Right top pulmonary vein is a venous anomaly of which surgeons should be aware in subcarinal dissection for thoracoscopic esophagectomy: a case report and literature review.

BACKGROUND: A right top pulmonary vein (RTPV) that crosses behind the right main or intermediate bronchus is a variation of the superior posterior pulmonary vein in the right upper lobe. Damage or ligation of this abnormal vessel can lead to massive intraoperative bleeding and serious complications, such as congestion of the posterior segment of the right upper lobe and cardiac tamponade. Subcarinal lymph node dissection is mandatory in radical thoracoscopic esophagectomy for esophageal cancer, and the RTPV is an anomalous vessel of which thoracic surgeons should be aware. CASE PRESENTATION: A 70-year-old man underwent thoracoscopic esophagectomy for esophageal cancer (T3N1M0). An anomaly of the superior posterior pulmonary vein in the right lobe was recognized on preoperative computed tomography imaging. With simulation and intraoperative navigation using three-dimensional imaging of the same view as that observed during the operation, radical subcarinal dissection could be performed with preservation of the RTPV. CONCLUSION: In our review of the relevant literature, the incidence of RTPV ranged from 0.28 to 9.3%, and its mean vascular diameter was 7.0 mm at the maximum and 2.2 ± 0.72 mm at the minimum, with the right superior pulmonary vein being a relatively common inflow site. Our case in which the RTPV ran dorsal to the right main bronchus is very rare. In radical subcarinal dissection of thoracoscopic esophagectomy, it is important to recognize the posterior pericardial plane and release the ventral fixation of these lymph nodes to free space for the back side. This is also true in the case of RTPV, which should be noted to avoid injury. In cases involving an RTPV larger than 4.5 mm, ligation should be avoided, and preoperative recognition of the exact run of this abnormal vessel using three-dimensional imaging can be very useful.

Oxidation of Anatase TiO2(001) Surface Using Supersonic Seeded Oxygen Molecular Beam.

We investigated the oxidation of oxygen vacancies at the surface of anatase TiO2(001) using a supersonic seeded molecular beam (SSMB) of oxygen. The oxygen vacancies at the top surface and subsurface could be eliminated by the supply of oxygen using an SSMB. Oxygen vacancies are present on the surface of anatase TiO2(001) when it is untreated before transfer to a vacuum chamber. These vacancies, which are stable in the as-grown condition, could also be effectively eliminated by using the oxygen SSMB.

Intra-dimer row and inter-dimer row coupling of the vibrational modes of chemisorbed CO on Si(001)-c(4×2) observed by angle-dependent transmission infrared spectroscopy.

The vibrational modes of chemisorbed CO on a Si(001) surface are investigated by means of transmission Fourier-transform infrared absorption spectroscopy. We observed the three components corresponding to the stretching vibration of the terminal-site CO adsorbed on the down-dimer sites of a Si(001) surface. The symmetric stretching vibration and asymmetric stretching vibration are observed separately. This assignment is consistent with the polarization dependence of the incident light and with the vibrational modes obtained by performing theoretical calculations. We found that both the intradimer row and interdimer row coupling should be considered to explain the appearance of the three components.

Electronic structure of α-sexithiophene ultrathin films grown on.

We investigated the electronic states of α-sexithiophene (α-6T) on by means of angle-resolved photoelectron spectroscopy using synchrotron radiation. The characteristic features of π states are observed in the valence region. The increase in the population of the S1 band, assigned to the surface state of , upon deposition of α-6T was measured and the change in the electron density was evaluated. The band diagram was constructed based on the measurement of the HOMO level and work function. The work function was found to change with the α-6T thickness in a characteristic manner. We constructed a model of the electron transfer at each growth stage based on the core levels of the substrate (Si 2p, Ag 3d) and α-6T molecule (C 1s, S 2p), as well as the valence state and work function change.

Adsorption and self-assembled structures of sexithiophene on the Si(111)-√3×√3-Ag surface.

