Multiple gastrointestinal stromal tumors in neurofi bromatosis type 1 treated with laparoscopic surgery

Gastrointestinal stromal tumors (GISTs) have been reported to occasionally occur in patients with neurofi bromatosis type 1 (NF-1), and many cases have had multiple lesions predominantly involving the small intestine. We report herein a case of multiple GISTs associated with NF-1 from whom laparoscopic surgery was benefi cial. In a 79-year-old female admitted with anemia and melena, the abdominal computed tomography revealed a tumor arising from the small intestine. Laparoscopic surgery was performed, and another small tumor was revealed during laparoscopic observation. Extracorporeal partial and wedge resection of the small intestine were undertaken. Both lesions were diagnosed as typical GISTs of low risk. Laparoscopic surgery would be useful for examination and a minimally invasive approach to tumors of the small intestine, especially on cases with the possibility of multiple tumors.</p

Abdominal wall and thigh abscess resulting from the penetration of ascending colon cancer.

An unusual case is described in which an abdominal wall and thigh abscess was an initial symptom of ascending colon cancer. A 76-year-old woman was referred to our hospital for investigation of fever and abdominal and thigh swelling. Computed tomography revealed a right abdominal wall, retroperitoneal, psoas and thigh abscess formation suspected to be caused by colon perforation. Due to the patient's poor general condition, local drainage of the abscess was performed on the following day of hospitalization. Histological examination of necrotic tissues removed form the retroperitoneal cavity demonstrated adenocarcinoma of the colon. The patient subsequently underwent right hemicolectomy with lymph nodal dissection after 19 days of the drainage procedure and was transferred to another hospital on the 49th day following the second surgery.</p

Peritoneal cecal cancer metastasis to a mesh-plug prosthesis : A case report

We report the case of a 77-year-old man who presented to our hospital with cecal cancer, lung metastasis, and liver metastasis in January 2013. After four courses of modified infusional intravenous fluorouracil and levofolinate with oxaliplatin (mFOLFOX 6) + bevacizumab, there was no new metastatic lesion and lung metastasis reduction was observed. Ileocecal resection was performed in May, left lower lung lobectomy in August, and extended right posterior segmentectomy + S8 partial liver resection was performed in December. The tumor marker declined initially ; thereafter, it gradually increased. Computed tomography (CT) performed in April 2014 revealed right inguinal mass around the mesh-plug prosthesis. A positron emission tomography-CT (PET-CT) also revealed a high 2-fluoro-2-deoxy-D-glucose (FDG) uptake at the same site. Right inguinal tumor resection was performed in July. Cancer tissues were confirmed by performing intraoperative rapid pathological diagnosis, and R0 resection could be achieved. Previous studies have reported malignant tumor metastases to the mesh-plug prosthesis, and this was believed to one of the sites that cancer cells can easily engraft. In particular, in patients with a history of advanced malignant tumors, if mass formation around the artifact insertion site is observed, the possibility of peritoneal metastasis should be considered

Combined resection of re-recurrent lateral lymph nodes and external iliac vein : Case Report and Literature

Herein, we describe the operative procedure for combined resection of re-recurrent lateral lymph nodes and the external iliac vein. There is no consensus on the clinical implications of resection of locally re-recurrent colorectal tumors, as the operative procedure is extremely difficult. We present the case of a 52- year-old woman who underwent abdominoperineal resection. About one year later, we excised a recurrent lymph node in the left lateral obturator area through an extraperitoneal approach. About 18 months later, lymph node re-recurrence in the left external iliac area was observed. Re-recurrent lymph nodes directly invade the left external iliac vein.We removed the re-recurrent lymph node with combined, radical segmental resection of the left external iliac vein, left obturator artery and vein, and left obturator nerve

