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We experienced 2 cases of pelvic recurrence from rectal cancer. These patients received radiofrequency ablation(RFA) therapy. Case 1 was a 76-year-old man who underwent intersphincteric resection for lower rectal cancer in October 2013. In May 2015, the patient received systemic chemotherapy for multiple lung metastases and pelvic local recurrence. In January 2017, RFA was performed to reduce the pain of the pelvic recurrence. Immediately after RFA, the pain markedly reduced, and 2 months after treatment, the patient discontinued his pain therapy. Case 2 was a 48-year-old man who underwent Hartmann 's procedure for ulcerative colitis with rectal cancer in November 2011. In July 2012, we performed abdominoperineal resection for rectal cancer that developed in the remnant rectum. In November 2012, he received systemic chemotherapy for multiple lung metastases and pelvic recurrence. In addition, we performed stereotactic radiotherapy(SRT)for the pelvic recurrence. In May 2016, because he developed bilateral hydronephrosis and painful pelvic recurrence, we performed bilateral nephrostomy and RFA for the painful pelvic recurrence. After RFA, pain reduced, but he developed a pelvic abscess that was treated by CT-guided drainage. He underwent complete ablation for the recurrent pelvic mass 2 years after RFA but died of exacerbation of multiple lung metastases. CT-guided RFA for painful pelvic recurrence from rectal cancer can be considered a feasible and effective treatment to reduce pain.

A 67-year-old woman was diagnosed with cecal cancer, para-aortic lymph node metastasis, peritoneum dissemination, and left breast cancer. We administered mFOLFOX6 plus panitumumab for cecal cancer and an aromatase inhibitor for her breast cancer. She received 7 courses of systemic chemotherapy and showed a partial response. She additionally received 5 courses of mFOLFOX6 plus panitumumab. We performed ileocecal resection, sigmoidectomy, right oophorectomy, dissection of the para-aortic lymph nodes, and peritoneal dissemination. The histopathological findings revealed adenocarcinoma, ypT3, ypN0, ycM0, ypStage II (therapeutic effect Grade 2). One month later, she underwent an enforced left breast segmental resection and sentinel lymph node biopsy(0/2). The results of the pathological examination indicated no residual cancers (therapeutic effect Grade 3). The patient is now in good health and was administered S-1 as an outpatient.

We had 2 cases of liver-limited and unresectable liver metastases from colorectal cancer with RAS mutations. These patients received hepatic arterial infusion chemotherapy(HAI), finally achieving pCR. Case 1 was a 76-year-old female with rectosigmoid cancer and multiple liver metastases. We underwent anterior resection for primary lesion. After surgery, the patient had received first-line and second-line systemic chemotherapy for the multiple liver metastases. The patient achieved SD and had Grade 3 neutropenia. We then performed HAI as third-line chemotherapy and we therefore underwent hepatectomy. The results of the pathological examination after hepatectomy pCR and is currently alive without cancer recurrence for 61 months. Case 2 was a 53-year-old male with sigmoid colon cancer and multiple liver metastases. We underwent sigmoidectomy with laparoscopic assistance. Three months after surgery, we underwent resection of the lateral segment of the liver under laparoscopy. This patient had cancer recurrence in the remnant liver at 6 months after surgery and had received first-line systemic chemotherapy. The patient had Grade 3 neutropenia after 1 course of chemotherapy and showed no improvement. We then performed HAI as second-line chemotherapy, and we therefore underwent hepatectomy. The results of the pathological examination after hepatectomy were pCR and he is currently alive without cancer recurrence for 30 months.

