Laparoscopic Resection Combined with a Transsacral Approach for a Recurrent Tailgut Cyst with a Refractory Fistula.

Tailgut cyst is a rare cystic disease of the anterior sacral surface and the remains of an embryonic tail gut. Tailgut cysts have a potential for malignancy, and complete resection with an adequate surgical margin is necessary. Even if incomplete resection does not result in recurrence of malignant disease, there is a risk of local infection leading to refractory fistulas. The optimal treatment for such refractory recurrent lesions has not been reported. We describe a case in which the combination of laparoscopic and transsacral approaches was effective for resecting a recurrent refractory fistula after incomplete resection of a tail gut cyst.

Development of medication regimen complexity index: Japanese version and application in elderly patients.

Background Medication regimen complexity includes various aspects of a regimen, including the dosage form, number of medications and need for additional information for use. Complicated medication regimens cause non-adherence to prescribed medications, making it essential to evaluate medication regimen complexity in older adults to improve adherence to prescribed medications and clinical outcomes. The medication regimen complexity index is currently the most widely used scale for quantifying regimen complexity; however, it has yet to be adopted in Japan. Objective This study aimed to translate the medication regimen complexity index to Japanese and assess its reliability and validity for application in elderly patients in Japan. Setting This study was conducted in a clinic that provides home medical care to patients in the southern part of Ibaraki prefecture, Japan. Method The validation process consisted of translation of the original English version of the medication regimen complexity index to Japanese followed by back-translation to English, comparison of the back-translated and original versions, pilot testing, and assessment of the Japanese version by two raters using the medication regimens of 72 patients with chronic diseases. Main outcome measure The psychometric properties of the index were evaluated according to inter-rater and test-retest reliability, and convergent and discriminant validity. Results The mean age of the 72 patients was 84.3 years. The scale showed high inter-rater reliability (intraclass correlation coefficient 0.946) and test-retest reliability (intraclass correlation coefficient 0.991) for total scores. The number of medications was positively correlated with total medication regimen complexity index score (rs = 0.930, P < 0.001). There were no statistically significant differences between age, sex and Charlson Comorbidity Index and medication regimen complexity index score (P > 0.05). Conclusions The Japanese version of the medication regimen complexity index is a reliable and valid tool for assessing the complexity of medication regimen in Japanese elderly patients.

A Standard Intervention Practice to Promote Appropriate Lamotrigine Therapy by Pharmacists.

The dosage and frequency of lamotrigine administration for each patient must be prescribed carefully according to the disease, age, concomitant medications, and administration period. According to Pharmaceuticals and Medical Devices Agency (PMDA) reports, either the number of patients with adverse events caused by the inappropriate use of lamotrigine or the ratio of the patients who have benefited from the Relief System for Adverse Drug Reactions did not change even after the revision of the package insert in 2015. The procedure for auditing lamotrigine prescriptions was standardized to improve patient safety in our hospitals. The efficacy of standardization was evaluated by investigating the patients' records and prescriptions. A total of 77 patients treated with lamotrigine were examined to evaluate the appropriateness of the dosage and frequency of administration as well as the number of prescription enquiries made by pharmacists retrospectively. In addition, the presence of adverse events such as skin rash was examined using medical records. The number of inappropriate cases found and the prescription questions asked by pharmacists during the 24-month period before and after standardization were compared. The rate of inappropriate prescriptions after standardization was significantly lower than that before (12.1 vs. 29%; p<0.05). The rate of prescription questions raised after standardization was significantly higher than that before (37.0 vs. 1.7%; p<0.05). Moreover, there was no adverse event after standardization. Our standardization practice was effective to easily identify inappropriate prescriptions and provide physicians with the appropriate dosage or frequency of administration for the patients.

[A case of hyperammonemic encephalopathy in a patient with recurrent colon cancer treated with modified FOLFOX6].

FOLFOX therapy is a commonly used chemotherapeutic regimen against recurrent and unresectable colon cancer. However, its acute neurotoxicity is rare and not well recognized. We herein report a case of mFOLFOX6-induced hyperammonemic encephalopathy in a patient having recurrent colon cancer. A 74-year-old female with a history of sigmoid colon cancer was diagnosed as liver, lung, and peritoneal recurrences by surveillance CT and PET/CT. She was initially treated with modified FOLFOX6 therapy. After completing treatment, she presented with sudden onset of confusion, cognitive disturbances, and repeated seizures. None of the other radiographic examinations and laboratory tests provided an explanation for her symptoms except hyperammonemia. She was treated with branched-chain amino acid solutions and high-volume drip infusion, 6 hours after which the encephalopathy resolved. Clinicians should be aware of the adverse hyperammonemia induced by mFOLFOX6 when patients treated with mFOLFOX6 present with neurological disorders.

Fieldservers and Sensor Service Grid as Real-time Monitoring Infrastructure for Ubiquitous Sensor Networks.

The fieldserver is an Internet based observation robot that can provide an outdoor solution for monitoring environmental parameters in real-time. The data from its sensors can be collected to a central server infrastructure and published on the Internet. The information from the sensor network will contribute to monitoring and modeling on various environmental issues in Asia, including agriculture, food, pollution, disaster, climate change etc. An initiative called Sensor Asia is developing an infrastructure called Sensor Service Grid (SSG), which integrates fieldservers and Web GIS to realize easy and low cost installation and operation of ubiquitous field sensor networks.

