[Long-Term Complete Response by S-1 Chemotherapy for Gastric Cancer with Para-Aortic Lymph Node Metastases]

We describe a 67-year-old man with long-term CR by S-1 chemotherapy for gastric cancer with para-aortic lymph node metastases after reduction surgery. The patient presented at our hospital with epigastric pain. He was diagnosed with gastric cancer with para-aortic lymph node metastases. We performed gastrectomy and D1 lymphadenectomy without any resection of the para-aortic lymph node metastases. We treated the patient with oral S-1 chemotherapy. The initial treatment schedule was 100mg/body/day, twice daily for 4weeks with 2weeks of rest. Grade 1 neutropenia developed at the end of the second course of treatment. The regimen was changed to 2 weeks of administration, with 1 week of rest. The para-aortic lymph node metastases immediately responded to the chemotherapy. Abdominal CT showed almost complete regression of the lymph node metastases 10 months postoperatively. The patient has received S-1 chemotherapy and remained in remission for more than 5 years 6 months.

Ultrasonographic Abdominal Screening of Atomic Bomb-Exposed Subjects

Abdominal ultrasonographic screening for cancer was performed in 6001 Hiroshima and Nagasaki A-bomb exposed and comparison subjects, all members of the Adult Health Study of the Radiation Effects Research Foundation, formerly the Atomic Bomb Casualty Commission. This study yielded 20 cancers, including 7 hepatocellular, 3 gastric, 3 renal and 2 urinary bladder cancers; one cancer each of the ovary, pancreas, colon and ureter; and one cancer metastatic to the liver, whose primary was unknown. Seventeen of these 20 subjects manifested no symptoms or signs of their disease. A variety of additional tumors, unproven and probably benign, including uterine myomata, and other abnormalities were also detected. Abdominal ultrasonographic screening greatly assisted in the detection of cancers, most of which neither the patients nor their physicians were aware. In this screened fixed population sample the cancer detection rate was 0.33%, exceeding any such rates previously reported in the medical literature.

[Case Report of a Splenic Abscess Due to Colon Cancer]

The patient was a 63-year-old man with a chief complaint of fever and abdominal pain. He was admitted with the diagnosis of splenic abscess on enhanced abdominal computed tomography. After improvement of general condition, we planned a colonoscopy. However, the symptoms were not relieved, so we decided to perform splenectomy. The operative findings included a bulky mass at the splenic flexure, which involved the spleen and the pancreatic tail. Therefore, partial colectomy, splenectomy, and distal pancreatectomy were performed. The pathological examination revealed that the splenic abscess had not developed as a direct extension of the colon cancer but the cancer spread to the splenic hilus. Surgical resection is the first choice in the therapy of splenic abscess developing from colon cancer.

[Cases of Obstructive Colon Cancer for Which Elective Surgery Was Performed after Colonic Stent Placement]

The present study investigated the short-term outcomes of 20 patients with obstructive colon cancer who underwent colonic stent placement as a bridge to surgery (BTS) during the 3-year period between April 2012 and March 2015. Subjects comprised 13 men and 7 women, with a mean age of 68.3 years. Placement and decompression were successfully achieved in all of the patients. Oral ingestion became possible from a mean of 2.7 days after placement. No serious complications associated with placement were encountered. Total colonoscopy was performed after placement in 17 patients (85%), and independent advanced cancer was seen in the proximal portion of the colon in 1 patient. Elective surgery was performed for all of the patients after placement. Excluding the 2 patients for whom preoperative chemotherapy or treatment of another disease was prioritized, the mean interval to surgery for the remaining 18 patients was 23.2 days. The operative procedure performed was laparoscopic surgery in 8 patients (40%). Although minor leakage (n=1) and abdominal wall abscess (n=1) were observed as postoperative complications, the patients generally had an uneventful course. Colonic stent placement for obstructive colon cancer is relatively easy and safe, and may be considered as an effective treatment method that enables favorable intestinal decompression preoperatively and one-stage resection.

Femtosecond mode-locked Nd(3+)-doped Ba(Zr,Mg,Ta)O(3) ceramic laser

We have demonstrated continuous wave (CW) laser operation and the first, to the best of our knowledge, sub-200 fs mode-locked laser operation of Nd(3+)-doped Ba(Zr,Mg,Ta)O(3) ceramic. Its disordered crystalline nature exhibits a broad gain bandwidth of 30 nm with a high-emission cross section. It also has higher thermal and mechanical properties than Nd:glass. In CW operation, a maximum output power of 1.5 W under 6.2 W of absorbed pump power was obtained. In mode-locked operation, a pulse duration of 196 fs with an average power of 60 mW was successfully achieved. The laser spectrum straddled both fluorescence peaks of A-site and B-site Nd(3+) ions.