Case 1: 63-year-old woman received abdominoperineal resection with lateral lymph node dissection for rectal cancer in 2008. After adjuvant chemotherapy, she suffered from lung metastasis and received partial pneumonectomy in 2012. However, chemotherapy was performed again for lung metastasis and mediastinal lymph nodes in 2013. Radiofrequency ablation (RFA)was performed to lung metastasis in 2016 due to ineffectiveness of chemotherapy. Case 2: 81-year-old man received Hartmann's procedure for rectal cancer with lung and liver metastasis in 2012. After 6 months of chemotherapy, liver partial resection and pulmonary partial resection were performed. In spite of additional chemotherapy, He received partial pneumonectomy in 2013. In 2014, he restart chemotherapy due to lung metastasis. In 2016, he received RFA for lung metastasis because of ineffectiveness of chemotherapy. After that, he received g-knife for brain metastasis. He is going to receive RFA for another lung metastasis.

The patient was a 65-year-old man. He had not defecated for a week in early December 2015, and had noticed abdominal pain and abdominaldistension from 4 days prior. The pain and distension worsened, and the patient was rush transported to our hospital. Via abdominal CT we found free air in the upper abdomen, expansion of the small and large intestines, and notably, significant intestinal tract expansion and a gas reservoir in the ascending colon. We found significant narrowing as well as hypertrophy along the entire circumference of the rectum and suspected gastrointestinal perforation due to rectal cancer ileus. Inflammation findings were abnormally high and we performed emergency surgery. We found a laceration on the ascending colon, which had expanded markedly. We elevated that location and installed a colostomy. Following surgery the patient developed mild SSI and ileus, which were alleviated through conservative treatment. A month after the operation we performed a colonoscopy and found a tumor along the entire circumference of the rectum Rs. It was diagnosed as group V tub1-2 via biopsy. We performed surgery in late January 2016(colostomy closure, laparotomy rectal low anterior resection). We are reporting a rare case where rectal cancer ileus caused perforation in the ascending colon.

In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.

A woman in her sixties underwent total gastrectomy for gastric cancer. The pathological diagnosis was pT3, pN3, sH0, pCY0, sP0, sM0, fStage IV. Chemotherapy with S-1 was used after surgical treatment. Because a CT scan after three courses chemotherapy showed the paraaortic lymph nodes swelling, combination chemotherapy with S-1 and docetaxel was used as a second-line chemotherapy. When the CT scan after 8 courses of this combination chemotherapy revealed multiple liver metastases, the chemotherapy was changed to CPT-11 monotherapy and paclitaxel monotherapy as the third-and fourth-line chemotherapy, respectively. In spite of those chemotherapies, the metastatic disease progressed, and therefore, combination chemotherapy with S-1 and CDDP was used as the fifth-line chemotherapy. After 6 courses of this treatment, serum CEA and CA19-9 levels dropped into the normal range. Multiple liver metastases were markedly reduced, and were considered as a partial response(PR). The patient is still alive, maintaining the effect of PR for 17 months without any adverse effects except appetite loss and vomiting of grade 2.

This report describes psychiatric occupational therapy practice and collaboration between occupational therapists and psychiatrists at Shinshu University Hospital. Collaboration with psychiatrists enables us to provide the following occupational therapy programs. (1) Individual occupational therapy approaches for patients at the early recovery stage in the psychiatric ward. (2) Psychoeducational interventions by a multi-disciplinary team (MDs, nurses, OTRs, PSWs, CPs). (3) Occupational therapy approaches used in combination with m-ECT for severe psychiatric disorders. (4) Recovery support programs for psychiatric outpatients. It is suggested that occupational therapists should collaborate with psychiatrists in order to facilitate rehabilitation services for people with psychiatric disorders.

von Hippel-Lindau (VHL) syndrome is an inherited neoplastic syndrome caused by abnormity of the VHL gene found on the short arm of the chromosome 3. We reported a case of VHL disease diagnosed by the detection of multiple pancreatic endocrine tumors and renal tumor 13 years after bilateral adrenalectomy. A 40-year-old man presented with multiple pancreas tumors (maximum size 42 mm in diameter) detected by screening abdominal ultrasonography. A 23 mm renal tumor was detected by contrast computed tomography scan at that time. His past history included left retinal angioma (age 15) and bilateral adrenal pheochromocytoma (age 27). VHL was diagnosed by genetic testing. Endoscopic ultrasound-guided fine-needle aspiration biopsy of the pancreas tumor was performed, and tumor was diagnosed as an endocrine tumor. After diagnosis, distal pancreatectomy (body-tail) was performed. This was a didactic case indicating that we should suspect VHL syndrome based on past history and family history and follow such cases up strictly.

