Search

The purpose of the present study is to demonstrate the correlation between the force applied to a ball and the joint motion of the hip, trunk, shoulder and elbow in adolescent baseball players. The subjects were 15 adolescent baseball players (13.7±0.8 yrs) and 15 college-age baseball players (22.1±1.5). Pitching motion images were captured by three high-speed cameras, and 3D analysis established by the direct leaner translation method was performed to obtain the angles and the angular velocity of each joint, as well as the acceleration of the wrist toward the target at ball release (Acc). In the adolescent players, a significant linear correlation was found between Acc and trunk rotation angle (r=-0.59), elbow extension angle (r=-0.75), shoulder internal rotation velocity (r=-0.76) and elbow extension velocity (r=-0.61). In the college-age players, a significant linear correlation was found between Acc and hip adduction velocity (r=-0.51) and elbow extension velocity (r=-0.61). The finding indicates that adolescent players may depend more on the upper extremity motion than the hip joint motion when pitching. Coaches and athletic trainers may need to focus on the hip joint motion in order to prevent pitching injuries among adolescent baseball players. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to demonstrate the correlation between MER during throwing and each range of motion (ROM) of the shoulder complex, which consist of external rotation of glenohumeral joint and posterior tipping of the scapula in baseball players. The subjects were 19 collegiate baseball players. A three-dimensional analysis was performed to obtain the MER. The ROM of the external rotation of the shoulder complex (ER-ROM), ROM of the external rotation of the glenohumeral joint (GHE), and ROM of the posterior tipping of the scapula (SPT) were also passively measured. The mean (± SD) value of the MER was 150 ± 10°. The mean (± SD) values of the ER-ROM, GHE, and SPT were 135 ± 12°, 89 &plumsn; 12°, and 32 &plumsn; 7° respectively. Significant linear correlations were found between SPT and MER (r = 0.48), ER-ROM (r = 0.65). No significant correlations were found between GHE and MER and ER-ROM. The finding may indicate the importance of scapula motion more than glenohumeral joint motion for MER and ROM of the shoulder complex. [ABSTRACT FROM AUTHOR]

This study analyzes motions of the lower extremities and upper extremities during pitching, presents information on the kinetic linkage for pitching motion, and discusses the cause of the throwing injuries. The subjects involved were five elite-level baseball pitchers who were right-handed and over-hand styled. Fifty fastball pitchings were analyzed through a 3-dimensional video system. Analysis was made of the adduction angle of the left hip, the direction angle of the femur and the velocity of the right hand. Fifteen pitchings of 2nd to 16th, in the first third, 15 pitches of 35 - the 49th, as a latter third, were compared with the reappearance of each movement. In Subjects A and B, the motion of the hip joint, the thigh, and the right hand, were similar in the two periods. In Subject E, the hip joint, the thigh motion and the right hand were different at the latter third from the first third. These results suggest that there is a relationship between each movement of the lower extremities and upper extremities. The purpose of pitching is to throw a faster ball toward a fixed target. It is supposed that the disorder of the lower extremities is corrected in the upper extremities, which may result in injuries. [ABSTRACT FROM AUTHOR]

We encountered a case in which emergency surgery was performed for a penetrating lung injury complicated by a hemodynamic cerebral infarction. A 45-year-old man sustained a chest injury due to a scattered piece of metal and was admitted to a nearby hospital. He was confirmed to have hemorrhagic shock due to a right hemopneumothorax, and a chest tube was inserted he was transferred to our hospital. Chest radiography and computed tomography (CT) revealed a metal fragment in the right lung and confirmed the diagnosis of a penetrating lung injury due to a foreign body. The patient also presented with total blindness of an unknown etiology. Emergency surgery was performed to treat the injury and remove the foreign body. A large amount of blood and hematoma were removed from the right thoracic cavity, and a metal fragment was found in the lower lobe of the right lung. After removing the foreign body, pulmonary suturing was performed. On the following day, head magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral occipital lobes, left frontal lobe, and left cerebellar hemisphere. However, no vascular occlusion or thrombus was found, and the patient was diagnosed with hemodynamic cerebral infarction due to hemorrhagic shock.

