A Case of Cornual Pregnancy after Ipsilateral Salpingectomy for Isthmic Pregnancy.

The patient was a 32-year-old woman, gravida three, para one with one prior cesarean section. She became pregnant spontaneously, but the pregnancy implanted in the isthmus of the right fallopian tube, and therefore, she underwent laparoscopic right salpingectomy. Eight months later, another spontaneous pregnancy occurred. the patient experienced abdominal pain and an ultrasound examination revealed a hematoma around the right cornual region. A wedge-shaped incision was made in the cornual pregnancy using monopolar cauterization, and the myometrium was sutured with a single nodule suture. We report a case of spontaneous cornual pregnancy after ipsilateral salpingectomy for an isthmic pregnancy.

Detection of Foreign Bodies in Soft Foods Employing Tactile Image Sensor.

In the inspection work involving foodstuffs in food factories, there are cases where people not only visually inspect foodstuffs, but must also physically touch foodstuffs with their hands to find foreign or undesirable objects mixed in the product. To contribute to the automation of the inspection process, this paper proposes a method for detecting foreign objects in food based on differences in hardness using a camera-based tactile image sensor. Because the foreign objects to be detected are often small, the tactile sensor requires a high spatial resolution. In addition, inspection work in food factories requires a sufficient inspection speed. The proposed cylindrical tactile image sensor meets these requirements because it can efficiently acquire high-resolution tactile images with a camera mounted inside while rolling the cylindrical sensor surface over the target object. By analyzing the images obtained from the tactile image sensor, we detected the presence of foreign objects and their locations. By using a reflective membrane-type sensor surface with high sensitivity, small and hard foreign bodies of sub-millimeter size mixed in with soft food were successfully detected. The effectiveness of the proposed method was confirmed through experiments to detect shell fragments left on the surface of raw shrimp and bones left in fish fillets.

Live birth by cesarean section after rupture of uterine cornua in simultaneous corneal and intrauterine pregnancies.

A patient became pregnant by in vitro fertilization and embryo transfer (IVF-ET). She had a history of laparoscopic bilateral salpingectomy and enucleation of a left ovarian tumor due to bilateral hydrosalpinx and left endometriotic cyst in primary infertility. She noticed abdominal pain and visited the nearby general hospital by ambulance (gestational age 6 weeks and 1 day). She was admitted to our department because of ascites. An abdominal hemorrhage due to a rupture of the residual corneal segment of the fallopian tube was suspected and emergency laparoscopic surgery was performed. Simultaneous internal and external pregnancy resulted in rupture of the right tubal corneal at the ectopic site of pregnancy. The baby in the uterus grew smoothly and was delivered by cesarean section. This is a report of a case in which live birth after rupture of uterine cornua in simultaneous corneal and intrauterine pregnancies. We searched the literature for similar cases and examined management methods.

Leptomeningeal metastasis of uterine cervical cancer 17 years after primary tumor treatment.

Leptomeningeal metastasis (LM) of uterine cervical cancer is extremely rare. A 54-year-old woman with uterine cervical cancer treated with surgery and radiotherapy developed LM manifesting as ptosis 17 years later. Although rare, LM should be considered in patients with a history of uterine cervical cancer presenting with cranial nerve symptoms.

[Efficacy of supportive care for albumin-bound paclitaxel(nab-paclitaxel)in 20 patients with metastatic breast cancer].

PURPOSE: The objective of this retrospective study was to evaluate the efficacy of albumin-bound paclitaxel(nab-paclitaxel) treatment and the required supportive care for severe adverse events. METHODS: A total of 20 patients with advanced or recurrent breast cancer received nab-paclitaxel every 3 weeks between February 1, 2011 and December 31, 2012. The treatment course was repeated for 6 cycles thereafter, until evidence of disease progression or unacceptable toxicity was noted. RESULTS: The median number of treatment cycles was 6.0(range 2-6), the median cumulative dose was 1,560(range 440- 1,560)mg/m / / 2, and the median delivered dose intensity was 82.3(range 65.0-86.7)mg/m2week. Primary chemotherapy was associated with higher response rates than second-line or subsequent chemotherapy(42.9% v 23.1%). The response rate was 26.7% for cases with taxane pretreatment. Adverse events included neutropenia in 15 cases(75%), of Grade 4 severity in 4 cases(20%), and febrile neutropenia after 1 cycle in 1 patient(5%). In addition, Grade 3 peripheral neuropathy was observed in 2 cases(10%)during the treatment period. CONCLUSION: Nab-paclitaxel therapy was efficacious as primary chemotherapy and was effective for patients pretreated with taxanes. To prevent severe adverse events, supportive care is important, primarily for febrile neutropenia and neuropathy.

