[Long-Term Relapse-Free Survival after Resection of Lung Metastasis in a Patient with Pancreatic Cancer-A Case Report].

The patient was a 71-year-old man with the pancreatic cancer. He underwent subtotal stomach-preserving pancreaticoduodenectomy and D2 lymphadenectomy. CT conducted 38 months after the surgery revealed the 10-mm mass at the lower lobe in the left lung. On PET-CT, the mass showed an abnormal uptake. We suspected that the mass was either a lung metastasis or a primary lung cancer. Partial resection of the left lung was performed, and pathological findings led to the diagnosis of lung metastasis originating from the primary pancreatic cancer. Currently at 9 years post-surgery, the patient has not had any recurrence of the metastasis. In this study, we report our case and discuss the literature.

[A Patient with Gastric Adenosquamous Cell Carcinoma].

A 73-year-old female was referred from a local clinic with abdominal pain. A diagnosis of gastric cancer(cT3, cN0, M0, cStage ⅡB)and acute cholecystitis was made. Distal gastrectomy, D2, and cholecystectomy were performed. Postoperative pathological examination led to a diagnosis of adenosquamous cell carcinoma(pT3, pN2, M0, pStage ⅢA). SOX therapy was administered as postoperative adjuvant chemotherapy. However, multiple liver metastases were detected. XP and DTX therapies were administered; however, there was a reduction in performance status. The patient died 10 months after surgery. Gastric adenosquamous cell carcinoma is classified as a specific type according to the Japanese Classification of Gastric Carcinoma(15th edition). This carcinoma accounts for 0.3 to 0.5% of patients undergoing gastric cancer surgery and is relatively rare. Its malignancy level is higher than that of gastric adenocarcinoma, and its prognosis is poorer.

[A Case of Malignant Lymphoma Incidentally Diagnosed by Lymph Node Dissection during Gastrectomy].

A 65‒year‒old man was diagnosed with gastric cancer during a detailed examination for anemia and hospitalized for surgery. Laparoscopy‒assisted distal gastrectomy, D1+ dissection, and Billroth Ⅰ reconstruction were performed. The postoperative course was favorable, and he was discharged on postoperative day 8. The histopathological stage of the cancer was pStage ⅠA(T1aN0M0). A malignant lymphoma was found in the dissected No. 3, No. 4d, and No. 8a lymph nodes. He was diagnosed with a large B‒cell lymphoma(Stage Ⅲ)by hematological examination and is currently being administered R‒ CHOP. No gastric cancer recurrence has occurred for 2 years since the surgery. There is no published report on the diagnosis of such a double cancer, ie, malignant lymphoma diagnosed by lymph node dissection during surgery for gastric cancer. We herein report this case with reference to the literature.

[A Case of Strangulation Ileus Caused by Pseudomyxoma Peritonei of Appendiceal Origin].

The patient was a 38-year-old woman who visited our hospital with a chief complaint of abdominal pain. She was diagnosed with strangulation ileus and was subsequently admitted to our hospital to undergo surgery. During the surgical procedure, we observed mucus adhesion accumulating within the peritoneal cavity and identified strangulation ileus resulting from a cord-like structure. We did not observe intestinal necrosis. Given that the appendix was swollen, we made the diagnosis of strangulation ileus caused by pseudomyxoma peritonei of appendiceal origin and performed ileocolic resection. The patient recovered well postoperatively and was discharged on postoperative day 9. Pseudomyxoma peritonei is often diagnosed in patients who present with ascites, abdominal swelling, or appendicitis. This is the first case report of pseudomyxoma peritonei diagnosed in a patient with strangulation ileus.

A pure line derived from a self-compatible Chrysanthemum seticuspe mutant as a model strain in the genus Chrysanthemum.

Asteraceae is the largest family of angiosperms, comprising approximately 24,000 species. Molecular genetic studies of Asteraceae are essential for understanding plant diversity. Chrysanthemum morifolium is the most industrially important ornamental species in Asteraceae. Most cultivars of C. morifolium are autohexaploid and self-incompatible. These properties are major obstacles to the genetic analysis and modern breeding of C. morifolium. Furthermore, high genome heterogeneity complicates molecular biological analyses. In this study, we developed a model strain in the genus Chrysanthemum. C. seticuspe is a diploid species with a similar flowering property and morphology to C. morifolium and can be subjected to Agrobacterium-mediated transformation. We isolated a natural self-compatible mutant of C. seticuspe and established a pure line through repeated selfing and selection. The resultant strain, named Gojo-0, was favorable for genetic analyses, including isolation of natural and induced mutants, and facilitated molecular biological analysis, including whole genome sequencing, owing to the simplicity and homogeneity of its genome. Interspecific hybridization with Chrysanthemum species was possible, enabling molecular genetic analysis of natural interspecific variations. The accumulation of research results and resources using Gojo-0 as a platform is expected to promote molecular genetic studies on the genus Chrysanthemum and the genetic improvement of chrysanthemum cultivars.

