ABSTRACT
We performed aortic valve replacement in 2 patients with aortic regurgitation (AR) in whom a "dovecoo" murmur was heard. Here we discuss the valve shape and the origin of the heart murmur. In the 1st patient, echocardiography revealed prolapse of the right coronary valve cusp toward the left ventricular outflow tract during the diastolic phase and fibrillation of the valve leaflet due to the AR jet. In the 2nd patient, surgical findings revealed thickening of the middle part of the leaflet of the right coronary cusp, which caused prolapse of the right coronary valve cusp toward the left ventricle. We hereby report 2 rare cases of "dove-coo" murmur in which the cause of the murmur was morphologically confirmed by echocardiography in one case and by surgical findings in the other case.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Aged , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Echocardiography , Humans , Male , Treatment OutcomeABSTRACT
A 60-year-old man complaining of black stool, body weight loss, and anemia, was examined and diagnosed with advanced gastric cancer (M, type 3, por 2, cT3, cN3, cH0, cP0, cM0, cStage IV). A poor prognosis was predicted, yet we tried neoadjuvant chemotherapy (NAC) expecting downstaging of the tumor. Considering the efficacy and safety, we chose S-1+CDDP as the NAC regimen. S-1 (120 mg/day) was administered orally for 21 days, followed by CDDP (75 mg/body) div on day 8. Distal partial gastrectomy and lymph node dissection (D2) were performed, with Billroth I reconstruction. Histological examination of the resected stomach and lymph nodes revealed no residual cancer cells, suggesting complete histological remission (grade 3) according to the Japanese classification of gastric carcinoma.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoadjuvant Therapy , Stomach Neoplasms/drug therapy , Stomach Neoplasms/pathology , Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Agents/administration & dosage , Cisplatin/administration & dosage , Drug Combinations , Gastrectomy , Humans , Lymph Node Excision , Male , Middle Aged , Oxonic Acid/administration & dosage , Tegafur/administration & dosageABSTRACT
A 78-year-old woman was admitted to our hospital for treatment of liver cirrhosis and an esophageal varix. Endoscopy revealed a protruding nodular lesion with a transparent smooth surface proximal to the pylorus, which was accompanied by a partly yellow-whitish spot. A depressed lesion with an even edge was found. Histologically, the protruding lesion and depressed lesion showed amyloid deposits, mainly in the mucosal layer. The lesions were found to correspond to AL type amyloidosis by immunochemical analysis. General examination showed no other amyloid deposits. Thus, we diagnosed localized amyloidosis of the stomach.
Subject(s)
Amyloidosis/pathology , Stomach Diseases/pathology , Aged , Female , Gastroscopy , HumansABSTRACT
BACKGROUND: There is little general agreement concerning the effectiveness of serum carcinoembryonic antigen (CEA) as a prognostic indicator for non-small cell lung cancer (NSCLC) in clinical stage I patients. We conducted a retrospective study to investigate the relationship between serum CEA level and survival. METHODS: We assessed 297 consecutive patients with clinical stage I NSCLC who underwent surgical resection at Toneyama National Hospital from 1985 to 1998. Serum CEA levels were measured with an enzyme-linked immunosorbent assay kit with the upper limit of normal defined as 7.0 ng/mL based on the 95% specificity level for benign lung disease, in our hospital. RESULTS: There were 56 (19%) patients with serum CEA greater than 7.0 ng/mL. The high CEA group had a median survival time of 50 months and a 5-year survival rate of 49% compared with a 5-year survival rate of 72% (p < 0.0001) for the normal CEA group (n = 241). Patients with postoperatively high CEA levels (n = 15) had the worse prognosis (median survival time 35 months, and 5-year survival 18%) compared with patients whose levels returned to normal (n = 41, median survival time 8.8 months, and 5-year survival 68%; p = 0.01). These differences were also observed in patients with pathologic stage I or II tumors but not in those with pathologic stage III or IV tumors. CONCLUSIONS: Serum CEA level is a useful predictor of survival for patients with clinical stage I NSCLC, and a persistently high CEA level after surgery is an especially strong indicator of a very poor prognosis.