Early Triple Carcinomas Metachronously Involving the Sigmoid Colon, Stomach and Gallbladder Report of a Case

We present a case of early triple carcinomas metachronously involving the sigmoid colon, stomach and gallbladder in order to emphasize that a mass screening is useful in the detection of early cancer of the alimentary tract. A 61-year-old male was admitted to the hospital for investigation of a flat elevated lesion of the sigmoid colon. The patient received partial resection of the sigmoid colon with the diagnosis of carcinoma. Pathologic findings showed adenocarcinoma confined to the mucosa. Sixteen months after surgery, a depressed stomach lesion was found through a mass screening. Distal gastrectomy was performed because of carcinoma, which was histologically confined to the mucosa. Sixty-five months later, he underwent cholecystectomy because of a polypoid lesion of the gallbladder. Pathologic findings disclosed adenocarcinoma infiltrated into the muscular layer of the gallbladder. The patient is currently in good health about 4 years after undergoing cholecystectomy. Zusammenfassung Wir berichten über einen Fall von drei Frühkarzinomen, die metachron in Sigmoid, Magen und Gallenblase auftraten, um darauf hinzuweisen, dass ein Massenscreenig zur Entdeckung von Frühkarzinomen des Verdauungstraktes sinnvoll ist. Ein 61-jähriger Mann wurde zur Abklä,rung einer flach erhöhten Läsion des Sigmoids stationär aufgenommen. Der Patient unterzog sich einer Teilresektion des Sigmoids mit der Diagnose eines Karzinoms. Die pathologische Aufarbeitung ergab ein Adenokarzinom, das auf die Mukosa beschränkt war. 16 Monate nach der Operation zeigte sich bei einer Reihenuntersuchung eine indurierte Magenläsion. Es folgte eine distale Gastrektomie aufgrund eines Karzinoms, das auf die Mukosa begrenzt war. 65 Monate später musste sich der Patient wegen einer polypoiden Läsion der Gallenblase einer Cholezystektomie unterziehen. Die pathologischen Befunde ergaben ein Adenokarzinom, das die Muskelschicht der Gallenblase infiltriert hatte. Der Patient is zur Zeit, etwa vier Jahre nach der Cholezystektomie, bei guter Gesundheit.     

Long-term results of a prospective study of anterior decompression with fusion and posterior decompression with laminoplasty for treatment of cervical spondylotic myelopathy

Background

There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).

Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure: Propensity score matching analysis

Purpose

Stoma closure has been associated with a high rate of surgical site infection (SSI) and the optimal skin closure method is still controversial. The aim of this study was to compare the short-term and long-term outcomes between the conventional linear closure (CC) and the persestring closure (PC) using propensity score matching analysis.

Simple method to make a supersaturated oxygen fluid

Journal of Artificial Organs - Intravenous oxygenation has demonstrated significant increase in partial pressure of oxygen (PO2) in animal models. A highly dissolved oxygen solution might be able...     

Strain on the repaired supraspinatus tendon during manual traction and translational glide mobilization on the glenohumeral joint: a cadaveric biomechanics study

There has been no report on the mechanical effects of joint mobilization on rotator cuffs. The purpose of this study was to determine whether it is safe to use grade 3 joint mobilization techniques after rotator cuff repair. Nine fresh frozen cadaveric shoulders were used in this study. The strains on the artificially repaired supraspinatus tendon during joint mobilization were measured at 0 degrees and 30 degrees of shoulder abduction and were compared with those at the maximal stretching position and relaxing position. Additionally, gap distances were measured during this experiment. The strain at 30 degrees of abduction of the repaired tendon during each joint mobilization was significantly smaller than that at 0 degrees abduction (P<0.05). At 30 degrees of abduction, the strain during joint mobilization was not statistically different from that of the shoulder in the relaxing position, except during the inferior glide technique. Gap distances were 0mm at 30 degrees , while the distances were 1.06-1.46 mm at 0 degrees. Our findings suggest that joint mobilization techniques, except inferior glide, can be performed safely without significantly straining the repaired tendon at 30 degrees of abduction, if rotator cuff repair is performed at 0 degrees of abduction.     

Pulmonary coccidioidomycosis that formed a fungus ball with 8-years duration

Coccidioidomycosis, caused by inhaling Coccidioides immitis, is a mycosis imported from endemic regions including the southwestern United States. C. immitis is so virulent that even a short-term stay in the endemic area can provide a chance for infection. Here, we report a 33-year-old Japanese man with formation of a fungus ball inside the pulmonary cavity secondary to coccidioidomycosis with a duration of 8 years, which is considered rare. He was infected with C. immitis in the United States in 1996. A nodule remained in the lung, which later cavitated with fungus ball formation. We identified Coccidioides immitis in the cultured specimen from the cavity and serum antibodies against it. We performed a lobectomy in 2003 since anti-fungal treatment was only temporarily effective. He is still free of disease 6 months later.     

