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The optimal management of patients with appendiceal endometriosis has not been determined because of the difficulty of establishing a preoperative diagnosis. There are no reports of preoperative hormone therapy for a patient with appendiceal endometriosis. We report a patient who underwent resection of appendiceal endometriosis after hormone therapy. A 40-year-old woman with history of recurrent pelvic abscesses presented to the emergency department with lower abdominal pain. The recurrent pelvic abscesses were synchronised with her menstrual cycle. CT scan demonstrated a 25 mm contrast-enhanced luminal structure adjacent to the cecum, which was thought to be a mucocele of the appendix. Considering the recurrent symptoms during menstruation, endometriosis was suspected. Treatment with a gonadotropin-releasing hormone agonist was started for appendiceal endometriosis, which alleviated the symptoms. After 3 months, elective laparoscopic appendectomy was performed. Preoperative hormonal therapy is an option for patients with appendiceal endometriosis, especially when there is concern for dense adhesions.

Efficient irrigation and drainage management are highly required for increasing crop productivity in paddy rice and upland crop rotation. However, conventional management does not sufficiently consider the water status of the plants and soil in the root zone. The aim of this study was to evaluate whether the hydraulic resistance of soil (Rs) or plant (Rp) principally controlled transpiration in rotational paddy fields (RPFs) located in humid regions. To achieve this, we conducted field measurements of soil water conditions, evapotranspiration rate, and leaf water potential in RPFs cropped with soybean after the flowering stage and calculated Rs and Rp based on the theory of root water uptake. After the flowering stage, the soil was sometimes saturated owing to intermittent precipitation, and thus Rs was maintained at a low value. By contrast, Rp gradually increased over time and ranged between 5.1 × 108 and 10.3 × 108 s, which was one to three orders of magnitude higher than Rs. The ratio of the actual to the potential transpiration rate decreased throughout the investigation period and hardly reached 1.0, even though the soil was sufficiently wet. These results indicate that Rp, which probably increases with continuous soil saturation, controls crop transpiration in RPFs under humid climates. Our results suggest that drainage systems are essential in RPFs to avoid a change in Rp and improve crop productivity.

PDF file - 160K, FISH findings for interphase nuclei

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PDF file - 108K, Knockdown of PVT1-NBEA chimeric transcript using siRNA

PDF file - 243K, Genome copy number changes at 8q24 detected by SNP array analysis

PDF file - 467K, Genome copy number alterations of translocation partner loci

PDF file - 91K, MYC and PVT1 expression in cell lines and normal lymphocytes

Water management methods regulate water temperature in paddy fields, which affects rice growth and the environment. To understand the effect of irrigation conditions on water temperature in a paddy field, water temperature distribution under 42 different irrigation models including the use of ICT water management, which enables remote and automatic irrigation, was simulated using a physical model of heat balance. The following results were obtained: (1) Irrigation water temperature had a more significant effect on paddy water temperature close to the inlet. As the distance from the inlet increased, the water temperature converged to an equilibrium, which was determined by meteorological conditions and changes in water depth. (2) Increasing the irrigation rate with higher irrigation water amount increased the extent and magnitude of the effects of the irrigation water temperature. (3) When total irrigation water amount was the same, increasing the irrigation rate decreased the time-averaged temperature gradient effect over time across the paddy field. (4) Irrigation during the lowest and highest paddy water temperatures effectively decreased and increased the equilibrium water temperature, respectively. The results indicate that irrigation management can be used to alter and control water temperature in paddy fields, and showed the potential of ICT water management in enhancing the effect of water management in paddy fields. Our results demonstrated that a numerical simulation using a physical model for water temperature distribution is useful for revealing effective water management techniques under various irrigation methods and meteorological conditions.

