Mucinous adenocarcinoma associated with chronic anal fistula reconstructed by gracilis myocutaneous flaps

Mucinous adenocarcinoma associated with chronic anal fistula is extremely rare, and such tumors have often reached an advanced stage at the time of presentation. Here we report a case of mucinous adenocarcinoma associated with chronic anal fistula that involved repair with gracilis myocutaneous flaps and review other reported cases. A 67-year-old man with an approximate 30-year history of an anal fistula was referred to our hospital due to enlargement of the perianal induration accompanied by mucinous secretion and pain. Physical examination of the perianal region revealed an ulcerated and discharging lesion on the buttocks. Histologic examination of a biopsy specimen of the ulcerated lesion revealed mucinous adenocarcinoma. An abdominoperineal resection was performed with resection of the ischiorectal fossa, coccyx, part of the gluteus maximus, and the obturator internus. The extensive defect was repaired with bilateral gracilis myocutaneous flaps. The patient did not experience a decrease in the strength of hip adduction and survived for 58 months without recurrence until he died of pneumonia. The repair using myocutaneous flaps was considered to contribute to a physically active life without recurrence.

Ventricular energetics in Fontan circulation: evaluation with a theoretical model

BACKGROUND

Both pulmonary and systemic circulation must be maintained by a single pump in Fontan circulation. This unique property of Fontan circulation may be related to decreased exercise tolerance or increased instantaneous postoperative mortality rate, often observed in patients with this circulation. To better understand Fontan physiology, the present study theoretically investigated cardiac performance of Fontan circulation by using ventricular-vascular coupling framework analysis.

METHODS

End-systolic volume elastance (Ees), as a chamber contractile property, and effective arterial elastance (Ea), a lumped measure of ventricular afterload, were estimated both in normal left ventricular systemic circulation and in Fontan circulation.

RESULTS

End-systolic volume elastance was decreased and Ea was increased in Fontan circulation. Both ventricular external stroke work (SW) and mechanical efficiency (EFF) under Fontan circulation were lower compared with those under normal circulation. Furthermore, the Ees-Ea relationship in Fontan circulation predicted limited cardiac reserve in terms of SW and EFF. Such cardiac performance in Fontan circulation stemmed from increased impedance due to the additional connection of the pulmonary vascular bed to the systemic vasculature and from the lack of a compensatory increase in contractility for increased afterload.

CONCLUSIONS

Thus, it was inferred that Fontan circulation had intrinsic disadvantages and this may explain, in part, abnormal functional status and decline in survival following this procedure.

[Minute carcinoid tumor in the rectum with liver metastasis]

A 65-year-old woman was admitted to our hospital for evaluation of multiple liver tumors following endoscopic polypectomy for rectal polyp a year earlier. The polypectomy specimen was reexamined and showed inclusion of a carcinoid tumor 3 mm in diameter. The perirectal lymph node was palpated by digital examination on readmission. The patient died one mouth after readmission due to liver failure. Autopsy revealed metastatic carcinoid tumor in the liver and perirectal nodes.

[A new chemosensitivity test for cancer cells by measuring intracellular ATP content]

Several in vitro chemosensitivity tests have been developed to select effective anticancer agents for individual cases. However, none of them is used routinely because of the low evaluability or the time consuming nature. We developed a new practical method which is simple, rapid, and applicable to fresh human tumors. The principle of the method is to measure the ATP content of cancer cells by bioluminescence after drug exposure. A linear relationship was observed between either the number of cells or their viability and light intensity. Four established human stomach cancer cell lines and five colon cancer cell lines were examined for their chemosensitivity with a test plate having 96 wells. A clear dose-dependent response was seen with almost all drugs tested in this study, and each cell line showed an identical response to drugs. For the clinical application, cancer cells taken from three human solid tumors were tested. In all cases, the chemosensitivity was clearly evaluable. This simple, rapid and sensitive method can be a good indicator for the determination of anticancer agents in cancer chemotherapy.

A simple and rapid in vitro test for determining sensitivity of cancer cells to anticancer drugs

For practical utilization of chemosensitivity tests of malignant cells to anticancer drugs in clinical studies, we developed a new method which is simple, rapid, and applicable to fresh human tumors. The principle of the method is to measure the content of ATP of living cells by chemoluminescence, after drug exposure. A straight linear relationship was observed between the number of viable cells and the light intensity. This method seems to be a good indicator for the selection of anticancer drugs in cancer chemotherapy.

Well-differentiated adenoma at the anorectal junction

Twenty-six cases of patients having adenomatous polyps at the anorectal junction are presented. Most polyps in this region were well-differentiated, and atypical polyps were infrequently seen. Well-differentiated adenomatous polyps in the anorectal junction were larger in average size than ordinary colorectal polyps having the same grade of epithelial pseudostratification. The reason adenomatous polyps at the anorectal junction grow to large sizes with only a relatively rare occurrence of malignant degeneration is discussed in relation to their specific location. Some well-differentiated adenomas were considered to develop secondarily in the bases of hemorrhoids or in pre-existing fibrous polyp that were the end result of hemorrhoids.

Is rectal carcinoid argyrophilic? Application of Grimelius' silver nitrate stain in four cases

In four cases, small rectal carcinoids from patients who did not have accompanying significant clinical signs or metabolic disturbances were found to give a definite argyrophil reaction by double or triple impregnation of Grimelius' silver nitrate stain, but not by other silver methods for argyrophil or argentaffin granules, regardless of variations of cellular arrangement in ribbon-like, solid, and sclerosing patterns. The implication that the carcinoid tumor occurring in the rectum may constitute a group distinct from carcinoids arising from other sites is discussed.