A Case of Pneumatosis Cystoides Intestinalis Mimicking Intestinal Perforation

An 85-year-old man was referred to the Department of Gastroenterological and General Surgery after complaining of abdominal pain and distention. Abdominal computed tomography (CT) revealed intra-abdominal free air, mimicking perforated peritonitis, with air collection within the jejunum bowel wall. On the basis of these findings, we made a diagnosis of pneumatosis cystoides intestinalis (PCI) with intra-abdominal free air. The PCI signs had disappeared completely by Day 7 of hospitalization. The patient was discharged from hospital after 15 days. At the time of writing, the patient’s PCI has not reappeared. This case highlights the clinical importance of PCI, and that the lung window settings of abdominal CT are useful tools to enable an accurate diagnosis of PCI

A Case of Ischemic Ileal Obstruction Secondary to Seat Belt Trauma

We report a case of seat belt trauma with delayed ischemic ileal obstruction. A 62-year-old woman presented with symptoms and signs of bowel obstruction three weeks after an automobile traffic accident. A plain radiograph of the abdomen showed dilated small bowel loops with air fluid levels that were consistent with intestinal obstruction. Enhanced computed tomography clearly demonstrated a stenotic ileal loop with mural thickening that was associated with a mesenteric hematoma. Upper endoscopy revealed an ulcer of the ischemic ileal obstruction. The patient underwent resection of the stenotic ileal loop by single-incision laparoscopic surgery. The stenotic ileal loop was located 120 cm oral side from the terminal ileum. In gross finding, the wall of stenotic ileal loop was thickened and the adjacent mesentery was shortened with a hematoma. The mucosa of the ischemic ileal obstruction showed ulcerative changes. The abnormal ileal loop, which was 15 cm in length, was resected. Postoperative recovery was uneventful

Chemoradiotherapy for Squamous Cell Carcinoma of the Anal Canal: A Case Report

A 79-year-old woman presented to our hospital with frequent episodes of hematochezia. Colonoscopy revealed an apparent tumor with central ulceration, and analysis of biopsy specimens confirmed the presence of non-invasive squamous cell carcinoma of the anal canal. No distant metastases were identified on enhanced computed tomography (CT). The cancer was classified as stage II (T2N0M0), and chemoradiotherapy (CRT) was selected as the first-line treatment. A continuous intravenous infusion of 5-fluorouracil with daily cisplatin was planned on days 1 to 5 of a 4-week cycle. After the first course, the drug administration was discontinued because the patient experienced diarrhea as an adverse event, and treatment with daily oral titanium silicate-1 (TS-1) was initiated. In addition, a total of 65Gy of radiation was applied to the primary lesion, pelvis, and bilateral groin area. Four weeks after the completion of CRT, colonoscopy showed the disappearance of the tumor and analysis of biopsy specimens confirmed the absence of any viable cancer cells. CT showed no evidence of lymph node metastasis or distant metastases. At 10 months after the completion of CRT, the patient showed no recurrence and with complete response

A Case of Laparoscopic Ileocecal Resection for Intussusception Secondary to Cecal Cancer

An 83-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension. She had no medical or surgical history. Clinical examination revealed a right lower abdominal mass, abdominal distension, and decreased bowel sounds in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A Gastrografin enema showed a tumor shadow with an irregular defect caused by the intussusception in the transverse colon. The protruding tumor was also pushed back into the cecum by the enema pressure. Colonoscopy revealed a protruding mass at the leading edge of the intussusception in the ascending colon, and biopsy results of the cecal mass indicated an adenocarcinoma. The patient underwent laparoscopic ileocecal resection of the intussuscepted cecal cancer using reduced port surgery. The resected specimen contained a type 1 tumor measuring 40mm that was histopathologically diagnosed as cecal cancer. The patient remains asymptomatic 8 months after surgery

Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential to be non-inferior to higher doses in US patients: An international collaborative observational study