Highlights • Intestinal leiomyosarcoma is a rare tumor with a decreased incidence due to redefinition by WHO. • Perforation is an atypical presentation of intestinal leiomyosarcoma. • Invasion of the surrounding intestine weakened the intestinal wall resulting in perforation., Introduction and Importance The majority of gastrointestinal sarcoma is gastrointestinal stromal tumors and intestinal leiomyosarcoma is rare. Small intestinal mesenchymal tumors are often large at diagnosis, and they commonly present with bleeding or intussusception. We report a perforation associated with intestinal leiomyosarcoma. Case Presentation A 66-year-old man presented with severe epigastric pain. A physical examination showed tachycardia and a diffusely tender and rigid abdomen. Computed tomography showed a massive tumor and free air. A laparotomy was performed to treat lower digestive perforation. Massive tumor, which invaded surrounding intestine, was 20 cm in size at the ileum. The involved intestine was perforated. We confirmed that feeding artery was superior mesenteric artery and performed partial intestinal resection. His clinical course was uneventful and discharged 10 days postoperatively. The pathological findings showed spindle shaped and the tumor invaded the mucosa at the perforated site. Immunohistochemical spectrum resulted c-kit negative, S-100 negative, Desmin positive, alpha smooth muscle actin(αSMA) positive and Ki-67 30–40 %. The pathological findings were leiomyosarcoma. Discussion Gastrointestinal sarcoma is sometimes found by bleeding. In our patient, leiomyosarcoma invaded surrounding intestine, it made the intestine wall frail and caused perforation. The intestinal perforation which was involved by leiomyosarcoma has been rarely reported to the best of our knowledge since WHO refined leiomyosarcoma. Conclusions Although intestinal leiomyosarcoma is rare, we should know that it can involve surrounding intestines and make them perforated.

Our analyses revealed the spatial variability of the vertical distribution of fallout radiocesium measured in small cylindrical soil cores taken in a non-disturbed paddy field contaminated by the F...

Introduction and importance With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as “sacless hernias”. Presentation of case A 61-year-old man presented with a left inguinal bulge. On physical examination, the diagnosis of bilateral inguinal hernias was made, and laparoscopic transabdominal repair was performed. Intraoperatively, the left peritoneal hernia orifice was not identified from the peritoneal cavity and there was only a lipoma. Pressing the lipoma with forceps from inside the peritoneum confirmed the presence of a hernia. The preperitoneal space was opened and the hernia orifice revealed. Discussion The terminology and definition of sacless hernias are poorly defined, even though this is not a rare condition. Consistent with Russell's dogma, there are arguments that any prolapse can only be called a hernia if there is an accompanying peritoneal sac. The proportion of patients with sacless hernias and pure cord lipomas are very similar and these conditions are often confused. Detailed and repeated physical examination may distinguish a sacless hernia from a pure lipoma. A watchful waiting strategy is useful and ensures safety. Conclusion Once the diagnosis of inguinal hernia is made on physical examination, open the preperitoneal cavity if a peritoneal hernia orifice was not identified during laparoscopy., Highlights • The exact terminology and definition of a “sacless hernia” is still unclear and there were very few literatures, despite this situation has been commonly known. • Attention should be paid not to confuse a sacless hernia with a spermatic cord lipoma. Preoperative physical examination and diagnosis is a key to distinguish them. • Once a robust diagnosis of inguinal hernia is made by physical examination, open the preperitoneal cavity if the peritoneal hernia orifice was not identified during laparoscopy.

Background. Over several decades, standard management of blunt spleen injury (BSI) has been changed from operative intervention to the selective operative and nonoperative management (NOM). However, some patient needs laparotomy first. This article describes a case of a BSI patient who failed nonoperative management after angioembolization (AE). Case Presentation. A 58-year-old man fell from his motorcycle and was brought to our hospital. His vital sign was stable after extracellular fluid bolus. A contrast-enhanced computed tomography scan of the abdomen showed AAST grade V spleen injury. AE was performed for the splenic artery, but his systolic blood pressure suddenly dropped under 60 mmHg. The resuscitative endovascular balloon occlusion of the aorta was inserted, and immediate laparotomy was performed. A pancreatic tail injury was detected, and the splenic artery and vein were burst at the pancreatic tail and controlled by hemostatic suture. After splenectomy, a drain was placed at the pancreatic tail and the abdomen was temporally closed. The postoperative course was not remarkable except for abdominal abscess treated with antibiotics, and he was discharged on foot. Conclusion. Although NOM is becoming one of the choices for severe BSI, there will still be a patient who requires surgery. Surgeons should be aware of the mechanism of injury and the limitation of AE as an adjunct to NOM. Patient selection for initial NOM and timing to convert to laparotomy are important.

