ABSTRACT
Case I was a 85-year-old woman. She was referred to us as her serum CEA level was found as high as 9.2ng/ml at a clinic in her neighborhood. CT and ultrasound scans revealed a cystic tumor in the appendix area. A barium enema examination showed a tubercular lesion in the subcecal area. The surface of the lesion was flat and smooth. The vermiform appendix was not scanned with the contrast medium. She was diagnosed with mucinous cystadenoma of the appendix. Partial cecotomy was performed. The postoperative serum CEA fell to a normal level of 4.7ng/ml. Case II was also a woman . The 74- year-old inpatient was being treated for high blood pressure and hyperlipemia when her serum CEA level was found elevated to 12.3ng/ml. CT and ultrasonograph examinations revealed a cystic tumor in the appendix area. A barium enema examination showed a mucocele-like tubercle in the appendix. The patient was diagnosed with mucinous cystadenoma of the appendix and partial cecotomy was performed. The CEA level was normalized postoperatively with 1.5ng/ml. The pathologic tests confirmed either of these two cases was mucinous cystadenoma of the appendix. Immunohistochemical staining showed a CEA positive.
ABSTRACT
This report takes up a 65-year-old woman. Suspecting a tumorous superior fovea in the left clavicle, she consulted with our hospital’s Department of Otolaryngology. As a result of the lymph node biopsy performed at the department, she was diagnosed as having moderately differentiated tubular carcinoma. CT scanning revealed a number of swollen lymph nodes and parietal tylosis in the sigmoid colon. Endoscopy produced no abnormalities in the upper digestive tract, but an endoscopic check of the lower digestive tract revealed an all-around Type II tumor. The ailment was pathohistologically identified as tubular carcinoma. That said, the patient was diagnosed as suffering from sigmoid colon accompanying Virchow lymph node metastasis. Then, sigmoidostomy and the dissection of the D3 lymph node were performed. Pathohistological diagnosis revealed moderately differentiated tubular carcinoma, SE, N3, HO, PO, M1 (Virchow lymph node metastasis), Stage IV. Chemotherapy was postoperatively initiated with mFOLFOX6.
ABSTRACT
A 86-year-old woman visited us, complaining about sharp abdominal pain she had very morning when she got up. Ultrasound and computer tomography scans of the abdomen revealed notable parietal hypertrophy and swelling of the gallbladder. The old woman was diagnosed with acute cholecystitis and immediately admitted to the hospital. Her condition did not improve on conservative management. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The bile thus aspirated was bloody, which led us to suspect necrotizing cholecystitis. Emergency cholecystectomy was done. The abdominal operation found the gallbladder wandering with a torsion of 360 degrees around the gallbladder neck as the axis and the leakage of bile in the abdominal cavity from what could be presumed to be the area where the PTGBD was placed. After the torsion was corrected, the gallbladder was surgically removed. Neither gallstones nor tumors were found in it. There were signs of hemorrhagic necrosis in the mucus membrane. The patient made good progress after the operation and was discharged on the 15th hospital day. Torsion of the gallbladder is a comparatively rare entity and its symptoms are not always specific. Therefore, it defies preoperative diagnosis. In this paper, we report our experience with a case of this disease which presented characteristic radiographic images and discuss the treatment strategies including PTGBD.
ABSTRACT
We simulated mountain climbing using walking on a treadmill in order to systematically evaluate the physical load during mountain climbing. The conditions of three types of load-(1) inclination of the walking path (walking uphill and downhill), (2) walking speed, and (3) backpack weight-were varied within the range assumed for normal mountain climbing (40 sets of conditions in total). When the three types of load were expressed as vertical work rate, energy expenditure (VO<sub>2</sub>) during walking uphill and downhill was distributed along roughly the same curve. The following characteristics of walking uphill and downhill were observed.A. Walking uphillFor all three types of load, increase in load gave a linear increase in VO<sub>2</sub> and heart rate (HR). A lactate threshold (LT) appeared at an intensity of 62%VO<sub>2max</sub>, when HR was 78% HR<sub>max</sub>. Rating of perceived exertion (RPE) was evaluated for the “Breathlessness” and “Leg Fatigue”, and both of these increased roughly in proportion to %VO<sub>2max</sub>.B. Walking downhillWhen walking downhill, VO<sub>2</sub> was 35-50% the intensity of VO<sub>2</sub> when walking uphill on the same slope and at the same speed. Energy expenditure did not exceed 60%VO<sub>2max</sub> in any of the load conditions, and no LT was seen. RPE values were higher for walking downhill than walking uphill, even when %VO<sub>2max</sub> values were the same. RPE values for the “Leg Fatigue” tended to be higher than for the “Breathlessness” at the same speed in downhill walking.Using these data, we created a table giving the intensity of exercise of mountain climbing expressed as VO<sub>2</sub> per unit body mass and metabolic equivalents (Mets) with vertical migration velocity and total weight (Body weight + Backpack weight) as variables. This table gives mountain climbers a systematic understanding of the physical load under various mountain climbing conditions. It is likely to be of use as a reference for mountain climbers of different levels of physical fitness when practicing mountain climbing appropriate to their individual level. The present results suggest that in downhill walking, it is insufficient to express the physical load in energy expenditure (VO<sub>2</sub> and Mets) alone, and the load on the leg muscles must also be judged using the RPE in the “Leg Fatigue”.