Maeda M., Humber D., Hida E., et al. (2024) Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential to be non-inferior to higher doses in US patients: An international collaborative observational study. PLoS ONE 19(3.0): e0299510. doi.org/10.1371/journal.pone.0299510.The Japanese national guidelines recommend significantly lower doses of carvedilol for heart failure with reduced ejection fraction (HFrEF) management than the US guidelines. Using real-world data, we determined whether initial and target doses of carvedilol in Japanese patients (JPNs) differ from those in US patients (USPs), especially in Asian Americans (ASA) and Caucasians (CA), and investigated differences in outcomes. We collected data from the electronic medical records, including demographics, carvedilol dosing, tolerability, cardiac functional indicators like EF, cardiovascular events including all-cause deaths, and laboratory values from the University of California, San Diego Health and Osaka University. JPNs had significantly lower doses (mg/day) of carvedilol initiation (66 USPs composed of 38 CAs and 28 ASAs, 17.1±16.2; 93 JPNs, 4.3±4.2, p<0.001) and one year after initiation (33.0±21.8; 11.2±6.5, p<0.001), and a significantly lower relative rate (RR) of dose discontinuation and reduction than USPs (RR: 0.406, 95% confidence interval (CI): 0.181–0.911, p<0.05). CAs showed the highest reduction rate (0.184), and ASAs had the highest discontinuation rate (0.107). A slight mean difference with narrow 95% CI ranges straddling zero was observed between the two regions in the change from the baseline of each cardiac functional indicator (LVEF, -0.68 [−5.49–4.12]; LVDd, −0.55 [−3.24–2.15]; LVDd index, −0.25 [−1.92–1.43]; LVDs, −0.03 [−3.84–3.90]; LVDs index, −0.04 [−2.38–2.30]; heart rate, 1.62 [−3.07–6.32]). The event-free survival showed no difference (p = 0.172) among the races. Conclusively, despite JPNs exhibiting markedly lower carvedilol doses, their dose effectiveness has the potential to be non-inferior to that in USPs. Dose de-escalation, not discontinuation, could be an option in some Asian and ASA HFrEF patients intolerable to high doses of carvedilol

A novel approach to prevent spinal cord ischemia: Inoue stent graft with a side branch of small caliber for the reconstruction of the artery of Adamkiewicz

ObjectivesParaplegia remains a serious complication after endovascular repair of thoracic aortic aneurysms, and it has been reported that paraplegia might be due to ischemia of the artery of Adamkiewicz. This study investigates the feasibility of an Inoue stent graft with a side branch of a small caliber for the reconstruction of the intercostal artery branching the artery of Adamkiewicz.MethodsBranched Inoue stent grafts were implanted into the thoracic aorta and 11th intercostal artery of 5 mongrel dogs. The side branch measured 3 × 5 mm and contained a bare-metal coronary stent for fixing to the intercostal arterial wall. Aortography and selective angiography of the 11th intercostal artery were performed before and immediately after implantation and after 1, 4, 8, and 12 weeks. The luminal diameter of the intercostal artery before implantation was 2.4 ± 0.3 mm.ResultsAll stent grafts were successfully deployed. The main body of the graft did not develop endoleak or migrate, and the side branch remained patent for 12 weeks. Angiography performed 1 week postoperatively revealed smooth flow with slight stenosis (4.2% ± 1.7%) along the side branches and the intercostal arteries in all dogs. Four weeks postoperatively, however, mild concentric stenosis (38% ± 16%) along the side branch was observed in 4 of the 5 dogs. The percent stenosis at 8 and 12 weeks was 38% ± 15% and 33% ± 11%, respectively; these values were not significantly different from the value at 4 postoperative weeks.ConclusionsA novel Inoue stent graft with a side branch of small caliber was successfully deployed into the canine thoracic aorta and intercostal artery; the side branch remained patent for 12 weeks. This novel technique may enable endovascular reconstruction of the Adamkiewicz artery