Emphysematous cystitis is a relatively rare form of urinary tract infection. A 72-year-old man with diabetes mellitus and long-term indwelling urethral catheterization was diagnosed with emphysematous cystitis. The clinical findings were resolved by conservatively managing the patient with antibiotics. However, cystoscopy subsequently revealed a yellowish-white soft tissue mass in the bladder, which was unlikely to be a bladder tumor. The mass could not be removed easily and frequently caused urinary catheter obstruction. We successfully removed this mass by performing transurethral resection twice. Through histopathological examination, the mass was identified as necrotic tissue comprising bacteria, fibrin, and suspected bladder mucosa.

In STA-MCA bypass surgery, it is important to select the optimal recipient using preoperative simulation to avoid complications. We report a preoperative simulation for STA-MCA bypass using the Brain LAB iPLAN platform ® BRAIN LAB)and the 3DCG simulation software GRID ® Kompath). Here, we introduce the basics and applications of preoperative simulation for occlusive atherosclerotic lesions and present a target bypass for periventricular anastomosis and peripheral vessels of aneurysms in Moyamoya disease. By creating and visualizing 3D fusion images, the optimal donor and recipient can be selected. Determining the skin incision and extent of craniotomy according to the case is also applicable to the minimally invasive STA-MCA bypass. Preoperative simulations enable accurate pinpoint bypass surgery and prevent complications.

We report a case of perforated rectal cancer with laparoscopic low anterior resection. Case: A 60-year-old man was transported to the hospital with a chief complaint of sudden lower abdominal pain. Computed tomography revealed wall thickening of the upper rectum and free air localized around the rectum and fecal mass in the mesorectum. He was diagnosed with perforated rectal cancer. Because of the early onset, young age, and ascites confined to the pelvic floor, we decided to perform laparoscopic low anterior resection(D3 dissection). Intraabdominal observation revealed tumor in the upper rectum with a large rectal perforation 3 cm proximal to the tumor. By using gauze and suction, we were able to complete the surgery with ingenuity laparoscopically. The postoperative course was good, and he was discharged 9 days after surgery. Postoperative pathological examination revealed pT4apN0sM0, pStage Ⅱb. Adjuvant chemotherapy of 8 courses of capecitabine was performed. There has been no recurrence 3 years after surgery.

We report a case of robotic abdominoperineal resection for rectal cancer with Leriche syndrome. Case: A 75-year-old male. Colonoscopy, which was performed due to persistent diarrhea, revealed type 2 lower rectal circumferential tumor. Pathological examination revealed adenocarcinoma. Computed tomography revealed no distant metastasis, and incidentally complete occlusion from the abdominal aorta to both common iliac arteries. He was diagnosed to rectal cancer(RbRaP, cT3N0M0, cStage Ⅱa)with Leriche syndrome. Therefore, robotic abdominoperineal resection(D3 dissection)was performed. There was no complication, and he was discharged 15 days after surgery. Postoperative pathological examination revealed pT3N1asM0, pStage Ⅲb.

We herein report a 63-year-old woman who presented with about 20 mm-sized mass in the right breast and the right nipple with erosion. Preoperative examinations revealed a diagnosis of HER2-type pagetoid carcinoma with axillary lymph node metastasis. After neoadjuvant chemotherapy(pertuzumab, trastuzumab, and docetaxel, followed by adriamycin and cyclophosphamide), a pathological complete response was achieved. The patient was treated with anti-HER2 therapy without recurrence.

