Akinori Miura

Development and Validation of a Symptom Scale to Evaluate Postoperative Patients with Esophagogastric Cancer

BACKGROUND Postgastrectomy or esophagectomy symptoms can be a significant burden for patients. However, no standard scale for evaluating these symptoms has been established. We recently developed a postoperative symptom-specific scale. STUDY DESIGN After a draft scale was prepared based on a pilot study, psychometric methods were used to assess its reliability and validity. This study involved specialized and multifaceted discussions by a team consisting of gastrointestinal surgeons, gastroenterologists, psychologists, and epidemiologic researchers. The draft questionnaire included 40 questions and 3 domains. A factor analysis was carried out to refine the items and subscale design. To assess the reliability, Cronbachs alpha and score distributions were estimated. To assess the criterion-related validity, the correlations with the Short Form (SF)-12, Gastrointestinal Symptom Rating Scale (GSRS), endoscopic findings, and nutritional indicators were analyzed. RESULTS A total of 344 patients were enrolled in this study. In an exploratory factor analysis (principal factor method), the eigenvalue attenuation data showed 4 domains. The final scale, named the Esophagus and Stomach Surgery Symptom Scale (ES(4)), included 23 items and 4 domains; 7 items for cervico-thoracic symptoms, 6 for abdominal hypersensitivity symptoms, 4 for abdominal distention symptoms, and 6 items for systemic symptoms. Cronbachs alphas for these domains were 0.82, 0.81, 0.79, and 0.74, respectively. The scale scores were normally distributed, and there were significant associations with the endoscopic findings, nutritional indicators, the summary score of the SF-12, and the GSRS. CONCLUSIONS The ES(4) scale has high psychometric validity and can evaluate the profiles and severity of postoperative symptoms. This scale is applicable as an outcomes measure for various interventional studies on esophagogastric surgery aimed at alleviating postoperative symptoms.

The Effect of Anti-Platelet Aggregation to Prevent Pressure Ulcer Development: A Retrospective Study of 132 Elderly Patients

Background: As the number of bedridden elderly patients increases, prevention of pressure ulcers is becoming a more important issue. However, an approach to this problem using medication has not been considered sufficiently in the clinical context. Objective: To test the hypothesis that anti-platelet aggregation therapy administered to the elderly patients may be helpful in preventing pressure ulcer formation, the medical records of 132 bedridden elderly patients were analyzed. In addition, the propensity of platelets to aggregate was also measured in some of the bedridden patients. Methods: Patients were divided into two groups, with pressure ulcers (group P, 52 patients) and without (group N, 80 patients). Subsequently, six factors defining the clinical characteristics age and gender, underlying disease, cause of being bedridden, level of consciousness, mobility and activity as defined on the Braden scale, and frequency of anti-platelet aggregation medication were investigated in groups P and N. In addition, physical findings (three factors): body mass index, blood pressure (BP), and heart rate were investigated in both groups. Furthermore, laboratory data (seven factors): total protein (TP), albumin, total cholesterol, hemoglobin (Hb), hematocrit (Hct), platelets, and platelet aggregation were compared between two groups. Results: There were no significant differences in clinical characteristics between the two groups with the exception of the frequency of anti-platelet aggregation medication (23.1% of group P vs. 40.0% of group N, χ2 = 4.06, p < 0.05). There was also no significant difference in physical findings except a difference between systolic and diastolic BP (48.4 mm Hg in group P vs. 57.1 mm Hg in group N, p < 0.01). Values of TP, albumin, Hb, and Hct in both groups were lower than the normal range, but there was no significant difference between the two groups. The platelet count was significantly greater in group P than in group N after lying supine (p < 0.03), and platelet aggregation in group P was significantly higher compared with group N (p < 0.03). Conclusions: Although our hypothesis must be tested by a randomized prospective trial, these results indicate that increased platelet aggregation is possibly associated with the development of pressure ulcers; therefore anti-platelet aggregation therapy may prevent their occurrence in bedridden elderly patients.

