Sigmoid colon perforation induced by the vascular type of Ehlers-Danlos syndrome: report of a case.

The vascular type of Ehlers-Danlos syndrome (vEDS) is a rare inherited disease of the connective tissues, and is caused by abnormal type III collagen resulting from heterogeneous mutations of the type III collagen COL3A1 gene. We herein report the case of a vEDS patient who developed a sigmoid colon perforation and was given a definitive diagnosis by a genetic and biomolecular assay. The patient demonstrated clinical manifestations caused by tissue weakness such as frequent pneumothorax events and a detached retina. During the operation, we noticed easy bruising and thin skin with visible veins on the patient's abdominal wall. Finally, a diagnosis was confirmed by the reduction of type III collagen synthesis and by the identification of a mutation in the gene for type III collagen. We conclude that it is difficult to diagnose a vEDS patient without clinical experiences and specialized genetic methods. Furthermore, all organs must be treated gently during therapy, because the tissues of vEDS patients are extremely fragile.

Successful Resuscitation Following Intraoperative Acute Pulmonary Embolism With a Focus on Control of Bleeding After Thrombolytic Therapy: A Case Report.

Acute pulmonary embolism is a serious perioperative complication. Current guidelines focus on hemodynamic stabilization and rapid restoration of pulmonary artery blood flow. However, various complications, most notably bleeding, are associated with treatment of the embolism. We report a case of acute pulmonary embolism with cardiopulmonary arrest during orthopedic surgery. Prompt thrombolysis and gaining control of both thrombolytic therapy-induced bleeding from the wound and a hepatic cyst enabled the patient to recover without neurological deficits.

Synchronous double primary cancers of the extrahepatic bile duct: A case report and literature review.

BACKGROUND: Double cancers of the biliary tract system are rare. Most of these cancers are synchronous double cancers of the gall bladder and bile duct, associated with pancreaticobiliary maljunction (PBM). Synchronous double cancers of the extrahepatic bile duct without PBM are especially rare, and only 4 cases have been reported. CASE PRESENTATION: A 78-year-old woman was admitted to our hospital for examination of hyperbilirubinemia and liver dysfunction. Contrast-enhanced abdominal computed tomography, Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed 2 stenotic regions in the common bile duct: at its junction with the cystic duct and in the distal bile duct. No findings suggested PBM, such as a markedly long common channel. The diagnosis based on endoscopic brush cytology from both stricture portions was adenocarcinoma. The patient had a pylorus-preserving pancreaticoduodenectomy with regional lymph node resection. Macroscopically, there were 2 stenotic regions at the cystic duct junction and in the distal bile duct. Microscopically, the tumor at the junction of the cystic duct was a well-to-moderately differentiated adenocarcinoma. On the other hand, the tumor of the distal bile duct was a poorly differentiated adenocarcinoma. There was no evidence of communication between these 2 cancers. CONCLUSION: Double cancers of the extrahepatic bile duct without PBM are very rare. Therefore, an accurate diagnosis prior to surgery is necessary. Furthermore, this rare condition seems to be associated with a poor prognosis.

Successful continuation of pregnancy after repair of a midgestational uterine rupture with the use of a fibrin-coated collagen fleece (TachoComb) in a primigravid woman with no known risk factors.

We report the first case of successful continuation of pregnancy after repair of a midgestational uterine rupture with the use of a fibrin-coated collagen fleece (TachoComb, Nycomed, Linz, Austria). For midgestational uterine rupture, adequate uterine repair and close surveillance of preterm labor could improve perinatal outcome by permitting continuation of the pregnancy.

Gastric mixed adenoneuroendocrine carcinoma with thyroid transcription factor-1-positive neuroendocrine component.

Small cell carcinoma of the stomach, which is considered synonymous with neuroendocrine carcinoma, is rare. We encountered a case of mixed adenoneuroendocrine carcinoma. Gastrointestinal endoscopy revealed a type 0 IIa + IIc lesion in the stomach. Biopsy suggested well-differentiated adenocarcinoma. Endoscopic submucosal dissection was performed and gastric cancer comprising both well to moderately differentiated adenocarcinoma within the mucous membrane and small cell carcinoma invading to the submucosa with accompanying vessel invasion was found. Mixed adenoneuroendocrine carcinoma was diagnosed and the small cell carcinoma was thyroid transcription factor-1 positive. No tumor lesions were apparent in other organs, so distal gastrectomy and lymph node dissection were performed. Lymph node metastases were not observed. The patient is currently alive without recurrence. Thyroid transcription factor-1-positive gastric neuroendocrine carcinoma is very rare, and the thyroid transcription factor-1-positive rate may contribute to the prediction of prognosis and treatment selection. Accumulation of cases is thus very important.