The adsorption and self-assembled structures of α-sexithiophene (α-6T) have been investigated on a Si(111)-Ag surface using scanning tunneling microscopy (STM), low-energy electron diffraction, and density functional theory calculations. The adsorbed α-6T molecules are arranged into unidirectional molecular rows with a side-by-side orientation. The molecular rows reveal three kinds of appearances in the filled-state STM images, which reflect the distinct adsorption sites. From tunneling spectroscopy, we find that the filled-state STM images of α-6T should be influenced by the surface states of Si(111)-Ag. At one monolayer coverage, sequentially ordering of the triple molecular rows results in the close-packed arrangement of the α-6T overlayer.

Subxiphoid pericardial drainage for gastric tube ulcer penetrating the pericardium after esophagectomy: A case report.

INTRODUCTION: Reconstructed gastric tube ulcers are common complications of esophagectomy. When the pericardium is penetrated, digestive juices can cause severe cardiac inflammation, leading to an extremely poor prognosis. We report the first case of pericardial penetration of a constructed stomach tube via the posterior mediastinal route and the first use of subxiphoid pericardial drainage and continuous irrigation lavage. PRESENTATION OF CASE: This case involved a 50-year-old woman who underwent an esophagectomy for esophageal cancer nine years prior with gastric tube reconstruction via the posterior mediastinal route. She developed pericardial penetration due to a gastric tube ulcer. Her respiratory and circulatory condition worsened, and pericardial drainage and a prophylactic tracheostomy were performed to prevent septic shock. A 5-cm longitudinal incision was made in the epigastric region, and a 4-cm T-shaped incision was made through the pericardium. Two double-lumen drainage tubes were placed in the anterior and posterior pericardium, and continuous irrigation was initiated via each tube. We successfully treated the patient without complications using subxiphoid pericardial drainage and continuous irrigation lavage, and she was discharged on postoperative day 23. DISCUSSION: We presented this case to discuss surgical techniques and optimal treatment strategies. CONCLUSION: Subxiphoid pericardial drainage and continuous irrigational lavage are effective for pericardial penetration of a constructed stomach tube via the posterior mediastinal route.

A perforation of a duodenal diverticulum in a 97-year-old patient after total gastrectomy and Roux-en-Y reconstruction: a case report.

Most duodenal diverticula (DD) are asymptomatic and rarely develop perforations. Perforation is the most serious complication of DD and often requires emergency surgery. A 97-year-old woman who had undergone total gastrectomy and Roux-en-Y reconstruction 30 years ago was referred to our department with chief complaints of abdominal pain and fever during her hospitalization after femoral neck fracture surgery in the orthopedic department. Contrast-enhanced computed tomography showed free air and residue in the abdominal cavity and right retroperitoneum, and an emergency laparotomy was performed. The abdominal cavity was mildly contaminated, and a 6-cm DD with a 1-cm perforation in the wall of the diverticulum on the contralateral side of the mesentery of the duodenum was found. Diverticulectomy and duodenal closure were performed and a drainage tube was placed. The patient experienced no complications and was transferred to the orthopedic department on postoperative day 10. Reports of perforation of DD after gastrectomy are very rare. Particular attention should be paid to perforation of DD after Billroth-II and Roux-en-Y reconstructions as they involve the formation of a duodenal stump that differs from the normal anatomy and may be highly invasive surgical procedures, depending on the degree of inflammation and fistula formation.

Emergence of metallic surface states and negative differential conductance in thinß-FeSi2films on Si(001).

The electronic properties of the surface ofß-FeSi2have been debated for a long. We studied the surface states ofß-FeSi2films grown on Si(001) substrates using scanning tunnelling microscopy (STM) and spectroscopy (STS), with the aid of density functional theory calculations. STM simulations using the surface model proposed by Romanyuket al(2014Phys. Rev.B90155305) reproduce the detailed features of experimental STM images. The result of STS showed metallic surface states in accordance with theoretical predictions. The Fermi level was pinned by a surface state that appeared in the bulk band gap of theß-FeSi2film, irrespective of the polarity of the substrate. We also observed negative differential conductance at ∼0.45 eV above the Fermi level in STS measurements performed at 4.5 K, reflecting the presence of an energy gap in the unoccupied surface states ofß-FeSi2.

Optimal surgical approaches for esophageal epiphrenic diverticulum: literature review and our experience.

