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Background: One characteristic of Lynch syndrome, which is caused by germline mutations in a group of genes encoding mismatch repair proteins, is the early onset of colorectal cancer. Here, we report a rare case of juvenile colon cancer, diagnosed based on the onset of intussusception with high microsatellite instability (MSI) and the absence of BRAF mutations, which was suggestive of Lynch syndrome. Case presentation: A 28-year-oldman presented with right lower abdominal pain for approximately 3 months and defecated blacky stool for several weeks. He visited our hospital because of increasingly intense right lower abdominal pain. Computed tomography revealed a contrast-enhanced tumor and lymph nodes with a crab-claw-like fitted image extending into the ascending colon. Colon endoscopy revealed a large submucosal tumor-like lesion with ulceration. Laparoscopy-assisted ileal resection with level 3 lymph node dissection was performed 3 days after the endoscopic reduction of the intussusception. The histological diagnosis was a poorly differentiated adenocarcinoma. Gene analysis of the resected tumor revealed high MSIand KRAS mutations, and the absence of BRAF mutations. Immunohistochemistry indicated the absence of MLH1 and PMS2 expression in tumors. Genetic analysis of peripheral blood and tumors revealed no pathological mutations in MLH1, MSH2, PMS2, or MSH6. Conclusion A rare case of Lynch-like syndrome was diagnosed with intussusception. MSI-high, wild-type BRAF, and the absence of MLH1 and PMS2 expression suggested Lynch syndrome. The absence of pathological mutations in germline and somatic genes suggests the possibility of MLH1 promoter methylation or MLH1 epimutation in the pathogenesis of this case.

Authors: Kembu Nakamoto, Hiroshi Hashiyada, Sadahiro Kawamoto, Toshiyuki Fujii. Introduction: Electrolyzed saline (ES) is a non-toxic virucidal disinfectant. A treatment strategy for COVID-19 infections, in which initial decontamination was achieved by gargling ES, was retrospectively investigated. Methodology: Thirty-eight COVID-19 patients were admitted between June 8, 2021, and September 30, 2021. Each patient gargled ES 3 times a day for as long as salivary SARS-CoV-2 antigen (Ag) tests produced positive results. Treatment effects were evaluated based on the salivary Ag level. Results: Gargling ES solution was used to decontaminate the primary infection site in 33 patients (study group), whereas it was used at 7~10 days after admission in 5 patients (control). Thirty patients were

Rationale: Super acidic (pH

Objective: The cause of the prevalence increase in community-acquired pneumonia is unclear. The environmental bio contamination of residential spaces was investigated. Patients and Methods: A retrospective analysis of 146 pneumonia patients admitted between January 2019 and December 2019 was performed. Age, living status, smoking status, and nursing care status were assessed. Bio contamination in residential spaces and the bactericidal effects of tobacco, incense-stick smoke and electrolyzed saline (ES) were examined using Koch’s method. Results: The patients were quite old (mean age: 80.9 ± 12.6 y.o.). Living in a private residence, where smoking tobacco, pesticide and incense-stick use might be allowed, carried a low risk of pneumonia (OR: 0.026, 95% CI: 0.003–0.190). Current smokers had a low risk of pneumonia (OR: 0.348, 95%CI: 0.143–0.844). Patients that did not require nursing care had a low risk of pneumonia (OR: 0.004, 95%CI: 0.001–0.026). Significantly more colony-forming units (CFU) were detected in communal spaces than in private spaces (5.85 ± 1.41 vs 0.30 ± 0.24 CFU/5 min). Significantly more CFU were detected in places where smoking was restricted than in spaces where smoking was allowed (5.90 ± 1.49 vs 1.24 ± 0.79 CFU/5 min). However, the examined residential spaces were generally clean. The number of CFU in vocalized droplets was very high (thousands). Both tobacco and incensestick smoke had bactericidal effects on droplet-borne bio contamination; i.e., they reduced the number of CFU by >90%, as did ES solution, which also suppressed oropharyngeal bio contamination. Conclusions: Smokeless residential environment might be responsible to the prevalence increase of communityacquired pneumonia. ES might contribute to preventing pneumonia epidemics.

Background: The empyema space is refractory to elimination of bacterial colonization. Electrolyzed saline (ES) was used as intra-pleural irrigation for rapid disinfection of the empyema space. Patients and Methods: Twenty consecutive patients with para-pneumonic empyema were reviewed in this study from 2007 to 2015. The empyema space was irrigated by miniaturized thoracoscopic surgery (mini VATS), and the efficacy and safety of the use of ES were evaluated. Results: Sixteen patients were male and four were female, with a mean age of 66.5 ± 9.5 y (27–90 y). Bacterial cultures of the purulent effusions from all 20 patients had positive results. Seventeen patients subsequently underwent continuous catheter irrigation and drainage. No patient had chest pain during ES irrigation. Fever duration after mini VATS was 2.8 ± 1.8 d (0–5 d). Catheter indwelling time was 10.3 ± 7.2 d (3–33 d). Inflammatory markers significantly improved (p