Surgery for gastric cancer patients of age 85 and older: Multicenter survey.

AIM: To investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter survey. METHODS: Therapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed. RESULTS: Eighty-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P = 0.01), particularly in cStage II patients (P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P = 0.07). CONCLUSION: Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.

Ezetimibe ameliorates atherogenic lipids profiles, insulin resistance and hepatocyte growth factor in obese patients with hypercholesterolemia.

BACKGROUND: Ezetimibe ameliorates serum low-density lipoprotein cholesterol (LDL-c) and it has been approved for the treatment of hypercholesterolemia. However, the effects of ezetimibe on specific biomarkers have not been fully clarified in obese Japanese patients. METHODS: A total of 101 patients (47 males and 54 females) were registered in this study during 2011 and 2012. All patients were over 20 years old, were obese [body mass index (BMI) ≥ 25 kg/m(2)] and had hypercholesterolemia (LDL-c ≥ 120 mg/dl). After excluding 10 subjects (7 who dropped out and 3 with missing data), 91 patients (39 males and 52 females) were analyzed. They were treated with 10 mg ezetimibe once a day for 24 weeks and were evaluated at 12 and 24 weeks. RESULTS: Following 12 weeks of ezetimibe therapy, BMI (p < 0.001), waist circumference (p < 0.001), total cholesterol (p < 0.001), LDL-c (p < 0.001), non high-density lipoprotein cholesterol [HDL-c] (p < 0.001), triglycerides (p < 0.05) and remnant-like particle cholesterol (RLP-c; p < 0.001) were significantly decreased. Following 24 weeks of ezetimibe therapy, BMI (p < 0.05), waist circumference (p < 0.001), total cholesterol (p < 0.001), LDL-c (p < 0.001), non HDL-c (p < 0.001), triglycerides (p < 0.05), RLP-c (p < 0.001), insulin (p < 0.05) and hepatocyte growth factor (HGF; p < 0.05) were significantly decreased. In contrast, HDL-c (p < 0.001) was significantly increased. CONCLUSIONS: Ezetimibe ameliorated not only atherogenic lipid profiles but also anthropometric factors, insulin resistance and biomarkers such as HGF. Ezetimibe may have pleiotropic effects on obese patients with hypercholesterolemia.

Beneficial cardiometabolic actions of telmisartan plus amlodipine therapy in elderly patients with poorly controlled hypertension.

BACKGROUND: There is a growing body of evidence that blood pressure (BP) level is one of the major determinants of cardiovascular morbidity and mortality in individuals, including elderly people. However, to achieve a target BP level in the elderly is more difficult compared with patients aged <65 years. Current guidelines recommend combination drug therapy with different modes of action for the treatment of elderly patients with moderate hypertension (HT). However, the optimal combination regimen is not well established in elderly HT. HYPOTHESIS: We hypothesized that combination therapy of telmisartan plus amlodipine would exert favorable cardiometabolic actions in elderly HT. METHODS: Seventeen elderly patients with essential HT who failed to achieve a target home BP level with treatment of 5 mg amlodipine plus 80 mg valsartan or 8 mg candesartan for at least 2 months were enrolled. Then the patients were assigned to replace their valsartan or candesartan with 40 mg telmisartan. The subjects were instructed to measure their own BP at home every day during the study periods. RESULTS: Replacement of valsartan or candesartan by telmisartan in amlodipine-treated elderly hypertensive patients showed a significant reduction in morning home systolic BP and evening home systolic and diastolic BP at 12 weeks. Switching to telmisartan significantly increased serum adiponectin level. CONCLUSIONS: Our present study suggests that combination therapy with telmisartan plus amlodipine may exert more beneficial cardiometabolic effects in elderly patients with HT compared with valsartan or candesartan plus amlodipine treatment.

Efficacy of combination therapy with telmisartan plus amlodipine in patients with poorly controlled hypertension.