Water management techniques such as continuous irrigation with running water (CIRW) have been used by Japanese farmers to control the thermal environment for rice cropping. In this study, to optimize this method to control the thermal environment in paddy fields, theoretical equations for predicting water and vegetation temperatures in a paddy field were obtained. First, the equations to calculate water and vegetation temperatures in a paddy field were obtained by solving the heat balance equations of the paddy water and vegetation, taking into account the effect of horizontal heat convection driven by irrigation. The equations were validated by comparisons with observed water temperatures in a conventional paddy field under CIRW. The calculated changes in water temperatures over time and distance showed good agreement with observed values, with a root mean square error of 0.39 °C. This result indicated that the equations satisfactorily expressed the features of paddy water temperature under CIRW. Next, these equations were used to determine the effects of irrigation rate, paddy water depth and wind speed on water and rice plant temperatures. The following results were obtained. 1) The area cooled by CIRW was positively related to irrigation rate and negatively related to water depth. 2) Low water depths were preferable for application of CIRW during the nighttime. 3) Slower wind speeds and latent heat flux from vegetation strengthened the effects of water management on vegetation temperature. The proposed equations and analyses represent the common features of the effect of irrigation on water and vegetation temperatures in a paddy field, and provide quantitative information about the effects of water management techniques on the thermal environment for rice cropping.

For a practical technique of cross-sectional imaging of animal bodies, we developed a new method using spatially resolved backscattered light. This method is based on the solution of the one-dimensional nonlinear inverse problem, and on the lateral scan of the source–detector pair along the object surface. Using this method, unknown variables in inverse problems can be reduced more greatly than when using conventional methods. A stable solution for the inverse problem becomes possible. The possibility of using the proposed method was assessed using simulation analysis. The results verified that cross-sectional imaging from several to 10 millimeter depths is possible for animal tissue. This analysis clarified the specific spatial resolution and accuracy in the estimated absorption coefficient. Distortionless imaging was confirmed. Results suggest that the proposed method represents new options as a stable and practical method for biological cross-sectional imaging.

The occurrence of water ponding on soil surfaces during and after heavy rainfall produces surface run-off or surface water accumulation in low-lying areas, which might reduce the water supply to soils and result in a reduction of the soil water that plants can use, especially in arid climates. On Mongolian rangeland, we observed ponded water on the surface of a specific soil condition subjected to a heavy rainfall of 30 mm/hr. By contrast, ponded water was not observed for the same type of soil where livestock grazing had been removed for 6–8 years via a fence or for nearby soil containing less clay. We measured the infiltration rate (the saturated hydraulic conductivity of the surface soil, Ks) of the three sites by applying ponded water on the soil surface (an intake rate test). The results showed that Ks in the rangeland was lower than the rainfall intensity in the site where water ponded on the soil surface; however, Ks of the soil inside of the fence has recovered to 3 times that of the soil outside of the fence to exceed the rainfall intensity. Heavy rainfall that exceeds the infiltration rate occurs several times a year at the livestock grazing site where we observed ponded water. Slight water repellency of the soil reduces rain infiltration to increase the possibility of surface ponding for the soil.

Highlights • Intestinal malrotation accompanied by colon cancer is extremely rare. • Laparoscopic resection of a sigmoid colon cancer with intestinal malrotation was performed without difficulty using the usual trocar placement. • Attention should be paid to a variation in vascular anatomy., Introduction Intestinal malrotation is a congenital abnormality which occurs due to a failure of the normal 270° rotation of the midgut. The non-rotation type is usually asymptomatic and discovered incidentally on imaging studies. Intestinal malrotation accompanied by colon cancer is extremely rare. Presentation of case A 53-year-old male presented with postprandial abdominal discomfort. Colonoscopy showed a 14 mm polyp in the sigmoid colon and endoscopic polypectomy was performed. Pathological evaluation revealed an adenocarcinoma invading the submucosa more than 1000 μm with positive vertical and horizontal margins. A contrast enhanced computed tomography scan showed an anatomic variant of the ileocolic and inferior mesenteric arteries originating from a common channel branching from the abdominal aorta. Laparoscopic sigmoid colon resection was performed. The patient did well post operatively. Discussion The usual trocar placement for laparoscopic left side colectomy was used, and we found no difficulties intraoperatively. To secure safe ligation, the divisions of the common channel branching from the abdominal aorta were exposed as in a usual D3 dissection, and the inferior mesenteric artery was ligated after confirmation of the bifurcation of the ileocolic and inferior mesenteric artery. Conclusion To the best of our knowledge, this is the first report of laparoscopic resection of a sigmoid colon cancer with intestinal malrotation. It was performed without difficulty using the usual trocar placement, with appropriate attention to the variant in vascular anatomy.

