Determination of probability of causative pathogen in infectious keratitis using deep learning algorithm of slit-lamp images.

Corneal opacities are important causes of blindness, and their major etiology is infectious keratitis. Slit-lamp examinations are commonly used to determine the causative pathogen; however, their diagnostic accuracy is low even for experienced ophthalmologists. To characterize the "face" of an infected cornea, we have adapted a deep learning architecture used for facial recognition and applied it to determine a probability score for a specific pathogen causing keratitis. To record the diverse features and mitigate the uncertainty, batches of probability scores of 4 serial images taken from many angles or fluorescence staining were learned for score and decision level fusion using a gradient boosting decision tree. A total of 4306 slit-lamp images including 312 images obtained by internet publications on keratitis by bacteria, fungi, acanthamoeba, and herpes simplex virus (HSV) were studied. The created algorithm had a high overall accuracy of diagnosis, e.g., the accuracy/area under the curve for acanthamoeba was 97.9%/0.995, bacteria was 90.7%/0.963, fungi was 95.0%/0.975, and HSV was 92.3%/0.946, by group K-fold validation, and it was robust to even the low resolution web images. We suggest that our hybrid deep learning-based algorithm be used as a simple and accurate method for computer-assisted diagnosis of infectious keratitis.

[A case of recurrent liposarcoma treated with bevacizumab chemotherapy resulting in prolonged disease-free survival and long-term overall survival].

Retroperitoneal dedifferentiated liposarcoma is associated with a poor prognosis, and the efficacy of chemotherapy in such cases is controversial. We report a case of long -term survival in a patient with dedifferentiated liposarcoma treated with bevacizumab after repeated local recurrences. A 65-year-old man complained of abdominal pain. Abdominal computed tomography (CT) showed a well-enhanced retroperitoneal tumor. The tumor was resected together with the right kidney and adrenal gland. On the basis of histopathological findings, the tumor was diagnosed as a dedifferentiated liposarcoma adenocarcinoma. Eleven months later, local recurrence was diagnosed and the tumor was resected. Thereafter, repeated local recurrences were diagnosed, and repeated tumor resections were performed. Local recurrence and distant metastasis in the axilla and scapula soft tissue was detected 5.9 years after the initial operation. Bevacizumab therapy was initiated, and the tumor markedly reduced in size. Bevacizumab treatment has been continued for 6.7 years after the initial operation, with no tumor recurrence or metastasis.

[Vanishing glottis cyst following difficult intubation].

A 68-year-old male patient underwent laparoscopic cholecystectomy under general anesthesia. Following anesthesia induction and muscle relaxation, laryngoscopy using Macintosh laryngoscope found a tumor of thumb size above the glottis completely obscuring the vocal cords. There appeared to be a possibility of tumor impaction into the glottis leading to total obstruction when the tumor was pushed down by a tracheal tube. Consent was obtained for emergency tracheostomy if necessary. The glottis and its surrounding were thoroughly observed using a fiberscope via the Fastrach laryngeal mask. The tumor appeared to be a soft cyst. A fiberoptic bronchoscope, tentatively introduced into the gap between the cyst and the epiglottis, went unexpectedly and smoothly into the trachea. A tracheal tube was introduced railroading over it. Information collected so far suggested that the patient was able to breathe without tracheal tube. As expected the patient did not show any difficulty in breathing and phonation following extubation. Seven days afterward, E.N.T. surgeon found no evidence of scarring or healing in the throat. The cyst might have been ruptured at the time of extubation or afterward, or absorbed.

A long-term survivor after pancreaticoduodenectomy for metastatic undifferentiated carcinoma of an unknown primary.