Esophageal epiphrenic diverticulum is a rare condition usually secondary to a primary esophageal motility disorder. Although epiphrenic diverticulum may be treated by thoracoscopic and laparoscopic management, the optimal surgical approach have not been established. We successfully treated a left epiphrenic diverticulum along with achalasia and paraesophageal hernia by a planned combination of thoracoscopic and laparoscopic procedures aided by preoperative simulation using three-dimensional imaging. We reviewed a series of 17 reports on esophageal epiphrenic diverticulum that required either planned or unplanned unexpected transthoracic surgery. The main reasons for requiring a transthoracic approach were adhesions, site and size of the diverticulum, and length of the diverticulum neck. Unplanned procedure changes were required in 12 of the 114 cases for a conversion rate of 10.5%. Diverticulectomy, myotomy, and fundoplication were the most common surgical treatments administered at 42.6%. Based on literature review and our experience, we have developed a flowchart to identify the characteristics of epiphrenic diverticulum cases that require a transthoracic approach. This flowchart can help to determine therapeutic strategies and the optimal surgical approach to esophageal epiphrenic diverticulum treatment and may reduce unplanned changes in the surgery.

A case of laparoscopic appendectomy for appendiceal bleeding.

BACKGROUND: Appendiceal bleeding is very rare, accounting for about 0.4% of all lower gastrointestinal bleeding. We present a case of laparoscopic appendectomy in a patient with a diagnosis of appendiceal bleeding. CASE PRESENTATION: A 71-year-old man came to our hospital with a complaint of bloody stools. He had progressive anemia and persistent fresh bloody stools, so he underwent lower gastrointestinal endoscopy. Active bleeding was confirmed from the orifice of the appendix, but the bleeding could not be stopped even with clips, so an emergency laparoscopic appendectomy was performed. His postoperative course was good, and he was discharged on the third postoperative day. Although the pathology results did not allow identification of the source of the bleeding, an appendiceal diverticulum was observed, and appendiceal diverticular bleeding was suspected. CONCLUSION: Appendiceal bleeding is often difficult to stop endoscopically, so appendectomy should be performed as soon as possible.

A case of advanced hypopharyngeal cervical esophageal cancer treated by curative resection with management of tracheoesophageal fistula.

Advanced esophageal cancer with tracheal invasion is fatal due to airway narrowing and the possibility of tracheoesophageal fistula (TEF) formation during the treatment process. If a TEF develops, palliative care is often chosen. It is very rare that curative treatment is performed including with chemoradiotherapy (CRT) or surgery in such cases. A 71-year-old man presented with dysphagia. He was diagnosed as having hypopharyngeal and cervical esophageal cancer with severe airway stenosis (cT4b [main bronchus, thyroid] N3 M0 cStage IIIC), and we initially created a tracheostomy. Second, we chose induction chemotherapy to avoid fistula formation by CRT, but after one course of chemotherapy, he developed a TEF due to remarkable tumor shrinkage. We strictly managed both his airway and nutrition by continuous suctioning over the cuff of the tracheal cannula and prohibiting swallowing of saliva and enteral nutrition via nasogastric tube. After three courses of chemotherapy were administered, we performed pharyngo-laryngo-esophagectomy followed by adjuvant chemotherapy. The patient remains alive and recurrence free at 9 years postoperatively. In cases of upper TEF caused by advanced hypopharyngeal and cervical esophageal cancer, radical treatment may be possible by effective induction chemotherapy combined with strict airway and nutritional management after prior tracheostomy.

Cost-effectiveness of combination therapy of polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisolone for previously untreated diffuse large B-cell lymphoma in Japan.

