New device for collecting intra-oral findings of unknown body

In dental identification, the collection of intra-oral images is extremely important. We propose the Dental Watch(?) as a new device for collecting intra-oral findings in situations where sufficient jaw-opening or adequate lighting cannot be obtained in such cases of dead bodies within a day after death or burned bodies encountered in mass disaster. This device is an improved home video camera for taking intra-oral images. It is lightweight and cordless, allowing it to be operated with one hand, and an audio function allows comments to be made and recorded on obtaining findings at the same time as images are taken. In addition, this device allows images of the entire oral cavity to be taken comparatively easily, even when only a minimal degree of jaw movement is available. This device is extremely useful in situations where a single dentist inspector must obtain findings and make an accurate and detailed Dental Chart.     

Advanced esophageal cancer with situs inversus totalis successfully treated with chemoradiotherapy followed by esophagectomy: case report

We report a case of advanced esophageal cancer successfully treated with neoadjuvant chemoradiotherapy followed by esophagectomy in a 53-year-old man with situs inversus totalis. Upper gastrointestinal endoscopy in a clinical examination revealed a tumor in the lower third of the esophagus, and moderately differentiated squamous cell carcinoma was diagnosed from the biopsy findings. He was referred to us and the disease was diagnosed as esophageal cancer (clinical T3N1M0, cStage III) after further evaluation. According to the therapeutic strategy of our department, neoadjuvant chemoradiotherapy was commenced. The regimen was composed of radiotherapy (2 Gy/day, 5 days/week, 4weeks, total 40Gy) with cisplatin (70 mg/m2/day, day 1) and 5-FU (700 mg/m2/day, day 1-4). We performed a subtotal esophagectomy with radical lymph node dissection through a left thoracotomy because of the existence of situs inversus totalis. The thoracic operation could be performed with relatively safety because the organs were arranged in a mirror image of their normal positions. On the other hand, it was relatively difficult to construct a gastric tube. In particular, ligation of the gastrosplenic ligaments was difficult and this led to increased blood loss compared with usual operation. Histopathological examination revealed no residual carcinoma at the site of the primary focus. The patient has been followed up periodically on an outpatient basis and has remained free of recurrence for longer than 2 years 5 months after surgery.     

'Takotsubo' cardiomyopathy in a maintenance hemodialysis patient

An 84-year-old woman undergoing maintenance hemodialysis presented with chest discomfort lasting several days and electrocardiographic abnormalities. She had stopped smoking 2 weeks earlier and was experiencing irritability. Upon admission, electrocardiography showed ST-segment elevation in leads I, II, aVF, and V2-6 and an abnormal Q wave in leads II, III, and aVF. Ultrasound cardiography showed left ventricular anteroapical akinesia and basal hyperkinesia. The chest discomfort disappeared without specific therapy. During hospital days 1-5, the ST-segment elevation gradually improved. Giant negative T waves then developed. The left ventricular asynergy resolved by day 8. Radionuclide imaging with iodine-123-beta-methyl-p-iodophenyl pentadecanoic acid, but not with technetium-99 m-sestamibi, showed an apical defect. Elective coronary angiography showed no stenosis. 'Takotsubo' cardiomyopathy was diagnosed. After discharge, the patient continued regular dialysis without cardiac symptoms. We concluded that endogenously activated sympathetic nerve action in hemodialysis patients, especially those under emotional or physical stress, might be a causative factor for Takotsubo cardiomyopathy.     

Pancreaticoduodenectomy for pancreatoblastoma: a case report and literature review

Pancreatoblastoma (PB) is extremely rare. A 11-year-old boy, who had excision of dilated common bile duct with hepaticoduodenostomy when 9 years old was referred to our institute for further management of abdominal pain and steatorrhea. Imaging studies showed a solid 4 cm tumor in the head of the pancreas and two lesions in the liver. Needle biopsies diagnosed PB with liver metastases. After five courses of chemotherapy, the primary tumor was completely resected with pancreaticoduodenectomy (PD) and Child’s pancreaticobiliary tract reconstruction. The liver metastases were resected. Postoperative recovery was uneventful. Here, we present this case and review the literature focusing on management of PB.     

Clinical features of symptomatic primary biliary cirrhosis initially complicated with esophageal varices

Background Esophageal varices (EV), one feature of portal hypertension, have been regarded as a late complication of liver diseases. However, accumulating evidence indicates that EV sometimes develop early during the course of primary biliary cirrhosis (PBC). The prognosis is usually poorer for patients with symptomatic PBC than for those with asymptomatic PBC. Nevertheless, the clinical features and prognosis of patients with PBC whose initial symptoms are EV have not been clarified. Methods The clinical features and the prognosis of patients who initially developed EV without other symptoms (v-PBC) were retrospectively investigated in 54 patients with symptomatic PBC. Results The leukocyte and platelet counts were lower in patients with v-PBC than in those with PBC accompanied by other symptoms (s-PBC). Liver function tests, autoantibodies, and histological stage did not differ between patients with v-PBC and those with s-PBC. Although the prognosis did not differ, the incidence of hepatocellular carcinoma was significantly higher in v-PBC than in s-PBC (P = 0.0037). Conclusions These data indicate that v-PBC is a hypercarcinogenic state and constitutes a new subgroup of PBC.     

Curative Resection Performed Twice for Circular-Staple-Line Recurrence After Colorectal Carcinoma Surgery: Report of a Case

Staple-line recurrence is an important pattern of recurrence after colorectal carcinoma surgery, occurring in approximately 1% of patients. We report the case of a 44-year-old woman who underwent resection of carcinoma recurrence in a circular-staple-line twice within 34 months. Initially, she underwent sigmoidectomy for carcinoma of the sigmoid colon, followed by end-to-end anastomosis, done using a circular stapler. Subsequently, she underwent an anterior resection, then a low anterior resection, 12 and 34 months after the initial operation, respectively, both to treat a circular-staple-line recurrence of the tumor. Histological examination of all resected specimens revealed moderately differentiated adenocarcinoma with clear surgical margins and no lymph node metastasis. The patient remains well with no evidence of disease 48 months after her initial operation. To our knowledge, this is the first reported case of curative surgical resection being performed twice for circular-staple-line recurrence of colorectal carcinoma. Based on our experience and our review of the literature, early detection by follow-up colonoscopy and surgical resection may improve the prognosis of patients with a staple-line recurrence after the resection of colorectal carcinoma.