Near-infrared photoimmunotherapy(NIR-PIT)is a novel cancer treatment modality that employs antibody-IRDye700DX (IR700)conjugates. Recently, the clinical application of NIR-PIT has received approval in Japan for patients with inoperable head and neck cancer, specifically targeting the human epidermal growth factor receptor(hEGFR). Furthermore, NIR-PIT extends beyond the scope of tumor antigens and can be employed to eliminate specific host cells that contribute to the creation of immune-permissive environments supporting tumor growth. One of the distinguishing features of NIR-PIT is its ability to selectively eliminate various cell types within the tumor microenvironment(TME)by specifically targeting distinct antigens. By employing podoplanin(PDPN)-targeted NIR-PIT, PDPN-expressing fibroblasts were selectively eradicated, resulting in the suppression of tumor progression and a notable extension of overall survival. Additionally, we investigated the efficacy of depleting myeloid-derived suppressor cells(MDSCs)using NIR-PIT. This approach led to the selective elimination of MDSCs within tumors, and remarkable abscopal effects were observed in bilateral tumor models. Hence, NIR-PIT holds immense promise for the treatment of diverse cancer types by precisely targeting tumor cells, fibroblasts, and immune cells.

A 52-year-old male patient with Stage Ⅲc ascending colon cancer underwent laparoscopic right hemicolectomy with D3 lymph node dissection. Adjuvant chemotherapy was administered for 6 months, and no recurrence was observed during the follow-up period. Left lung metastasis was detected and surgically removed 7 years after the initial surgery. He underwent open partial small bowel resection with lymph node dissection when mesenteric lymph node metastasis was identified 2 years later. Although chemotherapy was conducted on the identification of mediastinal lymph node metastasis 2 years later, the mediastinal lymph nodes increased. Although attempted, lymph node dissection was impossible because of the strong adhesion to the trachea. Subsequently, chemotherapy and radiation therapy were administered. However, an infiltration of the mediastinal lymph nodes into the trachea was observed. The patient underwent bronchoscopic laser tumor ablation. The patient died 4 months after the resumption of chemotherapy(18 years after the initial surgery). Mediastinal lymph node recurrence after curative resection for colon cancer is a rare clinical condition. Nevertheless, long-term survival could be achieved by multimodal treatments in such patients.

A 46-year-old man was diagnosed with chronic myeloid leukemia (CML) in chronic phase. He was treated with imatinib, nilotinib, and dasatinib, but failed to achieve a complete cytogenetic response (CCyR). After tyrosine kinase inhibitor therapy, F317L BCR-ABL1 kinase domain mutation was detected. At age 66, the patient started ponatinib (PON) at 45 mg/day, and achieved CCyR within three months. Subsequently, PON was tapered to 15 mg once weekly due to arterial-occlusive events. PON was discontinued after a 3-year deep molecular response (≥ MR 4.5 ). However, the patient lost MR 4.0 within two months, and PON (15 mg once weekly) was restarted. He achieved MR 4.0 again within one month, and then a deeper molecular response (MR 5.0 ) after starting dialysis therapy at the same PON dose. The trough value of PON (15 mg once weekly) was 5.8 ng/ml, which suppressed F317L mutation in the CML clone. Currently, the patient is 77 years old and is sustaining MR 5.0 . Chronic renal failure may cause hyperabsorption and metabolic retardation in patients receiving PON. Initiation of hemodialysis may improve homeostasis resulting in enhanced anti-tumor immunity against CML.

The development and exacerbation of autoimmune diseases following coronavirus disease 2019 (COVID-19) vaccination have been reported; however, there are few reports of autoimmune hemolytic anemia (AIHA). A 75-year-old woman was admitted to the emergency department 46 days after receiving her third dose of the mRNA-1273 COVID-19 vaccine because of fatigue and general weakness. Initial laboratory analyses revealed severe hemolytic anemia with positive direct and indirect Coombs test and elevation of serum indirect bilirubin and lactate dehydrogenase. The patient had no underlying disease after a close examination and was diagnosed with warm AIHA, which was thought to be associated with COVID-19 vaccination. The anemia improved daily after the administration of prednisolone. Clinicians should be aware of the possibility of AIHA being caused by COVID-19 vaccination, and monotherapy with prednisolone should be considered in cases of severe anemia.

