Three cases of small cell carcinoma of the urinary bladder: a case report

We report three cases of small cell carcinoma of the urinary bladder. Case 1: A 69-year-old man showed microscopic hematuria during follow up of prostate cancer of stage D2. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0. Complete remission was achieved by three courses of chemotherapy consisting of irinotecan and carboplatin. The patient was died by prostate cancer 16 months after the chemotherapy. Case 2: An 83-year-old woman presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0 and partial cystectomy was performed. The patient has been alive without any evidence of tumor recurrence at 6 months after surgery. Case 3: An 84-year-old man presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage ofcT3bN0M1 with multiple liver metastases. Complete remission was achieved by three courses of chemotherapy consisting of etoposide and carboplatin.     

Shape of the joint gap for 90° and 120° knee flexion after total knee arthroplasty

BACKGROUND: The joint gap is set rectangular at 90 degrees flexion during total knee arthroplasty (TKA). However, the condition of the joint gap in deep knee flexion is obscure. METHODS: The method for obtaining a posteroanterior view radiograph of the knee at 90 degrees flexion (the epicondylar view) was modified, and a method to obtain an anteroposterior view radiograph at 120 degrees flexion (deep flexion view) was established. With this method, subjects lie on the radiography table with their thighs placed on a device so their lower legs hang down in neutral rotation with a 1.5-kg weight attached to the ankle. The joint gap angle and medial and lateral joint space widths were measured on epicondylar view and deep flexion view radiographs in 20 normal male subjects, 20 normal female subjects, and 20 subjects after TKA. RESULTS: The joint gap was almost rectangular at two flexion angles in normal subjects. In the implanted knees, the gap angle was 1.4 degrees varus +/- 3.3 degrees (mean +/- standard deviation), and no significant difference was found between medial and lateral joint space widths at 90 degrees flexion. In contrast, the gap angle was 2.5 degrees varus +/- 2.5 degrees and the lateral joint space width was significantly wider than the medial joint space width at 120 degrees flexion (P < 0.001). The gap angle was more varus with a significant difference in the implanted knees than that in the normal subjects at 120 degrees flexion (P < 0.001). CONCLUSIONS: The joint gap was trapezoidal with a wider lateral side at 120 degrees flexion even though it was almost rectangular at 90 degrees flexion after TKA.     

Cecal volvulus in cerebral palsy: Report of a case

A rare case of cecal volvulus in cerebral palsy that was preoperatively diagnosed and surgically treated without complications is herein reported. A 45-year old man, who had been treated for cerebral palsy as a result of a neonatal cerebral hemorrhage, was admitted to our hospital because of abdominal pain and vomiting. A plain abdominal X-ray film showed evidence of a huge quantity of gas in the left abdomen. Using a gastrographin enema from the colonoscope, an obstruction of the ascending colon was revealed with tapering of the lumen. A computed tomography scan showed a grossly dilated air-distended bowel in the left abdomen and soft tissue with internal architecture containing swirling strands of soft tissue and fat attenuation. An emergency laparotomy was performed. During the laparotomy the ileocecal region, which was unfixed at the retroperitoneum, was found to be twisted counterclockwise by 360° around the mesentery with the terminal ileum, thus resulting in a diagnosis of cecal volvulus. We therefore conducted an ileocecal resection. Cecal volvulus is an uncommon form of intestinal obstruction with a high mortality rate and may present considerable difficulty in diagnosis. Although cecal volvulus is rare as a cause of intestinal obstruction, it should be included in the differential diagnosis of bowel obstruction in cerebral palsy.     

Long-term survival after a surgical resection of pulmonary metastases from gastric cancer: Report of a case

We describe a patient who survived for a prolonged period after repeated resections of pulmonary metastases from gastric cancer. A 59-year-old man underwent a distal gastrectomy for gastric cancer. A right middle lobectomy and a left lower lobectomy were performed for metastases from gastric cancer at 34 months and 82 months after the initial gastric resection, respectively. The patient died of cerebral infarction 65 months after the first lung resection, with no further relapse. To our knowledge, long-term survival after resection of pulmonary metastases from gastric cancer has only been reported in 3 patients previously. We herein review the literature and discuss the role of surgery in such patients.     

Primary carcinoid of the testis associated with carcinoid syndrome

Testicular carcinoid is a rare disease accounting for less than 1% of all testicular neoplasms. It rarely manifests symptoms of carcinoid syndrome. Recent reports have noted that only 1.1-3.1% of testicular carcinoid tumors are complicated by carcinoid syndrome. In general, large tumor size and the presence of carcinoid syndrome are features associated with a malignant course. In the present case, pathological findings revealed pure carcinoid of the testis without metastasis. Moreover, watery diarrhea due to carcinoid syndrome disappeared and the serum serotonin level normalized following orchiectomy. The patient was followed up for 12 months with whole body computed tomography scan and assessment of serotonin levels. To date, there is no evidence of tumor recurrence. These findings suggest that monitoring serum serotonin levels may be useful as a marker during follow up of this type of tumor.     