Unlabelled: We evaluated the efficacy of gastrojejunostomy for advanced gastric cancer patients with peritoneal dissemination., Patients and Methods: We evaluated the clinical outcome of 11 patients (average age 73.5 years for 8 men) who received gastrojejunostomy for gastric outlet obstruction caused by advanced gastric cancer with peritoneal dissemination between October 2003 and December 2008. We performed stomach-partitioning gastrojejunistomy with tube jejunostomy., Results: Three patients with performance status 3 and severe peritoneal dissemination deteriorated during the early postoperative days and were transferred to terminal care. These three patients died after 23, 26 and 60 days. The other 8 patients were discharged from hospital between 10 and 35 days postoperatively (median hospital stay 16 days) and received chemotherapy with S-1 on an outpatient basis. All patients died within one year except the one who showed a partial response to chemotherapy and lived for 40 months (MST: 8 months in all patients)., Discussion: It seemed that there was little adaptation to gastrogejunostomy as palliation surgery for patients with poor performance status (PS 3) and severe peritoneal dissemination.

We present a case of advanced esophageal cancer with multiple lymph node metastases successfully treated by combination therapy of docetaxel, cisplatin and 5-FU (DCF) followed by salvage lymphadenectomy. The patient was a 60-year-old female with the diagnosis of squamous cell carcinoma of the middle thoracic esophagus. The clinical stage diagnosis was cT2N4M0, cStage IVa. Systemic chemotherapy with DCF was started as the initial treatment. The changes noted on endoscopy and CT scan in the primary lesion and lymph nodes after two cycles of DCF were judged as complete response (CR). However, recurrence was diagnosed in the left cervical lymph nodes based on FDG uptake on FDG-PET. Salvage cervical lymphadenectomy was performed. Thereafter, the patient again achieved CR after the second administration of DCF for upper mediastinal lymph node recurrence. At present, she is still alive three years after the first visit. Combination therapy of DCF and salvage lymphadenectomy is potentially effective for advanced esophageal cancer with lymph node metastases.

Skip metastasis in colorectal cancer consists of about 10% of lymph node metastases. We report a rare long-term surviving patient of skip metastasis to lateral nodes after lymph node dissection. A forty-two years old female received anterior resection for advanced rectosigmoid cancer. Because pathological stage of the patient was stage IIIa (T3N1M0), standard adjuvant chemotherapy was provided. Serum CEA increased just two years after the first operation. PET scan showed abnormal FDG uptake in lymph nodes along the aorta. Lymph nodes along the inferior mesenteric artery (IMA), bilateral common iliac artery and aorta were dissected. There were metastases to nodes along the common iliac artery but no metastasis along the IMA was observed. So we diagnosed it as skip metastasis. The patient is still alive without any metastasis after 6 years from the second operation.

Since the Odor Stick Identification Test for Japanese (OSIT-J) has proved clinically useful in Japan, the Open Essence (OE) smell identification test card has been developed to amend OSIT-J deficits. To determine its clinical effectiveness, we administered the OE to 93 Japanese subjects reporting olfactory dysfunction. They scored their olfactory dysfunction on levels one to five, i.e., normal to anosmic, using the Japan Rhinologic Society Self-Administered Odor Questionnaire (SAOQ) and the visual analog scale (VAS). They also took the Japanese standard olfactory test (T & T olfactometry) and intravenous olfactometry (Alinamin test). Opinions on the OE and OSIT-J were recorded from those previously administered the OSIT-J and testers familiar with OSIT-J administration. The OE took 5.1+/- 1.6 minutes to administer. Scores correlated significantly for the OE, self-reported olfactory function, SAOQ, VAS, T & T olfactometry recognition threshold, and Alinamin latency and duration time. Subjects and testers reported the OE to be easier, shorter, more interesting, and more convenient, indicating its utility in clinical olfactory dysfunction evaluation and its convenience for both subjects and testers.

