The relationship between ambulatory ability before surgery and the D-dimer value after total hip arthroplasty: the evaluation of ambulatory ability by the timed "Up & Go" test.

We examined whether ambulatory ability before surgery might influence the post-operative D-dimer level after total hip arthroplasty (THA). One hundred two patients with hip osteoarthritis receiving THA were included in the current study. The patients were all female, and their ages ranged from 45 to 81 (average 65.0 +- 9.3 years). Age, operated side, body mass index (BMI), disease duration before surgery, pre-operative pain evaluated by visual analogue scale (VAS), total cholesterol value, maximal circumference of the lower leg of the operated side, and timed &#34;Up &#38; Go&#34;test (TUG) before surgery, were retrospectively investigated to examine their relationship with D-dimer levels on post-operative day 7. Patients were divided into 2 groups according to the D-dimer value: over 10 microg/ml (Group D), and under (Group N). Patients in group D (N= 52)were older, had a higher BMI, and had less ambulatory ability than patients in group N (N= 50). As age showed a relationship with the D-dimer value on the 7th day and TUG results, patients in the 2 groups were further subdivided into 50's, 60's, and 70's age brackets. In the 50's bracket, patients in group D had higher BMI than patients in group N, but time for TUG was not significantly different. In the 60's and 70's bracket, patients in group D had less ambulatory ability than patients in group N, but the time for TUG was not directly correlated with the D-dimer value. The results suggest that pre-operative low ambulatory ability in patients with osteoarthritis over 60 years might influence the postoperative D-dimer after THA, indicating the potential risk for post-operative deep venous thrombosis.</p

ホウシャセン チリョウ ガ コウカテキ デ アッタ チョクチョウナイ ブンピツ サイボウ ガン ノ 1 レイ

A 54-year-old woman was seen at the hospital because of anal bleeding. Colonoscopy examination showed a type 2 tumor in the lower rectum and the histological diagnosis from the biopsy specimen was undifferenciated adenocarcinoma. Abdomino-perineal amputation of the rectum were performed. The resected specimen was positive for synaptophysin stain immunohistochemically and we diagnosed it as an endocrine cell carcinoma. We underwent adjuvant chemotherapy by bolus CPT-11, and the post operative course was uneventful. Intra-pelvic recurrence was observed 15 months after operation, and further 4 months later, metastasis developed around the pancreas. And we noticed the tumor in supraclavicular region 21 months after operation. The tumor was sensitive to chemotherapy, but continued to progress. So we underwent radiotherapy for each lesion. The lesion treated with radiotherapy were controlled until she died of cancer, 31 months after the operation. As a result of autopsy, an exellent effect of radiotherapy was confirmed

キョウセン ヒテイケイテキ カルチノイド ノ 1セツジョレイ

Background. Thymic carcinoids are rare disease to account for ２-４％ of anterior mediastinal tumors. So, the clinicopathologic characters are not known enough. Case. A ６７ years old man was followed up old myocardial infarction, and he was taken chest CT scan for evaluate coronary artery. It revealed three anterior mediastinal tumors and we diagnosed thymoma by needle biopsy. We treated by neoadjuvant chemotherapy（CAMP therapy）, but it was ineffective. We performed thoracoscopic thymothymomectomy, and the pathological diagnosis was thymic atypical carcinoid. He is free of clinically event recurrence one year and a half after treatment. Conclusions. When we found an anterior mediastinal tumor, and if the clinical course is usually different, we should consider the possibility of a thymic carcinoid

A feasibility study of postoperative adjuvant chemotherapy with fluoropyrimidine S-1 in patients with stage II-IIIA non-small cell lung cancer

Background : Adjuvant chemotherapy with uracil tegafur (UFT) improved survival among patients with completely resected stage I lung adenocarcinoma. S-1, an oral dihydropyrimidine dehydrogenase (DPD)- inhibitory 5-fluorouracil, is a more potent DPD inhibitor than UFT ; therefore, we hypothesized that postoperative adjuvant chemotherapy with S-1 would be effective for advanced non-small cell lung cancer (NSCLC). We conducted a feasibility study of S-1 as postoperative adjuvant chemotherapy in patients with curatively resected pathological stage II and IIIA NSCLC. Methods : Adjuvant chemotherapy consisted of 9 courses (4-week administration, 2-week withdrawal) of S-1 at 80-120 mg/body per day. Twenty-four patients with completely resected NSCLC were enrolled in this study from November 2007 through December 2010. The primary endpoint was the rate of completion of the scheduled adjuvant chemotherapy. The secondary endpoints were safety, overall survival, and relapse-free survival. Results : Five patients were censored because of disease recurrence. The planned 9 courses of S-1 were administered to completion in 8 patients. Twelve patients completed more than 70% of the planned courses. Grade 3 adverse reactions, such as elevated total bilirubin (4.2%) and pneumonitis (4.2%), were observed, but there were no Grade 4 adverse reactions. Patients who completed more than 70% of the 9 courses demonstrated better overall survival than those who completed less than 70%. Conclusion : Postoperative administration of S-1 may be possible with few severe adverse events as adjuvant chemotherapy for patients with curatively resected pathological stage II-IIIA NSCLC

