[Long-Term Survival by Low-Dose Imatinib after Recurrence of GIST].

A man in his 70s was observed to have GIST recurrence 19 months after surgery. Chemotherapy was initiated with imatinib 400 mg/day orally. The dose was eventually reduced to 100 mg/day to avoid side effects. Tumor reduction was confirmed 3 months after treatment initiation. Currently, 84 months after the onset of GIST, the patient survives with continuous intake of the same dose of oral imatinib. We were able to observe long-term survival in a patient with recurrent GIST after the administration of a small dose of imatinib.

Total Synthesis of (-)-Sigillin A: A Polychlorinated and Polyoxygenated Natural Product.

The total synthesis of (-)-sigillin A, a highly chlorinated and oxygenated octahydroisocoumarin, is described herein. A hexahydroisocoumarin skeleton was constructed from (R)-4-(trichloromethyl)oxetan-2-one in seven steps. Its unique manganese oxidation provided an enone as the key intermediate of sigillin A. Stereoselective installation of two hydroxy groups and formation of gem-dichloroalkene from the corresponding ketone led to the total synthesis of (-)-sigillin A in a total of 16 steps.

Methylene chain ruler for evaluating the regioselectivity of a substrate-recognising oxidation catalyst.

Regioselective C-H oxidation of aliphatic molecules with synthetic catalysts is challenging. We incorporated substrate-recognition sites into a ruthenium porphyrin-heteroaromatic N-oxide catalytic system in order to characterise its regioselectivity for the oxidation of alkanes. This substrate-recognition catalytic reaction exhibits high regioselectivity and high reaction efficiency.

[Marginal zone lymphoma of mucosa-associated lymphoid tissue of the parietal pleura; report of a case].

An 76-year-old man was referred to our hospital due to right hydrothorax. The diffuse thickening of parietal pleura with increased fluoro-2-deoxy-D-glucose (FDG) uptake was noted by computed tomography (CT) and positron emission tomography (PET). Surgical biopsy was performed and the tumor was diagnosed as mucosal associated lymphoid tissue (MALT) lymphomas of parietal pleura origin by pathology. Complete remission was achieved by postoperative chemotherapy (R-CHOP), and the patient is now alive without recurrence.

[Lymphoepithelioma-like carcinoma（ LELC） of the lung].

A 77-year-old woman was admitted to our hospital with abnormal chest shadow detected on a medical checkup. Chest computed tomography(CT)showed a well-defined tumor in the upper lobe of the right lung. On positron emission tomography by fluorodeoxyglucose(FDG),the tumor revealed to be positive. We performed right upper lobectomy with hilar and mediastinal lymph node dissection. The histopathological diagnosis was lymphoepithelioma-like carcinoma (LELC). In the past 25-years, 41 cases have been reported in Japan. The average age is 64 years old, including 25 male cases and 16 female cases. Among these cases, more than half were in the early resectable stage.

[Sarcoidosis with right middle lobe atelectasis initially suspected of malignant lymphoma; report of a case].

60-year-old woman was admitted with an abnormal shadow on the chest roentgenogram. Computed tomography showed atelectasis of the right middle lobe and hilar and mediastinal lymphadenopathy. Bronchoscopic examination revealed an obstruction at the orifice of the right middle lobe bronchus and biopsy was performed. The biopsy suggested malignant lymphoma. A diagnosis of methotrexate-associated lymphoproliferative disorders was suspected because the patient was administered methotrexate to treat the rheumatoid arthritis. The video-assisted thoracoscopic surgery was performed. Histological examination showed no malignancy and sarcoidosis in the peribronchial lymph nodes. The compressed middle lobe bronchus by enlarged lymph nodes was consider to be the cause of the middle lobe atelectasis.

[Human pulmonary dirofilariasis].

The patient was a 60's-year-old man, who was incidentally pointed out a coin lesion in the right lung by chest radiogram. Chest computed tomography showed a round-shaped, well defined nodule of 2.5 cm in size in the right S1. Positron emission tomography did not show the accumulation of fluorodeoxyglucose in the nodule. We considered the tumor to be benign, but the patient chose surgical treatment. Partial resection of the lung was performed by thoracoscopic surgery. Histopathological diagnosis was human pulmonary dirofilariasis.

[Adult Bochdalek hernia combined with pneumothorax].