(Introduction) Beginning in April of 2022, infertility services-including assisted reproductive technologies and examinations and treatments for male infertility-were covered by health insurance in Japan. Although these changes are expected to bolster birth rates in Japan, increased numbers of patients and surgeries are anticipated, particularly following reductions in patient visits caused by COVID-19. (Materials and methods) We surveyed 13 members of the Male Infertility Special Interest Group of the Japanese Society for Reproductive Medicine using Microsoft Forms. Respondents were asked about the number of new male infertility patients and surgeries at their respective facilities before the COVID-19 pandemic, after the first wave, after the sixth wave, and after the insurance changes to cover treatments for male infertility. Respondents were also asked to describe challenges in meeting the demand created by these insurance coverage changes. (Results) Patients and surgeries (varicocelectomy and testicular sperm extraction) declined markedly after the first wave of COVID-19 but gradually recovered after the sixth wave. However, once male infertility-related services were covered by insurance in Japan, respondents observed a marked increase in new patients and surgeries compared to pre-COVID-19. The most frequently reported problem was that sperm cryopreservation was not covered by insurance. (Conclusions) This survey should be readministered after additional time has passed to capture longer-term changes following changes to insurance coverage in Japan. We anticipate the responses to the survey will reflect ongoing challenges associated with changes in insurance coverage for male infertility-related services.

Giant cell arteritis (GCA) is closely associated with polymyalgia rheumatica (PMR). We herein report an 82-year-old woman who developed GCA during PMR treatment. She initially presented with shoulder pain and was diagnosed with PMR based on elevated serum C-reactive protein (CRP) levels and bursitis detected in both shoulders on ultrasonography (US). Treatment was initiated with a daily dose of 15 mg prednisolone (PSL), which led to rapid symptom alleviation, and the dosage was tapered to 1 mg/day. One month later, she developed myalgia extending from the lumbar region to the thigh and tenderness in the left temporal region. However, no abnormalities in the temporal artery were observed on US. Although the PSL dose was increased to 2 mg for relapse of PMR, the symptoms did not improve. One week later, she developed occipital pain with an increased CRP level of 9 mg/dL. She was diagnosed with GCA based on the 1990 ACR Classification Criteria. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) detected anomalous accumulations in the bilateral superficial temporal and vertebral arteries, but not in the larger vessels. We therefore diagnosed her with cranial-type GCA. At this time point, we repeated US and found a halo sign in the temporal artery. Although epithelioid and giant cells were not observed in the temporal artery biopsy, vascular inflammatory findings such as disruption of the internal elastic lamina and chronic inflammatory cell infiltration were noted. Symptoms improved immediately and CRP levels decreased after the PSL dose was increased to 30 mg daily. To mitigate the risk of steroid-induced diabetes, tocilizumab was introduced, and gradual tapering of PSL was implemented. In conclusion, we encountered a case of GCA that developed after PSL reduction during the course of PMR. PET/CT confirmed intracranial artery inflammation and facilitated a definitive diagnosis. Although PET/CT cannot be routinely performed for diagnose in Japan, we consider it useful as an adjunctive diagnostic tool.

A tyrosine kinase inhibitor (TKI) was used to treat the patient, a 35-year-old woman who was diagnosed with chronic myeloid leukemia at the age of 22 years. Since a four-year deep molecular response (DMR) was obtained, spontaneous pregnancy was planned under TKI withdrawal. Even though her disease had advanced to MR2.0 at the time of pregnancy confirmation, 2 months from TKI cessation, interferon α therapy was initiated in light of the patient's history. Later, the patient reached MR3.0, gave birth to a healthy baby, and maintained MR3.0-4.0. TKI was resumed after about 6 months of breastfeeding. Treatment-free remission (TFR) is required for natural conception despite the teratogenicity and miscarriage risks associated with BCR::ABL1 TKIs. When planning a pregnancy, it is also necessary to take the patients' backgrounds, disease states, and medical history into account.

