A case of carcinoma of the papilla of Vater in a young man after subtotal colectomy for familial adenomatous polyposis.

BACKGROUND: Carcinoma and adenoma of the duodenum, including the papilla of Vater, are problematic diseases in patients with familial adenomatous polyposis (FAP). CASE PRESENTATION: A 36-year-old man underwent a periodic medical examination for early colon cancer originating from FAP for which laparoscopic-assisted subtotal colectomy with a J-shaped ileal pouch-rectal anastomosis was performed 3 years earlier. A tumor was detected at the papilla of Vater along with elevation of total bilirubin and hepatobiliary enzymes. Although cytology did not determine the tumor to be an adenocarcinoma, we suspected adenocarcinoma due to its hypervascularity shown by contrast-enhanced computed tomography. Pylorus-preserving pancreaticoduodenectomy with modified Imanaga reconstruction and regional lymph node dissection (D2) was performed. The pathological study showed that the tumor was a papillary and moderately differentiated tubular adenocarcinoma. The patient is currently in good health without recurrence, weight loss, or severe diarrhea at 12 months after surgery. CONCLUSIONS: Awareness of biliary-pancreatic symptoms and periodic gastroduodenoscopy might contribute both to the early detection of duodenal or periampullary polyps and cancer and to the radical treatment of FAP. Modified Imanaga reconstruction has the potential to become one of the more effective procedures for providing good quality of life to FAP patients with duodenal or periampullary cancer.

Two cases of mastectomy after Paclitaxel + bevacizumab therapy for locally advanced breast cancer.

INTRODUCTION: Locally advanced breast cancer (LABC) deteriorates the quality of life (QOL) of the affected patients. Combination chemotherapy or extended chemotherapy is considered to help to shrink local lesions. CASE 1: A 71-year-old female with a history of tympanitis and cystitis with methicillin-resistant Staphylococcus aureus (MRSA) visited our hospital. There was a tumor of 7 cm in diameter in her right breast with skin ulceration. Paclitaxel + bevacizumab therapy was started, and after five cycles of therapy, a mastectomy with axillary dissection was performed. Chemotherapy with anthracycline was avoided for fear of activating the MRSA. After the operation, the patient's wound opened. However, it naturally epithelialized. CASE 2: A 41-year-old female visited our hospital due to a tumor of 8 cm in diameter in her right breast with skin ulceration. Four cycles of paclitaxel + bevacizumab therapy were started, and her tumor almost disappeared during the first cycle. Then, doxorubicin + cyclophosphamide therapy was performed for four cycles, and a mastectomy with axillary dissection was performed. Her postoperative course was good. DISCUSSION: Chemotherapy with bevacizumab or extended chemotherapy is generally not considered to contribute to a survival improvement. However, such therapy contributes in increasing the response to chemotherapy, and should be considered for patients with LABC to shrink the local lesions and improve the QOL.

Drying dissipative structures of nonionic surfactants in aqueous solution.

Macroscopic and microscopic dissipative structural patterns form in the course of drying a series of aqueous solutions of polyoxyethylenealkyl ethers. The shift from the single round hill with accumulated surfactant molecules to the broad ring patterns of the hill in a macroscopic scale occurs as the HLB (hydrophile-liophile balance) of the surfactant molecules increases. The patterns correlate intimately with the HLB values of the surfactants. Microscopic patterns of small blocks, starlike patterns, and branched strings are formed. The size and shape of the surfactant molecules themselves influence the drying patterns in part. The pattern area and the time to dryness have been discussed as a function of surfactant concentration and HLB of the surfactants. The convection flow of water accompanying the surfactant molecules, the change in the contact angles at the drying frontier between solution and substrate in the course of dryness, and interactions among the surfactants and substrate are important for the macroscopic pattern formation. Microscopic patterns are determined in part by the shape and size of the molecules, translational Brownian movement of the surfactant molecules, and the electrostatic and hydrophobic interactions between surfactants and/or between the surfactant and substrate in the course of solidification.