Adult axillary lymphangioma removal using indocyanine green fluorescence imaging system: A case report.

INTRODUCTION: Lymphangiomas are benign cystic tumors which arise from congenital malformations of the lymphatic system and are extremely rare in adulthood. We report a case of adult lymphangioma of the axilla that was removed after identifying the feeding lymphatic vessel using an indocyanine green (ICG) fluorescence imaging system. PRESENTATION OF CASE: A 35-year old woman presented to our hospital with a rapidly growing mass on her left axilla. She had been pregnant once before and delivered at 34 years of age. Mammography, ultrasonography, and magnetic resonance imaging revealed a tumor that consisted of multiple cysts, which led to a diagnosis of cystic lymphangioma. The ICG fluorescence imaging system indicated that only one lymphatic vessel, which was completely removed with ligation of the feeding lymphatic vessel, was flowing to the tumor. An immunohistological study demonstrated that the cystic endothelia were positive for podoplanin (D2-40), a marker of lymphatic vessels. DISCUSSION: In addition to congenital factors, mechanical obstruction to lymphatic vessels by an external force, such as trauma or congestion of the lymphatic flow caused by increasing venous pressure during pregnancy or delivery might lead to lymphangioma in adulthood. Therefore, our patient's pregnancy and delivery one year prior to discovery of the tumor seems to be the cause of her lymphangioma. CONCLUSION: Based on our findings, we recommend the complete excision to successfully treat adult-onset lymphangioma. We also suggest that visualization with ICG fluorescence imaging system is very useful for detecting the feeding lymphatic vessel and performing complete excision of the lymphangioma.

Small intestinal strangulation due to a rare type of primary internal hernia.

Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.

[Efficacy of high-dose toremifene as a second-line hormone therapy in patients with advanced or metastatic breast cancer resistant to aromatase inhibitor].

BACKGROUND: Aromatase inhibitors(AIs)are frequently employed for advanced or metastatic postmenopausal breast cancer as first-line hormone therapy. However, it is unknown which hormonal agent is the most appropriate after AI has failed. PATIENTS AND METHODS: Five hormone-responsive postmenopausal women who used AI as a first-line hormone therapy for advanced or metastatic breast cancer, but AI failed, received high-dose toremifene therapy(HD-TOR: 120mg/day)in our hospital. Efficacy and safety were evaluated. RESULTS: Patients were all-hormone sensitive, and only one case had HER2 overexpression. All patients had received anastrozole(ANA)as first-line hormone therapy. Of a total of 5 cases, 3 were evaluated as partial responses(PR), 1 was a long stable disease(L-SD), and 1 was a progressive disease(PD). The overall response rate (RR)was 60. 0%(3/5 cases)and the clinical benefit rate(CB)was 80. 0%(4/5 cases). Grade 1 dry mouth was observed in one case as an adverse event. CONCLUSIONS: HD-TOR as a second-line therapy is optimal for advanced or metastatic AI resistance postmenopausal breast cancer.

2H NMR study of 2D melting and dynamic behaviour of CDCl3 confined in ACF nanospace.

Two-dimensional melting of trichloromethane (chloroform) confined in activated carbon fibre was investigated using differential thermal analysis and (2)H NMR techniques. Differential thermal analysis revealed a thermal anomaly with an endothermic peak at 269 K, which was distributed from 250 K to 287 K on the heating direction. This anomaly was also observed upon cooling at the same temperature. Furthermore, (2)H NMR revealed that slow motion such as molecular hopping and/or diffusion of CDCl(3) in ACF affected the spectral line width. The temperature dependence (Arrhenius plot) of the spectral line width showed an inflection point at 227 K. The activation energy of molecular motion of CDCl(3) in ACF was 4 kJ mol(-1) at temperatures greater than 227 K and 7.7 kJ mol(-1) at temperatures less than 227 K. Reduction of the activation energy suggests that the average intermolecular distance between CDCl(3) molecules enlarges above the inflection point. The difference of activation energy (3.7 kJ mol(-1)) is close to the enthalpy of fusion in typical plastic crystals. These results reveal that the thermal anomaly and the transition of dynamic process correspond respectively to melting of CHCl(3) in ACF and the pre-melting phenomenon.