The recruitment and training of early-career researchers are important for the development of science, especially in countries with low birth rates, such as Japan. In several academic societies for social medicine, early-career researchers have formed associations for the purposes of networking and career development. However, to date, little information about the activities of these associations has been shared. Therefore, we organized a symposium at the 93rd Annual Meeting of the Japanese Society for Hygiene (March 4, 2023) to introduce the early-career researcher associations that have been formed within five academic societies namely the Japanese Society for Hygiene, Japan Epidemiological Association, Japan Society for Occupational Health, Japan Society for Medical Education, and Japan Society for Healthcare Administration. In this paper, we summarize the activities, challenges, and future prospects of each association and their strategies for future development and collaboration on the basis of presentations and discussions at the symposium.

A 67-year-old woman was found to have multiple liver abscess and pneumonia. Liver abscess was improved after percutaneous transhepatic abscess drainage(PTAD). A diagnosis of rectal cancer was made by colonoscopy and the patient underwent colostomy for rectal cancer on February 2018. Laparoscopic low anterior resection was performed on July 2019 after mFOLFOX plus bevacizumab(BEV)14 courses. Lower leaf partial lung resection was performed on September 2019 and upper leaf partial resection was performed on September 2020 for lung metastasis. The patient is currently alive without relapse after 21 months. Liver abscess was caused by portal vein infection of rectal cancer. Effective chemotherapy with surgery was successful.

Local control is important in the treatment of locally advanced rectal cancer(LARC). In Western countries, the standard therapy for LARC is preoperative chemoradiotherapy(CRT)followed by total mesorectal excision. Recently, addition of intensive chemotherapy to CRT known as total neoadjuvant therapy(TNT)is increasing. We herein report a 69-year-old woman who developed LARC(cT3N3M0, cStage Ⅲc). She was diagnosed as clinical complete response after TNT, and she chose"watch and wait". She did not have a recurrence for 16 months.

A 73-year-old woman was admitted with a chief complaint of weight loss. Colonoscopy revealed rectal cancer. After the placement of a colonic stent, the patient was referred to our department. Computed tomography, magnetic resonance imaging, and cystoscopy indicated extensive invasion of the bladder. Since total pelvic exenteration was necessary at the first diagnosis, total neoadjuvant therapy(TNT)was conducted. The diagnosis after TNT was ycT4bycN0ycM0. Low anterior resection with partial resection of the bladder and a diverting ileostomy were performed. The patient was discharged on the 16th day post-surgery with a good postoperative course. The pathological examination revealed a complete response, ypT0ypN0.

We report a case of laparoscopic sigmoidectomy for sigmoid colon cancer where a laparotomy transition prevented peritoneal metastasis from being missed. Case: A 64-year-old woman was diagnosed with sigmoid colon cancer. Computed tomography revealed a large bowel obstruction and a 12 mm wide basal bulge in the gallbladder. A laparoscopic sigmoidectomy( D3 dissection)was first performed, and intra-abdominal observation revealed no disseminated nodules. A laparoscopic cholecystectomy was performed continuously but, due to strong adhesions, a laparotomy was administered. Three disseminated nodules were observed in the omentum during the laparotomy and a postoperative pathological examination revealed pT4aN1b(2/23)M1c1(P2), pStage Ⅳc. Adjuvant chemotherapy of 8 courses of CAPOX was performed and there has been no recurrence 20 months after surgery.

An 81-year-old male was referred to our department with a tumor in the left wall of the urinary bladder, which was detected by contrast-enhanced abdominal computed tomographic scan (CT), incidentally. Cystoscopy revealed a smooth non-papillary tumor. The patient underwent transurethral resection (TUR) of tumor. An immunohistochemical study showed the tumor cells positively stained for chromogranin A, synaptophysin, CD56, and Ki67. The Ki67 index of the tumor was ＞0.5%, which confirmed the diagnosis of a pure carcinoid tumor. There was no recurrence of bladder tumor and no metastasis after the primary treatment.