Several novel fusion transcripts were identified by next-generation sequencing in gastric cancer; however, the breakpoint junctions have yet to be characterized. The present study characterized a plethora of APIP-FGFR2 genomic breakpoints in the SNU-16 gastric cancer cell line, which harbored homogeneously staining regions (hsrs) and double minute chromosomes. Oligonucleotide microarrays revealed high-level amplifications at chromosomes 8q24.1 (0.8 Mb region), 10q26 (1.1 Mb) and 11p13 (1.1 Mb). These amplicons contained MYC and PVT1 at chromosome 8q24.1, BRWD2, FGFR2 and ATE1 at chromosome 10q26, and 24 genes, including APIP, CD44, RAG1 and RAG2, at chromosome 11p13. Based on these findings, reverse transcription-polymerase chain reaction (PCR) was performed using various candidate gene primers to detect possible fusion transcripts, and several products using primer sets for the APIP and FGFR2 genes were detected. Eventually, three in-frame and two out-of-frame fusion transcripts were detected. Notably, PCR analysis of the entire genomic DNA detected three distinct genomic junctions. The breakpoints were within intron 5 of APIP, which contained three distinct breakpoints, and introns 5, 7 and 9 of FGFR2. Fluorescence in situ hybridization showed several fusion signals within hsrs using two short probes (~10-kb segments of a bacterial artificial chromosome clone) containing exons 2-5 of APIP or exons 11-13 of FGFR2. Although, for any given fusion, a multiplicity of transcripts is thought to be created by alternative splicing of one rearranged allele, the results of the present study suggested that genomic fusions of APIP and FGFR2 are generated in hsrs with a diversity of breakpoints that are then faithfully transcribed.

Although Lake Kasumigaura stores twice as much radiocesium compared to the direct fallout onto the lake surface, the additional source of radiocesium has not been determined. The present study examined the major source of radiocesium deposited in the lake based on surveys of the dry beds of the rivers flowing into the lake. The basin of four rivers, two of which flow through an urbanized region and the other two through a rural region to Lake Kasumigaura, were selected. The radioactivity per unit area of the dry river bed and the top of the river bank was measured. On the dry river beds of the rivers flowing from the urbanized area, the deposition of radiocesium per unit area was found to be much higher than the direct fallout per unit area, revealing a considerable amount of radiocesium had been discharged from the urbanized upstream of the rivers by flooding events. On the other hand, rivers flowing from the rural area stored almost the same amount of radiocesium as the direct fallout. These observations revealed that the urbanized areas located upstream to Kasumigaura Lake were a major additional source of radiocesium contamination in the lake.

Irrigating water into a paddy field inevitably changes the water temperature and produces a temperature distribution in the field. In this study, a numerical model for predicting the horizontal water temperature distribution in a paddy field was developed. In addition to considering the heat exchange between the atmosphere, paddy rice, water, and soil, the model also considers the horizontal heat convection within the paddy field due to the inflow of irrigation water and outflow of paddy field water. The horizontal water flow in the field is modeled by the water balance equation of paddy water. The model was validated using field measurements collected in a paddy field where the continuous irrigation with running water (CIRW) management method was applied. The calculated changes in water temperatures over time and distance showed good agreement with the observed values. Further, the root mean square error (RMSE) of the water temperature during the entire validation period was 0.98 °C, and the RMSE during the nighttime CIRW irrigation was 0.55 °C. These results indicate that the model satisfactorily expresses the features of paddy water temperature distribution under the effect of irrigation water inflow. Moreover, a comparison of the calculation results of the proposed model to those of the conventional methods that do not consider the water temperature distribution demonstrated that the prediction accuracy significantly improves when the water temperature distribution is considered. Our results suggest that the prediction of water temperature distribution is useful for a more accurate prediction of paddy heat environment and various phenomena affected by water temperature in a paddy field.