疫学的に日本住血吸虫症患者に肝細胞癌が発生することが報告されているが,実際に経験することは稀である.今回われわれは病理組織学的に日本住血吸虫の虫卵結節を確認することのできたB型C型肝炎ウイルス感染のない肝細胞癌の1例を経験した.症例は80歳,男性.右季肋部痛を主訴に近医を受診.腹部エコーで肝腫瘍を指摘され,加療目的で紹介された.精査の結果,肝内に計5個の腫瘍を認めた.肝細胞癌の診断で肝右葉切除術,ラジオ波焼灼療法を施行した.病理組織学的に腫瘍部は中分化型肝細胞癌であった.非腫瘍部は肝硬変像を呈し,グリソン鞘内の門脈枝内に多数の虫卵結節を認めた.

症例は45歳の男性.検診で便潜血反応陽性であったため精査目的で外来を受診した.大腸内視鏡検査で横行結腸に粘膜下腫瘍を認め,腹腔鏡補助下結腸楔状切除術を施行した.病理組織検査では紡錘形細胞が線維束状に増殖しており,免疫染色でc-kit, vimentin, S-100, NSE (neuron specific enorase)が陽性, CD34, desmin, α-SMA (smooth muscle actin), NF (neurofilament)が陰性であった.横行結腸gastrointestinal stromal tumorのneural typeと診断した.術後10カ月経過した現在,無再発生存中である.

Purpose: Autoimmunity has been proposed to play a role in the pathogenesis of the abdominal aortic aneurysm (AAA). Several autoimmune diseases are associated with specific HLA DR alleles. These experiments were carried out to determine whether the same HLA DR types that have been reported to be associated with AAA in a mixed North American population are similarly associated with AAA in a more homogeneous group of patients in Japan. Method: HLA DR typing was performed by a serologic method on samples of peripheral blood of patients with nonspecific infrarenal AAA in Nagasaki University Hospital in Japan. The frequencies of HLA DR antigens were compared with those of volunteers approximately matched for age and sex from the same referral area. Results: HLA DR haplotypes were determined in 46 Japanese patients with AAA and in 50 patients in a control group. The HLA-DR2(15) antigen was observed in 27 (58.7%) patients (29 alleles 31.5%) with AAA and in 14 (28%) subjects (16 alleles 26.0%) in the control group ( p Conclusions: The data suggest that HLA-DR2(15) has an important role as a genetic risk factor for AAA in Japanese patients, as previously reported in a mixed North American population. (J Vasc Surg 1998;27:500-503.)

Norepinephrine (NE) is one of the most potent positive inotropic drugs available for the treatment of low-output state following open-heart surgery. However, its inotropic effect is often masked by a significant increase of peripheral vascular resistance due to marked vasoconstriction. The purpose of the present study was to investigate whether the use of nicardipine (Nc) and phentolamine (Ph) in combination with NE could ameliorate the adverse vaso-constrictive action of NE. A low-output-state (LOS) model was produced by global myocardial ischemia due to electrically induced intermittent ventricular fibrillations in open-chest dogs. Twenty-eight dogs were divided into 6 groups according to the drugs infused after producing LOS. In the control group, hemodynamic changes similar to the clinical low-output state were observed, e.g., a decrease in cardiac output (CO) and left ventricular dp/dt, and an increase in the systemic vascular resistance (SVR). The use of NE alone produced marked increases in the systemic arterial pressure (SAP), heart rate, and SVR, with a slight increase in CO. The infusion of Nc alone produced decreases in SVR and SAP with a slight increase in CO. The concomitant infusion of NE and Nc produced increases in SV and CO, and decreases in SAP and SVR. The infusion of Ph alone produced no significant hemodynamic changes. The combined use of NE and Ph produced increases in CO, SAP and heart rate, but not to a significant extent. These results suggest that there are major advantages in the concomitant use of NE and Nc for the control of LOS.

冠動脈に有意病変を有しない僧帽弁膜症患者で, 初回手術時, 再手術時の2回にわたり高度の術中冠攀縮を発生したまれな1例を経験した. 患者は56歳女性. 7年前 (49歳時) の僧帽弁交連切開術の際にも術中に強い冠攀縮をきたし, IABP駆動下にようやく救命できた. 再手術時には, 麻酔導入時から心電図上STの高度上昇を伴う徐脈と低血圧の発作が頻回に生じ, ニトログリセリン静注も効果が少なく, そのまま体外循環に移行して僧帽弁置換術を施行した. 人工心肺離脱後も冠攀縮発作が頻発したが, ニトログリセリン, ノルエピネフリン, IABPなどの併用により救命できた. 術中術後の全経過を通じて心筋逸脱酵素の上昇を認めなかった.

