Thoracic aneurysm expansion secondary to collateral supplies via thyrocervical trunk and intercostal arteries in a patient after thromboexclusion.

A case of thoraco-abdominal aortic aneurysm complicated after permanent clamping of the descending aorta (thromboexclusion) is reported. Angiographic and operative findings were: (1) a pseudo-aneurysm right at the distal anastomosis of previous intrathoracic bypass for pseudo-coarctation of the aorta filled by left ninth intercostal artery, which was supplied by the left internal thoracic artery; and (2) the cervical and thoracic spinal cord were supplied by the left vertebral artery and the mediastinal branch of the left thyrocervical trunk. This rare cause of a thoraco-abdominal aortic aneurysm and the significance of the subclavian artery as a source of spinal cord blood supply are discussed.     

The Effect of Religious Dietary Cultures on Food Nitrogen and Phosphorus Footprints: A Case Study of India

The excessive consumption of nitrogen (N) and phosphorus (P), two vital nutrients for living organisms, is associated with negative environmental and health impacts. While food production contributes to a large amount of N and P loss to the environment, very little N and P is consumed as food. Food habits are affected by multiple regulations, including the dietary restrictions and dictates of various religions. In this study, religion-sensitive N-Calculator and P-Calculator approaches were used to determine the impact of religious dietary culture on the food N and P footprints of India in the major religious communities. Using 2013 data, the food N footprint of Hindus, Muslims, Christians, and Buddhists was 10.70, 11.45, 11.47, and 7.39 kg-N capita⁻¹ year⁻¹ (10.82 kg-N capita⁻¹ year⁻¹ was the national average), and the food P footprint was 1.46, 1.58, 1.04. and 1.58 kg-P capita⁻¹ year⁻¹ (1.48 kg-P capita⁻¹ year⁻¹ was the national average). The findings highlight the impact of individual choice on the N and P food footprints, and the importance of encouraging the followers of religion to follow a diet consistent with the food culture of that religion. The results of this study are a clear indication of the requirement for religion-sensitive analyses in the collecting of data pertinent to a particular country for use in making government policies designed to improve the recycling of food waste and the treatment of wastewater.     

Lynch syndrome-associated chordoma with high tumor mutational burden and significant response to immune checkpoint inhibitors

Chordoma is a rare malignant bone tumor arising from notochordal tissue. Conventional treatments, such as radical resection and high-dose irradiation, frequently fail to control the tumor, resulting in recurrence and re-growth. In this study, genetic analysis of the tumor in a 72-year-old male patient with refractory conventional chordoma of the skull base revealed a high tumor mutational burden (TMB) and mutations in the MSH6 and MLH1 genes, which are found in Lynch syndrome. The patient and his family had a dense cancer history, and subsequent germline genetic testing revealed Lynch syndrome. This is the first report of a chordoma that has been genetically proven to be Lynch syndrome. Chordomas usually have low TMB; however, this is an unusual case, because the TMB was high, and immune checkpoint inhibitors effectively controlled the tumor. This case provides a basis for determining the indications for immunotherapy of chordoma based on the genetic analysis. Therefore, further extensive genetic analysis in the future will help to stratify the treatment of chordoma.

     

Surgical technique for repair of benign stricture of the bile ducts,preserving the papilla of vater

From March 1977 to October 1983, we examined 6 patients with benign bile duct stricture. Four were female and 2 were male, ranging in age from 55 to 69 years. These patients were treated by operative methods in which the papilla of Vater was preserved. These operative methods were end-to-side anastomosis of the bile ducts, repair of the bile duct utilizing a part of the gallbladder or a remnant of the cystic duct, and repair of the bile duct using a patch of jejunal wall. The postoperative observation period is 8 months to 7 years and 4 months. It is our policy to preserve the function of the papilla of Vater when possible because with this method the flow of bile is uninterrupted. We especially recommend a jejunal patch for repair of the bile duct, when no remnant of the cystic duct is available. This method is applied when the bile duct stricture is less than 3 cm long. We have operated on 2 patients with this method and the results have been completely satisfactory.

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Resumen En presencia de estrecheces benignas de los canales biliares los cirujanos generalmente realizan coledoco-yeyunostomía o coledocoduodenostomía como forma de manejo operatorio. Sinembargo, en ocasiones se producen complicaciones indeseables como resultado de estas operaciones, tales como colangitis recurrente, estrecheces de la anastomosis o formación de cálculos intrahepáticos. Con el objeto de evitar este tipo de problemas, una operación que logre la conservación de la papila Vater y de su función viene a significar algo ventajoso.Entre marzo de 1977 y octubre de 1983 tuvimos 6 pacientes con estrecheces biliares benignas. Cuatro eran mujeres y dos hombres, con edades entre 55 y 69 años. Estos pacientes fueron tratados mediante operaciones conservadoras de la papila. Tales operaciones fueron la anastomosis término-lateral de los canales biliares, la reparación biliar utilizando una parte de la vesícula biliar o un remanente del canal cístico y la repación biliar utilizando un parche de pared yeyunal. El periodo de observación postoperatoria osciló entre 8 meses y 7 años cuatro meses. Nuestra política es la de conservar la función de la papila de Vater cuando ésto sea posible, puesto que ello significa un flujo de bilis fissiológico. Nosotros recomendamos especialmente el uso de un parche yeyunal para la repación biliar, en casos en los cuales no exista un remanente utilizable de canal cístico. Este método es aplicable cuando la estrechéz biliar es de menos de 3 cm. Hemos operado dos pacientes con este método y los resultados han sido enteramente satisfactorios.