Background: Using the ELISPOT assay, a promising immunological tool for detecting Mycobacterium tuberculosis (MTB) antigen-specific response, we monitored the clinical course of patients with tuberculosis (TB)., Methods: Blood samples were obtained from 35 patients with TB and healthy controls, numbering 52 age-matched control subjects and 43 university students. Nine of those with TB were examined twice before and after anti-tuberculosis treatment. The frequency of IFN-gamma secreting cells was determined using the ELISPOT assay in peripheral mononuclear cells (PBMC) stimulated with purified protein derivative (PPD), early secretory antigenic target 6 (ESAT-6), and culture filtrate protein 10 (CFP-10)., Results: The frequency of PPD secreting cells correlated significantly with tuberculin skin test (TST) magnitude in BCG-vaccinated individuals. Significant responses to either ESAT-6 or CFP-10 were found in 94% of those with TB. The frequency of IFN-gamma secreting cells decreased when negative sputum tests were confirmed by successful tuberculosis treatment., Conclusions: The ELISPOT assay detecting MTB-specific immune response is promising both in diagnosing MTB and monitoring responsiveness to tuberculosis therapy.

We report a patient with an advanced gastric cancer complicated by pyloric stenosis who was effectively treated by S-1 mono-therapy after gastrojejunostomy. A 62-year-old man consulted a general practitioner for abdominal pain and anorexia. Gastric roentgenography and upper gastrointestinal endoscopy showed gastric cancer(Borrmann Type 3) with pyloric stenosis. He was referred to our department. He underwent laparotomy, which revealed a T4 tumor invading the pancreas head, but neither liver nor peritoneal metastasis. A gastrojejunostomy was made. After the operation, chemotherapy of S-1(120 mg/day, day 1-21)+cisplatin(100 mg/day, day 8)was administered. After 2 courses, level of tumor marker decreased remarkably and abdominal enhanced computed tomography showed a significant size reduction of lymph nodes and that direct invasion to the pancreas was not clear any more. Second laparotomy was carried out and curative surgery was performed. After 4 courses of S-1(120 mg/day, day 1 approximately 28)mono-therapy as adjuvant chemotherapy, bone metastasis was confirmed by scintigram. Then methotrexate+5-FU, irinotecan+cisplatin and cisplatin+paclitaxel were chosen as second-, third-and fourth-line chemotherapy, which were not effective for long. He died 572 a days after the initial surgery. In the past, gastrojejunostomy was regarded as useful palliative treatment for those with gastric outlet stenosis to ameliorate the QOL. As S-1 is taking major role in the chemotherapy for advanced gastric cancer recently, usefulness of bypass surgery for such patients is highlighted even for longer survival time.

We clarified the clinical features of "flavor dysfunction," defined as olfactory dysfunction with self-reported hypogeusia but normal taste function in gustatory tests compared to those of "smell and taste dysfunction" hyposmia and hypogeusia in olfactory and gustatory tests. Patients with flavor dysfunction reported significantly milder taste loss than those with other smell and taste dysfunction. The major smell and taste loss etiology was upper respiratory tract infection (URI) in the flavor dysfunction group and the URI rate was significantly higher in the flavor dysfunction group than in the smell and taste dysfunction group. Smell identification thresholds in T & T olfactometry were not different between groups. Flavor dysfunction, hyposmia was treated medically but not with conventional hypogeusia medication. Medication including zinc was administered for other smell and taste dysfunction. Both groups significantly recovered from taste dysfunction. Our results indicate that treating olfactory dysfunction effectively improves flavor dysfunction but hypogeusia need not necessarily be treated. Hyposmia and hypogeusia must be treated together for other smell and taste dysfunction, making it vital that we conduct appropriate gustatory testing to correctly differentiate between flavor and other smell and taste dysfunctions.

