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Preoperative serum levels of sialyl Lewis(a) (CA 19-9), sialyl Lewis(x) (SLX), and sialyl Tn (STN) antigens in colorectal cancer patients were examined to establish predictive factors for serum levels of these antigens compared with carcinoembryonic antigen (CEA). A total of 308 patients who underwent resection for a colorectal cancer were divided into low and high antigen groups (higher or lower than a selected diagnostic-based cutoff value). The cutoff values were 37 U/ml for CA19-9, 38 U/ml for SLX, 45 U/ml for STN, and 2.5 ng/ml for CEA. The American Joint Committee on Cancer Classification and Stage grouping was used to classify the tumors. Statistical tests were conducted using univariate and multivariate logistic regression analyses. For CA19-9, 81 patients (26.3%) were assigned to the high antigen group: for SLX, 39 (12.7%); for STN, 33 (10.7%); and for CEA, 133 (43.2%). Multivariate logistic regression analysis revealed that predictive factors associated with high antigen levels were female sex (odds ratio [OR], 1.78 vs male sex), T4 (OR, 3.26 vs T1/T2), and M1 (OR, 3.35 vs M0) for CA19-9; M1 (OR, 6.40 vs M0) for SLX; mucinous carcinoma (OR, 8.45 vs well differentiated adenocarcinoma) and M1 (OR, 8.24 vs M0) for STN; and mucinous carcinoma (OR, 7.21 vs well differentiated adenocarcinoma), T3/T4 (OR, 3.84/4.18, respectively, vs T1/T2), and M1 (OR, 6.39 vs M0) for CEA. In conclusion, high serum levels of CA19-9, SLX, and STN are strongly associated with distant metastasis. In addition, high serum levels of CA19-9 may be an independent predictor for female gender and T4, and high serum levels of STN may be an independent predictor for mucinous carcinoma. [ABSTRACT FROM AUTHOR]

The present study was designed to provide a systemic analysis of prognosis in 62 patients who underwent hepatic resection for colorectal liver metastasis. The analyzed factors included microvessel counts stained by CD34 and expression of two adhesion molecules, E-cadherin and CD44 variant exon 6-(v6) in these tumors. No significant factors related to recurrence were identified and only negative expression of CD44v6 tended to correlate with recurrence (P = 0.075). A short disease-free period to recurrence was noted in patients with high CEA levels (>10 ng/ml) and H2/3 classification. A short surgical margin, H2/3 classification, high microvessel counts (>60/field, x200), and negative expression of CD44v6 and E-cadherin tended to be associated with poor prognosis. A high microvessel count was the most significant prognostic factor by multivariate Cox proportional hazards regression model. Hepatic resection without tumor exposure and a careful follow-up in cases identified with poor prognostic factors are necessary. [ABSTRACT FROM AUTHOR]

The clinicopathological characteristics and outcome of splenic flexure cancer after surgery have yet to be fully elucidated. The aim of the current study was, therefore, to establish predictive factors related to splenic flexure cancer and outcome after surgery. We compared the clinicopathological characteristics and outcome of 34 patients with splenic flexure cancers (which represents 3.7% of the total number of colon cancers in our series) with those of 418 patients with right colon and 475 patients with left colon cancers by univariate and multivariate analyses, using logistic regression analysis and Cox's proportional hazards model. Splenic flexure cancers had a high risk of obstruction (26.5% of patients), and had a more advanced stage and lower cure rate than left colon cancers. Logistic regression analysis revealed that two independent factors, colonic obstruction and the presence of distant metastases, were related to the splenic flexure tumor site. Splenic flexure cancer patients had a poorer outcome than those with left colon cancer (P = 0.0361). However, there was no difference in survival between patients with splenic flexure, those with right colon cancer and those with left colon cancer who underwent curative surgery. Cox's regression analysis revealed that neither the site of splenic flexure nor colonic obstruction was an independent prognostic factor. In conclusion, splenic flexure cancer is characterized by a high risk of obstruction and the presence of distant metastases. However, after curative resection, splenic flexure cancer has a similar outcome to colon cancer at other sites. In addition, neither the splenic flexure site nor colonic obstruction had an independent influence on patient survival after surgery. [ABSTRACT FROM AUTHOR]

