Pulmonary zygomycosis with Cunninghamella bertholletiae in a killer whale (Orcinus orca)

An adult female killer whale (Orcinus orca) was transported to the Port of Nagoya public aquarium in June 2010. While the animal was being maintained in the aquarium there was a gradual decrease in body weight. On October 1st, 2010 the whale exhibited signs of gastrointestinal disease and died on January 14th, 2011. At necropsy examination the gastric compartments were filled with a large number of variably-sized rocks (total weight 81.4 kg) and there was marked ulceration in the third compartment. There were multifocal tubercle-like nodules within the lungs and on sectioning there were numerous abscesses and pulmonary cavities. Microscopically, there was severe suppurative pneumonia associated with fungal hyphae that were infrequently septate and often branched. Numerous bacterial colonies were also present. The hyphae demonstrated immunohistochemical cross-reactivity with Rhizomucor spp. and Cunninghamella bertholletiae was cultured. Bacteriological culture revealed the presence of Proteus mirabilis, Pseudomonas aeruginosa and Pseudomonas oryzihabitans. This case represents the first documentation of zygomycosis associated with C. bertholletiae in a marine mammal.

Peritoneal tuberculosis with gastric cancer: a case report

This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.

[Frequent chemolipiodolization and prostaglandin E1 administration for hepatocellular carcinoma with advanced liver cirrhosis]

"Frequent Chemolipiodolization & Prostaglandin E1 administration Therapy (FCPT)" which performed frequent chemolipiodolization to Hepatocellular carcinoma (HCC) and Prostaglandin E1 (PGE1) intra-hepatic arterial administration for avoiding serious liver damage by using reservoir was carried out for 7HCC cases with severe liver cirrhosis. Chemolipiodolization was performed every 4 weeks to 6 cases. PGE1 was given to all cases with 10 or 20 micrograms/4 hours every week after 7 days administration. In 6 cases that carried out Chemolipiodolization, FCPT demonstrated complete response in a case and partial response in 3 cases. Two other cases showed the progression of HCC in spite of the frequent chemolipiodolization. The serum hepaplastin levels were stable or improved in 5 cases. Improvement of the serum total protein levels was seen in the long survival cases. The general malaise of all cases was disappeared after FCPT. In 5 cases who had ascites before FCPT, the ascites was gradually decreased. We concluded that the FCPT was useful to treat HCC with advanced liver cirrhosis, and also the intra-hepatic arterial administration of PGE1 might have the possibility that is contributing to the liver function improvement of a liver cirrhosis.

Rectal expander-assisted transanal endoscopic microsurgery in rectal tumors

Rectal expander-assisted transanal endoscopic microsurgery (RE-TEM) was performed for two cases of early rectal cancer and a case of villous tumor under saddle block anesthesia. RE-TEM is the new technique for local excision of rectal tumors with a rectal expander that we developed. The rectal expander expands the rectum after insertion through the anus and provides adequate vision for microsurgery with standard video monitors. Tumors were located 8, 8, and 5 cm from the anal verge, and all of them were excised completely with no difficulty. Minor bleeding was noted in all cases and was controlled by electric coagulation and/or sutures. Average operative time for the three cases was 105 min. We conclude that RE-TEM is useful for rectal tumors and/or early rectal cancer that cannot be removed by endoscopy.

[Japan Surgical Society recertification: the viewpoint of surgeons in a local area]

The system of recertification is evaluated from the view point of the surgeons in a local area. The system only requires attendance at the national meeting of the Japan Surgical Society and/or meetings that are designated by the Japan Surgical Society for recertification. Half of such meetings have been held in the Kanto area over the past 10 years, resulting in an imbalance in the status of recertification between surgeons in the Kanto area and in local areas. In questionnaires about surgical recertification in local areas, many respondents pointed out this imbalance and the necessity for changing the conditions of recertification. The aim of recertification must be clarified and a new system of recertification investigated based upon the purpose of certification without imbalances between areas.

Chemolipiodolization and prostaglandin E1 administration with use of hepatic arterial infusion port for the treatment of hepatocellular carcinoma and liver cirrhosis

Frequent chemolipiodolization and prostaglandin E1 (PGE1) administered through a hepatic arterial infusion port were used for treatment in 2 cases of hepatocellular carcinoma (HCC) with liver cirrhosis. Chemolipiodolization was performed every 4 weeks with 6 ml lipiodol, 3 ml Optilay and 30 mg Epirubicin or 10 mg Mytomycin C. PGE1 (10 ug) was administrated to the hepatic artery once every week after the first 7 days administration. The treatment resulted in a decrease of the AFP level, an arrest of HCC growth and a reduction in ascites with an improvement of clinical and biochemical parameters in both cases. These encouraging preliminary results show that frequent lipiodolization is effective for unresectable HCC and frequent PGE1 administration via the hepatic artery is a safe and efficient treatment for liver cirrhosis.

