A Common Diagnosis Delayed by Three “Wrong Footing” Anchoring Errors – it is Difficult to Remember What You Have Forgotten

Very often in clinical practice, an inflamed pelvic appendix shows left lower quadrant abdominal pain as the primary painful area. The clinicians are anchored to the most prominent symptom, thereby taking an unnecessary detour in reaching an accurate diagnosis. A 40-year-old man presented to our emergency department with persistent lower left abdominal pain with a fever of 38 oC from a day earlier. He had a good appetite and repeatedly complained of severe constipation at the time of his visit. Physical examination revealed tenderness in the lower left abdomen without a peritoneal sign. Abdominal ultrasound and non-contrast-enhanced computed tomography revealed a left hydroureter. The next day, a radiologist pointed out the possibility of appendicitis. An urgent laparoscopic appendectomy was performed.  The intriguing point of this case is the diagnostic delay because of three anchoring biases. First, the typical right lower abdominal pain of appendicitis was shielded by the intense left lower abdominal pain. Moreover, the presence of a left hydroureter distracted the physicians from the actual location of the pain. Furthermore, the presence of constipation anchored the physicians to constipation as the cause of abdominal pain. In overcoming these biases, specific diagnostic strategies to avoid biases should be implemented

Carbon Monoxide Poisoning in a Psychiatric Patient Mistaken for Indefinite Complaints

Introduction: Carbon monoxide (CO) binds to haemoglobin with a much higher affinity than oxygen, forming carboxyhaemoglobin (COHb), which impairs oxygen transport and utilization. As CO concentrations can easily peak in closed environments, non-fire-related CO poisoning can also occur. However, because CO poisoning is often a nonspecific clinical finding, it can result in a diagnostic error. This report details the misdiagnosis of a 42-year-old male patient with psychiatric disorders.Case description: The patient presented to the hospital with dizziness, abdominal pain and nausea on multiple occasions. His symptoms were ascribed to his psychiatric conditions. On his fifth visit, we diagnosed the patient with CO poisoning. Discussion: It is apparent that this patient was misdiagnosed because of his medical history, and standard analysis was overlooked. When patients with psychiatric disorders have nonspecific symptoms, it is important to check for urgent underlying conditions during diagnosis

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

Secular and coseismic changes in S-wave velocity detected using ACROSS in the Tokai region

Abstract We discovered a secular change in the travel time of direct S-waves over a 10-year observation period by means of continuous operation of an artificial and stable seismic source, called Accurately Controlled Routinely Operated Signal System (ACROSS), which is deployed in the central part of Japan along the Nankai Trough. We used 13 High Sensitivity Seismograph Network Japan (Hi-net) stations around the ACROSS source to monitor the temporal variation in travel time. Green’s functions were calculated for each station daily from March 29, 2007, through October 30, 2017. Secular advance in the temporal variation in travel time was seen for the whole operation period, in addition to a steplike delay associated with the 2011 Tohoku earthquake. We estimated the rate of secular change and the amount of coseismic step by modeling the transfer function of S-waves with a linear trend and the coseismic step of the 2011 Tohoku earthquake. Distance dependences of the travel time changes can be explained as a combination of common bias and dispersion for each station, for both the secular and coseismic changes. This can be interpreted as a randomly distributed change in seismic velocity over the range of the observation region. An azimuthal dependence exists for both changes and shows larger changes in the NE–SW direction than in the NW–SE direction from the ACROSS source

Development of EM-ACROSS and Its Field Test

A new electromagnetic sounding method called EM-ACROSS is proposed by Ogawa and Kumazawa [1996]. The characteristic feature of this approach is the use of accurately controlled electromagnetic waves to determine the accurate transfer function between source signal and observed signal. Upon developing the hardware system of EM-ACROSS, the first field test was carried out in the Tono area. The transmitting test and trial observations with a rectangular wave signal from current dipole showed that the system worked well up to 100Hz. Data stacking represented the reduction of the observation noise as accurately as theoretically expected. With stacking for eight hours, signals were detected up to 30Hz at a distance of 3km. Whereas the results obtained so far are preliminary, the ACROSS approach is thought to have potential for underground exploration and monitoring