Hepatobiliary cystadenoma exhibiting morphologic changes from simple hepatic cyst shown by 11-year follow up imagings

<p>Abstract</p> <p>Background</p> <p>A long-term follow up case of hepatobiliary cystadenoma originating from simple hepatic cyst is rare.</p> <p>Case presentation</p> <p>We report a case of progressive morphologic changes from simple hepatic cyst to hepatobiliary cystadenoma by 11 – year follow up imaging. A 25-year-old man visited our hospital in 1993 for a simple hepatic cyst. The cyst was located in the left lobe of the liver, was 6 cm in diameter, and did not exhibit calcification, septa or papillary projections. No surgical treatment was performed, although the cyst was observed to gradually enlarge upon subsequent examination. The patient was admitted to our hospital in 2004 due to epigastralgia. Re-examination of the simple hepatic cyst revealed mounting calcification and septa. Abdominal CT on admission revealed a hepatic cyst over 10 cm in diameter and a high-density area within the thickened wall. MRI revealed a mass of low intensity and partly high intensity on a T1-weighted image. Abdominal angiography revealed hypovascular tumor. The serum levels of AST and ALT were elevated slightly, but tumor markers were within normal ranges. Left lobectomy of the liver was performed with diagnosis of hepatobiliary cystadenoma or hepatobiliary cystadenocarcinoma. The resected specimen had a solid component with papillary projections and the cyst was filled with liquid-like muddy bile. Histologically, the inner layer of the cyst was lined with columnar epithelium showing mild grade dysplasia. On the basis of these findings, hepatobiliary cystadenoma was diagnosed.</p> <p>Conclusion</p> <p>We believe this case provides evidence of a simple hepatic cyst gradually changing into hepatobiliary cystadenoma.</p

ショクドウガン ジュツゴ ソウキ ニ キカン イカンロウ オ ガッペイ シタ 1レイ

The patient was a４５-year-old man. He had suffered from nephrotic syndrome at time of his twenties and had steroid salvage treatment. But he retired the treatment by himself. Esophageal tumor was suspected at the screening, and he was referred to our hospital. Preoperative diagnosis was the adenocarcinoma of the esophagogastric junction（cT２N０M０ stage Ⅱ）． Thoracoscopy assisted subtotal esophagectomy in prone position with D２dissection was performed. Gastric role was prepared in laparoscopic approach, and pulled up to the neck via posterior mediastinal route. Although early postoperative course was uneventful and esophageal fluoroscopy on the７th day showed no leakage, sudden dyspnea appeared on the８th day. CT examination and Bronchoscopy showed tracheoesophageal fistula. Unfortunately, the fistula didn’t get well, and we considered that it was difficult to close the fistula by only conservative treatment. Esophageal covered stent was inserted on the５６th day. After that, he could start ingestion intake and was discharged from hospital on the８５th day. Now, he is being followed up in our hospital

チュウスイ ゲンパツ フクゴウガタ セン シンケイ ナイブンピツ ガン ノ イチチケンレイ

A５２-year-old man visited our hospital because of epigastralgia. The colonoscopic examination revealed an about ４cm-protruded lesion like SMT on the appendix and findings of the biopsy specimen were compatible with the disgnosis of signet ring cell carcinoma. The primary lesion was unknown by upper gastrointestinal endoscopy, CT and PET, and the tumor markers were normal revel. At laparotomy, severe peritoneal metastasis was revealed in the abdominal cavity, especially appendix. Severe stenosis of ileocecum was found, so we conducted ileocecal resection. The histopathological diagnosis was primary signet ring cell caicinoma of appendix, SE, N２, M０, P３, pStage Ⅳ. Postoperatively mFOLFOX was started, but allergic reaction was seen after１cycle. We started Panitumumab/CPT-１１and the patient attended our emergency department with shivering chill and fever on treatment day１０. The next day he became shock state and CT revealed free air. Operation might not save his life and we started supportive care. He died on the day. The cause of his death was peritonitis by cancer perforation