An artifice in the insertion of the Hickman catheter in small children

Although the Hickman catheter is commonly used in pediatric patients, it is difficult to place this catheter safely in small children, especially infants. A multiple-step method, starting with a thinner catheter, makes the placement easier and safer.Keywords: central venous catheter, children, Hickman cathete

Favorable Outcome of Repeated Salvage Surgeries for Rare Metastasis to the Ligamentum Teres Hepatis and the Upper Abdominal Wall in a Stage IV Gastric Cancer Patient

Gastric cancer with peritoneal metastases is typically a devastating diagnosis. Ligamentum teres hepatis (LTH) metastasis is an extremely rare presentation with only four known cases. Herein, we report salvage surgery of successive metastases to the abdominal wall and LTH in a patient originally presenting with advanced gastric cancer with peritoneal metastasis, leading to long-term survival. A 72-year-old man with advanced gastric cancer underwent curative-intent distal gastrectomy with D2 lymph node dissection for gastric outlet obstruction. During this procedure, three small peritoneal metastases were detected in the lesser omentum, the small mesentery, and the mesocolon; however, intraoperative abdominal lavage cytology was negative. We added cytoreductive surgery for peritoneal metastasis. The pathological diagnosis of the gastric cancer was tubular adenocarcinoma with pT4aN1pM1(PER/P1b)CY0 stage IV (Japanese classification of gastric carcinoma/JCGC 15th), or T4N1M1b stage IV (UICC 7th). Post-operative adjuvant chemotherapy with S-1 (TS-1)+cisplatin (CDDP) was administered for 8 months followed by S-1 monotherapy for 4 months. At 28 months after the initial surgery, a follow-up computed tomography (CT) detected a small mass beneath the upper abdominal wall. The ass showed mild avidity on 18F-fluorodeoxyglucose positron-emission (FDG-PET) CT. Salvage resection was performed for diagnosis and treatment, and pathological findings were consistent with primary gastric cancer metastasis. At 49 months after the initial gastrectomy, a new lesion was detected in the LTH with a similar level of avidity on FDG-PET CT as the abdominal wall metastatic lesion. We performed a second salvage surgery for the LTH tumor, which also showed pathology of gastric cancer metastasis. There has been no recurrence up to 1 year after the LTH surgery. With multidisciplinary treatment the patient has survived almost 5 years after the initial gastrectomy. Curative-intent gastrectomy with cytoreductive surgery followed by adjuvant chemotherapy for advanced gastric cancer with localized peritoneal metastasis might have had a survival benefit in our patient. Successive salvage surgeries for oligometastatic lesions in the abdominal wall and the LTH also yielded favorable outcomes

多量の疫病菌遊走子のうを得るための紙蓋平面培養法(農学部門)

Phytophthora capsici Leon.の遊走子のうを多量に形成させるための培養法を開拓した。培地としてはキュウリ, ダイコン, タマネギ, ナス, ニンジン, および, キャベツの食用部分のジュースのうちで, キュウリが最もすぐれていた。このジュースは果実をミキサーで粉砕後4枚のガーゼで滬過した程度がよく, 混在する組織断片や細胞顆粒の中に旺盛な遊走子型発芽能力をもった遊走子のうの形成に有効な物質が含れている。このジュースは原液のままより, むしろ, 2倍程度に稀釈したほうが遊走子のうの形成には適している。この培地に菌体を植込み, 28℃で2週間, 前培養したのち, 形成された菌そうを取出して, 滅菌した脱イオン水でよく洗い, 表を上にして, 湿った滬紙を敷いたペトリ皿に移し, 障子紙を張った木枠のふたをかぶせて, 28℃螢火灯照明付定温器内に並べておくと, 24-28時間の後培養で, 菌そうの上面に多量の遊走子のうが形成されるので, これをかき取って供試することになる。Paper lid method for the cultural formation of abundant zoosporangia of Phytophthora capsici Leon. was described on this paper. The juice medium of cucumber was most favorable for obtaining numerous zoosporangia among that of seven vegetable plants, i.e. cucumber, radish, onion, eggplant, carrot, cabbage and V-8 juice (Campbell Soup Co.). Cucumber fruits were homogenized by an electric mixer, and filtered through four sheets of gause. The filtrate contained fine tissue debris and cellular particles, which were indespensable as active factors for production of zoosporangia released vigorously swimming zoospores. The cucumber juice medium was produced by adding same volume of deionized water to the filtrate. Thirty ml of the medium in each of 200ml Erlenmyer flask was sterilized by autoclaving at 121℃ for 15min. Many times of sterilization by autoclaving were unfavorable for mycerial growth and zoosporangium formation. This medium was inoculated with a 5mm diam disk of mycerium grown on PDA plane ager in Petri dish at 28℃ for 4 days. The inoculated medium was incubated at 28℃ for 2 weeks. The grown mycerial mat was removed from the flask, and rinsed with sterilized deionized water through a Buchner funnel with a sheet of 70mm diam filter paper (Toyo No. 2). The clean mycerial mat put on two sheets of 90mm diam wet filter paper in Petri dish which was covered with a special paper lid, instead of ordinary glass lid of Petri dish. The paper lid was a wooden hoop with 100mm diam, 13mm wide and 3mm thick, covered with Japanese paper on upper side. The lid keeps the surface of mycerial mat in moderately dry condition which was very effective for sporangium production by this fungus, and prevents it from being contaminated by another microorganisms. The Petri dish placed in a 28℃ incubator illuminated with fluoresent lamp. The illumination was about 50 ft-c at the surface of the Petri dish. Numerous zoosporangia were formed on the surface of mycerial mat after 24 hours. They were easily collected by a small spatula, or suspended in water by stirring with a short brush