[The Quick Return Service of electroencephalogram]

Because electroencephalography (EEG) examinations take time and numerous channels are used, they generate an enormous volume of data. Vast amounts of space would be required to store the data on shelves and in storage rooms, and a great deal of time and labor would be needed to retrieve the data and use it again. We developed an EEG optical disk filing system to solve such problems. With this system display terminals are set up in the various outpatient departments which often request EEG examinations, i.e., the neurology department, psychiatry department, and pediatric department, making it possible to search and display EEG waveforms, the content of EEG reports, etc., stored on the optical disks at any time. Using such functions patients can be examined without having to send for charts and EEG paper-output waveforms, which is troublesome and time-consuming, and contributes to shortening examination time.

Endoscopic findings and clinical manifestation of gastric anisakiasis

OBJECTIVES

To identify the endoscopic findings and clinical manifestations of anisakiasis, we studied 87 cases of gastric anisakiasis.

METHODS

Patient information was analyzed by means of patient records. The interval between the day of intake of Anisakis and endoscopic examination was determined in 86 cases. Then the endoscopic findings of each interval were elucidated.

RESULTS

Moderate to severe gastric mucosal edema tends to occur within 1 or 2 days after Anisakis infection, accompanied by leukocytosis. As to the sites of penetration of Anisakis, 55% of cases were found in the greater curvature with severe mucosal edema. Among 87 cases, four patients experienced anisakiasis twice during the interval examined, and six patients had past histories of anisakiasis before the investigated interval.

CONCLUSIONS

Gastric anisakiasis may be caused by an allergic reaction to the Anisakis antigen. There is a classic relationship between clinical and endoscopic findings and the interval after Anisakis administration. Anisakis usually is found in the greater curvature.

Percutaneous transhepatic portacaval shunt for high-risk esophageal varices

Percutaneous transhepatic portacaval shunt (PTPS) was performed in a patient with high-risk esophageal varices prior to sclerotherapy. PTPS was accomplished with the aid of two catheters. The first catheter was placed in the right hepatic vein under ultrasonographic guidance, and the second was placed in the portal vein. The two catheters were then connected together. The color of the esophageal varices changed from blue to white, and serum protein levels were increased 8 weeks after PTPS. Sclerotherapy was then performed without any difficulty. PTPS is the easy and quick method of performing a portacaval shunt and may have importance for the management of patients with high-risk esophageal varices prior to the treatment of sclerotherapy or liver transplantation.

A small pedunculated adenomatous polyp of the colon found to contain the focus of invasive carcinoma extending to the serosa: report of a case

A small pedunculated polyp was detected among other polyps in the transverse colon of a 64-year-old man, the resected specimen of which showed an adenomatous polyp 1 cm in diameter, containing the foci of adenocarcinoma invading the submucosa, muscularis, and serosa. This case report stresses the importance of performing careful pathologic examination of resected specimens obtained from endoscopic polypectomy, even for small pedunculated colon polyps.

[Host factors which influence the outcome of pneumonia in the elderly]

We examined 135 elderly patients with pneumonia to clarify the factors predicting on the outcomes of the elderly pneumonic patients. In the fatal cases respiratory symptoms such as cough and sputum, except for dyspnea were less frequent but pulmonary infiltrations on chest roentgenograms were more massive as compared with those in the survived cases. Thus, it was suggested that in the fatal cases the more advanced pneumonia had developed at the time when the diagnosis of pneumonia was made. The fatal cases showed hypoalbuminemia, hypocholesterolemia and hyponatlemia more frequently as compared with survived cases. Among these laboratory values, the decreased serum albumin concentration seemed to be most closely correlated with the fatal outcome of the elderly pneumonic patients. There were significant differences in the outcomes among three groups of the patients, those who were the prolonged bed-ridden, those with severe underlying diseases such as cancer and those treated as out-patients. The out patients showed the most favorable outcome and the prolonged bed-ridden patients the worst outcome. Approximately, 39% of the fatal cases were complicated with multiple organ failure. These results suggest that more important factors which affect the outcomes of pneumonia in the elderly may be not merely aging but the conditions of the host at onset of the disease.