Search

Case Report, A 58-year-old Japanese man was diagnosed with T4b (descending aorta) N2M1, stage IVB lower thoracic Barrett's esophageal adenocarcinoma. He was initially treated with definitive chemotherapy with cisplatin and 5-fluorouracil (FP therapy). After one course of FP therapy, he developed renal dysfunction complications. Computed tomography showed no remarkable change in the main tumor and metastatic lesion. Therefore, radical esophagectomy with resection of the invaded descending aorta and removal of the solitary metastatic lesion was performed. Superior mediastinal dissection, esophageal transection, and left adrenal gland removal were performed simultaneously. The patient underwent curative resection but died of multiple hematogenous metastases 116 days postoperatively. As aortic infiltrates were infected, artificial blood vessel replacement was selected. Although he underwent radical esophagectomy, hematogenous metastases have occurred in the early postoperative period.

While the prognosis of patients with schizophrenia has dramatically improved after the advent of chlorpromazine, the antipsychotics currently available are so numerous that it has become a challenge for psychiatrists to choose from among these drugs for each patient presenting for care. In addition, while numerous studies show that an effective antipsychotic should be continued indefinitely to prevent relapses or worsening, many patients appear to have difficulty remaining on any drug thus initiated. Brexpiprazole, a dopamine D2 receptor partial agonist, appears to provide a unique profile that has much to offer in this light. Specifically, this novel drug is potentially better suited for long-term use, with decreased risk of extrapyramidal side effects, hyperprolactinemia, weight gain, psychosis, insomnia, akathisia, nausea/vomiting or restlessness, thus potentially facilitating patients’ reintegration into society. Indeed, brexpiprazole has been shown in randomized, double-blind, placebo-controlled trials to have proven efficacy not only in improving the symptoms of schizophrenia but in preventing relapses. It is also suggested in both short- and long-term studies that brexpiprazole offers a favorable safety and tolerability profile. This review also includes a proposed treatment algorithm incorporating brexpiprazole, based on the clinical trial results available, as well as on the authors’ clinical experience, where brexpiprazole may be best used as a drug of first choice for the treatment of schizophrenia. Thus, overall, brexpiprazole appears to play a more significant role in the treatment of schizophrenia than other antipsychotics.

Case Report, There is no consensus regarding the ideal surgical procedure for treatment of combined atrial septal defect without an inferior septal rim and partial anomalous right lower pulmonary venous connection. A 41 year-old woman had previously undergone ineffective surgical closure of an ostium secundum-type atrial septal defect. Intraoperatively, we ascertained the correct diagnosis of partial anomalous right lower pulmonary venous connection combined with a residual defect. Incision of the atrial septal wall up to the superior margin along the previous suture line yielded a flap adequate for the atrial septal wall, and this flap was slid again into the entire opening. The spatially complex intracardiac lesion was repaired by using only autologous tissue.

Original Article, Introduction: Some reports suggest that rifampicin treatment of vascular grafts is useful when surgically treating vascular infections and mycotic aneurysms. However, the experimental evidence is limited, and the antibacterial effects of other antibiotic-treated vascular grafts are unknown. Methods: Vascular grafts were immersed in several antibiotic solutions (rifampicin, colistin, vancomycin, or daptomycin). After Pseudomonas aeruginosa PAO1 or Staphylococcus aureus N315 were inoculated into the graft exterior, the number of colony-forming units (CFU) inside and outside the grafts was measured over time. Moreover, bonding of colistin and vancomycin to the grafts was quantified. Results: For grafts immersed in rifampicin, the CFU values outside the grafts decreased over time and those inside the grafts did not increase when the grafts were exposed to a 106 CFU/mL concentration of PAO1 or N315. However, at 108 CFU/mL, the CFU values increased over time outside and inside the grafts. In PAO1 testing, grafts treated with colistin resisted pathogens in the tested area, and grafts treated with both colistin and rifampicin had even greater resistance. In N315 testing, vancomycin-treated grafts had some resistance to infection, but daptomycin-treated grafts did not. The bonding of colistin and vancomycin to the grafts depended on the immersion time. Conclusions: Rifampicin-bonded grafts have a strong antibacterial effect when the concentrations of pathogens are low. Colistin-bonded grafts are effective against P. aeruginosa infection, and vancomycin-bonded grafts are effective against S. aureus infection.