[Stage IV Gastric Cancer Made Resectable Following a Chemotherapy Regimen That Included Trastuzumab-A Case Report]

A 70-year-old man was referred to our hospital after anemia was identified by his general practitioner. A detailed examination led to the diagnosis of unresectable StageIV gastric cancer with metastasis to the paraaortic lymph nodes. The cancer was HER2-positive; therefore, the patient was administered trastuzumab, capecitabine, and cisplatin combination therapy. A remarkable reduction in the size of the lymph nodes was observed. The reduction in the size of the metastatic foci was accompanied by enlargement of the primary tumor, which was considered an indication for surgery. He underwent total gastrectomy, and histopathology showed absence of cancerous cells in the resected lymph nodes, indicating a curative resection. In Japan, trastuzumab, capecitabine, and cisplatin combination therapy is currently recommended as the standard therapy for unresectable advanced/recurrent HER2-positive gastric cancer, and the findings of the present case suggest that it may also be useful as neoadjuvant chemotherapy.

[Study of S-1 and oxaliplatin(SOX) plus bevacizumab as first-line therapy in patients with unresectable colorectal cancer]

We examined the safety and efficacy of S-1 and oxaliplatin plus bevacizumab (SOX+BV)as first-line therapy for advanced/recurrent unresectable colorectal cancer. The subjects were 14 patients with colorectal cancer who received ≥3 courses of SOX+BV therapy in our department.The dosing regimen for 1 course was as follows: BV (7.5 mg/kg) and oxaliplatin (130 mg/m(2)) were administered via intravenous drip infusion on the first day of the course, and S-1 was orally administered twice a day for 2 weeks, repeated every 3 weeks. All patients completed the study treatment, and the median number of courses completed was 9 courses (range: 3-17 courses). In terms of anti-tumor efficacy, complete remission (CR) was observed in 1 patient (7.1%); partial remission (PR), in 9 patients (64.3%); stable disease (SD), in 3 patients (21.4%); and progressive disease (PD), in 1 patient (7.1%), with a response rate of 71.4% and a disease control rate of 92.9%. The median relapse-free survival based on baseline PD was 12 months, and the median relapse-free survival based on PD according to the Response Evaluation Criteria in Solid Tumors (RECIST) was 10 months.The most common adverse events observed included peripheral sensory neuropathy (100%), fatigue (68.3%), anorexia (57.1%), and leukopenia/neutropenia (35.7%); however, almost all adverse events were Grade≤2 and could be managed.The SOX+BV therapy demonstrated an antitumor efficacy similar to that observed with oxaliplatin, fluorouracil, and folinic acid (FOLFOX)+BV therapy without the use of a central venous port.Therefore, the SOX+BV therapy may be among the effective option as first-line therapy for advanced/recurrent colorectal cancer.

Relationship between midgut malrotation and anatomy of the hepatoduodenal ligament: a rare anatomical variation in a deceased donor

INTRODUCTION

Anatomical variations around the hepatoduodenal ligament greatly influence surgical procedures and the difficulty of operations. Here, we report the case of a deceased donor with midgut malrotation (MgM) and anatomical variation. We also present an anatomical comparison between MgM and normal cases.

CASE REPORT

The donor, a male in his 60s, was diagnosed with MgM based on preoperative computed tomography. Intraoperatively, the liver graft was harvested from the proper hepatic artery (PHA), but its length was too short for reconstruction. Therefore, the hepatic artery was reconstructed at both the left and right hepatic arteries.

METHODS

The length of the proper hepatic artery (l-PHA) and main trunk of the portal vein (l-PV) was compared between MgM and control groups (n = 9) using computed tomography. The ratio of PHA (r-PHA) and PV (r-PV), which was calculated as the l-PHA or l-PV divided by the patient's height, was also compared.

RESULTS

The r-PV was 1.3% in the MgM group and 1.6% in the control group (P = .09). The r-PHA was 0.23% in the MgM group and 0.92% in the control group (P < .01). Thus, the PHA was significantly shorter in the MgM group. Additionally, anatomical variations of the hepatic artery were confirmed in four cases.