Development and Validation of a Disease-Specific Instrument to Measure Diet-Targeted Quality of Life for Postoperative Patients with Esophagogastric Cancer

BackgroundPatients who have undergone esophagectomy or gastrectomy have certain dietary limitations because of changes to the alimentary tract. This study attempted to develop a psychometric scale, named “Esophago-Gastric surgery and Quality of Dietary life (EGQ-D),” for assessment of impact of upper gastrointestinal surgery on diet-targeted quality of life.MethodsUsing qualitative methods, the study team interviewed both patients and surgeons involved in esophagogastric cancer surgery, and we prepared an item pool and a draft scale. To evaluate the scale’s psychometric reliability and validity, a survey involving a large number of patients was conducted. Items for the final scale were selected by factor analysis and item response theory. Cronbach’s alpha was used for assessment of reliability, and correlations with the short form (SF)-12, esophagus and stomach surgery symptom scale (ES4), and nutritional indicators were analyzed to assess the criterion-related validity.ResultsThrough multifaceted discussion and the pilot study, a draft questionnaire comprising 14 items was prepared, and a total of 316 patients were enrolled. On the basis of factor analysis and item response theory, six items were excluded, and the remaining eight items demonstrated strong unidimensionality for the final scale. Cronbach’s alpha was 0.895. There were significant associations with all the subscale scores for SF-12, ES4, and nutritional indicators.ConclusionsThe EGQ-D scale has good contents and psychometric validity and can be used to evaluate disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer.

Linitis plastica-type adenocarcinoma of the esophagus: a case report

Abstract“Linitis plastica” refers to a histological characterization of diffusely infiltrating, poorly differentiated adenocarcinoma. Linitis plastica-type esophageal adenocarcinoma is extremely rare: this is thought to be only the sixth case report of linitis plastica involving the esophagus. A 60-year-old man was referred to our hospital after repeated endoscopic examinations over the course of a few months. Because he complained of dysphagia, upper endoscopy was performed, revealing stenosis with a few mucosal changes of the lower esophagus. Gastroesophageal reflux disease was initially diagnosed, but biopsy revealed adenocarcinoma. At the time of operation, peritoneal metastasis was noted. Macroscopically, the lesion was diffusely infiltrating, almost completely covered with normal squamous epithelium that showed positive staining with iodine. Pathological examination showed poorly differentiated adenocarcinoma. Despite the poor prognosis, the patient survived a comparatively long 18 months following esophagectomy with oral chemotherapy using S-1.

A case of lymph node metastasis after endoscopic mucosal resection of esophageal cancer invading the muscularis mucosa

A 70-year-old man was diagnosed with a thoracic esophageal squamous cell carcinoma invading the muscularis mucosa without lymph node or distant metastases in June 2003. Endoscopic mucosal resection was conducted. Histological examination showed squamous cell carcinoma invading the deep mucosal layer without lymphatic permeation. In April 2006, a chest CT scan revealed a metastasis to the right recurrent laryngeal nerve chain (106recR) lymph node, and chemoradiotherapy and chemotherapies were performed but were not very effective. He died of esophagobronchial fistula in October 2007. We reexamined this case in detail, and a deeper cut of the block revealed positive lymph vessel invasion and droplet infiltrations. We were initially unable to identify lymphatic permeation but specific findings were determined, such as high degrees of cellular atypia, downward extension of irregular epithelial processes, and irregular margins of cancer alveoli. Extreme caution is required for treating patients with these morphological changes.

News from the IAG

This year marks the 50th anniversary of the International Association of Gerontology. To celebrate this watershed occasion, the IAG Executive, Regional Chairs and Presidents of member associations will have the opportunity to meet in December and consider future strategic directions for the association and contribute to a United Nations’ project, ‘Research Agenda on Ageing for the 21st Century’ (RAA-21). Invitations to the meeting have been distributed. The Salsomaggiore Therme has generously offered to provide full accommodation and board for delegates for the 3 days of the IAG meeting and travel grant assistance is being provided by the Novartis Foundation for Gerontology for presidents whose travel cannot be funded by their associations. A full day will be devoted to discussion of future strategic directions for the IAG. The next half day will be a joint consultation when the IAG representatives and a panel of experts with an ongoing involvement in developing the Research Agenda will convene. Participants will also include the Officer in Charge, Dr. Alexandre Sidorenko, and others from the UN Office on Ageing. The UN and Expert Panel will continue their deliberations for a further 2 days in order to draft the final Research Agenda. The United Nations Research Agenda project is supported by the Novartis Foundation for Gerontology and is convened by the IAG in support of the UN Programme on Ageing. The Second Congress Planning Committee Meeting for the 2001 Vancouver Congress convened by Dr. Gloria Gutman, President-Elect of IAG, will precede the gathering of presidents and regional chairs. Hence the 50th anniversary of the IAG will represent an occasion when it will be possible to build upon the proud history of the association and vigorously pursue the further development and achievements of national and global gerontological activities into the opening years of the new century. An agenda will be set for the meeting in Salsomaggiore, Italy, that we are confident will engender vigorous and positive consideration and debate about the IAG’s future directions and will set goals and objectives to guide the organization through the coming years.