There is accumulating evidence that blood pressure (BP) control significantly reduces the risk of future cardiovascular events in patients with essential hypertension. However, strict BP control is often difficult to maintain, and half of hypertensive patients fail to attain BP goals on single-drug therapy. Therefore, current guidelines recommend combinations of drugs that have complimentary mode of actions for treatment of patients with moderate hypertension. In this study, we examined in hypertensive patients uncontrolled by the combination treatment with 5 mg amlodipine plus 80 mg valsartan or 8 mg candesartan whether additional BP lowering could be achieved by switching to 5 mg amlodipine plus 40 mg telmisartan. Forty-seven patients with essential hypertension who failed to achieve a target BP level by the treatment of 5 mg amlodipine plus 80 mg valsartan or 8 mg candesartan for at least 2 months were enrolled. Replacement of valsartan or candesartan by telmisartan showed a significant reduction in both mean clinic systolic and diastolic BP at 4, 8 and 12 weeks; BP level decreased from 143.7/82.3 mmHg at baseline to 135.4/77.5 mmHg at 12 weeks. Furthermore, in 8 patients of valsartan group, switching to telmisartan significantly reduced central BP by 11.8 mmHg. Our present study suggests that combination therapy with telmisartan plus amlodipine may be more beneficial than valsartan or candesartan plus amlodipine treatment for controlling brachial and central BP, which could lead to more favorable cardiovascular outcomes with this drug combinations.

Effect of physical training on insulin resistance in patients with chronic heart failure.

BACKGROUND: The effect of physical training on insulin resistance (IR) in chronic heart failure (CHF) remains unclear. METHODS AND RESULTS: Fourteen patients with CHF performed physical training using a bicycle ergometer; 9 patients (64%) were hyperinsulinemic and insulin resistant (HOMA IR > 1.97). Exercise tolerance increased (5.1 +/- 1.7 to 6.9 +/- 2.7 METs, p < 0.05) and heart rate at rest decreased (82 +/- 15 to 72 +/- 6, p < 0.05) in the IR group after physical training. Physical training also decreased the insulin level (15.1 +/- 5.6 to 9.8 +/- 2.6 microU/ml, p < 0.05) and HOMA IR (3.7 +/- 1.4 to 2.3 +/- 0.6, p < 0.05) in the IR group, but not in the 5 patients (36%) without IR or in 6 control patients. CONCLUSION: Physical training can improve hyperinsulinemia and IR in patients with CHF.

Diagnostic cytopathology in type II angiosarcoma of the breast: a case report.

BACKGROUND: The rare occurrence of angiosarcoma of the breast is reflected in limited descriptions of fine needle aspiration (FNA) cytomorphologic findings in this neoplasm. We present a case of angiosarcoma of the breast and discuss the pitfalls in diagnostic cytopathology that can potentially lead to incorrect diagnoses in such cases. CASE: A 45-year-old woman presented with a 2-year history of a right-sided breast mass. FNA cytology revealed a hypocellular smear composed of cohesive ductal epithelial cells; isolated or loosely arranged, round to spindle-shaped fibroblastlike cells; and projectile growths of round, oval and polygonal cells on loose tangles of connective tissue. The background was hemorrhagic, with scattered foam cells. The overall cytologic diagnosis was inconclusive but suggested phyllodes tumor (of borderline malignancy). Excisional biopsy was performed, followed by simple mastectomy. Histologic features were consistent with angiosarcoma, a diagnosis that was supported by immunohistochemical studies. CONCLUSION: On FNA smear, 49.1% of isolated atypical cells were positive for the endothelial marker CD34; however, cytomorphologic appearance of these cells resembled that of CD34-negative active mesenchymal cells. Angiosarcoma rarely occurs in the breast, and a definitive diagnosis is difficult based on cytologic examination of hypocellular smears alone. However, the presence of atypical round, oval and polygonal cells on loose tangles of connective tissue, suggesting sheared vasculature, can be an important diagnostic feature.

[A case report--TS-1/CDDP combined chemotherapy found effective for metastatic recurrence after operation for colon cancer].

A 68-year-old male with a history of gastric resection for gastric cancer underwent resection of the sigmoid colon for a sigmoid colon cancer in February, 2000. The cancer was classified as stage III b. After operation, l-LV + 5-FU therapy was administered, but metastases to the abdominal wall, right inguinal lymph node and spleen developed in succession, and resection was repeated. In October 2001, 1 year and 8 months after sigmoidectomy, however, multiple metastasis to the intraperitoneal lymph node had developed. As surgery was not indicated, TS-1/CDDP combined chemotherapy was started. TS-1 80 mg/day was administered for 4 weeks, the drug was withdrawn for 2 weeks and CDDP 80 mg was injected by intravenous drip at the 8th day of TS-1 administration, which was used as one course. From the second course after inception of the administration, CA19-9 decreased, and after the third course the upper intraperitoneal metastatic lesion disappeared on CT. CR has been continued for 4 months up to the present. Our results suggest a possibility that this therapy is effective not only for gastric cancer but also for colon cancer. This therapy can be administered at home. It is considered to be a useful therapy from the viewpoint of QOL as well. The high DPD activity of the tumor may have been one reason this treatment was effective. This case also seems significant from the viewpoint of attaining individualization of the drug selection in chemotherapy.