Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report.

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76-year-old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.

[Surgical Resection and Adjuvant Chemotherapy with FOLFOX6 for Primary Duodenal Adenocarcinoma and Nodal Metastasis Resulted in Complete Remission].

Primary duodenal adenocarcinoma is a rare disease, and cases with nodal metastases have a poor prognosis. A 46-year-old man complaining of bloody stool visited our hospital. Endoscopy, CT, and PET-CT showed adenocarcinoma in the 2nd portion of the duodenum. We performed radical resection (PpPD) and pathological findings showed T3N1M0 (Stage III). Chemotherapy consisting of FOLFOX6 was administered for 6 months after surgery. The patient was alive without recurrence 5 years later. This case suggests that adjuvant chemotherapy (FOLFOX regimen) following curative resection including lymph node removal is an effective treatment for cases with tumor involvement of the lymph nodes.

Successful treatment of a patient with an infected urachal remnant via single-incision laparoscopic surgery: Report of a case.

We report on a case of an infected urachal remnant successfully treated via a single-incisional laparoscopic technique. An 18-year-old woman was diagnosed with an infected urachal remnant. The center of the umbilicus was pulled and inverted from the skin, and the cephalic side of the urachus was dissected from the umbilicus. A single-incision laparoscopic technique employing ultrasonic coagulating shears was used to dissect the urachal remnant from the stump of the umbilicus to the caudal end. Single-incision laparoscopic excision of the urachal remnant can be used successfully as a minimally invasive technique with optimal cosmetic outcomes.

Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis.

A 72-year-old woman with a sigmoid colon cancer and a synchronous colorectal liver metastasis (CRLM), which involved the right hepatic vein (RHV) and the inferior vena cava (IVC), was referred to our hospital. The metastatic lesion was diagnosed as initially unresectable because of its invasion into the confluence of the RHV and IVC. After she had undergone laparoscopic sigmoidectomy for the original tumor, she consequently had 3 courses of modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus cetuximab. Computed tomography revealed a partial response, and the confluence of the RHV and IVC got free from cancer invasion. After 3 additional courses of mFOLFOX6 plus cetuximab, preoperative percutaneous transhepatic portal vein embolization (PTPE) was performed to secure the future remnant liver volume. Finally, a right hemihepatectomy was performed. The postoperative course was uneventful. The patient was discharged from the hospital on postoperative day 13. She had neither local recurrence nor distant metastasis 18 mo after the last surgical intervention. This multidisciplinary strategy, consisting of conversion chemotherapy using FOLFOX plus cetuximab and PTPE, could contribute in facilitating curative hepatic resection for initially unresectable CRLM.

[A case of an advanced gastric cancer patient on hemodialysis achieving long-term progression-free survival after CPT-11+CDDP therapy].

A 59-year-old male with chronic kidney disease was diagnosed as having advanced gastric cancer(cT2N1P0H1M0), and CPT-11+CDDP therapy was started for him simultaneously with hemodialysis(HD). Serum CDDP concentrations were measured in the 1st course, and free-platinum(f-Pt)showing the anti-tumor effect was found to be eliminated by HD. Serum f-Pt levels, however, re-elevated until 24 hours after HD completion. Serum concentrations measured in the 15th course showed that f-Pt levels became higher than those observed in the 1st course, suggesting that CDDP was not completely removed by HD. Medical treatment was continued until the liver metastases were judged to be a progression disease at completion of the 18th course. When CDDP was administered to patients on HD, it was necessary to pay attention to various CDDP serum concentrations, and to tailor the dose to a tolerable level in each patient. Such an individual therapy might enable CPT-11+CDDP therapy to be one of the medical treatments of choice for advanced gastric cancer patients on HD.

Fungal biodegradation of CCA-treated wood and removal of its metal components.