Spontaneous closure of dural arteriovenous fistula after performing diagnostic angiography

The pathogenesis and clinical treatment of dural arteriovenous fistulas (DAVF) has been well established. However, only 15 cases of spontaneous closure of DAVFs have been reported. We describe a case of spontaneous closure of a DAVF. A 60-year-old male presented with pulsatile tinnitus. Selective cerebral angiography revealed a left posterior DAVF fed by the left occipital artery and the middle meningeal artery, which drained into the left transverse sinus and sigmoid sinus. Following the initial angiography, the patient exhibited vomiting with transient disorientation and amnesia. These symptoms, along with the tinnitus, disappeared by the following day. Seven days after the initial angiography, a second angiography was performed that revealed the complete disappearance of the DAVF. Previous reports have described a long period of closure for DAVFs following initial diagnosis. Possible mechanisms for spontaneous closure of DAVFs include the development of scar tissue or a sinus thrombosis that leads to occlusion of the DAVF In this case, the DAVF closure may have been due to a sinus thrombosis induced by sinus stenosis, since occlusion of the draining sinuses coincided with the spontaneous closure of the DAVF. In cases of non-traumatic DAVF without cortical venous reflex that do not present severe symptoms, a prudent course of treatment is necessary since there is a chance of spontaneous closure of the DAVF occuring.     

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy

Purpose

We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair.

Methods

Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group).

Results

All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups.

Conclusion

Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.     

Endoscopic submucosal dissection for colorectal neoplasia during the clinical learning curve

Background

The efficacy of colorectal endoscopic submucosal dissection (ESD) has been reported mainly from Japanese referral centers. However, ESD is technically difficult and associated with a higher risk of adverse events than endoscopic mucosal resection, especially for novices performing colorectal ESD with little experience in gastric ESD. The current study evaluated the results of colorectal ESD during the clinical learning curve by retrospectively examining the results of colorectal ESD performed by four endoscopists who had experience with fewer than five cases of gastric ESD.

Methods

The study retrospectively investigated the first 20 cases managed by each endoscopist, for a total of 80 cases. The main outcome measurements were procedural time, en bloc resection rate with tumor-free margins (R0 resection rate), and adverse events rate. From among clinicopathologic characteristics, factors that affected main outcome measurements were identified.

Results

Of the 80 cases (56 colonic and 24 rectal lesions; 44 granular laterally spreading tumors (LSTs) and 23 nongranular LSTs, 5 depressed, and 8 protruding), 54 cases (67.5 %) had resection using a standard tip-type knife, and 26 cases (32.5 %) had resection using a small scissors-type knife. The mean tumor diameter was 34.9 ± 14.1 mm, and the mean procedural time was 108.8 ± 53.4 min. The resection in 75 cases (93.8 %) was performed en bloc, and the R0 resection rate was 75 % (60/80). Perforation occurred in six cases (7.5 %) and postoperative hemorrhage in three cases (3.8 %). Multivariate analyses showed that colonic lesions and larger lesions (≥40 mm) were significantly associated with prolonged procedural time (≥90 min). Use of the scissors-type knife was significantly associated with a higher R0 resection rate. Perforation occurred only in colonic lesions.

Conclusions

For novices in colorectal ESD, beginning with rectal and smaller lesions may be advisable. Also, using scissors-type knives may increase the R0 resection rate.     

Lumbar foraminal stenosis causes leg pain at rest

Purpose

Lumbar intra-spinal canal stenosis is characterized by leg pain that intensifies during walking and intermittent claudication, while leg pain at rest is a characteristic neurological symptom of lumbar disc herniation. Until now, a correlation between leg pain at rest and symptomatic foraminal stenosis has not been reported. This is a prospective and comparative study of unilateral leg pain from L5 nerve root compression due to spinal canal stenosis to determine clinical characteristics of lumbar foraminal stenosis.

Methods

Clinical and neurological findings were compared among 38 patients receiving L5–S1 transforaminal lumbar interbody fusion for L5–S1 foraminal stenosis (FS group) and 60 patients receiving L4–5 decompression or/and fusion for L4–5 intra-spinal canal stenosis (CS group).

Results

The only significant difference between the FS and CS groups in demographic clinical data was leg pain at rest. The prevalence of leg pain was significantly higher in the FS group compared to the CS group (76 vs. 35 %). The visual analogue scale for leg pain at rest was also significantly higher in the FS group than in the CS group (6.6 ± 3.1 vs. 1.3 ± 1.9).

Conclusions

Leg pain at rest is characteristic of L5–S1 foraminal stenosis.