Cytomegalovirus colitis after systemic chemotherapy in a patient with recurrent colon cancer: a case report.

INTRODUCTION: The occurrence of cytomegalovirus colitis is well known in immunosuppressed patients, such as neoplastic patients following chemotherapy, although its exact etiology remains unclear. CASE PRESENTATION: We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer. Initial colonoscopy revealed multiple punched-out ulcers in the transverse colon and the diagnosis of cytomegalovirus was based on positive cytomegalovirus antigen detected by indirect enzyme antibody method, although immunohistological examination of tissues biopsied at colonoscopy was negative. The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually. CONCLUSION: The most probable cause of the cytomegalovirus colitis in this case was impaired immunity following chemotherapy. Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.

Synthetic studies on glycosphingolipids from Protostomia phyla: syntheses and biological activities of amphoteric glycolipids containing a phosphocholine residue from the earthworm Pheretima hilgendorfi.

Two types of amphoteric glycosphingolipid found in the earthworm Pheretima hilgendorfi, PC(-->6)-beta-d-Galp-(1-->6)-beta-d-Galp-(1-->1)Cer (1) and PC(-->6)-beta-d-Galp-(1-->6)-beta-d-Galp-(1-->6)-beta-d-Galp-(1-->1)Cer (2), and their derivatives (4, 5) were synthesized. These were examined for their ability to enhance production of interleukin-8 (IL-8), a potent inflammatory cytokine involved in neutrophil chemotaxis, in a TNFalpha-stimulated granulocytic HL-60 cells. Compounds 1 and 2 were found to be potent enhancers of IL-8 production.

[Marked response to S-1 chemotherapy for para-aortic lymph node metastasis arising from gastric cancer].

We report a recurrent case of gastric cancer with para-aortic lymph node metastasis that showed a marked response to systemic chemotherapy consisting of S-1 alone. A 70-year-old male was admitted to our hospital with appetite loss and left abdominal pain. He had a history of distal gastrectomy due to the advanced gastric cancer. Endoscopy revealed a submucosal tumor-like elevation with central ulcer, and the biopsy specimen was poorly-differentiated adenocarcinoma histologically. CT of the abdomen demonstrated a para-aortic lymph node swelling behind the remnant stomach, indicating an unresectable recurrent gastric cancer. We initially treated the patient with S-1 chemotherapy (60 mgx2/day) by oral administration. His tumor immediately responded to the chemotherapy, and restaging abdominal CT after 2 cycles of chemotherapy showed almost complete regression of lymph node metastasis. The patient has undergone S-1 chemotherapy and currently has remained in remission for more than 21 months with no severe adverse events. The S-1 regime was effective and safe, suggesting that S-1 could be the first-line chemotherapy for recurrent gastric cancer.

Risk of accidental invasion and expansion of allochthonous mice in Tokyo metropolitan coastal areas in Japan.

House mouse (Mus musculus) is one of the perilous animal vectors for imported zoonosis such as a lymphocytic choriomeningitis (LCMV) infectious disease, and probably unknown emerging and/or re-emerging infectious diseases as well. It is necessary to prevent such diseases by regular surveys for behavioral trends of these allochthonous mice. However, such a trial has never been attempted in Japan. From 1998 to 2002, we analyzed partial sequences of the D-loop region in mtDNA, which provides powerful diagnostic SNPs for subspecies identification in the Mus musculus species, from 301 individuals of mice collected in 23 international bays or airports in Japan. We found that invasion of many allochthonous mice, which were identified as European subspecies, Mus musculus domesticus, occurred in Tokyo metropolitan coastal area. Based on the evidence, we warn that extensive invasion of allochthonous mice has occurred recently and, therefore, the risk of emerging and/or re-emerging infectious diseases invasion might be high in Tokyo metropolitan area.

ICAM-1 expression and the soluble ICAM-1 level for evaluating the metastatic potential of gastric cancer.

ICAM-1 plays an important role in cell-cell and cell-extracellular matrix interactions, especially tumor invasion and cytotoxicity of lymphocytes. In the present study, the relationship between metastasis of gastric cancer and ICAM-1 expression by cancer cells or the serum level of s-ICAM-1 was (s-ICAM-1) was examined. ICAM-1 was detected by immunohistochemic staining in 49.0% of 108 patients with gastric cancer. The ICAM-1 expression rate was higher at a more advanced stage, based on lymph node metastasis, being 46.9% in node-negative and 56.1% in node-positive cases. In patients with liver metastasis, the rate was 90.9%, while it was 43.3% in patients without liver metastasis (p < 0.05). The serum s-ICAM-1 level was 262.1 ng/ml (median 205.5, range 176.0-271.0) in healthy subjects and 391.5 ng/ml (median 317.5, range 148.7-1,768.0) in gastric cancer patients (p < 0.001). The serum s-ICAM-1 level was significantly higher in patients with liver metastasis than in patients without liver metastasis (p < 0.0001). In addition, positive ICAM-1 expression cases had significantly higher s-ICAM-1 levels than negative ones, 408.9 +/- 188.4 and 308.1 +/- 88.1 ng/ml, respectively. These results suggested that ICAM-1 was overexpressed in cancer cells and released as s-ICAM-1, which would promote hematogenous metastasis by suppressing local anticancer immunity.