An 86-year-old woman in a wheelchair was accompanied by her husband and son as she visited our outpatient clinic due to disturbed consciousness and fever. Twenty-seven years earlier, she had been diagnosed with rheumatoid arthritis and had been treated with methotrexate (MTX) and low-dose prednisolone (PSL). She stopped taking MTX four years previously when she was diagnosed with diffuse large B cell lymphoma of the paranasal sinus. Her lymphoma went into remission after six cycles of systemic immunochemotherapy. MRI after hospitalization revealed a lesion in the splenium of the corpus callosum that was hyperintense on diffusion-weighted imaging and which had low apparent diffusion coefficient values. An analysis of the cerebrospinal fluid revealed no atypical cells. The MRI findings were atypical, but her consciousness disturbance improved, leading to the diagnosis of mild encephalitis/encephalopathy with a reversible splenial lesion, which would be associated with a transient consciousness disturbance with a good course. However, her consciousness worsened over the next 3 weeks. One month later, a contrast-enhanced MRI showed an enlarged lesion in the callosum as well as new lesions, and the diagnosis of secondary CNS lymphoma was made. Brain biopsy is often not feasible. Less invasive and highly accurate diagnostic methods are needed, such as the identification of a spinal fluid tumor marker.

A 68-year-old male patient with lung adenocarcinoma, who was treated with chemotherapy and immune checkpoint inhibitors (ICIs), developed lymphadenopathy during treatment. His para-aortic lymph nodes increased to 2.0 cm in diameter. Both inguinal lymph nodes were 1.5 cm in diameter, and multiple hepatic masses appeared. After the ICI readministration, both inguinal lymph nodes increased to 2.0 cm in diameter, but the para-aortic lymph nodes and hepatic masses remained. Angioimmunoblastic T-cell lymphoma (AITL) diagnosis was established after the right inguinal lymph node biopsy, which was accompanied by an infiltration of Epstein-Barr virus (EBV)-encoded small ribonucleic acid-positive B-cells. After the ICI discontinuation, the inguinal lymph nodes decreased to 1.5 cm in diameter, but the para-aortic lymph nodes remained, and hepatic masses increased. Hepatic lesions were possibly lung cancer metastasis. The ICI administration and EBV reactivation were potentially associated with AITL development in the present case. The natural shrinkage of lymphoma after the ICI cessation implied the immunological mechanism like that of the methotrexate-related lymphoproliferative disease.

A 46-year-old man with myelodysplastic syndrome/myeloproliferative neoplasm-unclassifiable underwent myeloablative bone marrow transplantation from an HLA-DR-1-antigen-mismatched related donor while receiving tacrolimus and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. However, grade III acute GVHD of the gut occurred on day 20 and was treated with prednisolone (PSL) and oral beclomethasone dipropionate while continuing MMF. Subsequently, he presented with progressive epigastric pain. Endoscopy demonstrated multiple stomach and duodenal deep ulcers. The ulcers were suspected to be GVHD; thus, the PSL dose was increased and infliximab was administered; however, the ulcers exacerbated, resulting in repeated perforations and hemorrhagic shock. Furthemore, MMF was suspected as the cause of refractory ulcers and was discontinued on day 156, which resolved the ulcers after 6 months. MMF-induced gastrointestinal (GI) injury resembles anti-inflammatory drug-related ulcers and upper and lower GI tract GVHD, respectively. MMF-induced GI injury has been reportedly resolved after discontinuing or reducing the MMF dose. Several reports suggested that refractory upper GI ulcers and rectal sparing colitis were associated with MMF toxicities rather than GVHD in hematopoietic stem cell transplantations. Physicians should be aware that MMF can induce severe GI injury.

Migration test of food utensils, containers, and packaging is an important test method for confirming the safety and their compliance to the standards. However, there is little report on inter-laboratory study which was performed to evaluate the entire migration test, including migration operations and quantification. An interlaboratory study was performed participating 22 laboratories using 8 types of model synthetic resin samples containing 10 substances with a wide range of Log P ow values to evaluate the accuracy of the entire migration test. As a result, most of HorRat (r) values met the target criteria (0.3