Effect of Hinokitiol on Salivary Secretory-IgA Antibody Production System

ヒノキチオール（HNK）は，古くから細菌や真菌に対する抗菌作用を有し，生体に対してはストレス緩和作用という生理機能改善効果が知られ，現在，歯磨剤や整髪料，アロマ，食品に広く応用されている．だが，生体防御機構である免疫システムへのHNKが与える影響についてはほとんど知られていない．本研究では，HNKが粘膜免疫学的影響の一端を明らかにすることを目的に，マウス鼻腔からHNKを投与し，投与前・後の唾液中の分泌型IgA抗体（SIgA Ab）量の測定と，顎下唾液腺（SMG）における免疫細胞学的解析を行った． BALB/cマウス（8週齢，メス）に，HNK 50 μgを毎週1回計4回経鼻投与し，各投与日の投与前および投与0.5時間後，1.5時間後，3時間後，6時間後の唾液採取を行い，唾液SIgA Abの定量を行った．さらに最終投与日（初回投与から21日目；Day 21）のHNK投与前・後のマウスSMGにおけるIgA Ab産生細胞（IgA AFCs）数を計測し，さらにIgA AFCsの生存・増殖能の測定を行った. HNK各投与日におけるSIgA Ab分泌量は，投与1.5時間後が最大であり，投与6時間後で投与前と同レベルになることが認められた．興味深いことに，投与回数とSIgA Ab分泌量は正の相関傾向が認められた．Day 21のHNK投与前・後においては，SMGのIgA AFCs数に有意な差は認められなかったが，IgA AFCsの生存・増殖能はHNK投与0.5時間後と1.5時間後に有意な上昇が認められた．以上から，HNKの経鼻投与は，投与後1.5時間までのSMG IgA AFCsを活性化し，唾液SIgA Abの分泌を促進している可能性が示唆された.Hinokitiol (HNK) is a well-known antimicrobial and antifungal agent, and is widely used in various formulations including tooth pastes, mouth rinses, aromatics, cosmetics, and food. There is limited information on the immunobiological activity of HNK. In the present study, we investigated the effects of interanasally administered HNK on salivary secretory-IgA antibody (SIgA Ab) secretion in mice. BALB/c (8 weeks old) mice were given 50 μg of HNK four times at weekly intervals (Days 0, 7, 14, and 21) via the nasal route. Saliva samples were collected prior to (−0 hour) and after (0.5, 1.5, 3, and 6 hours) the nasal administration of HNK on respective days, and the levels of salivary SIgA Ab were determined by ELISA. Furthermore, the numbers of SIgA Ab-producing cells (SIgA AFCs) in submandibular glands (SMG) were examined by ELISPOT, and proliferation responses of IgA+ B cells were measured by MTT assays based on the same schedule on Day 21. On Days 0, 7, 14, and 21, the maximum level of SIgA Ab secretion in saliva occurred at 1.5 hours after the nasal administration of HNK. Interestingly, the number of doses of HNK and quantities of SIgA secretion showed a positive correlation. On Day 21, there were no significant differences between the number of SMG IgA AFCs prior to and after (0.5, 1.5, 3, and 6 hours) the nasal administration of HNK. However, significantly increased levels of IgA AFCs due to promotion of their proliferative activity were noted 0.5 and 1.5 hours after the nasal administration of HNK. Our results suggest that HNK has an impact on salivary SIgA Ab secretion immediately after nasal administration via elevating the proliferative activity of SMG IgA AFCs

Treatment of severe pneumonia by hinokitiol in a murine antimicrobial-resistant pneumococcal pneumonia model.

Streptococcus pneumoniae is often isolated from patients with community-acquired pneumonia. Antibiotics are the primary line of treatment for pneumococcal pneumonia; however, rising antimicrobial resistance is becoming more prevalent. Hinokitiol, which is isolated from trees in the cypress family, has been demonstrated to exert antibacterial activity against S. pneumoniae in vitro regardless of antimicrobial resistance. In this study, the efficacy of hinokitiol was investigated in a mouse pneumonia model. Male 8-week-old BALB/c mice were intratracheally infected with S. pneumoniae strains D39 (antimicrobial susceptible) and NU4471 (macrolide resistant). After 1 h, hinokitiol was injected via the tracheal route. Hinokitiol significantly decreased the number of S. pneumoniae in the bronchoalveolar lavage fluid (BALF) and the concentration of pneumococcal DNA in the serum, regardless of whether bacteria were resistant or susceptible to macrolides. In addition, hinokitiol decreased the infiltration of neutrophils in the lungs, as well as the concentration of inflammatory cytokines in the BALF and serum. Repeated hinokitiol injection at 18 h intervals showed downward trend in the number of S. pneumoniae in the BALF and the concentration of S. pneumoniae DNA in the serum with the number of hinokitiol administrations. These findings suggest that hinokitiol reduced bacterial load and suppressed excessive host immune response in the pneumonia mouse model. Accordingly, hinokitiol warrants further exploration as a potential candidate for the treatment of pneumococcal pneumonia