Caleified lesions of the temporomandibular joint dises obtained from 135 human cadavers were studied. Calcifications were observed in 92 of 250 dises by soft x-ray radiography. Studies by light and electron microscopy and x-ray diffraction revealed that there were two different types of calcification in the disease apatite crystal deposition with or without ossification, and calcium pyrophosphate dehydrate (CPPD) crystal deposition. Calcifications were recognized more frequently posteriorly than anteriorly, and were related to dise perforation. The results of this investigation suggest that dise degeneration, which may occur as a result of again or mechanical stress, causes calcifications. [ABSTRACT FROM AUTHOR]

Palmoplantar pustulosis (PPP) is a chronic, debilitating skin disease of the palms and/or soles. We report the efficacy and safety of risankizumab (RZB), an interleukin 23 p19 inhibitor, from the JumPPP study (a phase 3, multicenter, randomized, placebo-controlled, double-blind study to evaluate RZB in adult Japanese sUbjects with Moderate-to-severe PalmoPlantar Pustulosis; NCT04451720). Patients were randomized 1:1 to receive RZB (150 mg) or placebo at weeks 0 and 4; all patients received RZB from week 16 to week 52 (patients initially randomized to RZB) or week 56 (patients initially randomized to placebo). The primary end point was a Palmoplantar Pustulosis Area and Severity Index (PPPASI) change from baseline; secondary end points were ≥50%/≥75% improvement in PPPASI (PPPASI 50/75) at week 16. Efficacy and safety were evaluated to 68 and 76 weeks, respectively. In total, 119 patients (RZB, n = 61; placebo, n = 58) were enrolled. Greater improvement with RZB versus placebo was demonstrated by the significant difference in PPPASI change from baseline at week 16 (least squares mean treatment difference, -3.48; p < 0.05). At week 16, a greater proportion of patients receiving RZB vs placebo achieved PPPASI 50 (41.0% vs 24.1%; nominal p < 0.05) but not PPPASI 75 (13.1% vs 15.5%; nominal p = 0.74). Improvements generally continued through to week 68. The safety profile was generally consistent with previous studies of RZB in psoriasis. RZB demonstrated efficacy over placebo at week 16 in Japanese patients with PPP, with improvements sustained through to week 68, and was well tolerated with no unexpected safety findings., (© 2025 The Author(s). The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Cystic adventitial disease (CAD) of the popliteal artery with spontaneous regression is rare. We describe a 44-year-old man with rapid onset of severe intermittent claudication who is currently undergoing conservative follow-up. CAD was diagnosed, and resection of the lesion with autologous vein replacement was scheduled. However, the claudication suddenly improved at 5 weeks after onset. Computed tomography and ultrasound revealed that the cystic lesion in the adventitia had nearly disappeared. This case report describes the imaging findings and the possibility of conservative treatment. CAD can occur in the popliteal artery and is usually treated surgically. However, reports of spontaneous regression are rare. We report our experience with a case of CAD that eventually spontaneously regressed.

Background and aims: In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Subjects and methods: Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density [LEED], and the incidence of surgical site infections [SSI]) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Results: Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm 2 , respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ±7 minutes, which was statistically significant ( p <0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. Conclusions: This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is >20 mm or in patients with highly tortuous veins.

