Well-differentiated liposarcoma causing non-islet cell tumor hypoglycemia.

Non-islet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome that causes severe hypoglycemia. The tumor involved produces high-molecular-weight insulin-like growth factor-II (IGF-II). NICTH can be caused by various benign and malignant tumors. However, NICTH due to liposarcoma (LPS) is rare. A 38-year-old man was brought to the hospital emergency department with complaints of vomiting and unconsciousness. His abdomen was distended, and a large tumor was palpable. He had severe hypoglycemia that required continuous glucose infusion. Radiological examination revealed a large 40-cm mass that filled the abdominal cavity, and LPS of the mesentery was suspected. Laboratory data showed low levels of insulin, C-peptide, and IGF-I concentrations. Subsequently, an LPS-induced NICTH was suspected. Complete resection of the tumor and the encased small intestine was performed. The pathological diagnosis was well-differentiated liposarcoma (WDLPS). The Western immunoblot showed that the high-molecular-weight IGF-II confirmed in the serum preoperatively, had almost disappeared postoperatively. Based on these findings, NICTH caused by a WDLPS was diagnosed. The postoperative course was uneventful. In the last 4 years since the primary operation, the patient had not experienced further hypoglycemia symptoms. Here, we report a case of NICTH caused by a large WDLPS. NICTH should be considered in patients with both severe hypoglycemia and large tumors. In these cases, appropriate treatment including semi-urgent surgery should be provided.

Ion-Pairing Assemblies of π-Electronic Anions Formed by Intramolecular Hydrogen Bonding.

π-Extended nitro-substituted dipyrrolylphenol derivatives were synthesized, and upon deprotonation they provided π-electronic anions stabilized by hydrogen bonding between the phenolate (phenoxide) moiety and the pyrrole NH group. Ion-pairing assemblies of the deprotonated anions were formed in the solid state and as mesophases. In the solid state, the extended π plane was found to be more suitable to form charge-by-charge assemblies in combination with tetraalkylammonium cations with highly anisotropic orientations as a result of efficient stacking. The mesophase also included a charge-by-charge assembly comprising the deprotonated anion bearing aliphatic chains, as revealed by synchrotron X-ray diffraction analysis.

[A Case of Locally Advanced Neuroendocrine Carcinoma of the Stomach Could be Curably Resected after Chemotherapy with CPT-11/CDDP].

A 64-year-old man was admitted to our hospital because of epigastralgia. Gastrointestinal endoscopyrevealed a submucosal tumor with ulceration in the upper bodyof the stomach. The tumor was histologicallydiagnosed as a neuroendocrine carcinoma. CT showed that the tumor had directlyinfiltrated the pancreas and splenic vessels. The patient underwent onlyan exploratorylaparotomybecause the tumor seemed to involve the celiac artery. Chemotherapywas conducted using CPT-11/ CDDP. After 15 courses of chemotherapy, a significant tumor reduction was obtained. We performed total gastrectomy with D2 lymphadenectomy, distal pancreatectomy and splenectomy. Histopathological examination of surgical specimens showed that onlyfew carcinoma cells remained in the stomach and pancreas. Neoadjuvant chemotherapycan be a useful treatment for unresectable locallyadvanced neuroendocrine carcinoma of the stomach.

[Two Episodes of Colostomy-Associated Intestinal Perforation during Chemotherapy for Metastatic Rectal Cancer].

A 77-year-old woman with rectal cancer and synchronous liver metastasis underwent a Hartmann operation with D3 lymph node dissection in June 2014. mFOLFOX6 plus bevacizumab(bev)was then administered to treat the liver metastasis.In February 2015, multiple liver metastases were detected and the regimen was changed to FOLFIRI plus bev.After 3 courses, peritonitis due to intestinal perforation around the descending colostomy occurred, and an emergency operation(partial resection of the descending colon and transverse colostomy)was performed.FOLFIRI was then administered from 2 months after the operation.After 3 courses of this regimen, a CT scan showed progression of the hepatic metastases.The regimen was therefore changed to mFOLFOX6.Five months later, another CT scan showed an intestinal perforation of the transverse colostomy at the abdominal wall, and an emergency cecostomy was performed.At this stage, chemotherapy was ceased.This case highlights the risk of intestinal perforation during chemotherapy, regardless of the use of bev.

[Surgical Resection after Gemcitabine plus Cisplatin Chemotherapy for Intrahepatic Cholangiocarcinoma with Multiple Lymph Node Metastases - Report of a Case].

An 82-year-old man with upper abdominal pain was referred to our hospital because of an elevated serum CEA level and dilatation of the intrahepatic bile ducts on ultrasonography.Computed tomography revealed a hypovascular mass measuring 5.0 cm in size in the lateral section, dilatation of the peripheral intrahepatic bile ducts, and swollen lymph nodes around the lesser curvature of the stomach, the common hepatic artery, and the paraaorta.He was diagnosed with unresectable intrahepatic cholangiocarcinoma, and he received chemotherapy with biweekly gemcitabine plus cisplatin.After 33 courses of the chemotherapy, computed tomography revealed that the tumor size decreased over 63%, and all swollen lymph nodes had almost resolved.He underwent a left hemihepatectomy 1 year 6 months after the start of the chemotherapy.He remains alive and well with no evidence of recurrence, 11 months after resection.

[A Case of Radical Resection for Locally Advanced Pancreatic Cancer with Positive Peritoneal Cytology Treated with Chemoradiotherapy].

A 54-year-old female patient was admitted with obstructive jaundice. The patient was diagnosed with locally advanced unresectable pancreatic cancer of the head with invasion to the super mesenteric artery and the third portion of the duodenum. A biliary- and gastric-enteric bypass surgery was performed, and peritoneal lavage cytology was positive during surgery. After 6 courses of gemcitabine and S-1 combination chemotherapy, the CA19-9 level was normalized and the primary tumor shrank to 79% of its original size. Diagnostic laparoscopy revealed that distant metastasis was not detected and the peritoneal lavage cytology was negative. After additional chemoradiation therapy, a pancreaticoduodenectomy was perfomed. Microscopic investigation revealed that about 60% of the cancer tissue had been replaced by fibrosis and no cancer cells were found at the surgical margin. The patient was alive with no evidence of recurrence 17 months after radical surgery.

Effect of transient occlusal loading on the threshold of tooth tactile sensation perception for tapping like the impulsive stimulation.

The objectives of this study were (1) to establish a reliable method for detecting the force threshold of the tooth tactile sensation while avoiding experimenter bias and (2) to examine the effect of occlusal force loading on the threshold for impulsive force stimulation in subjects with normal dentition. Twenty volunteers participated in this study (10 males and 10 females; mean age, 26.6 ± 2.9 years). To simulate the bite force during occlusal tapping, a force-loading device was designed to exert impulsive force to the occlusal surface in the direction parallel to the tooth axis. The impulsive force detection threshold of the periodontal sensation was measured before and after loading 98 N of occlusal force on the left upper first molar for 1 min. Transient mechanical loading of the upper first molar caused an increase in the absolute threshold for impulsive force. This increase did not vanish immediately, and the increment of the threshold was maintained during the remainder of the experiment. A computer-controlled method for the evaluation of tooth tactile sensation using impulsive stimulation was established. Transient occlusal force loading parallel to the tooth axis increases the threshold of periodontal sensation for mechanical impulsive stimulation.