AIM: The POLARIX trial showed that Pola + R-CHP (polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisolone) prolongs progression-free survival (PFS) in patients with previously untreated diffuse large B-cell lymphoma (DLBCL) compared with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), the conventional standard of care, with a similar safety profile. However, Pola + R-CHP has not been evaluated from the viewpoint of health economics in Japan. This study evaluates the cost-effectiveness of Pola + R-CHP for previously untreated DLBCL from a Japanese public healthcare payer's perspective. METHODS: A partitioned survival analysis model was constructed to estimate lifetime costs and effectiveness of Pola + R-CHP and R-CHOP in previously untreated DLBCL who had an International Prognostic Index score (IPI) score of ≥2. A parametric survival model was applied to data analyzed in the POLARIX trial to estimate the lifetime overall survival (OS) and PFS for each treatment. The parameters required for the model were based on the results of a literature search and expert opinion. RESULTS: The incremental cost-effectiveness ratio (ICER) of Pola + R-CHP vs. R-CHOP was JPY2,710,238 per quality-adjusted life year (QALY), less than the ICER of JPY7.5 million per QALY that is considered to be cost-effective based on the threshold of the Japanese cost-effectiveness evaluation system. One-way sensitivity analysis showed that the parameters influencing the results of the analysis were median PFS and the total cost per regimen of salvage chemotherapy, patient weight, and patient age. Probabilistic sensitivity analysis showed that the probability of Pola + R-CHP having superior cost-effectiveness was 99.2% when the reference value was JPY7.5 million. The results of scenario analysis suggested that prolongation of PFS was an important factor in the evaluation of cost-effectiveness in previously untreated DLBCL with or without prolongation of OS. CONCLUSIONS: This study suggests that Pola + R-CHP is a cost-effective treatment for previously untreated DLBCL in Japan under the public health insurance system.

Thermal oxidation process on Si(113)-(3 × 2) investigated using high-temperature scanning tunneling microscopy.

Thermal oxidation of Si(113) in a monolayer regime was investigated using high-temperature scanning tunneling microscopy (STM). Dynamic processes during thermal oxidation were examined in three oxidation modes - oxidation, etching, and transition modes - in the third of which both oxidation and etching occur. A precise temperature-pressure growth mode diagram was obtained via careful measurements for Si(113), and the results were compared with those for Si(111) in the present work and Si(001) in the literature. Initial oxidation processes were identified based on high-resolution STM images.

Antimicrobial activities of amphiphilic cationic polymers and their efficacy of combination with novobiocin.

Today, drug-resistant bacteria represent a significant problem worldwide. In fact, bacteria are becoming resistant even to newly developed antibiotics. Therefore, there is an urgent need to develop antibiotics to which bacteria cannot become resistant. In this study, antimicrobial polymers to which bacteria cannot develop resistance were prepared from 6-aminohexyl methacrylamide and N-isopropyl acrylamide. The polymers with molecular weights of the order of 105 showed little antimicrobial activity against Staphylococcus aureus and Escherichia coli as well as low toxicity. On the other hand, polymers with lower molecular weights (of the order of 104) did show antimicrobial activity against S. aureus and E. coli. These polymers were combined with novobiocin to investigate the combined usage effects against E. coli. The combined usage of novobiocin and the low-molecular-weight polymers reduced the minimum inhibitory concentration, which was less than 0.0625 µg/mL against E. coli. This result indicates that the combination is useful for increasing the efficacy of antibiotics and broadening their antimicrobial spectrum. Furthermore, the results showed the possibility that the antimicrobial polymers serve not only as antibiotics to which bacteria have not developed resistance but also as adjuvants for other antibiotics.

Asymptomatic pulmonary thromboembolism diagnosed based on prolonged fever after gastric cancer surgery: A case report with literature review.

INTRODUCTION: Venous thromboembolism (VTE) is a serious postoperative complication with potentially fatal outcome. However, asymptomatic VTE is difficult to diagnose and is often discovered by chance. We report a case of suspected VTE diagnosed based on prolonged fever after surgery and discuss the literature. PRESENTATION OF CASE: A 48-year-old man was referred to us with a diagnosis of gastric cancer. Upper gastrointestinal endoscopy revealed a neoplastic lesion from the anterior wall of the mid-gastric mass to the upper part of the gastric body, and biopsy revealed adenocarcinoma. Contrast-enhanced computed tomography (CT) showed no obvious distant metastasis. The preoperative diagnosis was gastric cancer, cT4aN1M0 cStage III, and radical surgery was performed. During surgery, an intermittent pneumatic compression pump was used. Subcutaneous injection of enoxaparin was started postoperatively. A high fever continued on postoperative day 4, and high D-dimer level of 14.3 µg/mL was found. Contrast-enhanced CT scanning showed thrombus in the left upper lobe pulmonary artery A4/5. Lower extremity venous ultrasonography revealed a thrombus in the right soleal vein, and apixaban 20 mg/day was started that day. Thereafter, fever resolved quickly, and the D-dimer level gradually decreased. The patient was discharged from hospital on day 21 having made good progress. DISCUSSION: It sould be rememberd that there are VTE found in persistent fever after gastric cancer surgery. The main complaint was simply fever, and the fever disappeared with anticoagulant. CONCLUSION: This cases suggests the importance of perioperative measures against VTE. Peri operative treatment with apixaban was safe and effective.

