Crohn's disease-related anal fistula cancer diagnosed by examination under anesthesia: a case report.

BACKGROUND: As the number of patients with inflammatory bowel disease (IBD) increases, the incidence of IBD-related colorectal cancer (CRC) is also on the rise. Crohn's disease (CD)-related CRC has been reported to have a poorer prognosis than sporadic CRC, and the early detection of CD-related CRC is difficult. Japanese patients with CD are reported to have a higher frequency of anorectal cancer than the Western population; however, methods for early diagnosis have not yet been established because of perianal pain during the examination. CASE PRESENTATION: We report a case of CD-related anal fistula cancer that was detected early by surveillance examination under anesthesia (EUA). The patient was a 37-year-old man, diagnosed with CD at the age of 15 years and started medical treatment. However, due to poor disease control, the intestinal tract remained highly inflamed and the patient continued to have over 10 bowel movements per day. He was referred to our hospital for surgical treatment after a colonoscopy (CS), which revealed multiple active ulcers and stenoses. Since three perianal seton drainage tubes had been placed around his anus since the age of 33 years, we decided to perform an EUA to rule out cancer coexistence in the anorectal region. After a random biopsy of the rectum by CS under general anesthesia, we resected and curetted multiple perianal fistulas as much as possible and reinserted the seton drainage tubes. Pathological examination of the fistula tract revealed adenocarcinoma in one tract, indicating the coexistence of anal fistula cancer. Based on the diagnosis of multiple intestinal stenoses and anal fistula cancer due to CD, we performed hand-assisted laparoscopic total colectomy, rectal amputation, extensive perineal resection, and reconstruction using a left rectus abdominis flap. CONCLUSION: In a long-term CD patient with anorectal lesions, we performed an EUA to diagnose the coexistence of anal fistula cancer at an early stage, and surgical resection was achieved. EUA is effective for the early detection and treatment of CD-related CRC and may contribute to an improved prognosis.

Migrations and Catalytic Action of Water Molecules in the Ionized Formamide-(H2O)2 Cluster.

Isomerization dynamics involving the migrations, proton transfer reaction, and catalytic actions of water molecules upon vertical ionization of the formamide (FA)-(H2O)2 cluster is investigated by the infrared spectroscopy and theoretical reaction path search calculation. The infrared spectroscopic result indicates the [FA-(H2O)2]+ cation has the hydrogen-bonded structure of the enol isomer cation of formamide and the water dimer. This structure is formed by proton transfer from the CH bond to the carbonyl group through the catalytic action of the water molecules. The isomerization paths involving this enolization in ionized FA-(H2O)2 are explored by using the anharmonic downward distortion following method. We found multiple enolization paths which accompany proton exchanges among the formamide moiety and water molecules through the catalytic actions of the water molecules.

A new protocol for intermittent androgen suppression therapy of prostate cancer with unstable saddle-point dynamics.

Intermittent androgen suppression (IAS) therapy is a class of hormonal treatment for prostate cancer, in which a drug-induced androgen deprivation can reduce the population of prostate cancer cells. In IAS therapy, drugs are administrated only in on-treatment periods that are separated intermittently by off-treatment periods. The presence of off-treatment periods may be beneficial for maintaining the sensitivity of the tumor cells to androgen deprivation. Thus, IAS can be superior to continuous androgen suppression (CAS) for delaying or possibly preventing relapse of a tumor. IAS therapy usually monitors the level of serum prostate-specific antigen (PSA), which is related to the population of tumor cells. Each on-treatment period begins when the PSA level is greater than an upper threshold; treatment results in a decrease in the PSA level. The on-treatment period is suspended when the PSA level falls below a lower threshold; the PSA level then rises again until the beginning of the next on-treatment period. To determine the transitions between on- and off-treatment periods, we propose a new IAS protocol that uses a model-based estimate of the state point in the phase space of the tumor dynamics. We show that the proposed protocol is effective if, in each of the on- and off-treatment periods, the tumor dynamics exhibits a saddle-point instability accompanied by a stable manifold. Mathematical analysis reveals that tumor dynamics can be controlled in a more effective and robust manner with the proposed protocol than with conventional IAS. We also discuss the clinical feasibility of the proposed protocol as an alternative to conventional IAS therapy.

Size-selected infrared predissociation spectroscopy of neutral and cationic formamide-water clusters: stepwise growth of hydrated structures and intracluster hydrogen transfer induced by vacuum-ultraviolet photoionization.

Vibrational spectroscopy of size-selected formamide-water clusters, FA-(H2O)n , n = 1-4, prepared in a supersonic jet is performed with vacuum-ultraviolet-ionization detected-infrared predissociation spectroscopy (VUV-ID-IRPDS). The cluster structures are determined through comparisons of the observed IR spectra with theoretical calculations at the MP2/6-31++G** level. The FA-(H2O)n , n = 1-3, clusters have ring-type structures, where water molecules act as both single donor and single acceptor in the hydrogen-bond network between the amino and carbonyl groups of FA. For FA-(H2O)4, on the other hand, the absence of the free NH stretching vibration indicates formation of a double ring type structure, where two NH bonds of the amino group and the carbonyl oxygen of FA form hydrogen bonds with water molecules. An infrared spectrum of the formamide-water cluster cation, [FA-H2O](+), is also observed with infrared predissociation spectroscopy of vacuum-ultraviolet-pumped ion (IRPDS-VUV-PI). No band is observed for the free OH stretches of neutral water. This shows [FA-H2O](+) has such a structure that one of the hydrogen atoms of the water moiety is transferred to the carbonyl oxygen of FA(+).