The functional decline of subsurface drainage systems has become a problem for the cultivation of upland crops in rotational paddy fields, necessitating the development of methods to determine its origin. This study aimed to quantify the water flow resistance (WFR) along the pathway from the plow layer to the drainage canal via aged subsurface drainage in a clayey paddy field. Hydrological monitoring was conducted in a clayey paddy field where subsurface drainage was installed over 20 years ago and soybeans were cultivated during the monitoring. The surface and subsurface drainage rates were measured using flowmeters attached to the drainage outlet. The water pressures along the pathway were measured using tensiometers or pressure transducers installed in the wells. Assuming continuous water flow through the pathway, the time evolution of the sectional WFR was determined from the measured total head gradient and the drainage discharge. Then, potential horizontal and vertical water flow rates, defined as the quotient of the maximum possible driving forces divided by the minimum WFR, were calculated. During rainfall events, the subsurface drainage rate increased rapidly after the start of the drainage, became high and nearly constant with time, and then gradually decreased. When the subsurface drainage rate was high, the total water head gradient in the vertical direction from the plow layer to the collecting drain was large, while the horizontal water head gradient in the plow layer was very small. The potential flow rates of the vertical and horizontal sections ranged from 2.1–5.7 mm/h, and from 6.2 to over 79 mm/h, respectively, indicating that the vertical WFR mainly determined the potential subsurface drainage rate. Our results suggest that simultaneous measurement of the pressure distribution along the water pathway and the subsurface drainage rate is a promising method for the diagnosis of aged subsurface drainage systems.

Necrotizing soft tissue infection (NSTI) is a rare but rapidly progressing soft-tissue infection. Few reports of NSTI caused by colon cancer have been published. We present a rare case of NSTI of the thigh associated the retroperitoneal spread of ascending colon cancer. A 64-year-old man had noticed right hip pain since 3 months before admission, he felt pain in the right thigh which was reddening, and he had difficulty in walking. He was referred to Yokosuka general hospital Uwamachi. Anterolateral aspect of his right thigh was reddening and swelling. The patient was diagnosed with a psoas abscess and a NSTI of the right thigh caused by penetration of ascending colon tumor. The patient underwent debridement of severely necrotized tissue in the right thigh, diverting ileostomy and subsequently a right hemicolectomy with reversal of the ileostomy were performed. He was discharged 70 days after the first surgery. Colon cancer can be a cause of retroperitoneal abscess accompanied by NSTI of the thigh. Two-stage surgery was an efficient option in this patient with NSTI of the thigh associated with locally advanced ascending colon cancer.

We report the spin transport properties in a pigment-red (perylene-3,4,9,10-tetracarboxylic dianhydride: PTCDA) film prepared by thermal evaporation. In a palladium (Pd)/PTCDA/Ni80Fe20 tri-layer sample, a pure spin-current is generated in the PTCDA layer by using the spin-pumping driven by the ferromagnetic resonance of the Ni80Fe20 film. The generated spin current is absorbed into the Pd layer, converted into a charge current with the inverse spin-Hall effect in Pd, and detected as an electromotive force. This is clear evidence for the spin transport in a PTCDA film, and it is confirmed that a PTCDA film is useful not only as a robust protection layer material but also as a spintronic material.

