[A Case of Intrahepatic Cholangiocarcinoma in Contact with the Gastroduodenal Anastomosis in Which Proton Beam Therapy Was Performed after Placement of an Absorbable Spacer].

Chemotherapy is the standard therapy for unresectable intrahepatic cholangiocarcinoma(ICC), but chemotherapy is not efficacious. Proton beam therapy(PBT)has been covered by Japanese health insurance for ICC since 2022, and the number of cases is expected to increase. In some cases, irradiation is difficult due to the close proximity of the gastrointestinal tract to the tumor. We report our management of a patient with ICC close to the gastrointestinal tract. The patient was a 69-year- old woman with a history of distal gastrectomy and Billroth-Ⅰ reconstruction for gastric cancer. A CT scan showed a tumor in liver S3; a biopsy revealed ICC. Because the tumor was in contact with the gastroduodenal anastomosis, we placed an absorbable spacer and performed PBT. After the treatment, the tumor shrank slightly. Although the liver is anatomically adjacent to the digestive tract, the placement of absorbable spacers facilitates performing PBT without adverse events, and is thus considered a useful treatment.

Robotic surgical procedure for diffuse cavernous hemangioma of the rectum: A case report.

Diffuse cavernous hemangioma of the rectum (DCHR) is a relatively rare benign vascular disease. DCHR is marked by recurrent bleeding and anemia, and it is difficult to diagnose correctly. Here, we report the case of a 34-year-old man diagnosed with DCHR by colonoscopy, CT, and endoscopic ultrasonography. The patient underwent a robot-assisted anterior abdominal excision and subsequently recovered well from the surgery. Ileostomy closure was performed 3 months after surgery. Eight months after surgery, he had no evidence of rectal bleeding, and his defecation function was good, with no fecal incontinence. Regardless of the characteristics of DCHR and the susceptible age of DCHR, it is important to diagnose DCHR correctly as soon as possible and to treat it without a permanent colostomy. Robot-assisted resection may be a good option for the treatment of DCHR.

Laparoscopic two-stage procedure for gallstone ileus.

Gallstone is a rare cause of bowel obstruction and is associated with high rates of morbidity and mortality. Here, we report a case of gallstone ileus treated by laparoscopic two-stage procedure. A 65-year-old man, without a history of any surgery, presented to our hospital with abdominal pain and vomiting. His abdominal computed tomography revealed gallstone ileus with cholecystoduodenal fistula. Then, enterolithotomy was performed as an emergency laparoscopic surgery. After 1 year of the surgery, a second laparoscopic procedure was performed for cholecystectomy and fistula closure. The patient was discharged on the 7th postoperative day. Laparoscopic two-stage procedure is a safe and an efficient approach for the management of gallstone ileus. This definitive treatment is minimally invasive, thereby suitable for treating elderly patients.

Paracecal hernia with intestinal ischemia treated with laparoscopic assisted surgery.

INTRODUCTION: Paracecal hernia is rare, and strangulation with ischemia has been infrequently observed in the limited number of published reports on paracecal hernias. PRESENTATION OF CASE: We describe a case of an incarcerated paracecal hernia with resultant ischemic bowel that was successfully treated with laparoscopic-assisted surgery. A 54-year-old man who had not undergone any surgery previously presented to our hospital with abdominal pain and vomiting. An abdominal computed tomographic scan showed evidence of an intestinal obstruction at a paracecal site. An emergency laparoscopic surgery demonstrated incarceration of a loop of the small bowel in the paracecal fossa. We removed the incarcerated small bowel from the paracecal fossa, noted that the tissue was necrotic, and resected this segment of bowel through a mini-laparotomy incision. The patient was discharged on the 13th postoperative day. DISCUSSION AND CONCLUSION: This case is unique in that the patient presented with small bowel strangulation, causing intestinal ischemia. Laparoscopic surgery is useful in the diagnosis of internal hernias and is also useful for the treatment of small bowel obstruction due to paracecal hernias complicated by ischemic bowel.

Yezo'otogirins D-H, Acylphloroglucinols and Meroterpenes from Hypericum yezoense.

Investigation of the methanolic extract from the aerial parts of Hypericum yezoense resulted in the isolation of three new acylphloroglucinols, yezo'otogirins D-F (1-3), and two new meroterpenes, yezo'otogirins G (4) and H (5). The structures of 1-5 were assigned on the basis of spectroscopic data. Yezo'otogirin D (1) is an acylphloroglucinol with a monoterpene moiety linked through an ether bond, while yezo'otogirins E (2) and F (3) are polyprenylated acylphloroglucinols possessing a tricyclic core. Yezo'otogirins G (4) and H (5) are linear meroterpenes with an enolized ß-diketone moiety. Yezo'otogirin E (2) exhibited antimicrobial activity against Escherichia coli and Staphylococcus aureus.

Hikiokoshins A-I, diterpenes from the leaves of Isodon japonicus.

Diterpenes, hikiokoshins A-I, and twelve known diterpenes were isolated from the leaves of Isodon japonicus (Burm. f.) H. Hara (Lamiaceae). The hikiokoshins A-I possess various skeletons such as ternifonane {hikiokoshin A}, ent-6,7:8,15-diseco-6,8-cyclokauran-7,20-olide {hikiokoshin B}, ent-6,7-secokauran-7,20-olide {hikiokoshin C}, and ent-7,20-epoxykaurane {hikiokoshins D-I}. Their structures were elucidated on the basis of spectroscopic analysis. Antimicrobial activities of hikiokoshins A and B were evaluated.