Many surgeons apply povidone-iodine (PVP-I) to the skin around an incision before closing a wound to reduce wound infection rates. However, the effectiveness of this procedure has not been proven. Forty-seven cases of gastric surgery and 60 cases of colorectal surgery performed at Kanto Medical Center between July 2004 and December 2004 were randomly assigned to the group with PVP-I or the group without PVP-I. Wound infection and surgical site infection (SSI) rates were compared between these two groups. Applying PVP-I was effective in eliminating skin contamination, as cultures became negative in all cases after applying PVP-I. However, this study could not demonstrate the reduction of wound infection or SSI in the group with PVP-I, possibly because the number of cases in this study was too small to make a difference. Subcutaneous tissue contamination was considered a more important factor than skin contamination in causing wound infection.

Aims/Introduction Flash and continuous glucose monitoring systems are becoming prevalent in clinical practice. We directly compared a flash glucose monitoring system (FreeStyle Libre Pro [FSL ‐Pro]) with a continuous glucose monitoring system ( iP ro2) in patients with diabetes mellitus. Materials and Methods Glucose concentrations were simultaneously measured using the FSL ‐Pro, iP ro2 and self‐monitoring blood glucose in 10 patients with diabetes mellitus, and agreement among them was assessed. Results Parkes error grid analysis showed that the 92.9 and 7.1% of glucose values measured using the FSL ‐Pro fell into areas A and B, respectively, and that 96.3, 2.8 and 0.9% of those determined using iP ro2 fell into areas A, B and C, respectively. The median absolute relative differences compared with self‐monitoring blood glucose were 8.1% (3.9–12.7%) and 5.0% (2.6–9.1%) for the FSL ‐Pro and iP ro2, respectively. Analysis of 5,555 paired values showed a close correlation between FSL ‐Pro and iP ro2 glucose values (ρ = 0.96, P < 0.01). Notably, 65.3% of all glucose values were lower for the FSL ‐Pro than the iP ro2. Median glucose values also decreased by 3.3% for the FSL ‐Pro compared with the iP ro2 (177.0 [133.0–228.0] vs 183.0 [145.0–230.0] mg/dL, P < 0.01). The difference in glucose values between the two systems was more pronounced in hypoglycemia. The median absolute relative difference between FSL ‐Pro and iP ro2 during hypoglycemia was much larger than that during euglycemia and hyperglycemia. Conclusions Both the FSL ‐Pro and iP ro2 systems are clinically acceptable, but glucose values tended to be lower when measured using the FSL ‐Pro than the iP ro2. Agreement was not close between these systems during hypoglycemia.

BackgroundOxidative posttranslational modifications (OPTM) impair the function of Sarcoplasmic/endoplasmic reticulum (SR) calcium (Ca2+) ATPase (SERCA) 2 and trigger cytosolic Ca2+ dysregulation. We investigated the extent of OPTM of SERCA2 in patients with non-ischemic cardiomyopathy (NICM).Methods and resultsEndomyocardial biopsy (EMB) was obtained in 40 consecutive patients with NICM. Total expression and OPTM of SERCA2, including sulfonylation at cysteine-674 (S-SERCA2) and nitration at tyrosine-294/295 (N-SERCA2), were examined by immunohistochemical analysis. S-SERCA2 increased in the presence of late gadolinium enhancement on cardiac magnetic resonance imaging. S-SERCA2/SERCA2 and N-SERCA2/SERCA2 correlated with cardiac fibrosis evaluated by Masson’s trichrome staining of EMB. SERCA2 expression modestly increased in parallel with an upward trend in OPTM of SERCA2 with aging. This tendency became prominent only in patients aged >65 years. OPTM of SERCA2 positively correlated with brain natriuretic peptide (BNP) values only in patients aged ≤65 years. Composite major adverse cardiac events (MACE) increased more in the high OPTM group of younger patients; however, MACE-free survival was similar irrespective of the extent of OPTM in older patients.ConclusionsOPTM of SERCA2 correlate with myocardial fibrosis in NICM. In younger patients, OPTM of SERCA2 correlate with elevated BNP and increased composite MACE.

Preoperative small-bowel endoscopy proved useful for diagnosing the cause of hemorrhagic lesions in the small intestine.

