ABSTRACT
A chest X-ray taken during a medical checkup for a 75-year-old man revealed a nodular shadow in the right middle lung field. Chest computed tomography (CT) for further examination showed an intra-abdominal tumor as an additional finding, and the patient was referred to our department. Contrast-enhanced CT revealed a tumor (16×10×5 cm) in the left upper to middle abdomen. The tumor had a clear border and uniform fat density inside. It compressed the stomach to the ventral side, but the patient had no subjective symptoms. Magnetic resonance imaging also showed the tumor contained a uniform fatty component inside, as well as no obvious non-fatty components. An intra-abdominal lipoma was suspected, but the possibility of a welldifferentiated liposarcoma could not be ruled out due to its size. During curative surgery, intraoperative findings revealed a soft tumor, weighing 612 g, with a well-defined border in the mesentery of the transverse colon. Pathological findings showed proliferation of mature adipocytes without malignancy. We report here this case of mesenteric lipoma, a rare intraabdominal tumor, and review the relevant literature.
ABSTRACT
We report a case of a 72-year-old woman with a tumor arising from a colostomy site that had been created 25 years earlier when rectal amputation was performed for perforated sigmoid cancer. She was referred to our hospital due to complaints of pain from the colostomy. The diagnosis was carcinoma arising at the colostomy site with lymph node metastasis. Laparoscopic surgery was performed by attaching an Applied Alexis® wound retractor to the incision site of the colostomy. Lymph node dissection was performed and the left hemicolon was resected. Carcinoma arising from a colostomy site is rare. Laparoscopic surgery was considered to be a useful procedure because it allows for lymph node dissection and intestinal mobilization with minimal invasiveness.
ABSTRACT
A 57-year-old man was admitted to our hospital with adhesive bowel obstruction following pancreaticoduodenectomy performed for cholangiocarcinoma 4 months earlier. After admission, the patient remained nil per os and was closely observed. On the third day of admission, he developed worsening abdominal pain, and computed tomography revealed strangulation of the small intestinal mesentery dorsal to the superior mesenteric artery, with prolapse of the small intestine into the right upper quadrant to form a closed loop. Strangulated bowel obstruction secondary to internal hernia was diagnosed, and he underwent emergency surgery. Intraoperatively, we detected a hernia orifice formed by the mesentery and peritoneum at the site of the defect following resection of the ligament of Treitz, and we observed that approximately 2 m of the small intestine had prolapsed into the right upper quadrant. The herniated intestine was returned to the abdominal cavity, and the hernia orifice was sutured following hernia reduction. Few reports have described an internal hernia after pancreaticoduodenectomy; however, it has been reported that this operation can result in various types of internal hernia because of the complicated reconstructive procedure. Here we report our findings in this unique case together with a literature review.
ABSTRACT
The patient was an 80-year-old man who was diagnosed with cStage IIIB non-small cell lung cancer (NSCLC) and early gastric cancer. The advanced lung cancer was treated with chemotherapy while the gastric cancer was monitored. Immune checkpoint inhibitors were effective against the lung cancer for a long period, but new gastric cancer appeared and progressed to an advanced stage, necessitating total gastrectomy 5 years after the diagnosis of NSCLC. The patient is currently being treated with a molecular targeted agent for progression of the lung cancer after gastrectomy. In the future, the number of cases with multiple primary cancers will increase alongside aging of the population and advances in cancer treatment, and a system for tumor-agnostic treatment selection and medical treatment will be necessary.
ABSTRACT
A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.
ABSTRACT
This case is a 56-year-old woman. With multiple bone metastases, she was referred to the Department of Palliative Care on the same day as core needle biopsy had just been performed in the Department of Surgery. Aggressively increased oxycodone was administered to relieve her significantly severe pains by bone metastases. After relief of the pains, cancer chemotherapy of EC and weekly PTX regimens were performed parallel to palliative care. In this case, chemotherapy could be performed after the pains had been sufficiently relieved with closer cooperation between the palliative care doctor and the attending surgeon. It is important for patient-focused medical care to be delivered by both the attending doctor administering cancer treatment and the palliative care doctor working for relief of the symptoms, while they are striving to foster their tie-up.
ABSTRACT
To report a case of amiodarone-induced thyrotoxicosis [AIT] concomitant with thyroid cancer in multinodular goiter [MNG]. A 61-year-old man treated with amiodarone for 5 years presented with mild sweating. He was found to have AIT simultaneously with thyroid papillary cancer and MNG. Administration of amiodarone was stopped, and he was treated with methimazole for AIT. Five weeks after the initial treatment, thyroid function normalized. Total thyroidectomy was considered to enable use of amiodarone again. This case showed that thyrotoxicosis, MNG and amiodarone may contribute to thyroid carcinogenesis. Amiodarone should be carefully commenced in cases with MNG
Subject(s)
Humans , Male , Thyrotoxicosis , Thyroid Neoplasms , Goiter, Nodular , MethimazoleABSTRACT
One patient was intervened by our palliative care team (PCT) to relieve neuropathic pain due to postoperative recurrence of rectal cancer. The dosage controlled-release oxycodone was increased, analgesic adjuvant drugs were changed and the administration of betamethasone were started. Furthermore, the number of times the patient took controlled-release oxycodone increased two to three times a day. These changes in medication resulted in relief of symptoms. Cetuximab therapy was given twice during the course. The other patient was intervened by the PCT for right upper limb pain and dyspnea due to postoperative recurrence of breast cancer. Morphine sulfate hydrate and analgesic adjuvant were additionally given. As pain increased three days after the administeration of transdermal fentanyl patches, the patches were changed every other day, instead of every three days. FEC100 therapy was given twice during the course. In the present two cases, the PCT was intervened with great zeal and rapid relief of symptoms resulted. In the meantime chemotherapy proceeded uneventfully. We thought that trust of the chief doctor in the PCT was most important for effective intervention.
