Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women: two cases with different clinical courses and surgical approaches and review of the literature

We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-year-old woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases

A case of polypoid endometriosis mimicking advanced ovarian carcinoma with rapid growth, invasion, and dissemination

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present.Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification

Struma ovarii with massive ascites mimicking ovarian carcinoma treated with conservative laparoscopic surgery: a case report

Struma ovarii is a rare taratoma that accounts for 0.5-1% of all ovarian tumors. It is sometimes difficult to differentiate struma ovarii from ovarian carcinoma. We encountered a case of struma ovarii that was suspected to be malignant due to the accumulation of massive ascites and an elevated CA125 level. It was successfully treated with laparoscopic surgery.A 37-year-old nulliparous woman consulted a local physician with a chief complaint of abdominal distention. Computed tomography (CT) of the abdomen revealed a pelvic tumor with a large amount of ascites. She was referred to our department. Contrast-enhanced magnetic resonance imaging (MRI) and CT showed bilateral ovarian tumors with multicystic and solid components. CA125 level was markedly elevated. Two cytological examinations of ascites showed no malignant cells. Preoperatively, malignancy was strongly suspected, but considering the possibility of a benign ovarian tumor, laparoscopic surgery was scheduled. During laparoscopic surgery, 4,850 mL of ascites were aspirated, and the left adnexa was removed. Intraoperative rapid pathology suggested struma ovarii with no evidence of malignancy. Postoperative pathology showed mature teratoma and struma ovarii.Although struma ovarii is benign in 90-95% of cases, there have been scattered case reports in which suspected malignancy led to unnecessary or excessive surgery. We propose that appropriate preoperative imaging and accurate intraoperative rapid pathology can prevent excessive surgery, conservative or laparoscopic excisions should be considered

Four cases of pseudomyxoma peritonei with ovarian tumors at our hospital

We describe four cases of pseudomyxoma peritonei (PMP) that were diagnosed and treated at our hospital.Case 1: A 26-year-old woman with a large multicystic ovarian tumor and massive ascites was diagnosed with PMP originating from a borderline mucinous ovarian tumor. She underwent fertility-preserving staging laparotomy and was treated with three courses of intraperitoneal chemotherapy. There has been no recurrence in the 15 years since her first operation. Case 2: A 72-year-old woman with a giant ovarian tumor and massive ascites was diagnosed with PMP originating from low-grade appendiceal mucinous neoplasm (LAMN). After laparotomy, the patient was managed conservatively because she did not want aggressive treatment. She has remained asymptomatic with a small amount of ascites for 3 years. Case 3: A 82-year-old woman with ovarian tumors, massive ascites, and suspected PMP underwent emergency laparotomy due to appendiceal perforation and pan-peritonitis. She was diagnosed with PMP originating from LAMN. She has remained asymptomatic with a small amount of ascites for 2 years. Case 4: A 42-year-old woman with multicystic ovarian tumors and massive ascites underwent laparotomy. She was diagnosed with PMP originating from LAMN. Since multidisciplinary treatment was indicated and desired, the patient was referred to a specialized facility where cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was performed. The patient has done well since the treatment.Although most cases of PMP originate from mucinous tumors of the appendix, female patients with PMP often present with ovarian tumors and are commonly referred to gynecology clinics. It is therefore important for gynecologists to be familiar with PMP and to be able to diagnose it accurately and select the most suitable management including multidisciplinary treatments

A Case of Pill-Induced Esophagitis With Mucosal Dissection

With the advance of gastrointestinal endoscopy, pill-induced esophagitis has been detected more frequently, but the association of mucosal dissection is rare. We reported a case of pill-induced esophagitis associated with mucosal dissection

Indentation-induced stress distribution and pressure effect on the resistivity of YSZ

International audienceIonic conductivities measured under GPa-order high pressure provide various information about ion hopping mechanisms such as the activation volume (ΔV). Traditionally, anvil cells have been used for high-pressure measurements. We previously reported a new method for high-pressure impedance measurements, up to a few GPa, employing an indentation-induced local stress field. In this method, both mechanical and electrical (Young's modulus and high pressure impedance) properties can be obtained simultaneously. However, in this method, high pressures are induced only around the tip of the indenter, and such stress distribution should be considered for the estimation of ΔV accurately. In the present study, employing a finite element method (FEM) calculation, the stress distribution around the tip of the indenter, and effects of such GPa-order high pressures on the O2− ion conduction of Y2O3-doped zirconia (YSZ) are shown

A case of congenital unilateral partial absence of fallopian tube

Congenital partial absence of a fallopian tube has rarely been reported in the literature. A 29-year-old nulligravida woman presented with a two-year history of infertility. Hysterosalpingography revealed an obstructed left fallopian tube with a normal uterine cavity and right fallopian tube. After several AIH treatments, diagnostic laparoscopy was performed, revealing segmental absence of the mid portion of the left fallopian tube. Only a 1-cm stump of the left fallopian tube remained, the majority of the isthmic portion was absent. A 3-cm distal ampullary portion with normal-appearing fimbria was attached to the left pelvic sidewall near the pelvic brim. No other abnormal findings were observed for the uterus, right fallopian tube, and ligaments surrounding the uterus. There are two possible etiologies of partial absence of the fallopian tube:congenital absence associated with developmental alterations of the Müllerian ducts or asymptomatic torsion followed by autoamputation and reabsorption

Practical Approaches to New Course of Study for Japanese Language Education by MEXT : Developing students' language competencies through collaborative learning.

本研究は, 学習者が自分のまわりの他者と出会いかかわり合うことをとおして, 自分自身の言葉の世界を広げ, 学びを探究していくことができるようにするための効果的な指導法を開発していくことを目的としている。他者とのかかわり合いをとおして, 自分の思いを表現し, 知識をもとにした的確な判断を行う学習を積み重ねることで, さまざまな場面で活躍していくための力を育み, 学びを実生活や社会の中に生かしていくことで他者とのよりよい関係を築いていくことにつながると考えた。そこで, 「言葉を学ぶ意欲の喚起」「多様な他者との出会い」「コミュニケーションを大事にした協同的な学び」「認識の広がりや深まりを実感させる場の設定」「表現を磨き合う場の設定」の5点に留意して単元構成を行った。その結果, 4年生では, 筆者の主張について, より深く考えさせ, 教材文の筆者の工夫を, 調べ学習の発表原稿やまとめ方の工夫に生かさせることができた。6年生では, 多くの他者の存在を意識して学習を進め, 本校の子どもたちに報道する事を意識し, 様々な視点からニュース番組を構成させることができた。今後も, 学習者を取り巻く環境を考慮し, 他者を意識した多様な実践を積み重ねていきたい