Background Decision-making for surgical palliation remains one of the most challenging clinical scenarios. We investigated the optimal indications for surgical palliation in advanced gastric cancer (AGC) patients presenting with gastrointestinal (GI) obstruction. Methods A retrospective analysis was performed on 53 consecutive patients who underwent surgical palliation for GI obstruction caused by AGC between 2000 and 2007 at Osaka National Hospital. The clinical course of each patient was followed until death. Postoperative improvement of oral intake, achievement of hospital discharge, and implementation of chemotherapy in each patient were documented and used as a triad to assess the quality of life (QOL). Prognostic factors for overall survival were investigated by univariate and multivariate analyses. In addition, postoperative morbidity and mortality rates were recorded. Results Of the entire patient cohort, 64% demonstrated a QOL improvement by having achieved the triad. Performance status (PS) of 1 or less was the only significant predictive factor for QOL improvement. The median survival time (MST) of the whole patient cohort following surgical palliation was 161 days, while the MSTs of patients fulfilling the triad and of those failing to achieve the triad were 253 and 60 days, respectively, with a significant difference between them (P \ 0.0001). PS of 1 or less (hazard ratio 0.265, P = 0.0008) and recurrent disease (hazard ratio 0.394, P = 0.043) were identified as significant independent prognostic factors for longer survival on multivariate analysis. Overall morbidity and 30-day postoperative mortality rates were 24.5% (13 patients) and 7.5% (4 patients) respectively. Conclusions In AGC patients presenting with GI obstruction, surgical palliation was beneficial in patients with PS of 0-1 and those with recurrent disease, in terms of improved QOL and prolonged survival, with acceptable operative morbidity and mortality rates.
This study was undertaken to assess the efficacy of electric toothbrushes in bacterial plaque removal. These brushing times were longer than 3 minutes, which was previously considered to be the standard time. When the brushing was performed for an arbitrary time, plaque removing efficacy was 10-15% higher than that of 3 min. Differences were noted on the lingual and interproximal surfaces, both thought to be important in plaque control. These results show that longer brushing times than 3 min are recommendable.Furthermore, the subjects were divided into two groups on the basis of differences in technical ability to use a manual toothbrush. Efficiencies in removing plaque with the electric toothbrushes were then compared.Plaque removal in both groups, the high technical skill group and the low technical skill group, was
We examined sagittal or nearly horizontal histological sections of the pelvic floor tissues from 10 elderly cadavers. These sections included the anal canal/inferior part of the rectum (inferior rectum) as well as the vagina and its associated tissue. The conjoint longitudinal muscle coat, which was rich in elastic fibers, ran inferiorly between the lateral extension of the perineal body (LEPB) and the internal anal sphincter and the end of the external anal sphincter. The longitudinal muscle coat often divided into two bundles and the anterior one ended at the LEPB. Because the rectovaginal septum or fascia was thin and fragmented, the longitudinal muscle coat was a limited, constant plate-like structure interposed between the anal canal and vagina. In the anterior and anterolateral side of the anal canal/inferior rectum, the highest nerve density was seen along the vaginal wall: most of them appeared to run obliquely to the supero-inferior axis. Likewise, the paracolpium contained abundant nerves running almost along the anteroposterior axis. Most of them contained sensory, sympathetic and parasympathetic nerve fibers. To avoid injury to nerves during surgical treatment of rectocele, an approach along the immediately vaginal side of the longitudinal muscle coat seems to be suitable.
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