A case of successful surgical treatment for pseudoaneurysm and graft obstruction is pesented. This rare complication was caused by prosthetic laceration following crossover femoro-femoral bypass grafting using 8mm knitted Dacron prosthesis. The patient was an 81-year-old man. There is a history of undergoin arterial reconstruction for atherosclerotic obstruction 13 years before. He was seen again at the hospital with a large lower abdomonal mass 7 months before the second operation. The mas was diagnosed radiographically as pseudoaneurysm due to rupture of the prosthetic graft. He underwent second operation and two longitudinal 7cm tears were found at the mid-portion of the prosthesis. The prosthesis was completely obstructed with thrombus. Twenty four cases of intrinsic prosthetic rupture have been reported inthe Japanese literature. A careful postoperative follow up should be very important because an increase of this kind of complication is highly expected.

The evaluation, surgical repair and follow up are described for an asymptomatic 5-year-old girl with unilateral total anomalous pulmonary venous return from the left lung through the innominate vein without atrial septal defect (ASD). Although the patient had not any symptoms except faint heart murmur with Qp/Qs 1.5 and L→R shunt 36%, the correction was completed, because the disease in the right normal lung could become fatal. The anomalous vein was divided and anastomosed directly to the LA_??_LA appendage. The anastomosed area was made widely with 5-0 Polydioxanone (PDS) continuous and interrupted suture under cardioplegic arrest with extracorporeal circulation. The postoperative course was uneventful and an excellent hemodynamic result was confirmed by postoperative angiogram. Partial anomalous pulmonary venous return itself is not so rare disease, but it often occurs as the anomalous return of the right pulmonary vein and most cases of the diseases are associated with ASD. Total left anomalous pulmonary venous return like this case is so rare that only 14 cases have been reported in the Japanese literature as far as we could review. This case appears the 6th report in Japan, if we review such cases without ASD.

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revasculariza tion can reduce the mortality rate. The authors present a patient with sudden throm bosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.

The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.

We report an unusual adult case of aneurysm associated with the ductus arteriosus. A 67-year-old female, who suffered recurrent nerve palsy, was diagnosed as having an aneurysm of the ductus arteriosus. The aneurysm, located in the medial aspect of the aortic ischimus and projected toward the pulmonary artery, was successfully repaired using a Dacron patch. A pathologic review of the aneurysm revealed the degeneration of the aortic media.

Aneurysms of the popliteal artery are most common in the periphral arterial aneurysms, and the majority is the aneurysm associated with arteriosclerosis. Reports of the popliteal pseudoaneurysm are rare in Japan and those are traumatic. We experienced two cases of popliteal pseudoaneurysm, one was caused by the stab wound associated with sepsis and the genesis of the other one was unknown. Both cases were diagnosed by CT scan and angiography, and CT scan seemed to be more important in the diagnosis of this disease.

Coronary artery fistula (CAF) is an uncommon congenital anomaly. Bilateral CAFs, arising from both right and left coronary arteries are rare. Myocardial infarction is by far a less frequent complication of CAF than angina pectoris. Ligation of CAF and coronary artery bypass graft were performed in the treatment of coronary artery stenosis with CAF.

The effects of Na+ and Ca2+ concentrations in the reperfusate on post-ischemic myocardial recovery were examined. Also, the myocardial protective effects of amiloride, an inhibitor of the Na+/Ca2+ and Na+/H+ exchange systems, added to cardioplegic solutions were assessed, using an isolated working rat heart perfusion system. Global myocardial ischemia was induced by 30-min normothermic cardioplegic arrest, using St. Thomas’ solution. The concentration of Na+ in the reperfusate varied, stepwise, from 75 to 145 mM/l, and that of Ca2+, from 0.1 to 2.5 mM/l. In this study post-ischemic functional recovery was best at 110 mM/l Na+ and 1.2–1.8 mM/l Ca2+ in the reperfusate. A significantly greater postischemic functional recovery and a lower creatine kinase release were observed when amiloride was added to the cardioplegic solution. Ca2+ overload via Na+/Ca2+ and Na+/H+ exchange systems would, thus, appear to be due, at least in part, to post-ischemic reperfusion injury.

After December 1982, the new criteria for blood donor selection to reduce the incidence of non-A, non-B hepatitis was established. This criteria consists in (1) GPT≤20 KA unit (2) serum Guanase≤2.9 unit for the recipients under 50 year old.Our former criteria for blood donor was GPT≤35 KA unit only. We compared the incidence of non-A, non-B hepatitis between the patients group belong to former and new criteria. The total number of both group are 307. (former criteria group: 176 pts, new criteria group: 131).The incidence of non-A, non-B hepatitis with the criteria of GPT≤20 KA unit was 12.2% lesser than 21% with former criteria of GPT≤35 KA unit. (p≤0.05).When Guanase check (≤2.9 unit) add to this criteria of GPT≤20 KA unit, the incidence of non-A, non-B hepatitis was 10.4% lesser than 18.1% without Guanase check. (N. S.)It is our conclusion that new criteria of GPT limitation under 20 KA unit is effective to reduce the incidence of non-A, non-B hepatitis.