As shown in the ATTRACTION-2 trial, nivolumab is effective as third-line chemotherapy for advanced or recurrent gastric cancer and esophagogastric junction cancer. We report a patient with esophagogastric junction cancer who underwent conversion surgery after third-line chemotherapy with nivolumab. The patient was a 72-year-old woman. Upper gastrointestinal endoscopy revealed advanced esophagogastric junction cancer of Siewert type Ⅱ, and computed tomography revealed multiple hepatic and pulmonary metastases. The esophagogastric junction cancer was diagnosed as cT3N1M1, cStage Ⅳb, and she was administered SP as first-line and nab-PTX/RAM as second-line treatment, but progressive disease remained. Nivolumab as a third-line treatment remarkably reduced the hepatic and pulmonary metastases after its administration was initiated, and conversion surgery was performed after 28 courses. The pathological diagnosis was ypT1b2(SM2), ypN0. After discharge from the hospital, postoperative chemotherapy with nivolumab was continued in the outpatient clinic, and there has been no evidence of disease progression.

Introduction: We report a case of submucosal(SM)adenocarcinoma of the sigmoid colon which developed distant metastasis 3 months after endoscopic mucosal resection(EMR)., Case: 54-year-old, male. Colonoscopy, which was performed due to positive fecal occult blood test, revealed 18 mm Isp sigmoid polyp. EMR was performed with en bloc resection. Pathological examination revealed adenocarcinoma(tub>por>sig), pT1b, Ly1c, V1a, pHM0, and pVM1. Therefore, laparoscopic sigmoidectomy(D2 dissection)was performed. Postoperative pathological examination revealed pT1b, pN2b(10/11), PN1b, pPM0, pDM0, pStage Ⅲb. Distant nodal involvement were found on computed tomography 3 months after EMR, although systemic chemotherapy(mFOLFOX6 plus panitumumab 18 courses and FOLFIRI plus bevacizumab 4 courses)was performed, the patient died of liver failure caused by liver metastasis 21 months after EMR., Conclusion: We present a case of T1 sigmoid adenocarcinoma which developed distant metastasis 3 months after EMR with literature review.

A 47-year-old woman with a complaint of weight loss for the past 5 months was referred to our hospital. Colonoscopy revealed advanced rectal cancer 20 cm from the anal verge. The patient had left hydronephrosis caused by ureteral invasion. Firstly, we performed transverse colostomy and left nephrostomy. After 8 courses of capecitabine, oxaliplatin plus bevacizumab( CAPOX plus Bmab)therapy, colonoscopy and computed tomography revealed shrinkage of both the primary and metastatic lesions. Laparoscopic high anterior resection was performed, and the left ureter was successfully preserved. The patient received chemotherapy after surgery. Neither local recurrence nor enlargement of metastases has been observed 8 months after surgery.

A 43-year-old man who had no previous medical history or family history had positive fecal occult blood test in a local physician. Colonoscopy revealed a type 2 tumor of the ascending colon and a 10 mm submucosal tumor(SMT)of the lower rectum. Biopsy indicated moderately-differentiated adenocarcinoma of the ascending colon and neuroendocrine tumor (NET)of the lower rectum. No metastasis was detected by computed tomography. Therefore, the rectal SMT was resected first by endoscopic submucosal resection. Histopathologically, the lesion was localized in the submucosa and no lymphovascular invasion was found. Vertical margin was also negative. We decided not to perform additional intestinal resection for rectal NET. Thereafter, the patient underwent laparoscopic right hemicolectomy for ascending colon cancer. The histopathological findings were pT3, pN1, pM0, pStage Ⅲb. The patient received adjuvant chemotherapy. No relapse was found 18 months after surgery. We reported a rare case of a lower rectal NET with concomitant ascending colon cancer.

A 32-year-old woman was admitted to our department for hematuria and dysuria.Computed tomography (CT) and cystoscopy revealed a 2-cm pedunculated tumor with rich blood supply and a smooth surface in the bladder trigone. We performed a transurethral resection of bladder tumor. The pathologic diagnosis was alveolar soft part sarcoma (ASPS). CT, bone scintigraphy, positron emission tomography, and pelvic magnetic resonance imaging revealed no other lesions; thus, she was diagnosed as having a primary bladder ASPS. Postoperative follow-up with regular cystoscopies and CTs over 10 years have shown no local recurrence or metastasis.Primary ASPS of the bladder is exceedingly rare, and this case is the 8th case (the 2nd case in Japan) reported in literature.