Purpose: This study was performed to compare endovascular repair with conventional open repair of isolated iliac artery aneurysms (IAAs)., Methods: We retrospectively reviewed the charts of all patients who underwent repair of isolated IAAs between January 2008 and June 2012. Patients with infected, mycotic and ruptured iliac aneurysms and those with concurrent infrarenal abdominal aortic aneurysms greater than 30 mm in diameter were excluded from this analysis., Results: A total of 32 patients were treated with isolated IAAs. There were 20 open and 12 endovascular repairs. A comparison of the length of the operation (238 ± 84 min in the open group vs 176 ± 72 min in the endovascular group, P = 0.03) and intraoperative blood loss (1,735 ± 1,177 ml in the open group vs 503 ± 711 ml in the endovascular group, P = 0.01), revealed significant differences in favor of the endovascular procedure. Postoperative complications were less common in the endovascular group, although the difference did not reach statistical significance., Conclusions: The management of isolated IAAs with both endovascular and open repair can be accomplished with very low morbidity rates. Therefore, endovascular repair can be considered an alternative treatment for isolated IAAs.

Purpose: The aim of this study was to investigate the outcomes correlated with our treatment strategy for prosthetic graft infection., Methods: Seventeen patients were treated for prosthetic graft infections between 1997 and 2009. Initially, total graft excision was applied in five cases, partial graft excision was applied in six cases and graft preservation with drainage and irrigation was applied in six cases. Among the graft-preserved cases, four patients were infected with methicillin-resistant Staphylococcus aureus (MRSA) and treated with gentian violet (GV)., Results: The overall survival rate was 88% at 30 days and 82% at 1 year in this series. Of the excised cases, nine patients survived; however, two patients died. Among the cases in which MRSA-infected grafts were preserved, three patients survived; however, one patient died under a septicemic state. Infected graft preservation was applied at a high rate of 36%, and the mortality rate remained at 16%, without any signs of graft reinfection., Conclusions: In the treatment of infected grafts, the patient's condition should be considered in order to select the appropriate treatment in each case. Graft preservation should be considered as an alternative treatment option, especially in high-risk patients, and GV can be effective for conservative treatment of prosthetic graft infections, including MRSA infections.

Purpose: Iliac vein compression syndrome (May-Thurner syndrome) is characterized by left iliac vein obstruction secondary to compression by the right common iliac artery against the fifth-lumbar vertebra, which increases incidence of deep venous thrombosis (DVT). We treated the patients with DVT due to May-Thurner syndrome (MTS) by surgical thrombectomy and simultaneous stenting, and this study is to evaluate the outcomes of this procedure., Methods: From January 2009 to December 2011, a total of 8 patients underwent surgical thrombectomy with stenting. All patients were admitted for acute DVT involving the left iliofemoral segment, and diagnosed MTS. Patients were followed-up, and stent patency was assessed by means of duplex sonography., Results: In all patients, the procedure was successful in achieving re-canalisation of the iliofemoral veins at the end of the operation. Perioperatively, there was no mortality and there was no case of clinically detected pulmonary embolism. Rethrombosis occurred within seven days of operation in 2 patients. During the follow-up period (mean; 16 months), 6 of 8 patients kept patent stents., Conclusion: Venous thrombectomy with simultaneous stenting is a potent technique to treat acute iliofemoral DVT due to MTS. This technique can restore venous patency and provide relief of the acute symptoms.

Purpose: To determine the influence of the abdominal aortic aneurysm (AAA) anatomy on the clinical outcomes after endovascular AAA repair (EVAR)., Methods: Between January 2008 and December 2010, 53 patients underwent EVAR. The parameters outside of the device instructions for use (IFU) were: short neck length (<15 mm), proximal neck angulation (>60 degrees), small diameter of external iliac artery (<7 mm) and bilateral internal iliac embolization., Results: A total of 37% of these grafts were placed outside of at least one IFU parameter. The intraoperative problems encountered included one (3%) acute graft limb thrombosis, and one (3%) access vessel rupture within the IFU (w-IFU) group. One perioperative mortal case was observed in the w-IFU group due to thoracic aortic dissection. After one year follow-up, type II endoleak (EL) was recognized in 8 of 28 (29%) patients in the w-IFU group, and in 2 of 12 (17%) patients outside of the IFU (o-IFU) group. There was also no significant difference of early and mid-term outcomes between favorable neck anatomy and hostile neck anatomy (HNA)., Conclusion: In our series, EVAR provided acceptable results even in the o-IFU group and HNA. This suggests that the IFU can be extended to other selected patients.