In the present study, 5 isolates of brown-rot fungi were used for fungal bioprocessing (FB) of chromated copper arsenate (CCA)-treated wood wastes: Antrodia vaillantii SEL8501, Fomitopsis palustris TYP0507 and TYP6137, and Crustoderma sp. KUC8065 and KUC8611. The isolates showed notable capacity for the degradation of treated wood and removal of CCA components via the American Wood Protection Association soil block test. Among them, Crustoderma sp. KUC8611 effectively decayed the treated wood, causing a mass loss of up to 60%. F. palustris caused extensive leaching of CrO(3) of up to 79% and As(2)O(5) of up to 87%, but only moderate leaching of CuO of up to 50%. This high capacity for removal of CrO(3) and As(2)O(5) showed a strong logarithmic relationship with the amount of oxalic acid produced in the decayed wood. The majority of metals removed from treated wood during the decay process were deposited in the soil and feeder strip. Further investigation will be required to establish the capability of selected fungi for FB of full-sized lumber treated with CCA.

[A case report of primary duodenal adenocarcinoma responding to chemotherapy with S-1 and irinotecan].

A 5 3-year-old woman was admitted to our hospital because of vomiting. CT scan and gastroduodenoscopy showed severe stenosis of the duodenal 3rd portion. There was no evidence of malignancy. We diagnosed a stricture due to a duodenal ulcer and laparotomy was performed. By means of biopsy of No.14d lymph node in the operation, adenocarcinoma of the duodenum was pointed out and we performed a pancreatoduodenectomy. Although adjuvant chemotherapy with S-1/paclitaxel (S-1 80 mg/body, po, day 1-14 and paclitaxel 120 mg/body iv day 1, 8)was administered after operation, the patient's serum CEA was elevated and metastic lymph nodes around the supra mesenteric artery were pointed out. The patient was started on combined chemotherapy with S-1/CPT-11(S-1 80 mg/body, po, day 1-14 and CPT-11 120 mg/body iv day 1), serum CEA levels returned to normal range, and marked reduction of lymph node size was observed on CT. The patient is still alive and free of disease three years after the operation. S-1/CPT-11 could therefore be a treatment option for patients with duodenal carcinoma.

[A case of synchronous multiple liver metastasis of sigmoid colon cancer with a pathological complete response to combination chemotherapy of 5-FU/LV and bevacizumab].

A 73-year-old man was referred to our hospital with sigmoid colon cancer in July 2009. CT and MRI showed synchronous multiple liver metastasis. After a sigmoid colon resection in August, he received convergent chemotherapy in combination with 5-fluorouracil(5-FU)/Leucovorin(LV)(RPMI regimen)and bevacizumab for liver metastasis. After two courses without any major adverse effects, liver metastasis remarkably reduced on CT and MRI examination. We thus performed a liver resection, and pathological examination revealed a complete response in liver. Combination chemotherapy of 5-FU/LV and bevacizumab can be expected to provide safe and effective treatment for liver metastasis of colon cancer.

[A case of liver metastases from rectal cancer showed a complete response by FOLFIRI and bevacizumab chemotherapy].

A 62-year-old man had undergone anterior resection of rectum for rectosigmoid colon cancer with liver metastases. Postoperatively, the FOLOFOX6 regimen was performed in three courses. Metastatic liver tumors showed progressive disease(PD) on CT scan. The treatment was then changed to the FOLFIRI regimen for three courses. Metastatic liver tumors showed a partial response(PR)on CT scan. After six courses of the FOLFIRI regimen, the patient was given seven courses of the FOLFIRI +BV regimen. Hepatic resection of S2, S3, S4 and S6 segment was performed. The histological effect of chemotherapy was complete response(CR).

Characteristics of a bioxalate chelating extraction process for removal of chromium, copper and arsenic from treated wood.

