BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical techniq...BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.展开更多
The RAND Corporation reported that insufficient sleep causes an economic loss of $138 billion (2.92% of GDP) in Japan every year. In this study, we investigated the sleep improvement effect of a novel innovative sleep...The RAND Corporation reported that insufficient sleep causes an economic loss of $138 billion (2.92% of GDP) in Japan every year. In this study, we investigated the sleep improvement effect of a novel innovative sleeping mattress called “AiR SI” (Nishikawa Co., Ltd.) to find a simple method to solve the problem of sleep deprivation. We conducted a 2-week randomized, open-label, crossover, self-controlled study in 14 healthy adults in their 30s to 50s (control: 1 week, AiR SI: 1 week), with sleep quality as the primary endpoint as well as salivary components (cortisol, melatonin) and autonomic nervous function (sympathetic nerve, parasympathetic nerve) as secondary endpoints. Trends toward improvement in sleep were suggested for all the endpoints, regardless of differences in the subject background. The results suggested that the use of AiR SI for 1 week not only improved sleep but normalized both the endocrine and autonomic functions as well. We conclude that, by using a sleeping mattress with a high sleep improvement effect, the user may easily achieve higher labor productivity and have a lower mortality risk. Eliminating sleep deprivation with a sleeping mattress may lead to a reduction in national economic losses and ultimately produce significant economic effects.展开更多
BACKGROUND Wound management is an essential part of emergency medicine practice.A good suture technique should deal a complex irregular traumatic wound without any complications of dehiscence/gaping,infection,delayed ...BACKGROUND Wound management is an essential part of emergency medicine practice.A good suture technique should deal a complex irregular traumatic wound without any complications of dehiscence/gaping,infection,delayed wound healing,frequent dressings and further stay in hospital.There is no ideal technique of suturing for any wound.In pursuit of the new techniques,we have introduced a new suturing technique called combined oblique and vertical everting running(COVER)stitch which has showed good healing with less complications.AIM To compare the outcomes between the COVER stitch and conventional suturing group.METHODS In this study,we included 40 cases which were divided into two groups.Group 1 patients were managed by COVER stitch,and group 2 patients underwent conventional suturing for their wounds.The outcomes were measured in terms of scar quality,suturing duration and length of suture material used,suturing related complications and suture removal time which were compared by t-test usingχ^(2) test.RESULTS Better results were seen in COVER stitch than the conventional suturing.COVER group had significantly better results in terms of time taken for suture,amount suture material used and time taken for suture removal compared to the conventional group.No wound related complications were seen in this group.Moreover,scar formed was also better in COVER group.CONCLUSION COVER stitch is another new technique which can be used to deal simple to complex wounds and it is an emerging idea with good healthy scars with less complications.展开更多
文摘BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.
文摘The RAND Corporation reported that insufficient sleep causes an economic loss of $138 billion (2.92% of GDP) in Japan every year. In this study, we investigated the sleep improvement effect of a novel innovative sleeping mattress called “AiR SI” (Nishikawa Co., Ltd.) to find a simple method to solve the problem of sleep deprivation. We conducted a 2-week randomized, open-label, crossover, self-controlled study in 14 healthy adults in their 30s to 50s (control: 1 week, AiR SI: 1 week), with sleep quality as the primary endpoint as well as salivary components (cortisol, melatonin) and autonomic nervous function (sympathetic nerve, parasympathetic nerve) as secondary endpoints. Trends toward improvement in sleep were suggested for all the endpoints, regardless of differences in the subject background. The results suggested that the use of AiR SI for 1 week not only improved sleep but normalized both the endocrine and autonomic functions as well. We conclude that, by using a sleeping mattress with a high sleep improvement effect, the user may easily achieve higher labor productivity and have a lower mortality risk. Eliminating sleep deprivation with a sleeping mattress may lead to a reduction in national economic losses and ultimately produce significant economic effects.
文摘BACKGROUND Wound management is an essential part of emergency medicine practice.A good suture technique should deal a complex irregular traumatic wound without any complications of dehiscence/gaping,infection,delayed wound healing,frequent dressings and further stay in hospital.There is no ideal technique of suturing for any wound.In pursuit of the new techniques,we have introduced a new suturing technique called combined oblique and vertical everting running(COVER)stitch which has showed good healing with less complications.AIM To compare the outcomes between the COVER stitch and conventional suturing group.METHODS In this study,we included 40 cases which were divided into two groups.Group 1 patients were managed by COVER stitch,and group 2 patients underwent conventional suturing for their wounds.The outcomes were measured in terms of scar quality,suturing duration and length of suture material used,suturing related complications and suture removal time which were compared by t-test usingχ^(2) test.RESULTS Better results were seen in COVER stitch than the conventional suturing.COVER group had significantly better results in terms of time taken for suture,amount suture material used and time taken for suture removal compared to the conventional group.No wound related complications were seen in this group.Moreover,scar formed was also better in COVER group.CONCLUSION COVER stitch is another new technique which can be used to deal simple to complex wounds and it is an emerging idea with good healthy scars with less complications.