[A case of recurrent breast cancer with multiple bone metastasis successfully treated with S-1 and zoledronic acid therapy].

For a case of recurrent breast cancer with multiple bone metastasis, an oral pyrimidine fluoride-based anti-cancer drug S -1, and zoledronic acid(a third-generation bisphosphonate formulation), were prescribed in experiments to test their efficacy. S-1 was prescribed orally at doses of 100 mg/day(twice)over a 4-week period with a cessation period of 2 weeks. Zoledronic acid was commenced with a strict administration of 4 mg every 4 weeks, taken intravenously. At the conclusion of the 1st S-1 course, the tumor markers began to improve to a certain extent with an improvement in the symptoms. Following the 16 courses, there was no abnormal accumulation detected by PET. Now, at the end of the 21st course, the treatment is being continued, and there has been no recurrence of inflammation or reoccurring growth detected. No adverse effects of more than Grade 1 occurred during the elapsed process. As a form of combined therapy, we can expect zoledronic acid to be a good anti-cancer drug because of its effectiveness and tolerability in treating recurring breast cancer.

GRP78 induced by estrogen plays a role in the chemosensitivity of endometrial cancer.

OBJECTIVE: Molecular chaperone 78 kDa glucose-regulated protein (GRP78) is a residential protein in the endoplasmic reticulum (ER) that is induced by an unfolded-protein response triggered under many kinds of stress against a cell. GRP78 is also known to act as an anti-apoptotic factor by protecting ER-stress-induced cell death. In this study, we examined the significance of GRP78 expression in endometrial cancer. METHODS: Tissue samples obtained from patients with a diagnosis of enodometrial cancer were subjected to immunohistochemistry and RT-PCR to determine protein and mRNA expression levels of GRP78 and estrogen receptor α. We used Western blot and RT-PCR to examine whether estrogen induced GRP78 expression in cancer cell lines. Western blots and MTT assays of GRP78 siRNA transfected Ishikawa and HHUA cells were used to demonstrate whether GRP78 is involved in chemoresistence. RESULTS: GRP78 was highly expressed in well and moderately differentiated endometrial carcinoma. Estrogen induced GRP78 expression, which was correlated with cell viability and resistance to paclitaxel and cisplatin. Western blot analysis indicated that active caspase-3 and the 85-kDa protein poly (ADP-ribose) polymerase (PARP) were increased by incubation with either paclitaxel or cisplatin, suggesting that the apoptotic pathway was involved in cancer-drug-induced cell death. CONCLUSIONS: These results may open up a novel therapeutic strategy for endometrial cancer: namely, the targeting of GRP78 to sensitize the tumor cell to chemotherapy.

A case of adult-onset Still's disease (AOSD)-like manifestations abruptly developing during confirmation of a diagnosis of metastatic papillary thyroid carcinoma.