Nonlinear stress analysis of titanium implants by finite element method.

With use of dental implants on the rise, there is also a tandem increase in the number of implant fracture reports. To the end of investigating the stress occurring in implants, elasticity and plasticity analyses were performed using the finite element method. The following results were obtained: (1) With one-piece type of implants of 3.3 mm diameter, elasticity analysis showed that after applying 500 N in a 45-degree direction, stress exceeding 500 MPa which is the proof stress of grade 4 pure titanium - occurred. This suggested the possibility of fatigue destruction due to abnormal occlusal force, such as during bruxism. (2) With two-piece type of implants that can tolerate vertical loading of 5,000 N, plasticity analysis suggested the possibility of screw area fracture after applying 500 N in a 45-degree direction. (3) On the combined use of an abutment and a fixture from different manufacturers, fracture destruction of even Ti-6Al-4V, which has a high degree of strength, was predicted.

Construction of a low-temperature thermodynamic measurement system for single crystal of molecular compounds under pressures.

An apparatus to obtain low-temperature thermodynamic information under high pressures for a tiny single crystal of molecular compounds was developed based on the ac technique. To detect small temperature oscillation of a sample inside the cramp-type pressure cell, we have used a small ruthenium oxide chip sensor as a thermometer. The adoption of the four-terminal method by the ac resistance bridge has made high-resolution detection of thermal anomaly possible in the low-temperature region. The constructed high-pressure thermodynamic system was mounted on a 3He refrigerator and we have succeeded to detect the thermal anomaly in relevant to magnetic order of single crystal sample of Mn4-cluster complex up to 1.05 GPa. A distinct peak of the heat capacity and its upward shift with increasing pressures was observed using a tiny crystal of about 100 microg. The high-pressure behavior of the discontinuity of heat capacity at the superconductive transition of 6 mg of metal indium has also been detected by this apparatus. The details and performance of the technique are reported.

Auditory-conditioned-fear-dependent c-Fos expression is altered in the emotion-related brain structures of Fyn-deficient mice.

Fyn-tyrosine-kinase-deficient mice exhibit increased fearfulness. To elucidate the neural mechanisms of their emotional defects, we compared fyn(-/-) and fyn(+/-) mice by behavioral analysis of conditioned fear and by functional neuroanatomical analysis of the distribution of highly responsive neurons associated with conditioned fear. The mice were exposed to the auditory conditioned stimulus paired with electric shock as the unconditioned stimulus. After the fear conditioning, auditory stimulus-induced freezing behavior was enhanced in fyn(-/-) mice. When the occurrence of c-Fos-immunoreactive neurons in the brain of fear-conditioned mice was examined following exposure to the auditory stimulus, a significant increase in immunoreactive neurons was found in the amygdala, hypothalamus, and midbrain of both genotypes. The occurrence of conditioned-fear-dependent c-Fos-immunoreactive neurons was enhanced in the central, medial, cortical, and basomedial amygdaloid subdivisions, the hypothalamic nuclei, and the midbrain periaqueductal gray of the fyn(-/-) mice in comparison with the fyn(+/-) mice. However, remarkably, the occurrence of conditioned-fear-dependent c-Fos-immunoreactive neurons was very low in the basolateral and lateral amygdaloid subdivisions of the fyn(-/-) mice, in striking contrast to a significant increase in c-Fos-immunoreactive neurons in these subdivisions in the fyn(+/-) mice. These findings suggest that the increased excitability of the specific amygdaloid subdivisions including the central nucleus, and of the projection targets such as the hypothalamus and midbrain in fyn(-/-) mice, is directly related to the enhanced fear response, and that the decreased excitability in the basolateral and lateral amygdaloid subdivisions is involved in the defective control of the neural circuit for emotional expression in this mutant.