Is histopathological evidence really essential for making a surgical decision about mucinous carcinoma arising in a perianal fistula? Report of a case.

We report an unusual case of mucinous adenocarcinoma of the anus associated with a chronic anal fistula, treated successfully by abdominoperineal resection (APR). Although multiple biopsies failed to reveal any histological evidence of malignancy, cancer was diagnosed from the mucin obtained for cytology. Subsequent histological examination of the resected specimen revealed clusters of cancer cells floating in a mucous lake, suggesting that it would have been difficult to acquire the cells in a biopsy sample. Conversely, the presence of mucin lakes and globules in specimens drained from the region of perianal sepsis may have been histologically informative for diagnosis. Thus, although biopsy of the lesion is undoubtedly essential for diagnosis, it often fails to provide enough information to make a definite diagnosis of mucinous carcinoma. This case illustrates that clinicians should base their decision on whether to perform surgery on clinical manifestations, imaging findings, and cytology of mucin obtained by drainage when it is difficult to obtain malignant cells by biopsy.

Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: report of a case.

We report a pancreatobiliary fistula caused by an intraductal papillary-mucinous pancreatic neoplasm (IPMN), manifesting as obstructive jaundice. Computed tomography showed dilatation of the bile duct and main pancreatic duct, with multiple cystic masses in the head of the pancreas. Endoscopic retrograde pancreatocholangiography showed a patulous papilla with mucin secretion. Contrast enhancement outlined amorphous material obstructing the lower part of the common hepatic duct. Pancreatogram and magnetic resonance cholangiopancreatography showed diffuse dilatation of the main pancreatic duct and side branches without communication with the adjacent organs or duct. We performed pancreaticoduodenectomy for IPMN of the pancreatic head and a tumor-like lesion in the lower common bile duct (CBD). Macroscopically, impacted thick mucus protruded into the CBD from the pancreas via a pancreatobiliary fistula. Histologic examination revealed a pancreatobiliary fistula caused by intraductal papillary-mucinous carcinoma of the pancreas with mucin hypersecretion, an adenoma without interstitial infiltration, and isolated implantation of an IPMN in the bile duct mucosa around the fistula.

The development of core-type Transcutaneous Energy Transmission System for artificial heart.

Recently, Artificial Heart (AH) is recognized as the alternate method of the heart graft. Though there are many problems and defect on AH, long term durability, miniaturization and weight saving interfaced with flow rate performance, efficiency of device. Considering rehabilitation into the society and advancement of QOL (Quality of Life), the construction of power source which supplies electric power to the device is important and has many problems. Especially, the electric feeder line restricts behavior of the transplant recipient and disturbs rehabilitation into the society. For solving these problems, Transcutaneous Energy Transmission System (TETS) is noticed and studied. This study proposes core-type TETS. It achieves high magnetic coupling compared with air-core-type TETS which is carried out on clinical study. Because core-type TETS has high magnetic coupling, it is possible to reduce the input current and to miniaturize transformer size. This paper mentions the characteristic of core-type TETS.