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Résumé De mars 1977, à octobre 1983, les auteurs ont opéré 6 sténoses bénignes des voies biliaires chez 4 femmes et 2 hommes, leur âge étant compris entre 55 et 69 ans. Les techniques opératoires suivies eurent pour but de préserver l'intégrité de la papille de Vater. Elles ont consisté en anastomose terminolatérale biliaire, reconstruction du canal biliaire en employant un segment de la vésicule ou le moignon cystique ou encore en utilisant un patch jéjunal. Le suivi de ces interventions s'étend de 8 mois à 7 ans et 4 mois. La tactique a été de préserver les fonctions de la papille de Vater dans la mesure du possible pour respecter la physiologie biliaire.Les auteurs conseillent d'avoir recours au patch jéjunal quand un moignon cystique n'est pas disponible; cette méthode en fait ne peut être appliquée qu'en présence d'une sténose biliaire dont la longueur est inférieure à 3 cm. Dans 2 cas, où elle été employée elle a donné d'excellents résultats.

     

Dynamics of neutrophil and C‐reactive protein reflect the clinical course of pyrexia during combination therapy with dabrafenib and trametinib

Pyrexia is the most common adverse event in patients with melanoma or other solid organ malignancies that are treated with the combination of dabrafenib and trametinib (combi‐DT). Given the expanded indication for combi‐DT, management of pyrexia is a high priority. No previous case series has revealed which blood markers reflect the course of pyrexia and there is no consensus on the management strategy for pyrexia. The current case series study describes the utility of neutrophil count (NC), neutrophil ratio (NR) and C‐reactive protein (CRP) in 11 patients with metastatic melanoma and BRAF V600 mutations who experienced pyrexia during combi‐DT in our department. We also described the clinical course of pyrexia episodes that were managed with the concomitant use of oral prednisolone and immediate withdrawal of combi‐DT. Consequently, the analysis of 37 pyrexia episodes in 11 patients showed that the differences in NC, NR and CRP at the onset of pyrexia were significantly different from those at pyretolysis (P = 0.01, 0.006 and 0.03, respectively). Additionally, in the 24 pyrexia episodes treated with the concomitant use of oral prednisolone and the immediate withdrawal of combi‐DT, the mean duration of pyrexia and the mean time to restart combi‐DT were 3 and 6 days, respectively. Therefore, the blood markers that reflect the course of pyrexia during combi‐DT may be helpful for the appropriate management of pyrexia; also, our management strategy for pyrexia successfully reduced the duration of pyrexia and did not require a long‐term drug holiday. Further large‐scale studies are required to verify our results.     

Novel bromomelatonin derivatives as potentially effective drugs to treat bone diseases

Several reports indicate that melatonin is involved in the regulation of bone metabolism. To examine the direct effect of melatonin on osteoclasts and osteoblasts, we developed an in vitro assay using fish scales that contain osteoclasts, osteoblasts, and bone matrix, all of which are similar to those found in mammalian membrane bone. Using the assay, we demonstrated that melatonin suppressed osteoclastic and osteoblastic activities. These findings are in agreement with the reports from in vivo studies in mice and rats. In an attempt to develop molecules that increase bone mass, novel bromomelatonin derivatives were synthesized, and the effects of these chemicals on osteoclasts and osteoblasts using the scale assay were examined. As a result, novel bromomelatonin derivatives with the ability to possibly increase bone formation were identified. In scale osteoclasts, particularly, 1-benzyl-2,4,6-tribromomelatonin had a more potent activity than melatonin. In reference to osteoblasts, this agent (10(-9)-10(-6)M) significantly activated osteoblasts. The effect of 1-benzyl-2,4,6-tribromomelatonin on bone formation was confirmed in ovariectomized rats. Thus, the oral administration of 1-benzyl-2,4,6-tribromomelatonin augmented the total bone mineral density of the femoral metaphysis of ovariectomized rats. The stress-strain index of the diaphysis in 1-benzyl-2,4,6-tribromomelatonin-treated rats significantly increased in comparison with that in ovariectomized rats. In rats fed a low-calcium diet, the total bone mineral density of the femoral metaphysis significantly increased following the oral administration of 1-benzyl-2,4,6-tribromomelatonin. These studies identified a melatonin derivative that may have potential use in the treatment of bone diseases, such as osteoporosis.