Rupture of thoracoabdominal aortic aneurysm associated with Behcet's disease

Surgical treatment of arterial Behcet's disease (BD) has a higher incidence of graft-related complications such as anastomotic pseudoaneurysm or graft occlusion. A 64-year-old man presented with a rupture of the thoracoabdominal aortic aneurysms associated with BD. Evaluation shows a large hematoma in the retroperitoneum and multiple aneurysms of the thoracoabdominal aorta. Physical examination and past history fulfills the diagnostic criteria of BD. The abdominal aorta was replaced with an allograft and the major branches were reconstructed with its branches. The postoperative course was uneventful. A 10-month follow-up computed tomographic scan did not show any graft-related complications. This case suggests the usefulness of an allograft for arterial involvement of BD.     

Anesthesia for nephrectomy in a patient suspected of spurious polycythemia

A 46-year-old man suspected of spurious polycythemia received nephrectomy. Spurious polycythemia patients with high blood pressure as a complication have a high possibility of developing cerebral vascular disease. For its prevention, it is important to decrease blood viscosity by phlebotomy and to perform anticoagulation therapy. It is also necessary to deal with these patients as a high-risk group of cerebral vascular disease even if there is no symptoms. We were able to manage this case safely without any complication by aggressive perioperative phlebotomy and anticoagulation therapy.     

Adenomyoepithelioma of the breast diagnosed by a mammotome biopsy: Report of a case

Adenomyoepithelioma is an uncommon primary breast tumor. It is conspicuous for two elements of the tumor, namely, ductal and myoepithelial components. Recently, a Mammotome biopsy, or stereotactic vacuum-assisted biopsy has become popular and various benign or borderline lesions are obtained. We report an adenomyoepithelioma of the breast in a 56-year-old woman. She was pointed out to have a cluster of some microcalcifications on mammography and a 9-mm hypoechoic mass lesion was detected by ultrasound. A Mammotome biopsy revealed a well-defined lesion. Histologically, the tumor demonstrated a thick and bi-cellular growth pattern consisting of ducts and myoepithelium. Immunohistochemically, epithelial cells were positive for cytokeratin AE1/AE3 and cytokeratin, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA), negative for alpha-smooth muscle actin (alpha-SMA). In addition, myoepithelial cells were positive for alpha-SMA and CEA, which were scatterly positive for cytokeratin AE1/AE3, and negative for EMA. In examinations of non-palpable lesions found on mammography and ultrasound, a Mammotome biopsy is useful for making diagnosis, however, and adenomyoepithelioma is rarely found. In diagnosing such a rare disease from the limited information obtained from a needle biopsy, an immunohistochemical study was thus found to be useful for making a differential diagnosis.     

Survey of the current status of cancer rehabilitation in Japan

Purpose. To elucidate the current status of cancer rehabilitation in institutions nationwide.

Method. A questionnaire survey regarding the current status of cancer rehabilitation in 1693 healthcare institutions was conducted by mail. The survey first asked whether rehabilitation was being conducted for cancer patients and, in facilities in which it was being conducted, it then asked about the content of the rehabilitation, the stage of the cancer patients, etc. Facilities in which cancer rehabilitation was not being conducted were surveyed in regard to whether there was a need for cancer rehabilitation.

Results. Valid replies were obtained from 1045 (62.0%) institutions and 864 (82.7%) of them conducted rehabilitation for cancer patients. A high proportion of the content of the rehabilitation was found to be related to physical function. Activities of daily living guidance and training were also found to be conducted in a high proportion. Low proportions of the facilities conducted content that was specialized for cancer. Of the 181 facilities in which rehabilitation was not being conducted for cancer patients, 171 (94.5%) replied that they felt that rehabilitation was needed for cancer patients.

Conclusions. Based on the results of this fact-finding survey it will be necessary to consider strategies for popularizing and developing rehabilitation programmes for cancer patients in Japan.     

Repair of a torn medial meniscus with an anteromedial meniscofemoral ligament in an anterior cruciate ligament-injured knee

We report a rare case of longitudinal tear of the anterior segment of the medial meniscus in association with the anteromedial meniscofemoral ligament (AMMFL) in an anterior cruciate ligament-injured knee. The tear was repaired, and the anterior horn was transferred to the tibia using the pull-out technique after excising the AMMFL. Repeat arthroscopy performed 7 months postoperatively revealed that the medial meniscus had completely healed and the anterior horn was firmly fixed to the tibia. Two years after the surgery, the patient could play basketball without any symptom. A posteroanterior flexion weight-bearing radiograph did not show any narrowing of the medial joint space. Considering the excellent healing observed in this case, preservation of the meniscus should be considered despite an association between a torn meniscus and an anomalous insertion.     

