Spontaneous esophageal perforation within a hiatal hernia : A case report

Introduction: Spontaneous esophageal perforation, also commonly referred to as Boerhaave's syndrome, is one of the most lethal diseases causing an acute abdomen. Though rare, emergent surgical intervention is often required and management can be various based upon the site of the perforation. This literature has been written in line with the SCARE criteria (Agha et al., 2020) [1]. Presentation of case: A 76-year-old man presented with acute abdominal pain. Computed tomography (CT) revealed and an emergent esophagogastroduodenoscopy (EGD) was performed carefully, which revealed a 7 cm all-layer esophageal laceration in the left lower esophageal wall. In our case, a hiatal hernia was protruding into the mediastinum, and the perforation site was inside of it, but there was no invasion into the thoracic cavity, thus a transabdominal approach was performed without thoracotomy. Discussion: This type of esophageal perforation within a hiatal hernia is quite rare and provides a unique clinical challenge. In addition, A review reported the average length of spontaneous esophageal perforation to be around 2 cm while our case had a perforation with a length of 7 cm. We chose the combination of the simple suture with omental buttress and wide drainage, but a complete fundoplication was impossible due to its large size of perforation. Conclusion: We chose the open abdominal approach because the case had high inflammation, a hiatal hernia and possibility of retro-gastric perforation. However, MIS should have been considered first if a situation or human resources allow it

ChREBPアイソフォームによる糖・脂質代謝関連遺伝子の転写制御機構

学位の種別: 課程博士審査委員会委員 : (主査)東京大学教授 佐藤 隆一郎, 東京大学教授 加藤 久典, 東京大学准教授 三坂 巧, 東京大学准教授 小林 彰子, 東京大学准教授 井上 順University of Tokyo(東京大学

Patient survival after total knee arthroplasty.

The authors analyzed the 5-year and 9-year survival in 134 of 165 patients who underwent total knee arthroplasties from 1989 to 1996 in our department. Patients were followed until December 31, 1998, or until the time of death. Diagnoses were rheumatoid arthritis in 81 patients (132 knees) and osteoarthritis in 53 patients (79 knees). The survival of the patients was compared to that of the age- and sex-adjusted general population. Kaplan-Meier survival curves were constructed. Twenty-two patients in the study died before the end of the follow-up. The cumulative 5-year patient survival was 88.7%, and 9-year patient survival was 64.4% for total knee arthroplasty patients. The standardized mortality ratio was 0.11 (95% confidence interval: 0.02-0.40) for the patients with osteoarthritis, and 0.81 (95% confidence interval: 0.52-1.25) for the patients with rheumatoid arthritis. The Cox proportional hazards model showed that the factors of male sex and rheumatoid arthritis were related to a higher mortality rate in the total knee arthroplasty group.</p

トウカ ニオケル ダイチョウ センコウ 83レイ ノ リンショウテキ ケントウ

Introduction : Colon perforation easily causes septic shock and multiple organ failure, mortality rate is high. We studied prognostic factors with colon perforation. From January１９９９to December ２００８, ８３ patients with colon perforation underwent emergency surgery in this department. Methods : Subjects were retrospectively divided into survivors（n＝６７）and nonsurvivors（n＝１６）. We studied their clinical factors and compared mortality for each factors. Results : Overall mortality was１９％ １６／８３）. The mean age was７４years, and significantly higher mortality over ８０years. The cause perforation was idiopathic in２５cases, cancer in２１cases, diverticulitis in１９ cases, iatrogenic in８cases, trauma in２cases, others in８cases. The perforation site was the most sigmoid colon. Patients with SOFA score at least five points before surgery and preoperative shock and leucopenia and older than２４hours before surgery was significantly higher mortality. Each was no difference in complications before surgery. PMX-DHP was performed in ３９ cases １３％ mortality. Discussion : In patients with colon perforation, preoperative assessment SOFA score was trusted to reflect the outcome

Schwannoma resembling metastatic lymph node

In this report, we describe a rare case of vagus nerve schwannoma associated with esophageal cancer. A 70-year-old man visited our hospital complaining of worsening dysphagia. His upper gastrointenstinal endoscopy revealed a mass in the esophagus. A contrast-enhanced chest computed tomography also detected a 15 mm nodule attached to the tracheal membrane. This nodule was diagnosed as a metastatic lymph node. Although the primary tumor reduced after neoadjuvant chemotherapy, the nodule remained intact ; it showed fluorodeoxyglucose accumulation on positron emission tomography. We had a clinical diagnosis of stage III after neoadjuvant chemotherapy and underwent surgery. Intraoperatively, the nodule could not be detached from the right vagus nerve ; therefore, we excised the nodule along with the adjacent vagus nerve. The nodule was pathologically diagnosed as a vagus schwannoma. The nodule was not a regional lymph node metastasis of esophageal cancer. His postoperative course was uneventful, and he is currently undergoing outpatient follow-up without recurrence

A case of thoracic esophageal cancer undergone esophagectomy after induction chemotherapy in a Jehovah’s Witness

