[The Study of a Relaxed Patient Position in Whole Lower Limb Radiography].

PURPOSE: In whole lower limb radiography, a position of the patella is the center of the knee with a leg slight internal rotation (a knee frontal position). However, we revised the positioning to stand naturally so that we can evaluate the lower limb alignment while standing more naturally (a relaxed patient position). In this study, we compared a lower limb alignment of a relaxed patient position and a knee frontal position. METHODS: The images of 84 patients who underwent artificial joint replacement surgery were analyzed, separately for the group with artificial joint and without it. The Mikulicz line (the functional axis of the lower limb connecting the center of the femoral bone and the ankle joint) is drawn on the image of the whole lower limb radiography. The intersection between the proximal tibia joint surface and the Mikulicz line defines the percentage of mechanical axis (%MA). Furthermore, we compared the %MA between a relaxed patient position and a knee frontal position and assessed them by the Bland-Altman analysis. RESULTS: The correlation coefficient (R) was 0.792 in the group with artificial joint and 0.856 in the group without artificial joint. There was a fixed error between the relaxed patient position and the knee frontal position. CONCLUSION: The %MA tends to be smaller in a relaxed patient position than in a knee frontal position. Besides, it is found that there is a correlation between them.

An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level.

There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

[A case of effective response to TS-1 of inoperable gastric cancer, in the course of chemotherapy for malignant lymphoma].

We encountered a case of effective response to TS-1 of inoperable gastric cancer, in the course of chemotherapy for malignant lymphoma. A 78-year-old man, in the course of chemotherapy for malignant lymphoma, complained of appetite loss. A biopsy from gastric endoscopy indicated gastric carcinoma. This was diagnosed as inoperable gastric cancer, and gastro-jejunostomy was performed. After administration of TS-1 orally for 4 courses, it was observed to be effective with no severe adverse events.

Paraneoplastic hypercalcemia with adenosquamous carcinoma of the colon.

Hypercalcemia is a well-known manifestation of paraneoplastic syndromes associated with a variety of malignancies. However, colon cancer has only rarely been associated with hypercalcemia. Here we present the first case of adenosquamous carcinoma of the sigmoid colon in a patient who was found to have hypercalcemia associated with parathyroid hormone-related protein (PTHrP), with no radiological evidence of metastasis to other organs. A 78-year-old woman was admitted to our hospital complaining of lower abdominal pain. Physical examination and computed tomography revealed a tumor, 13 cm in diameter, in the sigmoid colon. Laboratory data showed an elevated serum calcium level (11.2 mg/dl). Primary colostomy was performed. After the primary operation, the patient was found to have hypercalcemia and an elevated PTHrP level. We performed sigmoidectomy, total hysterectomy, and partial urinary bladder resection 1 month after the primary operation, and both PTHrP and calcium levels immediately returned to normal. The histopathologic diagnosis was poorly differentiated adenosquamous carcinoma. The patient died due to tumor recurrence 4 months after the second surgery.