A case of the primary mediastinal seminoma invading into the extradural space of the thoracic spine

Seminomatous germ cell tumors can arise as primary mediastinal malignancies in the mediastinum without involving the testis. The usual location is the superior mediastinum and histologically it is identical to the testicular seminoma. Here we report a case of extradural spinal cord tumor by primary mediastinal seminoma. The patient, 24 year old male, was evaluated for complaints of severe back pain associated with dysesthesia in lower limbs. He was operated as primary mediastinal seminoma when he was 21 years old. On admission, physical examination was unremarkable except for hypereflexia in lower extremities. The testis were normal. Chest radiography and computed tomography revealed a large mediastinal mass which invaded into the extradural space of the thoracic spine. He had a laminectomy of the thoracic spine and was treated by the radiation therapy and chemotherapy. This is the first report showing the neuroradiological findings of the extradural spinal cord tumor by primary mediastinal seminoma.     

An autopsied case of the Crow-Fukase syndrome: a neuropathological study with emphasis on spinal roots

Summary An autopsied case of the Crow-Fukase syndrome is reported. Neuropathological findings were as follows: (1) in the sural nerve, there was marked decrease of large and small myelinated fibers. Myelinated fibers showing axonal degeneration and segmental demyelination and remyelination were moderately increased. (2) In the lumbar spinal roots, myelinated fibers showing segmental demyelination and remyelination were frequently observed. The density of myelinated fibers of the ventral root was less at the dural site than the spinal site, while that of the dorsal roots was less at the spinal site than the dural site. (3) In the dorsal root ganglion, there were Nageotte's residual nodules and satellitosis; (4) in the lumbar and thoracic spinal cord, there was pallor of the dorsal column; and (5) nerve cells showing central chromatolysis were frequently observed in the spinal anterior horn cells. Segmental demyelination and remyelination in the spinal roots and loss of myelinated fibers with axonal degeneration in the sural nerve are fibers with axonal degeneration in the sural nerve are main neuropathological features of this syndrome.     

RADIATION THERAPY FOR PROSTATE CANCER CONFINED TO PELVIS

To evaluate the usefulness of external beam radiotherapy for patients with prostate cancer confined to the pelvis, long-term results and prognostic factors were analyzed. During the period–1989, 44 cases were treated with staging pelvic lymphadenectomy followed by monotherapy using external beam irradiation by Linac X-ray and/or fast neutrons and observed without any treatment until relapse was evident. All patients were followed until death or for a mean of 78.6 mo (range:–113 mo) for patients still alive. Four cases died of prostate cancer at 26, 28, 54, and 83 mo from the start of radiation. Eleven cases died of other causes (10-72 mo, mean 36.4 mo). Fourteen cases (31.8%) manifested clinical relapse of cancer; 4 had local relapse, 7 developed bone metastases, and 3 relapsed at lymph nodes. After relapse, endocrine therapy was effective in most cases. The five-year disease-free survival rates of pNO (32 cases) and pN1 (8 cases) patients were 79.8% and 52.5%, respectively, but that of pN2 (4 cases) was worse. Cause-specific survival was similar between patients with pNO and pN1 disease, the rate at 5 yr being 92.5% in the former and 100% in the latter. Those with high levels of serum prostate specific antigen (PSA) before treatment and advanced local disease (clinical stage C) showed unfavorable prognoses. The number of argyrophilic nucleolar organizer regions (AgNORs) might be a predictive factor in patients treated with irradiation. In conclusion, prostate cancer patients with stage A₂-C, diagnosed as pN0-1 by staging pelvic lymphadenectomy, were successfully treated with external beam radiotherapy. The selection of candidates using prognostic factors such as N category, clinical stage, PSA, and AgNORs seems to be important for monotherapy with radiation.     

Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft

This article describes second-look arthroscopic evaluation of the transplanted grafts after anatomical two-bundle ACL reconstruction, which had been performed between December 2000 and March 2004. Using two double-looped semitendinosus tendon grafts via separate femoral and tibial tunnels in the anatomical ACL footprints, 65 patients (mean age of 24 years) underwent anatomical two-bundle ACL reconstruction. The evaluation was performed for those who had undergone the procedure 5–29 months (mean 16.5) previously, with emphasis on graft tension and the presence of graft damage by meticulous probing. None of the anteromedial (AM) grafts showed rupture, while 11% of the posterolateral (PL) grafts showed substantial damage around the femoral tunnel aperture. Both the AM and PL grafts were evaluated as lax without apparent graft rupture in 9% of the knees. These results suggest that the currently performed anatomical two-bundle ACL reconstruction and postoperative regimen still remain to be improved to achieve better postoperative graft morphology.