Aims/Introduction The importance of low‐density lipoprotein cholesterol (LDL‐C) in the primary prevention of cardiovascular disease has recently been reported in the population aged ≥75 years with hypercholesterolemia. Therefore, the current status of LDL‐C management for primary prevention of coronary artery disease in patients aged ≥75 years with type 2 diabetes mellitus was investigated. Materials and Methods A total of 124 patients aged ≥75 years who had type 2 diabetes mellitus, but no coronary artery disease, were investigated. The patients' background characteristics, LDL‐C, glycemic status, ankle‐brachial index and cardio‐ankle vascular index were compared between patients taking and not taking LDL‐C‐lowering agents, such as hydroxymethylglutaryl‐CoA reductase inhibitors (statins) and ezetimibe. The details of the antihyperlipidemic and antidiabetic agents used in the present study were also examined. Results LDL‐C was significantly lower in patients taking LDL‐C‐lowering agents (LDLCLT[+]) than in patients not taking them (LDLCLT[−]), although LDL‐C was maintained <120 mg/dL in both groups (93.0 mg/dL vs 102.1 mg/dL). Approximately half of the cases in the LDLCLT(+) group received moderate‐intensity statins, with pitavastatin being the most prescribed statin. Glycated hemoglobin was significantly lower in the LDLCLT(+) group than in the LDLCLT(−) group (6.9% vs 7.3%). Sodium‐glucose transporter 2 inhibitors were more frequently used in the LDLCLT(+) group than in the LDLCLT(−) group. The ankle‐brachial index/cardio‐ankle vascular index did not differ between the groups. Conclusion Low‐density lipoprotein cholesterol was properly managed for primary prevention of coronary artery disease in patients aged ≥75 years with type 2 diabetes mellitus regardless of the presence or absence of LDL‐C‐lowering agents.

osteoma is presumed to be associated with prostaglandin E2 secretion. While some articles have reported elevation of prostaglandin E2 locally, 5,6) none have reported elevated plasma concentration of prostaglandin E2 in peripheral blood. The present report is the first to describe a change of the plasma prostaglandin E2 concentration in patients with osteoid osteoma. Case Presentation I. History and examinationA 25-year-old man visited the Department of Orthopedic Surgery in our hospital with a history of severe occipital pain that worsened at night. The patient had received nonsteroidal anti-inflammatory drugs (NSAIDs) and nerve block in other institutions for pain over the previous 2 years, but the pain gradually worsened and interfered with his sleep. Computed tomography (CT) scans revealed a 10-mm radiolucency in the left occipital condyle (Fig. 1a, b). Bone scintigraphy showed localized uptake of Technetium 99m ( 99m Tc) in the same lesion (Fig. 1e). The lesion was hypointense in T 1 and T 2 weighted images in magnetic resonance image (MRI) (Fig. 1c, d). After another year of conservative treatment at our hospital without improvement, the patient decided to undergo surgical resection. The preoperative concentration of plasma prostaglandin E2 was 12 pg/mL, somewhat above the normal range (< 8.4 pg/mL). II. OperationThe patient was placed in the prone position. A curved linear skin incision was made from the right asterion to behind of the tip of mastoid process, and then curved medially inside the hairline. The vertebral artery and C1 lateral mass were identified in the suboccipital triangle. The C0/C1 facet was exposed by dissecting the obliquus capitis superior muscle and rectus capitis posterior major muscle from the occipital bone. The medial half of the occipital condyle was drilled with the help of CT navigation. The lesion could not be clearly distinguished from the surrounding bone tissue (Fig. 2). III. Pathological findingsMicroscopic examination revealed trabeculae of woven bone and surrounding fibrovascular stroma (Fig. 3a). Those findings were consistent with a diagnosis of osteoid osteoma, but no osteoblasts were detectable in the small specimen Osteoid osteoma is a benign bone tumor characterized by local pain that typically increases at night. The tumor commonly occurs in the long bones of the lower extremities, and in rare instances in cranial bones. Here we report the case of a 25-year-old man diagnosed with an osteoid osteoma of the right occipital condyle. The patient suffered from severe occipital pain in the 3 years leading up to surgery, and the pain disappeared after surgical resection of the tumor. Due caution must be taken to avoid vertebral artery injury in the surgical approach in this region. An intraoperative navigation guidance system and preoperative analysis using threedimensional reconstructed computed tomography (CT) images improved the accuracy and safety of the resection. The typical pain in osteoid osteoma is presumed to be associated with prostaglandin E2 secretion. Pla...

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Background The management of pancreatic injury is not well‐established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption. Case Presentation A 68‐year‐old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso‐pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso‐pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla. Conclusion We report a case of severe pancreatic injury managed using multi‐stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.