The disposal of wood waste treated with chromated copper arsenate (CCA) is a problem in many countries. We have proposed a novel chelating extraction technique for CCA-treated wood using bioxalate, a solution of oxalic acid containing sufficient sodium hydroxide to adjust the pH to 3.2, which is an effective way to obtain an extraction efficiency of 90% for chromium, copper, and arsenic. The purpose of the present study was to investigate the characteristics of bioxalate extraction of CCA-treated wood. Extractions of CCA-treated western hemlock chips with solutions of bioxalate, oxalic acid, and sodium hydroxide were carried out. The use of bioxalate was confirmed as the most effective extraction technique for chromium, copper and arsenic, with an efficiency of 90%. Extraction with simple oxalic acid was ineffective for copper (less than 40% extraction efficiency), but effective for chromium and arsenic, with 90% efficiency. Sodium hydroxide showed a similar tendency, being ineffective for chromium and copper (less than 20% extraction efficiency), but relatively effective for arsenic (around 70-80% efficiency). We also discovered an interesting phenomenon whereby the addition of sodium hydroxide to a simple oxalic acid solution during the oxalic acid extraction progress resulted in dramatically increased extraction efficiency for copper, chromium and arsenic, up to 90%. Although oxalic acid was ineffective for copper extraction, the addition of sodium hydroxide during the oxalic acid extraction process rendered it effective.

Characterization of a strong CCA-treated wood degrader, unknown Crustoderma species.

In this study, basidiomycete isolates that possessed a strong ability to degrade chromated copper arsenate (CCA)-treated wood were characterized. These fungal isolates, which were collected from CCA-treated pine log wastes, showed no recognizable morphological properties on culture media. Nucleotide sequence analysis of the large subunit rDNA of the isolates revealed that they were one species. Based on the high sequence similarity (>95%) and close phylogenetic relationship with several known species of Crustoderma, the fungal isolates characterized in this study were classified as a Crustoderma sp. In a wood degradation test, Crustoderma isolate KUC8611 produced a remarkably higher weight loss in CCA-treated Pinus radiata (68.7%), Pseudotsuga menziesii (39.7%), and Tsuga heterophylla (38.5%) wood than other evaluated basidiomycete species, including Crustoderma flavescens and Crustoderma corneum. In addition, extracellular enzymes for cellulose and protein degradation were detected when the isolates were cultured in chromogenic media, which supports the finding that isolate KUC8611 is a wood degrader. Furthermore, an in vitro test for metal tolerance revealed that isolate KUC8611 showed strong arsenic tolerance, but that it could not tolerate copper. Finally, isolate KUC8611 produced lower amounts of oxalic acid than copper-tolerant fungi such as Fomitopsis palustris and Antrodia vaillantii. To the best of our knowledge, this is the first study to report the degradation of CCA-treated wood by a Crustoderma species.

Feeding preference of Coptotermes formosanus (Isoptera: Rhinotermitidae) for gamma-irradiated wood impregnated with benzoylphenylurea compounds under laboratory conditions.

The feeding preference of Coptotermes formosanus Shiraki (Isoptera: Rhinotermitidae) for 200-kGy gamma-irradiated Cryptomeria japonica D. Don (Japanese cedar) sapwood impregnated with benzoylphenylurea compounds such as hexaflumuron and noviflumuron was examined by three laboratory tests. Although termites were not deterred from feeding on gamma-irradiated wood samples that had been impregnated with hexaflumuron or noviflumuron, termite mortality was significantly higher compared with solvent controls in the no-choice test. All live termites were transferred to paper disks immediately after the no-choice test to investigate changes in mortality with time, and this test also confirmed the effects of hexaflumuron and noviflumuron on worker termites, which showed a significant feeding preference for gamma-irradiated wood. Only the 1480 ppm noviflumuron-impregnated gamma-irradiated wood specimens showed significant differences in mortality in the two-choice test. These results suggest that gamma-irradiated C. japonica wood, which is locally abundant in Japan, may have potential as a bait substrate for benzoylphenylurea compounds.

Synergistic effect of heartwood extractives and quaternary ammonium compounds on termite resistance of treated wood.

