Oral Gonadotropin-Releasing Hormone Antagonist Relugolix Has the Same Effect as Gonadotropin-Releasing Hormone Agonist Injections in Terms of Preparation for Transcervical Resection Myomectomy.

For preparing the optimal condition in transcervical resection (TCR) surgery, gonadotropin-releasing hormone (GnRH) agonist has been utilized. Recently, an oral GnRH antagonist (relugolix) is available and acts directly on GnRH receptor, avoiding flare up and reducing blood E2 levels rapidly. We retrospectively compared the oral GnRH antagonist (n = 14) effect to that of subcutaneous GnRH agonist (n = 19) for the pretreatment of endometrium in TCR myomectomy. Endometrial thickening was determined by intraoperative videos. The color tone of the endometrium in the normal part was assessed by digital image processing. The median duration of the first GnRH agonist injection and the surgery was 67 days (21-136 days), which is significantly longer than that of the oral GnRH antagonist group, 18.5 days (7-157 days P < 0.01). Both the GnRH agonist and antagonist groups did not exhibit prominence in the endometrium. The GnRH antagonist group showed the same degree of whiteness in the normal endometrium as the GnRH agonist group. The oral GnRH antagonist administration could rapidly atrophy the endometrium and create an optimal surgical field for TCR in a short period.

First report in Japan of a delivery of a woman with the 2019 novel coronavirus disease.

On April 2, 2020, we received a maternal transport from a local city hospital of a pregnant woman (38 weeks and 0 days of gestation) in her 20s, who had the 2019 novel coronavirus disease (COVID-19). We performed an emergency cesarean section with spinal anesthesia because of an abnormal fetal heart rate pattern. A healthy 3106-g male baby was delivered. All the severe acute respiratory syndrome coronavirus 2 polymerase chain reaction tests of nasal and oral discharges, anal swabs and blood samples of the neonate at 9 h, 30 h and 4 days after birth were negative. Because the mother was diagnosed as having COVID-19 pneumonia, the neonate was given formula milk. The mother's nasal discharge samples at 20 and 21 days were negative. The mother first held her baby in her arms on the 22nd day after birth, and they were discharged on the following day. To the best of our knowledge, this is the first report in Japan of a delivery of a baby from a woman infected with COVID-19.

[Case of Central Venous Catheter Laceration of the Pectoralis Minor Muscle].

A 50's underwent gastrectomy for gastric cancer 4 years before. He had received chemotherapy for para-aortic lymph node metastases. A central venous catheter with a subcutaneous port was implanted via the right subclavian vein, under ultrasonographic guidance, 1 year 3 months earlier. The patient complained of swelling in his right chest during intravenous injection of ramucirumab and paclitaxel via the port. A chest radiograph revealed that a catheter fracture. A CT scan showed that the fractured catheter had lacerated the pectoralis minor muscle and the tip was in the right inferior pulmonary artery. The catheter fragment was removed using a pigtail catheter and a snare catheter via a percutaneous transfemoral approach, without any complication. The catheter was cut at 15.5 cm from the tip. This fracture was thought to be caused by a kink in the pectoralis muscle.

Prognostic Factors of Oral Intake After Endoscopic Gastroduodenal Stent Placement for Advanced Gastric Cancer.

Gastroduodenal stents are effective for gastric outlet obstruction (GOO) due to gastric cancer. However, some patients are unable to eat again soon. We retrospectively analyzed the cause of short-feeding periods. Between 2011 and 2015, we performed stent placement in 22 patients who could not eat solids. The effects of clinical characteristics on duration of oral intake were analyzed using Cox proportional hazards models. Univariate analyses revealed that the degree of GOO [no oral intake/liquids only; hazard ratio (HR), 10.9; 95% confidence interval (CI), 2.5-48.1; P=0.003], performance status score (2 or 3/0 or 1; HR, 5.7; 95% CI, 1.8-16.9; P=0.004), and poststenting chemotherapy (no/yes; HR, 5.7; 95% CI, 1.9-18.9; P=0.002) were significant factors for cessation of oral intake. Multivariate analysis showed that GOO and chemotherapy were significant factors. Gastroduodenal stents were less effective for patients with severe stenosis or without poststenting chemotherapy.

[A Case of Liver Metastasis from Colorectal Cancer That Showed a Pathological Complete Response to mFOLFOX6 plus Cetuximab].

A 68-year-old man was diagnosed with rectal cancer on colonoscopy and liver metastasis of rectal cancer on abdominal computed tomography(CT). He underwent resection of the primary lesion, and the final diagnosis was A, N1, H1, P0, M0, fStage IV. After resection of the primary lesion, he received chemotherapy with mFOLFOX6 plus cetuximab. After 6 courses of the treatment, CT revealed partial response of the liver metastasis. Then, he underwent resection of the liver metastasis. The pathological finding revealed that the resected specimen had no cancer cells. After resection of the liver metastasis, he received 6 courses of chemotherapy with the same regimen, and relapse-free survival continues until the time of this writing.

