A Case of Retroperitoneal Schwannoma Difficult to Diagnose Preoperatively

We report a case of retroperitoneal schwannoma misdiagnosed as a liver tumor in the caudate lobe. Preoperative diagnoses should be made with great care in cases of retroperitoneal tumors contacted to the liver since it is difficult to differentiate from intrahepatic tumors

Massive Desmoid with Keloid of the Anterior Neck

It is a case report of a massive recurrent desmoid and overlying keloid that simultaneously occurred inthe anterior neck. A 21-year woman presented with a 4-year history of a recurrent desmoid with a keloidof the skin in the anterior neck. The desmoid and overlying keloid were excised en-bloc with episternotomy.The defect was covered with the rotated pectoralis major muscle flap, and then resected episternum wasreturned after inactivation by liquid nitrogen. Skin defect of the anterior neck was covered with the free radialforearm flap. Although there is no evidence of recurrence of the desmoid a year later, recurrence of thekeloids is remarkable. As to our knowledge, it is rare that desmoids and keloids occur simultaneously. Itmight be an opportunity to explain a strange character of desmoids based on clinical nature of keloids

Evaluation of Gastroesophageal Reflux and Gastroesophageal Reflux Disease with Esophageal Endoscopy and Histology in Children

Objectives:The roles of esophageal endoscopy and mucosal biopsy in making diagnoses of gastroesophageal reflux( GER) and gastroesophageal reflux disease( GERD) were retrospectively examined in children.Methods:Thirty-four patients, whose ages ranged from 1 month to 18 years (median, 4 years), underwent diagnostic evaluation of GER/GERD. Group I patients( n=5) had symptoms suggesting GER, but had no underlying abnormalities. Group II patients( n=23) had chronic symptoms suggesting GERD and underlying abnormalities, neurologic impairment( n=22) and post-repair of esophageal atresia( n=1). Group III patients( n=6) were neurologically impaired but had no symptoms and underwent evaluation as a preoperative examination of gastrostomy placement. Reflux esophagitis was endoscopically graded according to the modified Los Angeles classification and grouped into grades?M, A, and?B. The results of GER studies and the histologic findings of reflux esophagitis were compared between these groups.Results:The parameters of 24-h pH monitoring were significantly higher in patients with grade?B than grade?M, and endoscopic grades improved after antireflux surgery along with the improvements in reflux index. There were no significant correlations between the endoscopic grade and the percentages of patients in whom histologic findings of reflux esophagitis were present.Conclusion:Esophageal endoscopy is useful for examining the severity of reflux esophagitis and monitoring the effect of treatment in children with GER/GERD. The modified Los Angeles classification can also be used for that purpose. Although treatment is seldom influenced by the results, histologic evaluation of the esophageal mucosa should be performed to exclude other disorders

Reinforcement of Coracoacromial Ligament Transfer for Severe Acromioclavicular Dislocation using the Suture Anchor and the Hook Plate : Results of the cases

Introduction : Three cases of successfully treated Rockwood type V acute acromioclavicular joint dislocation in high activity patients with modified (reinforced) coracoacromial ligament transfer were reported. Materials and methods : All patients were operated on within 3 weeks after injury. The operation is constructed with three parts, namely the coracoclavicular ligament repair with 2 suture anchors, the coracoacromial ligament transfer, and internal fixation of the acromioclavicular joint with short-hook-3-hole plate as a temporary support until ligaments heal. Postoperatively, the patient\u27s shoulder is lightly immobilized with a sling. The sling is removed at the first postoperative day and the patient is allowed to begin circumduction exercises with a gradual increase. No overhead activities or full abduction was allowed until the hook plate removal at three months. Results : The mean follow-up duration was one year. Mean Constant score at a year was 95 out of a maximum of 100. Mean ASES score at a year was 29 out of a maximum of 30. Although follow-up was a short period, both subjective and objective assessments including X-ray evaluation were excellent. Conclusion : Combination of the repaired coracoclavicular ligament with the suture anchors and the transferred coracoacromial ligament must keep more rigid strength against redisplacement, and the temporary hook plate strongly prevents the ligaments from any stress during their healing period. Since reliable stability from the initial postoperative stage can ease mandatory limitation in daily activities earlier, this reinforced procedure may consequently help early reinstatements of the patients

Modified Bentall operation with bioprosthetic valve and Valsalva graft conduit:the "slit skirt" technique

We elucidated the efficacy of the slit skirt technique to prevent bleeding from the proximal anastomosis between the graft and aortic annulus. Between September 2008 and September 2014, 15 patients underwent a modified Bentall operation with the slit skirt technique at our institution. No patients had bleeding from the proximal anastomosis. No re-thoracotomy for bleeding was required. During midterm follow-up (median period, 21 months), no patient had pseudoaneurysms at the proximal suture line. We conclude that the slit skirt technique is useful to prevent bleeding from the proximal anastomosis after the Bentall operation

フククウキョウ カ チュウスイ セツジョ ジュツ オ シコウ シタ チュウスイ ケイシツ エン ノ 1レイ

本邦では虫垂憩室炎は比較的稀な疾患であり臨床的に診断が困難である.虫垂炎が疑われる症例の中にも本症例のように虫垂憩室炎が存在する可能性がある.しかしそのような場合でも腹腔鏡下手術が有用と考えられる.慢性に経過し画像上虫垂憩室炎の診断に苦慮したが,治療に鏡視下手術が有用であった一例を経験し文献的な考察を加えて報告した.虫垂の炎症疾患を疑い外科的治療を施行する際には腹腔鏡下手術が望ましいと考えられた.Diverticulum of the vermiform appendix is rarely encounteredin Japan. It is difficult to diagnose diverticulum ofthe appendix preoperatively. A 37-year-old male patientcame to our hospital with presentation of acute abdominalpain in the right lower quadrant. We performed laparoscopicappendectomy under the diagnosis of the suspicion ofacute appendicitis. It showed severe adhesion between thetip of appendix and retroperitoneum with local inflammatoryreaction. Pathological examination revealed severalchronic diverticulitis and acute diverticulitis in the appendix.Laparoscopic surgery is very useful to dissect severeadhesion of appendix. Laparoscopic surgery for diverticulumof the appendix is an effective procedure