This study evaluates the synergistic effect of wood extractives and quaternary ammonium compounds (QACs) on the resistance to termites of several treated wood species. Wood specimens from different natural durability classes were extracted with either hot water alone or hot water + ethanol/benzene. The extracted and unextracted wood specimens were treated with either didecyldimethylammonium tetrafluoroborate (DBF) or commercial didecyldimethylammonium chloride (DDAC) solutions and then exposed to subterranean termites, Coptotermes formosanus Shiraki, for 3 weeks under laboratory conditions. The results showed that extractives of the heartwood portions of the wood species contributed to increased resistance against termite attack in the presence of either DBF or DDAC wood preservatives. The synergistic effect of wood extractives and DBF was much clearer with Pseudotsuga menziesii (Mirbel) Franco and Tsuga heterophylla Sarg wood samples. Further studies are needed for a better understanding of the synergism between wood extractives and either DBF or DDAC using both the sapwood and heartwood portions of the same wood species.

A novel extractant for removal of hazardous metals from preservative-treated wood waste.

The purpose of this study was to develop a one-step metal extraction process that would effectively remove hazardous elements from wood powder or chips of western hemlock [Tsuga heterophylla (Raf.) Sarg.] treated with chromated copper arsenate (CCA) preservative. In addition, we tested this method for wood treated with other copper-based preservatives such as ammoniacal copper quaternary (ACQ) and copper, boron, and azole (CuAz). A bioxalate solution consisting of 0.125 M oxalic acid adjusted to pH 3.2 with sodium hydroxide was tested for its ability to extract chromium, copper, and arsenic from wood treated with CCA and copper from ACQ, CuAz, or a mixture of CCA-, ACQ-, and CuAz-treated wood in single step. The extraction proceeded efficiently with 6 h of treatment, and was insensitive to the differences in chemical characteristics, including solubility of individual elements. After 6 h of treatment, approximately 90% of chromium, copper, and arsenic were effectively removed from wood treated with CCA or a mixture of CCA, ACQ, and CuAz and 90% of copper from ACQ- and CuAz-treated wood. These results demonstrate that the solvent extraction technique using pH-adjusted bioxalate solution with sodium hydroxide is a promising method for pollution minimization by various types of wastes contaminated with heavy metals and arsenic.

Designing a purification process for chromium-, copper- and arsenic-contaminated wood.

The disposal of chromated copper arsenate (CCA)-treated wood is becoming a serious problem in many countries due to increasing levels of contamination by the hazardous elements, chromium, copper and arsenic. The present experiment was conducted as a preliminary step toward one-step solvent extraction of CCA-treated wood. Because chromium, copper and arsenic have different chemical characteristics, it is best to consider them separately prior to designing a one-step extraction process. As a basis, various two-step extraction processes were first designed and tested experimentally to determine feasibility. Among these combinations, the treatment combining oxalic acid as the 1st step and a sodium oxalate solution under acidic conditions (pH 3.2) as the 2nd step was found to be an effective way of extracting CCA elements from treated wood. Extraction efficiency reached 100% for arsenic and chromium and 95.8% for copper after a 3-h sodium oxalate treatment, following a 1-h pre-extraction process with oxalic acid. On the other hand, the same combination under alkaline conditions (pH 11.2) during the 2nd step was ineffective for copper removal, indicating that pH plays an important role in complexation with sodium oxalate solution. The present results suggest that the extraction of CCA elements using a combination of oxalic acid and acidic sodium oxalate solution is a promising basis for application to a one-step extraction method.

Intracellular cytokine patterns of peripheral blood T cells as a useful indicator of activeness of Crohn's disease.