Undifferentiated carcinoma of unknown primary (CUP) is a relatively rare disease and carries a dismal prognosis. With this context, there is no report of a long-term (> 5-year) disease-free survivor after a pancreaticoduodenectomy (PD). A 53-year-old female had complaints of intermittent high fever and a large palpable epigastric tumor. A CT scan revealed that a very large well-circumscribed solid mass occupied the posterior portion of the head of the pancreas and extended to the hepatic hilum. The serum carcinoembryonic antigen (CEA), CA-125 and carbohydrate antigen 19-9 (CA19-9) levels were within the normal ranges. A PD with hepatic arterial reconstruction was performed. Histologically, the tumor showed solid or diffuse proliferation of pleomorphic cells, and the immunohistochemistry suggested a metastatic tumor originating from the epithelium, the primary site was not determined despite of full review of all metastatic lesions to pancreas handled surgically and non-surgically. Adjuvant oral chemotherapy of UFT and cimetidine continued for 3 years and the patient alive and healthy 6 years after surgery. Even for dismal prognostic undifferentiated CUP, radical surgery would be an effective component of multidisciplinary treatment, provided that the tumor is respectable without elevation of serum tumor markers and adjuvant chemotherapy is able to appropriately supplement.

A long-term survivor of repeated inguinal nodes recurrence of papillary serous adenocarcinoma of CUP: case report.

BACKGROUND: Tumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis. CASE PRESENTATION: A 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125 (cancer antigen 125). She underwent complete resection of the right inguinal tumor and multiple pelvic tumors, which involved the rectum, ovary and uterus. Pathological examination revealed the tumors to be metastases of a papillary serous adenocarcinoma with a psammoma body of CUP. On the 28th postoperative day, newly developed asymptomatic small left inguinal node metastases in the setting of a normal CA125 level were removed. Four and a half years after the primary resection, the CA125 level increased again and newly developed asymptomatic metastases were found in the right deep inguinal nodes and extirpated at that time. All surgical resections followed the modified FAM (5FU, Adriamycin; ADM, MMC) regimen, including protracted dairy oral administration of UFT or 5'-FDUR, Cimetidine and PSK (protein-bound polysaccharide K) as an immunomodulator or biological response modifier in conjunction with intermittent one-day continuous infusion (ADM+MMC) or intermittent single bolus injection of ADM+MMC. At present, the patient has been living in good health for almost 7 years with no evidence of relapse. CONCLUSION: Aggressive resection surgery followed by effective adjuvant chemotherapy is necessary for surviving long time without relapse of poorly prognostic patients with metastases outside of the abdominal cavity from peritoneal papillary serous adenocarcinomas.

[A successful combination therapy with resection and infusion chemotherapy for a patient with metastases from cancer of unknown origin].

A 71-year-old female was admitted to our hospital because of a right inguinal mass in June 1999. She was diagnosed as having cancer of unknown origin with metastases of the right inguinal and pelvic space. These tumors were resected in July 1999, followed by resection of early postoperative relapse in the left inguinal nodes. Histopathological examination revealed that surgical specimens were metastases of bilateral inguinal nodes and pelvic peritoneum from adenocarcinoma of unknown origin. She received adjuvanting combination chemotherapy consisting of continuous oral administration of fluoropyrimidin derivatives and intermittent 24-hour continuous infusion of adriamycin plus mitomycin C for 2 years after resection. No significant adverse effects encountered in any treatment course. She is living healthily 42 months after surgery with no evidence of recurrence. Complete resection in combination with appropriate adjuvant chemotherapy was effective for cancer of unknown origin that had a poor prognosis.

A salvage treatment for solid liver metastasis after radical resection of Klatskin tumour.

BACKGROUND: Long-term survival has not been described following surgical resection for liver metastasis after radical resection of an advanced hilar bile duct carcinoma (Klatskin tumour). One such patient who developed liver metastasis after radical treatment for stage IVA (pTNM) hilar cholangiocarcinoma has survived 5.5 years after resection of the liver metastasis followed by chemotherapy. CASE REPORT: A 50-year-old man developed a solid liver metastasis in segment VIII 17 months after radical resection of a stage IVA (pT3 pN I MO) Klatskin tumour followed by postoperative radiotherapy (54 Gy) and systemic chemotherapy (oral UFT 450 mg/day plus intravenous cisplatin 20 mg on 5 consecutive days each month). The patient is alive at 7 years after the primary resection followed by resection of the liver metastasis plus further systemic chemotherapy comprising oral UFT combined with intravenous adriamycin (ADM) and mitomycin C (MMC). CONCLUSION: Aggressive salvage resection surgery can be an effective component of a multidisciplinary treatment regimen, even for a postoperative liver metastasis that developed after radical resection of an advanced Klatskin tumour, provided that the metastasis is solid and has not failed local-regional control.