We encountered a rare case of lymphocytic interstitial pneumonia (LIP) complicated with primary Sjögren's syndrome (SjS), followed by chest CT scanning for a long period of time. A 54-year-old man with hemoptysis was admitted to our hospital in December, 2001. A diagnosis of SjS was made based on elevation of anti-SS-B/La antibody titer in serum in combination with diagnosis of keratoconjunctivitis sicca and xerostomia on a Schirmer test and a lip biopsy, respectively. Subsequent histopathological diagnosis by open lung biopsy showed LIP. Chest CT in September, 1995 at previous hospital revealed ground-glassed opacity (GGO), small nodules, thickened bronchovascular bundles and cyst formation in lungs. Chest CT was performed every year until 2008, when remarkable progression from thickened bronchovascular bundles accompanied by nodular opacities to an air-space consolidation in the right lower lobe was observed. Also, appearance of cyst formation in the right middle lobe, nodular lesions and GGO in the left lower lobe were noticed. Although the nodular opacities and GGO improved after an administration of corticosteroid (PSL 0.5 mg/kg/day), little improvement in the consolidations and cyst formation was demonstrated. In conclusion, it was suggested that differences among CT findings of LIP may be important for evaluating of efficacy of treatment by steroid agents for LIP associated with SjS.

A mass screening of subjects for prostate specific antigen (PSA) was conducted to investigate whether this method is effective in detection of early stage prostate cancer. From 2001 to 2005, 1022 patients in Yokosuka City with pathologically diagnosed prostate cancer by using prostate needle biopsy were divided into screened (S: 276 patients) and non-screened (NS: 746 patients) groups. Clinical factors (mean age, PSA at diagnosis, clinical stage, Gleason score, WHO classification, cases of radical prostatectomy) were evaluated and analyzed. Statistical significance was analyzed by Mann-Whitney's U-test. The mean age was 70.7 and 72.7 (p<0.0001) in the S group and NS group, respectively; mean PSA at diagnosis was 10.5 and 18.6 ng/ml (P=0.0139); percentage of organ-confined disease (T2b or lower clinical stage), 75 and 55 (p<0.0001); percentage of non-metastatic diseases was 92 and 77 (p<0.001) and percentage of pathologically poor-risk cancer (8 or more Gleason score) was 22 and 38 (p=0.0004), respectively. In conclusion, PSA mass screening was found useful to detect early stage prostate cancer in Yokosuka City. Further studies should be conducted to determine whether PSA mass screening will be able to decrease mortality of prostate cancer.

Intranasal topical steroids are commonly used for the treatment of olfactory dysfunction. Although the side effects are considered to be minimal, these have not been studied in detail. We examined the side effects of intranasal topical treatment with steroids in patients with olfactory dysfunction. We treated 62 patients with intranasal topical application of 0.1% betamethasone sodium phosphate (Rinderone) administered to the olfactory clefts. After treatment for 1 or 2 months, serum ACTH or cortisol was reduced in 42 (68% of total) patients, however, no clinical symptoms associated with steroid side effects were observed. The treatment was discontinued in 8 of these patients, who elected to withdraw from the treatment. In these patients, the serum ACTH or cortisol returned to normal a month after stopping the treatment. In the remaining 34 patients, the topical treatment was continued and in only 4 of these patients, minor steroid-associated side effects such as the sensation of facial swelling and facial hair thickening, appeared 2-5 months after beginning the treatment. These side effects disappeared within a month after stopping the treatment. Regarding the therapeutic efficacy, in 18 (78%) of the 23 patients who continued treatment for an average period of 5 months, steroid treatment significantly improved their olfactory dysfunction. In conclusion, although it is important to consider the potential side effects of long-term intranasal topical treatment with steroids for olfactory dysfunction, this treatment is a highly effective method against olfactory dysfunction with minimal side effects.