Recently, the alteration of peripheral T cells has become a focus of attention in research on Crohn's disease (CD). To examine the characteristics of peripheral T cells in CD patients, we analyzed the expression of a memory T cell marker (CD45RO(Bright)CD3+) and the cytokine production by peripheral helper and cytotoxic T cells in patients with CD. With the use of monensin to prevent the secretion of cytokines under stimulation, we measured the count of intracellular cytokine-positive cells for production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-2, IL-4, IL-6, IL-10, and granulocyte-macrophage colony stimulating factor (GM-CSF) in the peripheral T cell population using flow-cytometry. The counts of lymphocytes, T cells, and helper T cells in patients with CD were significantly lower than in normal volunteers. Although no difference in the counts of lymphocytes, total T cells, helper and cytotoxic T cells was observed, the counts of intracellular cytokine producing helper T cells in IFN-gamma, TNF-alpha or GM-CSF were significantly higher in active cases than in quiescent cases. These results suggest that stable CD patients are immunosuppressive, and activation of some kinds of T-cells, especially Th1-associated cytokine producing T-cells, correlate with disease progression. Th1-associated cytokine analysis of peripheral T cells may be one of the useful markers to evaluate the activeness of Crohn's disease.

Removal of copper, chromium, and arsenic from CCA-treated wood onto chitin and chitosan.

Chitin and chitosan are naturally abundant biopolymers which are of interest to research concerning the sorption of metal ions since the amine and hydroxyl groups on their chemical structures act as chelation sites for metal ions. This study evaluates the removal of copper, chromium, and arsenic elements from chromated copper arsenate (CCA)-treated wood via biosorption by chitin and chitosan. Exposing CCA-treated sawdust to various amounts of chitin and chitosan for 1, 5, and 10 days enhanced removal of CCA components compared to remediation by deionized water only. Remediation with a solution containing 2.5 g chitin for 10 days removed 74% copper, 62% chromium, and 63% arsenic from treated sawdust. Remediation of treated sawdust samples using the same amount of chitosan as chitin resulted in 57% copper, 43% chromium, and 30% arsenic removal. The results suggest that chitin and chitosan have a potential to remove copper element from CCA-treated wood. Thus, these more abundant natural amino polysaccharides could be important in the remediation of waste wood treated with the newest formulations of organometallic copper compounds and other water-borne wood preservatives containing copper.

Two possible pathways for the release of arsenic during pyrolysis of chromated copper arsenate (CCA)-treated wood.

The behavior of arsenic during pyrolysis at temperatures between 135 and 500 degrees C has been widely studied. We examined the release of arsenic during the pyrolysis of chromated copper arsenate (CCA)-treated wood, and here we propose two models for the volatilization of arsenic: (a) a reacted arsenic compound, chromium arsenate, in CCA-treated wood was initially decomposed to arsenic pentoxide, which then appeared to be released at around 400-500 degrees C as a form of arsenic trioxide; and (b) an unreacted arsenic compound, arsenic pentoxide, in CCA-treated wood was released at much lower temperatures than reacted arsenic compound, as a form of arsenic trioxide. In order to restrain the release of arsenic during pyrolysis, it is possible to pyrolyze CCA-treated wood carefully at temperatures around 300-350 degrees C only if the wood contains little unreacted arsenic compound. Under these conditions, almost all toxic elements remain in the pyrolysis residue, and a weight reduction of the wood of approximately 50% can be obtained. On the other hand, the release of arsenic can be achieved easily using an unreacted arsenic compound under the same pyrolysis conditions. However, in the present study it was difficult to determine the accurate release point of arsenic in both cases due to the level of experimental uncertainty.

Effect of pyrolysis on solvent extractability of toxic metals from chromated copper arsenate (CCA)-treated wood.

Solvent extraction was conducted to investigate the behavior of toxic metals in chromated copper arsenate (CCA)-treated wood and its pyrolysis residue. Four kinds of solvents, along with sulfuric and phosphoric acid as mineral agents, and citric and oxalic acid as complexing agents, were used. The CCA elements from the wood treated without pyrolysis were easily extracted. However, only a small amount of CCA elements were extracted from the pyrolyzed residue, even under very low pH conditions. The toxic elements in the pyrolyzed wood showed high stabilization against the solvent extraction. Pyrolysis strongly immobilized the toxic elements in the residue. Therefore, pyrolysis is not suitable as a pretreatment.