A 68-year-old Japanese man was admitted to our hospital suffering from abrupt onset of high fever accompanied by arthralgia, myalgia, sore throat, macular eruption, and liver dysfunction. Six months before the onset of these manifestations, (18)F-fluoro-deoxy-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) had detected, unexpectedly, three calcified thyroid lesions without (18)F-FDG uptake. Two months before the onset of the present manifestations, ultrasonography-guided fine-needle aspiration had led to a diagnosis of papillary thyroid carcinoma (PTC). Soon after the occurrence of the rheumatic manifestations, a subsequent (18)F-FDG PET/CT scan showed not only the three thyroid lesions, the same as those in the previous scan, but also (18)F-FDG uptake in the thyroid lesion. A diagnosis of adult-onset Still's disease (AOSD)-like manifestations associated with PTC was made, and treatment with 40 mg/day of prednisolone (PSL) resolved the symptoms promptly. PSL was gradually tapered, without recurrence of the (AOSD)-like manifestations. Five months after the initiation of treatment with PSL, total thyroidectomy, followed by (131)I thyroid ablation treatment, was performed while the patient was on a PSL dose of 18 mg/day. Seven months after the thyroidectomy, the dose of PSL was tapered to 2 mg/day, and neither the AOSD-like manifestations nor the PTC relapsed. On confirming a diagnosis of AOSD, it may be necessary to consider the presence of an associated malignancy, including solid tumors such as PTC.

[A case of metastatic breast cancer resistant to anastrozole treatment responding to high-dose toremifene].

The patient was a 56-year-old female. At the age of 35 years, she had under gone left mastectomy and axillary lymph node dissection for breast cancer. After surgery, hormonal therapy was continued for 3 years. Then, no treatment was performed. In this study, single therapy with an AI agent was started to treatbilateral supraclavicular fossa/mediastinal lymphnode metastases. After 6 months, a partial response(PR)was achieved. However, progression of the disease(PD)was noted after 1 year. Thereafter,the regimen was switched to single high-dose(120mg/day)TOR therapy. CT revealed the disappearance of the bilateral supraclavicular fossa lymphnodes and a marked reduction of the other lymphnodes. Currently, the patient is being treated, with an interval of 10 months from the start of TOR therapy.

Total esophago-gastrectomy followed by composite reconstruction with retrosternal pedicled jejunum and antethoracic-free jejunal autograft: a case report.

The patient was a 72-year-old man. He received a detailed gastrointestinal examination because of severe anemia. Early multiple esophageal cancers (affecting 3 sites of the esophagus) and advanced gastric cancer were detected. The patient was scheduled to undergo surgical treatment (esophagectomy and total gastrectomy). This operation would be followed by reconstruction with a pedicled jejunum via the antethoracic route. During the operation, however, the mesentery was found to be thick and short, and the anteroposterior dimension of the patient's body was longer than normal. For these reasons, reconstruction with a pedicled jejunum alone via the antethoracic route was judged to be impossible. We then tried composite reconstruction with a pedicled jejunum and free jejunal autograft via the ante-thoracic route. With this method, the pedicled jejunum was not long enough to allow safe anastomosis of both ends of the intestine. To resolve this difficulty, we raised the pedicled jejunum via the retrosternal route to reduce the needed distance for raising, and the free jejunal autograft before the chest wall was guided to a location behind the sternum at the 3rd intercostal level, followed by anastomosis. In this way, we achieved reconstruction while avoiding tension to the reconstructed intestine. Composite reconstruction using the pedicled jejunum and free jejunal autograft is useful as a means of reconstruction of the esophagus when the stomach affected by disease cannot be used for reconstruction, since this method is expected to reduce the tension to the anastomosed area and ensure good blood supply. Our technique is useful when the intestine to be raised is not long enough for composite reconstruction via the antethoracic route.

Compartment syndrome with thrombosis of common iliac artery after gynecologic surgery.

BACKGROUND: Compartment syndrome is a potentially devastating complication with possible permanent neuromuscular and kidney damage. CASE: A woman who had undergone radical hysterectomy with pelvic and paraaortic lymphadenectomy was diagnosed with compartment syndrome of the lower left limb. Thrombosis of the left common iliac artery was also found after emergency fasciotomy. CONCLUSION: Arterial thrombosis is less common than deep vein thrombosis during gynecologic operations, but the lithotomy position may cause insufficient arterial circulation in both the pelvis and legs.

A case of intrathoracic giant malignant peripheral nerve sheath tumor in neurofibromatosis type I (von Recklinghausen's disease).