ゼツヘンペイジョウヒガン ニ オケル KPNA 2 ハツゲン ノ リンショウ テキ イギ ニ カン スル ケントウ

KPNA2(Karyopherin-α 2)は,核- 細胞質間蛋白輸送因子の一つで,癌の細胞増殖ならびに転移に関与することが報告がされているが,その発現と臨床的意義については,なお不明な点が多い.今回われわれは,舌扁平上皮癌におけるKPNA2 の発現と臨床病理学的因子(年齢,性別,T stage, pN, Stage, 分化度,YK- 分類,Ki-67,5 年累積生存率)との関係について検討したので報告する.対象は,当科にて手術療法を施行した舌扁平上皮癌一次症例66 例で,未治療生検組織を用い免疫組織化学染色を行い,発現検索を行った.その結果,KPNA2 の発現は頸部リンパ節転移症例,Stage IV,低分化型,Y-K4 型ならびにKi-67L.I. 高率症例に有意に多く,5 年累積生存率では,発現例は非発現例と比べ,有意に生存率が低い結果であった.また,多変量解析の結果,KPNA2 発現は腫瘍の増殖,ならびにリンパ節転移の危険因子と考えられた.以上より,舌扁平上皮癌においても,KPNA2 発現は,リンパ節転移,腫瘍の分化,浸潤,増殖ならびに治療成績と関連し,新たな予後規定因子になり得ると思われた.Background Karyopherin- α2 (KPNA2) is a member of the importin alpha family and has recently been reported to play an important role in lymph node metastasis and tumorigenesis and tumor progression. The aim of the current study was to elucidate the clinicopathological significance of immunohistochemical expression of KPNA2 in tongue squamous cell carcinomas( SCC).Patient and Method Biopsy specimens were obtain from 66 tongue SCC patient( 43 males and 23 females) who had undergone resection at Dokkyo Medical University, Department of Oral and Maxillofacial surgery between 2003 and 2011 after obtaining their written informed consent. The age of patients ranged from 27 to 90 years with a mean of 60.5 years. KPNA2 expression was investigated by immunohistochemical in 66 tongue SCC biopsy specimens, and the association of KPNA2 expression with clinicopathologic features was also examined.Result Expression of KPNA2 in tongue SCC tissues. 30 (45.5%) cases showed positive expression of KPNA2 and 36( 54.5%) did not. Positive expression of KPNA2 showed a significant association with lymph node metastasis (P=0.005), poor differentiation (P=0.002). YK-classfication (P=0.032), Ki-67 labeling index (P<0.001). The overall survival rate of the tongue SCC patients whose tumors demonstrated positive expression of KPNA2 was significantly lower than that of the tongue SCC patients that did not( P=0.046).Conclusion KPNA2 expression suggests poor prognosis in patients with tongue SCC

ナイ ジカク ニ タイ スル リュウサン アルミニウム ・ タンニン サン チュウシャ エキ ( ALTA ) リョウホウ シコウ 5 カゲツゴ ニ ショウジ タ コウモン カン ・ チョクチョウ ネンマク ヘンセイ ノ 1 レイ : ALTA シコウ ゴ ノ ネンマク ヘンセイ

症例60歳女性,10年来の脱出性内痔核の治療として2014.2.12硫酸アルミニウムカリウム・タンニン酸注射液(Aluminium Potassium Sulfate Tannic Acid:以下ALTA)を使用した四段階注射痔核硬化療法を受けた.経過良好であったが,7月中旬よりの肛門痛・発熱にて入院,触診のみでボロボロ崩れ落ちてゆく5時方向を中心とした約1/4周を占める広範な肛門管・直腸粘膜変性壊死を認めデブリードマン施行.疼痛・発熱は持続したが,禁食,抗生物質・解熱剤の投与,2回の追加デブリードマンにて,変性壊死部位は脱落し潰瘍と変化し,一か月後軽快退院した.非常に稀な経過と考えられたため報告した.Recently, the number of the Aluminum Potassium Sulfate and Tannic Acid(ALTA)injections therapy for internal hemorrhoids have been increasing markedly in Japan because of its minimal invasive therapy, quick response and acceptable recurrence rate. However, there are some reports of adverse reactions and side effects after ALTA such as Fournier\u27s Gangrene, rectovaginal fistula and rectal ulcer. We experienced a case of anorectal mucosal degeneration and necrosis after five months ALTA injection for internal hemorrhoids. A 60 year-old female was treated with sclerosing therapy with ALTA injection for grade II～III internal hemorrhoids according to the Gligher classification. Although the patient was in good course in 5 months after therapy, she developed a high fever and anal pain. Antibiotics were administrated, but remission was not achieved. Three times debridements were performed under local and intravenous anesthesia with a diagnosis of anorectal mucosal degeneration and necrosis. After approximately a month admission in the hospital was necessary for the treatment of the anorectal ulcer after debridements, she has been free from fever, pain and hemorrhoids