A case report--intrahepatic arterial infusion with CDDP and S-1 administration can elicit long-term survival for the patient with recurrenced intrahepatic cholangiocarcinoma after resection

To cure intrahepatic cholangiocarcinoma (ICC), only a surgical resection is the potential treatment at present. However, recurrence tumors in residual liver and/or distant organs even after curative surgery are commonly experienced in clinical course. Unfortunately the potential treatment for this recurrent disease is not established at present. Accordingly, the prognosis of this recurrent ICC is extremely poor. Here, we report the prolonged survival case with recurrent ICC after hepatic resection followed by combined therapy of intrahepatic arterial infusion with CDDP and S-1 administration. The patient was a 71-year-old female. She had been treated for hepatitis B for last 5 years. After that, liver tumor of 30 mm in diameter was detected in S1/8 by abdominal CT examination. Subsequently, caudate lobectomy and partial resection of Segment 8 were performed under the diagnosis of Hepatocellular carcinoma in Osaka university hospital. The pathological stage was T2N0M0, Stage II with moderately differentiated intrahepatic cholangiocarcinoma. As the recurrence tumor was found in Segment 4 of residual liver, we started a treatment with intrahepatic arterial infusion with CDDP and S-1 administration, immediately. These combined therapy displayed beneficial effects and a recurrent liver tumor was well controlled. At present, this patient is still survived for over 5 years after the operation.     

Effects of fragrance administration on stress-induced prefrontal cortex activity and sebum secretion in the facial skin

Although fragrances have long been known to influence stress-induced psychosomatic disorders, the neurophysiological mechanism remains unclear. We evaluated the effect of fragrance on the relation between the level of sebum secretion in the facial skin and the stress-induced prefrontal cortex (PFC) activity, which regulates the activity of the hypothalamic-pituitary-adrenal axis. Employing near infrared spectroscopy, we measured hemoglobin concentration changes in the bilateral PFC during a mental arithmetic task in normal adults (n=31), and evaluated asymmetry of the PFC activity in terms of the laterality index (i.e., [(right-left)/(right+left)]) of oxyhemoglobin concentration changes (LI-oxyHb). We measured the level of sebum secretion in the facial skin before the task performance. There was a significant positive correlation between the LI-oxyHb and the level of sebum secretion (r=+0.44, p=0.01). We selected the subjects who exhibited high levels of sebum secretion and right-dominant PFC activity for the study on the fragrance effect (n=12). Administration of fragrance for four weeks significantly reduced the level of sebum (p=0.02) in the fragrance group (n=6). In addition, the LI-oxyHb decreased significantly from 0.11+/-0.07 to -0.10+/-0.18 (p=0.01), indicating that the dominant side of the stress-induced PFC activity changed from the right to left side. In contrast, neither LI-oxyHb nor the levels of sebum secretion changed significantly in the control group (n=6). These results suggest that administration of fragrance reduced the level of sebum secretion by modulating the stress-induced PFC activity. The PFC may be involved in the neurophysiological mechanism of fragrance effects on systemic response to mental stress.     

Clinical features of spinal infection in individuals older than eighty?years

Purpose

Japan has one of the most rapidly increasing numbers of elderly individuals; therefore, future trends in spinal infections in the elderly in other countries may be predicted by studying such characteristics in Japan. The purposes of this study were to identify whether the incidence of spinal infection in individuals more than 80 years old is increasing and to define its clinical characteristics.

Methods

We retrospectively reviewed the medical records of 98 patients treated in our hospital for spinal infection between 1999 and 2008. Patients were divided into two groups: those admitted to our hospital during the initial five year period, and those admitted during the latter five year period. We evaluated changes in the percentage of individuals over the age of 80 years. To define the clinical characteristics of spinal infection, patients were also divided into another set of two groups: those over 80 years and those around the age of 80 years.

Results

The percentage of patients over 80 years with spinal infection was significantly increasing. There was no significant difference in the gender distribution, prevalence of immunocompromised hosts, common involved levels, or mortality rate between the two age groups. The pathogenic organism was isolated in 78.6%, and of these, the rate of methicillin-resistant Staphylococcus aureus or epidermidis was 2.46 times higher in the elderly group than in the younger group.

Conclusions

The number of patients over 80 years with spinal infection is expected to rapidly increase in aging societies. This advanced age group is more susceptible to infection with drug-resistant organisms, which makes infection management more difficult.     