Tumor resection and caval tumor thrombectomy, with or without cavotomy and inferior vena cava (IVC) replacement are sometimes performed in patients with renal cell carcinoma (RCC) extending into the IVC or liver tumors invading the IVC. Two such cases were treated. Case 1: a 68-year-old female was transferred with a diagnosis of right RCC with tumor thrombus extending into the IVC. A plication was performed to prevent extension into the right atrium before the nephrectomy and cavotomy with removal of the tumor thrombus was accomplished, because the IVC was almost completely obstructed and the hemodynamics were stable during cross-clamping of the IVC. Case 2: a 37-year-old female was transferred with a diagnosis of a giant metastatic liver tumor. A trisegmentectomy with resection of the invaded IVC and IVC replacement was performed while the abdominal aorta was cross-clamped to maintain the hemodynamics. Therefore, abdominal aortic cross-clamping was convenient to maintain the hemodynamics when the IVC replacement was performed during IVC cross-clamping.

Objective: To evaluate the long-term outcomes of surgical treatment for popliteal artery entrapment syndrome (PAES)., Materials and Methods: This study was undertaken from a retrospective review of case notes of patients treated for PAES between August 1974 and July 2013. We examined patients' characteristics and surgical procedures, and evaluated long-term outcomes including clinical symptoms and graft or native artery patency., Results: Twenty-nine limbs (24 patients, mean age: 32 years) underwent surgery. Popliteal arteries were occluded (n = 18) stenosed (n = 7) and normal (n = 4). Twenty-five limbs required both revasularization (interposition [n = 24] and bypass surgery [n = 1]) and myotomy. Four limbs were treated solely with myotomy. During the long-term follow-up period, three limbs required reoperation. The overall primary graft and native popliteal artery patency rates at one and 5 years were 96.3% and 91.9%, respectively., Conclusion: The treatment of PAES with myotomy and selective revascularization achieves good short- and long-term outcomes. The use of an interposition vein graft reconstruction is associated with minimal morbidity and good long-term patency.

Background: The purpose of this study is to introduce a new method, indocyanine green fluorescence imaging (ICG-FI), as an adjunct to distal pressure measurements in patients with peripheral arterial disease and symptomatic lower limb ischemia., Methods: A total of 34 patients with peripheral arterial disease, including 11 with claudication (Fontaine II), 7 with rest pain (FIII), and 16 with an ulcer or gangrene (FIV), were enrolled. After an intravenous injection of ICG (0.1 mg/kg), foot perfusion was recorded by an infrared light camera. Fluorescence intensity was plotted on a time-intensity curve using recorded images, allowing the calculation of new parameters. Severity of ischemia was assessed as the duration between the rising point and half value of maximum brightness (T½). The difference in the fluorescence intensity between 10 seconds after the rising point and baseline (PDE10) was compared with the transcutaneous oxygen pressure (tcPO2) at the same site (n=51)., Results: Median T½ was 23 seconds in FII, 41 seconds in FIII (P<0.05), and 17 seconds in FIV patients. PDE10 correlated moderately with tcpO2 (r2=0.5). A cut-off value (PDE10=28) predicted a critically ischemic limb (FIII and FIV), defined as tcpO2<30 mm Hg with a sensitivity of 100% and specificity of 86.6%., Conclusions: Local tissue perfusion can be quantitatively evaluated by using ICG fluorescence imaging. It is a safe, fast, noncontact method of imaging, which may be useful even at the ulcer itself and in the circumferential area., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: The treatment guidelines for isolated superior mesenteric artery (SMA) dissection have not been established. We assessed 14 cases of SMA dissection and reviewed the literature on this entity., Methods: The subjects were 11 men and 3 women (average age 64 years), with SMA dissection diagnosed by computed tomography (CT) scan or digital subtraction angiography, between 2001 and 2009, at our institution. Eight patients presented with symptoms such as abdominal pain, but SMA dissection was diagnosed incidentally during investigations of another illness in six patients. Thirteen patients were treated conservatively with anticoagulation and/or antiplatelet drugs, but one underwent exploratory laparotomy. The median follow-up period was 22 months., Result: The symptoms did not worsen, and ultimately resolved in the eight patients who had symptoms. Isolated dissection improved dramatically in two of the six patients with obstruction of the false lumen and was not seen on computed tomography (CT) scans 1 and 3 months after its onset., Conclusion: We recommend conservative treatment as the first choice for isolated SMA dissection, even if the patient has abdominal pain and tenderness, given that there are no signs of peritonitis.