ABSTRACT
The effect of moxibustion on duodenal motility was examined. Duodenal motility was measured by the balloon method in anesthetized, artificially ventilated rats. The stimulation temperature and duration of moxibustion varied. Treatments were applied to the hind paw and abdomen.<BR>The duodenal motility exhibited an excited response by pinch stimulation of hind paw, and inhibitory response by abdominal pinch stimulation. Duodenal motility did not show any response to indirect moxibustion stimulation of the hind paw and abdomen. Duodenal motility exhibited an excited response by direct application of moxibustion to the hind paw and an inhibitory response by direct application of moxibustion to the abdomen.
ABSTRACT
The reflex mechanisms of the responses in heart rate elicited by acupuncture stimulation in anesthetized rats were examined. An acupuncture needle measuring 160μmin diameter was inserted into skin and the underlying muscles to the hindlimb to a depth of about 5mm and was twisted once every second for 1min. A decrease in the heart rate was observed in 55% of 22 trials and in 70% of 20 trials when muscles separated from the overlying skin were stimulated. The response was abolished completely by cutting the femoral and sciatic nerves. The response was not influenced by transecting of the bilateral vagi but was totally abolished by transecting of the cardiac sympathetic nerves. Therefore, we conclude that the decrease in heart rate elicited by acupuncture stimulation of a hindlimb is based on a somato-autonomic reflex, in which the afferent pathway is composed of hindlimb muscle afferents and the efferent pathway is composed of cardiac sympathetic nerves.
ABSTRACT
The meta-analytic method including a criteria-based assessment and a uniformly defined effective rate of clinical studies was used to study the clinical effect of acupuncture. This method of analysis can be used for a clinical study including case-series study. A criteria-based assessment may reveal the generality and lack of bias in a clinical study and the uniformly defined effective rate represents the general effectiveness led by the study.<BR>We tried to analyze the clinical effect of acupuncture on migraine headache. As a result of analyzing to 16 reports of acupuncture treatment for migraine headache, the criteria-based assessments were widely distributed from 3 to 17 out of 20 points. In its distribution, the 4 reports designed by the randomized controlled trial scored 13, 16, 16 and 17 points, those of 2 prospective clinical studies scored 10 and 17 points, and those of 10 case-studies all scored less than 13 points.<BR>As for the uniformly defined effective rate (%) in clinical studies, the average of the reports was 77.8% (its 95% confidence interval ranged from 68.2-86.0 %) and was much higher than the placebo effective rate of mock TENS (30-35%).<BR>Considering the result of 4 randomized controlled trials, this meta-analytic result suggests the high efficacy of acupuncture in the treatment of migraine headache.
ABSTRACT
Twenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB<sub>2</sub> (stable metabolite of thromboxane A<sub>2</sub>), and 6-keto-PGF<sub>1</sub> (stable metabolite of PGI<sub>2</sub>) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB<sub>2</sub> level, and TXB<sub>2</sub>/6-keto-PGF<sub>1</sub> ratio showed a tendensy to decrease (<i>p</i><0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB<sub>2</sub> level, and TXB<sub>2</sub>/6-keto-PGF<sub>1</sub> ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.
ABSTRACT
The purpose of this study was to investigate changes in muscle strength of the quadriceps femoris after intraarticular acupuncture treatment of the affected joint in subjects with unilateral osteoarthritic knee. Isometric muscle strength was measured by standard dynamometry at 90 degree knee flexion when the subjects contracted the quadriceps muscle slowly and maximally without any pain.<br>In the preliminary experiment, the repeated measurement yielded a high reliability coefficient (correlation coefficient r=0.95, there is no significant difference between the two means) in the affected knee as well as the normal side for 19 patients with osteoarthritic knee.<br>Nine subjects, whose muscle strength of the affected side had fallen by more than 20% compared with the normal side, participated in the study. An acupuncture needle was inserted into the point where the tenderness of the affected meniscus was marked. The results revealed a noticeable increase in muscle strength of the quadriceps femoris in the affected side from 14.3±2.2kg before acupuncture to 22.9±3.0kg after intraarticular acupuncture (p<0.001), with no significant change in the normal side from 26.0±2.4kg to 27.1±2.8kg (p>0.05).<br>A hypothesis was formulated that the dicreased muscle strength of the quadriceps femoris in the osteoarthritic knee results from reflex inhibition from joint receptors and that intro-articular acupuncture has a disinhibition effect on this inhibition of the extensor muscle activity.