CONCLUSION

Preoperative radiological evaluation is not always adequate for identifying anatomical abnormalities in deceased donors. MgM is a rare but important anomaly because of the possibility of associated anatomical variations of the hepatic artery.

Laparoscopic partial hepatectomy of focal nodular hyperplasia

Focal nodular hyperplasia is a benign liver lesion incidentally discovered with increasing frequency because of the proliferation of imaging studies. Radiographic characterization can diagnose this pathologic lesion and nonoperative therapy is the standard of care. However, surgical resection may be required for diagnostic reasons or symptomatic patients. Depending on the anatomic location of the lesion, biopsy and/or resection can be performed laparoscopically. We herein report the case of a 26-year-old Japanese woman with a hepatic tumor who required a medical examination. Her medical history was negative for alcohol abuse, oral contraceptive administration and trauma. Clinical examination showed no significant symptoms. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass located in the left lateral segment of the liver with a diameter of about 40 mm. It was difficult to diagnose the tumor definitively from these imaging studies, so we performed laparoscopic partial hepatectomy with successive firing of endoscopic staplers. The histopathological diagnosis was focal nodular hyperplasia. Surgical procedures and postoperative course were uneventful and the patient was discharged from the hospital on postoperative day 5.

[A case of advanced gastric cancer responding to S-1 therapy, leading to pathologically complete response]

Our patient was a 74-year-old man with abdominal pain. A gastrofiberscope revealed type 2 advanced gastric cancer. An abdominal computed tomography(CT)demonstrated liver and lymph node metastases. The No. 8a lymph node was 7 cm in diameter, and it invaded the head of the pancreas. Since a curative operation was deemed impossible, S-1 was administered orally for 28 consecutive days with a 14-day interval. After 2 courses of monotherapy, CT showed that metastatic lymph nodes were reduced and that liver metastases had mostly disappeared. After 8 courses, the primary lesion was scarred and the lymph node metastases were remarkably reduced. Therefore, we conducted distal gastrectomy and lymph node resection (D2). Histological findings revealed that there were no cancer cells in either the primary tumor or the lymph nodes, meaning that the resected lesions were Grade 3 in pathology. This rare case showed that S-1 monotherapy enabled curative surgery of unresectable gastric cancer with pathological CR.

Necrotizing fasciitis caused by a primary appendicocutaneous fistula

We report a case of necrotizing fasciitis in the loin of a 76-year old man with several coexisting or past health issues, including diabetes mellitus, hypertension, alcohol-related liver cirrhosis, gastrectomy for gastric cancer, subarachnoid hemorrhage, normal pressure hydrocephalus, and cerebral infarction. Incision of the necrotizing fasciitis was successful, but it revealed an appendicocutaneous fistula; thus, we performed appendectomy and fistulectomy. We think that the necrotizing fasciitis was caused by appendicitis perforation involving the retroperitoneum, inducing the formation of an appendicocutaneous fistula. Necrotizing fasciitis and appendicocutaneous fistulae are rare complications of appendicitis. Moreover, to our knowledge, this is the first report of fluoroscopic examination demonstrating that a primary appendicocutaneous fistula had caused necrotizing fasciitis. Our search of the literature found 12 cases of necrotizing fasciitis caused by preoperative appendicitis. We discuss the characteristics and findings of these cases.

Adenomyoma of the ileum leading to intussusception

Adenomyoma of the ileum is a rare condition. A 68-year-old Japanese man presented with nausea and distension of the abdomen. Enhanced computed tomography of his abdomen revealed wall thickening in the ileum and dilation of the proximal small intestine. Open laparotomy was performed to find the cause of the patient's small bowel obstruction, and a tumor was found in the ileum, which had resulted in intussusception. The tumor and 20 cm of the adjacent ileum were resected. The resected specimen displayed a macroscopic appearance suggestive of a submucosal tumor. Histopathological evaluation showed duct cell proliferation and bundles of smooth muscle cells from the mucosa to the serosa, leading to a diagnosis of adenomyoma. Immunohistochemical examination found that cytokeratin 7 and carbohydrate antigen 19-9 were expressed in the duct epithelia. We report a rare case of ileal adenomyoma leading to intussusception in an adult and present the immunohistochemical evaluation of the adenomyoma.