Objective: The purpose of treatment for critical limb ischemia (CLI) is to prevent major amputation. The purpose of this study was to evaluate our experience of treating CLI with free tissue transfer (FTT) and revascularization., Materials and Methods: From January 2010 to December 2012, seven lower extremities in seven patients were treated with revascularization and free tissue transfer for CLI with tissue loss. All seven patients had tissue loss with a Rutherford category 6 status. Six patients underwent bypass surgery, and one patient underwent percutaneous transluminal angioplasty for revascularization. All patients also underwent free tissue transfer using the latissimus dorsi muscle simultaneously and separately in two and five patients, respectively., Results: Five of the seven patients exhibited flap patency and survival. One patient obtained flap survival and limb salvage, although the flap graft was occluded after the patient achieved limb salvage. One patient developed partial flap necrosis requiring skin grafting and acquired limb salvage. The flap survival rate was 85%, and the limb salvage rate was 100%., Conclusion: FTT with arterial reconstruction for CLI achieves successful wound healing and limb salvage. Both bypass surgery and endovascular treatment are useful for maintaining the vascular supply.

Introduction: Maggots are potent debriding agents capable of removing necrotic tissue and slough; however, it is still unclear which wounds are most likely to benefit from maggot debridement therapy (MDT). Thus, we performed this retrospective review to gain insight into the patient and therapy characteristics influencing outcome., Patients and Methods: We reviewed patients with foot ulcers caused by critical limb ischemia, encountered during the period between June 2005 and May 2010. The treatment outcomes were defined as effective or ineffective., Results: There were 16 patients with 16 leg ulcers. The patients were 13 men and 3 women, with an average age of 67.2 years (range, 47-85 years). Ten (63%) of the 16 ulcers were treated effectively. According to univariate analyses, an ankle brachial pressure index (ABI) lower than 0.6 (p = 0.03) had a negative impact on the outcome of MDT; however, outcome was not influenced by gender, obesity, ischemic heart disease, diabetes mellitus, hemodialysis, smoking, or laboratory findings., Conclusions: Some patient characteristics, such as gender, obesity, ischemic heart disease, diabetes mellitus, hemodialysis, and smoking, do not seem to contraindicate eligibility for MDT. However, a limb with an ABI lower than 0.6 is less likely to benefit. (English Translation of J Jpn Coll Angiol 2011; 51: 209-213.).

Object: We assessed whether or not deep venous reflux (DVR) improved after short saphenous vein (SSV) stripping was performed in patients with SSV reflux and DVR., Materials and Methods: Sixty-eight patients with SSV reflux who underwent SSV striping every Monday between 2008 and 2011 at Ryougoku Ashino Clinic were enrolled in this study. Forty-six of the 68 patients were selected for the analysis because they underwent duplex ultrasound examinations before and after the operation. The DVR was classified into four categories: type 0, no reflux; type I, reflux in popliteal vein; type II, reflux from popliteal vein to the middle of the superficial femoral vein (SFV) and type III, reflux from the popliteal vein to the SFV., Results: There were 23, 13, 2 and 8 patients with type 0, I, II, III before operation, respectively. There were 33, 8, 1, 4 patients with type 0, I, II, III after operation, respectively. There were no changes in 29 patients, improvement in 15 and new DVR in three (type 0 to I)., Conclusion: SSV stripping is feasible in patients with DVR and the DVR might not be deteriorated even though that is performed.