ABSTRACT
A 78-year-old man was referred to our hospital with diarrhea, melena, and weight loss. During a digital rectal examination, a protuberant mass located 7-8 cm above the anal verge was palpable. Computed tomography(CT)scans of his chest, abdomen, and pelvis revealed an intestinal obstruction with a target sign in the lower rectum, indicating intussusception due to a sigmoid colon mass. A gastrografin enema examination revealed a typical filling defect with a crab claw sign in the rectum. However, the enema did not reduce the intussusception. The surgical findings showed that the sigmoid colon had slipped inside the rectum, consistent with the diagnostic imaging findings. A radical sigmoidectomy(D2)with diverting colostomy was performed to address the unprepared colon with accompanying edema. Pathology of the resected specimen revealed a type 2 tumor measuring 5 cm in size and comprising moderately differentiated adenocarcinoma(pT3pN0M0, pStage â ¡). The patient's postoperative course was uneventful, and his stoma was closed 2 months later. Intussusception occurs less frequently in adults than in children. In a case of bowel-within-bowel configuration, in which layers of the bowel are duplicated to form concentric rings, the target-like sign on CT images may be a useful diagnostic marker of colorectal intussusception.
Subject(s)
Adenocarcinoma , Intestinal Obstruction , Intussusception , Sigmoid Neoplasms , Adenocarcinoma/complications , Aged , Colon, Sigmoid , Humans , Intestinal Obstruction/etiology , Intussusception/etiology , Male , Sigmoid Neoplasms/complicationsABSTRACT
A 68-year-old man who had a history of bone marrow transplantation for acute myeloid leukemia was referred to our hospital due to an abnormal liver function test. Based on the clinical diagnosis of P-NET G2 with multiple livermetastases, pylorus-preserving pancreaticoduodenectomy with combined resection of the portal vein and liver sampling were performed (R2 resection). The resected specimen revealed NET-G2 tumorof the pancreatic head(Ki-67 proliferation index 5.0%)and hepatic metastasis(Ki-67 index 2.2%). Although CDDP/ETP(PE)and everolimus(AfinitorTM)regimen were started postoperatively, PE was discontinued due to bone marrow suppression. As the liver metastasis stayed SD for 4 months by everolimus single therapy, 6 hepatic metastases were resected for curative intent 5 months postoperatively. Thereafter, multiple liver metastases appeared 10 months after the metastasectomy. Everolimus single therapy was restarted. As the metastases were maintained SD for 4 months, repeat hepatectomy was performed for curative intent after right portal vein embolization. Multimodality therapy including repeat metastasectomy should be considered for selected patients with P-NET G2 with liver metastases for prolonged survival, if the operation can be performed with low perioperative morbidity.
Subject(s)
Liver Neoplasms , Neuroendocrine Tumors , Pancreatic Neoplasms , Aged , Combined Modality Therapy , Hepatectomy , Humans , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Male , Neuroendocrine Tumors/secondary , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/pathologyABSTRACT
Dexmedetomidine is a selective α2 adrenergic agonist. Although dexmedetomidine is widely used for sedation and analgesia, it frequently produces hypotension and bradycardia. The present study aimed to evaluate the effects of dexmedetomidine on cardiac function and coronary circulation using Langendorff-perfused guinea pig hearts. Coronary perfusion pressure (CPP) and left ventricular pressure (LVP) were continuously monitored, and electric field stimulation (EFS) was applied to stimulate sympathetic nerve terminals. Dexmedetomidine almost completely inhibited the EFS-induced increase in LVP at all ages. The effect of dexmedetomidine on coronary artery resistance varied according to postnatal age, i.e., dexmedetomidine had little effect on CPP in young hearts (<4 weeks) but increased CPP by 10 mmHg at 4-8 weeks and by 15 mmHg at >8 weeks. The increase in CPP in adult hearts was inhibited by imiloxan, an α2B antagonist, and prazosin, an α1 antagonist. The results suggest that dexmedetomidine acts on α2 adrenergic receptors at sympathetic nerve terminals to suppress the release of norepinephrine. In addition, the findings suggest that dexmedetomidine directly affects α1 adrenoceptors and/or α2B adrenoceptors on coronary smooth muscles to increase CPP. The age-related changes in α adrenoceptor subtypes may be linked to the cardiodepressant effects of dexmedetomidine.
Subject(s)
Aging/physiology , Coronary Circulation/drug effects , Dexmedetomidine/pharmacology , Heart/drug effects , Myocardial Contraction/drug effects , Adrenergic alpha-2 Receptor Agonists/pharmacology , Analgesics, Non-Narcotic/pharmacology , Animals , Coronary Vessels/drug effects , Coronary Vessels/physiology , Guinea Pigs , Heart/physiology , Heart Rate/drug effects , Hypnotics and Sedatives/pharmacology , In Vitro Techniques , Ventricular Function, Left/drug effectsABSTRACT
Gallbladder (GB) perforation is a very rare posttraumatic abdominal injury. It is potentially life-threatening, and good outcome requires early diagnosis. We present a case of isolated posttraumatic GB perforation in which the precise sonographic (US) diagnosis led us to apply proper management. Color Doppler US showed a clear to-and-fro flow signal passing through the perforation site, and contrast-enhanced US confirmed the presence of a small defect in the GB wall. When examining posttraumatic patients, the possibility of GB perforation must be kept in mind. Color Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation.
