A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery (SCA) occlusion and a patent left vertebral artery with retrograde flow were revealed( subclavian steal syndrome). Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.
Purpose The purpose of this study is to identify the unique features of Japanese unintentional injury and to consider strategies for injury prevention. Method Mortality data for unintentional injuries available from Vital Statistics of Japan and the patient survey in 2008 was used, and the rate of hospitalisations and practice visits for unintentional injury was calculated. Results In 2008, the mortality for unintentional injury was 13.2, the rate for hospitalisations was 441, and the rate for practice visits was 26 838 per 100 000 populations under 1 year old. Among 1–4 years, 3.8 and 423 and 42 850. Among 5-14 years, 2.1 and 452 and 41 907. Among 15–24 years, 8.2 and 834 and 23 405. Among 25–34 years, 7.0 and 549 and 15 578. Among 35–44 years, 8.4 and 530 and 14 255. Among 45–54 years, 13.2 and 624 and 14 229. Among 55-64 years, 22.4 and 861 and 14 666. Among 65-74 years, 44.8 and 1383 and 15 651. Over 75 years, 159.3 and 3872 and 16 074. Conclusions Though the rate of mortality and hospitalisations among 1–4 and 5–14 year olds groups was lower than the other age groups, the rate of practice visits was higher than the other age groups. Also, it was necessary to pay attention to the mortality for among 65–74 year olds and over 75 year olds, the hospitalisation rates for over 64 year olds.
(Background) We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy.(Methods) We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters.(Results) The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (x2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients.(Conclusion) It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.
This study was undertaken in order to evaluate the effectiveness of Appleby's operation on the postoperative survival rate as compared with that of conventional total gastrectomy accompanying pancreatosplenectomy and that of subtotal gastrectomy with lymph node dissection of the conventional style preserving the spleen and the pancreas. In our study Appleby's operation was performed in 65 cases and the conventional procedures were in 41 cases and 50 cases, respectively. Both groups have almost identical prognostic backgrounds except for the lymph node status. The overall 5-year survival rate of Appleby's procedure group was higher (49.5%) than that of the conventional procedure group (23%) in spite of higher percentage of positive rate of the 2nd group of lymph node(n2+) in Appleby's procedure group. Furthermore, in the cases with serosal invasion(se) and positive metastasis in the 1st group of lymph node (n1+), the 5-year survival rate of Appleby's procedure group was higher (64%) than that of the conventional procedure group (32%), and the difference was statistically significant (p less than 0.01). On the other hand, no difference was observed in the 5-year survival rate between both groups in which the serosae were invaded and the 2nd group of lymph nodes were involved. Our study shows that Appleby's procedure salvaged further 32% of patients that would have been lost if they had undergone the conventional procedure.