This report presents a proposal of a new technique to estimate the cross-sectional absorption distribution of turbid media from backscattered light by solving a nonlinear inverse problem. After illuminating a beam of light on the surface of a turbid object and measuring the backscattered light as a function of distance from the light incident point, we divide the object into multiple virtual layers to estimate the absorption distribution. The path lengths of photon propagation in the respective layers are calculated using Monte Carlo simulation. The absorption coefficient of each virtual layer can be estimated from the backscattered intensity and the path length distribution in a depth direction. For solving this inverse problem, the linear calculation results are useful as initial solutions. Then the final solutions are obtained from iteration of the nonlinear calculation. Convergence into a unique solution and robustness of the solution against the measurement noise were confirmed. The effectiveness of the proposed technique was verified through simulation and measurement. By lateral scanning of a source–detector pair, we can reconstruct a cross-sectional image of the turbid medium to the depth to which the detected light reaches.

Introduction. Transarterial chemoembolization (TACE) is the first-line therapy for patient with unresectable hepatocellular carcinoma (HCC). Although TACE is a generally safe procedure, major complications can be occurred. We describe a patient with rupture of HCC after TACE followed by gastric bleeding. Case Presentation. An 81-year-old man presented with worsening epigastric pain. He had been diagnosed with multiple HCC with nonalcoholic steatohepatitis and underwent TACE 19 days previously. A contrast enhanced computed tomography (CT) scan of the abdomen showed rupture of an HCC. He was treated nonoperatively and discharged on hospital day 18. Five weeks after TACE, he was emergently admitted with massive hematochezia and shock. A contrast enhanced CT scan demonstrated extrinsic gastric compression by an HCC lesion with extravasation of contrast into the stomach. Emergent upper gastrointestinal endoscopy showed a bleeding gastric ulcer with extraluminal compression which was successfully controlled by hypertonic saline-epinephrine injection. Due to tumor progression, he was discharged for palliative care and died six weeks after TACE. Conclusion. Rupture of HCC is a life-threatening complication after TACE with mortality rates up to 50%. After treatment of a ruptured HCC, extragastric compression and bleeding can occur due to direct compression by a primary lesion or intraperitoneal dissemination.

We evaluated cross-reactivity of immunoglobulin A (IgA) secreted on the nasal mucosa in mice that were nasally inoculated 4 times with a mixture of inactivated H1N1 influenza A viruses and poly(N-vinylacetamide-co-acrylic acid) (PNVA-co-AA) bearing d-octaarginine at 7-day intervals. Three viral strains (A/Puerto Rico/8/34, A/New Caledonia/20/99 IVR116, and A/Solomon Islands/03/2006) and D-octaarginine-linked polymers with different molecular weights were used as antigens and their carriers, respectively. Secretion of intranasal IgA was barely observed when the inactivated virus alone was administered. The polymer induced the production of intranasal IgA specific to the inoculated viruses, irrespective of the viral strain and molecular weight of the polymer. The respective antibodies cross-reacted to recombinant hemagglutinin proteins of not only the viral strain used for immunization but also other H1N1 strains, including A/Puerto Rico/8/34 strain whose hemagglutinin proteins are diverse from those of other strains. Mice with high reactivity of IgA to the inoculated viruses tended to acquire clear cross-reactivity to other viral strains. Notably, IgA induced by inactivated H1N1 A/New Caledonia/20/99 IVR116 strain with the strongest immunogenicity between 3 antigens in the presence of the polymer cross-reacted to recombinant hemagglutinin proteins of the A/Brisbane/10/2007 and A/Viet Nam/1194/2004 strains, which are categorized into H3N2 and H5N1, respectively. Our polymer is a potential candidate for an efficient antigen carrier that induces mucosal IgA having cross-reactivity to antigenically drifted variants, irrespective of the subtype of viral strains.

Some reports suggest the positive correlation between Schistosoma japonicum infection and colorectal cancer, however the sufficient evidence that supports a causal relationship between them has not been established. Japan used be an endemic area of S. japonicum infection for 40 years ago. But now all of Japan is a non-endemic area of S. japonicum infection. We report a case of ascending colon cancer associated with deposited ova of S. japonicum in non-endemic area.

