キュウセイ タンノウエン デ ハッショウシ ジュツゼン ニ DIC トナッタ タンノウセン ヘンペイ ジョウヒガン ノ 1レイ

We report a case of resected adonosquamous carcinoma of the gallbladder with acute cholecystitis and preoperative DIC. A 79-year-old woman was admitted to our hospital because of acute cholecystitis due to cystic duct obstruction by carcinoma of the gallbladder. There were high fever and henns ‘egg-sized tumor with severe tenderness on the right hypochondrium. Based on various examinations, a diagnosis advanced crcinoma of the gallbladder (Hinf3) was determined. Until the operation, because of exacerbation of acute cholecystitis, DIC occurred. The day before operation, percutaneus transhepatic gallbladder drainage was done. Then partial liver segmentectomy (S4a and S5) with cholecystectomy was carried out. Direct infiltration to the liver was observed. Histopathologically, the gallbladder tumor was adenosquamous carcinoma. After the operation, she recovered from DIC. But metastatic lymphnodes around common bile duct were enlarged rapidly, and obstructive jaundice appeared. On 55th day after the operation, she died because of peritonitis carcinomatosa 55 postoperative days. It was considered that preoperative acute cholecystitis, DIC and postoperative obstructive jaundice resulted from rapid growth of adenosquamous carcinoma

スイトウブ スイカンナイ ニュウトウ シュヨウ ニ タイシ スイトウ ジュウニシチョウ ダイ2ブ セツジョジュツ オ オコナッタ 1レイ

We report a case of IPMT (intraductal papillary-mucinous tumor) that was performed pancreatic head resection with segmental duodenectomy. A 42-year-old man was admitted to our hospital because he was pointed out a cystic tumor of the pancreas head by near doctor. Abdominal ultrasonography and intra ductal ultrasonography showed a multiple cystic tumor with hypertrophied septum. But there were no elevated tumors in the cystic mass. MRCP showed a racemose multiple cystic tumor. ERCP showed a big orifice of papilla Vater and mucinous discharge. Based on these various examinations a diagnosis IPMT was determined. Because of no elevated tumor in the cystic mass, we suspected it was adenoma or hyperplasia. Then we determined to perform a minimal invasive operation, and underwent pancreatic head resection with segmental duodenectomy. After the operation there were no stasis of stomach and no weight loss. To determine the surgical procedure of benign IPMT, we should try to preserve the organ function. It was considered that this procedure was a useful method for benign IPMT of the pancreas head

ヒダリガワ タンノウショウ ニ タイシ フククウキョウカ タンノウ テキシュツジュツ オ シコウ シタ 3レイ ノ ケントウ

We experienced a series of 370 cases of laparoscopic cholecystectomy (Lap-C) between January 1992 and December 2001, of which three cases (0.8%) were left-sided gallbladder. When we perform Lap-C to left-sided gallbladder, we have to recognize the anatomical specificity of this disease, and to avoid the complication like injury of arteries or bile ducts. In this study we performed Lap-C to three cases of left-sided gallbladder. In all cases, the gallbladder bed were located at the left side of the hepatic round ligament, and the cystic duct were connected to normal position of the common bile duct. And in all cases, there were no anomalies of the intrahepatic portal vein. One of these cases, falling of the hepatic round ligament was seen, then we tried to insert a trocar at the left side of the ligament and to pick up it by silk. Then we could get a good view and easily performed Lap-C. In all cases we could underwent Lap-C without complication. We considered that Lap-C was to be a standard operation method for malformation cases like a left-sided gallbladder

Chemotherapy on QOL and night sleep of CC patients

Background : The aim of this study was to investigate quality of life (QOL) and night-time sleep disturbance in colon cancer patients with middle risk chemotherapy for proper antiemetic therapy. Methods : The study enrolled 139 patients with colorectal cancer. All patients received oxaliplatin or irinotecan-based chemotherapy. Patients completed a questionnaire about chemotherapy-induced nausea and vomiting and sleep disturbance. Sleep disturbance was checked, and the relationship between sleep disturbance and nausea was analyzed. Results : The prevalence of nausea was 48.9% (68 / 139). The degree of the nausea was slight / moderate / severe in 51 / 11 / 6 patients, and 12 patients had vomiting. Appetite showed no change / slightly decreased / half / one-fourth / none in 51 / 34 / 33 / 6 / 7 patients. There were significant differences in the mental component summary (MCS) score and the role-social component score (RCS). (MCS : nausea(+) vs nausea(-) 46.4 ± 1.1 vs 54.1 ± 1.1 p < 0.01 RCS : nausea(+) vs nausea(-) 33.1 ± 2.1 vs 41.6 ± 2.1 p < 0.01). Using the MCS with a cut-off score of 50, patients were divided into two groups, and nausea was significantly correlated with a low MCS score. Furthermore, patients were divided into two groups using a Pittsburgh Sleep Quality Index cut-off score of 6, and sleep disturbance was correlated with old age and second-line chemotherapy. Conclusions : Nausea affects QOL and night-time sleep of colon cancer patients with middle risk chemotherapy

Balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration for ruptured duodenal varices after operation for rectal cancer with multiple liver metastasis : report of a case

We report a patient with duodenal varices oozing blood who had undergone low anterior resection of the rectum and resection of the liver tumor because of multiple liver metastasis from rectal cancer 80 months previously. Although endoscopic variceal ligation (EVL) was carried out for the ruptured duodenal varices, their bleeding persisted and hepatic encephalopathy also appeared. Finally, balloon occluded retrograde transvenous obliteration (BRTO)with percutaneous transhepatic obliteration (PTO)was carried out for the duodenal varices. Percutaneous transhepatic portography revealed detailed hemodynamics. Following PTO, the duodenal varices were stagnated by BRTO, and no complications were recognized. No re-bleeding episode has been observed since the treatment. In addition, the hepatic encephalopathy was also improved

Low-Lying Excited States of Quantum Antiferromagnets on a Triangular Lattice

We study low-lying states of the XY and Heisenberg antiferromagnets on a triangular lattice to clarify whether spontaneous symmetry breaking occurs at $T=0$ in the thermodynamic limit. Approximate forms of low-lying states are proposed, in which degrees of freedom of the sublattice magnetization and of the chirality are separated. It is shown that low-lying states can be accurately described with the present approximation. It was argued that low-lying states play an important role in symmetry breaking. With help of this approximation, we discuss the contribution of low-lying states to symmetry breaking of two types, namely creation of the spontaneous sublattice magnetization and the spontaneous chirality. Furthermore, to show an evidence for the occurrence of the symmetry breaking, we numerically study the low-lying states of finite systems of the XY and Heisenberg antiferromagnets. It is found that the necessary conditions for the symmetry breaking to occur are satisfied in these models.Comment: LaTex 22 pages, figures included in uuencoded form, to be published in J.Stat.Phy

Cytology Reporting System for Lung Cancer from the Japan Lung Cancer Society and the Japanese Society of Clinical Cytology: An Extensive Study Containing More Benign Lesions

Introduction: The Japan Lung Cancer Society (JLCS) and the Japanese Society of Clinical Cytology (JSCC) have proposed a new four-tiered cytology reporting system for lung carcinoma (JLCS-JSCC system). Prior to the proposal, the Papanicolaou Society of Cytopathology (PSC) had proposed a revised reporting system (PSC system), which comprises the “neoplastic, benign neoplasm, and low-grade carcinoma” category (N-B-LG category), in addition to the 4 categories of the JLCS-JSCC system. This study aimed to evaluate the interobserver agreement of the JLCS-JSCC system with an additional dataset with more benign lesions in comparison with the PSC system. Methods: We analyzed 167 cytological samples, which included 17 benign lesions, obtained from the respiratory system. Seven observers classified these cases into each category by reviewing one Papanicolaou-stained slide per case according to the JLCS-JSCC system and PSC system. Results: The interobserver agreement was moderate in the JLCS-JSCC (k = 0.499) and PSC (k = 0.485) systems. Of the 167 samples, 17 samples were benign lesions: 7 pulmonary hamartomas, 5 sclerosing pneumocytomas, 2 squamous papillomas, one solitary fibrous tumor, one meningioma, and one lymphocytic proliferation. There were diverse sample types as follows: 11 touch smears, 3 brushing smears, 2 aspirations, and one sputum sample. Fourteen samples (82.3%) were categorized into “negative” or “atypical” by more than half of the observers in the JLCS-JSCC system. Conversely, 3 samples were categorized as “suspicious” or “malignant” by more than half of the observers in the JLCS-JSCC system. On the other hand, 11 samples (64.7%) were categorized into the N-B-LG category by more than half of the observers in the PSC system. Conclusions: The concordance rate in the JLCS-JSCC system was slightly higher than that in the PSC system; however, the interobserver agreement was moderate in both the JLCS-JSCC and PSC systems. These results indicate that both the JLCS-JSCC and PSC systems are clinically useful. Therefore, both systems are expected to have clinical applications. It may be important to integrate the 2 systems and construct a universal system that can be used more widely in clinical practice