Subtotal esophagectomy followed by subtotal gastric reconstruction for Boerhaave's syndrome: Case report with literature review.

INTRODUCTION: Boerhaave's syndrome, or spontaneous esophageal rupture, is a potentially fatal disease requiring prompt diagnosis and effective treatment. We report Boerhaave's syndrome in a patient who underwent subtotal esophagectomy and temporary cervical esophagostomy for esophageal perforation to the right thoracic cavity, followed by subtotal gastric reconstruction as the second step. PRESENTATION OF CASE: A 70-year-old man with diarrhea and vomiting as chief complaints had underlying disease of reflux esophagitis. He experienced frequent hematemesis. Computed tomography (CT) at another hospital revealed right pleural effusion and abnormal mediastinal air and fluid retention around the esophagus, and he was transferred to our hospital. From the CT findings, he was diagnosed as having Boerhaave's syndrome with esophageal perforation into the right thoracic cavity. He was in shock, and emergency right thoracotomy was performed, revealing a severely purulent thoracic cavity, ruptured parietal pleura, and 5-cm perforation in the right front middle esophageal wall that was surrounded by mucosal necrosis. Subtotal esophagectomy, temporal cervical esophagostomy, and enteral feeding tube insertion were performed. After hospital discharge, he underwent subtotal gastric reconstruction 43 days postoperatively. His course was good, and he was transferred to another hospital for rehabilitation 36 days after reconstruction. DISCUSSION: In Boerhaave's syndrome, depending on the size of the perforation and fragility of the esophageal wall, subtotal esophagectomy may be feasible. CONCLUSION: Two-step reconstruction following esophageal rupture is possible after sufficient local infection control, and anastomosis can be performed if the patient's general condition is good, but only under conditions that guarantee no anastomotic leakage.

A possible indicator for removal of a large foreign body from the esophagus via a cervical approach: a case report with literature review.

Foreign body intake in adults is more common among people with mental illness. Edentulous adults are at increased risk for foreign body ingestion, including of dentures. We experienced a patient who aspirated a large denture that we removed via a cervical surgical approach. A 72-year-old woman presented complaining of chest discomfort. Her medical history revealed that she suffered from schizophrenia and deafness. She had previously visited another hospital for possible loss of her denture. Chest discomfort and pain began the next day. Computed tomography showed the accidentally swallowed denture in her esophagus. Upper gastroendoscopy was attempted to remove the denture via endoscopic forceps, but it was too large to be removed and was strongly stuck. As it was difficult to perform open right thoracotomy due to left pneumonia and there was no perforation or mediastinitis, we decided to remove the denture via a left neck skin incision under general anesthesia. The denture was located in a gap between the aortic arch and vertebral body. The denture was grasped with pean forceps and extracted. The patient was discharged from hospital 18 days postoperatively. This case suggests how high a foreign body in the esophagus can be reached from a cervical incision.

An incarcerated internal hernia of the sigmoid colon through a defect in the broad ligament: A case report.

INTRODUCTION AND IMPORTANCE: Hernias through a defect of the broad ligament are rare, accounting for only 1.6-5% of internal herniations [1]. This report describes a rare case of sigmoid colon obstruction due to hernia through a defect of the broad ligament, which was diagnosed before surgery. CASE PRESENTATION: A 78-year-old multiparous woman presented with lower abdominal pain and nausea. Contrast-enhanced multi-detector CT (MDCT) demonstrated a dilated sigmoid colon and edematous mesentery of the sigmoid colon in the left Douglas' fossa, the uterus was compressed dorsally to the right and the left ovary was compressed ventrally. We diagnosed an internal broad ligament defect hernia with incarceration of the sigmoid colon, and performed emergency laparotomy. The necrotic sigmoid colon was resected and anastomosis was performed by the double stapling technique. The postoperative course was uneventful. CLINICAL DISCUSSION: We consider the treatment of hernia of sigmoid colon through a broad ligament defect. CONCLUSION: We recognize that there is a possibility that, in addition to the small intestine, proximally located organs may be incarcerated. In the case of the colon, we should choose the treatment method carefully according to whether or not the colon is expected to be necrotic.

