Medication Optimization Protocol Efficacy for Geriatric Inpatients: A Randomized Clinical Trial.

Importance: There is currently no consensus on clinically effective interventions for polypharmacy among older inpatients.

Objective: To evaluate the effect of multidisciplinary team-based medication optimization on survival, unscheduled hospital visits, and rehospitalization in older inpatients with polypharmacy.

Design, Setting, And Participants: This open-label randomized clinical trial was conducted at 8 internal medicine inpatient wards within a community hospital in Japan.

Curved Axillary Incision with Video-Assisted Thoracoscopic Surgery: An Alternative Approach for Teenage Female with Large Apical Chest Wall Tumor.

Primary chest wall tumors are rare, their common clinical features are not well known, and surgical resection remains the main treatment. Apical chest wall tumors require large skin incisions and dissection of the chest wall muscles, making it difficult to maintain cosmetic appearance, respiratory function, and support of the upper extremity. There are few treatment options and no studies have reported on thoracotomy that spares muscles and preserves cosmetic superiority.

Spontaneous pleural aspergillosis in an immunocompetent young adult treated with minimally invasive surgery.

Spontaneous cases of pleural aspergillosis in healthy adults are rare, and the optimal therapeutic approach has not been established. Here we report a rare case of spontaneous pleural aspergillosis in an otherwise healthy young adult. Two-stage surgery with decortication and cavernostomy, followed by systemic antifungal therapy, finally resulted in a successful resolution of his empyema without any serious complications.

Double vision approach applied by two teams for retrosternal gastric conduit for gastric tube cancer.

Gastric tube cancer is classically treated with resection through a midline sternal incision. However, because of its invasiveness and limited reconstructive potential, transdiaphragmatic laparoscopic or thoracoscopic dissection of the gastric tube has been investigated. As resection from only the abdominal or thoracic cavity is difficult, we performed surgery with a thoracic surgeon approaching from the thoracic cavity and an abdominal surgeon simultaneously approaching from the cervical and abdominal regions.