We report the case of a 50-year-old female Jehovah’s Witness with advanced esophageal cancer who underwent esophagectomy following induction chemotherapy. She visited our hospital complaining of dysphagia and was diagnosed of advanced esophageal cancer by upper endoscopy. She refused allogeneic transfusion. Induction chemotherapy was performed. Severe anemia occurred as an adverse event. A subtotal esophagectomy was performed after her anemia improved. During the surgery, a large volume of replacement fluid was injected, the blood was diluted, and intraoperative bleeding was relatively reduced. Intraoperative blood salvage was made using Cell Saver. The postoperative course were stable by using autologous blood and albumin infusion. The patient was discharged on postoperative day 27. Jehovah’s Witnesses with gastrointestinal malignancies can be treated safely by performing surgical therapy based on blood replacement therapy and autologous blood transfusion

Usefulness of peripherally inserted central catheters

Introduction : Central venous catheter (CVC) use is essential for treating esophageal cancer. Peripherally inserted central catheters (PICC) are commonly used recently for improved patient comfort and safety. We compared centrally inserted central catheters (CICC) and PICC insertions and examined their safety. Methods : We retrospectively investigated complications at the catheter insertion and post-insertion for 199 patients’ esophageal cancer treatment (CICC : 45, PICC : 154) from 2013 to 2018. In addition, we summarized the results of catheter tip culture. Results : No serious complications occurred at the catheter insertion in either group. The rate of complications at catheter insertion was 5.8% for PICC and 6.7% for CICC patients. Post-insertion complications were observed in 6.5% and 11.1% of patients with PICC and CICC, respectively, and this difference was not significant. The incidence of catheter-related blood stream infection (CRBSI) was significantly lower in PICC than CICC patients (0.3 vs. 1.8 / 1,000 catheter-days ; p = 0.029). Catheter-related thrombosis was observed in PICC : 0.5 and CICC : 0.6, and occlusion due to blood flow reversal was observed in PICC : 0.5 and CICC : 0.6. Conclusion : PICCs are safer and more effective than CICCs for the treatment of esophageal cancer, and reduce the incidence of CRBSI. We hope to standardize the insertion procedures, conventionalize techniques, and establish training systems

MONITORING ANAPLASTIC THYROID CANCER MODELS BY PET/CT

Anaplastic thyroid carcinoma (ATC) is a rare type of thyroid carcinoma with a poor prognosis. Thus, suitable preclinical tumor models are required for the development of new ATC therapies. In the present study, orthotopic tumor xenograft models were established using ATC cell lines and SCID mice, and tumor invasion and the effects of anticancer drugs were evaluated using positron emission tomography/computed tomography (PET/CT) to repeatedly and non-invasively monitor these models. Three ATC cell lines (8305c, 8505c, and ACT-1) were used. Their sensitivities to two anticancer drugs (paclitaxel and lenvatinib) were investigated. The 8505c cell line was orthotopically implanted into SCID mice, which were then divided into three groups: no chemotherapy, paclitaxel (5 mg/kg, administered intraperitoneally, every week), and lenvatinib (5 mg/kg, oral route, every day) groups. PET/CT was performed and tumor growth and the effects of anticancer drugs based on tumor volume and fludeoxyglucose (FDG) uptake were evaluated. 8505c cells exhibited the highest sensitivity to the anticancer drugs. In mice implanted with 8505c cells, continuous increases in FDG uptake associated with tumor growth were detected on PET/CT in the group that received no chemotherapy. The tumor volume and FDG uptake increased by 91.5- and 2.4-fold, respectively, within 2 weeks. The increase observed in tumor volume was 26.9- and 12.2-fold in the paclitaxel and lenvatinib groups, respectively, within 2 weeks. Furthermore, the increase in FDG uptake was 1.8-fold and 1.6-fold in the paclitaxel and lenvatinib groups, respectively, within 2 weeks. In our orthotopic SCID mouse model, tumor growth and the effects of anticancer drugs were repeatedly and non-invasively monitored using PET/CT. The present method is useful for the development of new ATC treatments

ショクドウガン シュジュツチュウ ニ シンシツ サイドウ オ ショウジ キュウメイシエタ イチレイ

The patient was６０years old, man. He is in the hospital with diabetes and spinal cord injury, admitted passing disorder, diagnosed with advanced esophageal cancer, and introduced to our hospital. Start the chemotherapy following systemic examination became operative after completion chemotherapy. Chest operation is carried out under full thoracoscopy, the end without any problems. Abdominal operation is done laparoscopy, towing the thoracic esophagus into the abdominal cavity, who developed ventricular fibrillation in a few minutes after the esophageal hiatus became a release. Immediately start cardiopulmonary resuscitation, underwent defibrillation, it was restored to the normal waveform. It was restarted operation. Reconstruction using a gastric tube, in the chest wall before route, was anastomosis in the neck. The postoperative course good, rather than after-effects and postoperative complications, and it was discharged on day ３４. Esophageal cancer surgery is a highly invasive surgical procedure, there is a high frequency of arrhythmia will develop. We ventricular fibrillation develop in the esophagus resection surgery, and that a reported rare example that was life-saving