We encountered a very rare case of cT0N2M0 small cell lung cancer (SCLC) with Lambert-Eaton myasthenic syndrome (LEMS). A 69-year-old man with a complaint of muscle weakness was admitted to our hospital. Although his chest radiograph on admission showed no abnormal findings, CT scanning detected a mediastinal lymphadenopathy. Also, 2-[18F]-2-fluorodeoxy-D-glucose position emission tomography (FDG-PET) revealed increased accumulation in the same portion in the mediastinum. A diagnosis of LEMS was made from the distinctive electromyogram (EMG) findings (waning and waxing phenomenon in response to low-and high-frequency repetitive stimulation, respectively) in combination with the increased serum level of a P/Q-type anti-voltage-gated calcium channel (VGCC) antibody. Subsequent histopathological diagnosis by mediastinoscopic resection of a paraaortic lymph node was small cell carcinoma. No distant metastasis was detected by MRI of the brain, abdominal CT scan or an FDG-PET. Eight courses of chemotherapy (carboplatin + etoposide) with radiotherapy of the mediastinum (for a total dose of 45 Gy) was performed. A decreased serum level of P/Q-type anti-VGCC antibody titers followed by marked improvement of neurological dysfunction (muscle weakness, gait disturbance and scanning speech) and of an EMG finding (a loss of waning phenomenon) was observed. A close relationship between reduction of the antibody titers and improvement of neurological symptoms after the therapy was noticed. It was suggested that monitoring the level of a P/Q-type anti-VGCC antibody titer in the serum is important for evaluating the efficacy of chemotherapy for LEMS associated with SCLC.

We report 2 cases of congenital anosmia, in a 13-year-old girl and the other in a 10-year-old boy. They reported having no concept of "smell". The girl has no complications but the boy has congenital microphthalmia and is completely blind. They showed scale-out results on both T & T olfactometry and intravenous Alinamin test. Brain MRI detected hypoplasia or lack of the olfactory bulbs, tracts, and olfactory sulci in the frontal lobe of the brain in both patients. Neither had endocrinal dysfunction. In the boy, we biopsied the nasal mucosa in the olfactory cleft and found it had no olfactory epithelial cells at all. We found MRI to be the most useful imaging for diagnosing congenital olfactory disturbance.

We retrospectively analyzed 72 children suffering from respiratory disturbance during sleep at Mie University Hospital for sleep study or surgical treatment from 1992 to 2001. Their clinical symptoms included snoring (100% of 72 inpatients), sleep apnea (60%), mouth breathing (44%), and nasal obstruction (30%). Forty-seven reported sleep apnea and 28 (60% of total) corresponded to criteria for the sleep apnea syndrome (apnea index: AI > or = 5.0). These symptoms were caused by adenoid vegetation and/or hypertrophy of the palatine tonsils. No significant correlation was seen among size of the adenoid, that of the palatine tonsil, body mass index, AI, and blood oxygen saturation (SpO2) during sleep. Surgical treatment with adenotomy and/or tonsillectomy was performed in 66 patients. After treatment, clinical symptoms diminished within a week, and AI and SpO2 during sleep improved significantly. Recurrence of snoring was observed 19, 23, and 21% of patients 1, 3, and 5 years after treatment. Sleep apnea recurred in only 1 patient 7 years after adenotomy. Seventy-five percent of children who had the clinical symptoms 1 month after treatment have shown the same symptoms continuously for a long time. In conclusion, surgical treatment for children's respiratory disturbance during sleep is effective and involves a low rate of symptom recurrence.