[A case of HER2-positive advanced gastric cancer successfully treated via capecitabine, cisplatin, and trastuzumab combination chemotherapy].

We report a case of human epidermal growth factor receptor 2 (HER2) -positive advanced gastric cancer effectively treated via capecitabine, cisplatin, and trastuzumab (XPT) chemotherapy followed by curative gastrectomy. The patient was a 66- year-old man with type 2 gastric cancer in the greater curvature of the gastric angle. Biopsy revealed that the tumor was a well or moderately differentiated adenocarcinoma, and immunohistochemistry showed positive expression of HER2(3+). Chest and abdominal computed tomography(CT)showed a liver tumor 21×9 mm in size in the caudate lobe and swollen lymph nodes in the paragastric, para-aortic, and left supraclavicular regions. After 4 courses of XPT, a clinical complete response was obtained. The patient received additional 13 courses of trastuzumab and capecitabine and underwent Billroth I distal gastrectomy with D2 lymph node dissection and resection of the para-aortic and left supraclavicular lymph nodes. Liver metastasis was not detected. No residual cancer cells were found in the stomach or lymph nodes except for the left supraclavicular lymph nodes. Pathological classification according to the Japanese Classification of Gastric Carcinoma, 14 th edition, was ypT0, ypN0, ypM1(LYM), Grade 2, ypStage IV. The patient developed a post-operative anastomotic leakage that required drainage via laparotomy, but was discharged 76 days after surgery in good condition.

[A case of liver and para-aortic lymph node metastasis of colorectal cancer responding to S-1].

A 78-year-old woman was diagnosed with liver and para-aortic lymph node metastasis of colorectal cancer via abdominal computed tomography (CT) during a post-operative follow-up. She and her family declined intensive chemotherapy. Therefore, reduced S-1 (80 mg/body/day) was administered for 2 weeks followed by a 2 week interval. After 5 courses, CT revealed a complete response for the liver metastasis and a partial response for the para-aorticlymph node metastasis. Twenty-four courses of chemotherapy were completed, and only a follow-up CT examination was performed. The paraaorticlymph node grew larger, but the liver metastasis did not reappear. Herein, we report a case that showed a good response to S-1.

Our experience of treating undifferentiated gastric carcinoma: report of four cases.

Undifferentiated gastric carcinoma is a rare histopathological type of cancer that does not show any differentiation toward adenocarcinoma or squamous cell carcinoma. It is thought to be highly malignant, and is associated with a poor prognosis. However, its clinical behavior has not yet been fully analyzed because of its rarity. We herein review the clinical characteristics and prognoses of patients with undifferentiated gastric carcinoma treated at our institutions. Among 2,651 gastric cancer patients, four (0.2 %) were histopathologically diagnosed to have undifferentiated carcinoma. These four patients included three males and one female. The median age of the patients was 60-year old (range 47-75). Three cases had distant metastases at diagnosis. One of these three cases was treated with chemotherapy alone, and the other two were treated with palliative gastrectomy and chemotherapy. The patient with no distant metastasis underwent curative gastrectomy and adjuvant chemotherapy. All patients died of cancer at a median of 5.4 (range 3.5-7.1) months after their diagnoses.

Prognostic factors for gastrectomy in elderly patients.

The decision to undergo surgery for gastric cancer patients aged ≥85 years should be made carefully. We retrospectively reviewed the prognostic factors of gastrectomy for 64 patients aged ≥85 years who had undergone curative gastrectomy for gastric cancer. The effects of various clinical characteristics and surgical interventions on survival were retrospectively analyzed. Univariate analysis revealed that sex (male/female; P = 0.001), the extent of gastric resection (total/distal; P = 0.028), the extent of lymph node dissection (D2/

[Report of a successful case of multidisciplinary therapy for a patient with lung and liver metastasis from rectal adenocarcinoma].

A strategy of multidisciplinary therapy is considered necessary for the longer survival of a patient diagnosed with advanced colorectal cancer. We report a successful multi-disciplinary therapy case of a 70's-year-old male who received pulmonary resection for metastatic lung cancer twice after primary resection for rectal cancer. Solitary metastatic liver cancer with portal vein tumor thrombus (PVTT) was diagnosed 5 years and 4 months after primary surgery. Although systemic chemotherapy was started immediately, disease control was poor and local pulmonary recurrence appeared. Although intrahepatic metastasis was considered the most important prognostic factor, radiation therapy against PVTT (50 Gy) was initially performed to control disease. After verifying that no new recurrent lesions had arisen during radiation therapy, a third pulmonary resection (in the left upper remnant lobectomy)was performed. Hepatectomy(in the right lobectomy)was then performed for curative purposes. Pathological efficacy of radiation therapy to PVTT was revealed as GradeIb according to Evans' classification. In accordance with the patient's request, no adjuvant treatment was planned. Seven years after primary resection no sign of recurrence is evident. Radiation therapy is suggested to be most useful for disease control and patient selection.

Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only.

BACKGROUND: There is controversy regarding strategies for treating very elderly patients with gastric carcinoma. We aimed to assess survival after surgery in very elderly patients according to their clinical characteristics. METHODS: Gastric cancer patients aged ≥85 years were retrospectively reviewed. There were no significant differences in clinical characteristics between 58 patients with curative resection (OP group) and 32 patients with best supportive care alone (BSC group) in cancer stage IA-IIIC and with a performance status of 0-3. RESULTS: Overall survival (OS) was significantly better in the OP group than in the BSC group in females [hazard ratio (HR) 0.27, 95 % confidence interval (CI) 0.12-0.57, P < 0.001] but not in males (HR 0.71, 95 % CI 0.35-1.49, P = 0.35). OS was significantly better in the OP group in patients aged 85-89 years (HR 0.44, 95 % CI 0.25-0.78, P = 0.006) but not in patients aged ≥90 years (HR 0.47, 95 % CI 0.12-1.66, P = 0.24). OS was significantly better in the OP group in patients with stage IB-IIIC cancer (HR 0.29, 95 % CI 0.14-0.58, P < 0.001) but not in patients with stage IA cancer (HR 0.52, 95 % CI 0.21-1.27, P = 0.15). CONCLUSIONS: Females, patients aged 85-89 years, and patients with stage IB-IIIC cancer had significantly better OS with surgery than without. For males, patients aged ≥90 years, or stage IA patients, the decision to perform surgery should be carefully made, and BSC might be an optimal strategy.

Gastric neuroendocrine tumors in our institutions according to the WHO 2010 classification.

In 2010, World Health Organization classified gastric neuroendocrine tumor (NET) as follows: NET grade (G) 1, NET G2, neuroendocrine carcinoma (NEC). We reviewed 22 gastric NETs that were encountered in our institutions. Nine, 6, and 4 were NET G1, G2, and NEC, respectively. We also encountered 3 NET G3. NET G1 was treated with observation in 2 patients, endoscopic mucosal resection (EMR) in 3, and gastrectomy in 4 patients. No recurrence was experienced during a median of 53 months of follow-up. All NET G2 was treated with gastrectomy. No patient experienced recurrence during a median of 25 months of follow-up. NET G3 was treated with gastrectomy. One patient died of liver metastasis 52 months after gastrectomy. For NEC, gastrectomy was performed in 3 cases and no patients died of tumor-related death. We conclude that the prognoses of NET G1 and G2 were good. We also experienced long-term survivors of NEC. An accumulation of more patients is needed for further investigation.

Blunt thyroid trauma with acute hemorrhage and respiratory distress.

We report a rare event of acute hemorrhage into a thyroid adenoma after blunt trauma and causing respiratory distress. A 65-year-old woman fell and hit the left side of her anterior neck without any other injuries. The next day, she suffered from severe dyspnea and respiratory distress, and visited a community hospital. She required endotracheal intubation and was immediately transferred to a regional emergency center. Computed tomography and magnetic resonance imaging revealed significant tracheal deviation to the right due to an extensive hematoma surrounded by a capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. The patient was referred to our hospital because the diagnosis of malignant thyroid tumor was not completely ruled out. She successfully underwent left lobectomy of the thyroid gland without sternotomy. The pathological examination revealed follicular adenoma of the thyroid gland with massive intratumor bleeding.

Usefulness of an estimation of physiologic ability and surgical stress (E-PASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery.

Surgical intervention induces various host responses to maintain homeostasis. When postoperative inflammation is intense and persists for a long time, postoperative complications may occur, sometimes developing into multiple organ failure. Therefore, it is very important to assess surgical stress and predict the risk of morbidity and mortality. Using a new scoring system, an estimation of physiologic ability and surgical stress (E-PASS) scoring system, surgical stress following gastrointestinal surgery was evaluated to assess the feasibility of this scoring system. This system comprises a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) that is calculated from both the PRS and the SSS. The relationship of the E-PASS score to the incidence of morbidity and mortality was examined. The relationship between the E-PASS score and a sequential organ failure (SOFA) score was also evaluated. The CRS had a significant positive correlation between not only the incidence but also the grade of postoperative complications. Total maximum SOFA score in patients with a CRS of more than 1 was significantly higher than that in patients with a CRS of less than 1. In conclusion, the E-PASS scoring system will be useful for predicting and recognizing the risk of postoperative complications. This scoring system is brief, simple, and reproducible and can be useful in all types of hospitals.