A 71-year-old man, who had been given a diagnosis of Bochdalek hernia in infancy, was referred to our hospital for dyspnea The chest X-ray and computed tomography (CT) showed left pneumothorax with bullas and intestines in his left thoracic cavity. He was admitted to our hospital and a chest tube was inserted into the left pleural cavity. The left lung expanded immediately and air leakage was stopped. He became asymptomatic and he was discharged from the hospital on the 8th day. Most Bochdalek hernias are observed in infancy, and adult cases combined with pneumothorax and bullas are very rare.

[Catamenial pneumothorax; report of a case].

A 40-year-old female had right-sided pneumothorax. She was treated with a chest tube. On the 2nd day, her menstruation started. Because of a persistent air leak, she underwent a thoracoscopic operation on the 15th day. During the operation, we noted a pulmonary bulla at the apex and multiple blue berry spots both on the visceral pleura and the tendinous part of the diaphragm. We performed a resection of the pulmonary bulla, partial diaphragmatic excision plus suture. Section of visceral pleura and diaphragm shows ductal structures, which is insistent with endometriosis. The serum CA125 level decreased to 39 U/ml. Following surgery, oral contraceptives was started and no recurrence was encountered thereafter.

[Palliative home care of a breast cancer patient with esophageal metastasis after the operation of gastric fistula and tracheotomy--a case study].

A 66-year-old woman felt dysphagia gradually seven years after an operation of breast cancer. We diagnosed her with esophageal metastasis of the breast cancer, and carried out irradiation and outpatient chemotherapy. Because her general condition became worse after the treatment for about four years, we performed an operation of gastric fistula and tracheotomy to manage her nutrition and of an accidental swallowing. Although the patient and her family resisted a discharge from hospital due to the progressive nature of her illness and change in physical surroundings, she was eventually switched to take a homecare medical treatment with the support of a team care approach. The main purposes of the homecare treatment were to manage gastric fistula including the administration of anti-cancer drugs, cervicobrachial pain control and tracheal cannula exchange. Though she was mentally stable and got along well with the family during the home stay, she was hospitalized again two months after the homecare treatment because of aggravated symptoms and the family's fatigue. We respected the value of her quality of life and gave careful considerations to support her during the entire period of re-hospitalization. She gently died two months after re-hospitalization. We considered that this palliative home care could be realized with the palliative team care, nursing intervention visit and family support.

Basic and clinical aspects of Clostridium difficile colitis.

Clostridium difficile, a gram-positive anaerobic bacillus dubbed as the difficult clostridium because it resisted early attempts of isolation and culture. After some decades in the darkness, it became famous, when in 1978, a cytotoxin of the C. difficile was found the responsible of the pseudomembranous colitis. We review in this paper aspects of the epidemiology of the C. difficile in health and disease. Also the importance of C. difficile as a cause of nosocomial infections. We review the characteristics of the toxins A and B produced by the pathogenic strains of C. difficile. Finally, clinical aspects of infection with C. difficile in special in the pseudomembranous colitis. The diagnosis, medical therapy, complications and surgical indications are briefly described.

Gastrointestinal stromal tumor of the rectal mesentery.

We report a case of gastrointestinal stromal tumor (GIST) arising from the rectal mesentery. GIST of the large intestine is a rare tumor that accounts for only 0.1% of all colorectal cancers. The patient presented to our hospital with constipation and abdominal distension. Computed tomography (CT) revealed a huge mass in the pelvic cavity, and laparotomy disclosed diffuse peritoneal dissemination from the primary tumor. Radiochemotherapy was commenced, but the patient became too ill to complete it and died of the disease 2 months after surgery. A large high-grade tumor with diffuse dissemination was recognized as an indicator of poor survival in this patient.

Diagnosis and treatment of obturator hernia.

Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.

Adenomatous polyposis coli gene as a gatekeeper.

The Adenomatous Polyposis Coli (APC) Gene is a tumor suppressor gene located in the chromosome 5q21. It has a sequence of 2843 amino acids and a weight of 312 kD. The mutation of the APC gene occurs at the early stages of most sporadic colorectal cancers; and up to 30% in familial adenomatous polyposis. The absence of APC will indicate the inadequate migration of colon mucous cells and its accumulation resulting in polyps formation, which determines a stage in carcinogenicity. An adequate study in prone groups may lead to chemoprophylaxis and/or early treatment of polyps.