Background Although gastrointestinal involvement in patients with granulomatosis with polyangiitis is uncommon, it is associated with mild to severe life-threatening complications. We present a case of pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis that was treated successfully with hyperbaric oxygen. Case presentation A 70-year-old Japanese man with a 3-year history of granulomatosis with polyangiitis consulted our hospital with a complaint of severe back pain. Computed tomography showed a large amount of gas located in his bowel wall and mesentery. He underwent urgent exploratory laparotomy, which led to a diagnosis of pneumatosis cystoides intestinalis without intestinal perforation or necrosis. He consequently underwent 13 sessions of hyperbaric oxygen therapy and was discharged from our hospital without complications. Conclusions Several previous reports have supported the efficacy of hyperbaric oxygen for treating pneumatosis cystoides intestinalis. The present case, however, is the first in which pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis was successfully treated with hyperbaric oxygen. We therefore suggest that hyperbaric oxygen therapy could be a candidate treatment for pneumatosis cystoides intestinalis in patients with granulomatosis with polyangiitis.

Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disease known to develop in the early postoperative period after various surgery. We report a rare case in which a patient who underwent Caesarean section developed TSS caused by methicillin-resistant Staphylococcus aureus (MRSA) on the 39th postoperative day. She was treated with debridement because of the possible diagnosis of necrotizing soft tissue infections. Culture test from the resected specimen was positive for MRSA. She was diagnosed with TSS caused by suture abscess and was treated with intensive care including antimicrobials. After a good postoperative course, she was discharged on the 30th postoperative day. TSS occurring 4 weeks after operation is extremely rare, but late-onset of suture abscess is known to occur. We should becognizant of development with TSS beyond early postoperative period.

Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.

Diverticulitis in the terminal ileum is uncommon. Past reports suggested that conservative therapy may be feasible to treat terminal ileum diverticulitis without perforation; however, there is no consensus on the therapeutic strategy for small bowel diverticulitis. We present a 37-year-old man who was referred to our hospital for sudden onset of abdominal pain and nausea. He was diagnosed with diverticulitis in the terminal ileum by computed tomography (CT). Tazobactam/piperacillin hydrate (18 g/day) was administered. The antibiotic treatment was maintained for 7 days, and the symptoms disappeared after the treatment. Thirty-eight days after antibiotic therapy, he noticed severe abdominal pain again. He was diagnosed with diverticulitis in terminal ileum which was flare-up of inflammation. He was given antibiotic therapy again. Nine days after antibiotic therapy, laparoscopy assisted right hemicolectomy and resection of 20 cm of terminal ileum were performed. Histopathology report confirmed multiple ileal diverticulitis. He was discharged from our hospital 12 days after the surgery. Colonoscopy was performed two months after the surgery and it revealed no finding suggesting inflammatory bowel disease. Surgical treatment should be taken into account as a potential treatment option to manage the diverticulitis in the terminal ileum even though it is not perforated.

Helicobacter cinaediis a rare human pathogen which has various clinical manifestations such as cellulitis, bacteremia, arthritis, meningitis, and infectious endocarditis. We report an abdominal aortic aneurysm infected withHelicobacter cinaedi, treated successfully with surgical repair and long-term antimicrobial therapy.

We have proposed a new nonlinear inversion technique to estimate the spatial distribution of the absorption coefficient (μa) in the depth direction of a turbid medium by spatially resolved backscattering measurement. With this technique, we can obtain cross-sectional image of μa as deep as the backscattered light traveled even when the transmitted light through the medium cannot be detected. In this technique, the depth distribution of absorption coefficient is determined by iterative calculation using the spatial path-length distribution (SPD) of traveled photons as a function of source-detector distance. In this calculation, the variance of path-length of many photons in each layer is also required. The SPD and the variance of path-length are obtained by Monte Carlo simulation using a known reduced scattering coefficient (μs’). Therefore, we need to know the μs’ of the turbid medium beforehand. We have shown in computer simulation that this technique works well when the μs’ is the typical values of mammalian body tissue, or 1.0 /mm. In this study, the accuracy of the μa estimation was analyzed and its dependence on the μs’ was clarified quantitatively in various situations expected in practice. 10% deviations in μs’ resulted in about 30% error in μa estimation, in average. This suggested that the measurement or the appropriate estimation of μs’ is required to utilize the proposed technique effectively. Through this analysis, the effectiveness and the limitation of the newly proposed technique were clarified, and the problems to be solved were identified.