MRI Reveals Edema in Larynx (But Not in Brain) During Anaphylactic Hypotension in Anesthetized Rats

Purpose

Anaphylactic shock is sometimes accompanied by local interstitial edema due to increased vascular permeability. We performed magnetic resonance imaging (MRI) to compare edema in the larynx and brain of anesthetized rats during anaphylactic hypotension versus vasodilator-induced hypotension.

Methods

Male Sprague Dawley rats were subjected to hypotension induced by the ovalbumin antigen (n=7) or a vasodilator sodium nitroprusside (SNP; n=7). Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on MRI performed repeatedly for up to 68 min after the injection of either agent. The presence of laryngeal edema was also examined by histological examination. Separately, the occurrence of brain edema was assessed by measuring brain water content using the wet/dry method in rats with anaphylaxis (n=5) or SNP (n=5) and the non-hypotensive control rats (n=5). Mast cells in hypothalamus were morphologically examined.

Results

Mean arterial blood pressure similarly decreased to 35 mmHg after an injection of the antigen or SNP. Hyperintensity on T2-weighted images (as reflected by elevated T2RT) was found in the larynx as early as 13 min after an injection of the antigen, but not SNP. A postmortem histological examination revealed epiglottic edema in the rats with anaphylaxis, but not SNP. In contrast, no significant changes in T2RT or ADC were detectable in the brains of any rats studied. In separate experiments, the quantified brain water content did not increase in either anaphylaxis or SNP rats, as compared with the non-hypotensive control rats. The numbers of mast cells with metachromatic granules in the hypothalamus were not different between rats with anaphylaxis and SNP, suggesting the absence of anaphylactic reaction in hypothalamus.

Conclusion

Edema was detected using the MRI technique in the larynx during rat anaphylaxis, but not in the brain.     

Robot-assisted total remnant gastrectomy for interposed jejunal pouch dysfunction 25 years after proximal gastrectomy for gastric cancer: A case report

Proximal gastrectomy (PG) in combination with jejunal pouch interposition is a technique aimed at improving the postoperative dietary outcomes; however, some cases are reported to require surgical intervention owing to difficulty of food intake caused by pouch dysfunction. Herein, we present a case of robot-assisted surgery for interposed jejunal pouch (IJP) dysfunction in a 79-year-old male, occurring 25 years after the initial PG for gastric cancer. The patient had chronic anorexia for 2 years and was treated with medications and dietary guidance; however, 3 months prior to admission his quality of life had reduced, owing to worsening symptoms. The patient was diagnosed with pouch dysfunction due to extremely dilated IJP identified using computed tomography and underwent robot-assisted total remnant gastrectomy (RATRG) with IJP resection. After an uneventful course of intraoperative and postoperative treatment, he was discharged with sufficient food intake on postoperative day 9. RATRG can, thus, be considered in patients with IJP dysfunction after PG.     

A Physician’s Attempt to Self-Medicate Bipolar Depression with N,N-Dimethyltryptamine (DMT)

N,N-dimethyltryptamine (DMT) is a psychoactive substance that has been gaining popularity in therapeutic and recreational use. This is a case of a physician who chronically took DMT augmented with phenelzine in an attempt to self-medicate refractory bipolar depression. His presentation of altered mental status, mania, and psychosis is examined in regards to his DMT use. This case discusses DMT, the possible uses of DMT, and the theorized mechanism of DMT in psychosis and treatment of depression, particularly involving its agonist activity at 5-HT1A, 5-HT2A, and 5-HT2C. It is also important to recognize the dangers of self-medication, particularly amongst physicians.     

Gastric vascular and motor responses to anaphylactic hypotension in anesthetized rats,in comparison to those with hemorrhagic or vasodilator-induced hypotension

Anaphylactic shock is life-threatening, but pathophysiology of the stomach lesion remains unclear. We determined gastric hemodynamics and gastric functions during anaphylactic hypotension, as compared to hypotension induced by hemorrhage or sodium nitroprusside (SNP) in anesthetized and ovalbumin-sensitized Sprague–Dawley rats. Systemic arterial pressure, portal venous pressure, and gastric arterial blood flow were measured, and gastric vascular resistance (GVR) was determined. Separately, the intragastric pressure (IGP) and gastric effluent, as a measure of gastric flux, were continuously measured. During anaphylaxis, GVR decreased only transiently at 0.5 min, followed by an increase. IGP increased markedly, while gastric flux decreased. During hemorrhage, GVR and IGP increased, while gastric flux did not change. When SNP was injected, both GVR and IGP decreased and gastric flux increased only just after injection. In conclusion, gastric vasodilatation occurs only transiently after antigen injection, and gastric motility increases, but gastric emptying deceases during anaphylactic hypotension in anesthetized rats.