The patient was a 32-year-old woman with neurofibromatosis I (von Recklinghausen's disease), with chief complaints of shortness of breath and back pain. CT and MRI revealed a giant mass occupying the right thoracic cavity almost completely. The mass compressed the mediastinal structure to the left and the liver downwards. She underwent surgery to alleviate respiratory and circulatory disorders caused by compression of the right lung and inferior vena cava due to the giant tumor. Intraoperatively, the tumor was found to have originated from the 5th intercostal nerve. The resected tumor was 20x17x15 cm in size and 2,300 g in weight. It was histologically diagnosed as a malignant peripheral nerve sheath tumor. Her postoperative course was uneventful. All indicators of respiratory function improved, and edema of the lower half of the body disappeared, accompanied by disappearance of shortness of breath. She was discharged 21 days after surgery. Seven months after surgery, however, a recurrent tumor was found in the right thoracic cavity. She died of rapid growth of recurrent tumor 3 months thereafter. This tumor often complicates neurofibromatosis I and has a high frequency of local recurrence and distant metastasis, resulting in poor prognosis. Neither an optimal extent of resection needed for complete resection of this tumor nor an optimal regimen of chemotherapy, radiotherapy, or other therapy for the tumor has yet been established. It is desirable to establish them in the near future.

A 90-year-old woman with trachea-invading thyroid cancer requiring four-ring resection of cervical trachea because of airway stenosis.

The patient was a 90-year-old woman with chief complaints of hemoptysis and wheezing. Cervical computed tomography (CT) scans revealed a mass (2.5x2.0 cm) in the right lobe of the thyroid. The mass was exposed into the tracheal lumen, causing marked stenosis of the airway. When examined by bronchoscopy, the maximal degree of airway stenosis was about 75% of the tracheal cross section. During surgery, a resection of the right lobe of the thyroid was combined with a resection of the second to fifth cartilage ring of the cervical trachea for the purpose of complete resection of the thyroid cancer. During the same operation, the trachea was reconstructed by end-to-end anastomosis. For 1 week after surgery, a Mini-Trach II tube was left inserted to aspirate sputum, and the neck was kept bent forward (in the position of flexion). When sleeve resection of the trachea and subsequent end-to-end anastomosis are being performed, it is essential to manipulate the trachea in a protective manner, to preserve the nourishing vessels, to perform operative manipulation aseptically, to appropriately move the trachea, and to ensure reliable suturing with the goal of minimizing the incidence of complications such as anastomotic failure and stenosis of the anastomosed area. Although the patient was in advanced old age, her postoperative course was uneventful.

Leiomyoma of an accessory tracheal bronchus.

We present a rare case of leiomyoma arising in an accessory right bronchus in a 55-year-old man who had been treated for bronchial asthma. Diagnosis was established on the results of bronchoscopic biopsy. An emergency operation was performed because the patient had begun to complain of severe dyspnea. The tumor was completely removed by electrocautery with a wire snare by rigid bronchoscopy. Postoperative bronchoscopic findings revealed a tracheal bronchus arising above the carina, and the root of the tumor existed in the orifice of the branch. Final histology revealed a leiomyoma.

Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach.

Primary mediastinal liposarcoma is an unusual variant of mediastinal neoplasms. We describe a long-term survivor who underwent repeated operations. After resections through a posterolateral thoracotomy and median sternotomy, a third operation was performed for recurrent bilateral huge tumors through a clamshell incision, and both tumors were removed en bloc. Results of pathologic examination showed that both tumors were well-differentiated liposarcoma. The patient is currently well 16 years after the first operation. Aggressive surgical intervention whenever possible appears to improve the quality of life and prolong the survival of patients with mediastinal liposarcoma.

Bactericidal activity of Ag-zeolite mediated by reactive oxygen species under aerated conditions.

The bactericidal activity induced by the introduction of silver ions into zeolite was studied. Escherichia coli was used as the test microorganism. Silver ions were loaded into zeolite by the ion-exchange method. Silver-loaded zeolite was demonstrated the strong bactericidal activity. Dissolved oxygen was an essential factor for the occurrence of the bactericidal activity because the activity was observed only under aerated condition. Superoxide anions, hydrogen peroxide, hydroxyl radicals and singlet oxygen were formed. Scavengers of these each reactive oxygen species (ROS) inhibited the bactericidal activity. This means that all ROS contributed to the activity.