Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method

PURPOSE: The aim of this study was to clarify the distribution of lymph node metastasis in colorectal cancer. We also examined the relationship between the primary tumor (T) and the regional node (N) categories of the TNM (primary tumor, regional nodes, metastasis) classification. METHOD: Lymph nodes of surgical specimens in 311 consecutive patients with colorectal cancer were studied using the modified clearing method. RESULTS: Lymph node metastasis was seen in 59.2 percent of the total cases. The upward metastasis rate was 30.7 percent. In the longitudinal spread, most of the lymph node metastasis was seen within 10 cm. On the oral side in rectal cancer, there was no metastasis beyond 4 cm. The lateral metastasis rate in rectal cancer was 8.8 percent and in the lower rectum, the rate of cancer within 6 cm from the anal verge or beyond pT3 was much higher. CONCLUSION: In the TNM classification, there was no significant difference between colon and rectal cancer except pT1 with rectal cancer. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis, and lateral lymph node dissection or radiation therapy should be performed.     

Emergency aortic arch replacement in a patient with idiopathic thrombocytopenic purpura

We herein report the case of a 56-year-old man with idiopathic thrombocytopenic purpura who required an emergency aortic arch replacement. Intraoperatively, hemostasis was achieved using platelet transfusions. Postoperatively, the use of high-dose -globulin therapy was able to maintain an adequate platelet count and good hemostasis.     

A case of advanced gastric cancer with multiple liver metastases responding to TS-1 and CDDP

A 44-year-old male presented to our hospital with abdominal pain. The upper endoscopy revealed advanced gastric cancer. On the abdominal CT, there was evidence of multiple, massive liver metastases. After total gastrectomy, the patient was treated with daily oral administration of 120 mg TS-1 for 4 weeks followed by 2 weeks' rest and 6 weekly infusions of 10 mg CDDP in an intra-hepatic artery as 1 cycle. On the follow-up CT, the liver metastases had decreased significantly both in size and number after 2 cycles. The current case suggests that TS-1 and CDDP may have a potent therapeutic efficacy in cases of advanced gastric cancer with multiple liver metastases.     

IL-1 beta, IL-1 receptor antagonist and soluble type II IL-1 receptor in synovial fluid of patients with temporomandibular disorders

Among the members of the interleukin-1 (IL-1) family, IL-1 beta, which is a major agonist, has been detected in synovial fluid (SF) of the temporomandibular joint (TMJ) of patients with temporomandibular joint disorders (TMD). However, there is little knowledge regarding suppressive molecules, such as IL-1 receptor antagonist (IL-1ra) and the soluble form of type II IL-1 receptor (sIL-1RII), in TMD patients. The aim of this study was to investigate the levels of IL-1 beta, IL-1ra and sIL-1RII in the TMJ SF of patients with TMD and their relationship. Fifty-two SF samples from TMD patients and nine samples from asymptomatic volunteers were examined. Detected levels of IL-1 beta and sIL-1RII were significantly higher in the TMD group compared with the volunteer group. There was no significant difference in IL-1ra levels between the TMD and volunteer groups. The IL-1 beta/IL-1ra ratio in the TMD group, however, was higher than that in the volunteer group. In the TMD group, positive correlations were found between IL-1 beta and IL-1ra, IL-1ra and sIL-1RII, and IL-1 beta and sIL-1RII. In addition to increased IL-1 beta, development of TMD may also lead to decreased IL-1ra and increased sIL-1RII in response to increasing IL-1.     

A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion

The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.