Efficacy and safety of endoscopic submucosal dissection under general anesthesia

AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD) under general anesthesia.METHODS: From January 2011 to July 2014, 206 consecutive patients had undergone ESD under general anesthesia for neoplasms of the stomach, esophagus, and colorectum were enrolled in this retrospective study. The efficacy and safety of ESD under general anesthesia were assessed.RESULTS: The en bloc resection rate of esophageal, gastric, and colorectal lesions was 100.0%, 98.3%, and 96.1%, respectively. The complication rate of perforationand bleeding were 0.0% and 0.0% in esophageal ESD, 1.7% and 1.7% in gastric ESD, and 3.9% and 2.0% in colorectal ESD, respectively. No cases of aspiration pneumonia were observed. All complications were managed by conservative treatment, with no surgical intervention required.CONCLUSION: With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications.

Family Environment Factors to Impact on the Effect of the Smoking Prevention Educational Program for Elementary and Junior High School Students

Smoking is a major health problem in many countries. It has been reported on the effects of education on youth with a reduced smoking rate and developed awareness of avoiding smoking verified as a result of educational intervention. The aim of this study was to verify the relationship between sex, school age, and family smoking and the effectiveness of smoking prevention education program (SPEP) as factors that impact the effectiveness of SPEP in elementary school and junior high school students. The participants in this survey were 6676 students, who attended elementary and junior high schools in Tokushima Prefecture between 2011 and 2015, and attended the SPEP. As factors that influence the effectiveness of the SPEP, we examined school types, sex, smokers in the family. Participants were asked the following questions before and after the SPEP to measure awareness of and attitudes toward smoking: “intention not to smoke cigarettes as adults”, “intention to refuse cigarettes when offered”, “attitude of staying away from smokers”, and “desire that their family will not smoke”. The number of survey collected was 6676, with effective responses from 5974 (90%). Among the 5974, there were 2963 (50%) males and 3011 (50%) females, 5106 elementary school students (86%), and 868 junior high school students (15%). In the case of smoker mother, it was difficult to improve these children’s “intention not to smoke as adults”, “intention to refuse cigarettes when offered”, and smoker father, it was difficult to improve these children’s “attitude of staying away from smokers”, and “desire that their family will not smoke”. Especially, in the case of smoker parents, it was particularly difficult for the SPEP to be effective in improving awareness of and attitudes toward smoking among elementary and junior high school students.

Does an “Overactive to Underactive Bladder Transition” Phenomenon Exist in a Rat Lumbar Spinal Canal Stenosis Model?

Purpose: To investigate the association between the maximum cystometric capacity (MCC) and other cystometric parameters in lumbar canal stenosis (LCS) rats. Material and Methods: One small hole was drilled at the fifth lumbar vertebral arch (Sham), and a rectangular piece of silicone rubber was then placed in the epidural space (LCS) of Wister rats. Two weeks after surgery, awake cystometry was performed. LCS rats were divided into three groups: Group A (n = 5, MCC < 0.87 mL), Group B (n = 13, MCC 0.87 - 1.81 mL), and Group C (n = 14, MCC > 1.81 mL). Cystometric parameters were investigated in sham and LCS groups. Results: MCC did not significantly correlate to the frequency of non-voiding contractions (NVCs), voided volume (VV), or maximum intravesical pressure during voiding (Pmax), but significantly positively correlated to postvoid residual urine volume (PVR) and residual urine rate (RUR) (Spearman’s correlation coefficients (ρ) = 0.8973 (p < 0.0001) and 0.4915 (p = 0.0068), respectively). Compared with the sham rats, LCS rats in each group revealed significantly smaller VV, larger RUR, and lower Pmax. On the other hand, among LCS rats, VV, RUR, and Pmax were not significantly different. The frequency of NVCs in each LCS group was not significantly different from that in sham-operated rats (Tukey-Kramer’s HSD test). However, a Jonckheere-Terpstra trend test revealed a significant trend toward higher NVCs in the order of sham, Groups C, B, and A (p = 0.036). Conclusions: LCS rats showed the same degree of detrusor underactivity regardless of MCC. NVCs did not significantly increase in LCS rats with decreased MCC, but the trend toward higher NVCs with smaller MCC was significant.

Efforts to Improve the Images from ⁶⁷Ga Whole-Body Scintigraphy

The acquisition method for planar 67Ga imaging has hardly changed for 30 years. In this study, in order to improve image quality and diagnostic accuracy, we take steps to optimize the acquisition method, and to choose a scatter correction. First, we acquired individual images from the 93 keV, 185 keV, and 300 keV photopeak;then the images were added together and compared to the individual images. Second, we compared results from a low-medium-energy (LME) collimator with those from a conventional medium-energy (ME) collimator. Also, we examined whether to combine the data from all three of the usual window locations (set about 93 keV, 185 keV, and 300 keV) or to use the data from only two. Third, we compared results from a conventional photopeak ± 10% window with those from a photopeak ± 9 keV window. Fourth, for scatter correction we compared results using the triple energy window (TEW) method with those using the multi-photopeak dual window (MDW) method. The phantoms studied were cold rods in a uniform background, and hot spheres within a cylinder containing uniformly radioactive water. The clinical study involved 22 patients with lung lesions. By the comparison by the contrast ratio in cold rods phantom, 15.6% is improved in LME (2 peaks) than ME (3 peaks), and 3.2% is improved in photopeak ± 9 keV than photopeak ± 10%, 10.2% is improved in TEW than MDW. However, the TEW scatter correction method recognized unstable to the contrast ratio in a clinical study. In addition, a body outline might disappear.