzed the burst pressures of anastomoses. Comparison was made in five groups, with different staple heights, presence of Neoveil® (Gunze, Japan), with or without crotch buttressed with nylon. Using an endoscope inserted into the intestinal lumen, we observed the burst process. We observed a significant difference in the resistance of the crotch to leak between the two types of reinforcement. In all experimental groups, the leak was observed not only on the serosal surface but also from within the lumen. Neoveil® significantly increased the burst pressure (41.4 ± 3.6 vs. 88.8 ± 14.6 mm Hg; p

Highlights • The indications for stripping of the esophagus have decreased due to the widespread of endoscopic mucosal resection and thoracoscopic surgery. • Even if indications for this procedure have decreased, this is an important option in the armamentarium of the esophageal surgeon., Introduction Patients with esophageal cancer frequently cannot tolerate thoracotomy due to their overall debilitated condition. Moreover, some patients have severe adhesions in the thoracic cavity. Eversion stripping of the esophagus is an option for resection in these patients. Presentation of case A 64-year-old man was admitted to our institution with the chief complaint of epigastric pain. Endoscopic examination showed a protruding lesion 22 cm from the incisors, with a superficial and circumferential mucosal irregularity on the distal side of the lesion. Biopsy revealed squamous cell carcinoma. Clinical stage was T1b(sm)N0M0, cStage I. In addition to the poor pulmonary status of the patient, adhesions in the intrathoracic cavity were predicted. The decision was made to perform esophageal resection without a thoracotomy. In order to ensure complete invagination of the esophagus, the esophagus was insufflated prior to stripping. The stripping process was observed with a gastroscope. During the stripping, the esophagus did not bunch up, and stripping was smooth and with minimal resistance. Discussion The stripping resection of the esophagus is an important option for the esophageal surgeon. In this case report, we describe a new eversion stripping method of the esophagus. This easy and reliable stripping method incorporates intraesophageal insufflation. Conclusion The indications for blunt esophageal dissection without thoracotomy have been decreasing. On the other hand, our method seems to be useful in optimal case of stripping of esophagus.

With advances of combined modality therapy, prognoses in esophageal cancer have been improving. After resection of esophageal cancer, the development of gastric tube cancer is a risk. While such cancer in an early stage can be cured endoscopically, total gastric tube resection is indicated in advanced stages. A 68-year-old man underwent subtotal esophagectomy reconstructed with a gastric tube through the retrosternal route. Gastric cancer was found one and a half years postoperatively. The gastric tube was resected without sternotomy. This is the first report of a patient undergoing resection of the gastric tube reconstructed through the retrosternal route without sternotomy.

In this paper, we present a support system for ontology construction just based on a given specialized book with lowest possible cost. The system tries to combine minimum hand and mostly automatic constructions. It extracts required information for the ontology design from the specialized book with presenting yes-no selections to an expert of the specialized book. The ontology construction is performed automatically just using the answers of the expert. The constructed ontology is reliably and highly technical since it is constructed on the basis of the specialized book. In addition, since user operations are restricted only to yes-no selection, any expert can make use of our system without any special knowledge about ontology.

Medullary hemorrhage in the medulla oblongata of an infant with Chiari malformation, hydrocephalus, meningomyelocele and hypogenesis of the corpus callosum is reported. Four days after placement of a ventriculoperitoneal shunt, spontaneous respiration diminished. Magnetic resonance imaging (MRI) successfully revealed a small medullary hemorrhage.