Prognostic importance of neuroendocrine differentiation in Japanese breast cancer patients

Purpose

To evaluate the frequency and prognostic importance of neuroendocrine differentiation (NED) in Japanese breast cancer patients.

Methods

We used standard immunohistochemical techniques to examine 50 patients who underwent resection of breast cancer between 1988 and 1993 at the Department of Surgery II, Nagoya University Hospital, for NED, defined as positive reactivity for four markers: neuron-specific enolase (NSE), synaptophysin, CD57, and chromogranin A (CGA). Neuroendocrine differentiation was defined by the presence of at least one marker including CGA, CD57, and synaptophysin, or at least two markers when one was positive for NSE.

Results

Neuroendocrine differentiation was found in 13 (26%) of the 50 patients examined. There were no significant differences in the distribution of patients with positive or negative NED in terms of age, menopausal status, tumor size, lymph node metastasis, histological grade, ER, PgR, and HER2. We calculated the cumulative survival rates of patient groups according to NED status, and found no significant difference in overall or disease-free survival between patients with and those without NED.

Conclusion

Neuroendocrine differentiation was identified in a subset (26%) of Japanese breast cancer patients, but this appeared to have no relationship with established prognostic factors or patient outcome.     

Stent thrombosis after complex multivessel stenting in an elderly patient

We report a challenging case in terms of procedural difficulty as well as long‐term patency. Multivessel stenting procedures for long subtotal occlusions in the right coronary artery (RCA) and left anterior descending coronary artery (LAD) were successfully performed in an 84‐year‐old female who had complications of severe left ventricular dysfunction and a recent history of gastric ulcer bleeding. Two bare‐metal stents were successfully deployed in the mid and distal RCA. A drug‐eluting stent could only be deployed in the proximal RCA. Two drug‐eluting stents were deployed in the proximal LAD and LMT. Late stent thrombosis in the proximal RCA occurred about 3 months later. We speculated that a lack of aspirin and bare metal stent restenosis were the reasons for the late stent thrombosis. This case was very challenging in terms of balancing the risk of ischemia and bleeding after coronary stent deployment. © 2010 Wiley‐Liss, Inc.     

Sensitivity surveillance of Pseudomonas aeruginosa isolates for several antibacterial agents in Gifu and Aichi prefecture (2008)

We investigated the susceptibility to antibacterial agents of 334 strains of Pseudomonas aeruginosa isolated from medical facilities in Gifu and Aichi prefectures from May to September 2008. For the beta-lactams, meropenem (MEPM) and doripenem (DRPM) gave the lowest MIC50 at 0.5 microg/mL, and tazobactam/piperacillin (TAZ/PIPC) gave the highest susceptible rate of the breakpoint by Clinical and Laboratory Standards Institute (CLSI) at 93.1%. For the quinolones, ciprofloxacin (CPFX) gave the lowest MIC50 at 0.25 microg/mL, followed by pazufloxacin (PZFX) at 0.5 microg/mL, and levofloxacin (LVFX) at 1 microg/mL, and susceptible rate was 76.0% for CPFX and 73.4% for LVFX. Susceptible rates to amikacin (AMK) and tobramycin (TOB) of aminoglycocides and colistin (CL) of polypeptides were 98.2%, 97.6% and 96.4%. In 334 strains, IMP-1 MBL producing P. aeruginosa was 1 strain, and the strain showed resistance to all antibacterial agents except AMK and CL used in this study. The strains isolated from urine were lower susceptible rate in comparison with those from sputum, notably the susceptible rate to CPFX from urine was less over 30% than those from sputum. Because the results of the susceptibility test against P. aeruginosa were different in each area, it is important for us to pay attention to the susceptibility to antibacterial agents and the emergence of resistance in the clinical strains through continuous susceptibility surveillance.     

Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report

We present a case of malignant mesothelioma of the peritoneum with massive direct invasion to the liver in a 58-year-old Japanese woman. She had no history of asbestos exposure or other malignancies. Abdominal computed tomography revealed one 8-cm intrahepatic mass adjacent to the abdominal wall with peritoneal thickening, multiple smaller nodules in the peritoneal cavity, and intra-abdominal lymphadenopathy. Liver biopsy showed a small cluster of atypical cells similar to epithelial neoplasm, which formed a tubulopapillary structure. The tumor cells were positive for calretinin with strong nuclear and cytoplasmic expression together with podoplanin (D2-40) and some cytokeratins, but were negative for hepatocyte paraffin 1 and other adenocarcinoma markers. We confirmed a diffuse peritoneal mesothelioma with direct invasion to the liver. Liver masses with other peritoneal nodules are mostly encountered as metastatic diseases. However, the possibility of mesothelioma should be considered, even in women without an apparent history of asbestos exposure.