Burden of caring for Alzheimer's disease or dementia patients in Japan, the US, and EU: results from the National Health and Wellness Survey: a cross-sectional survey.

AIMS: The growing prevalence of Alzheimer's disease (AD) worldwide has sparked the implementation of national policies to support the growing burden among caregivers of AD/dementia patients. This study aims to quantify and compare the burden of AD/dementia caregivers and evaluate how different living arrangements might impact health outcomes among caregivers in Japan, five European countries (5EU), and the United States (US). MATERIALS AND METHODS: This is a cross-sectional study based on existing data from the 2018 National Health and Wellness Survey. Health outcome measures included health-related quality of life (HRQoL), health state utilities, work productivity and activity impairment (WPAI), and measurement of depression and anxiety amongst AD/dementia caregivers and non-caregivers. Pairwise comparisons between AD/dementia caregivers in Japan, 5EU, and the US were conducted. Multivariate analysis was used to compare across groups within each region, with adjustment for potential confounding effects. RESULTS: A higher proportion of caregivers of AD/dementia patients in Japan were 65 years or older as compared to 5EU and US. On the contrary, female caregivers were significantly higher in the US than Japan and 5EU. The HRQoL and health state utilities index scores amongst AD/dementia caregivers were highest in Japan and lowest in the US. Caregivers in Japan incurred the lowest WPAI among the three regions. The proportion of AD/dementia patients reportedly living in an institution was highest in Japan as compared to the US and EU. Notably, US caregivers whose patients lived in an institution experienced significantly less caregiving burden as compared to caregivers whose patients lived in the community. CONCLUSIONS: The caregiving burden among AD/dementia caregivers was substantial across the three regions, with similarities and differences between the West and Japan. The lower caregiving burden in Japan was potentially associated with national policies supporting long-term healthcare and institutionalized nursing care facilities for AD/dementia patients.

Humanistic burden among caregivers of patients with Alzheimer's disease or dementia in Japan: a large-scale cross-sectional survey.

AIMS: As the population in Japan is rapidly aging, the prevalence of dementia, particularly Alzheimer's Disease (AD), is expected to increase, resulting in a growing need for caregivers. This study aims to quantify and compare the humanistic burden of caregivers of AD/dementia patients with caregivers of patients with other conditions in Japan. MATERIALS AND METHODS: This cross-sectional study used data from the 2018 Japan National Health and Wellness Survey (NHWS). Outcome measures included the Short-Form 12-item Health Survey (SF-12) for health-related quality-of-life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, impact of health on productivity and activity, and evaluation of depression and anxiety. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects. RESULTS: A total of 805 caregivers of AD/dementia patients, 1,099 other caregivers, and 27,137 non-caregivers were identified. Both AD/dementia caregivers and other caregivers had lower HRQoL and EQ-5D scores, higher total activity impairment, and more caregivers tended to experience anxiety than non-caregivers. There were no significant differences in the involvment in basic and instrumental activities of daily living (ADL) between AD/dementia caregivers and caregivers of other conditions. Notably, AD/dementia caregivers were more involved in making treatment decisions and finance management than other caregivers. Among AD/dementia caregivers caring for one patient, 395 patients lived in the community and 282 in an institution. AD/dementia caregivers whose patients lived in the community were more significantly involved in basic and instrumental ADL. Caregivers of patients with both AD/dementia and cancer had higher caregiving burden than caregivers of patients with either condition. CONCLUSIONS: Caregivers of AD/dementia patients in Japan reportedly experienced significant humanistic burden which is associated with patients' living arrangements and the presence of an additional chronic condition. Therefore, provision of effective care/support is essential to relieve the burden experienced by the caregivers.