A 79-year-old woman visited our hospital complaining of bloating. An abdominal enhanced CT scan revealed pancreatic body cancer with cancerous ascites and multiple liver metastases. We started gemcitabine(GEM)plus nab-paclitaxel chemotherapy. Chemotherapy was not continued because she was unable to take oral medication owing to increased cancerous ascites. We conducted modified KM-cell-free and concentrated ascites reinfusion therapy(KM-CART). Her symptoms improved, and she began having oral intake after KM-CART. Chemotherapy was then re-initiated. Seven months have now passed since we started chemotherapy, and we can continue chemotherapy while conducting KM-CART repeatedly. KM- CART is useful for treating unresectable pancreatic cancer with massive cancerous ascites in terms of continuing chemotherapy.

A 95-year-old male developed general subcutaneous petechiae, tongue hematoma, and melena two days after receiving the second BNT162b2 mRNA COVID-19 vaccine. Two days later, his platelet count decreased to below 1,000/µl. Laboratory testing was positive for a slight increase in D-dimer, Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody, lupus anticoagulant, and anticardiolipin IgG antibody levels. There were no severe infections or symptomatic thrombosis. Platelet transfusions were transiently effective. He was diagnosed with newly developed immune thrombocytopenia (ITP). We administered prednisolone (PSL) at 0.5 mg/kg/day and intravenous immunoglobulin (IVIG) at 0.4 g/kg/day. From the following day, his platelet count rapidly increased, with an improvement in bleeding tendency. H. pylori was eradicated after platelet count recovery. Thrombocytopenia did not relapse although PSL was tapered three months later. Causes of thrombocytopenia after SARS-CoV-2 vaccination include ITP, vaccine-induced immune thrombotic thrombocytopenia, and thrombotic thrombocytopenic purpura. Differential diagnosis is important to determine the proper therapy. Case reports of newly diagnosed ITP after SARS-CoV-2 vaccination have been increasing recently. In these cases, including ours, the responses to steroids and IVIG were good. Further follow-up studies are needed to manage thrombocytopenia following SARS-CoV-2 vaccination.

A 60-year-old man with sigmoid colon cancer invading the urinary bladder underwent sigmoid colectomy and partial cystectomy. He developed headache and vomiting 12 weeks after surgery, and urgently hospitalized. Contrast MRI of head and whole spinal cord inspected no abnormality. CSF examination showed elevated CA19-9 20,551 U/mL, and the cytology revealed atypical cells similar to the sigmoid colon cancer cells. He was diagnosed as meningeal carcinomatosis, and received 1 course of CAPOX plus bevacizumab chemotherapy. He died 18 weeks after the surgery.

Microvascular decompression(MVD)is an effective treatment for hemifacial spasm and trigeminal neuralgia. However, there are few reports regarding its use with abducens nerve palsy. Here, we report the case of a 77-year-old male who presented with diplopia and was admitted to our facility for right abducens nerve palsy. MRI constructive interference in steady-state(CISS)showed that the right anterior inferior cerebellar artery(AICA)was curved in a posterior-superior direction at the beginning of the region of origin, causing compression of the root exit zone of the right abducens nerve. In addition, MRI showed an unruptured fusiform aneurysm(5.3mm×7.1mm)of the vertebral artery(VA)involving the posterior inferior cerebellar artery(PICA). However it was not related to abducens nerve paralysis. The aneurysm was successfully treated with an occipital artery-posterior inferior cerebellar artery(OA-PICA)bypass and clipping of the proximal VA and PICA origin. The position of the offending artery was moved using a Teflon ® felt fibrin glue and the retrosigmoid transcondylar fossa approach. The patient recovered from abducens nerve paralysis with no new neurological deficit. We emphasize the importance of choosing an appropriate approach as this increases the possibility of treating abducens nerve paralysis in a timely manner.